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Start Where You Are: #1 Orthopedic Surgeon’s Protocol to Feel Stronger & Look Younger in Weeks

If you’ve ever thought, “I don’t have time to take care of myself,” or “this is just part of getting older,” this episode is for you. Today, you’re going to learn exactly what to do to start feeling better and getting stronger, with results you'll see and feel in as little as 4 weeks. In this episode, renowned orthopedic surgeon and longevity expert Dr. Vonda Wright, MD returns to give you the wakeup call of a lifetime and share her brand new, complete, science-backed protocol to build muscle, strengthen your bones, restore your balance, and reverse the effects of aging, no matter where you're starting from. Dr. Wright is a double board-certified orthopedic surgeon and one of the world’s leading experts on mobility, musculoskeletal aging, and longevity. She’s also one of your favorite expert guests ever to appear on The Mel Robbins Podcast, which is why Mel invited her back on the show to share all new insights. Dr. Wright has treated over 100,000 patients and studied thousands more, and she is here to sum up what she has learned: No matter when you start or how small the steps, it’s not too late; your body can rebuild, and you have far more control over how you age than you think. In just 4 weeks, you will start feeling better. In today’s episode, you’ll learn: -The biggest lies you’ve been told about aging (and why they’re holding you back) -Why the time between age 44 and 60 is the most critical window of your life and the exact steps to take right now to protect your future -How women silently lose up to 20% of their bone density in the years around perimenopause and what to do to stop it -Why muscle is your most powerful anti-aging tool and how to build it in just 2 days a week -What every woman needs to know about bone health, menopause, and strength to become “unbreakable” -The longevity formula: The 4 simple steps you can start today to feel younger in just weeks -Why it’s never too late to rebuild strength, balance, and energy (even if you sit all day) -How to go from 0 to strong: Dr. Wright's protocol is specifically designed for people who feel too tired, too busy, or too far behind to begin Whether you or someone you love is feeling stiff, tired, or worried about how you’re aging, this episode will change how you think about your body and what’s possible. If you’re ready to feel stronger, more energized, and more in control of your future, this episode is where you start. Whether you're 30 and want to get ahead of aging, 45 and in the thick of perimenopause, or 65 and convinced it's too late, this episode will give you a clear, science-backed roadmap to staying strong, mobile, and independent for life. For more resources related to today’s episode, click here for the podcast episode page: https://www.melrobbins.com/episode/episode-396/ Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast I’m just your friend. I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I’ll see you in the next episode. Visit your local Ashley store or head to ashley.com to find your style. In this episode: 0:00 Introduction 2:30 Why Movement Is the #1 Anti-Aging Habit (Especially for Women) 8:02 You Can Build Strength at Any Age (Even Starting From Zero) 17:36 One Fall Can Change Everything: Hip Fracture Risks for Women 21:00 Bone Density 101: How to Protect Bone Health as You Age 27:19 The 4-Step Fitness Plan: Walk, Lift, Balance, Cardio (Beginner-Friendly) 35:03 How to Exercise With Pain: Joint-Safe Training That Works 37:38 Why Muscle Is So Important: Metabolism, Blood Sugar, and “Feeling Strong” 44:40 Protein for Women: Simple Daily Targets + Why It Matters 49:43 The Critical Window (35–45): Perimenopause, Muscle Loss, and Prevention 55:47 What Every Woman Needs to Know About Menopause and Aging 1:04:13 How to Train During Menopause: Strength, Cardio, and Recovery 1:07:08 HRT Explained: Hormone Therapy Facts + Myth Busting — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

Mel RobbinshostDr. Vonda Wrightguest
May 18, 20261h 15mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 2:30

    Introduction

    1. MR

      What's the biggest lie that you and I have been sold about aging?

    2. VW

      Oh, the biggest lie is that there's nothing you can do about it.

    3. MR

      Dr. Wright is a world-renowned orthopedic surgeon and a specialist in women's health, and today, she's not playing around. You have four steps to getting fit, even if you're starting from zero.

    4. VW

      Let's say you're stepping away from the couch for the first time in years. All you have to do to start is go for a walk today. Then, let's figure out how to lift some weights. Number three, we need to retrain our balance. We need to stand on one leg doing anything, working at our desk, brushing our teeth.

    5. MR

      And what is the fourth?

    6. VW

      I want you to get your heart rate up. You could swing a kettlebell and get your heart rate up to the max. You could do a rowing machine, treadmill. You could run between light posts on your street if you're so inclined. It's about your heart rate.

    7. MR

      Now, I'm gonna be honest, I don't like this.

    8. VW

      Oh, no, no, no, no, you must. The number one killer of women is heart disease.

    9. MR

      Wait, what?

    10. VW

      Yes. Here's what we know from the science. Not only will your body respond by getting stronger, by becoming less painful, but it will prove to yourself that you are worth this investment that you are making.

    11. MR

      Dr. Vonda Wright, I am so excited to see you.

    12. VW

      I'm excited to be here with you.

    13. MR

      I, I am so excited to talk to you today because every time I read your work or I listen to you or I get a chance to sit down with you, it really opens my eyes to both the stupid things that I'm doing that I didn't realize-

    14. VW

      [laughs]

    15. MR

      ... were counteractive.

    16. VW

      Mm-hmm.

    17. MR

      And also the simple changes you can make.

    18. VW

      Yeah.

    19. MR

      I feel stronger, and I, I love how you break things down-

    20. VW

      Yeah

    21. MR

      ... into what I can do.

    22. VW

      Mm-hmm.

    23. MR

      And how I wanna start is, I'd love to have you tell the person who's listening right now-

    24. VW

      Yeah

    25. MR

      ... what they might experience in, about their life-

    26. VW

      Mm-hmm

    27. MR

      ... and how they feel that could be different if they really take to heart everything that you're about to teach us today. I mean, you've seen over 100,000 patients.

    28. VW

      Yeah.

    29. MR

      You've authored 44 research studies. You are a renowned orthopedic surgeon. You are a team doc for professional sports. You are an expert in longevity. You have the number one book in the world, uh, ranked in longevity right now, The New York Times bestseller, Unbreakable. What is it that's gonna change about their life or my life if we take

  2. 2:30 – 8:02

    Why Movement Is the #1 Anti-Aging Habit (Especially for Women)

    1. MR

      to heart everything you're about to share with us?

    2. VW

      You know, Mel, the reality is, that I find is sometimes we feel so bad, sometimes the road has been so long since the last time we felt really good, that we think that there's nothing we can do, and that we've waited too long, and that we should've st- we have the re- regret of should've started before. But here's what we know from the science. Here's what I know from taking care of people: that there is never an age or skill level when your body will not respond to the investment you make in it. So whether you take all the advice we give today and start down the road, or whether you just want do one thing, not only will your body respond by getting stronger, by becoming less painful, but it will prove to yourself that you are worth this investment that you are making.

    3. MR

      Hmm. Amazing. You know, one of the things that you say that you hear most from patients is, "I don't want to end up like my mother."

    4. VW

      Yeah.

    5. MR

      What does that mean?

    6. VW

      Every day, I have people come in, and whether they're in pain or they have a, a, an orthopedic injury, or maybe they're just coming to me to talk about their menopause, and they look to the person that is closest to them to see how it's gonna be.

    7. MR

      Hmm.

    8. VW

      And sometimes they see their mother suffering, not able to do what they've always done, which is take care of the whole family, not able to enjoy the years that they should be enjoying, right? We work our whole lives to get to a point where we have time to take care of ourselves or do what we wanna do, and sometimes we're in so much pain or so frail, we can't. And people come in and say, "I'm afraid that's gonna be me. I don't want that to be me. What do I do now? I'm already starting to be in pain," or, "I don't know the roadmap to not end up in the same place as this person that I love. What am I gonna do?" But the reality is, if you're saying that phrase out loud, "I don't wanna age like your mother," go a little deeper. What part of her aging do you want to be different?

    9. MR

      Hmm.

    10. VW

      Is it the frailty? Is it the, we need to be concerned about our brain health because 70% of all Alzheimer's occurs in women? What do we do about our brain health, and when do we start that? I, I just need people to not wait so long to care about their futures, to not assume we're always gonna be the way we were when we were in our 20s and 30s, 'cause the reality is, we will age like our mothers if we don't step in front of it.

    11. MR

      I think pe- so many people are gonna resonate with that, and what I love about what you just said is that even if you're in your 20s-

    12. VW

      Mm

    13. MR

      ... like, so many of our moms didn't take care of themselves-

    14. VW

      Yeah. Midlife-

    15. MR

      ... or aren't taking care of themselves

    16. VW

      ... midlife women with 20-year-old daughters.

    17. MR

      Yes.

    18. VW

      Absolutely.

    19. MR

      Like, I can f- I almost sense those of you in your 20s and 30s sharing this with your mom right now, saying, "Mom, please-

    20. VW

      Yeah

    21. MR

      ... take care of yourself."

    22. VW

      It's time. Yeah.

    23. MR

      "It's time for you to put yourself first."

    24. VW

      "I love you. It's time."

    25. MR

      "I love you. It's time."

    26. VW

      Mm-hmm.

    27. MR

      Uh, for the person that received this from somebody that they love-

    28. VW

      Yeah

    29. MR

      ... what do you wanna say to them, because they've hit play-

    30. VW

      Yeah

  3. 8:02 – 17:36

    You Can Build Strength at Any Age (Even Starting From Zero)

    1. MR

      So for somebody that's, like, frail right now-

    2. VW

      Yeah

    3. MR

      ... so they've take, they, they had no access to you, they were told the lie that there's nothing they can do-

    4. VW

      Mm-hmm

    5. MR

      ... and they're feeling frail, or they love somebody that's frail, what would you say to that person is available in what you're about to share?

    6. VW

      You know, some of the various earliest research that I ever read in preparing to be a longevity researcher was done on 90-year-old men in a nursing home, who really were living in chairs. And those people, in the very first studies, were put through chair exercises with little bitty hand weights, and they increased their function 150%. The research shows that there is never an age or skill level when you cannot get stronger, no matter where you're starting. But I'm gonna tell you a very personal story. Do you mind?

    7. MR

      Please.

    8. VW

      So my parents live with us. Uh, it's a tradition in our family. They're 86. My dad has been a, a lifelong, um, endurance athlete, so he continues to do what he's always done. My mother, who's 86, was born in a generation where women didn't sweat, right? So [laughs]

    9. MR

      No, I'm laughing 'cause it's true.

    10. VW

      It's true. Yeah. And so, you know, she, she was doing fine, but she had very little physiologic reserve, meaning, what's in the health bank account for her? So during COVID, she got really, really sick, and lost a lot of weight, and became extremely frail. Well, the poor woman lives with me, and she can't not hear me say all these things.

    11. MR

      [laughs]

    12. VW

      So one day, I look outside, and she's shuffling along, we here live in Florida, around the pool, and she's got these, something in her hands, and she's doing biceps things with it. And I look and my mother is curling Campbell's Soup cans.

    13. MR

      [laughs]

    14. VW

      And do you know that between that time, when she was so frail that all she could do was shuffle around with Campbell's Soup, she now is, is biceps curling 10 pounds and squatting in her chair with 10 pounds. This 86-year-old woman goes from almost dying in an ICU to curling 10 pounds. It just shows, we, even within my own family, there is never an age or skill level when your body will not respond to the positive stress you put on it.

    15. MR

      Mm.

    16. VW

      We are made to adapt. It's the way we're made. And so that was a very long answer to answer the question with the simple truth, there is never an age or skill level when your body will not respond p- to the positive stress you put on it. So don't give up, people.

    17. MR

      Well, what I love about you, Dr. Wright, is you are the positive stress.

    18. VW

      [laughs]

    19. MR

      Because you don't take excuses. You're the expert-

    20. VW

      That's right. Mm-hmm

    21. MR

      ... in longevity, in my opinion-

    22. VW

      Yeah

    23. MR

      ... because you've treated over 100,000 patients-

    24. VW

      Yeah

    25. MR

      ... you're still in clinical practice, you're an orthopedic surgeon. You have authored 44 research publications on the topic, but you're also like, "You can't out excuse me."

    26. VW

      Yeah.

    27. MR

      So what has the research studies taught you-

    28. VW

      Yeah

    29. MR

      ... about aging and people's, like, biggest excuses that they can't do anything?

    30. VW

      I think there's so much that the research taught me. We, uh, we did a series of studies at University of Pittsburgh while I was there earlier in my career that basically showed that when you take the variable of sedentary living away, like, I only studied active people. Not pro athletes, active people over 50. We-

  4. 17:36 – 21:00

    One Fall Can Change Everything: Hip Fracture Risks for Women

    1. MR

      As an orthopedic surgeon, why can one fall be the moment that changes everything, especially for a woman?

    2. VW

      Yeah. So one in two women will have, um, an osteoporotic fracture, so a fracture related to poor bone health in their life-

    3. MR

      Wait, one in two?

    4. VW

      Yeah, so statistically, Mel, it's either you or me, and when you, you say it like that, it becomes really real. But if you fall and you break your hip, these are the statistics you're talking about. 70% of hip fractures are in women.Because of the complications of being frail, and fragile, and being sedentary, and having a big stress like a big fracture, 30% of the time you may die in the first year.

    5. MR

      30% of the time?

    6. VW

      It’s huge. It’s not a small number. If you survive, 50% of the time you will not return to pre-fall function, which means maybe you have to go live in a nursing home, which is nobody’s destination of choice. Maybe you have to move in with your kids, or you have to hire somebody full time. So this becomes not only a personal burden, it becomes a family responsibility.

    7. MR

      And the, the, that we will break a bone or fracture a bone not because of some catastrophic thing, but because our bone density's bad?

    8. VW

      Low energy fall. So there’s a difference.

    9. MR

      What? A low energy fall? What is that?

    10. VW

      Well, there’s a difference. I'm tr- making the di- the distinction between being in a terrible car accident-

    11. MR

      Yes

    12. VW

      ... wrapping your... That’s another, uh, story. But all it takes is tripping over the curb, or the little bitty dog that runs around the house, or the rug that wasn’t latched down, and you land hard, and that frail bone which had not previously broken, breaks.

    13. MR

      Ah.

    14. VW

      And if it’s your hip and you end up in the emergency room, it sets off a catastrophic series of events that can lead to death. So, we want to be as strong as possible, which is much lean muscle mass as possible. Not just thin, but lean, uh, as possible. Uh, we want bones as strong as possible. But what we really need to do is not fall, and so that’s why in Unbreakable, I don’t leave it as, "We gotta do cardio," which I do say that. "We have to lift weights," which I do say that. But we talk about rebuilding our balance-

    15. MR

      Ah

    16. VW

      ... and working on foot speed so that we don’t have a fatal fall that ends you up in the emergency room dealing with that.

    17. MR

      So I’m thinking now, 'cause I’ve got daughters in their mid- 20s.

    18. VW

      Yes. Mel, here’s the deal. Falling and breaking a hip is not inevitable. Having poor bone health is not inevitable. Poor bone health manifests when we’re older, but it begins when we’re younger. And so we need to pivot from only arriving in midlife to say, "What am I gonna do here?" to pivot and saying, "Oh my God, I’ve gotta tell my kids this. I’ve gotta talk to them about their bone health when they’re reach- in their late 20s and their 30s." And when you talk about bone and muscle, we reach those peaks around the age 30. What peak are we reaching from then we’re gonna draw for the next 40, 50, 60 years, right? So this is a lifetime conversation, not just, "Oh, I’ve hit midlife and I’m getting older," conversation.

  5. 21:00 – 27:19

    Bone Density 101: How to Protect Bone Health as You Age

    1. MR

      How do you know if you have bad bone health, or what should you be doing for good bone health?

    2. VW

      Yeah, really good, really good question. Um, bone reaches a peak between about twen- 15, post-puberty, 25, 30. We-

    3. MR

      And what do you mean by peak?

    4. VW

      Yeah. We have the most bone density we’re gonna have at that point.

    5. MR

      Okay.

    6. VW

      Right? The strongest bones. If we’ve been jumping around in our childhood, if we’ve been feeding ourselves, if we’ve actually had periods and enough estrogen, and there are some young girls who don’t have periods. I mean, I didn’t. I was a dancer. I thought it was fine. I, little did I know. Um, so we have to build bone so that we ha- reach a peak, the best bone we’re gonna get, around age 30. Because when we hit perimenopause and lose our estrogen, we could lose 15 to 20% in a, in s- the five to seven years.

    7. MR

      Wait. W- I just wanna make sure I understand this, because what you just said is very important.

    8. VW

      Yes.

    9. MR

      15 to 30, 25.

    10. VW

      We’re reaching peak bone density.

    11. MR

      You’re reaching your peak bone density.

    12. VW

      Yes.

    13. MR

      Okay. And then 30 to whatever, 40, perimenopause, you’re kind of in that zone, but then when you start experiencing perimenopause into menopause-

    14. VW

      Yes

    15. MR

      ... when estrogen basically falls off a cliff-

    16. VW

      That’s right

    17. MR

      ... and women are, in the female version, castrated almost-

    18. VW

      That’s right

    19. MR

      ... because our estrogen is gone.

    20. VW

      That is the language. Mm-hmm.

    21. MR

      Um, you lose 15 to 20% of your bone density?

    22. VW

      Yes. The loss of bone is estimated in men and women to around 30, after peak bone density, to decline at about 1% per year. Men continue that, but women, when estrogen walks out the door, increase their loss of bone to 3 to 4% a year. Over five to seven years of perimenopause, when most women are trying to figure out what’s going on, that adds up.

    23. MR

      I am gonna say I never knew-

    24. VW

      Yeah

    25. MR

      ... that there was a connection between estrogen-

    26. VW

      Mm-hmm

    27. MR

      ... and the fact that women experience, is it called osteoporosis? What’s it called?

    28. VW

      Osteoporosis.

    29. MR

      Yes.

    30. VW

      Mm-hmm.

  6. 27:19 – 35:03

    The 4-Step Fitness Plan: Walk, Lift, Balance, Cardio (Beginner-Friendly)

    1. VW

      you have four steps to-

    2. MR

      Yes

    3. VW

      ... getting fit, even if you're starting from zero.

    4. MR

      Yeah.

    5. VW

      Walk us through what we should be doing.

    6. MR

      So I think that it can be very complicated, but it doesn't have to be-

    7. VW

      Okay

    8. MR

      ... at all.

    9. VW

      Just simplify it, please. [laughs]

    10. MR

      It doesn't. So let's say, let's say you're stepping away from the couch for the first time in years.

    11. VW

      Okay.

    12. MR

      Let's just say, I call, I call that adult onset exercisers, meaning you've gotten the message, "We're gonna start."

    13. VW

      [laughs]

    14. MR

      All you have to do to start is f- go for a walk today.

    15. VW

      Okay.

    16. MR

      In fact, put this on, put Mel and I in your ear-

    17. VW

      Yes

    18. MR

      ... and let's walk together-

    19. VW

      Great

    20. MR

      ... for as long as you can, and you're gonna do that for seven days. I don't want you to go to the... I don't want you to lift tomorrow. I just want you to walk for seven days, because you know what that is, Mel? That is a streak. In exercise world and running world, we call doing something daily a streak.

    21. VW

      Okay.

    22. MR

      Well, if you walk every day, preferably after your biggest meal, you're not gonna wanna not do it on the eighth day, 'cause you've accomplished something-

    23. VW

      Mm

    24. MR

      ... and you're gonna feel good about that. So after you've started that, then let's figure out how to lift some weights. So maybe we start out with body weights. We're just gonna get up and off a chair 10 times in a row. We're gonna grab some books off the shelf and do it with some books. It doesn't have to be complicated or lifting heavy weights, because you know what'll happen? When we start with our body weight and then progress to lifting light weights, give yourself six months, you're gonna be in a gym with a, a bar on your shoulders throwing weights around. I mean, you can progress over six to nine months to truly lifting weights in the way that you see people in the gym doing it. We're gonna start by walking and creating a streak. We're gonna start lifting then. Once you're lifting, you can maintain by lifting twice a week.

    25. VW

      That's it.

    26. MR

      That... I mean, you can maintain twice a week, two total body workouts twice a week. And then when you get advanced enough to lift heavy, you'll get more specialized, but we don't start that on day one. Number three, uh, we need to retrain, uh, our balance. We need to stand on one leg doing anything, working at our desk, brushing our teeth, doing kitchen work.

    27. VW

      So even if I just were to stand on one leg as I'm brushing my teeth-

    28. MR

      Mm-hmm

    29. VW

      ... that counts?

    30. MR

      Yeah, because you brush your teeth for one to two minutes, and that's a lot of training.

  7. 35:03 – 37:38

    How to Exercise With Pain: Joint-Safe Training That Works

    1. MR

      Exercise isn't for people like me. What do you wanna say to a person that feels that way, Dr. V?

    2. VW

      I understand where they're coming from. Pain is a huge deterrent, but what they don't understand is that stiff joints are painful joints.

    3. MR

      Hmm.

    4. VW

      The stiffer you are, the more pain you're gonna be in.

    5. MR

      Wait, so if you're stiff already-

    6. VW

      Mm-hmm

    7. MR

      ... and you don't move, you're gonna be in more pain?

    8. VW

      And stiffer. So the joints thrive on m- motion. We build more joint fluid by moving our joints, so that even if we're stiff, moving our joints will help us feel not stiff. Not sitting down. Think about if you're sitting in a car for long periods of time, your six-hour trek, you know?

    9. MR

      Yeah.

    10. VW

      You get out a- of the car, and you're stiff, and everybody's getting out of the car a little stiff. Well, moving makes that go away, even if you have arthritis, so continue moving. The second reason we feel more pain with stiff joints or, or arthritis is because we don't have the muscle p- support above and below. For instance, when someone comes to me with knee pain, the first thing I do as I'm writing their notes is tell them, "We're gonna get strong. We're gonna get strong like a bull. We're gonna build our butt, core, and hip." Why? My joints hurt. So that every time you take a step, it's not like putting a sledgehammer of two bones together. Muscle is shock absorbers.

    11. MR

      Hmm.

    12. VW

      So we have less hard impact. So move-Build muscle to get strong. So you may not feel like it. Let's say walking on the road hurts. Well, let's find a YMCA that has a hot pool. They're like community resources with sliding scales for the fees, right? They all have warm pools. You just get into chest-high water. Don't even get your hair wet. Pile it up. I've got all... Listen, you cannot excuse me. [laughs]

    13. MR

      I was just gonna say, there's nowhere too high.

    14. VW

      [laughs] There isn't. You don't have to get your hair wet. Get in the chest-high water. You just walk back and forth 'cause the buoyancy will help your pain. You really wanna get out of pain in seven days, you stop eating sugar of all kinds. Pe- when people take my advice and stop adding sugar, read the label so you know how much added sugar is in all this processed food we eat, stop drinking juice and eating the fruit instead, I'm not kidding you, to a person, when they come back, they're like, "You know, my joints felt better in about seven days." These are all really simple things. So even if you are in pain, it doesn't give you license to

  8. 37:38 – 44:40

    Why Muscle Is So Important: Metabolism, Blood Sugar, and “Feeling Strong”

    1. VW

      do nothing.

    2. MR

      One thing I would love to have you talk about is you spent a lot of time in your New York Times bestseller, Unbreakable, teaching about the really magical impact that muscles have.

    3. VW

      Yeah.

    4. MR

      'Cause I think there's so much out there now about resistance training-

    5. VW

      Mm-hmm

    6. MR

      ... and getting more high-quality protein in. But a lot of us don't understand why exactly-

    7. VW

      Yeah. Mm-hmm

    8. MR

      ... medically speaking, resistance training-

    9. VW

      Mm-hmm

    10. MR

      ... is important, and I think as a woman, for a long time, I resisted resistance training, no pun intended.

    11. VW

      Yeah. Yeah.

    12. MR

      And I resisted and didn't want to eat a lot of protein because I was so afraid to bulk up.

    13. VW

      Yeah.

    14. MR

      But in reading Unbreakable, I learned so many new things about why muscles-

    15. VW

      Mm-hmm

    16. MR

      ... in particular are so important to healthy aging. Could you just break that down in a simple way?

    17. VW

      I think that it's an understandable position to not understand that what you see in the mirror is not the story.

    18. MR

      What does that mean?

    19. VW

      What you see in the mirror in terms of how much muscle, what do your muscles look like, bulking up or, or, "I look fine in my clothes. I, I don't need muscle," that's not the story. The story of muscle is that it was designed as a metabolic engine.

    20. MR

      What does that mean, metabolic engine?

    21. VW

      It is important for locomotion. Without muscle, you would just be a skeleton that didn't move, just like without a skeleton, your muscle would just be a heap of tissue.

    22. MR

      [laughs]

    23. VW

      So, so muscles are important for locomotion, but they're very important for glucose metabolism. When you eat, carbs in particular, and your body breaks it down into glucose, it is your muscles that, s- uh, that work as a sink to that glucose so that it's not just all stored in fat. So it's really critical. Muscle itself contributes to your longevity. Muscle interacts, uh, communicates with bone to help build better bone. So what you see in the mirror-

    24. MR

      Okay

    25. VW

      ... is not the story of muscle. The story of muscle is the other jobs that it does in your body. So if you want to walk around when you're 80, 90, 100, be less prone to falls, you need muscle to do that. If you want to help control your metabolism, decrease your, your chance of getting diabetes or metabolic disease, we need more muscle. We need healthy muscle. If we want to burn more calories, because many people are worried about gaining weight, we need more muscle. Muscle burns more calories just to live than fat does as a tissue.

    26. MR

      You mean just sitting around, muscles-

    27. VW

      Yeah

    28. MR

      ... burn more calories?

    29. VW

      Yeah. 120-pound person that's 50% fat will burn much less calories in a day just to live than 120-pound person that has a 25% body fat because of the different ratios of the tissue. So that's what I mean when we tell the story of muscle. It's critical, not for the way we look in the mirror. That's the bonus. It is critical for the metabolic way that it helps our body function today and for the longevity it infers through proteins.

    30. MR

      Thank you for explaining that because I feel like you hear the words resistance training, you hear the words protein-

  9. 44:40 – 49:43

    Protein for Women: Simple Daily Targets + Why It Matters

    1. MR

      In your New York Times bestseller, Unbreakable, I am, uh, looking at this entire chapter, and you even have recipes in this book.

    2. VW

      Yeah.

    3. MR

      But you have an entire chapter in your New York Times bestseller, Chapter 10: Unbreakable Nourishment.

    4. VW

      Mm-hmm.

    5. MR

      And you write extensively about protein.

    6. VW

      Mm-hmm.

    7. MR

      As an orthopedic surgeon, will you just bottom line for us how much protein you recommend that-

    8. VW

      Yeah

    9. MR

      ... we get, especially as women? 'Cause it's very, very confusing.

    10. VW

      To support our growth of muscle, to support our normal metabolism, I recommend 0.8 to one gram of protein per pound a day. The protein should be high-quality protein, which means it contains the essential amino acids, including the most important one, leucine, which is the most powerful stimulant for muscle growth. So we need an absolute amount, and we need high-quality protein.

    11. MR

      When you say either 0.8 grams or, to one gram-

    12. VW

      Mm-hmm

    13. MR

      ... per weight, is it what you weigh now, what you wanna weigh? Like, how do you do... 'Cause that's a, like, when I think about that, I'm like, "That's a lot of protein."

    14. VW

      That's a lot. So I normally-

    15. MR

      Am I gonna get bulky from eating that much protein?

    16. VW

      Yeah, no.

    17. MR

      [laughs]

    18. VW

      I [laughs] I normally say the very minimums that, that muscle scientists talk about are about 100 grams a day.

    19. MR

      100 grams a day.

    20. VW

      Minimum. But, but if we're really growing muscle, 0.8 to one gram per ideal pound. Most of us know ideally what we would want to weigh, uh, or we do know, because we've had a, we've had a body composition-

    21. MR

      Mm

    22. VW

      ... and we know for the body percentage. So it's not what we currently weigh, unless we're at our ideal, ideal weight. It's our ideal weight.

    23. MR

      Thank you for clarifying that.

    24. VW

      Yeah.

    25. MR

      You know, Dr. V, one of the things that you hear from patients is, "I don't wanna be a burden as I get older."

    26. VW

      Yeah. Mm-hmm.

    27. MR

      Can you speak directly to the person that's either watching or listening and feels that way-

    28. VW

      Yeah

    29. MR

      ... they're starting to get nervous about it?

    30. VW

      Yeah. So when someone is in my office and they say, "I don't wanna be a burden to my children," and yet they're sitting in front of me with terrible knee pain, or they're, or they've come in for whatever reason, I know what they mean. They mean that they have always been the independent person, the person who took care of everything, held the glue of the family together. Usually, it's women who say this to me. They have always had it all together, but they see themselves in pain. They see themselves slowing down.

  10. 49:43 – 55:47

    The Critical Window (35–45): Perimenopause, Muscle Loss, and Prevention

    1. MR

      You talk about something called the critical decades-

    2. VW

      Yeah

    3. MR

      ... in your work. Can you explain what they are and why critical decades matter so much, Dr. V?

    4. VW

      Yes. So, uh, there was a paper that came out last year that looked at the inflection points of aging.

    5. MR

      Yeah.

    6. VW

      Meaning, when biologically do we age rapidly? And, and I think we were all surprised to read, it happens according to this paper, at 44 and 60.

    7. MR

      44, and so there's two, 44 and 60?

    8. VW

      Well, two big inflection points, 44 and 60. So for me, it divided our lives into critical decades, right? So if we start at the youngest critical decade, I call it 35 to 45.

    9. MR

      Okay.

    10. VW

      It is the decade in life when you're not a child anymore, you have more access to choices, but you have all your hormones. It is the decade to get your health standards together. Let's figure out how to lift, figure out how to eat, figure out how we're gonna commit our lifestyle to the standards that will help us live in the future the way we're living today. That is a critical decade. And notice what happens at the end of that critical decade, the first inflection point of aging. For women, the next critical decade is this perimenopause decade, 45-ish to 50, early 50s, when our estrogen is going out the door. Why does that happen? It's because our ovaries, which are not sex organs, they just happen to make estrogen, which is not a sex hormone. Ovary aging is an emergent science that really informs us why women age differently, and it's because in men, we have a slow, steady decline, about 1% a year, right? So that's why when the bros talk about longevity, it's a very different thing than for women, longevity, meaning because we have a catastrophic decline and change in our ovarian health, our release of estrogen. Estrogen is such a critical hormone in every organ. It profoundly affects our aging process across the body. We know we lose muscle mass. We know we're gonna lose bone density. We know we accumulate fat. We know our cartilage is highly responsive to estrogen, as are our muscle stem cells. This is another critical decade that we cannot wait through to establish health standards. If we haven't started all the lifestyle behaviors before, let's start them now, and let's make our hormone optimization decision so that if we choose to replenish our estrogen, progesterone, and testosterone, that, um, we make that decision now, and not wait until the next decade when we've already hit the second inflection point of 60. Now, hear me, people.

    11. MR

      Yeah, everybody over 60 is having a heart attack right now.

    12. VW

      I know.

    13. MR

      So if you're past the critical decade, and say again what the, the critical decade means. These are moments when-

    14. VW

      These are inflection points. 20, 35 to 45, you still have all your hormones.

    15. MR

      Yep.

    16. VW

      Let's get our standards going. They're gonna make a huge difference right now. 45 to early 50s, we're in perimenopause. We're rapid, more rapidly aging because of our ovarian aging that's happening-

    17. MR

      Yep

    18. VW

      ... and the role of estrogen. Once our ovaries have retired, gone, it is never too late. You can still respond to lifestyle interventions. Sometimes it's just harder. It doesn't mean don't try. It doesn't mean don't start. There are plenty of examples, uh, commonly now, all over the digital world, of people picking up the mantle of, "I'm gonna live better," starting at 60. There's never a time. Is it gonna be harder than it was when you were 35? Sure.

    19. MR

      Okay, so what you're basically saying is, if you're listening or you have people in your life that you love that are 35 to 44, send them this because they need to wake up. Because if they start making the changes-

    20. VW

      Yeah

    21. MR

      ... now, it's gonna have a bigger impact on longevity-

    22. VW

      Mm-hmm

    23. MR

      ... because they still have all their hormones. It's a season of life where-

    24. VW

      It's truly adulting.

    25. MR

      Yes.

    26. VW

      If we're truly adulting and preparing for our adult life, we're n- out of grad school, we're out of college, we're-

    27. MR

      Yep

    28. VW

      ... hopefully have a, a job that's sustaining us, well, let's do the next adult thing and figure out how to maintain our body for the rest of our lives, right?

    29. MR

      Yes, and it has a bigger impact long-term.

    30. VW

      Profound. There's like a compound, and, you know, in, in banking, you put a little money away in the beginning and it compounds. Think of it like that. We're building physiologic reserve that we get to draw from. But if we, if we, in our 30s, are frail already, what are we gonna be doing for 50 more years, right? So that's the first critical decade.

  11. 55:47 – 1:04:13

    What Every Woman Needs to Know About Menopause and Aging

    1. MR

      And so, Dr. V, what do you wish every woman knew about menopause?

    2. VW

      Menopause is not to be feared if we step in front of it. If we are lucky enough to live long enough, everybody born with XX chromosomes, and therefore ovaries, will go through it. I am gonna be honest with you, it can be very hard if you are not prepared.

    3. MR

      Mm.

    4. VW

      But that's why I want us all to know what's going on. Menopause is a physiologic, a hormonal, a psychologic, and a social transition. Nothing will be the same, but it can be great or better. That's the framework I want people to know. What is menopause biologically? Well, it is the exhaustion of our ovaries. We are born, little girls are, XX pe- XX people, little girls are born with two ovaries that contain all the eggs they're ever gonna have. Those eggs are used all through our cycling years until we have so few during perimenopause that we can't produce the estrogen that we once did, and it starts getting a little chaotic hormonally. Until, skip ahead to on average, depending on who you are, 51, 52, your ovaries are just done. They're no longer producing any eggs, therefore no estrogen from the egg follicle, and you're post-menopausal, right? That's what menopause is. Everything we feel, from our brains to our hearts, to our bones, to everything, our mood, I don't feel like myself, is due to the alteration in estrogen load. It's such a critical hormone in our body.

    5. MR

      Right.

    6. VW

      It doesn't mean life's over when it stops, it just means life's different.

    7. MR

      Mm.

    8. VW

      And what I encourage women to do is not just to take the attitude that I hear a lot, which is women tell me they have a really high pain tolerance, and they're just gonna suffer through it. And I ask, "Why do you have to suffer through it? Why, what, why do we enculturate women to bear suffering? Why is that our lot in life when there are things we can do to feel better?"

    9. MR

      Huh.

    10. VW

      Right? That is another common thing women say to me, is that they're used to the suffering. So when it comes to menopause, some women say, "I'm just gonna gut through this." Some women say, "I didn't really feel that bad." But even if women say, "I don't feel that bad," they can't perceive the physiologic changes that are happening, like loss of bone density, loss of muscle mass. I need people to understand that whole picture. It's a physical, psychological, social, and hormonal transition that is natural. We are all meant to do it. It's not that we did anything wrong. It's not that we're not trying hard enough. It's the way we are designed.

    11. MR

      I'm just struck by your observation as a physician-

    12. VW

      Mm

    13. MR

      ... of how often you hear women say that they're gonna suffer through it.

    14. VW

      Every day. I have clinic every Tuesday and Thursday. Every day, without fail, people say that to me. And I wonder why. Listen, I'm a sports doctor. I get being in pain. I get it, right? I take care of athletes. We're in pain all the time, but it's different. What these women say to me is not pain of, of blowing out their ACL or being tackled on a football field. What these women are saying to me is that their body hurts, and they're just gonna live with it, and for years. And it goes on. So I just wanna know why we accept that. I don't have an answer for that. Why do we enculturate our girls to accept that?

    15. MR

      The only thing that popped into my head is I wonder if it's, has anything to do with the pain associated with childbirth-

    16. VW

      Hmm

    17. MR

      ... and the expectation that you're just gonna have to bear it, and then-

    18. VW

      And live through it.

    19. MR

      Yes.

    20. VW

      Well, I th- I think you may be right, right? For some women, their periods hurt. We know predictably we're just gonna bear it. And then we go through childbirth.

    21. MR

      It's true, because you're not gonna talk about it publicly.

    22. VW

      Every week.

    23. MR

      Yes.

    24. VW

      I mean, every month for the 30 years you have your period. And then childbirth hurts. Uh, and then so maybe it's just another phenomena we're gonna live through, but when it becomes limiting, when it becomes a reason not to live with hope for the future, when it becomes a reason not to seek out the kind of-

    25. MR

      Hmm

    26. VW

      ... lifestyle and hormonal and all the other interventions that could possibly help you live to the capacity you were created to live, I think it's not useful.

    27. MR

      What do you say to somebody that's sitting across from you as a patient that just says, "I'm just gonna suffer through it"?

    28. VW

      Well, I respect their autonomy in doing that.

    29. MR

      Yeah.

    30. VW

      I mean, if that's what they wanna do, I'm not here to berate them for making that choice, but the, but I educate them-

  12. 1:04:13 – 1:07:08

    How to Train During Menopause: Strength, Cardio, and Recovery

    1. MR

      Dr. V, how does menopause change how you want us to think about exercise, strength training, recovery?

    2. VW

      I think it adds a sense of urgency to it. We know how much muscle, bone, tendon, liga- we're gonna lose. We know. We know that the future that I see in the emergency room of women laying frail in a bed with, with a broken hip, we know that happens a lot. So for women in menopause, the messaging of now is the time, even if you've never paid attention to yourself before. If you were overrun with oxytocin and you took care of everybody but yourself, you don't have as much estrogen right now, so you're not gonna have as much oxytocin. So now is the time. It's this sense of urgency. It's now or never, people. And that's not true. It's not never, but it's now. What is holding us back? Why can't we step across the threshold of caring about ourselves in the way that we've always cared about other people?

    3. MR

      Mm.

    4. VW

      Right? What is that? And maybe, Mel, that takes a little bit of work, some stepping back, of reflection, of what is keeping me from taking care of myself, from doing the thing? 'Cause it's not motivation. Motivation lasts about 32 seconds, you know? Or 21 days, according to the resolution people. It's not that. It has to be a deep, abiding belief that you are worth it.

    5. MR

      Mm.

    6. VW

      That you are worth the investment, that the future can be hopeful. It, it, it's a mindset shift, right? The actions will follow.

    7. MR

      Well, what's interesting is you have a lot of daughters coming in, saying, "I don't wanna turn out like my mom," and there's an opportunity-

    8. VW

      To-

    9. MR

      ... for you as the mom to go, "I don't wanna model this for my daughters."

    10. VW

      I, ugh, such a good point, Mel. Exactly. Across their lifespan, right, how do our children learn how to be healthy? They watch us, right? And so if you're a midlife woman and you're in a position that you have 25 and 30, like both of us.

    11. MR

      Yeah.

    12. VW

      We have daughters in this. I have two daughters and three daughters-in-law all in this age group. Um, they are very mo- self-motivated. But let's say they were watching me to see how could it be? Do I have to suffer? I can model for them vibrance and energy and doing really hard things, and acting now, as I have my whole life, or I could model for them getting weaker and sadder and not being able to do what I've always done, that the family has enjoyed, right?

    13. MR

      Mm.

    14. VW

      And therefore, giving them hope for the future.That's the real gift, Mel, truly.

    15. MR

      And your granddaughters and your grandson.

    16. VW

      Mm-hmm.

    17. MR

      I, I love that shift in perspective.

  13. 1:07:08 – 1:15:34

    HRT Explained: Hormone Therapy Facts + Myth Busting

    1. MR

      As an orthopedic surgeon, what are your thoughts on HRT?

    2. VW

      Oh. [laughs] My thoughts on HRT as an orthopedic surgeon are that, number one, everyone gets to make their own choice. We're not gonna put this on you. But you must make this choice from facts, not fear, and that includes knowing the data. And if you have to dig deep and read the studies that are now everywhere, or if you just wanna be told what to do, the guidelines that the medical societies put out, like the Menopause Society, are very clear. They're in layman's language. Find the information, number one. Number two, if you don't wanna end up frail in a hospital bed with a broken bone, low muscle mass, fat everywhere, uh, unable to live the life you envision, well, then let's consider adding estrogen, progesterone, and testosterone to the toolbox of your lifestyle interventions. It is a critical part of lifestyle intervention. I just think you need to make the decision conscientiously, not out of fear.

    3. MR

      Do you, do you have a concern 'cause there's a tremendous amount of misinformation out there about it?

    4. VW

      I have a concern. I just think that, uh, certainly in the era where any computer can generate an AI image of me saying whatever they want it to say, that you have to be responsible for the information you take in.

    5. MR

      Hmm.

    6. VW

      Right?

    7. MR

      Yeah.

    8. VW

      So exercise that responsibility. Read the original book. Just dig a little deeper. You're worth that curiosity, right?

    9. MR

      Well, it changed my life.

    10. VW

      Yeah.

    11. MR

      And I had a lot of unfounded fear about it because of all the reports-

    12. VW

      Oh, yeah

    13. MR

      ... that had been reversed.

    14. VW

      Oh, yeah.

    15. MR

      And come to find out that it is, it's a safe option.

    16. VW

      Yeah.

    17. MR

      Which it is for the vast majority.

    18. VW

      For the vast majority of people. Mm-hmm.

    19. MR

      And now that I understand the connection to bone density-

    20. VW

      Yeah

    21. MR

      ... and the implications-

    22. VW

      Yeah

    23. MR

      ... I'm like, why wouldn't you if it's safe for you? Like-

    24. VW

      If it's safe for you, why wouldn't you, right? It's still your choice, but if it's safe for you, which it is for most people, why wouldn't you? But even if we're talking about, if we're clarifying who, th- what does safety really mean, well, we're really talking about systemic estrogen and, you know, take high enough doses that affect your whole body. But what if, even from an orthopedic perspective, even if it's not safe for you, systemic because of a history of certain kinds of cancer, personal history of certain kinds of cancer, vaginal estrogen is safe for everybody. The studies have been done. It does not absorb, but it can save you from the genitourinary syndrome of menopause, which from an orthopedic perspective, many old ladies fall down in their kitchens and break a hip and potentially die because they have chronic UTIs, bladder infections, that have never been treated. They've never had vaginal estrogen. They have chronic infections, which makes their heads a little woozy. They lose their balance because they're feeling woozy, and they break their hip. It is a known phenomenon that chronic bladder infections can affect your balance and your brain, and you fall and break your hip. And it just leads to this spiral. So if I'm trying to prevent falls, I want every tool, I want everybody to be on vaginal estrogen so that they don't have these chronic UTIs that can lead to falls.

    25. MR

      Uh, Dr. V, if the person listening to this takes just one action today from everything that you've shared and that you've-

    26. VW

      Mm-hmm

    27. MR

      ... taught us-

    28. VW

      Mm-hmm

    29. MR

      ... what do you think the most important thing to do is?

    30. VW

      The most important thing to do, the one thing to do, if you have never invested in your health ever, is to start today.

Episode duration: 1:15:35

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