Why bone is a master communicator and not just a frame

1. 0:00 – 2:03

   Intro

   1. VWDr Vonda Wright0:00

      Runners who only run are hurt a lot, and it's usually due to a motion imbalance. So I always do this test to show them whether your butt muscles are strong enough to keep your pelvis straight, and whether you're strong enough to keep your knee from falling into this position.

   2. SBSteven Bartlett0:14

      I look like I'm drunk or something. How are you doing this with your heels on? Dr. Vonda Wright is a leading orthopedic surgeon and longevity expert. Leveraging her expertise with elite athletes. To revolutionize the way we move, eat, and train.

   3. VWDr Vonda Wright0:25

      To live longer, stronger, and better. I am on a rampage to make bone sexy again, because in the United States, at least 50% of women will get osteoporosis, along with two million men. Now, osteoporosis is low bone density, and studies show that people with low bone density have higher cognitive decline. It increases your risk of fracture. If you break your hip, 50% of the time, whether you're a man or a woman, you will not return to pre-fall function. And 30% of the time, you will die. And there's a lot that causes bone fragility, such as aging, not building enough bone in our youth. It's our sedentary lifestyles, the myth that women have to be teeny tiny, and it's even things like a woman breastfeeding will lose 20% of her bone density in the first six months. But it's not inevitable, and I will lay out a lifestyle that I call Unbreakable. It's about muscle, bone, nutrition, but the most important part is mindset.

   4. SBSteven Bartlett1:13

      I'm very, very excited. Uh, just to pause there, is there a link between menopause and bone density?

   5. VWDr Vonda Wright1:19

      Yes, and it's because of the plummeting of estrogen, which is critical for muscle, bone, tendon, ligament, that. And without it, it can have dire effects. So, you need to know the following.

   6. SBSteven Bartlett1:32

      This has always blown my mind a little bit. 53% of you that listen to this show regularly haven't yet subscribed to this show. So could I ask you for a favor before we start? If you like this show, and you like what we do here, and you wanna support us, the free simple way that you can do just that is by hitting the subscribe button. And my commitment to you is, if you do that, then I'll do everything in my power, me and my team, to make sure that this show is better for you every single week. We'll listen to your feedback. We'll find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much.

2. 2:03 – 3:59

   Vonda's Mission to Help People Live a Longer, Stronger Life

   1. SBSteven Bartlett2:03

      Dr. Vonda Wright.

   2. VWDr Vonda Wright2:06

      Yes.

   3. SBSteven Bartlett2:07

      For anyone that's unaware of what you do and who you do it for, what do you do and who do you do it for?

   4. VWDr Vonda Wright2:13

      So, you know, in, as a sports doctor over the years, we've learned how to take really high-performing athletes, you know, those are who are winning all the time, who need to continually get better and better and better at their craft. And over the 30 years of my career, we've gone from really focusing on how they train, the periodization of their training, to the last time I, uh, was at the University of Pittsburgh, I was the medical director of the UPMC Lemieux Sports Complex, which is where the Pittsburgh Penguins are housed. And it had gotten so, uh, scientific. They had a full-time chef. Every meal, from breakfast, lunch, dinner, every meal on the planes were prepared. Because when it comes down to split-second agility, top-of-brain thinking, every little bit counts. And so, in the 30 years of my, of my medical career, it's gone from just learning more about performance science of how to train, to how to feed people, to how to recover people. So instead of doing, for instance, I think Dara Torres was talking about her, uh, Olympic runs in her 40s, right? She trained much differently when she was 24 and in her 40s. After she had had a child, it was much more about recovery, not as much hours in a pool. So, I take all those things that we've learned over the course of my career and now apply them not only to athletes, but to people like you and me who, we're in high-performance jobs. I need to be tip-top in every sphere of my life, as you do. And how do we eat better, recover better, take the principles of performance that we've learned from athletes into high-performers and even mere mortal athletes like me?

3. 3:59 – 6:03

   How Much of Vonda's Work Crosses Into the Cognitive Realm?

   1. VWDr Vonda Wright3:59

   2. SBSteven Bartlett3:59

      A lot of my work involves, like, cognitive performance.

   3. VWDr Vonda Wright4:01

      Yes.

   4. SBSteven Bartlett4:02

      Making sure my brain is sharp when it needs to be.

   5. VWDr Vonda Wright4:03

      Yes.

   6. SBSteven Bartlett4:04

      How much of your work crosses over into the cognitive realm?

   7. VWDr Vonda Wright4:08

      You know, I am not a brain scientist myself, but I am fortunate to be surrounded by people who are expert in that. So from my own perspective, I've come to appreciate, at a much deeper level personally, um, as well as professionally, the role of sleep. In fact, we've talked about my previous books from the early 2000s before, and when I wrote those books, mobility was king. I wrote only about mobility. And then as I progressed in my career, I got deeper, deeper, deeper into nutrition, and then I would say, "Okay, nutrition is number one, and mobility is second." But at this phase of evolution of sleep science and knowing how restoring the brain and providing adequate time and nutrients, I put sleep first, sleep and recovery first, because you can't do any of these other things without a well, well-recovered brain. In fact, somebody asked me the other day about timing of working out, and is it always necessary to do it in the morning? Like, that's the mantra. "Get up. Go do your workout." And my answer to that was, "You have to know how your brain works." For instance, my brain is best between 5:00 AM and 2:00 PM. That is when I'm gonna get all my deep work done. I'm gonna be creative. I'm gonna think. After 2:00 PM, I could build you a house. I can continue operating. But if I'm gonna write a book, it's gonna be early. So I do not work out in the morning, because I'm not gonna waste that brain energy on physical activity when I need it for this deep work. So, that's the way I apply brain science. But I, I'm so lucky to be surrounded in, in the place I am now with people who put EEGs on your head and map your brain and tell you which brain pathways you're too stressful on and, and which brain pathways we can train. And you can train the physical brain like a muscle.

4. 6:03 – 7:14

   Training the Brain Like a Muscle

   1. SBSteven Bartlett6:03

      You can train the physical brain like a muscle?

   2. VWDr Vonda Wright6:05

      Yeah. So there's this company called Nestree that I just happen to have access to, and they put EEG helmets on my Precision Longevity clients, and we map their brains and look at... For instance, here's an example. Things that are habitual take very little brain injury, uh, e- energy. Even if we need a lot of brain energy, they become so habitual, our brain turns away, uh, energy from them. Versus things we're learning or things we're stressed about, we devote so much energy to that. So once they, this company maps our brains, then they have this training program where it's almost like getting your, your cognitive brain out of the way, and let your subconscious brain reapply energy to the pathways that you actually need, that you, you've begun to f- to ignore, and it makes you more efficient. And I'm being inadequate in explaining it, but brain scientists believe that you can retrain the brain like a muscle and devote energy to neural pathways. So I know, we do this to athletes to try to squeeze performance out of them.

5. 7:14 – 9:24

   What Is Precision Longevity?

   1. SBSteven Bartlett7:14

      When you use that term Precision Longevity-

   2. VWDr Vonda Wright7:16

      Mm-hmm.

   3. SBSteven Bartlett7:17

      ... wha- what does that mean?

   4. VWDr Vonda Wright7:18

      So you know, after the understanding of human DNA, knowing what we're truly made of, it pushed us out of a time in medicine where we've been for the last 150 years, which is observe, and one size fits nobody. Now that we've sequenced the human genome, we can develop health plans, your health plan, my health plan. It's not generic. Here's an example. When I have c- people who want to talk to me about living healthier longer, and we, and we draw a set of biomarkers, it's not 6,000 biomarkers. It's just a set of about 23 that are beyond regular labs. And I see that, for instance, maybe Stephen you have a high load of senescent cells. Well, I'm going to specifically design your gap nutrition according to what you need. You might not need anything for inflammation because maybe your inflammation labs are good. But historically what we would have done is say, "Okay, let's just give everybody the same formula," but now we are able to devise what your body needs at your time. I do the same thing with exercise. I never say, "Let's have you do 150 minutes of moderate exercise," because I have access to lactate threshold testing, where you're walking on a treadmill, running on a treadmill or on a bike. Every four minutes we're pricking your finger, and I can tell exactly what t- when your mitochondria, the little energy storehouses in your cells, go from burning fat to burning carbo- carbohydrates, and that place is called the FatMax, and that is when your mitochondria, your energy, uh, organelles are most efficient. And that's where we wanna work out 80% of the time. So that's just an example of how I'm gonna tell you what heart rate you need to w- work out in. I'm gonna tell you how to get, fill the gaps in your nutrition instead of just doing broad guidelines 'cause that's the state of the art right now.

6. 9:24 – 11:17

   How Does the Body Change in Different Seasons of Life?

   1. VWDr Vonda Wright9:24

   2. SBSteven Bartlett9:24

      When you think about personalization-

   3. VWDr Vonda Wright9:26

      Mm-hmm.

   4. SBSteven Bartlett9:26

      ... I was thinking also, not just about the individual but different phases of life-

   5. VWDr Vonda Wright9:30

      Mm-hmm.

   6. SBSteven Bartlett9:30

      ... and how maybe in my, my 20s there's a certain set of things I need to be thinking about more so than in my 30s, in my 40s, in my 50s, in my 60s. Is that a, a useful way to think about it? Are there different things we need to be thinking about in different seasons of our life? Or is it the same things in every season?

   7. VWDr Vonda Wright9:47

      Well, I love that question, and the one, one-word answer is yes. Every season of our life is different. Let's take bones, for instance. We build, build, build bones-

   8. SBSteven Bartlett10:01

      Yeah.

   9. VWDr Vonda Wright10:01

      ... until, in women, we're about 28, and, uh, men, 30. We reach peak bone mass. We then reach a plateau where we keep our bone density, and then in women, it begins to plummet due to hormonal influences. For men, men usually maintain their bone density until their 70s when they plummet unless they have a metabolic problem, a, an autoimmune disease or having had the need to take a lot of steroids, and then you see a big difference at 50. So in bones, that's a good example how every few decades our bones are reacting differently. Muscle is the same way. We know that we can gain muscle at any time in our lives, but we do it most easily until we're about 30, right?

   10. SBSteven Bartlett10:48

       Mm-hmm.

   11. VWDr Vonda Wright10:50

       We also know of, uh, changes in the way our gut functions as we age having to do with absorption and the, uh, the ability of the microvilli in our gut to absorb nutrients and different kinds of nutrients. Women in midlife, for instance, need vitamins that are something called methylated, which means broken down a little more because our gut function is less efficient. So every phase of our aging, we're different.

7. 11:17 – 12:08

   Why Do Men's Bones Maintain Their Density Longer Than Women's?

   1. VWDr Vonda Wright11:17

   2. SBSteven Bartlett11:17

      Well, on that point of bones, that, that sounded like you were saying that men's bones maintain their density longer and women's don't. Why, why is that? Is that linked to menopause?

   3. VWDr Vonda Wright11:26

      Well, men, uh, because of the influence of testosterone and the genetics of having, um, XY chromosomes, build more bone initially, thicker cortices, more, more absolute poundage of bones, and so, um... And then because of the plummeting of estrogen which is critical for bone health, women lose bone faster than men, such that after about age of 40, when we get to that plateau, women start to lose bone density about 20% by the time they get to their menopause, and, um, that can have dire effects for women, but that is all due to the role of estrogen on controlling bone density.

8. 12:08 – 13:51

   Is Loss of Bone Density Inevitable for Women?

   1. VWDr Vonda Wright12:08

   2. SBSteven Bartlett12:08

      So is this inevitable?Is the loss of bone density inevitable for women?

   3. VWDr Vonda Wright12:12

      It is not. In, um, in 2004, we studied a very large group of masters athletes, meaning athletes, uh, 40 and older, in the National Senior Games, which is Olympics for, uh, people of that age demographic. And the National Games, you have to have won your state games to qualify, so these were pretty high-level recreational athletes. So we did a study looking at their bone density across time, and the first thing, the first study we found was that with chronic exercise, such as these people did, you could maintain your bone density at a very high proportion into your 80s. The second question we asked was, "Okay. If we know we can do that, what exercise is really important for that?" And so we divided the sports up into, uh, bounding sports, where the bones were being impacted-

   4. SBSteven Bartlett13:03

      Like?

   5. VWDr Vonda Wright13:04

      ... like basketball, running, um, volleyball, anything where you come down hard on your bones, versus swimming, bowling, the less- uh, biking.

   6. SBSteven Bartlett13:14

      Mm-hmm.

   7. VWDr Vonda Wright13:14

      And we found that bashing-your-bones impact was as important in maintaining bone density as things you can't control, like your age, whether you're born with XX chromosomes or XY chromosomes, family history. So impacting bones, causing them to build up over time, is critically important for maintaining bone density. So to answer your question, "Is loss of bone density inevitable?" Loss of estrogen is inevitable. Loss of bone density doesn't have to result in osteoporosis, fracture, and frailty.

9. 13:51 – 19:47

   Why Bone Health Is Crucial for Overall Health

   1. VWDr Vonda Wright13:51

   2. SBSteven Bartlett13:51

      So I want to get into why that's happening, but just to pause there, because a lot of people don't think bones are that important.

   3. VWDr Vonda Wright13:56

      Oh.

   4. SBSteven Bartlett13:56

      Like, I think a lot of people see our bones as just something that-

   5. VWDr Vonda Wright13:59

      Yeah.

   6. SBSteven Bartlett14:00

      ... we can't influence. You don't think of them like muscles. Muscles, I go to the gym. I can expand my muscles. I can get strong. But with bones, it feels like they're static, you- you know?

   7. VWDr Vonda Wright14:08

      Mm-hmm.

   8. SBSteven Bartlett14:09

      So how- how would you refute that so that I start caring about my bones?

   9. VWDr Vonda Wright14:14

      Yeah.

   10. SBSteven Bartlett14:14

       And what is the cost if I don't care about my bones?

   11. VWDr Vonda Wright14:17

       Well, you know what? I am on a rampage for this year that, to bring, to make bones sexy again, 'cause here from a very superficial level is why we should care, and then I'll tell you from a more scientific level. You know, we only think of our bones usually in a couple times, like you look in the mirror and somebody tells you, "Oh, your bone structure is magnificent. Look at this model's bones." And, or, uh, and y- we're all touching our cheekbones. Or we think about them when we hear about a great archeologist who's just discovered a new people group, and we can tell from our bones how they lived, how they died, how healthy they were. In fact, in that setting, bone is the last remnant of your whole life. It endures the longest. I mean, the hist-, y- the history you talk about in your bones outlives anything. Muscle goes away. Skin goes away, everything except your bones, which remain. That's fascinating, right? But the other reason we even think about our bones is when they break, right? When they, bones... People think bones are silent, like th- a strong, silent type just hanging back, until they break, and then they're screaming at you, right, and- and causing frailty. And here's some bone stats 'cause the real answer to the question is coming. One in two women will have an osteoporotic fracture in her lifetime, so it's either me or your partner, or me or your assistant, right? One in two will have an osteoporotic fracture. Women have 70% of all hip fractures. Hip fractures are one of the main contributors to ending up in a nursing home because you can no longer walk and take care of yourself, right? 70% are women. If you break your hip, 50% of the time, whether you're a man or a woman, you will not return to pre-fall function. You cannot go live in that house where you raised your children. You may not be able to drive and go be totally independent, right? And 30% of the time, it's a huge number, 30% of the time you will die either from the complications of the fracture, from the bedrest, from the infections you get, the bladder infections, just the sequelae of being that sedentary. So those are- those are s- not meant to scare people. That is the reality that I see every day as an orthopedic surgeon on call. But there are other reasons to care about the bones 'cause fracture is a big one. Bones, and it makes sense. Nature is so conservative. Bones are in our body from the top of our head to our pinky toe, right? Bones are master communicators. We think of muscle, which we're all talking about now, and bone, and adipose, and everything as- as siloed organs that don't have much to do with each other except they live next to each other. The fact of the matter is, for instance, when we're talking about the musculoskeletal system, bone, tendon, ligament, muscle, fat, cartilage, muscle stem cells, they're all derived from the same stem cell, the mesenchymal stem cell. So they're not distant neighbors. They're cousins, and they all speak in the same language. They may have different dialects. I was thinking about an example of- of this, you know how in the UK, it, English is the language, but depending on what parish you live in or which country within the UK, English sounds very different, but it's the same language. So within musculoskeletal tissue, muscle and bone are not separate. They are one ecosystem, such that when muscle releases a protein called irisin, it talks to the bone. When bone releases a protein called osteocalcin, it talks to the muscle. But in the case of bone...Osteocalcin, if we just stick with that protein, it talks to the whole body. When your osteoblasts, the bone-building cells in your bones, release osteocalcin, it goes to your brain and has a neuroprotective effect by decreasing inflammation. It goes to your brain and causes the synthesis of neurons in the hippocampus. It goes to the pancreas and helps with insulin insensitivity. It goes to the muscle and helps the muscles scoop up glucose out of the blood, right? If you're a man, osteocalcin can travel to the testes, and that organ, the Leydig cells, under stimulation of osteocalcin, will produce testosterone. So, it's like a miracle and a wonder that we just think of bones as the strong, silent type that hold up our muscle, because actually bone and, and the proteins that it produces are master communicators. And it makes so much sense because we have bone everywhere in our bodies. Why wouldn't our bodies use it like that?

   12. SBSteven Bartlett19:30

       I thought it was just a frame.

   13. VWDr Vonda Wright19:31

       Well, and it is a frame, right? What's muscle without bone? Just a heap o' metabolic tissue, right? It makes us, gives us our stature, but it's a master communicator. Th- the framework is almost a secondary job, in my opinion.

   14. SBSteven Bartlett19:46

       The bone

10. 19:47 – 21:52

    How Do Bones Release Substances Into the Body?

    1. SBSteven Bartlett19:47

       is releasing stuff.

    2. VWDr Vonda Wright19:48

       Mm-hmm.

    3. SBSteven Bartlett19:49

       Y- I got this, um, this little analogy I'm gonna put on the table.

    4. VWDr Vonda Wright19:55

       Yeah.

    5. SBSteven Bartlett19:55

       In one of the, one of the tubs, I've got some minerals, some ... And then this is the body.

    6. VWDr Vonda Wright20:01

       Yeah.

    7. SBSteven Bartlett20:01

       So, could you explain to me how the, the bone is releasing something into the body?

    8. VWDr Vonda Wright20:07

       So, we've talked about the bone being structural, right? It holds you up. It gives you your stature. We've talked about bone being a master communicator. Another job of the bone is as your body's storehouse. Two really, really important, maybe if we just talk about one of them, calcium. Calcium is, is a critical mineral in our body. We need it for, uh, muscle contraction, for pushing, um, molecules across cell membranes. But we've gotta store it somewhere. So, when we eat food, our body pull, our intestines pull it out of the food we eat and stores it in our bones. And so our body is always sensing, how much calcium, how much phosphorus do we have? What do we need? When our body senses that we need more, it goes to the bone. It tickles the osteoclast and say, "Osteoclast, we need some more calcium." The osteoclast breaks down some bone, releases calcium, and it goes into the body for use.

    9. SBSteven Bartlett21:10

       Okay.

    10. VWDr Vonda Wright21:10

        And then the body has enough to use. The body does not just keep piling it in, because hypercalcemia causes heart arrhythmias. It's bad, right? The body is perfectly in homeostasis, in balance. So, when the bone has released enough, it sits back and keeps storing it, right? The calcium your body doesn't need, if the bone is full, it's excreted through the kidneys. And this is a really fine balance between building bone, releasing the storehouse of minerals into the bloodstream, or saying, "Oh, we've got enough. Let's send it out in our urine." The body is such a miracle like that.

    11. SBSteven Bartlett21:51

        So,

11. 21:52 – 25:39

    What's Making Your Bones Fragile?

    1. SBSteven Bartlett21:52

       if I don't have enough calcium-

    2. VWDr Vonda Wright21:53

       Mm-hmm.

    3. SBSteven Bartlett21:53

       ... or some of these other minerals, does that mean that my bones are gonna become fragile?

    4. VWDr Vonda Wright21:59

       So, you know, there are lots of things that go into bone fragility or osteopenia, and one of them is not laying down enough bone in our youth. If we t- You asked me earlier about changes across a lifespan. When it comes to bone, what's interesting is that I get very, very young women in my clinic, four- 25, 28, whom, for various reasons, I do a bone density test on, and they are already have brittle bone. I know. It's abs- It's, it's shocking. Well, I think that happens for a number of reasons. Number one, we didn't build enough bone. There is still a myth in this country that women have to be teeny tiny, that we have to starve ourselves. And when that happens, many women do not have consistent menstrual cycles and estrogen, which then helps us lay down bone. So, that's number one. We don't, we-

    5. SBSteven Bartlett22:51

       Oh, estrogen plays a role in laying down bone?

    6. VWDr Vonda Wright22:53

       In ... Yes, it does. Critical role. So, we're not laying down enough. Or maybe we're athletes. We're in ... We ... Title IX, which is the law that, um, equalized sport for women in college, is 53 years old. So, maybe young women are not laying down enough bone because they're expending so much energy, 10,000 calories a day, and then they're not refeeding in the way, so they're always living in a state of energy deficit and not laying down enough bone. Or maybe young women are coming to my office with not enough bone because we're raising an entire generation of sedentary children who are sitting around in their basements, um, uh, playing games, building brains, but not building bodies. That is borne out by looking out of the University of Wisconsin, orthopedic researchers there studied which women's sports build the best bone, and it's gymnastics. It is the pounding and the feeding of those athletes that builds the best bone. So, we have trouble with not enough brittle bones in adolescence because we're not building it. The second place in the lifespan that we may become low in bone density ... And hear me, people, I am not saying not to breastfeed. I mean, I, in my children, I, my child, I breastfed for a year. It's really great for babies. But...A woman breastfeeding will lose 20% of her bone density in the first six months of breastfeeding, and if she's not really careful to get 500 milligrams of calcium a day in her food or through supplementation, she will not build it back. And then if you have children in ear- in succession, because many women are waiting until 30s to have their first child and then have less time, we may never build back bone. So, that's another key point that people don't realize could be dangerous to the bones. And then finally, yes, is this period about around perimenopause, starting around 45 when estrogen levels become very chaotic and then ultimately zero, that can cause the rapid decline in bone density and bone weakness that you're actually asking me about, and that's because estrogen is critical for controlling the absorption, this part, the absorption of bone, and without estrogen controlling the absorption, it just keeps breaking down bone faster than the osteoblast, the building cells, can build it. So, there's an un- an unbalance, a dysregulation.

12. 25:39 – 26:42

    Importance of Impact Sports for Bone Health

    1. VWDr Vonda Wright25:39

    2. SBSteven Bartlett25:39

       So, I wanna go into all of that, st- starting with the point you made about, um, having, doing impact sports when we're younger.

    3. VWDr Vonda Wright25:45

       Yeah.

    4. SBSteven Bartlett25:45

       'Cause I ... People often say if you do impact sports when you're younger, especially some of them, there's other consequences like injury or-

    5. VWDr Vonda Wright25:52

       Mm-hmm.

    6. SBSteven Bartlett25:52

       ... hitting your head, so you're saying that we should be running or jumping when we're younger to build our, our bone strength?

    7. VWDr Vonda Wright25:59

       Absolutely. To build everything. Oh, it's ... You know, we, we, um, make mitochondria, most the energy of our cells, we make a lot of mitochondria in our youth. If we're not active in our youth, we don't have the anabolic stimulus as much to make as much mitochondria. If we are sedentary children, we will make bone but we will not build bone to the extent we do if we're bashing it every day, and I, and I think the data out of Wisconsin is a good illustration of that.

    8. SBSteven Bartlett26:28

       And is that in all seasons of life? If I'm 60 years old, should I still be bashing that bone playing basketball?

    9. VWDr Vonda Wright26:33

       Absolutely. A- and that's what my study from the National Senior Game shows, that by impacting your bones across your lifespan, you can change your bone density.

13. 26:42 – 27:47

    How to Care for Bone Health During Pregnancy and Breastfeeding

    1. VWDr Vonda Wright26:42

    2. SBSteven Bartlett26:42

       So, on that point of pregnancy which was your second point there-

    3. VWDr Vonda Wright26:46

       Mm-hmm.

    4. SBSteven Bartlett26:46

       ... during my pregnancy, after my pregnancy, what do I need to be doing? Is it drinking milk?

    5. VWDr Vonda Wright26:50

       Yeah. So, if ... And this is, the data I gave you was specifically for breastfeeding.

    6. SBSteven Bartlett26:55

       Okay.

    7. VWDr Vonda Wright26:55

       So, for breastfeeding mothers, uh, you will lose about 500 milligrams of calcium a day as you're making milk for your child. You must replace that. I like people to replace their calcium with whole food, right, with prunes and dates and, and high calcium, um, dairy, if you will. If you simply cannot do that, okay, take a supplement, but if you forget to do that ... I mean, I get it. I was a young mother. I'm exhausted. I wasn't a young mother. I was a 40-year-old mother, exhausted. You have to be so mindful as your, the baby's latching on t- to eat some calcium. Eat your yogurt, eat your calcium chew from Whole Foods, if you will, so that you rebuild your bone, which you're completely capable of doing. Studies show you will rebuild your bone, but not if you're o- not aware, not if you're in the "I've got to lose the baby fat" starving phase.

14. 27:47 – 29:20

    What Is the Bone-Brain Axis?

    1. VWDr Vonda Wright27:47

       Let's not do that.

    2. SBSteven Bartlett27:49

       You talked, uh, about how bone has an impact on various parts of the body, and I've heard you talk about this phrase, the bone-brain axis.

    3. VWDr Vonda Wright27:56

       Yeah.

    4. SBSteven Bartlett27:57

       What is the bone-brain axis?

    5. VWDr Vonda Wright27:59

       Well, if we just talk about, um ... Just choose one of the, the proteins that bone makes, osteocalcin. So, as that's released into the bloodstream, one of the places it goes is int- it t- through, into the brain, and it can cause ... It can aid in the neuroprotective effects. So, what does that mean? Under normal metabolism, we, um, develop free radicals through d- due to normal metabolism cell work. Um, we develop oxidative stress, and osteocalcin works to decrease that oxidative damage, to repair cells in the brain, so that's number one. Number two, it stimulates the release of something called brain-derived neurotrophic protein, BDNF factor, which stimulates the growth of neurons in a part of the brain called the hippocampus, which is involved in memory. And here's, here's the opposite side of it. We know in people that have low bone density, they also have higher brain cognitive dysfunction with age and vice versa. There's an association in the literature with osteoporosis and cognitive decline and vice versa.

15. 29:20 – 34:04

    What Is the Critical Decade for Bone Health?

    1. SBSteven Bartlett29:20

       I heard you in a, the, the Business Insider interview do describe there being a critical decade-

    2. VWDr Vonda Wright29:25

       Yes.

    3. SBSteven Bartlett29:25

       ... for bone health.

    4. VWDr Vonda Wright29:28

       Mm-hmm.

    5. SBSteven Bartlett29:28

       What is the critical decade?

    6. VWDr Vonda Wright29:29

       I think the critical decade for most of our health, Stephen, is no later than 35 to 45 for men and women. That's because, um, we know for women, that's when estrogen starts to decline or become chaotic. So, when we're in our 30s to 40s, that is the time to get all of our health habits together. It's time to get a physical to see what your baseline labs are. I think it would be critical for men and women, particularly men, to get a baseline testosterone so that in the future when we're thinking about supplementing testosterone, we're supplementing back to your particular level.

    7. SBSteven Bartlett30:07

       Mm-hmm.

    8. VWDr Vonda Wright30:07

       Because in the future, let's say when you're 50, a man's testosterone could be 600, which falls within the normal range, but if he's still feeling low energy, not himself, a lot of tendon and ligamentous injuries, well, his young testosterone might have been 800 or 1,000.So I like people to get baseline labs, if they've never been to the doctor before, uh, around 35, all things, so that we know what we're returning you to, number one. Number two, if you have been so busy with your career and stepped away from any semblance of mobility and resistance training, now is the time. Because had I known then what I know now, when I was 40, I was training for triathlons. I was an aerobic athlete, right? I ran, I biked. But what I would have done then if... with what I know now is I would've been lifting a lot of weight to build maximum muscle while I still had the most hormones to start at a better place. 'Cause you can build muscle, but it's better to start from a higher average. So get some labs, make a relationship with the doctor, get all your preventive screening. Do not, uh, blow that off. Um, develop the habits that are going to carry you through a lifetime, whether it's smart anti-inflammatory nutrition, whether it's be- getting into a resistance training program, building up your cardiac machine. I saw that you were running a lot now, and we want the highest possible VO2 max that we can as we enter into midlife, because we never want, as we age, to cross something called the fragility line. So VO2 max is the measure of h- It's the ultimate measure of fitness, how much oxygen you are capable of pulling out of the air and diffusing across your lungs into your blood. World-class athletes. I was just at the US, uh, Olympic Center in Park City, Utah. Those athletes have a VO2 max of 75, 80, sometimes 90, right? Mere mortals are considered excellent when they have a VO2 max f- uh, of around 50, for women, fif- around 50. So you can build VO2 max, and should, in the critical decade, because once we hit midlife, we will decline 10% a decade if we don't consistently build it up. So what does that look like? So if I started at 50, 50 years old... My last VO2 max was when I was at fif- when I was 50, and it was 50. It was pretty good 'cause I was an endurance person, right? Just in whole numbers, by the time I turn 60, it's gonna be 45. 70, 40. 80, 35. I never, ever, ever want to hit 18 if I'm a man or 16 if I'm a woman, because that is the level of VO2 max when we can't get up from a chair by ourselves, we c- when we can't walk across the room, 'cause that takes cardiac function. And so the higher we get our VO2 max in our youth, the more runway we have, even if we don't continue to build it up.

    9. SBSteven Bartlett33:26

       Yeah, I've got a family member that can't walk upstairs without being out of breath. And it's so debilitating, because when you have grandkids-

    10. VWDr Vonda Wright33:33

        Absolutely.

    11. SBSteven Bartlett33:33

        ... and the grandkids start running around-

    12. VWDr Vonda Wright33:34

        Yeah.

    13. SBSteven Bartlett33:34

        ... and you wanna play with them, I- it's so sad watching this particular family member see the grandkids come, the grandkids say, "Let's play," the grandkids run off, and this person can't go after them, so they just have to watch. They literally watch their, their grandkids playing in the garden 'cause they can't play with them.

    14. VWDr Vonda Wright33:50

        Yeah. Yeah.

    15. SBSteven Bartlett33:50

        And I think it's s- such a sad thing. It's one of my big motivators to try and, try and stay healthy, is just to be able to extend my health span-

    16. VWDr Vonda Wright33:57

        That's right.

    17. SBSteven Bartlett33:58

        ... so that I can be healthier, uh, uh, hopefully until the day that I die. That'd be great, but touch wood. I want to talk about

16. 34:04 – 35:31

    What Is Osteoporosis?

    1. SBSteven Bartlett34:04

       running. I want to talk about VO2 max.

    2. VWDr Vonda Wright34:05

       Yes.

    3. SBSteven Bartlett34:06

       To close off on the subject of bones-

    4. VWDr Vonda Wright34:08

       Mm-hmm.

    5. SBSteven Bartlett34:08

       ... there's two terms that I, that I wanted to hit. One is this term osteoporosis.

    6. VWDr Vonda Wright34:13

       Yes.

    7. SBSteven Bartlett34:13

       Now, I have no idea what osteoporosis is.

    8. VWDr Vonda Wright34:15

       Yeah.

    9. SBSteven Bartlett34:15

       I've heard it a couple of times in my life-

    10. VWDr Vonda Wright34:16

        Mm-hmm.

    11. SBSteven Bartlett34:17

        ... but I don't know if it's something I should be thinking about, worried about, um, or what it means.

    12. VWDr Vonda Wright34:21

        Yes. Osteoporosis is the word we use to describe low bone density.

    13. SBSteven Bartlett34:26

        Okay.

    14. VWDr Vonda Wright34:27

        So the way we measure osteoporosis is, uh, using an X-ray called a DEXA scan, a dual X-ray, and it just measures... It compares your bone density to that of a 30-year-old healthy person, and it gives us something called a T-score. So it's, it's like when you're in school and you're graded on a bell curve, and the center of the curve is average, and that's the average for a 30-year-old. When you get a DEXA scan score and it's positive, fantastic. You have bones of a 30-year-old. If you get a T-score on a DEXA scan that's from zero to minus one, it's okay. Minus one is the definition of osteopenia, meaning watch out, your bones are getting weak. The definition of osteoporosis is minus... A T-score of minus 2.5 increases your risk of fracture by 40% or more. All the bad statistics that I talk to you about come with osteoporosis.

17. 35:31 – 36:48

    How Many Americans Over 50 Have Osteopenia?

    1. VWDr Vonda Wright35:31

    2. SBSteven Bartlett35:31

       And how many people have osteopenia, osteoporosis-

    3. VWDr Vonda Wright35:34

       Yeah.

    4. SBSteven Bartlett35:34

       ... age, over the age of 50 in America?

    5. VWDr Vonda Wright35:36

       Well, two million men have osteoporosis, interestingly. Isn't that interesting? You don't think about it as a men's disease. And, uh, one in two women will have an osteoporotic fracture, so at least 50% of women. But it's not inevitable. That's why I'm so interested in, in catching people early in the critical decade. It's not inevitable. But it will be inevitable if we don't catch it. But here's the thing that's bothersome. In the United States and in many other countries, uh, with people I deal with, you cannot get a DEXA scan paid for until you're 65.

    6. SBSteven Bartlett36:10

       Hm.

    7. VWDr Vonda Wright36:10

       By 65, the damage is done. Why are we waiting? Even with people who have had a fracture, there's a gap in follow-up such that they should all have a DEXA scan, because the number one thing that predicts future fracture is past fracture.So public service announcement, if you've had a fracture, get a DEXA scan. Even if it was a traumatic one, like you had been in a car accident. But definitely, if you have fallen, if your dog pulled you down, if it was a low-trauma fracture, get a DEXA scan. Because then at least you'll know where you are and can then plan a course for building

18. 36:48 – 37:44

    Early Warning Signs of Osteoporosis

    1. VWDr Vonda Wright36:48

       your bone.

    2. SBSteven Bartlett36:48

       Are there any early warning signs that I might be suffering from osteoporosis or on my way to osteoporosis?

    3. VWDr Vonda Wright36:55

       You know, I think you can get clues from your own family.

    4. SBSteven Bartlett36:58

       Okay.

    5. VWDr Vonda Wright36:59

       If your mother shrank, if you l- if you used to be able to look your mother in the eye, like me, my mother looked me in the eye 5'4", and now she's way down here, we lose height in both men and women due to a compression of our spine vertebrae, we lose height. So if your dad shrank, if your mother shrank, that's a good indication that you have a family history where osteoporosis can exist. Or if your mother had a hip fracture, or if, for some reason, maybe asthma, you've had to be on, uh, high-dose steroids your whole life, or an autoimmune, th- that's very bad for bones. So from a medical standpoint, from a family history standpoint, from a personal standpoint, usually fracture.

19. 37:44 – 38:28

    Smoking vs. Bone Health

    1. VWDr Vonda Wright37:44

    2. SBSteven Bartlett37:44

       What about if I'm a smoker, does that have an impact on my bone health and chances?

    3. VWDr Vonda Wright37:49

       Yeah, I'm really glad you asked that. Smoking is a poison to bone healing, whether it is fracture, will heal more slowly. In fact, we have a very, a much higher rate of nonunion, which is where we fix a fracture and it still doesn't heal, in smokers. We know that, uh, there is a big body of data within the orthopedic literature for people who have spine surgery who are smokers, they are not only less healing, but they're more infected. So the, the noxious chemicals in smoking are very bad for bone.

    4. SBSteven Bartlett38:19

       Good thing I don't smoke. I- is that smoking, vaping, or is it just-

    5. VWDr Vonda Wright38:23

       It's all. Vaping might be more dangerous, we just don't have as much literature.

    6. SBSteven Bartlett38:27

       Okay.

20. 38:28 – 39:09

    Is There a Link Between Alzheimer's and Bone Health?

    1. SBSteven Bartlett38:28

       And th- uh, the last thing before we talk about running and VO2 max and endurance and sports, all those things, is the link between Alzheimer's and bone health. Is there a link?

    2. VWDr Vonda Wright38:39

       That goes back to what we were talking about before, and there's a correlation. We, I don't believe we've worked out the causation-

    3. SBSteven Bartlett38:48

       Yeah.

    4. VWDr Vonda Wright38:48

       ... but there's a correlation. We see people with Alzheimer's and people with, uh, dangerous osteoporosis are sometimes the same group, 30% of the time. People with brain disease also have osteoporosis. And it may do, be due to this, uh, connection that we've talked about, uh, between the two organ systems.

21. 39:09 – 40:57

    Alzheimer's Disease in Vonda's Family

    1. VWDr Vonda Wright39:09

    2. SBSteven Bartlett39:09

       You had an aunt that passed away from Alzheimer's.

    3. VWDr Vonda Wright39:12

       I do, my Aunt Ida. She was brilliant, she was a teacher, and she stopped remembering, she didn't remember herself, she didn't remember the farm that we a- were all raised on. That's a really hard thing to witness. Um, sometimes people with Alzheimer's lose the inhibition and they become angry and enraged and afraid. She never did that. But, um, but that's a hard thing to witness.

    4. SBSteven Bartlett39:37

       How, how did that experience change you or change your focus or add to the sort of w- reservoir of thoughts, concerns, reference points in your life?

    5. VWDr Vonda Wright39:48

       Well, you know what it has done, it has put an urgency, and even, it still is a day-to-day battle. I don't want... I think sometimes think, people think for me personally, that because I talk about these things all the time and I do lift heavy and I do the thing, I live the life I prescribe for people, that it's easy, and it's not easy. You know, I just, I told you I had finished this book I was writing, and there was a big gap in the consistency of this lifestyle. But what motivates me to get back is the question of, what would it be like to live without a brain that's preserved? I mean, I don't know, sometimes I think about if I was aging and I had to choose one, would I choose an able body or an able brain? Isn't that hard? I don't know that you do have to choose, but I can't fathom what life would be like without an able brain. And so for me, that motivates me to lift, to make my skeletal muscles secrete the, uh, proteins that go to the brain and build better brain, to eat the foods that are not gonna clog my arteries. It's just as a motivator, because I wanna be this way until I die.

22. 40:57 – 41:52

    Would Vonda Choose an Able Body or an Able Brain?

    1. VWDr Vonda Wright40:57

    2. SBSteven Bartlett40:57

       Mm-hmm. What would you choose if you had to, an able body or an able brain? Uh, I, mine, it was super clear for me, I'd rather have the able brain, personally.

    3. VWDr Vonda Wright41:05

       Me too. Me too. I would rather-

    4. SBSteven Bartlett41:07

       'Cause that's your relationships.

    5. VWDr Vonda Wright41:08

       That is, that is the fullness of life.

    6. SBSteven Bartlett41:11

       And so you protect your brain

    7. NANarrator41:12

       (techno music)

    8. SBSteven Bartlett41:13

       ... but these things are also fundamentally interconnected, aren't they? That's why when I look at the Alzheimer's stats around bone health, I think, well, if you were, had osteoporosis or something-

    9. VWDr Vonda Wright41:20

       Yeah.

    10. SBSteven Bartlett41:20

        ... and you weren't moving as much, maybe-

    11. VWDr Vonda Wright41:22

        Yeah.

    12. SBSteven Bartlett41:23

        ... maybe th-

    13. VWDr Vonda Wright41:23

        You know what a huge motivator for my patients is, now that you've brought this up, is Alzheimer's disease is thought of as the third phase of diabetes, right? And so everybody is aware of diabetes, and it means you don't process sugar and you have glucose intolerance and your pancreas is no longer functioning and, and the bad sequela that can come with that. What people are not aware of as much, at least as of people who come to my clinic,

23. 41:52 – 46:12

    Prediabetes

    1. VWDr Vonda Wright41:52

       is prediabetes. And if you don't mind me diverging a little bit, 'cause it's so important to this question you just asked me, and can we prevent it, and, and h- if we got to choose, what would we choose? But I have people coming into my office all the time and I look at their labs, and they have a fasting glucose, they've had their labs drawn, they've done what we said, get in front of your critical decade, they've had their fasting glucose drawn, and it's 110.

    2. SBSteven Bartlett42:17

       Which is?

    3. VWDr Vonda Wright42:18

       I'm gonna tell you.

    4. SBSteven Bartlett42:18

       Okay.

    5. VWDr Vonda Wright42:18

       And, and their hemoglobin A1C is nearing 6. So fasting glucose is the glucose that remains in your blood after you haven't eaten for 12 hours. In a normally functioning pancreas metabolic system, we want our fasting glucose to be around 85.... right? That's normal. Means we eat something, insulin comes out of our pancreas, the sugar is put into our muscle, and then the blood sugar is around 85. If it's staying up 110 consistently, we know from the literature that you have a 70 to 100% chance of developing full-blown diabetes within 10 years. But what I see in people coming into my office is I'll say, "Did anybody ever tell you you were pre-diabetic?" And either the answer is no, or the answer is, "Oh, yeah. Somebody told me. They said, 'Just make a few, you know, focus more on your exercise and...'" And what I think the reaction to pre- the diagnosis of pre-diabetes should be is running and screaming to get healthy. Because if we know that with a consistent blood sugar in the pre-diabetic range, and we're casually told by our healthcare provider, "Oh, just go try to exercise more. You know, just casually approach this. Eat- don't eat so many carbs," that is not serious enough because we know from a preventive standpoint, from a precision longevity standpoint, which is all about prevention, we can prevent you from getting to diabetes in the next 10 years if we're really, really serious about lifting weights, about cardio health, about anti-inflammatory nutrition, following. So I don't view pre-diabe- betes as a casual thing at all, because if in a h- 10 years, you're gonna get diabetes, and in 10 more years, you're gonna have Alzheimer's disease, and I could have prevented that by paying attention when I was 40, it's almost inexcusable that we're not paying more attention to it. 96 million people in the United States have pre-diabetes.

    6. SBSteven Bartlett44:27

       96 million?

    7. VWDr Vonda Wright44:28

       96 million, according to the American Diabetes Association. I just gave a talk at their annual convention. 96 million have a preventable characteristic that we can prevent them b- from becoming diabetic and getting Alzheimer's disease, and yet it is too casually spoken of.

    8. SBSteven Bartlett44:47

       That's like one- almost one in three. That means that there's three of us in this room, so Jack's got pre- pre-diabetes.

    9. VWDr Vonda Wright44:53

       Perhaps.

    10. SBSteven Bartlett44:54

        Potentially. You were an end- you were an, uh, an endurance athlete, weren't you, Su?

    11. VWDr Vonda Wright44:58

        I was an endurance athlete, and I'm- I've been... I don't have it today, it ran out, but I'm a little obsessed with continuous glucose monitoring.

    12. SBSteven Bartlett45:04

        Same.

    13. VWDr Vonda Wright45:05

        So I've been wearing it for about 18 months. And, and, uh, it's so interesting. I told you that, you know, I just finished this book, and I've gotten a little bit off my regular intensity, and it changes my blood sugar. So I run a little h- high... Because I haven't been lifting four times a week-

    14. SBSteven Bartlett45:23

        Oh.

    15. VWDr Vonda Wright45:23

        ... only twice a week, because I haven't been sprinting twice a week, like I norm- my normal regimen is I lift heavy four times a week. I, on the other days, I do about four days of base training, zone two. Two of those days, I sprint. I always eat a lot of protein. That is my lifestyle. And my blood sugar is 85 when I do that, and I'm a midlife woman, and you know, the metabolic things that happen to midlife women. Even backing off a little bit starts to creep up my blood sugar. So this is a constant daily habitual lifestyle that we all need to lead. And so when I see that in someone as healthy as me, when my patients show up, and they've casually been told that they have something that's gonna kill them, I don't think that's enough attention.

24. 46:12 – 48:11

    Diet for Good Cognitive Performance

    1. VWDr Vonda Wright46:12

    2. SBSteven Bartlett46:12

       That's what I've been thinking a lot about recently, is what diet is gonna lead me to better cognitive performance as someone that spends a lot of my time talking-

    3. VWDr Vonda Wright46:19

       Yes.

    4. SBSteven Bartlett46:19

       But then also, I'm on stage, I'm in boardrooms-

    5. VWDr Vonda Wright46:21

       Yes.

    6. SBSteven Bartlett46:21

       ... I'm in meetings, I'm in negotiations, I'm reading emails, I'm writing books-

    7. VWDr Vonda Wright46:24

       Yeah.

    8. SBSteven Bartlett46:24

       ... et cetera. So I'm always thinking, "If I can just get a 5% edge."

    9. VWDr Vonda Wright46:28

       Well, I can tell you, for instance, the, the dieticians and chefs that make the food for the pro athletes that I've taken care of across my life, they're not only eating meat. They have a very well-balanced diet that includes lots of vegetables, lots of high protein. They, they take amino acid supplements if they need to fill in the gaps, right, if they're not getting enough leucine or something. But they just don't go down one, one pathway. I haven't seen that in the pros that I take care of.

    10. SBSteven Bartlett46:59

        Keto has given me a very sharp mind.

    11. VWDr Vonda Wright47:00

        Has it?

    12. SBSteven Bartlett47:01

        An extremely sharp mind.

    13. VWDr Vonda Wright47:02

        Mm-hmm.

    14. SBSteven Bartlett47:03

        It's so interesting as a podcast when you sit here and you have all these conversations.

    15. VWDr Vonda Wright47:06

        Mm-hmm.

    16. SBSteven Bartlett47:06

        Because some days you show up and s- sometimes these conversations last for four hours. And your brain and mouth just d- don't feel like they're connected.

    17. VWDr Vonda Wright47:13

        Yeah.

    18. SBSteven Bartlett47:13

        And then on other days, I come here-

    19. VWDr Vonda Wright47:15

        You're like boom, boom.

    20. SBSteven Bartlett47:15

        ... and it's au- au- automatic.

    21. VWDr Vonda Wright47:17

        Yeah.

    22. SBSteven Bartlett47:17

        It's like I don't have to think and it's just flowing off, off my mouth. And the variance, the big... The f- I said, so the causal factors are obviously sleep is one of them.

    23. VWDr Vonda Wright47:25

        Yeah. Mm-hmm.

    24. SBSteven Bartlett47:25

        The other one is how many carbohydrates I've had in recent-

    25. VWDr Vonda Wright47:29

        Yes.

    26. SBSteven Bartlett47:30

        ... hours.

    27. VWDr Vonda Wright47:30

        Mm-hmm.

    28. SBSteven Bartlett47:31

        So if I've had a lot of carbohy- hydrates-

    29. VWDr Vonda Wright47:34

        Mm-hmm.

    30. SBSteven Bartlett47:34

        ... something, you know, like, I've had bread.
25. 48:11 – 49:22

    The Perfect Diet for Vonda

    1. VWDr Vonda Wright48:11

    2. SBSteven Bartlett48:11

       And what do you eat?

    3. VWDr Vonda Wright48:13

       I eat 130 grams of protein a day. There's no upper limit on how much protein you can eat in a single setting. I try to get at least 30 'cause there is a lower thresholds for 30. And so if I do that, uh, it takes three meals and a couple snacks a day. I... That's a lot of volume of food, so I try to eat really dense, so, uh, a cup of Greek yogurt is like 18 grams, and a really pure b- beef stick is another 16. So at this time I've, at this point, I've memorized...... the most dense foods that I can to get that much protein.

    4. SBSteven Bartlett48:46

       That's a lot of protein.

    5. VWDr Vonda Wright48:47

       It's a gram per pound. It's a gram per pound, and that's what I need to build muscle. Studies have shown that, uh, eating high protein alone, without lifting as much as I want myself and others to do, will help maintain muscle. And then, I eat a lot of vegetables. I don't... Now, I hope people are not gonna throw them at me, but I don't eat fruit except blueberries. Fruit is nature's dessert. So, if we're gonna eat fruit, eat it as dessert. I eat, I eat blueberries with my yogurt. But, um, and then carbs, I only eat complex carbs if I eat them at

26. 49:22 – 50:28

    Ads

    1. VWDr Vonda Wright49:22

       all. (page turns)

    2. SBSteven Bartlett49:23

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27. 50:28 – 50:48

    Strong Muscles and Bones as Keys to Longevity

    1. SBSteven Bartlett50:28

       something that you continually come back to as the most important thing for people's longevity?

    2. VWDr Vonda Wright50:34

       I think I would put muscle and bone near the same category, because you can have all the muscle you want, but if you break your hip, you still have the downstream effects. Now, you're much liest- less likely to break your hip if you're strong, but I think muscle or bone are really important.

28. 50:48 – 53:28

    You're Never Too Old to Build Strength

    1. VWDr Vonda Wright50:48

    2. SBSteven Bartlett50:48

       What if you're s- 65 years old, 70 years old, and you haven't got-

    3. VWDr Vonda Wright50:54

       Mm-hmm.

    4. SBSteven Bartlett50:55

       ... strong muscles right now. Your muscles have, um, declined, let's say-

    5. VWDr Vonda Wright51:00

       Yes.

    6. SBSteven Bartlett51:00

       ... over the last couple of decades. Is it too late?

    7. VWDr Vonda Wright51:03

       Never.

    8. SBSteven Bartlett51:04

       It's never too late?

    9. VWDr Vonda Wright51:05

       It is never too late. Your body will always rise to the strategic stress you place on it. So, there are a lot of, and growing number, of what used to d- be anomalies all over the internet of people in their 60s, 70s, 80s, and beyond in a gym powerlifting, becoming, uh, competitive bodybuilders. So, even if you're starting not being able to get up out of a chair, over a very short amount of time, six months, a year, you can reverse the trajectory of your frailty. But it takes consistency, right?

    10. SBSteven Bartlett51:38

        I do wonder, though. I think about, I think about my father, and he's approaching his 70s now-

    11. VWDr Vonda Wright51:44

        Mm-hmm.

    12. SBSteven Bartlett51:44

        ... and I don't think he's done weight training for the last 15, 15 years.

    13. VWDr Vonda Wright51:48

        Yeah.

    14. SBSteven Bartlett51:49

        And there is a part of me that did wonder, is it too late now to, to start-

    15. VWDr Vonda Wright51:52

        Yeah.

    16. SBSteven Bartlett51:52

        ... doing weight training? Because it's almost like a, a, a two-sided problem in the fact that you haven't done it-

    17. VWDr Vonda Wright51:59

        Yes.

    18. SBSteven Bartlett51:59

        ... so y- you find it harder, so you don't do it, so you find it harder, and then you sort of spiral down to this sedentary state.

    19. VWDr Vonda Wright52:06

        Well, and you know what you do for that is nobody expects you to start with powerlifting, squats, deadlifts. Nobody expects that. Moving our body through a range of motion, doing body weight, progressing to free weights, progressing to light kettlebells, progressing to bands. Once you see that your body is capable of adapting and progressing, you will get there pretty rapidly. I used to do this program called, uh, START, where I would take people fresh off the couch, and over three months, we would get them to a 5K race, because 5K is a meaningful distance for people who are sedentary. And over that course of three months, we did a series of, um, body weight and kettlebell-type exercises in a circuit, followed by walking. And people started with 51% body fat, not being able to get through the warmup, not being able to hold themself up in a plank, and in three months, they could plank for two minutes, they could walk for three miles. They could keep going for the entire 10-minute circuit without having to stop. So, there is never an age or skill level when our body will not respond to the strategic stress you put on it. So, uh, get a trainer for your dad.

29. 53:28 – 55:26

    Workout Strategies for Building Muscle

    1. VWDr Vonda Wright53:28

    2. SBSteven Bartlett53:28

       If he'd accept it.

    3. VWDr Vonda Wright53:29

       If he would accept it, right? (laughs)

    4. SBSteven Bartlett53:29

       I'll call him after this. If I am trying to build muscle, are there a certain amount of days of the week, or repetitions, I need to do to build the muscle? I think about this a lot when I'm out here in LA, and I- I'm t- I'm trying to make sure that I don't lose my muscle, but-

    5. VWDr Vonda Wright53:44

       Yeah.

    6. SBSteven Bartlett53:44

       ... I spend a lot of time sat down in here-

    7. VWDr Vonda Wright53:45

       Mm-hmm.

    8. SBSteven Bartlett53:46

       ... recording podcasts. So, is there a certain amount of times I need to work out that muscle before I lose it?

    9. VWDr Vonda Wright53:52

       You know, I was just reading this morning, actually, that, um, even with a 10-week hiatus from... Let's say you're lifting consistently. Even with a 10-week hiatus, uh, you will retain muscle memory so that you don't make serious declines, which is a relief to me 'cause I'd spent a little while with this book. So, you retain muscle memory, and you can quickly, once you get started again, r- get back up to the place you were. Um, so all is not lost if you take a few days off. But the minimum, if we're really working at it, is a couple days a week, progressively lifting harder. For men in midlife, it's about eight reps, four sets. For women, once we've trained to the place we can lifting heavy, four reps, four sets. And when I say that out loud, I get a lot of comments about, "Somebody's gonna get hurt." Well, it's true.But you have to work your way up to that. Like any sport, you have to work your way towards that level, because what we're trying to do by lifting heavier, especially for women, is replace the anabolic stimulus that estrogen once was. You must work hard enough. Estrogen creates growth. We must signal our body by the intensity of our work to build muscle, and lifting heavy does that. So if you're starting on the couch, uh, start with bands, start with light weights, start with the namby-pamby pink weights that I rail against-

    10. SBSteven Bartlett55:18

        Hmm.

    11. VWDr Vonda Wright55:18

        ... but don't stay there. Continue to work your way up in a progressive way to heavy lifting, total body at least twice a week to maintain.

30. 55:26 – 56:46

    Higher or Lower Weights: What's Best for Building Muscle?

    1. VWDr Vonda Wright55:26

    2. SBSteven Bartlett55:27

       Do I need to increase the weight load to build muscle? 'Cause I wonder when I go to the gym, sometimes, y- you know, I might be using smaller dumbbells-

    3. VWDr Vonda Wright55:35

       Mm-hmm.

    4. SBSteven Bartlett55:35

       ... but I'm doing more repetitions.

    5. VWDr Vonda Wright55:36

       Yeah.

    6. SBSteven Bartlett55:37

       Is that still gonna build muscle?

    7. VWDr Vonda Wright55:38

       Well, it depends what you want. So, so lighter weights, higher reps, is, uh, will, will, uh, function for hypertrophy, for bigger, bigger total muscle, but not necessarily power and strength. In lo- in midlife and beyond, I am lifting for longevity and power, so I'm not as interested as I once was in the bigness of my muscle. I am interested in, can it move powerfully over time? Can I get up off the floor? Can I lift my suitcase above my head? So lifting for power is higher, lower reps, higher weights. So it just depends what our goal is. You may be focused on hypertrophy right now, which is fine, because you have not reached the critical decade.

    8. SBSteven Bartlett56:21

       So if I'm looking for hypertrophy?

    9. VWDr Vonda Wright56:23

       Yeah, higher reps, lower weights.

    10. SBSteven Bartlett56:26

        So 12-

    11. VWDr Vonda Wright56:27

        12, 15, mm-hmm.

    12. SBSteven Bartlett56:29

        ... 15 reps, lower weight. And then if I was looking for power then maybe six, eight?

    13. VWDr Vonda Wright56:32

        Six, eight. That's right.

    14. SBSteven Bartlett56:33

        How many do you do?

    15. VWDr Vonda Wright56:34

        I do four.

    16. SBSteven Bartlett56:35

        You do four?

    17. VWDr Vonda Wright56:35

        Mm-hmm.

    18. SBSteven Bartlett56:36

        So big weight, four?

    19. VWDr Vonda Wright56:37

        Big weights, four reps, four sets.

    20. SBSteven Bartlett56:41

        Interesting, I didn't know that.

    21. VWDr Vonda Wright56:42

        Mm-hmm.

    22. SBSteven Bartlett56:43

        Interesting. And,

31. 56:46 – 59:50

    Why Is Muscle Critical for Longevity?

    1. SBSteven Bartlett56:46

       uh, just to give some sort of foundational knowledge as to why muscle is so important, because some people still might not, um, be aware of the link between longevity and-

    2. VWDr Vonda Wright56:53

       Mm-hmm.

    3. SBSteven Bartlett56:54

       ... muscle. A lot of this is to do with, from what I understand, glucose?

    4. VWDr Vonda Wright57:00

       So it has to do with muscle is the sink for glucose. Uh, it is a key factor in preventing insulin resistance, not to mention strength, staying upright, not falling down, causing a fracture, right? So, muscle is a metabolic endocrine organ. It releases, when it releases, um, you know, one of the things it releases is skeletal muscle contraction, biceps curls, causes the transcription of a protein called klotho, which is the longevity protein. About 30 years ago, it was described in Nature. It is the protein when muscle contracts that's transcribed. It works on every organ. We know that it's critical for the longevity and repair of organs because mice, who are born without the ability to make klotho, die old very young. Chronologically, they're very young mice, but they die very old mice, because they have not enjoyed this protein, klotho. We make klotho by the contraction of skeletal muscle. Here's a study I did, uh, years ago that showed that I measured klotho level circulating in the blood of older masters athletes, people 60, 70, 80, younger masters athletes, 40, and sedentary people. And what I found, that the highest levels of circulating klotho, the longevity pro- protein, were in young athletes, not surprising. The second-highest level of longevity protein, klotho, were in old masters athletes, 70, 80. The lowest level of longevity protein were in young sedentary people. So even old athletes had more circulating klotho than young sedentary people. So just the contraction of skeletal muscle can add to your longevity through this protein. Another protein that's released with skeletal muscle contraction called galanin, i- it is transcribed, goes to the brain, works at a place called the nucleus coeruleus, which is critical for resilience. It makes you more resilient. It helps you able to problem solve. And then, you know, a very popular, uh, protein that is transcribed with skeletal muscle contraction is called irisin. It's the exercise protein, which, you know, it works on bone, it works on fat, to brown fat, from white fat to brown fat, which is, has higher thermogenesis. It has higher mitochondrial load. It... So muscle, just in doing its thing, not just looking pretty in a gym mirror-

    5. SBSteven Bartlett59:43

       Mm-hmm.

    6. VWDr Vonda Wright59:43

       ... does all these metabolic functions. And so, that's why we think it has such a key role in longevity.

32. 59:50 – 1:03:06

    Nutrients for Muscle Preservation

    1. VWDr Vonda Wright59:50

    2. SBSteven Bartlett59:50

       So if I'm trying to pro- protect my muscle as I age, are there any supplements that I should be taking?

    3. VWDr Vonda Wright59:56

       Mm-hmm.

    4. SBSteven Bartlett59:56

       I mean, do they sell klotho supple- supplements

    5. NANarrator59:59

       I'd like to know about.

    6. VWDr Vonda Wright59:59

       They don't. You have to make it.

    7. SBSteven Bartlett1:00:00

       Oh, fuck.

    8. VWDr Vonda Wright1:00:00

       (laughs) Contract your own muscles. Well, uh, you need to feed your muscles. I always quote people, "One gram per ideal pound," 'cause listen, I, I, I'm an actual practicing person, doctor, and here's what I know. People need really specific instructions and they can't be confusing. So, is there a range of protein people need? Yes, there is. But people can remember one gram per ideal pound. So you got to feed your muscle with protein. High quality protein. The highest quality protein has the greatest percentage of an, an essential amino acid called leucine. Leucine is not made by the body. It has to be taken in from the outside. It's a branched-chain amino acid, and you get it from whey protein.... the best source in the universe of leucine and whey protein is mother's milk, but most of us don't drink that as adults, so we get it from dairy products. You can get it from plants, for everybody that is a plant lover, you just have a much lower percentage. You have to eat a lot more of it. So high-quality protein, number one. Number two, there's a lot of research, uh, for, uh, creatine supplementation for both men and women. When I first started being aware of creatine in 1992, it was during the Olympics, I was working with a bunch of wrestlers at that time, um, we would give very, very high doses. We would cycle the creatine, we would come on and off. Now, steadily five, uh, grams a day will help build muscle, it'll help build brain.

    9. SBSteven Bartlett1:01:31

       It's really interesting, a couple of, uh, months ago, I asked the people in my office-

    10. VWDr Vonda Wright1:01:37

        Yeah.

    11. SBSteven Bartlett1:01:37

        ... if they used creatine.

    12. VWDr Vonda Wright1:01:38

        Yeah.

    13. SBSteven Bartlett1:01:38

        And a couple of the guys put their hands up. None of the women put their hands up.

    14. VWDr Vonda Wright1:01:42

        Huh.

    15. SBSteven Bartlett1:01:43

        And I asked them why, I said, "Why don't you use creatine?" They said that they thought it was for bodybuilders.

    16. VWDr Vonda Wright1:01:48

        Well, it started out for bodybuilders, but it's for everyone actually. It's very well studied, so.

    17. SBSteven Bartlett1:01:55

        I actually had this, um, debate with my girlfriend last year at Christmastime, um, because I was taking creatine and asked if she wanted some, and she made the same comment to me that it was for bodybuilders-

    18. VWDr Vonda Wright1:02:03

        Yeah.

    19. SBSteven Bartlett1:02:03

        ... and that she'd put on weight if she had it. And then I said, "No, that's not true." So she Googled it-

    20. VWDr Vonda Wright1:02:07

        Mm-hmm.

    21. SBSteven Bartlett1:02:07

        ... and she saw that it's good for, like, cognitive performance-

    22. VWDr Vonda Wright1:02:09

        Yes.

    23. SBSteven Bartlett1:02:09

        ... skin, hair, muscle, bone-

    24. VWDr Vonda Wright1:02:12

        Mm-hmm.

    25. SBSteven Bartlett1:02:12

        ... et cetera, et cetera, and now she takes it every day.

    26. VWDr Vonda Wright1:02:14

        Perfect.

    27. SBSteven Bartlett1:02:15

        I think there's a big, um, reeducation piece to be done there, because we used to-

    28. VWDr Vonda Wright1:02:18

        There is.

    29. SBSteven Bartlett1:02:18

        We almost used to think of it, like, uh, a steroid or something.

    30. VWDr Vonda Wright1:02:22

        And it's not at all.
33. 1:03:06 – 1:03:57

    How to Find Motivation to Take Responsibility for Your Health

    1. VWDr Vonda Wright1:03:06

    2. SBSteven Bartlett1:03:06

       Motivation.

    3. VWDr Vonda Wright1:03:06

       Mm-hmm.

    4. SBSteven Bartlett1:03:07

       How do you solve that?

    5. VWDr Vonda Wright1:03:09

       Sometimes, sometimes we solve it by scares, right? 'Cause you know, someone has a tremendous health problem. But sometimes that's not even enough. I have found that it is never going to be motivating enough to try to say, "Okay, if you do this today, in 20 years, you're gonna be much better." There's this temporal disconnect. People just don't get it, what they're gonna be like at 70. I think we have to make you feel good every single day. It's like when we were talking about your brain when you're doing heavy work and cognitive work, if you can feel better every single day, you'll continue the behavior, not for a promise. So I think that is the, that is the way to talk to anybody. It's the way I talk to my patients, "Can I make you feel better tomorrow? Can I make you feel like a badass 'cause you lifted heavy weights today?"

    6. SBSteven Bartlett1:03:56

       Mm-hmm.

34. 1:03:57 – 1:04:28

    Vitamin D: Crucial for Bone Health

    1. VWDr Vonda Wright1:03:57

       Um...

    2. SBSteven Bartlett1:03:57

       It's hard though with things like bone, you're telling someone that they need to be getting-

    3. VWDr Vonda Wright1:04:01

       Yeah.

    4. SBSteven Bartlett1:04:01

       ... I don't know, like their calcium and stuff like that.

    5. VWDr Vonda Wright1:04:03

       Mm-hmm.

    6. SBSteven Bartlett1:04:03

       They think, "Well, I can't see my bones," and osteoporosis is so far away that...

    7. VWDr Vonda Wright1:04:07

       Yeah. It's hard until you see someone fracture or you fracture yourself. I agree with you.

    8. SBSteven Bartlett1:04:12

       Um, vitamin D as well is crucial, isn't it, for bone health? I was reading that there.

    9. VWDr Vonda Wright1:04:15

       It is, it is.

    10. SBSteven Bartlett1:04:16

        Magnesium?

    11. VWDr Vonda Wright1:04:17

        Vitamin D, magnesium, uh, lesser known things, strontium, zinc, boron, and micronutrients. But big things, vitamin D,

35. 1:04:28 – 1:11:45

    How to Prevent Injury While Running

    1. VWDr Vonda Wright1:04:28

       magnesium.

    2. SBSteven Bartlett1:04:29

       Sleep.

    3. VWDr Vonda Wright1:04:30

       Sleep.

    4. SBSteven Bartlett1:04:30

       We talked about that a little bit as well-

    5. VWDr Vonda Wright1:04:31

       Yeah.

    6. SBSteven Bartlett1:04:32

       ... how important that was. Um, you mentioned I'm running now.

    7. VWDr Vonda Wright1:04:35

       Yes, you are.

    8. SBSteven Bartlett1:04:36

       Thank you for noticing.

    9. VWDr Vonda Wright1:04:36

       (laughs)

    10. SBSteven Bartlett1:04:37

        I thought you'd never mention it.

    11. VWDr Vonda Wright1:04:38

        And a million others are supposed to join you, I noticed.

    12. SBSteven Bartlett1:04:40

        Yes.

    13. VWDr Vonda Wright1:04:41

        Yeah.

    14. SBSteven Bartlett1:04:41

        We're gonna try and get a million people running, um-

    15. VWDr Vonda Wright1:04:42

        That's great.

    16. SBSteven Bartlett1:04:43

        ... especially people that-

    17. VWDr Vonda Wright1:04:43

        You're gonna save a lot of lives.

    18. SBSteven Bartlett1:04:45

        Oh, thank you. Um, but much of it's because of the work that people like you do and that come on my show and inspire me to think about things like my VO2 max, and I'd definitely been just weight training for the last couple of years-

    19. VWDr Vonda Wright1:04:54

        Mm-hmm.

    20. SBSteven Bartlett1:04:54

        ... and not really thinking about my bones or, uh, my VO2 max, so this has been quite a big shift for me.

    21. VWDr Vonda Wright1:05:00

        Yeah.

    22. SBSteven Bartlett1:05:00

        Um, but when I think about running, I definitely hated it. I still hate it a little bit-

    23. VWDr Vonda Wright1:05:05

        Mm-hmm.

    24. SBSteven Bartlett1:05:05

        ... but I, I hate and love it now, which is progress. What are the things I should be thinking about? 'Cause people talk to me about runner's knees-

    25. VWDr Vonda Wright1:05:14

        Mm-hmm.

    26. SBSteven Bartlett1:05:14

        ... and stuff like that-

    27. VWDr Vonda Wright1:05:15

        Yeah.

    28. SBSteven Bartlett1:05:15

        ... and I don't wanna get injured.

    29. VWDr Vonda Wright1:05:16

        Right.

    30. SBSteven Bartlett1:05:17

        But I'm running quite a lot.
36. 1:11:45 – 1:13:52

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    1. SBSteven Bartlett1:11:45

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37. 1:13:52 – 1:15:44

    Why Should People Avoid Obesity as They Age?

    1. SBSteven Bartlett1:13:52

       (paper rustles) On the subject of obesity and, and weight, we talked last time, really fascinating thing that you said to me which stayed with me is that the more weight we're carrying, the more harm it's doing to our bones in a really disproportionate way. Could you clarify that again? But also talk to me about, give me the case for keeping my body fat down as I age.

    2. VWDr Vonda Wright1:14:13

       So what we were talking about is, uh, joint health.

    3. SBSteven Bartlett1:14:17

       Yeah.

    4. VWDr Vonda Wright1:14:17

       And the fact that every bone, if... In your knee for instance, if your fem... If this is your femur, the end of every bone has a bumper of cartilage. Cartilage is a matrix of collagen fibers that has cells in it, and its entire job is to shock absorb. So the bones don't do so much of this, bones are pretty fragile, but they glide. Cartilage has a, in physics, a coefficient of friction that is less than ice. So it's smoother than ice, it glides, right? If it's perfect. Cartilage is very subject to the forces of weight, such that in our laboratories when we were doing cartilage research and wanted to damage cartilage, all we had to do was drop a marble on it. So it doesn't take much. So if we're carrying around a lot of heavy extra weight, and we don't have the muscles to support that, instead of muscles acting like a shock absorber and protecting our cartilage, we're banging more. Now remember, banging is good for bones, it's not good for cartilage. So we want to make sure that we have a healthy weight so that we're not exerting so much load, because it's seven to nine, we talked about last time, seven to nine times, uh, body weight pressure across the joints. And so that's why we want to compose our body and have a body composition, not a weight, a body composition of m- of m- more muscle than adipose tissue.

38. 1:15:44 – 1:18:32

    Strategies to Promote Motivation

    1. VWDr Vonda Wright1:15:44

    2. SBSteven Bartlett1:15:44

       Yeah, this kind of goes back to s- what we were saying earlier, 'cause you can say these things, but still, change is still far away for many, many people. And I was just wondering, i- in the people that you've seen make radical changes that you've worked with, are there key things that happen? We talked a little bit about someone hits rock bottom, they get a bad diagnosis, they're forced.

    3. VWDr Vonda Wright1:16:02

       Mm-hmm.

    4. SBSteven Bartlett1:16:03

       But is there, is there anything else that one can do to will themselves to change? To, keeping a journal, some kind of exercise?

    5. VWDr Vonda Wright1:16:11

       I think it's really helpful to know as much about yourself as possible. So if I'm intaking someone into a program we're gonna build, I don't... I weigh them, but w- what's most important is I do a body composition so that we can go through step by step and say, "In your current body, you have..." I'm making these numbers up, "32% body fat. You have very little lean muscle. So even though you may be okay with the way you look in a mirror, you're skinny fat, meaning you have too little muscle and too much adipose tissue." And, and we just, and we talk about all the things we've talked about, about why we need to build more muscle. But when you see those numbers, numbers don't lie, nor are they judgments. But an... If you're just looking in the mirror, you may say, "Oh, that's okay," or you may hate the little belly roll, but it's not, you don't hate it enough. But when you see that you have very little muscle mass and a very high percentage of fat, those data alone are sometimes a motivation. And then if we know that we're gonna redo that test in three months or six months and track changes over time, that can be an added motivator, besides tragedy. Data can be a motivator. Wanting to feel like yourself again, in m- in women in midlife, someone sometimes just say, "I just wanna feel like myself again." Well, we're different people after our estrogen goes away, and so it takes a different kind of work to feel like ourselves again. But at the end of the day, s- so tools-wise, I think journals are, are helpful, tracking, uh, keeping a record of how you felt on a day, what you did that day.

    6. SBSteven Bartlett1:17:49

       CGMs and stuff as well, anything that turns the lights on has been really...

    7. VWDr Vonda Wright1:17:52

       That's right. Data. CGMs are, you know, I learned what I was gonna learn at three months, but I've had it on for 18 months just 'cause that data spurs me on. Like, "Oh, I mean, that was a really stressful OR day. My sugar spiked up even though I wasn't eating. I must've been very high cortisol. I'm releasing so much from my liver." It just informs me about the inner workings of my body. But also, c- at the end of the day, you have to love yourself enough, Steven, and I can't make you love yourself. And I can't... A number of harassments in my office cannot make you value yourself enough to invest in yourself daily, and at the end of the day, that's what it's gonna take.

39. 1:18:32 – 1:21:22

    Myths About Menopause

    1. VWDr Vonda Wright1:18:32

    2. SBSteven Bartlett1:18:32

       I've talked quite extensively on this podcast about menopause.

    3. VWDr Vonda Wright1:18:35

       Mm-hmm.

    4. SBSteven Bartlett1:18:36

       It's really fascinating to me, I think in part because I didn't even know what it was.

    5. VWDr Vonda Wright1:18:39

       Yes.

    6. SBSteven Bartlett1:18:40

       Even a couple of years ago, probably a year and a half ago, I had no idea what it was. What are some of the pervasive myths about menopause that people still need to sort of get past?

    7. VWDr Vonda Wright1:18:51

       Despite everyone talking about it, despite you having lots of conversations about it, I still find a lot of people...... who have never heard of perimenopause, which is the decade leading up to the day of menopause, which is 365 days after your last menstrual c- menstrual cycle. On average in this country, it's about 51. People have not heard of perimenopause, they've never heard of hormone replacement therapy, and they don't know what to do about it, and they're ashamed to talk about it, because somehow needing things in this country, if you're a woman, have gone unnoticed. For instance, like, "Oh, I'm just gonna suffer through. My mom never talked about it." So, I think the myth that you have to suffer is a myth, there is more known now than there's ever been about how using lifestyle to feel better. I, uh, always encourage women to make their hormone replacement decision based on science and not fear, and to make it early.

    8. SBSteven Bartlett1:19:55

       How early?

    9. VWDr Vonda Wright1:19:56

       I, I encourage my patients even in the mid-40s to read the books, watch the podcasts, identify a clinician, so when it's time for them to make their decision, they've got everything s- um, lined up. And you can take hormones while you're still menstruating. There's no reason not to. In fact, that's what birth control is. Birth control is, is 10 times the dose of hormone replacement therapy. So, under careful supervision, you can make your decision very early. What I want people to do, uh, is educate themselves. I call it menopause literacy, because we have a very low level of menopause literacy in this country. I want them to make their hormone replacement decision, meaning, "Am I going to go on them? Where am I going to get them? Can I find a clinician to help me?" Number three, I would like them to, as we talked about earlier, build their unbreakable lifestyle. Develop the habits early, not when they're in the throes of menopause and feeling desperate, but early, of lifting weights, of cardio that includes base training and sprint intervals, anti-inflammatory nutrition, early, so that it's just the way you live. So that when you're feeling so bad, you're not trying to learn all these things at once.

40. 1:21:22 – 1:22:40

    Link Between Menopause and Bone Density

    1. VWDr Vonda Wright1:21:22

    2. SBSteven Bartlett1:21:22

       And there is a significant link between menopause and bone density, because you lose some of those critical hormones like testosterone.

    3. VWDr Vonda Wright1:21:31

       Like estrogen and testosterone. So estrogen on bones acts to control the cell that breaks down bones. We talked about, in bone health, there's a cell that breaks down bones called the osteoclast, with a C, and a cell that builds bones with- called an osteoblast. Estrogen helps control the osteoclast. So even in menopause, when there is no estrogen, we're still building bone, but breaking down bone outstrips building bone. So replacing hormones helps rebalance bone breakdown and bone rebuilding. And if we lose our estrogen around the time of this perimenopause, menopause, we can lose 15% of our bone density, and if we don't catch it, because insurance only pays for DEXA scans when we're 65, which is far too late in my opinion, we're behind the eight ball. So I encourage everyone, once they start going through perimenopause, to get a DEXA scan, whether they have to pay for it at their gym, save up their coffee money, it's worth knowing your bone status.

    4. SBSteven Bartlett1:22:39

       What are

41. 1:22:40 – 1:27:49

    The Musculoskeletal Syndrome of Menopause

    1. SBSteven Bartlett1:22:40

       some of the most, um, obvious but pertinent muscular skeletal syndromes of menopause?

    2. VWDr Vonda Wright1:22:47

       I'm glad you asked that. In July, my group and I created a nomenclature called the musculoskeletal syndrome of menopause, because women were showing up in my office saying things without prompting, because I- I'm a doctor who listens. I sit down on a stool, we have a conversation, I do not chart in front of you. So people talk to me, and out of nowhere women would say to me, "Doc, I feel like I'm falling apart. And I don't know what's going on, but I feel like I'm going crazy because I've been told nothing's wrong with me." And I started noticing that more and more as women started coming in with their shoulders not moving, which is an entity called frozen shoulder, and so as I started l- looking at this pattern and reading the very few studies that were done, we've known for 30 years that the incidents of arthritis, inflammatory arthritis in women after 50 is much higher than inflammatory arthritis in men. We've known it for 30 years. And as I started researching, remember how I said earlier that every musculoskeletal tissue is derived out of the same type of stem cell, the mesenchymal stem cell? All of those tissues, muscle, bone, tendon, ligament, fat, muscle-derived stem cells are all sensitive to estrogen, and without it, several things happen. There's something called arthralgia, which is total body pain, meaning your body hurts so much that you can't even get out of bed. That was one of the biggest things I had. I'm an athlete, and I could barely get out of bed because I was so inflamed due to the lack of estrogen. Estrogen is a huge anti-inflammatory agent. So I was totally inflamed, my body hurt. That's called arthralgia. Women come in, and I'm not kidding, they come in and they say, "My arm won't move. Literally it won't move," or, "I can't hook my bra." That is due to the inflammation of losing estrogen. In Asian cultures, it's called the 50-year-old woman shoulder, 'cause it happens to 50-year-old women. It is a sign of the inflammation of losing estrogen.We know about sarcopenia, the loss of lean muscle mass, about 20% when you lose your estrogen. We've talked about loss of bone density. We have increased incidents of tendon and ligament problems, Achilles tendon, tennis elbow, patellar tendon, because the collagen fibers of tendon and ligament have estrogen receptors on them. And so everything starts to work less well without the presence of estrogen. So I saw all of those things, and we gathered the world's data, which isn't a lot, a lot more research needs to be done, and we gave it a nomenclature. We called it and published it as the musculoskeletal syndrome of menopause, 'cause I tell you for sure, Stephen, if someone goes into their doctor's office, which in this country is so restricted in the time that we can spend, and says, "I have this and this and this and this and this," six things in 15 minutes, it is difficult to get through that. But if someone comes with a nomenclature of, "I think I have the musculoskeletal syndrome of menopause. My arm doesn't move, blah, blah, blah," immediately you don't have to go through a differential diagnosis of 600 things. You're like, "Oh," as a doctor. This paper on the musculoskeletal syndrome of menopause has currently been downloaded almost 300,000 times. And to put that in context, some of the biggest journals in the world, medical journals in the world, documented, they did a, a survey of how many times their best articles had been downloaded. The best scientific journals, their articles are downloaded about 10,000 times. This musculoskeletal syndrome of menopause has been downloaded nearly 300,000, and it's not because... Yes, it's a good paper. The need is so great, Stephen, to communicate what the heck is going on with people, that I made it open access, meaning you don't have to pay to get this article, and I encourage people to google it, it'll come up number one, to print it, to read it, to give it to your doctors, so that they can understand that you're highly inflamed, that's why your total body hurts. That your shoulder doesn't move because you're inflamed, that your knee hurts because you have the arthritis of menopause, and just to build the understanding of what is actually going on with people.

Episode duration: 1:45:13