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Dr Vonda Wright: How 30-second sprints melt fat fast

Orthopedic surgeon Vonda Wright shares her counterintuitive aging rule: a 30-second hard effort burns more fat than long runs, and muscle keeps you young.

Dr. Vonda WrightguestSteven Bartletthost
Jul 22, 20242h 7mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:18

    Intro

    1. VW

      You only have to do that for 30 seconds. That will burn 40% more fat than even high-intensity interval training.

    2. SB

      Really?

    3. VW

      So, it begins with-

    4. SB

      Dr. Vonda Wright is a renowned orthopedic surgeon and a pioneering researcher in mobility and aging. Through simple methods, she enables people to maintain their strength all the way through till their later life.

    5. VW

      We have no excuse until our mid-70s. We're slowing down. These are MRI slices of a 40-year-old athlete. We have beautiful muscle architecture, but if we sit around for 35 years and have a desk job, and we don't go move our muscles, this is what happens.

    6. SB

      Jesus, my God.

    7. VW

      But this is a 74-year-old who had just invested in their mobility four to five times a week. So if you're an 80-year-old consistently lifting weights, you are functionally as strong as a 60-year-old person who doesn't.

    8. SB

      But I worry about joint pain. Is joint pain inevitable?

    9. VW

      It is not. But one reason people have pain is because of how much we weigh. Small changes in our total body weight can have profound effects on the joint pain we feel. Let's say this rock is one pound. If you gain one pound, you would think that this is all the amount of pressure you're gonna feel, but because of the mechanics, what you actually feel is the weight of these bricks. So you think gaining 10 pounds doesn't mean much, but imagine gaining 100 pounds of pressure. So, how should you be investing in your mobility every day? There are four components that we should try to find time for. Number one is-

    10. SB

      Quick one before we get back to this episode. Just give me 30 seconds of your time. Two things I wanted to say. The first thing is a huge thank you for listening and tuning into the show week after week. It means the world to all of us, and this really is a dream that we absolutely never had and couldn't have imagined getting to this place. But secondly, it's a dream where we feel like we're only just getting started. And if you enjoy what we do here, please join the 24% of people who watch this channel regularly and have hit that subscribe button. It means more than I can say. And if you hit that subscribe button, here's a promise I'm gonna make to you. I'm gonna do everything in my power to make this show as good as I can, now and into the future. We're gonna deliver the guests that you want me to speak to, and we're gonna continue to keep doing all of the things you love about this show. Thank you. Thank you so much. Back to the episode. Dr.

  2. 2:18 – 5:50

    I Want Everyone To Have A Healthy Ageing Process

    1. SB

      Vonda Wright, you've been treating patients, learning about medicine, taking care of people, and working in the industry you've worked in for almost 35 years now.

    2. VW

      Yeah.

    3. SB

      To do that-

    4. VW

      Yes.

    5. SB

      ... you must have a great deal of passion. You must be on a bit of a mission. So my, my first question to you is, as you sit here today, what is-

    6. VW

      Mm-hmm.

    7. SB

      ... what is occupying your, your focus, your mind, your passion? What is that, when you wake up in the morning, and you think about the work you're doing and why you're doing it-

    8. VW

      Mm-hmm.

    9. SB

      ... what is the answer to that?

    10. VW

      The answer to the question of why I wake up every day and, and rush into my work, whether it's into the surgery or whether it's into taking care of indi- individuals or writing, is because I have been working under the mantra of, um, I'm gonna change the way we age in this country or in this world. Because when I started, there was this steadfast belief. The n- the national zeitgeist has changed now, but when I started, there was this belief that aging was an inevitable decline from the vitality of youth down a slippery slope to frailty where we would spend 20 years of our lives dying, going to the doctor's office every three years, and I never, ever believed that. I never believed it, and maybe it was because, when I was a child, I lived at that- in the '70s where you could just take your kid with you to a race, and my dad would do that, and he- he'd take me to a 5K and say, "Wait here. I'll be back in 20 minutes," and I would see people in their 50s and 60s racing, and they would be celebrated. Or, or maybe it's because I started as a cancer nurse, and I saw people fighting every day for their lives, and I believed that that was not the destiny that we were- that we were doomed to. So, as I progressed through my career, and I started doing the research myself, I realized that this myth we had in our country that, or all over the world, that aging had to be this inevitable decline was based on population studies. And what does that mean? Well, population studies just look at a cohort of people and see what happens over time. There's a huge study in the- uh, funded by the NIH in the United States called the Health ABC, for instance, and they looked at a population of 70-year-olds and just followed them over time. Well, what do we know about populations of people? Well, what we know is that up to 70% of them do not do one extra step of mobility a day. So what we know about aging has been what we know about sedentary living. And so, I did not believe that we truly understood how the trajectory of our aging could be for people who remained active across the course of their lives. So, my team and I did that original research, and we proved that you can be healthy, vital, active, joyful, long into the foreseeable future, much more than we gave ourselves credit for, and it drives me because even over all these years, 35 years, 20 years of it as an orthopedic surgeon, it is only now that people are beginning to pick up the mantle of prevention, and not only disease care. And so sometimes I sit back, and I think, oh my God, you know, I've been preparing for this time in the history of people my whole career. So, I am made for such a time as now.

  3. 5:50 – 8:05

    Your Ageing Mindset Is The Cause Of Your Health Decline

    1. VW

    2. SB

      So interesting 'cause it's only in recent times, I think from doing this podcast that I started to question the idea, the sort of mind virus that even I had that once I get to a certain age-

    3. VW

      Hmm.

    4. SB

      ... I just have to kind of concede to the inevitable decline.

    5. VW

      Yeah.

    6. SB

      And it's only recently that I thought, actually, there's, uh, been a couple people that have came here and told me about-... how to, how the, that's not the case.

    7. VW

      Uh-huh.

    8. SB

      And that actually it is a bit of a mind virus.

    9. VW

      Mm-hmm.

    10. SB

      Like, the virus of that belief, the impact of that belief is what causes you to give up.

    11. VW

      Yes.

    12. SB

      And just to become frail and to stop moving and those kinds of things.

    13. VW

      Well, because what that r- our brain tells us, we know this, I've... and you've had many discussions about the connection between our brain and our body. Our brain will believe whatever we tell it, and if our brain thinks that, "Oh, sometime, 63, a light bulb goes off and we go from youthful vigor to aging and decline," well, then we start believing that about ourselves. And, you know, there's a concept now that I work with all the time that really e- examines the difference between life expectancy. In the UK, life expectancy right now is 81. Unfortunately, in the United States it's 77.6. From the, from birth, babies born now have a life expectancy of that much. Our health expectancy, our health span, the amount of healthiness we have is only about 63. So, that gives us a huge runway to change the trajectory and it also tells us that we're not dying at 63. We're dying on average at 81, so we can do everything we possibly can in those 20 years. And we also know that 70 to 80 to 90%, depending on who you believe, of our health and aging is predetermined by our lifestyle choices, not the genes we inherit. So, my mother is very thankful that I stopped blaming her (laughs) for all the health things that go on. But, but each and every person has the ability to live outside of their genetic predisposition.

    14. SB

      Yeah.

    15. VW

      And that is a very hopeful message that can pivot your mindset virus.

  4. 8:05 – 10:50

    This Is When You’ll Start Having Life-Threatening Diseases

    1. SB

      I, I took the top sort of illnesses and diseases, things like heart disease, lung cancer, um, I can't even pronounce this one, chronic obstructive pulmonary disease.

    2. VW

      Yeah, COPD.

    3. SB

      Strokes, lower res- lower respiratory infections, Alzheimer's disease, type 2 diabetes, I can't pronounce this one either, colo- colon-rectal cancers?

    4. VW

      Colorectal cancers.

    5. SB

      I nailed that. Breast cancer and prostate cancer.

    6. VW

      Yes.

    7. SB

      And I got the average ages that typical-

    8. VW

      Yes.

    9. SB

      ... people typically get them.

    10. VW

      Mm-hmm.

    11. SB

      Then I weighted it by the amount of people that die, um, from each of those diseases, with heart disease being the most popular.

    12. VW

      Yeah.

    13. SB

      And it did actually come up, I used ChatGPT, I'm pretending I did this math myself, uh, it came up about 62.94 years old, chk, is the exact age where, on average, I'm going to get one of these and I'm gonna potentially die from one of these.

    14. VW

      Those are when they manifest. You may have them before then.

    15. SB

      Oh, okay, so they're not gonna...

    16. VW

      Maybe you never knew it because I have people who say to me when I ask them his health history, "What medical problems do you have?" And they're like, "I don't have any," only because they've never been to a doctor.

    17. SB

      Mm-hmm.

    18. VW

      Or maybe they've been diagnosed but they haven't gotten so bad that they're not spending three days a week in the doctor's office or maybe they are, they are sick, those three categories, right? But your ChatGPT data is correct that that is when it shows up and what does that correspond to? That corresponds to when the average person retires. So just when you start thinking you have time to live the life that you envision, you're saddled with health problems that you have not taken care of. But, but think about it this way, talking about this mind virus and how we need to change it, um, we can talk about this, but I think that 40 is the most remarkable decade of a person's life and it's also the time to adult or get your proverbial expletive together, it's time to get it together from a health perspective. Well, between 40, if you're just noticing your health at that time because maybe you've been working so hard and you never noticed it before or you're raising other people or whatever the circumstances are, between 40 and 63, you have time to course correct. But if you decide at 63 to pay attention, it is much, much, much harder. And so, you know, part of my mission, you asked me why I wake up every morning, to change the way we age in this country, is to not only take care of people in my demographic, my middle-aged demographic, but to really get to my Millennial children and my Millennial nieces and nephews to say, "You have such control of your health if you just look up and pay attention."

  5. 10:50 – 11:57

    What's Your Academic Background

    1. VW

    2. SB

      What's your academic education? Can you run me through your-

    3. VW

      Yeah.

    4. SB

      ... sort of qualifications and how that pivoted and turned, uh, throughout your career?

    5. VW

      Sure. I have a degree in biology, uh, from Wheaton College, and then immediately after that, uh, there was such a shortage of nurses that they, the uni- Rush University said, "If you have a good bachelor's degree, come. We'll give, we'll train you in another bachelor's degree in nursing and a master's degree in three years." So I did, and with that, I went and took care of people with cancer and ran the Rush Cancer Institute with the physician that was there at the time. And then at 28, I decided to m- that, uh, through a series of decisions we can talk about that, um, I wanted to do great research but I still needed to take care of people because it is in my heart and soul to do that. And so I went back to medical school at the University of Chicago at 28 only to choose the longest possible road, which is orthopedic surgery, which is an additional 11 years, because it's four years in medical school, six years of residency, a year of fellowship, and then I finally emerged.

  6. 11:57 – 13:20

    What's Orthopedic Surgery?

    1. VW

    2. SB

      What is orthopedic surgery?

    3. VW

      Oh. How long do we have?

    4. SB

      Explain it like a 10-year-olds.

    5. VW

      Yeah, so orthopedic surgery is the lifetime care of the musculoskeletal system, so what that includes is bones, tendons, ligaments, muscle, adipose tissue. It's...... the joints, the- from the spine to the shoulders, hips, the knees. It's everything from cancer care of those organs through... Each one of those has a subspecialty, hand, uh, foot, sports. I'm a sports surgeon, so I'm trained in shoulder, hip, and knee arthroscopy, meaning I do very big surgery through very small apertures, uh, for athletes and active people. Um, well, this fun orthopedic sports career I've had of taking care of active people and athletes of all ages and skill levels extends outside of the operating suite, right? I have, I take care of the whole person, which is unusual for an orthopedic surgeon.

    6. SB

      Mm-hmm.

    7. VW

      Usually, orthopedic surgeons are very procedurally driven, but I am whole person driven and I think that stems from, at 23 years old, taking care of peoples in the fight of their lives, knowing that their whole lives are worth taking care of, not just pushing chemo in the middle of the night.

    8. SB

      When you

  7. 13:20 – 16:53

    The Importance Of Healthy Mind During An Injury Recovery

    1. SB

      say y- you focus on the whole person, can you help me understand that? 'Cause I- I think on one end of that spectrum is doing the surgery-

    2. VW

      Yes.

    3. SB

      ... which you do.

    4. VW

      Mm-hmm.

    5. SB

      And then is the other end of that spectrum thinking about their, I guess, their psychology, their emotions-

    6. VW

      Yeah.

    7. SB

      ... their, how they're feeling? What-

    8. VW

      I'll give you a few examples. So if you're a, uh, you think of a sports surgeon taking care of young athletes. So if I have a young athlete come in who I ha- I'll give you an example of a real person. He's 19, he has been an athlete his entire life, and just, and been great at it, right? But never been hurt, had the great fortune of never being hurt until he stepped wrong. He got slide tackled on the football field and he blew out his knee, and his family was moving, so he didn't get immediate care like he could have had he been in his own town, so weeks later, he shows up to me with a knee that's completely non-functioning. This child, who's a 19-year-old man, is panicking in his brain. He doesn't know why he's in so much pain, why his knee won't work. Um, psychosocially, his family is in transition, they don't have any of the support system, and he no longer has his own team. So that young man is dealing not only with the physical pain of injury, he's dealing with the psychological anxiety of, "Oh my God, oh my God, oh my God, what just happened to my knee? Will I ever play again?" And they're dealing with the social aspects of here's a family without social support. So as a whole person doctor, reali- severely in this family, not on- no, not only as their sports surgeon, "You have an ACL tear, your meniscus teared. Here's how I'm going to fix it. Here's what we need to do before then. Here's the technical aspects of the surgery, but how much protein are you eating? Because I need your body in tip-top shape to heal." So I talk to my patients about their nutrition as well as their surgical. But then from the perspective of I, too, am a mother with a lot of children, thinking of myself, "How am I gonna meet the needs of my child?" Thinking of the mother, she has no resources in this town. She just moved here, right? Trying to set them up with the- the other people they will need to be surrounded with care.

    9. SB

      Mm-hmm.

    10. VW

      And that approach to this individual family is exactly the surrounding them with care approach we take with professional athletes. There is not one thing that is left unturned for a professional athlete. We take care of them from the minute they wake up to the minute they go to bed and their family needs. So this whole person care extends all the way across all types of people. For a woman, for instance, who comes with a... or it's so typical for midlife women to come in with an inflamed shoulder, a frozen shoulder. She'll come in because her shoulder no longer moves, but knowing what I know about the life cycle of a woman and what happens in midlife, before I even address the shoulder, because sometimes they come in saying to me without any prompting, "I think I'm falling apart." And sometimes I think I'm going crazy 'cause I didn't do anything to my shoulder, right? When they say that to me, we immediately start talking about, "Well, how are you sleeping? Are you having any hot flashes, night sweats?" So- so that I address them as a midlife woman who's lost her estrogen, not just as a shoulder that doesn't work, because for me, that's pretty cut and dry. It's the rest of it that truly is taking care of the whole person. So that's what it means to me.

    11. SB

      Mm-hmm.

  8. 16:53 – 22:47

    Taking Care Of The Whole Person Not Just Their Disease

    1. SB

      It's, um, it's personal to you, isn't it? I- I- I feel like you have a great deal of empathy. I can feel it on your-

    2. VW

      Mm-hmm.

    3. SB

      ... on the surface of you. I can see it in your face.

    4. VW

      Yeah.

    5. SB

      Where does that come from?

    6. VW

      Hmm. You know, I think, I think that I'm a much better... Listen, you make people cry on this podcast, and I think you're gonna make me cry, and I don't mean to, but that kind of question, I think that this unrelenting need to take care of the whole person has to have come from my time as a cancer nurse, because I was only, I was only 22, 22 to 28, I was a cancer nurse. And imagine what it's like to be so impressionable, right? You, I got all this education, but in the middle... So my job was giving chemotherapy to people who were in the struggle of their life, and I'm 23 years old. And chemo is pushed in the middle of the night, and at the time, in the '90s, we did something called primary nursing, which means every time that person came in, if you would've come in, I would've been your nurse every time you're in the hospital, every month for six months. So the kind of therapeutic relationship you develop is meaningful, and so I was 23 years old, 23 to 28, the formative times of how I built my perspective on the world, and I'll never forget. This is the one story. There's so many stories like this, but this is the one story that answers that question, I think, why this is personal to me.So, I'm taking care of this woman, and, you know, many, many of the people I took care of won their battles. You know, they ... I was with them for six months every night. (laughs) Some nights, because people just want to feel normal, I'm giving them their chemo, they're watching TV and buying stuff online on the TV. And I'm like, "Why are you buying all this?" 'Cause they just want to feel like themselves, right? And many, many people successfully walked out and forgot- forgot our names, right? But not everybody did. And so this one family, she had been with us for six months, and I don't know if you've ever been around people who are losing their battle with an illness or are- are- are living the last days of their lives, but you can tell it's coming just by the way they breathe. It is true, people rally right before they die. And so I knew this woman's time was coming, but she had the most faithful family, Steven. Her family came every single day, and she had a big family, and we knew they were coming, they were kind of loud and- and we loved having them here. But the night that answers this question, I knew it was going to be her last night, you can always tell, and it was just she and I. And the- the light in a hospital room, there's a light over the bed and then the bed, so there's this light behind her, and she's breathing in an agonal way, but I can tell that she's waiting. She knows her family's going to come the next morning. So we make it through the night, it's just she and I. And- and in the morning, in this hospital in Chicago, there's a- a window at the end of the hallway that faces Lake Michigan, and the light starts coming in, the floor lights up again, and that's starting to happen, it's about 7:00. And I hear the elevator, bing, and it was her family coming. So I step out into the hallway, and this one was different. They always came together every day, but this time her sister was dressed in her wedding gown and the whole family with i- was in their tuxedos, 'cause her sister was going to get married that day and they wanted her to be part of that, even though there was no way she was ever going to be part of that. So I- I'm 23 years old, I'm standing in the doorway, my patient is over here, her family is coming towards me. And that indelibly seared in me the- the balance between life and death, the woman who is not going to continue her journey and her sister who's beginning her journey. And I don't know how at 23 years old for that not to impact what I care about in life. Steven, if you come to my house, I don't give a rat's ass about my curtains or buying the shoes with the red soles, even though I can. But at 23, that kind of life and death made me decide that people were worth working for and worth saving. And so she had waited for them to come to her that day so she could share in the last family time they were going to have together, and I don't think you come out of a situation like that without your whole life perspective being different. And so even though, you know, I'm- I'm a sports doctor now, how is that remotely as hard as being a cancer nurse? I am a much better doctor now than I would have ever been had I gone straight into medicine.

    7. SB

      Well, what is th- that perspective it's given you, specifically that then translates to being an even better sports doctor? How does it change how you show up?

    8. VW

      It just means that I can't view the procedure as just putting screws in the ACL, or what ... I tried out a new ACL procedure last week. It was fascinating. But sometimes that is the beginning and the end. That's not the beginning and the end for me. How this kid, it was this 19-year-old kid, how this kid is going to recover in six to nine months and go back to living the life he envisions. How he's not going to feel abandoned by the sport that he loved, or how am I going to help him find a new team? Because sport is not only an individual thing, it's an entire environment. It's the- it's the- the society the kid lives in. So for me, it's not just the cool new technique I did on Wednesday in the OR. It's taking care of per- that whole person through the whole journey for the next nine months.

  9. 22:47 – 24:51

    How I Changed My View On Death

    1. SB

      The lady that you were taking care of when you were 23 years old, h- has that impacted wha- how you view death?

    2. VW

      Yeah. It has. I view death ... We're all going to die, Steven. How rapidly we get there can change, how we arrive there can change, how we feel about our life can change, but we're all going to get there. So I don't- I don't view it as something to run away from at all. In fact, in some circumstances, in some of my patients' circumstances, or even as an orthopedic surgeon in some of the traumas I've been involved in, I think death can be kindness, and death can be done with extreme dignity. I don't think it's always the enemy.

    3. SB

      Mm-hmm. One of the things that I- I think is- is also, um, really sort of front of mind in that image of the lady in the- in the bed when her sister arrives in the wedding dress is that she had friends and family there.

    4. VW

      Oh my goodness.

    5. SB

      And a lot of people, you know?

    6. VW

      Yeah. (laughs) Right.

    7. SB

      There's so much beauty in that moment, regardless of the- the, um, the reality of what's going on there-

    8. VW

      Mm-hmm.

    9. SB

      ... that she's losing her life, but she's losing it surrounded by-

    10. VW

      Yeah.

    11. SB

      ... a group of people that love her. And I think for many of us, I think ... I actually had a conversation with a good friend the other day, and their- their biggest fear in life is that they'll actually end up aging and dying alone because they don't have children yet, and they don't have children at all, they made the decision not to have children.

    12. VW

      Mm-hmm.

    13. SB

      Um, they don't have siblings. So, uh, you know, I- I'm not scared of death, I'd like to extend my health span, but, um-

    14. VW

      Yes.

    15. SB

      ... when I do die, I would like to have people around me that, uh, love me. And that's one of the things that I think she- she clearly had.

    16. VW

      Yeah, she- she did.It's funny you mention that. I think about that. What happens if we live so long in our quest for longevity that everybody we love or raised has already gone before us? And I don't know, what do I do? Would I hire the girl next door to (laughs) sit with me, take me to my doctors' appointments? You know, I don't know what to do.

    17. SB

      I could probably pay a few people to do that. (laughs)

    18. VW

      It takes a little bit of planning. (laughs) It takes a little bit of planning. (laughs)

    19. SB

      So

  10. 24:51 – 27:10

    Extending Your Health Span

    1. SB

      if we, if we talk then about this health span issue and your central mission-

    2. VW

      Yes.

    3. SB

      ... which you described at the start.

    4. VW

      Mm-hmm.

    5. SB

      Usually when I have these conversations, I try and hazard a guess where I should begin.

    6. VW

      Mm-hmm.

    7. SB

      But I actually want to, I want you to tell me where we should be beginning. If we're talking about extending our health span, where, where does that begin? Where do we need to start this conversation?

    8. VW

      That begins when your parents are raising you and they have the choice of teaching you how to eat, teaching you... Uh, I'm old enough that literally I got a cellphone at 38, so this is not a problem with me growing up. But there's a problem now where we don't send kids out due to safety and digital, to just go play and don't come in until dinner. That was a real thing when I was growing up. And so what we know is children's, uh, mitochondrial load, meaning how many of our powerhouse mitochondria metabolic, um, kingpins are really predetermined by how active we are as a child. So what's really a concern for those of us interested in metabo- metabolic health is, what are we doing when we raise our children to sit around for the first 10 years of our, of their lives when they're really made to run around, right? So it begins with what we teach our children, and I th- I hear parents a lot of times saying, "Oh, my kid won't eat this or that," or, "I can't get them to do anything." And I'm not scolding them when I respond in the way I'm about to respond to you. I get it. I'm the mother of a blended family of six children, and you can't always make your children do things. But here's what I know: children learn from what they see. My children were foam rolling with us, they learned to eat vegetables or they didn't get up from the table, or... They learn what we teach them. So the time to begin is when, uh, our children are little. Some would say the time to begin is in utero, which is frightening 'cause I might have done things differently during my pregnancy, but when they're little. But as they're being raised, I certainly think the time to really begin is no later than your mid-30s. I call between mid-30s to mid-40s with 40 being the center of that, the critical decade, literally. We're not children anymore. We've, at 30, the literature says we've probably maxed our bone out. We've probably maxed our muscle out.

  11. 27:10 – 30:47

    Why You Need To Look After Your Bones & Muscles At 30-40s

    1. VW

    2. SB

      Wait, what do you mean? I'm 30. Wha-

    3. VW

      I know, I'm thinking about you right now. (laughs)

    4. SB

      What do you mean I've maxed my what? What do you mean I've maxed my muscle out and my bone out?

    5. VW

      It means that some, some scientists, muscle scientists believe that at 30, we've got our peak muscle mass, and unless we really invest in growing more muscle the rest of our lives... Like if you choose to be sedentary the rest of your lives, you peaked at 30 and you're using it the rest of your life, right? And so same with bone. Bone maxes out at about 30 unless we continue to invest in it. Well, what do we know? 70% of our population is, is sedentary and don't reinvest. So between 35 and 45, I call it the critical decade. If you've never thought about your health before, now's the time to hone in. We need baseline labs, we need your first physical, we need some of your first screening exams. I think men, this is not policy anywhere, but I think as I'm trying to replace testosterone in men in the future, I don't know what I'm raising them up to. I know I'm putting them with, within a, within a healthy range, but I would want to return you to what your testosterone was when you were a young man like you are now, and not just guess. I think we need first labs, first physicals, um, to be more of a quantified self, just like you, we were talking earlier, you saw a human brain for the first time.

    6. SB

      Mm-hmm.

    7. VW

      To notice our bodies so that we can take better care of them early so that we can then do the exercise prescription that I'm sure we'll talk about, um, going forward, because it c- becomes very, very hard with every decade. But I think for men, 40 to 50 is a, an amazing decade for you for a lot of reasons. For women, I think between 35 and 45 is critically the time to get our stuff together before our hor- hormones start walking out the door. So it, it's much earlier than you would suspect. If you, if you suspected maybe 50's the age, maybe 60, no. Too late. Not too late, much harder, right?

    8. SB

      Mm-hmm.

    9. VW

      Yeah.

    10. SB

      You know, I, I... There's this image that I saw online the other day-

    11. VW

      Mm-hmm.

    12. SB

      ... and I saved it as a bookmark. I, uh, uh, it actually wasn't connected to me speaking to you, but I just found it to be fascinating 'cause it's part of this emerging picture in my mind about the importance of muscle.

    13. VW

      Mm-hmm.

    14. SB

      And one thing you said there is you think we reach our peak muscle by early 30s.

    15. VW

      Around 30. Mm-hmm.

    16. SB

      According to some sort of muscle scientists.

    17. VW

      Yeah. Mm-hmm.

    18. SB

      Is, does that kind of correlate to what I'm seeing here? I'll put this on the screen for anyone that can't see, and I'll link it in the description below.

    19. VW

      Yeah.

    20. SB

      But on this graph, which we'll call figure number one-

    21. VW

      Yeah.

    22. SB

      ... graph number one.

    23. VW

      Mm-hmm.

    24. SB

      Are you saying to me that the peak point there is-

    25. VW

      Around 30.

    26. SB

      Yeah.

    27. VW

      Yeah.

    28. SB

      And then from, it's sort of downhill from there.

    29. VW

      It goes down. So on, you know, on this graph, the peak, if we call it 30, this is a precipitous decline. It looks very hopeless. The, what I believe and what our research shows is that you can extend this green line into a more flat curve so that you die quickly (laughs) -

    30. SB

      Ah, nice.

  12. 30:47 – 36:44

    What's Lean Muscle Mass?

    1. SB

      about lean muscle mass, what does, what is lean muscle mass? I know what m- muscles are, but what's lean muscle?

    2. VW

      Yeah. You know what? I say lean muscle mass and people are like, "What do you mean?" Lean versus fatty muscle mass. What I'm talking about is your skeletal muscle mass. We have three kinds of muscle.

    3. SB

      Mm-hmm.

    4. VW

      We have smooth muscle, which is what our guts are. It's the peristalsis that's happening in our intestines. Our cardiac muscle, the muscle that will, that is our heart. That's the cardiac muscle. Um, and it beats unto itself. It has its own electrical rhythm. The rest of the muscle in our body is striated skeletal muscle, so every time you do this, it's with a type of muscle called skeletal muscle. We have 650 skeletal muscles. It is the reason you move. Uh, it is, muscle is not only important for locomotion, but it's very metabolically active. It sends off hormones that help control other processes in your body. It's where most of your mitochondria, which are the powerhouses of your body, take glucose from your blood and turn it into energy. So, it has a lot of roles. Most of us just think about it as what you see in the mirror at the gym getting-

    5. SB

      Mm-hmm.

    6. VW

      ... bigger and bigger, but it serves a function of locomotion and metabolism.

    7. SB

      You did a, a study.

    8. VW

      Yes, I did.

    9. SB

      Um, and I think that's the picture I, I have here-

    10. VW

      Yeah.

    11. SB

      ... which talks about 2012.

    12. VW

      In 2012.

    13. SB

      So what, I'll put this on the screen again.

    14. VW

      Yeah.

    15. SB

      This is picture number two for anybody that's listening on audio-

    16. VW

      Yeah.

    17. SB

      ... who wants to see the photos. Um, this is a pretty startling image.

    18. VW

      It is.

    19. SB

      Um, and it scares me. Please can you explain what it is?

    20. VW

      It shouldn't scare you because you are healthy and a- a- you are gonna be mobile every day when you leave me here. But, so remember that study I introduced, the Health ABC, which was an NIH-funded study of a group of 70-year-olds. They just took a cohort of 70-year-olds and watched what happened over a decade.

    21. SB

      Yeah.

    22. VW

      Well, they did a similar study as this, uh, using CAT scans. I used MRIs. And what they found is that, um, that what they described as the inevitable decline of muscle, the inevitable infiltration of your muscle with fat like marbling. And I said, "That cannot be true. That is what happens if you are sedentary and sit around for the trajectory of your life." So, because I'm a sports doctor, I am surrounded by masters athletes, so I did a study of masters athletes from 40 to 85. What this picture is, is MRI slices in their mid thighs. So, MRIs take pictures of us using a magnet and creates these beautiful pictures. So, at the top picture is the MRI slice of a 40-year-old tr- and my athletes were usually runners or triathletes, of the thigh of a 40-year-old. So, I'll describe this for you. It's gorgeous.

    23. SB

      Yeah, it's beautiful.

    24. VW

      Yes. We have beautiful muscle architecture of the quadriceps on the top, the hamstrings on the bottom. The bone has a nice cortex. There's very little peripheral fat. And when I looked inside the muscle, uh, with a microscope and special software, there was not infiltration of fat or marbling. So, if you want to say it colloquially, this is a flank steak-

    25. SB

      Yeah.

    26. VW

      ... with no marbling. This is lean muscle. If we sit around for 35 years and have a desk job and we, and we sit at the desk, uh, 10 hours a day and we don't go move our muscles, we're not purposeful, this is what happens. We lose our muscle architecture. These muscles are, are almost, you can't even tell what they are. Uh, they are-

    27. SB

      What's the age of that person?

    28. VW

      This is a 74-year-old. Now, I had a large group. This is one representative person in each of the groups.

    29. SB

      Right.

    30. VW

      This is the control group. But the center one, the muscle, I'll tell you, is grossly fatty infiltrated. It is well marbled. It is like a Kobe beef. And then there's a thick rind of peripheral fat. This is a picture of what we call sarcobesity, meaning we have loss of muscle, sarcopenia, and we have obesity, excess adipose tissue.

  13. 36:44 – 41:12

    What's The Best Exercise Regime To Stay Young

    1. SB

      or-

    2. VW

      Thigh.

    3. SB

      ... thigh.

    4. VW

      Mm-hmm.

    5. SB

      Thigh muscle-

    6. VW

      Yep.

    7. SB

      ... is arguably-

    8. VW

      Quads and hamstrings.

    9. SB

      And that's a triathlete. Is arguably not as good as the 70-year-old triathlete's.

    10. VW

      (laughs) Oh, wow.

    11. SB

      I would actually say that the 70-year-old triathlete-

    12. VW

      They're two different people, so. (laughs)

    13. SB

      No, I think the 70-year-old wins, uh, Vonda.

    14. VW

      (laughs)

    15. SB

      And that is, that is startling because I, I thought that aging, muscle decline, the sort of senescence I think it's called of the, of the body and the muscles is inevitable. And this is unequivocal evidence that it's not, that if I make good decisions now, if I become a triathlete, I can have the flank steak thighs when I'm 70.

    16. VW

      What it tells you is that there is no age or time in your life when your body will not respond to the positive stress you put upon it, and it takes daily investment. It's not like you can store it all up and then ride on it.

    17. SB

      Mm-hmm. (inhales sharply) It, yeah, it's so, it's so important. That's one of the things that's been a real revelation for me is this idea that muscle is so critical as I get older.

    18. VW

      Yeah.

    19. SB

      Um, (clicks tongue) I often think about different exercises that I should be doing as I age, and, you know, sometimes I think about, um, running, but I, but it's g- qui- I don't know.

    20. VW

      (laughs)

    21. SB

      I worry about joint pains and stuff.

    22. VW

      (laughs) Yeah.

    23. SB

      So I'm a bit of a upper-body workout freak, and I just focus on my upper body. Um, what do you think of my exercise regime? What should I be adding to it to make sure that I can have the flank steak thighs but also just a longer health span?

    24. VW

      You know, what's critical f- uh, for long-term function is being able to stay upright. So it's all great that you're f- making big arms and have upper body strength, can do pull-ups-

    25. SB

      Thank you so much.

    26. VW

      ... and lift your suitcase above the-

    27. SB

      Thank you.

    28. VW

      ... in the airplane.

    29. SB

      Thanks.

    30. VW

      But what you really want to do when you're 97 is walk anywhere you want to, go up and down the stairs, do, you know, drive any car you want to, and that takes lower body strength. So all your biggest muscles in your body are below your belly button. So if I were you and had all this trajectory of time, I would work equally as hard on my, my glutes, my quads, my hamstrings, my calves, every muscle below your body. But not only would I work on my strength to get bigger, but I would focus on power, and those are different lifting techniques, right? The hypertrophy aspect of growing big muscles 'cause they look really great. Uh, you do now, and I am not a, I am not a, a trainer, but I've done this quite a while, so trainers, you're welcome to add in. But, uh, you do more reps of lighter weights because that will stimulate hypertrophy. If we're truly building-

  14. 41:12 – 42:28

    The Importance Of Strong Muscles When Old

    1. VW

    2. SB

      If you fall down, if you tripped over your bag-

    3. VW

      Hmm.

    4. SB

      ... what's the knock-on effect of that? 'Cause you'll just heal, right?

    5. VW

      I just heal.

    6. SB

      Yeah.

    7. VW

      You know, I just, I ran a Spartan race recently and fell off an eight-foot ring and didn't break, so I am working towards being unbreakable in my own life. That's what I want to happen for you, but if you're, if you're not unbreakable, what happens when you trip over your bag and fall is you could break your hip.

    8. SB

      And then what happens?

    9. VW

      Yeah. Well, if you're of any age, but particularly older, when you fall and break your hip, 50% of the time, you do not return to pre-fall function, which means you cannot live in the home you raised your children, you cannot drive your car, uh, bones are- bones in adults take about three months to heal. Imagine being down for that amount of time. And unfortunately, in men greater than women, 30% of people die in the first year from the complications of being that sick with a hip fracture. So, you know, as your orthopedic surgeon, I am desperate to prevent frailty, I'm desperate to prevent you from falling and succumbing to that sequela. So, we gotta lift weights with our rear end and our legs. We gotta work on our speed and agility.

    10. SB

      I think

  15. 42:28 – 44:27

    The Sedentary Death Syndrome

    1. SB

      it was you that used this term, the sitting epidemic.

    2. VW

      Hmm.

    3. SB

      What is the sitting epidemic?

    4. VW

      The sitting at- epidemic is what we're doing in our country, uh, when we, in every aspect of our lives, whether we're working... We're working, but we're sitting at a table. We're, uh, playing, we're sitting, and we're-... playing on our phone or watching something. It is the epidemic where we're spending, I don't know, 10, 14 hours a day sitting in this position. In fact, I was thinking about it, if it was logest- logistically possible for a three-hour interview, we should go for a walk.

    5. SB

      (laughs)

    6. NA

      (laughs)

    7. VW

      (laughs) Not so much.

    8. NA

      Mm-hmm.

    9. VW

      But, but it's the epidemic of sitting around. What does sitting around do? Well, it sends us, uh, towards a pathway of something called sedentary death syndrome. I wish I had made that up, but I didn't. A professor out of Columbia University in Missouri made up this term that I have been using my whole career to describe what happens to us when we sit our entire lives. Sedentary death syndrome are the 33 chronic diseases that we die of, including the top five, cardiovascular disease, stroke, cancer, um, even f- even things like fracture, that are completely impacted in a positive way by mobility. So, if we could eliminate sedentary living from our lives, we could probably live better, and that was the whole supposition of all these studies I did in the beginning of my career at the University of Pittsburgh, was to prove that if we took sedentary living out of our vocabulary, that we could save our bones. We proved that with two studies. Our muscles, we proved it with the one that you just saw. We could save our brains. We were one of the first to do brain studies looking at the effect of mobility on their brain. And it's a very hopeful picture.

    10. SB

      It's

  16. 44:27 – 46:51

    80% Of The Population Will Have Back Problems

    1. SB

      super interesting, this subject. I, this week, had a friend of mine diagnosed with, I think, he'd slipped like two discs in his back-

    2. VW

      Mm-hmm. In his back.

    3. SB

      ... or something, of, I think it was disc five and six or something.

    4. VW

      Yeah.

    5. SB

      And he sent a x-ray of his back into the group chat.

    6. VW

      Mm.

    7. SB

      And I thought, "Oh, this is so interesting." Because I've had lots of conversations with people on my podcast about sitting-

    8. VW

      (laughs)

    9. SB

      ... and all of these things. I spoke to one particular guy called David Raichlen-

    10. VW

      Uh-huh.

    11. SB

      ... who went and studied the Hadza tribe-

    12. VW

      Mm-hmm.

    13. SB

      ... in Africa, I believe-

    14. VW

      Mm-hmm.

    15. SB

      ... which is a hunter-gatherer tribe.

    16. VW

      Mm-hmm.

    17. SB

      And what he found is they do sit for about nine or 10 hours a day, but they s-

    18. VW

      They squat.

    19. SB

      ... they squat.

    20. VW

      I knew that, yes.

    21. SB

      So we sit in chairs-

    22. VW

      They're not sitting, they're squatting.

    23. SB

      Yeah.

    24. VW

      Mm-hmm.

    25. SB

      He told me that, I think, it was him and, um, Daniel Lieberman told me that they'd brought, brought a chair over there.

    26. VW

      Yeah.

    27. SB

      And like these Hadza tribe had like never seen a chair before. So when they like walked off to go to the toilet, the Hadza were all sitting in the chair.

    28. VW

      They squatted. (laughs)

    29. SB

      No, but they would-

    30. VW

      Oh. (laughs)

  17. 46:51 – 47:57

    How To Avoid Future Body Aches

    1. SB

      What would you recommend-

    2. VW

      Yeah.

    3. SB

      ... in order to avoid the back pains-

    4. VW

      Yeah.

    5. SB

      ... the sort of sedentary death syndrome or whatever it was called? What do I do? Because I, I have, I have to run a business. I work in an office at a desk.

    6. VW

      Yes. Well, you know what? Even simple things. Uh, for instance, I bought my assistant a standing desk because when I'm in clinic all day, uh, for 10 hours, the choice for him was sitting at a desk or standing at his standing desk. And so that can go a long way, number one. Number two, taking mini blasts of mobility, right? Getting up, running up the stairs, be a fidgety person, go to the copier, get steps in, just be moving all the time. The other thing, honestly, nobody knows when you're on a phone call what you're doing. You could be wall-squatting. In fact, I have challenged whole groups of people in their next board meeting to wall-squat the whole time.

    7. SB

      (laughs)

    8. VW

      No (laughs) I don't know how much thinking would go on. But just adding little things, like add that in. You don't have to sit to take a phone call, um, even in a Zoom meeting. I mean, people have seen worse than you doing a wall squat, you know, in the time of COVID.

  18. 47:57 – 49:33

    What To Do About Body Stiffness

    1. VW

    2. SB

      I, I was wondering this morning, um, on my way here, because I was in the bathroom, and I dropped something on the floor. Can't remember what it was. Might have been the toothpaste or something. And I went down to pick it up, and my, my back is just like so tight.

    3. VW

      Is it?

    4. SB

      Like my whole, I feel like my whole bo- I'm so unflexible. I like went down to pick it up, and the way that I go down to pick it up is you'd think I was, you know... I was gonna say in age then, but that's kind of, after seeing that-

    5. VW

      I know. You don't want to... Right, right. Yeah.

    6. SB

      ... flank me, I'm like th- this guy's got better flexibility than me.

    7. VW

      Yeah.

    8. SB

      But I just feel like-

    9. VW

      You're stiff.

    10. SB

      ... I'm stiff as hell.

    11. VW

      Mm-hmm. Mm-hmm.

    12. SB

      And I don't know what to do about it c- I, I think there's like a, I don't know, is it a joint pain, joint pains that I have, or is it just I don't, I don't have strong core?

    13. VW

      It could be all those things. So, when I talk to people about, to go, to tie into the other question, how should you be working out, how should you be investing in your mobility every day, uh, there are four components that, that we should try to find time for. Number one is flexibility and dynamic stretching. So what that means is-... is warming up every single joint in your body every day, and that can be as, as simple as, seriously, a set of jumping jacks, doing, uh, there's something called an inch worm where it's, like, a pushup position and you walk your feet up, and that'll warm up your ankles, your knees, your hips, your shoulders. But going through a dynamic warmup every day to warm up the joint, putting them through, demanding they go through a full range of motion, and then not forgetting, after you work out, to static stretch. We don't static stretch before we work out. We static stretch after.

    14. SB

      It's

  19. 49:33 – 52:31

    What's Static Stretching?

    1. SB

      ...

    2. VW

      But a static stretch is what we were taught in, in elementary school with, you know, you stand against a wall. You hold the stretch for 30 seconds. That happens in every body part after you work out, before you dynamically warm up. And so that's when things like yoga and Pilates and whether it's reformer Pilates or, uh, floor Pilates are... can be great for people. To me, that is the, the salt and pepper of your workout regimen. It's not just what you do. It's what you sprinkle over it. So that's number one, flexibility. A... Oh, because the acronym I use is FACE-

    3. SB

      Oh.

    4. VW

      ... just so people remember. F, flexibility. A is aerobic, right? And we can talk about that. C is this weight lifting we talked about, C, carry a load. E is equilibrium and balance.

    5. SB

      Nice.

    6. VW

      So, when you were reaching over and thinking you were so stiff, you could still do it because you're in your 30s. You still have the y- youthful pliability to do it. Imagine you're 60 now, and you haven't done anything about it, and nothing's moving, and you reach over, and you don't have the foot speed to catch yourself. You fall over. It happens all the time from a standing position. So the way I teach people to retrain their balance, literally, is to stand on one foot while you're brushing your teeth every morning because the perturbation of moving your whole body requires core strength. It requires proprioception, and that's how you'll retrain that particular motion.

    7. SB

      So I really need to introduce something like P- Pilates or yoga to my...

    8. VW

      Or just daily stretching.

    9. SB

      Okay. For how long?

    10. VW

      Um, well, if you stretch every... You dynamically warm up before you do anything, including your weight lifting, and then, um, the static stretching afterwards of every major muscle group, whether it's your triceps or whether it's your hamstrings, which are critical for low back pain, or your calves. You hold the stretch without bouncing for 30 seconds, and what you'll feel is at the end of the 30 seconds, you'll kind of relax into it, and you'll get more of a stretch. And you only do four reps. You are gonna get most of the benefit of that stretching after four reps. But I don't want you to only do that. I find many people asking me, "I do Pilates and yoga. Is that enough for me?" And I say, "That's great, but it's never gonna be enough."

    11. SB

      One of the other things, which is related to this, that people see as being inevitable is this idea of joint pain. We think we kind of just get joint pain as we age.

    12. VW

      Mm-hmm. Mm-hmm.

    13. SB

      Is joint pain inevitable? You've actually brought a big bone with you today-

    14. VW

      I did.

    15. SB

      ... which absolutely nobody asked you to bring, but I guess this is what you carry around with you.

    16. VW

      Is that okay?

    17. SB

      Let's put it... (laughs)

    18. VW

      (laughs) Steven, this is a femur.

    19. SB

      A femur.

    20. VW

      A femur, yeah.

    21. SB

      This is a human femur. Um, and I guess a femur is the...

    22. VW

      It's the bone that connects your pelvis-

    23. SB

      Yeah.

    24. VW

      ... to your knee.

    25. SB

      Oh, okay, so it's that big bone in my leg.

    26. VW

      Yeah, it's the big bone. It's the longest bone in your body.

  20. 52:31 – 54:54

    Can We Revert Joint Pain?

    1. VW

    2. SB

      This bone you brought with you-

    3. VW

      Mm-hmm.

    4. SB

      ... um, a lot of people talk about joint pain.

    5. VW

      Yes.

    6. SB

      Is joint pain inevitable? I'll give it to you because you-

    7. VW

      Yeah.

    8. SB

      ... probably know more about this stuff than I do (laughs) .

    9. VW

      So, what is a joint?

    10. SB

      Yeah.

    11. VW

      A joint is the, is the space that's occupied by two bones. So the femur, the top of it, that's in your hip, is a ball, and it sits in a cup in your f- in your pelvis. So, two different bones. The pelvis is connected to the femur through the hip joint. It goes like this, right? So... And then on this end, this end of the femur is connected to your tibia, and it makes your knee. Right?

    12. SB

      Okay.

    13. VW

      Yup. So, uh, is joint pain inevitable? It is not. Do we get it with aging? Often, so that you would think it's inevitable, but it is not inevitable. Why do we get joint pain? Well, every bone, at the end, is covered in an endcap of a s- structure called cartilage. Cartilage is a smoother-than-ice matrix that cushions the bones so that you don't feel your joints. One reason people have pain is because they've traumatically disrupted that cartilage, and there's potholes in it. Like, if you're a football player, and you get hit hard, and a piece... it impacts so hard it pops off, that's a traumatic cartilage injury. You will have joint pain from that. Another reason we can have joint pain is not traumatic cartilage loss, but because you've just done so many reps over a lifetime that you've worn it down. That's called osteoarthritis. And so it's not a pothole per se. It's like the whole surface has been worn down with sandpaper, for instance, and there's just not enough of it. Well, the reason we get osteoarthritis, some of it's genetic, but much of it is how much we weigh. Sometimes it's related, especially in women, to whether or not we have estrogen. Um, we only get one set of cartilage for a lifetime, unless I reconstruct your cartilage 'cause you've been injured or something. Uh, we get one set, so we get joint pain because the cartilage has started to wear down. We can get joint pain because we've worked really hard in a workout and we've just seen a lot of impact and it inflames your joint, but that's usually temporary.

  21. 54:54 – 1:00:07

    Don't Do This When You Exercise!

    1. VW

    2. SB

      The permanent version is when you really wear down-

    3. VW

      The permanent is u- usually due to osteoarthritis.

    4. SB

      So, so how do I... If I wanna work out-

    5. VW

      Mm-hmm.

    6. SB

      ... and I want to make sure that I protect my joints so that I don't have this, uh, permanent sort of...... naturally irreversible joint pain.

    7. VW

      Yeah.

    8. SB

      Is there certain workouts that I should be avoiding? Are there certain workouts that are more likely to give me, to erode my cartilage and give me joint pain?

    9. VW

      Hmm. Well, I think principles that should be used are the principles of weightlifting with progressive overload. So if you started out cold and decided, "You know, I'm young, I'm healthy, I'm just gonna, uh, lift to my maximum all the time," you're probably gonna inflame your joint. Your joint is not used to seeing that kinds of load. Joints bear t- five to 10 times body weight. So if you've gone from zero to 500 pound squat, that is 5,000 pounds.

    10. SB

      Yeah.

    11. VW

      That's a lot. Versus, if you start from zero and progressively up, your body will get used to the load. Your bones will build. Your, uh, your cartilage won't grow, but it will become more used to the pressure. So the principle is, um, to not have aching joints as progressively go up and not just let your ego take over.

    12. SB

      So you're saying that muscle helps to kind of, as a suspension mechanism for the cartilage?

    13. VW

      Well, what things project- p- protect the joints? Uh, being of a healthy body composition, which includes weight and muscle mass, right? So the way muscle helps protect the joints is exactly of you said. Instead of pounding together like this-

    14. SB

      Yeah.

    15. VW

      ... muscle acts as a shock absorber, so the bo- the bones come together more softly.

    16. SB

      Ah, okay.

    17. VW

      So where for people with osteoarthritis, one of the remedies for that is building muscle.

    18. SB

      Oh. I've got, um... Y- you mentioned a second ago that staying at a decent weight also ha- helps to stave off joint pains-

    19. VW

      Mm-hmm.

    20. SB

      ... and that sort of erosion of cartilage.

    21. VW

      Mm-hmm.

    22. SB

      And I was, I was reading in your work about this pretty shocking, um... Grab my, my brick and my rock.

    23. VW

      (laughs)

    24. SB

      This pretty shocking stat.

    25. VW

      Yeah.

    26. SB

      That... Ugh, god, this is heavy. You can take that. Okay, I'm gonna put it down for you.

    27. VW

      I'm gonna use two here. Yep.

    28. SB

      Um... In your work, you describe how putting on even a small amount of weight-

    29. VW

      Uh-huh.

    30. SB

      ... increases the pressure on our joints by a huge amount.

  22. 1:00:07 – 1:02:48

    Losing Abdominal Fat

    1. SB

      these three me- major mindset changes that we need to kind of, um, experience in order to make sure that we can be fit and healthy in our later years, things like not focusing on weight loss, but instead focusing on building muscle.

    2. VW

      Mm-hmm.

    3. SB

      That for me is, um, again, it's a bit of a, of a narrative violation because, um, I think a- as we age, one of the things that we see as being ine- inevitable is that we are gonna gain weight. So mo- most people go to war with just trying to lose specifically abdominal fat.

    4. VW

      Mm-hmm.

    5. SB

      I think a lot of men are really quite-

    6. VW

      Mm-hmm.

    7. SB

      ... obsessed with their abdominal fat.

    8. VW

      Mm-hmm.

    9. SB

      Why, why do we need to make that mindset shift?

    10. VW

      You know what? And I'll take that shift even further, and it's... I like to frame it as we don't wanna lose weight. We want to, uh, recompose. What are we made of, right? We want to be made of healthy muscle. We, we want to care about how much body, what percentage of our body is fat. We need fat. Fat has a purpose in our body or we wouldn't have it. But what percentage are muscle? So what happens when we just focus on losing weight and our primary method is calorie restriction? What we know, it is clear from, from many papers that if we just calorie restrict with nothing else, we will lose 25 to 50% of our weight as muscle.... and then that makes us metabolically less healthy because muscle is a glucose sink.

    11. SB

      Uh.

    12. VW

      You know, when we feed ourselves and there's sugar circulating, it is taken up by our muscle, which if we lose 25 to 50% as we lose weight, we have less metabolic availability to get rid of all that. And then when we come off our crazy calorie-restriction diet, the weight we gain back is 80% fat. So if we are, if we're troubled with yo-yo diets, which so many people struggle with that, they'll lose weight, they'll gain weight, they'll lose weight, it becomes this circle as we're continuously losing more muscle. So when I frame it, for men and women, I want them to, to think of recomposing. "How, as I'm losing fat percentage, can I gain muscle?" And so that puts it in a different perspective. I don't care what you weigh. You know, I'm a muscly woman, I weigh more probably than people would think I would, because I have lower body fat, I have higher muscle content, and that's what we care about. And for people, I always chuckle when I say this, that are really interested in the way clothes fit, which I am, I'm as vain as they come, well, muscle is nature's Spanx. You may weigh more, but you're tighter and everything fits and looks better. So it's not weight, it's composition.

    13. SB

      Can we

  23. 1:02:48 – 1:05:43

    Can We Get As In Shape As When We Were 25?

    1. SB

      be as in shape as we were when we were 25 when we're 45?

    2. VW

      We can be different.

    3. SB

      Different, okay.

    4. VW

      There are lots and lots of examples all over of, uh, either people staying healthy... I mean, look at Tom Brady, he's a great example, right?

    5. SB

      Cristiano Ronaldo is a great example as well. He's got a big pack.

    6. VW

      Oh my God, I just saw him the other day, uh, playing actually in this Europe-

    7. SB

      Yeah.

    8. VW

      ... tournament. I just saw him playing. Um, there are lots of examples of that from pro sports now. But even in mere mortal athletes, they're posting all over the internet how they have maintained, or many people, a light bulb turns off and they say, "I'm as str- I'm sitting on my rear end. I'm as strong today as I'm ever going to be unless I do something." And we have pictures of people investing in weightlifting and high protein meals and, and getting in better shape than they ever were. I was in the best shape of my life when I was 40, and then I went through perimenopause and thought I was going to die, and now, I'm 57, I'm in some of the best shape of my life. I am in not, I'm not 19% body fat like I was when I was 40, but as a whole person, this is the best it's ever been.

    9. SB

      It's really interesting as a football fan, a soccer fan, um, you know what it is, it's called football. As a football fan, seeing how two different players at the same age, I'm thinking about, I won't name names because it makes it personal, but someone like Cristiano Ronaldo, and I compare him to another player from my club, Manchester United-

    10. VW

      Mm-hmm.

    11. SB

      ... who, he, Cristiano played there at one point, um, who is also 41 years old-

    12. VW

      Mm-hmm.

    13. SB

      ... or whatever Cristiano is now, and they look f- 15, 20 years apart.

    14. VW

      Really?

    15. SB

      And Cristiano Ronaldo carried on playing.

    16. VW

      Mm-hmm.

    17. SB

      He c- by all accounts from things that I hear at Manchester United has the most discipline with his routine, his nutrition.

    18. VW

      Mm-hmm.

    19. SB

      And then another player who at the time when they both played together in their 30s, they kind of looked the same physically.

    20. VW

      Yes.

    21. SB

      But just because for some reason they let go-

    22. VW

      Mm-hmm.

    23. SB

      ... it almost appears that they let go.

    24. VW

      Mm-hmm.

    25. SB

      They got on the alcohol a little bit.

    26. VW

      Mm-hmm.

    27. SB

      Their diet shifted. They now look like they're 15 years older than Cristiano.

    28. VW

      Mm-hmm. Mm-hmm.

    29. SB

      But at 35 they kind of look the same.

    30. VW

      Mm-hmm.

  24. 1:05:43 – 1:07:50

    How Cristiano Ronaldo Stays That Fit & Healthy

    1. SB

      the, the basics there that I need to think about in order to be a Cristiano Ronaldo as opposed to another one of his colleagues that didn't manage to stay in shape-

    2. VW

      (laughs) Yes.

    3. SB

      ... what are those fundamentals that you think Cristiano is hitting? Or from your work with athletes?

    4. VW

      Yeah. I think that, um... I think we harness the power of our age, the wisdom of our age, so he probably works out now differently than he did when he was 25. He, he probably, and I don't know his routine, but people like Dara Torres or, uh, Michael Phelps, they spend more time on recovery, more time on muscle work. They're very systematic about their workouts. They do max min. They, they get the maximum workout in, their skill set. They're skill workouts. They're not out on the field for four hours anymore. They get an hour and a half in, they work on the skills they need to do. So they're smarter, right? Number two, uh, nutrition is monitored from- literally when, uh, one of my jobs at the University of Pittsburgh was as the medical director of the UPMC Lemieux Sports Complex. We housed the Penguins, the Pittsburgh Penguins, which is the professional hockey team. They had a full-time chef. From the minute they woke up, they came in for breakfast, lunch was cooked, all snacks were provided. Even the food on the airplanes was provided so that they had this very regimented diet full of the nutrition they needed not only to fuel them, but to recover them. So that's nutrition. Nothing is a mistake. Uh, number three, they are, their workouts are not only, uh, the skilled workouts, but the conditioning workouts are completely monitored. I mean, you're sponsored by Whoop. Whoop takes care of a lot of athletes. We know their recovery state, we know how well they slept the night before, we know their response to the heavy lifting. So I think that athletes at that level are able to maintain the way they are because it's a science.... also, frankly, they're genetically specimens. They got this great cytoplasm they were born with.

  25. 1:07:50 – 1:10:57

    Sugar Impact On Our Body

    1. SB

      Sugar.

    2. VW

      Ah.

    3. SB

      You, you don't speak very fondly of it. Y- I, I read a quote where you say it will destroy your body on so many levels.

    4. VW

      It does. So, you know what? I love sugar. I'll, you know ... I love sugar. I would rather eat cookies for breakfast, but I don't. And, and the first time I sugar detoxed, after the first three days it was rough because, you know, sugar is addictive. There's an addictive center in our brain, you know? And so y- after three days, you can gut it out and use your willpower, discipline, but after three days, the fourth day you're going to your cupboard, and you're standing there, and you're like, "I don't know why I'm here." Well, it's your brain looking for a dopamine hit of sugar. So what does sugar do? I am not opposed to carbs. Our body needs carbs. It doesn't need as much we get, but we need fiber-filled carbs. Fiber is critical in our bodies. What we don't need is beet and sugarcane and honey and agave, all the simple sugars that have a, a steep glycemic index, meaning you eat it, it's, um, easily digested, rapidly digested, goes immediately to your blood, your blood sugar will spike. Give you some examples. And then what happens is our pancreas will release insulin, which will frantically try to carry it into our muscles to be used. Well, that happens at a finite rate, and when you have too much sugar circulating that overcomes the rate that it can be removed, our body stores it in fat, right?

    5. SB

      Mm.

    6. VW

      With a high blood glucose, our body goes through a circumstance called, uh, glycosylation, which is essentially caramelizing proteins in your body. It's like you have a steak and you leave it on the grill extra long and it gets that caramelized. Well, that state of our proteins in our body is highly inflammatory. Well, we know high inflammation is something that contributes to chronic disease. It contri- this excessive blood sugar contributes to insulin insensitivity, meaning our poor pancreas is trying to pop out enough insulin to get rid of the sugar that it pops out so much that, uh, we become insensitive to it. There's just an overabundance. So all of those reasons are why I'm not opposed to c- complex carbs and fiber. I am opposed to the highly processed, sugar-filled diet that is produced for us by our current food system, and by the choices we make. I don't blame society. I don't blame our food system. I blame them and the choices we make. Um, so I, that's one of the first things I recommend to my patients. Do you know it's the hardest thing for them to give up?

    7. SB

      Sure.

    8. VW

      And they'll do everything else. They'll get to a gym. They'll, they'll do aerobics the way I want them to, but then when I say, "And we need to eliminate s- simple sugar," that's when the excuses come out.

  26. 1:10:57 – 1:16:04

    How To Apply All These Knowledge To One's Self

    1. VW

    2. SB

      It's interesting 'cause, yeah, I mean, it's difficult. There's obviously a physiological, sort of chemical h-hold that sugar has over, over us, but on this point of psychology and, uh, willpower, whatever we wanna call it, everything that we've discussed so far today is kind of contingent on you making a decision.

    3. VW

      Yes.

    4. SB

      Now how ... Y- when you talk about the whole human-

    5. VW

      Mm.

    6. SB

      ... how can you influence someone who might've got this far in the conversation today and they, they understand everything you've said. They go, "Yeah, I know some of that stuff. I know this thing here, and you know, I've heard that over, in this book or this podcast before, but for some reason, I just can't-"

    7. VW

      Can't do it.

    8. SB

      ... can't do it, can't get myself to do it. Maybe I'll do it for one day, but then the yo-yo goes back to the bottom and ...

    9. VW

      There's this concept in banking called temporal disconnect. It's a banking term. I came upon it as I was writing these books initially, and the concept is that bankers, financial people, want us to put a little bit away every day, not for today. There's no satisfaction in that for today. In fact, it's deprivation for today. But it's for the future. The concept of temporal disconnect is that you don't know who you're gonna be in 30 years, your, or 40 years, a 70-year-old Steven. You don't know that guy. You don't care about that guy. You don't even know what he's like, what he's gonna become. So, but you do know today's Steven, and so you're gonna take care of this guy, not that guy. And so that's why bankers can't get us to invest our money, in the general population, right? Most people don't have much savings, right? The same is true when we apply it to our health. What do we want now? What's gonna make me feel good now? What, you know, can I bargain with myself that I'll do it tomorrow? Or this little bite's not gonna hurt me, right? Because the temporal disconnect of, "At 63, if I don't do something now, I'm gonna have chronic disease rear its ugly head," that is a hard argument. Some people are disciplined enough to think like that. That's a hard one. So some of the ways to help people now is to help them identify how amazing they're gonna feel now. In- instead of feeling sluggish, sitting in a chair all day with back pain, if we invest every day in walking, in sprint intervals, which is gonna make us lose fat, or lifting heavy, which is gonna put on the muscle of Spanx and make us look good, and plus, when you get done lifting heavy, you feel like a badass, right? If you can make that the reward, that is an easier thing to do, because you are right. We know what to do. We just don't do it. And we know what to do and we don't do it, because the battle is in the five and a half inches between our ears. It's not...... actually picking up the barbell, right?

    10. SB

      Mm-hmm.

    11. VW

      And so, it's identifying how this is going to make me feel today, not for 20 years. And here's the other thing. I honestly think sometimes it comes down to self-worth. Do I believe that I am worth the daily investment in my health, or do I believe that everything else is more important than me? And that's hard. And I have come to understand that until you believe that you are worth the daily investment in your health, nothing else matters.

    12. SB

      Yeah, it's so interesting, and I think, uh, one of the things, again, that has been, um, cured, that used to be a mind virus of mine was, I think part of me did think, "When I get to 50, when I get to 60, I'll address it then."

    13. VW

      Yeah.

    14. SB

      I.e., if I've got, um, certain, um, health issues when I'm 60, "Well, I'll just go to the gym then, and I'll just, uh-"

    15. VW

      Yeah.

    16. SB

      "... I'll just fix it then."

    17. VW

      Yeah.

    18. SB

      "I'll just start becoming, uh, active when I'm 50 or 60." But I, but that's not how any part of my life works. That's not how, uh, my business or my investing works.

    19. VW

      No.

    20. SB

      Everything is compounding now.

    21. VW

      Yeah.

    22. SB

      So the decisions I make at 20 or 25 or 30, or... Your daughter's upstairs. She's what? She- she's young. She's-

    23. VW

      She's 16.

    24. SB

      ... 16.

    25. VW

      Mm-hmm.

    26. SB

      The choices I start making then-

    27. VW

      Yeah.

    28. SB

      ... are sowing seeds that will flourish, for better or for worse, when I'm 60, 70.

    29. VW

      And you know what's easier than doing a little bit every day? That's easy. You know, my daughter upstairs, she, poor thing, can't get away from knowing what the right choices are.

    30. SB

      Yeah.

  27. 1:16:04 – 1:18:58

    Vitamin D Supplements

    1. SB

      Yeah, that's one of the things that's been... really helped me, I think, from doing this podcast is, obviously, I'm inundated with lots of information about health.

    2. VW

      Yeah.

    3. SB

      So the, the, the framework I use to decide what to take in and what to implement is ju-... I, I hear some things that my guests say, and they might say, "Oh, by the way, Steven, um, apple juice or orange juice is full of sugar."

    4. VW

      Mm-hmm.

    5. SB

      And in my head, I was going, "Oh my God, I thought that was healthy." And then-

    6. VW

      Mm-hmm.

    7. SB

      And I don't really... I could take it or leave it anyway. So these small sort of modifications, taking these sort of very sugary drinks out of my life is something that happened. Um, being consistent with my workouts, focusing on muscle gain, thinking a lot about how I sit, but also making sure I'm as active as I can be.

    8. VW

      Mm-hmm.

    9. SB

      Um, and then the other thing, actually, has been supplements.

    10. VW

      Yes.

    11. SB

      Because I sit in this Diary of a CEO studio a lot, and I sit in dragon's den, little dungeon a lot.

    12. VW

      Mm-hmm.

    13. SB

      I spend a lot of time sat at my desk inside-

    14. VW

      Mm-hmm.

    15. SB

      ... without any sort of natural light.

    16. VW

      Mm-hmm.

    17. SB

      So I've started taking vitamin D supplements frequently-

    18. VW

      Yes. Yeah.

    19. SB

      ... because, actually, I went to the doctor's, did my, my tests, and it-

    20. VW

      How low was it?

    21. SB

      How low was it? It was very low.

    22. VW

      Mm-hmm.

    23. SB

      They said, "Everything's fine, Steven. You're all good here, here, and here." I did, like, the full body. I did my testicles-

    24. VW

      Yeah.

    25. SB

      ... to my toes, to everything.

    26. VW

      Good.

    27. SB

      My blood, everything.

    28. VW

      Yeah.

    29. SB

      My moles, whatever it might be. And the, the one thing he did say to me is, "Your vitamin D levels are low."

    30. VW

      Mm-hmm.

  28. 1:18:58 – 1:22:33

    Strengthening Our Bone Structure

    1. SB

      new bone?

    2. VW

      Um, you can... Yes. You can, actually. You c- can increase your T-score. It's a multifactorial... T-score is a score that we measure using a test called a DEXA scan. Uh, a DEXA scan will tell us not only our absolute bone density, but, uh, but compare us to healthy people. And this, DEXA scans are usually used for women or older men who have fallen and fractured. But a T-score tells us what our bone density is compared to a healthy 30-year-old, right? Assuming a 30-year-old has laid down optimal amounts of bone. And we can talk about how that's becoming not true. But... So once we know our T-score, it tells us the health of our bones. Um-... just to give us a gauge of, can we rebuild? So yes, all the things. We can lift weights, we can impact our bones, we can have proper nutrition. If we are a woman and, uh, have lost our estrogen, which starts in our 40s, not our 50s, it starts in our 40s, we can make our estrogen decision, as I know you've talked about before. Uh, because estrogen and testosterone are critical in bone health. And then if you show up with a T-score that shows that you have frank osteoporosis ... Even two million men in the United States have osteoporosis. It's-

Episode duration: 2:07:22

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