You’re NOT Just Getting Old! — These Daily Habits Are Destroying Your Body After 40 | Vonda Wright

Dr. Rangan Chatterjee 0:00 When you look around across society, what are some of the common things people are doing that are perhaps resulting in them neglecting their bodies-

Dr. Vonda Wright 0:12 Mm

Dr. Rangan Chatterjee 0:12 ... and therefore increasing the speed at which they age?

Dr. Vonda Wright 0:15 I think there are a couple factors that may be surprising, and then several that are obviously not. But I think the first reason people begin to decline, without even realizing it, is this bias or this myth we believe that aging is an inevitable decline, and that there's something abnormal about it. But I say quite frequently that aging alone is the most natural thing we do from the minute of our conception to the moment of our death, and it's how we handle the passage of time that matters. But if you believe that there's absolutely nothing you can do about the future, then you're gonna resign yourself to the first time you feel an ache or a pain, or the first time you come up against a no, as, "Well, that's just getting old, I guess I'll just accept it." And what I find people doing is giving things up one at a time until they don't recognize it. I'll give you some examples. So believing the myth that it's inevitable is, I think, a primary motivator. The second motivator I see is that sometimes people don't believe they're worth the effort. Maybe everybody else is worth the effort, particularly for women, like, the, the neglect, the self-neglect comes because we're not neglecting others, we're investing all of our energy externally and not redirecting anything internally. And so those being primary drivers I see in the stepwise allowing decline.

Dr. Rangan Chatterjee 1:52 Hmm. It's interesting, this idea about mindset or beliefs.

Dr. Vonda Wright 1:59 Mm.

Dr. Rangan Chatterjee 1:59 You know, if we believe, if we get the message from the world around us that getting older means frailty-

Dr. Vonda Wright 2:07 Mm-hmm

Dr. Rangan Chatterjee 2:07 ... means weakness-

Dr. Vonda Wright 2:08 Mm-hmm

Dr. Rangan Chatterjee 2:08 ... means you have to give up the things that you don't wanna give up necessarily-

Dr. Vonda Wright 2:13 Mm-hmm

Dr. Rangan Chatterjee 2:13 ... then of course your behaviors are going to follow-

Dr. Vonda Wright 2:17 That's right

Dr. Rangan Chatterjee 2:18 ... your beliefs.

Dr. Vonda Wright 2:19 Mm-hmm.

Dr. Rangan Chatterjee 2:19 And there's so many things about your new book, Unbreakable, that I really, really enjoy.

Dr. Vonda Wright 2:24 Yeah.

Dr. Rangan Chatterjee 2:24 I think it's beautifully written. And in the introduction you actually say, "I contend that although we certainly undergo some life stage changes-

Dr. Vonda Wright 2:33 Mm-hmm

Dr. Rangan Chatterjee 2:34 ... what we call normal aging is actually normal aging for stressed out, undernourished people who are not intentionally building muscle, not attending to their hormonal health, and not prioritizing mobility."

Dr. Vonda Wright 2:51 Exactly. And what I mean by that is if you go back to the medical literature, there was a study, and there are many studies like this. Uh, there was a study called the Health ABC in the United States funded by our National Institutes of Health, that took a cohort of 70-year-olds and just watched them age over a decade. These were people straight out of the population. Well, what do we know about people in the world and in the United States in particular, is that more than 70% of them do not invest any energy any day in mobility or health habits. So if we're watching a population of people to see how they age, and they're truly just a random sample of the population, then you are sampling sedentary people who make very little effort to age in a different way. So I, I state that so clearly is because I contend, and why we formed the research group at the University of Pittsburgh called PRIMA, the Performance and Research Initiative for Masters Athletes, is because I wanted to see what we were capable of if we took the variable of sedentary living out of the way.

Dr. Rangan Chatterjee 4:07 Mm-hmm.

Dr. Vonda Wright 4:08 So we began studying active people, not professional masters age athletes, but people over 40 who were consistently active. Many of them were podium-type, uh, age group athletes-

Dr. Rangan Chatterjee 4:21 Mm

Dr. Vonda Wright 4:21 ... meaning, you know, winning the 50-year-old, uh, podium. So they were invested, but not pros, and what we found was very different than we find in the population. We found over 15 years we can retain muscle mass and bone density and brain function. Um, and so when I say that we don't really truly know the state of healthy, active ageing, it's based on facts, not fiction.

Dr. Rangan Chatterjee 4:50 Yeah. So in terms of what people can do then as they get older, we're gonna get into all the detail-

Dr. Vonda Wright 4:57 Yeah

Dr. Rangan Chatterjee 4:57 ... but top line-

Dr. Vonda Wright 4:59 Mm-hmm

Dr. Rangan Chatterjee 4:59 ... right at the top for people-

Dr. Vonda Wright 5:00 Mm-hmm

Dr. Rangan Chatterjee 5:01 ... what are some of the things that you want people to consider doing as they get older?

Dr. Vonda Wright 5:06 Mm-hmm. Yep.

Dr. Rangan Chatterjee 5:06 As I say, we'll get into all the detail-

Dr. Vonda Wright 5:08 Yeah

Dr. Rangan Chatterjee 5:08 ... but just top line, what are some of those things you want people to be focusing on as they get older?

Dr. Vonda Wright 5:13 Number one, mindset mobilization. We have to quit worshiping our youth. Number two, we have to work hard at building mental resilience. Aging is not for sissies. It can get hard, so we have to build the mental resistance to stay in the process. Number three, we need to build physical resilience, and part of this book is all about that. How do we know where we are physically, and then use the science-backed ways to build physical resilience? Um, and then I firmly believe and encourage people to form groups of at least five to travel this road with you-

Dr. Rangan Chatterjee 5:54 Mm-hmm

Dr. Vonda Wright 5:54 ... towards an aging process that is vibrant, because, you know, experts in, in social theory and, and relationships will say that we are the product of the five people we spend the most time with.

Dr. Rangan Chatterjee 6:07 Mm.

Dr. Vonda Wright 6:07 And if those five people are naysayers of health and aging, if they are naysaying in your ear, "What are you doing out there trying to get healthier?"It's gonna hold you back. So as a broad outline-

Dr. Rangan Chatterjee 6:20 Mm

Dr. Vonda Wright 6:20 ... those would be the things I identify.

Dr. Rangan Chatterjee 6:23 Yeah. I love those. This book is primarily focused on women.

Dr. Vonda Wright 6:30 Mm.

Dr. Rangan Chatterjee 6:31 I'm a man-

Dr. Vonda Wright 6:32 Yes

Dr. Rangan Chatterjee 6:33 ... in my 40s.

Dr. Vonda Wright 6:34 Yes.

Dr. Rangan Chatterjee 6:35 What is it you would like me to take from reading this book?

Dr. Vonda Wright 6:38 You know what? This book is specifically, uh, through the vision and voice of women, but many of the principles are directly applicable, especially the mindset principles, to men. But listen, all men are from women. S- y- all men were at one point in a woman's womb, right? So you, you must have a mother figure. Many men are partnered with women. You have sisters. You are in working relationships with women. The more understanding men have of the differences between what happens as a man ages and a woman ages, there will be a greater understanding and ability to work together, and, and even probably save a lot of midlife marriages because of an understanding that women go through a completely tumultuous time that is of not their choosing.

Dr. Rangan Chatterjee 7:28 Yeah.

Dr. Vonda Wright 7:28 It's just biology.

Dr. Rangan Chatterjee 7:30 Yeah, I love that. I mean, I, I, I believe that to be the case. I believe books like this can actually save many marriages.

Dr. Vonda Wright 7:35 Exactly.

Dr. Rangan Chatterjee 7:36 And I think it is very relevant to men.

Dr. Vonda Wright 7:40 Yes.

Dr. Rangan Chatterjee 7:40 Even though, you know, the strap line is A Woman's Guide to Ageing With Power.

Dr. Vonda Wright 7:44 [laughs]

Dr. Rangan Chatterjee 7:45 I really enjoyed reading it.

Dr. Vonda Wright 7:46 Mm-hmm.

Dr. Rangan Chatterjee 7:47 And of course, I'm married.

Dr. Vonda Wright 7:49 Yes, you are.

Dr. Rangan Chatterjee 7:50 Okay? Um, I, I help look after my elderly mum, so some of these things that you talk about-

Dr. Vonda Wright 7:54 Mm-hmm

Dr. Rangan Chatterjee 7:54 ... I have seen what happens if people don't pay attention. I have a daughter.

Dr. Vonda Wright 8:01 Yes.

Dr. Rangan Chatterjee 8:02 And I've heard you talk about the importance of bone health and how we get to our peak bone density maybe at 25 or 30.

Dr. Vonda Wright 8:09 Yes.

Dr. Rangan Chatterjee 8:10 And so this book has already made me think about, well, what is my daughter doing right now at 12 years of age-

Dr. Vonda Wright 8:16 Mm-hmm

Dr. Rangan Chatterjee 8:16 ... that's gonna ensure she's putting force and pressure through her bones to make sure she has the maximum bone capacity that she can have. So yeah, yes, it's for women. It's also just as relevant to men.

Dr. Vonda Wright 8:29 I love that you say that because, you know, particularly in reference to your daughter, is it's my intention, I have, I have two daughters and, and f- four daughters-in-law. It is my intention that they never suffer, because your... that, so that your 12-year-old and my 17-year-old and my 31-year-old will know what's going to happen, build solid bases of muscle and bone and, and brain health in their youth, know what's going to happen as estrogen walks out the door, and know where to have the resources. Because what's happened to certainly baby-booming women, certainly Generation X women, which we do not want to happen to the oldest millennial women who are 43, 44, is the hitting the wall phenomenon, not being yourself, cataclysmic changes. So for your 12-year-old and my 17-year-old, my vision and motivating factor is that they will never feel this.

Dr. Rangan Chatterjee 9:28 Yeah.

Dr. Vonda Wright 9:29 Mm-hmm.

Dr. Rangan Chatterjee 9:30 Let's take a big-picture view, right? You mentioned the differences between women and men. Of course, there are many differences.

Dr. Vonda Wright 9:37 Completely.

Dr. Rangan Chatterjee 9:38 But I saw you speak a couple of days ago in London.

Dr. Vonda Wright 9:41 Mm.

Dr. Rangan Chatterjee 9:41 And you put up some very provocative images.

Dr. Vonda Wright 9:45 Mm.

Dr. Rangan Chatterjee 9:45 They... Very, very thought-provoking. And one of them that I'm gonna make sure we pop up on screen-

Dr. Vonda Wright 9:51 Yes

Dr. Rangan Chatterjee 9:51 ... on the YouTube version of this-

Dr. Vonda Wright 9:52 Mm

Dr. Rangan Chatterjee 9:52 ... conversation, is how men and women's hormones change-

Dr. Vonda Wright 9:57 Yes

Dr. Rangan Chatterjee 9:57 ... through their life.

Dr. Vonda Wright 9:59 Mm-hmm.

Dr. Rangan Chatterjee 10:00 And the thing that I really took from this image was this idea that men have a gradual decline in testosterone over a number of decades.

Dr. Vonda Wright 10:10 Yes.

Dr. Rangan Chatterjee 10:11 Whereas women have this sharp, precipitous decline-

Dr. Vonda Wright 10:15 Mm-hmm

Dr. Rangan Chatterjee 10:15 ... in estrogen during perimenopause.

Dr. Vonda Wright 10:18 That's right.

Dr. Rangan Chatterjee 10:19 Could you speak to that-

Dr. Vonda Wright 10:20 Mm-hmm

Dr. Rangan Chatterjee 10:20 ... and speak to these more broad differences and why so many women go through what you went through, I think, at 47-

Dr. Vonda Wright 10:27 Yes

Dr. Rangan Chatterjee 10:28 ... which you can perhaps explain at some point.

Dr. Vonda Wright 10:29 Yes, I will.

Dr. Rangan Chatterjee 10:29 But just take us through what those differences are and how they manifest for us in terms of the quality of our lives.

Dr. Vonda Wright 10:36 So let's start back at the first big bump in the road for everyone who lives, which is adolescence, right? We come into our hormones. We all expect that to be an awkward stage.

Dr. Rangan Chatterjee 10:47 Mm-hmm.

Dr. Vonda Wright 10:47 We describe it as that. We describe it as, uh, all these body changes. It's something that we readily accept.

Dr. Rangan Chatterjee 10:53 Yeah.

Dr. Vonda Wright 10:54 And then after puberty, we enter our 20s, and by 30, our brains are fully formed, right? We mature our brains-

Dr. Rangan Chatterjee 11:02 Mm

Dr. Vonda Wright 11:02 ... in our late 20s. Same with bone and muscle, such that we reach peak, all of those tissues, by the time we're 30. At that point, we hit a little bit of a plateau, but then start, for men, to decrease their testosterone in a very slow, linear way, as you've described. Now, at some point in their 50s and early 60s, I see this, because I have, I have active men in my orthopedic practice. Sometimes men do get low enough on their testosterone that they're like, "I'm exhausted."

Dr. Rangan Chatterjee 11:34 Mm-hmm.

Dr. Vonda Wright 11:34 "I don't feel like myself. I'm popping tendons all over the place when I'm trying to do good work." And so we'll measure their testosterone, and it may be very large deltas different than what it was when we know what younger men are. So even for men, for my sons in their 30s, I'm asking them to get their testosterone checked-

Dr. Rangan Chatterjee 11:55 Right

Dr. Vonda Wright 11:55 ... in their youth, because when I test you again in your 50s, you may have a testosterone that's within the n- air quote, "normal range," which, in the United States, the normal range is 250 to 1,050.

Dr. Rangan Chatterjee 12:11 That's a big normal range. [laughs]

Dr. Vonda Wright 12:12 It's a big normal range. And so you may find at 50 that your testosterone is 600-Which is still normal, but you may have been 1,000-

Dr. Rangan Chatterjee 12:22 Mm

Dr. Vonda Wright 12:22 ... and you're gonna feel that. So even for men, being aware of your hormonal change, but that is not what happens for women. Women, after we reach our estrogen, every month we have this cyclical pattern of high and low estrogen that begets our menstrual cycle, which is normal. Our estrogen, uh, plateaus in our 30s, however, by the time we reach 40, and this is why this all happens, estrogen is predominantly made in women in the follicle or, like, the egg shell of our eggs, right? Here's the miracle of life. Every woman, your daughter, my daughter, me, your wife, we're born with all the eggs we are ever gonna have across our lifespan. So if we think about this in the universal sense, we're carrying generations of people at our b- Isn't that fascinating?

Dr. Rangan Chatterjee 13:21 Yeah.

Dr. Vonda Wright 13:21 Oh my God, to think about it like that. But when we're born, we have several million, and over time we lose a lot every month, such that by the time we're 40, it's estimated that we have 1 to 3% of those eggs left. So it's harder to produce enough estrogen.

Dr. Rangan Chatterjee 13:42 So, so women have lost 97 to 99%-

Dr. Vonda Wright 13:45 Yes

Dr. Rangan Chatterjee 13:46 ... of the eggs that they were born with-

Dr. Vonda Wright 13:47 Yes

Dr. Rangan Chatterjee 13:48 ... by the age of 40.

Dr. Vonda Wright 13:49 That's right, and it... and if the eggs are producing the estrogen that you need, once you have so few l- eggs left, uh, estrogen starts to decline, which makes our brain a little urgent-

Dr. Rangan Chatterjee 14:02 Mm

Dr. Vonda Wright 14:03 ... to have more estrogen. So it produces a hormone called follicle-stimulating hormone, which tries to ramp up this egg process, and it becomes hormonally a little chaotic. Like, if you measured a woman's hormones in the morning on one day and the morning of the next day, they could be completely in different ranges during the perimenopausal time. Well, that fluctuation in hormone levels is why women first start saying things like, "I just don't feel like myself." Or they'll say things like, "I am doing the exact same thing I've always done, but I'm gaining weight," or, "I'm not able to progress in my workouts." Or, uh, it's, it's when the most common manifestations of perimenopause happen, night sweats, brain fog, can't remember nouns, the, these changes that are due to estrogen. Because here's what people forget. Not only are we at 1% of our eggs which produce the estrogen by the time we're about 40, estrogen, progesterone, and testosterone are not sex hormones. They are hormones, like thyroid-stimulating hormone, like growth hormone, like every communicating molecule we have. I say that to say there are estrogen receptors, like little baskets to hold the estrogen, on every organ system in the body, from the brain to the gut to muscle to bone. So if these receptors are not being filled with the normal estrogen, nothing that they cause downstream is gonna happen, thus the brain fog, thus the heart palpitations, thus the night sweats. Or things that people don't consider, but my group and I wrote a paper on last summer, the musculoskeletal syndrome-

Dr. Rangan Chatterjee 16:01 Yeah

Dr. Vonda Wright 16:01 ... of menopause, where women, I had this, their entire bodies hurt because estrogen is a profound anti-inflammatory. So it seems like a lot, and it is. And so men are slowly declining in their testosterone. Women have this precipitous drop. I, I, I kiddingly say, estrogen walks out the door, she slams the door, she never looks back, right? And, and we feel that until the time when the arbitrary day, I, I firmly believe that the day of menopause, the 366th day after our last period when we say, "Oh, she's in menopause," it's an arbitrary number, right?

Dr. Rangan Chatterjee 16:48 It's just one day, isn't it?

Dr. Vonda Wright 16:49 It's one day. You've been losing estrogen for, for a l- five to seven years, sometimes a decade, and then after that day, you're post-menopausal for 40 years. And so this is the reason men and women age differently, to circle the conversation back. It's because of the differences in our hormones.

Dr. Rangan Chatterjee 17:11 Yeah. So essentially, are you saying that when a woman, of course, there's multiple possible factors that contributes here, but generally speaking, when a woman in her mid-late 30s-

Dr. Vonda Wright 17:27 Mm-hmm

Dr. Rangan Chatterjee 17:27 ... maybe early 40s-

Dr. Vonda Wright 17:29 Mm-hmm

Dr. Rangan Chatterjee 17:29 ... suddenly feels life is a bit more of a struggle-

Dr. Vonda Wright 17:32 Mm-hmm

Dr. Rangan Chatterjee 17:33 ... the things that they used to do are no longer working so well-

Dr. Vonda Wright 17:37 Mm-hmm

Dr. Rangan Chatterjee 17:37 ... you're basically saying that for some of those women, the precipitating event is that decline in estrogen?

Dr. Vonda Wright 17:46 Yes. There is a normal, natural aging process, and in the book I talk about what I call the time bombs of aging. They're actually the hallmarks of aging. We know aging happens at a cellular level, but women have stacked on top the loss of estrogen. Let... Do you mind if I give you a couple organ examples?

Dr. Rangan Chatterjee 18:05 Oh, take your time.

Dr. Vonda Wright 18:07 In the brain, for instance, the work of Lisa Mosconi has shown that the brain is covered, literally covered, with estrogen receptors. The work of Robbie Brinton-A brain scientist has shown that without estrogen sitting in those receptors, the brain literally starves and changes its chemistry. That's why it manifests as brain fog. We can't find our keys. We can't remember why we walked into a room. For me and many other women, I forgot nouns. Imagine this, I tell this story all the time, and I wanna tell everybody my brain is back. It's as good as it ever was because of the estrogen that I take now. But when I, bef- in my critical decade, before I became an expert on this, I would walk into the operating room, and I would know exactly what I was gonna do, and I was gonna know exactly how to do it, but I forgot the name of the piece of equipment that picks things up. And I would say to my scrub tech, "I need the thing..." For those of you listening, I'm, I'm doing a pincing motion. "I need the thing that does this thing." I needed a Nansen, which is a, which is a forcep.

Dr. Rangan Chatterjee 19:19 Mm-hmm.

Dr. Vonda Wright 19:19 I could-- I knew exactly what I was doing, but I lost my nouns, and I frankly thought that I was getting dementia. So I start googling early signs of dementia. Think how frightening that is for a brain person.

Dr. Rangan Chatterjee 19:30 That is, yeah.

Dr. Vonda Wright 19:31 Yeah. My... I'm a brain person. My brain's the best part of me. There's that. Many women experience that. Um, and I don't think it ends there. These mechanisms are not clearly worked out, but there must be a reason that 70% of all people with Alzheimer's are women. It can't just be coincidence. I think we're gonna work out the mechanisms to find that although multifactorial, it has to do with estrogen sharply declining. So that's the brain. The heart has an increase of 30% to 40% of microvascular disease.

Dr. Rangan Chatterjee 20:05 Mm-hmm.

Dr. Vonda Wright 20:05 When men's hearts have, have, uh, disease, it's in the big, major vessels. For women, it's in the much smaller vessels, so it goes undetected a lot of times. But we know that estrogen plays a critical role in heart health. If we get to musculoskeletal health, which is obviously where I live, there's a natural rate of decline of bone for men and women of about f- 1% a year in their bone density. During perimenopause, that precipitously increases to 2% to 3% a year so that over five to seven years, 10 years, you can lose 20% of your bone density. So if you've never built enough bone as a child, and now you're gonna lose 20% of it predictably, that's why 70% of all hip fractures are in women. Muscle is the same way. We will lose 8% to 10% of our muscle, um, mass in the decades surrounding perimenopause. The list goes on-

Dr. Rangan Chatterjee 21:03 Mm-hmm

Dr. Vonda Wright 21:04 ... and on and on. And so when I say men and women age differently, the most direct contributing factor, lifestyles being equal, has to be, at least in part, due to our estrogen.

Dr. Rangan Chatterjee 21:16 Yeah, it's interesting. Simply calling estrogen a sex hormone is so limiting-

Dr. Vonda Wright 21:22 Oh

Dr. Rangan Chatterjee 21:22 ... isn't it? These labels we put on these things.

Dr. Vonda Wright 21:27 Yes.

Dr. Rangan Chatterjee 21:27 And I feel medicine's done this in many different places.

Dr. Vonda Wright 21:30 Mm-hmm.

Dr. Rangan Chatterjee 21:31 Actually, there's been unintended consequences, right? So by viewing estrogen purely as a sex hormone, we therefore don't think about the effects of estrogen-

Dr. Vonda Wright 21:42 Yes

Dr. Rangan Chatterjee 21:42 ... on the brain-

Dr. Vonda Wright 21:43 Mm-hmm

Dr. Rangan Chatterjee 21:43 ... or the heart-

Dr. Vonda Wright 21:44 Mm-hmm

Dr. Rangan Chatterjee 21:44 ... or the bone. And you could sort of make the same case, like, with exercise, right, or physical activity, how for many years in society it was about weight.

Dr. Vonda Wright 21:56 Yeah.

Dr. Rangan Chatterjee 21:56 Physical activity is what you need to do to maintain a healthy weight.

Dr. Vonda Wright 22:01 Mm.

Dr. Rangan Chatterjee 22:01 And I would say, I think, over the last five or 10 years, realizing that your muscles aren't just dumb muscle sitting there.

Dr. Vonda Wright 22:09 [laughs]

Dr. Rangan Chatterjee 22:09 They're also important for your hormones-

Dr. Vonda Wright 22:12 Mm-hmm

Dr. Rangan Chatterjee 22:12 ... and all kinds of communication molecules around the body. And then yesterday, I was watching this beautiful 30-minute video on your YouTube channel about-

Dr. Vonda Wright 22:20 Oh

Dr. Rangan Chatterjee 22:20 ... bone.

Dr. Vonda Wright 22:20 Yes.

Dr. Rangan Chatterjee 22:21 And I was thinking the same thing with bone, right?

Dr. Vonda Wright 22:23 Yes.

Dr. Rangan Chatterjee 22:24 Like, muscle has had a PR job over the last five years, where we now understand that muscle is important for so much more than our physicality.

Dr. Vonda Wright 22:32 Yes.

Dr. Rangan Chatterjee 22:32 And I feel with that video [laughs] and in this book, you're almost giving this kind of new marketing to bone, saying, "Hey, bone isn't just your structure."

Dr. Vonda Wright 22:41 That's right. [laughs]

Dr. Rangan Chatterjee 22:42 Bone does so many other things.

Dr. Vonda Wright 22:45 Absolutely, and I'm so glad you're giving time to this on this podcast because it is now a, a vision and mission of mine to help people understand a- and care about their bones. I mean, it's Fashion Week in around the world right now, and that's about the only time we think about bones is, oh, gorgeous cheekbones.

Dr. Rangan Chatterjee 23:04 [laughs]

Dr. Vonda Wright 23:04 Look at our wrist structure, or when we fracture, obviously. Bones are seemingly silent until they break, and then they're screaming 'cause that's excruciating. But the reality is bones have so many functions in the body. From structure, sure, they're structural. Otherwise, you know, think about it. I love to say this out loud, that without bones, muscle that we're all in love with is just this heaping pile of metabolic tissue like a chicken breast on the counter. It does nothing but lay there. But with bone, you have structure. It gives you human form. It gives you locomotion, but it is a master communicator. Bone produces a multitude of hormones, one of which, uh, I talked about on that video you're referencing, called osteocalcin.

Dr. Rangan Chatterjee 23:54 Yeah.

Dr. Vonda Wright 23:54 Yeah. Osteocalcin is released by the bone. It goes to your brain. It causes your brain to secrete bone-derived neurotrophic factor, which builds better neurons. So bone is helping you build a better brain, yes. It goes to your muscles and helps with glucose absorption. It goes to your pancreas for insulin, uh, release and resistance. In men, it goes to the testicles and helps you produce testosterone. There are gut, uh, bone-brain axes. There are bone-gut axes that are only being worked out. AndNot only do they talk to the rest of the body, but they are intimately talking to muscle and fat.

Dr. Rangan Chatterjee 24:39 Mm.

Dr. Vonda Wright 24:40 Because the musculoskeletal system, fat, tendon, ligament, bone, muscle, muscle stem cells, are all from the same stem cell originally, the mesenchymal stem cell. They're all cousins. Why wouldn't they talk to each other and do so in a way that coordinates the whole body? And so not only is it a master c- a structural master communicator, it is the storehouse of all the minerals we need for our body to function, the calcium, the phosphorus, a lot of collagen. Bone is made out of collagen. When your body needs it to live, it will take it from the storehouse. It's not abnormal to resorb bone. What's abnormal is a disconnect between reabsorption and rebuilding s- because we use the products we store in our bone. It is also, believe it or not, the incubator of all of our blood cells. All of your blood cells are made in your pelvis, and when you're young, in your long bones. So if we were gonna do a stem cell therapy on you, we would get your stem cells from your pelvis.

Dr. Rangan Chatterjee 25:47 Mm-hmm.

Dr. Vonda Wright 25:48 Isn't that fascinating-

Dr. Rangan Chatterjee 25:49 Yeah

Dr. Vonda Wright 25:49 ... that bones are doing all these things? And listen, if I were designing a human being, why wouldn't I make bone the master communicator? Because we have bone from the top of our skull to the bottom of our pinky toe. It's a highway for communication. But you're right, we never think about it unless we're thinking about fracture. And it's funny, people say bones are silent. Bones are not silent, but we just can't hear them-

Dr. Rangan Chatterjee 26:16 Yeah

Dr. Vonda Wright 26:16 ... until they break. And I'm gonna tell you from being in the trauma bay many years, it's excruciating, and I never want someone to have to deal with it. But we think about it, especially bone health with aging, because as we lose our bone density and break big bones like the femur or, you know, the top of the femur is the hip, um, especially in women, men break their bones, too. M- uh, uh, let's just talk about this. Two million men in the United States have osteoporosis. It's not just a disease of women, but more prevalent in women. 70% of all hip fractures, which is the biggest bone in the body, happen in women. The instant, literally the instant, snap your fingers, the instant you break that bone, you have a 30% chance of dying in the next year. I mean, that's grave. Isn't that? That is a grave statistic, that if we could think about our 12-year-old and our 17-year-old daughters that we have, to get their bones so strong at peak mass that they never reach that point.

Dr. Rangan Chatterjee 27:23 Yeah.

Dr. Vonda Wright 27:24 So 30% of the time, Aunt Miriam, who's a story I told to the FDA in the United States recently as we're trying to change the thoughts about estrogen, 30% of the time she's gonna die, and if you live, 50% of the time you will not return to the home that you came from because you don't have the functional strength or, or you can't get up from a chair anymore. So bone is... That kind of fracture is not only a personal pain, it's a family and social dilemma. What do we do with Mom, right? Do we hire a full-time caregiver? That's expensive. Do we have her move in? You know, in some cultures, and I'm Chinese, in my culture, that's what would happen.

Dr. Rangan Chatterjee 28:11 Mm-hmm.

Dr. Vonda Wright 28:11 I mean, my parents live with me, 'cause that's just what we do. But in many cultures, that's not what you do. You find a place for your parents to live. Well, if you find a place for your parents to live, that is prohibitively expensive many places, and so in the United States, you must use your life savings to pay for that at the rate of 5 to $15,000 a month until you're a pauper, and that's when the Medicaid-

Dr. Rangan Chatterjee 28:38 Yeah.

Dr. Vonda Wright 28:38 Who wants to be in that situation?

Dr. Rangan Chatterjee 28:41 The difficulty is, Vonda, is that... I mean, as you, as you were talking there, I got flashbacks to when I qualified as a doctor. So my first job at the Royal Infirmary of Edinburgh in 2001, when I came out of medical school, was as a junior house officer, which is what we called it back then, in the orthopedic wards-

Dr. Vonda Wright 29:02 Oh. [laughs]

Dr. Rangan Chatterjee 29:02 ... at the Royal Infirmary. And I can still remember.

Dr. Vonda Wright 29:04 Yes.

Dr. Rangan Chatterjee 29:04 I think the first two months of my placement was doing orthopedics.

Dr. Vonda Wright 29:09 Yeah.

Dr. Rangan Chatterjee 29:09 And I just... I can just remember the ward, and it was mostly women.

Dr. Vonda Wright 29:14 Yes.

Dr. Rangan Chatterjee 29:15 Frail, older women who had neck of femur fractures.

Dr. Vonda Wright 29:19 Yes.

Dr. Rangan Chatterjee 29:20 Right? And I didn't know then what I know now. Of course, I was junior doctor, just come out of medical school.

Dr. Vonda Wright 29:26 Yeah, right.

Dr. Rangan Chatterjee 29:26 But I can look at that now, you know, through a different lens-

Dr. Vonda Wright 29:31 Mm-hmm

Dr. Rangan Chatterjee 29:32 ... from everything you just shared, why it affects women so much.

Dr. Vonda Wright 29:35 Mm.

Dr. Rangan Chatterjee 29:35 This is huge. But how do you get a woman in their late 30s who is in what you call the critical decade-

Dr. Vonda Wright 29:44 Yes

Dr. Rangan Chatterjee 29:44 ... which you can perhaps explain in a moment-

Dr. Vonda Wright 29:47 Yes

Dr. Rangan Chatterjee 29:47 ... to actually care about this neck of femur fracture that they might get at 75?

Dr. Vonda Wright 29:52 Yeah.

Dr. Rangan Chatterjee 29:52 Because that seems like, "Oh, yeah, whatever," you know.

Dr. Vonda Wright 29:55 I'll deal with it then.

Dr. Rangan Chatterjee 29:55 I'm still active.

Dr. Vonda Wright 29:56 Mm-hmm.

Dr. Rangan Chatterjee 29:56 I can still pick the kids up, and I can still see my girlfriends at the weekend and-

Dr. Vonda Wright 30:00 Mm-hmm

Dr. Rangan Chatterjee 30:01 ... you know. How do you get someone in their 30s or 40s to care about those bone density implications later on in life? It's difficult, isn't it?

Dr. Vonda Wright 30:13 It's so hard, because there's a temporal disconnect. There's this, there's this banking idea, I learned it from my bankers, that they experience called tem- temporal disconnect. On average, they cannot get the average person to save $10 for their s- fu- for their pension, right? It's the same in health.I cannot get people motivated in their youth for their old age. So for the women and men in the critical decade, which I call 35 to 45-

Dr. Rangan Chatterjee 30:41 I love that. Is, is it just for women though, or is it for men as well?

Dr. Vonda Wright 30:44 No, it's for men. It is time to get your proverbial health standards in check, because if you build a lifestyle where you're eating a non-inflammatory, high-protein diet so that you're able to build, or if you're eating at all, many women decide not to eat enough.

Dr. Rangan Chatterjee 31:01 Mm.

Dr. Vonda Wright 31:01 We can talk about that. If you've got your food down, and it doesn't mean you can't live and have an occasional... I, you know what, I had a piece of chocolate before I walked in here. I'm not talking about austerity. The standards of nutrition, a muscle-building practice, a cardiovascular building practice, it's a lifestyle to you. It is not a burden-

Dr. Rangan Chatterjee 31:22 Mm

Dr. Vonda Wright 31:22 ... if that's just the way you live.

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Dr. Vonda Wright 34:24 The critical decade is the time to get that in order before you lose your hormones, right? For women, once you hit your mid-40s, now you're adding that burden that we already discussed.

Dr. Rangan Chatterjee 34:38 Yeah. It's almost as if we can kind of get away with things until our mid-30s, right?

Dr. Vonda Wright 34:42 That's right.

Dr. Rangan Chatterjee 34:42 So yeah, there are health-promoting things to do, but even if you don't do them-

Dr. Vonda Wright 34:48 You'll skim by

Dr. Rangan Chatterjee 34:49 ... you still seem to get by-

Dr. Vonda Wright 34:50 Mm-hmm

Dr. Rangan Chatterjee 34:50 ... or a lot of us do in our 20s and early 30s.

Dr. Vonda Wright 34:54 Yeah.

Dr. Rangan Chatterjee 34:54 But then there does tend to come a point in most people's lives where it's like, "Well, wait a minute. If I don't pay attention to this-

Dr. Vonda Wright 35:02 Yes

Dr. Rangan Chatterjee 35:03 ... there are consequences." And of course, hormones are one of the big reasons for that.

Dr. Vonda Wright 35:08 Mm-hmm. Mm-hmm.

Dr. Rangan Chatterjee 35:09 I, I can't get this idea out of my head about, how do we get people to care about their bones early on in life and build that foundation to protect them later on in life? And I know from hearing you speak that you do DEXA scans with a lot of your patients.

Dr. Vonda Wright 35:25 All of them.

Dr. Rangan Chatterjee 35:26 Now, interestingly enough, in the NHS, the National Health Service here in the UK-

Dr. Vonda Wright 35:30 Mm-hmm

Dr. Rangan Chatterjee 35:30 ... it's not that easy to get a DEXA scan.

Dr. Vonda Wright 35:32 Mm-mm. It is not.

Dr. Rangan Chatterjee 35:33 Right? You have to meet certain criteria.

Dr. Vonda Wright 35:35 Yeah.

Dr. Rangan Chatterjee 35:36 But let's just flip it. If we were designing something from scratch and going, "Okay, bone health is important, but we need men and women to really focus on their bone health early on in life."

Dr. Vonda Wright 35:50 Yes.

Dr. Rangan Chatterjee 35:51 Teenagers, in their 20s, in their 30s. How are we gonna get them to do that? Oh, well, what if every single 20-year-old got a DEXA scan?

Dr. Vonda Wright 36:00 Mm-hmm.

Dr. Rangan Chatterjee 36:01 And then we could show them, this is the state of your bone health. Is that a good idea? Is that a flawed idea?

Dr. Vonda Wright 36:09 Mm.

Dr. Rangan Chatterjee 36:09 How would you put all that together for me?

Dr. Vonda Wright 36:11 I think in this day and age, data drives people. And so I have proposed that, um, we get a, a DEXA scan, which measures bone density, which is the mineralization, and if it's available where you are, which it is in the UK and Australia, and we're getting them in the US, an ultrasound, uh, which tells bone quality.And here's why that's important. Every time you take a step, the bone will bend a little. When it, you, when you put more pressure on it and it bends too much, it'll break, right? So we need to know the quality of the bone. You tell that with a REMS ultrasound scan, which are available here. We should have that in our critical decade. You know, we peak out at 30. Let's get it between 30 and 40, just like you get a mammogram, so that we know where we're starting, because here's the deal. If I get, I get these scans on people, and I find 30-year-olds with very bad bone because they've never built it. Well, then, we can do all the things to build better bone, including hormone optimization, jumping around, muscle building, a smart high-protein nutrition, because research finds that you need a, for the best fracture pre- prevention, a 10-year lead. It's okay to start these things when you're 55 or 60, but it's better if it's your lifestyle. But let's-

Dr. Rangan Chatterjee 37:41 Is it like an MOT? Well, um, I don't know if you have MOTs.

Dr. Vonda Wright 37:45 What is that?

Dr. Rangan Chatterjee 37:45 An MOT is something we have in the UK. So if your car is over three years old-

Dr. Vonda Wright 37:50 Uh-huh

Dr. Rangan Chatterjee 37:51 ... it has to undergo an annual MOT.

Dr. Vonda Wright 37:53 Exam, yeah.

Dr. Rangan Chatterjee 37:54 Okay? So to, to check that it's roadworthy-

Dr. Vonda Wright 37:56 Mm-hmm

Dr. Rangan Chatterjee 37:56 ... and if there's anything, problems with your tires or, I don't know, the wipers, you know, you-

Dr. Vonda Wright 38:02 Ironic that we do it for cars.

Dr. Rangan Chatterjee 38:04 Yeah.

Dr. Vonda Wright 38:05 We do it in the United States when we, every year we get our, uh, uh, new tag, and you have to have an emissions test.

Dr. Rangan Chatterjee 38:11 Yeah.

Dr. Vonda Wright 38:11 Yeah. Ironic.

Dr. Rangan Chatterjee 38:12 But what this, so, so what I, what I'm thinking is, I think I heard, did you say you've, you've seen 24-year-olds with osteopenia?

Dr. Vonda Wright 38:18 Oh, yeah, completely.

Dr. Rangan Chatterjee 38:19 Okay, so this is alarming, right? So, and, and this perhaps goes into the more societal piece over what conditioning women have been exposed to-

Dr. Vonda Wright 38:28 Mm-hmm

Dr. Rangan Chatterjee 38:29 ... for many years-

Dr. Vonda Wright 38:30 Mm-hmm

Dr. Rangan Chatterjee 38:30 ... and what women think they need to do-

Dr. Vonda Wright 38:32 Yes

Dr. Rangan Chatterjee 38:32 ... in order to look a certain way.

Dr. Vonda Wright 38:34 Yes.

Dr. Rangan Chatterjee 38:34 But why is it? I mean, do you remember that 24-year-old with osteopenia? What, why did she have-

Dr. Vonda Wright 38:40 Why? Mm-hmm

Dr. Rangan Chatterjee 38:41 ... poor bone density in her 20s?

Dr. Vonda Wright 38:43 I've given this a lot of thought, and, and the first thing I'm gonna say is that we think of osteoporosis and bone health as a disease of old ladies. Osteoporosis is a disease of young ladies that manifests when you're old. You begin this problem when you're young, and why is that? Well, number one, still, despite all the progress we've made, women are still taught to be teeny-tiny and take up no space and not eat a lot of food. Women think that they're gonna be healthiest if they don't eat a lot, and even though we've made progress, um, I'm, I am not against GLP-1s at all. They have some profound metabolic effects, but I fear that we're tipping the, the needle back to skinny is better, um, without using those with high protein and lifting practices, and we can talk about that. But the mantra that women must be skinny and not eat leaves many women with not enough materials and maybe not menstrual cycles and estrogen production in their youth. So that's number one. Number two, on the other side of the coin, we have had, uh, 54 years of rising equality in women's sports. It's the World Cup right now, right? The Rugby World Cup, uh, uh, in the world, and we've got great athletes. But what happens, as a sports doctor, I'll tell you that if you're burning 10,000 calories a day as a woman on the soccer pitch, uh, on the football pitch, that you have to replace that with something besides gummy worms, and, and you have to eat that many calories, and that's just not the culture of women to have training tables like it is for men. So maybe, uh, you're not eating enough and you're little. Maybe you're exercising so much and not replacing enough. And then the third reason I think we're seeing it, uh, is everybody's a digital native right now. Lo- gone are the days, we were not digital natives. We did not grow up with a cellphone. It came later in our you- in our growing up. All of our children now are scrolling, despite our, our best efforts, for long periods of time. We are no longer safe just to send our kids out to play for hours and hours. They're more sedentary.

Dr. Rangan Chatterjee 41:03 Mm-hmm.

Dr. Vonda Wright 41:03 So they're not bashing their bones and building bone. So you get to the peak building years not having built peak bone.

Dr. Rangan Chatterjee 41:12 Mm-hmm.

Dr. Vonda Wright 41:13 And then, so that accounts for the 20-year-olds and the 24-year-olds. I had a physics PhD student who was skinny fat, meaning she was thin as a rail, but she was sedentary, and she did not have lean muscle mass, and nor did she have high bone density. I have athletes in my clinic who are trying their best, but they're amenorrheic, meaning no periods for six to nine months because they have relative energy deficiency, and with low energy, your body goes into survival mode-

Dr. Rangan Chatterjee 41:45 Yeah

Dr. Vonda Wright 41:45 ... and doesn't produce, I mean, you're not, it, your body doesn't want you to have a child-

Dr. Rangan Chatterjee 41:49 No

Dr. Vonda Wright 41:49 ... when you're starving, which is what your body thinks you are, and so it doesn't cycle.

Dr. Rangan Chatterjee 41:54 Yeah.

Dr. Vonda Wright 41:54 I mean, does, that makes so much sense.

Dr. Rangan Chatterjee 41:56 Yeah, and I guess also one thing we're seeing across many countries now is a rise in eating disorders.

Dr. Vonda Wright 42:02 Mm.

Dr. Rangan Chatterjee 42:02 Um, yes, in men and, in boys and girls-

Dr. Vonda Wright 42:05 Mm-hmm

Dr. Rangan Chatterjee 42:06 ... in men and women.

Dr. Vonda Wright 42:06 Mm-hmm.

Dr. Rangan Chatterjee 42:06 But of course, if you're a woman-

Dr. Vonda Wright 42:09 Mm

Dr. Rangan Chatterjee 42:09 ... and you've had an eating disorder-

Dr. Vonda Wright 42:11 Mm-hmm

Dr. Rangan Chatterjee 42:11 ... and for a period of time have not been properly or adequately nourishing your body-

Dr. Vonda Wright 42:16 Mm-hmm

Dr. Rangan Chatterjee 42:16 ... for whatever reason-

Dr. Vonda Wright 42:17 Yeah

Dr. Rangan Chatterjee 42:17 ... which of course we need to-

Dr. Vonda Wright 42:19 Lots of reasons

Dr. Rangan Chatterjee 42:19 ... sensitively address.

Dr. Vonda Wright 42:20 Mm-hmm.

Dr. Rangan Chatterjee 42:20 That's going to have an impact.

Dr. Vonda Wright 42:22 Yeah.

Dr. Rangan Chatterjee 42:23 It's quite interesting that, I think you mentioned there was a, a PhD student in her 20s, and she was thin, skinny fat, I think you described her.

Dr. Vonda Wright 42:32 Skinny fat.

Dr. Rangan Chatterjee 42:32 And she was, um, performing well, right? So i- i- you know, what's interesting about that for me is that that individual probably thinks life's fine. "I'm skinny. I'm the way I wanna look."

Dr. Vonda Wright 42:43 Yeah.

Dr. Rangan Chatterjee 42:43 "I'm able to study."But perhaps my lifestyle, without me realizing it, has neglected my bones.

Dr. Vonda Wright 42:51 Mm-hmm.

Dr. Rangan Chatterjee 42:51 And as you say, of course, you know, the kids today are digital natives.

Dr. Vonda Wright 42:56 Yes.

Dr. Rangan Chatterjee 42:56 And it's something my wife and I are constantly talking about with our kids. I mean, my daughter's 12, and she got into netball about three years ago.

Dr. Vonda Wright 43:05 Mm-hmm.

Dr. Rangan Chatterjee 43:05 And so she probably plays five times a week.

Dr. Vonda Wright 43:08 Mm.

Dr. Rangan Chatterjee 43:09 And I'm delighted because she enjoys playing, her friends are there-

Dr. Vonda Wright 43:14 Mm-hmm

Dr. Rangan Chatterjee 43:14 ... so there's this big social component.

Dr. Vonda Wright 43:16 Mm-hmm.

Dr. Rangan Chatterjee 43:16 And I'm thinking, actually, you know what, if I think about netball through the lens of bone health-

Dr. Vonda Wright 43:23 Mm-hmm

Dr. Rangan Chatterjee 43:23 ... there's a lot of impact-

Dr. Vonda Wright 43:25 Nice

Dr. Rangan Chatterjee 43:25 ... a lot of jumping-

Dr. Vonda Wright 43:26 Yes

Dr. Rangan Chatterjee 43:26 ... a lot of speed. Um, I'm thinking, this is good.

Dr. Vonda Wright 43:29 Multidirectional jumping, perfect.

Dr. Rangan Chatterjee 43:33 Yeah, and I'm thinking, this is good, right?

Dr. Vonda Wright 43:35 Mm-hmm.

Dr. Rangan Chatterjee 43:35 Because there's a social component for her.

Dr. Vonda Wright 43:39 Mm-hmm.

Dr. Rangan Chatterjee 43:39 And as a side effect, she's getting all of this great movement in.

Dr. Vonda Wright 43:43 Yes.

Dr. Rangan Chatterjee 43:44 I think the difficulty for me would be is, well, if she wasn't into netball, actually, and I know a lot of, uh, parents face this, if their children don't enjoy a particular sport-

Dr. Vonda Wright 43:54 Yeah

Dr. Rangan Chatterjee 43:54 ... they could hear a podcast like this-

Dr. Vonda Wright 43:55 Mm-hmm

Dr. Rangan Chatterjee 43:56 ... and think, "Well, hold on a minute. What are my kids actually doing-

Dr. Vonda Wright 44:00 Mm-hmm

Dr. Rangan Chatterjee 44:00 ... to build their bone density?"

Dr. Vonda Wright 44:02 Yeah.

Dr. Rangan Chatterjee 44:02 I mean, they go to school, they come back, they're on screens, or whatever it might be.

Dr. Vonda Wright 44:06 Mm-hmm.

Dr. Rangan Chatterjee 44:07 I mean, this is urgent, isn't it?

Dr. Vonda Wright 44:09 It's critical. And to that, if a parent is recognizing that their kid isn't playing netball, or my youngest daughter was a ballet dancer, she's not in the studio 20 hours a week, I am a firm believer, and I say this with the most love in my heart for mothers and fathers, I am the mother of a blended family of six children, so I get raising children, um, from a very youngest age, kids will do what we show them.

Dr. Rangan Chatterjee 44:36 Yeah.

Dr. Vonda Wright 44:37 So if you want healthy children, you must be healthy yourself. They will grow up knowing that juice will rot their teeth and is bad for them. They will get down on the floor with you and play on a foam roller.

Dr. Rangan Chatterjee 44:50 Mm.

Dr. Vonda Wright 44:50 And I don't say that in any kind of judgment. I say that with the reality of, of that many children in my life, and now three grandchildren, who will do whatever I'm doing. So if we want healthy children, let's show them. So if, if your daughter's peers don't play this sport, which I think is just f- so fantastic, maybe it becomes a family affair.

Dr. Rangan Chatterjee 45:16 Yeah.

Dr. Vonda Wright 45:17 And it becomes what the family does. We do some kind of fun thing together that, oh, by the way, just happens to involve jumping and running and walking and-

Dr. Rangan Chatterjee 45:26 Because what, hey, kids love jumping and doing that stuff.

Dr. Vonda Wright 45:29 Oh, playing.

Dr. Rangan Chatterjee 45:30 Like, they don't necessarily need to know that when you jump, you're putting-

Dr. Vonda Wright 45:33 [laughs] That's right

Dr. Rangan Chatterjee 45:33 ... sheer force through your bones, and the osteoclasts are getting stimulated. And, like, sure, some of them do. Maybe my kids have heard that from me. But in general, like, kids like to jump around.

Dr. Vonda Wright 45:43 To play. And you know, when I'm advising adults right now, one of the things when we're talking about building better bone is I'm encouraging people to jump, and I'm, and, and when I'm talking about the cardio that I prescribe, I'm asking them to sprint. Well, when we think of the passage of time, we were talking about this earlier, people give up one thing at a time and don't even realize they're doing that. And the fun play activities that kids just do, like jumping and running, that are so healthy, they give up one at a time. But if it's a family affair-

Dr. Rangan Chatterjee 46:17 Mm-hmm

Dr. Vonda Wright 46:17 ... and it's just what our family does, maybe they won't give it up as soon, and it'll get the parents back into those behaviors that will build their bones.

Dr. Rangan Chatterjee 46:27 Going back to this idea that women and men age differently-

Dr. Vonda Wright 46:31 Yes

Dr. Rangan Chatterjee 46:31 ... I'm really interested as to what happens when a woman gets pregnant.

Dr. Vonda Wright 46:37 Oh.

Dr. Rangan Chatterjee 46:38 Because I know that can have an impact-

Dr. Vonda Wright 46:40 Completely, yes, uh-huh

Dr. Rangan Chatterjee 46:41 ... on bone health, and breastfeeding can as well.

Dr. Vonda Wright 46:43 Yes, mm-hmm.

Dr. Rangan Chatterjee 46:44 So can you just talk us through that?

Dr. Vonda Wright 46:46 Yes.

Dr. Rangan Chatterjee 46:46 Because again, I think it's empowering to realize the impact of those things-

Dr. Vonda Wright 46:51 Yes

Dr. Rangan Chatterjee 46:52 ... and therefore what we can do on the other end.

Dr. Vonda Wright 46:54 Completely love that you brought that up, because if we talk about that bone is a lifespan pursuit, we just talked about the young women, then when women enter their fertility years, when they're choosing to have children, or if you don't, bones are still of concern to you, but during pregnancy, we are building a baby from ourselves. The baby's not eating itself. The baby is eating the mother, either through the nutrients coming in, or if there's not enough, from her muscle, from her bone. Takes about 500 milligrams of calcium a day to build a baby. Where are we getting that? We're either absorbing it from the gut and then passing it to the baby, or we're resorbing the mother's bone.

Dr. Rangan Chatterjee 47:34 Um, and just for people who don't know what resorb means?

Dr. Vonda Wright 47:37 Yes. It means that there's a, the way bone works, just as a bone building primer, how bones work, our bones are constantly doing something called remodeling, meaning taking a little bit away, building a little bit up. It's two different cell types. The osteoclast, with a C, is taking bone away, and then you use all the minerals that you've harvested. And then the osteoblast, B, blast, is building bone.

Dr. Rangan Chatterjee 48:04 Mm.

Dr. Vonda Wright 48:04 And in normal circumstances, with enough hormones, that is a, a pretty equal process. Homeostasis, balance.

Dr. Rangan Chatterjee 48:11 Mm-hmm.

Dr. Vonda Wright 48:12 Those are all synonyms. If your body requires more than you're able to build or replace, you will get in bone deficit. That can happen during pregnancy if we're not getting enough nutrition. The mother's body will prioritize the baby and resorb what it needs, regardless of what happens to the mother, such that-

Dr. Rangan Chatterjee 48:36 Mm

Dr. Vonda Wright 48:36 ... there is a, a phenomenon called the osteoporosis of pregnancy. It's a documented medical phenomenon. Because women can lose a significant amount of bone density. Now, here's the good thing.Our bodies know this is gonna happen, and we are, we are designed to rebuild that bone, uh, post-pregnancy, but only if we eat enough. Mothers get busy. Sometimes they don't have time to take a shower, let alone eat, right? Pile on top of that breastfeeding. Now, I always like to have the caveat based on responses I've got that I am all for breastfeeding for women who choose to do it. I breastfed my youngest child for a year. I think it was that important. Where are we get... Again, it's the same argument. Where are we getting the nutrients from? It takes 500 milligrams of calcium a day to make enough milk for a baby. We're gonna take that from our bones. So every time your baby latches on, in addition to drinking water, we have to be thinking about replacing-

Dr. Rangan Chatterjee 49:36 Mm

Dr. Vonda Wright 49:36 ... our calcium, our magnesium, our phosphorus, so that we don't end up in deficit. Because now with women, uh, millennial women delaying childbirth into their early 30s, mid-30s, um, we're entering the critical decade, right? So we have less time to build bone back, and then what if we're having children more rapidly at an older age, and so we may never have time to build back? I just want people, women to be aware, right? Because you can correct that. But if you never correct that, and then we've already talked about what happens in perimenopause, losing 15 to 20% of your bone density, do you see how this can add up across a lifespan such that it is not un- it is even more common for women truly in their menopause years, I, at, at this conference we were at-

Dr. Rangan Chatterjee 50:30 Mm-hmm

Dr. Vonda Wright 50:31 ... I had many women come up to me afterwards and say, "You know what? I thought I was doing everything right." They're doing all the lifestyle things.

Dr. Rangan Chatterjee 50:40 Mm.

Dr. Vonda Wright 50:40 But they go and get this DEXA scan or this REMS scan, and they're osteopenic or osteoporotic, and they're so disappointed-

Dr. Rangan Chatterjee 50:47 Mm

Dr. Vonda Wright 50:48 ... because they thought they were doing everything right now. Well, they may be, but maybe they didn't build enough bone in their youth.

Dr. Rangan Chatterjee 50:55 Yeah. It's so interesting. You know, as you're talking now, I'm, I'm thinking about my wife. So my wife breastfed both of our kids, which is what she wanted to do-

Dr. Vonda Wright 51:06 Yes

Dr. Rangan Chatterjee 51:06 ... and she was able to.

Dr. Vonda Wright 51:07 Yes.

Dr. Rangan Chatterjee 51:07 I recognize that not every woman-

Dr. Vonda Wright 51:08 Can

Dr. Rangan Chatterjee 51:09 ... can. Okay?

Dr. Vonda Wright 51:09 Or wants to. Mm-hmm.

Dr. Rangan Chatterjee 51:10 But let's say there was four years of breastfeeding.

Dr. Vonda Wright 51:14 Mm-hmm.

Dr. Rangan Chatterjee 51:15 Given what you've just said-

Dr. Vonda Wright 51:16 Mm-hmm

Dr. Rangan Chatterjee 51:16 ... that's four years where my children, our children, were taking whatever they needed-

Dr. Vonda Wright 51:25 Yes

Dr. Rangan Chatterjee 51:25 ... from my wife's body.

Dr. Vonda Wright 51:27 That's right.

Dr. Rangan Chatterjee 51:28 And potentially leaching her bones for calcium.

Dr. Vonda Wright 51:31 It sounds terrible when we say it like this, doesn't it? [laughs]

Dr. Rangan Chatterjee 51:33 In order to sustain theirs.

Dr. Vonda Wright 51:36 That's right.

Dr. Rangan Chatterjee 51:37 Right?

Dr. Vonda Wright 51:37 Mm-hmm.

Dr. Rangan Chatterjee 51:37 Now, you know, in, in the context of you just saying what you said, which is at this conference we were both at this weekend in London, we're both speakers at this conference, wonderful conference. So many women said, "I thought I was doing everything right. I didn't realize there was an issue with my bones until I got the DEXA scan."

Dr. Vonda Wright 51:57 Mm-hmm.

Dr. Rangan Chatterjee 51:58 So without knowing anything about my wife, would you say, actually, that's someone who might be a good candidate for a DEXA scan?

Dr. Vonda Wright 52:06 I'm gonna order it for her myself. [laughs]

Dr. Rangan Chatterjee 52:08 Okay. Do you think it's that important? Because-

Dr. Vonda Wright 52:10 I do. What is the downside of knowing where we stand?

Dr. Rangan Chatterjee 52:13 Yeah.

Dr. Vonda Wright 52:14 Because it might serve as moti- we might find out she's perfect.

Dr. Rangan Chatterjee 52:17 Yeah.

Dr. Vonda Wright 52:18 Good for her. We're gonna keep going on the course. We might find out that there is an opportunity to get in front of this, uh, before, before she's 55. You know, this is the time to find out, and that's what I want people to do, is find out. Here's, here are all the reasons. I mean, there are dozens of risk factors for osteoporosis besides loss of estrogen and aging. But if your mother is shrinking, you know, my mother used to be as tall as me, and now she's down-

Dr. Rangan Chatterjee 52:50 Right

Dr. Vonda Wright 52:50 ... mid-head, right? If your mother is shrinking, if you notice you're shrinking, if you thought smoking was cool and smoked at any time in your life, s- smoking is poison to bones. If you had, uh, uh, an illness, a chronic illness, where you were required to take a lot of steroids, from asthma to cancer or any of the autoimmune diseases, um, there are dozens. Or if you had a fracture after 20, fracture is the number one predictor of future fracture. These are all risk factors for osteoporosis and poor bone health. Those are reasons to march into your doctor and say, "I have a risk factor for a bad bone, and I wanna know." If you were skinny fat your whole life, if you ha- have recovered from a, from a eating disorder, that, these are all reasons. We do not have to sit idly by and cross our fingers and hope-

Dr. Rangan Chatterjee 53:46 Yeah

Dr. Vonda Wright 53:47 ... that our bones are gonna be okay at 65 when finally a DEXA scan or will be paid for, you know?

Dr. Rangan Chatterjee 53:54 I think we also have to... Look, I, I, I'm, I'm sort of semi-familiar with the healthcare system in America.

Dr. Vonda Wright 54:00 Mm-hmm.

Dr. Rangan Chatterjee 54:00 But of course, I know the UK one much better.

Dr. Vonda Wright 54:02 Yes.

Dr. Rangan Chatterjee 54:04 I'm really of the view these days that the NHS, our National Health Service, cannot and will not be there for all of these issues.

Dr. Vonda Wright 54:13 Correct.

Dr. Rangan Chatterjee 54:14 It simply cannot pay for all of this stuff for everyone.

Dr. Vonda Wright 54:18 That's right.

Dr. Rangan Chatterjee 54:18 And I think we're, we're sort of waiting for this time where it gets funded well enough whereby all of us can have this. I don't think that's coming.

Dr. Vonda Wright 54:27 Yes.

Dr. Rangan Chatterjee 54:28 And, and I, I don't say that 'cause I, I want it to not be there. Yes, it would be great if all of this stuff could be funded, but I think at some point, we have to start recognizing that the NHS is gonna be there for s- and it's gonna be fantastic at some things.

Dr. Vonda Wright 54:42 Mm-hmm.

Dr. Rangan Chatterjee 54:43 Acute problems or... I shared with you, we were just from the fracture clinic this morning-

Dr. Vonda Wright 54:47 Yeah

Dr. Rangan Chatterjee 54:47 ... because my son fell a couple of weeks ago. Well-Four and a half weeks ago, broke two bones in his wrist

Dr. Vonda Wright 54:53 Mm-hmm

Dr. Rangan Chatterjee 54:53 We got great care from the NHS

Dr. Vonda Wright 54:55 Yes

Dr. Rangan Chatterjee 54:55 They X-rayed him, put him in a cast

Dr. Vonda Wright 54:58 Mm-hmm

Dr. Rangan Chatterjee 54:58 We've gone and had a review. That stuff, I think the National Health Service is fantastic at

Dr. Vonda Wright 55:02 Yeah

Dr. Rangan Chatterjee 55:03 But I do think, and of course, not everyone can afford this

Dr. Vonda Wright 55:07 Mm-hmm

Dr. Rangan Chatterjee 55:08 But if you're someone who's concerned, it may be that we have to take this into our own hands and go, "Actually-

Dr. Vonda Wright 55:15 Mm-hmm

Dr. Rangan Chatterjee 55:15 ... what is the cost of me not doing a DEXA scan?"

Dr. Vonda Wright 55:19 Mm-hmm

Dr. Rangan Chatterjee 55:19 Right?

Dr. Vonda Wright 55:20 Mm-hmm

Dr. Rangan Chatterjee 55:20 Because you outlined it before, what if at 72 you're with that break, and then it's your kids who are having to decide, "Are we gonna put Mum in a home?"

Dr. Vonda Wright 55:29 Mm-hmm

Dr. Rangan Chatterjee 55:29 "Gonna pay for care? Are we gonna decimate all the life savings?" Whatever it might be-

Dr. Vonda Wright 55:32 Right

Dr. Rangan Chatterjee 55:32 ... these are real things that are happening-

Dr. Vonda Wright 55:35 Yes

Dr. Rangan Chatterjee 55:35 ... and it's just going up, up, up. So this whole idea of cost as well, it goes back to what your banking friends were saying, right?

Dr. Vonda Wright 55:42 Yeah

Dr. Rangan Chatterjee 55:43 We, we don't- we can't really see it. We can't really see. I don't know how much a DEXA scan is here. Let's say it's £200, right? And of course, not everyone has £200, but we don't see it, where actually that £200 spent could literally save you tens of thousands of pounds-

Dr. Vonda Wright 56:00 Exactly

Dr. Rangan Chatterjee 56:01 ... in the future

Dr. Vonda Wright 56:02 In the future. Exactly. So I always encourage people to do exactly what you've said. Like, well, I have a comment about your health system and my health system in the United States. I have come to understand, even based on the way we bill, the job, by and large, of the US healthcare system is to get you out of the hospital alive, to make sure you don't end up dead in the hospital, and to take care of acute problems. There is not the time. I'm a practicing surgeon. Um, my practice is a third in terms of volume as it was, because I am trying to take whole-person care. But the average doctor in a fast-running-

Dr. Rangan Chatterjee 56:39 Mm

Dr. Vonda Wright 56:39 ... clinic does not have that luxury, right? So it sounds like here and in the US, we're just doing acute care and catastrophic care. I think people are responsible for their own health. I think we can't leave all the decisions to a clinician or all the prevention to a clinician, so this is one example. For instance, I encourage people, in the United States, you can get a DEXA scan for about $99, which is not a zero fund, is not a zero number. But think of how much we spend on a cup of coffee at Starbucks

Dr. Rangan Chatterjee 57:16 Mm-hmm

Dr. Vonda Wright 57:17 And I'm not zeroing out Starbucks, but the fancy coffee that I no longer buy there costs $7.18

Dr. Rangan Chatterjee 57:23 Yeah

Dr. Vonda Wright 57:24 If I do that every day, that's a DEXA scan. Can we please stop piddling away, and just save it for a month, and you'll get yourself a D- and I realize that that may be a privileged thing to say, but every single person has something. And save it for six months

Dr. Rangan Chatterjee 57:40 Yeah. But let's say, uh, let's, let's even say that someone cannot afford that, right?

Dr. Vonda Wright 57:44 Yeah

Dr. Rangan Chatterjee 57:44 Let's, let's go to the practical things because one of the... You know, w- I was- I went for a walk this morning. I was thinking about there was so much to cover from your book, and I thought, "We'll never get through it all." But I thought, "And we must go into bone health," because I think bone health has been undervalued.

Dr. Vonda Wright 58:00 Completely

Dr. Rangan Chatterjee 58:01 And even I've, I've heard a lot of your interviews, and I think there's... It's easy to focus on, you know, muscle and the strength training and the-

Dr. Vonda Wright 58:10 Yes

Dr. Rangan Chatterjee 58:10 ... VO2 max, and that's all great, and we're gonna get to that. But I do think bone needs to be raised in our awareness.

Dr. Vonda Wright 58:16 Thank you.

Dr. Rangan Chatterjee 58:16 So I really wanted to make sure we-

Dr. Vonda Wright 58:18 Yes

Dr. Rangan Chatterjee 58:18 ... we focused here. A lot of this book is talking about the incredible benefits of movement.

Dr. Vonda Wright 58:27 Mm-hmm.

Dr. Rangan Chatterjee 58:27 And of course, you have this wonderful acronym-

Dr. Vonda Wright 58:29 Acronym

Dr. Rangan Chatterjee 58:29 ... F.A.C.E., right?

Dr. Vonda Wright 58:30 Mm-hmm.

Dr. Rangan Chatterjee 58:30 Which is brilliant. Flexibility, mobility, aerobic activity, carrying a load, and equilibrium and fast speeds. But if we simply look at it through the lens of bone for a minute-

Dr. Vonda Wright 58:41 Yes. Mm-hmm

Dr. Rangan Chatterjee 58:41 ... and, yes, for people who can get a DEXA scan to see where they're at, great. Even if you can't or you won't, there are things that you can do to improve your bone health, right?

Dr. Vonda Wright 58:53 Yes

Dr. Rangan Chatterjee 58:53 So when it comes to movement, what kinds of things can we do that will directly improve the health of our bones?

Dr. Vonda Wright 59:00 Yes. Let's just assume you're losing bone density. Let's make it a given.

Dr. Rangan Chatterjee 59:03 Okay.

Dr. Vonda Wright 59:04 That, that's a good- that is a good place to start. Men and women are gonna lose bone density, blah. Here are the top things to do for your bone. Number one, optimize your hormones. Estrogen is so critical for bone health in the regulation of these two cells I was talking about earlier, that, uh, it will help rebalance the, the breaking down of bone and the building of bone. Number two, um, building muscle. Number three, and often forgotten, is the E of the F.A.C.E. acronym, equilibrium and foot speed. Because you may be fine sitting in a chair. You may be fine walking around. But if you lose your balance, we... Our, our neuromuscular pathways controlling balance start to degrade in our 20s, such as you reach for something, you lose your balance, you topple over.

Dr. Rangan Chatterjee 59:58 In our 20s.

Dr. Vonda Wright 59:59 Yes, but it can be totally re-

Dr. Rangan Chatterjee 1:00:01 [laughs]

Dr. Vonda Wright 1:00:01 ... totally retrained. Um, and we can talk about that. But we have to reestablish our balance so that we don't trip over our dog or our rug or just try to pick something up and fall over, 'cause you'll be fine before you fall, and then you have the fatal fall or the, you know-

Dr. Rangan Chatterjee 1:00:19 Mm

Dr. Vonda Wright 1:00:19 ... your child has had a month in a cast. It takes three months for an adult to heal a fracture because of our biology. Think of the inconvenience of that, even if it's a-

Dr. Rangan Chatterjee 1:00:28 Mm

Dr. Vonda Wright 1:00:28 ... minor fracture. So retrain our balance, and number two in that F-A-C-E, equilibrium, is the long-forgotten foot speed, meaning we lose our Type 2 muscle fibers, which is our fast-twitch fibers. And so I train people in speed and agility.

Dr. Rangan Chatterjee 1:00:48 Mm.

Dr. Vonda Wright 1:00:49 You know, it's all those things we see athletes doing, hopping over cones, um-Uh, jumping over little, uh, hurdles. Even I was teaching, uh, a US celebrity how to do toe taps and heel taps, and then alternate them really quickly because we lose the neuromuscular coordination that helps us jump over our work bag that sits-

Dr. Rangan Chatterjee 1:01:12 Mm

Dr. Vonda Wright 1:01:12 ... by our desk and trips us every day, right?

Dr. Rangan Chatterjee 1:01:15 Mm-hmm.

Dr. Vonda Wright 1:01:15 We may be fine until we lose our balance and fall down.

Dr. Rangan Chatterjee 1:01:20 Yeah.

Dr. Vonda Wright 1:01:20 So we can't forget to do that in our, in our general mobility, but specifically for bone if we're talking about it.

Dr. Rangan Chatterjee 1:01:28 Yeah. See, it's interesting. Things like swimming and cycling-

Dr. Vonda Wright 1:01:33 Mm-hmm

Dr. Rangan Chatterjee 1:01:33 ... are fantastic aerobic-

Dr. Vonda Wright 1:01:35 So good. Mm

Dr. Rangan Chatterjee 1:01:35 ... activities. But I say, personally, in my own life over the last years, I've really been thinking about weight-bearing activities.

Dr. Vonda Wright 1:01:44 Yes.

Dr. Rangan Chatterjee 1:01:44 And if I have limited time to move, and I'm making more and more time to move as I get older, I'm... L- let's-- we'll, we'll come to strength shortly, but in terms of more, I guess, what you would call in inverted commas, aerobic activities, I really focus on walking and running.

Dr. Vonda Wright 1:02:04 Yes.

Dr. Rangan Chatterjee 1:02:05 Don't get me wrong, I like cycling, I like swimming, but I'm thinking, yeah, but those things are not really putting load through my joints.

Dr. Vonda Wright 1:02:14 They're not.

Dr. Rangan Chatterjee 1:02:15 Right?

Dr. Vonda Wright 1:02:15 Mm-hmm.

Dr. Rangan Chatterjee 1:02:15 So they're great, but they're not loading my joints, whereas walking and running are literally putting pressure through my joints. So I personally am prioritizing those. As a sports medicine specialist-

Dr. Vonda Wright 1:02:28 Yes

Dr. Rangan Chatterjee 1:02:28 ... as an orthopedic surgeon, what's your take on that?

Dr. Vonda Wright 1:02:31 Um, I agree. I am not against swimming. Great for aerobics.

Dr. Rangan Chatterjee 1:02:34 Yeah, for sure.

Dr. Vonda Wright 1:02:35 I am not against cycling, aerobics, and building butt, core, and hips muscles. But if you're concerned about, uh, building better bones, not only is walking fine, it produces about one point five times body weight with the steps. Running is fine, about two and a half times body weight. To, to build better bone, we need four times body weight.

Dr. Rangan Chatterjee 1:02:58 Okay.

Dr. Vonda Wright 1:02:59 So if we really wanna get after it, we're gonna jump, and we're gonna, we're gonna jump at least off an eight-inch step because that will produce four times body weight and impact. 'Cause this is the way bones work chemically. The biomechanical impact of you landing hard on both feet from an eight-inch height and then jumping up straight in the air and landing again, that biomechanical impact becomes, through little channels of fluid in your bone, biochemical signal that tells the building cells, "Oh, I better lay down more bone. She's jumping around again." So the impact becomes the biochemical signal to build bone, but it has to be intense enough. So when you jump off-- uh, when you're running, I would stop and jump up and down ten to twenty times, or you can do it all at one time. Three d- three days a week, you can spend ten minutes jumping in multi directions. I just, uh, posted, um, reintroducing hopscotch-

Dr. Rangan Chatterjee 1:04:04 Yeah

Dr. Vonda Wright 1:04:04 ... to the world, right? Because it's multi-directional play jumping.

Dr. Rangan Chatterjee 1:04:08 Mm-hmm.

Dr. Vonda Wright 1:04:09 So, um, that's what I would add. And, and there are lots of studies, uh, to substantiate that. In fact, one that I published in this research group looking at what, what kind of activity... Number one, answering the question, can we maintain our bone density by being active across a lifespan? The answer to that study was yes. Uh, the subsequent study was, well, okay, what kind of activity maintains bone density best? And it seems logical, but we were studying, um, the, the senior Olympics, which is Olympics for people over fifty.

Dr. Rangan Chatterjee 1:04:46 Mm-hmm.

Dr. Vonda Wright 1:04:46 We found, not surprisingly, that the jumping sports like volleyball, basketball, because of the impact, maintained bones better-

Dr. Rangan Chatterjee 1:04:54 Wow

Dr. Vonda Wright 1:04:55 ... than the swimming, the running, the, the badminton, the bowling. Um-

Dr. Rangan Chatterjee 1:05:00 That's really interesting.

Dr. Vonda Wright 1:05:01 Isn't that fascinating?

Dr. Rangan Chatterjee 1:05:02 And can I-- just a point to clarify. So many people these days are jumping on trampolines or on rebounders. Now, what's interesting on those, of course, there's give-

Dr. Vonda Wright 1:05:11 Mm-hmm

Dr. Rangan Chatterjee 1:05:11 ... when you land.

Dr. Vonda Wright 1:05:12 Mm-hmm.

Dr. Rangan Chatterjee 1:05:13 So I'm guessing that you're saying no, no, you must make sure it's against a hard surface?

Dr. Vonda Wright 1:05:17 If you have a choice, if you are not so arthritic that you can barely move-

Dr. Rangan Chatterjee 1:05:22 Mm

Dr. Vonda Wright 1:05:22 ... please impact on against a hard surface. Um, that being said, NASA has some good evidence that when they bring astronauts back down-

Dr. Rangan Chatterjee 1:05:31 Yeah

Dr. Vonda Wright 1:05:31 ... from the space station, they use rebounders.

Dr. Rangan Chatterjee 1:05:33 Right.

Dr. Vonda Wright 1:05:34 You know? And, and it can be beneficial. But all things being equal, if you can jump on a hard surface, jump on a hard surface.

Dr. Rangan Chatterjee 1:05:41 Yeah. Okay. I love that. And of course, skipping ropes are brilliant as well for this.

Dr. Vonda Wright 1:05:44 Oh, skipping. Just skipping on a track. I mean, that kind of impact, getting your knees up really high adds some impact.

Dr. Rangan Chatterjee 1:05:52 Okay.

Dr. Vonda Wright 1:05:52 Mm-hmm.

Dr. Rangan Chatterjee 1:05:53 So let's zoom out again and go, well, one of the themes of this conversation is this idea, this central idea from your book, that our body doesn't fall apart with age, it falls apart from neglect.

Dr. Vonda Wright 1:06:03 Mm.

Dr. Rangan Chatterjee 1:06:04 You've spoken about the hormonal changes that happen-

Dr. Vonda Wright 1:06:08 Yes

Dr. Rangan Chatterjee 1:06:08 ... in a man's life and in a woman's life, and why in that critical decade, thirty-five to forty-five, particularly for women-

Dr. Vonda Wright 1:06:14 Yes

Dr. Rangan Chatterjee 1:06:15 ... hormones fall off a cliff, and it has a consequential impact on multiple aspects of our health: brain, heart, musculoskeletal system-

Dr. Vonda Wright 1:06:24 Yes

Dr. Rangan Chatterjee 1:06:24 ... whatever it might be.

Dr. Vonda Wright 1:06:25 Yes.

Dr. Rangan Chatterjee 1:06:25 And we've just gone deep into bone health.

Dr. Vonda Wright 1:06:27 Yes.

Dr. Rangan Chatterjee 1:06:28 The impacts on bone health and the sort of things that we can do to help improve it.

Dr. Vonda Wright 1:06:33 Mm-hmm.

Dr. Rangan Chatterjee 1:06:33 Okay. But then if we just take that broader theme in general about how we don't have to age with frailty, we can age with vitality-

Dr. Vonda Wright 1:06:45 Yes

Dr. Rangan Chatterjee 1:06:47 ... a big part of your book is around movement.

Dr. Vonda Wright 1:06:50 Mm.

Dr. Rangan Chatterjee 1:06:50 In fact, I think chapter two is literally making the case for movement.

Dr. Vonda Wright 1:06:54 Yes.

Dr. Rangan Chatterjee 1:06:54 Um, so could you make the case for movement? Explain to us why-- We, we, we've all heard that exercise is good for us.

Dr. Vonda Wright 1:07:02 Mm-hmm.

Dr. Rangan Chatterjee 1:07:03 Just build that case for us about movement. Why is it so important that we move in a variety of different ways-

Dr. Vonda Wright 1:07:09 Mm-hmm

Dr. Rangan Chatterjee 1:07:10 ... particularly as we get older?

Dr. Vonda Wright 1:07:13 So if we have, if we have hypertension, high blood pressure, there's a pill for that. If we have diabetes, metabolic disorder, there are a variety of pills for that. If there is heart disease, a pill for that. But there is one pill, one activity, one set of skills that treats everything, and that is movement, baseline. In fact, it is so critical in so many diseases that, um, a pro- I wish I had made this up. I didn't, but there's a professor out of, uh, Columbia University in Missouri in the United States that coined the word sedentary death syndrome. It is the 33 chronic diseases that we die from, including heart disease, that are directly impacted by the amount of movement we do. So how does that work? So, um, let's just take skeletal muscle contraction, mo- movement. Skeletal muscle contraction produces a, a, a cytokine, a hormone called irisin that is directly related to glucose metabolism, uh, insulin resistance. I've already talked about the way the bone talks to the brain and the muscle and the pancreas.

Dr. Rangan Chatterjee 1:08:35 Mm-hmm.

Dr. Vonda Wright 1:08:35 So any time we're moving our body, it's not just locomoting us, it's changing us chemically on the inside. When I recommend people sprint at the end of their cardio workout, literally get your heart rate way up, that will change the number of mitochondria, which are the powerhouse units in our cells. It will help stimulate the r- uh, the division of something called satellite muscle stem cells, which are called satellite cells. Mobility in the form of exercise causes the transcription and changing of body molecules of more than 9,800 molecules every time you go out for a run. It's signaling your DNA to express the genes that you need to stay healthy. Um, it, it's just fascinating that, that one modality, mobility, can change us at a cellular level. It can change us at a tissue level. Um, here's an experiment we did in the labs with my partners that I had at University of Pittsburgh. Mobility is actually the fountain of youth for our stem cells. So what the experiment was this. We took little old lady mice. A little old lady mouse is two years old. She's old.

Dr. Rangan Chatterjee 1:09:55 [laughs]

Dr. Vonda Wright 1:09:55 She's just sitting back in her cage waiting for her next meal. So we sampled her muscle, and we took out a few of her little muscle stem cells, and what did we find? We found that her muscle stem cells in sedentary living were dying. Dying cells, it's an active process.

Dr. Rangan Chatterjee 1:10:13 Mm-hmm.

Dr. Vonda Wright 1:10:13 You turn on something called programmed cell death. They were dying. They had lost their round plumpness. Healthy cells are round like a grape. They were more like a, a, a, a branch.

Dr. Rangan Chatterjee 1:10:24 Mm-hmm.

Dr. Vonda Wright 1:10:24 They were spindly, and they were no longer reproducing or producing growth factors. That's what these little old stem cells were doing. Then we took these girls, and I spent a lot of money buying mouse treadmills. It's unbelievable how much mouse treadmills cost. But I bought some, and we put these girls on the mouse treadmills, and they were just like the rest of us. They didn't wanna run, but we encouraged them to do so.

Dr. Rangan Chatterjee 1:10:49 Mm.

Dr. Vonda Wright 1:10:49 Twice a day for two weeks, we ran these girls on treadmills, and then we resampled their stem cells. The spindly dying stem cells were now plump like grapes again.

Dr. Rangan Chatterjee 1:11:01 Wow.

Dr. Vonda Wright 1:11:01 They were producing growth factors. They had turned off programmed cell death. So the simple act of mobility changed our stem cell function and rejuvenated it. It was a signal to these mou- mice bodies, these murine model, that we're not dead. We're living and ex-

Dr. Rangan Chatterjee 1:11:21 Yeah.

Dr. Vonda Wright 1:11:21 So down to the cellular level, so... And that's what I'm trying to r- to explain to people in the book and give them... I mean, I think my readers are smart. They need to know why-

Dr. Rangan Chatterjee 1:11:32 Yeah

Dr. Vonda Wright 1:11:32 ... not just go do this program. We can change our mitochondria. We can change the expression of our genes. We can change the amount of inflammation in our body-

Dr. Rangan Chatterjee 1:11:41 Yeah

Dr. Vonda Wright 1:11:42 ... by regulating glucose metabolism and insulin sensitivity, a- and really have profound changes of the hallmarks of aging by simple activities that become how we live, not just programs.

Dr. Rangan Chatterjee 1:11:58 Yeah. I, I love the bit sort of halfway through the book where you move on to the next section, where you've covered exercise in detail, and there's this beautiful chart where you, you've got listed all the time bombs of aging.

Dr. Vonda Wright 1:12:10 Uh-huh.

Dr. Rangan Chatterjee 1:12:10 DNA change and damage-

Dr. Vonda Wright 1:12:12 Yeah

Dr. Rangan Chatterjee 1:12:12 ... mitochondrial dysfunction, senescence, fuel gauge malfunction, and stem cell exhaustion.

Dr. Vonda Wright 1:12:18 Yes.

Dr. Rangan Chatterjee 1:12:18 And then you cross-reference that-

Dr. Vonda Wright 1:12:21 Mm-hmm

Dr. Rangan Chatterjee 1:12:21 ... with different kinds of exercise.

Dr. Vonda Wright 1:12:23 Yes.

Dr. Rangan Chatterjee 1:12:24 And basically, you follow that chart. You go, wait a minute. If you do this hybrid training program-

Dr. Vonda Wright 1:12:31 Mm-hmm

Dr. Rangan Chatterjee 1:12:31 ... that you outline in your book-

Dr. Vonda Wright 1:12:32 Mm-hmm

Dr. Rangan Chatterjee 1:12:33 ... you are basically gonna make sure you've hit every one of those six.

Dr. Vonda Wright 1:12:37 Yes.

Dr. Rangan Chatterjee 1:12:38 So all of the sort of physiological changes in your body that are driving aging in a perhaps unhealthy way or a, or a faster than needed way-

Dr. Vonda Wright 1:12:49 Yeah

Dr. Rangan Chatterjee 1:12:50 ... hybrid training targets them all.

Dr. Vonda Wright 1:12:53 Thank goodness.

Dr. Rangan Chatterjee 1:12:53 It's very, very inspiring, isn't it?

Dr. Vonda Wright 1:12:55 It is. You can hit all the boxes by doing this very simple lifestyle.

Dr. Rangan Chatterjee 1:13:00 You're obviously such a passionate proponent of this.

Dr. Vonda Wright 1:13:03 Mm-hmm.

Dr. Rangan Chatterjee 1:13:04 You, you know, you were really worried at 47 of what the hell was going on-

Dr. Vonda Wright 1:13:08 Yes

Dr. Rangan Chatterjee 1:13:08 ... with your body-

Dr. Vonda Wright 1:13:09 Yes

Dr. Rangan Chatterjee 1:13:09 ... and your brain.

Dr. Vonda Wright 1:13:10 Mm-hmm.

Dr. Rangan Chatterjee 1:13:11 And you've really turned things around-

Dr. Vonda Wright 1:13:13 Mm-hmm

Dr. Rangan Chatterjee 1:13:13 ... where, you know, I saw you at the end of the day in London.

Dr. Vonda Wright 1:13:16 Mm.

Dr. Rangan Chatterjee 1:13:16 You probably had jet lag, whatever.

Dr. Vonda Wright 1:13:19 [laughs]

Dr. Rangan Chatterjee 1:13:19 You were on fire on stage.

Dr. Vonda Wright 1:13:21 Mm.

Dr. Rangan Chatterjee 1:13:21 Your passion, your energy. I think that's why you're having such an impact in the world. It's not just what you're saying-

Dr. Vonda Wright 1:13:29 Mm-hmm

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Dr. Rangan Chatterjee 1:16:02 do check out my book, Make Change That Lasts: Nine Simple Ways to Break Free from the Habits That are Holding You Back. It's in all the usual places as a paperback, e-book, and as an audiobook, which I'm narrating. Now, back to the video. So I guess my question to you is, at this stage in your life, are you able to share with us what a typical week of training or movement looks like for you?

Dr. Vonda Wright 1:16:29 Sure, sure.

Dr. Rangan Chatterjee 1:16:29 And I appreciate that may not feel achievable for someone who's about to start, but I wonder if we could start off with what-

Dr. Vonda Wright 1:16:35 Yeah

Dr. Rangan Chatterjee 1:16:36 ... you do.

Dr. Vonda Wright 1:16:36 Yeah.

Dr. Rangan Chatterjee 1:16:36 And then we can perhaps wind back to someone who's never done any of this before and where they can start.

Dr. Vonda Wright 1:16:41 Absolutely, yes. Um, and n- number one, I want people to give themselves grace because sometimes when people say what I'm about to say, they're like, "Ugh, I could never." It's not about that. Start where you are.

Dr. Rangan Chatterjee 1:16:56 Mm.

Dr. Vonda Wright 1:16:57 And I'll give you the example. I'm on a book tour right now. I am really busy in different time zones, so I'm not doing everything that I would normally love to do, and I'm gonna give myself grace, it's the period of life, and not judge myself for it. But ideally, this is what I do. Um, I have a flexibility and mobility practice, meaning I am trying to stretch out my tendon, ligaments, and muscles nearly every day. This is where... I don't do Pilates or yoga, but if you do, this is where that comes in to be marvelous. I do s- a dynamic warmup every day, which gets every joint, every set of tendons and ligaments around my major joints moving, right? So daily flexibility and mobility.

Dr. Rangan Chatterjee 1:17:45 10 minutes?

Dr. Vonda Wright 1:17:46 You know what, it's just a series, and it's outlined in the book, the dynamic warm-up. It's just a series of 10 things that if I do the inchworm motion, it warms up my ankles, my knees, my hips. If I do, um, hamstring extensions, it gets my hips and my knees.

Dr. Rangan Chatterjee 1:18:04 First thing in the morning? Is that when you tend to do it?

Dr. Vonda Wright 1:18:06 No, I do it before I work out.

Dr. Rangan Chatterjee 1:18:07 Before you work out.

Dr. Vonda Wright 1:18:08 To work. I d- I put it all together.

Dr. Rangan Chatterjee 1:18:10 Yeah, that's interesting. And, and the only reason I ask is because I do mobility every day-

Dr. Vonda Wright 1:18:15 Yeah

Dr. Rangan Chatterjee 1:18:15 ... but it's part of my morning routine.

Dr. Vonda Wright 1:18:17 Oh, that's great.

Dr. Rangan Chatterjee 1:18:17 So I'll get up.

Dr. Vonda Wright 1:18:18 Yeah.

Dr. Rangan Chatterjee 1:18:19 I'll-- at the moment, I'm really into meditation, so I'll meditate, and then it's in my living room, which has got a carpet on the floor, so it's straight afterwards. I'll probably spend five, 10 minutes just doing a whole variety-

Dr. Vonda Wright 1:18:30 Yes

Dr. Rangan Chatterjee 1:18:30 ... of mobility exercises.

Dr. Vonda Wright 1:18:31 Mm-hmm.

Dr. Rangan Chatterjee 1:18:31 I almost feel like it's waking up all of my joints-

Dr. Vonda Wright 1:18:34 Mm-hmm

Dr. Rangan Chatterjee 1:18:34 ... for the day ahead.

Dr. Vonda Wright 1:18:35 Yeah.

Dr. Rangan Chatterjee 1:18:35 So you do it before you work out.

Dr. Vonda Wright 1:18:37 Yes.

Dr. Rangan Chatterjee 1:18:38 I do it first thing in the morning. But you're-

Dr. Vonda Wright 1:18:39 It doesn't really matter.

Dr. Rangan Chatterjee 1:18:40 Yeah, some form-

Dr. Vonda Wright 1:18:41 Mm-hmm

Dr. Rangan Chatterjee 1:18:41 ... of mobility to keep-

Dr. Vonda Wright 1:18:42 Yes

Dr. Rangan Chatterjee 1:18:42 ... all the joints moving. Okay.

Dr. Vonda Wright 1:18:43 That's right. And then when it comes to, and we'll just use this acronym that you, that you mentioned, F, that's F. A, aerobic. I used to be the marathon running, middle distance, getting my heart rate into middle zones all the time, as so many people did. I now use an 80/20 method. 80% of the time, I am in lower heart rate, base training heart rate zone, which is very metabolically efficient. It helps my mitochondria be flexible with what-... fuel source I'm using, whether it's protein, carbs, or fat, and it burns more fat than the middle distance, middle-high intensity exercising that I'll talk about in a minute. So 80% of the time. So that is three hours a week broken up into 45-minute sessions. I choose to do mine either by walking home from work, which is two and a half miles, or I have a treadmill in my room upstairs.

Dr. Rangan Chatterjee 1:19:42 So four 45-minute sessions a week-

Dr. Vonda Wright 1:19:45 Yes. Mm-hmm

Dr. Rangan Chatterjee 1:19:45 ... in what's typically these days called zone 2 training, which is basically-

Dr. Vonda Wright 1:19:49 Zone 2

Dr. Rangan Chatterjee 1:19:49 ... low heart rate training.

Dr. Vonda Wright 1:19:51 Yeah. And I, and I came to that based on the research of Inigo San-Millán, who is a physiologist for the Tour de France.

Dr. Rangan Chatterjee 1:19:59 Yeah.

Dr. Vonda Wright 1:19:59 So he has a lab in my building, so I use his method. And I've, I have the privilege of having my lactate threshold, which is telling me where my heart rate is, uh, done on a, with finger sticks. If you can't do that, then you can estimate it. Um, many wearables estimate it. But you could take your age min- 181 minus your age will give you a range, um, of heart rate.

Dr. Rangan Chatterjee 1:20:22 But you also, and you do share this in the book, that for people who don't wanna get that technical and don't wanna do lab testing-

Dr. Vonda Wright 1:20:29 Yeah

Dr. Rangan Chatterjee 1:20:29 ... it's, it's basically a lot easier than you think.

Dr. Vonda Wright 1:20:32 Oh, it's brisk walking.

Dr. Rangan Chatterjee 1:20:33 Y- it's brisk walking. It's basically where you can still talk, but if there was a person on the phone chatting to you, they would also know that you were working a little bit, right?

Dr. Vonda Wright 1:20:43 Yeah, you would be breathless.

Dr. Rangan Chatterjee 1:20:44 Yeah.

Dr. Vonda Wright 1:20:45 Yeah. And, and by the end of doing that, I break a little sweat, 'cause I can feel my metabolism revving up.

Dr. Rangan Chatterjee 1:20:50 So, so you're trying to do about three hours of that a week.

Dr. Vonda Wright 1:20:53 That's correct.

Dr. Rangan Chatterjee 1:20:53 Okay.

Dr. Vonda Wright 1:20:53 And that's when I listen to podcasts-

Dr. Rangan Chatterjee 1:20:55 Yeah, so it's, it's-

Dr. Vonda Wright 1:20:55 ... or I learn something. Yeah

Dr. Rangan Chatterjee 1:20:57 So it's relatively, in inverted commas, easy training.

Dr. Vonda Wright 1:21:00 Yeah.

Dr. Rangan Chatterjee 1:21:00 Relatively.

Dr. Vonda Wright 1:21:01 Yeah.

Dr. Rangan Chatterjee 1:21:02 You're burning fat, it's good for your metabolic flexibility.

Dr. Vonda Wright 1:21:05 That's right.

Dr. Rangan Chatterjee 1:21:06 The other thing which I think a lot of people don't realize about that form of training is that it doesn't spike your cortisol.

Dr. Vonda Wright 1:21:11 Right.

Dr. Rangan Chatterjee 1:21:11 And which is just incredible. I had Professor Steven Seiler-

Dr. Vonda Wright 1:21:14 Oh

Dr. Rangan Chatterjee 1:21:14 ... who's also at the same ELCATHE-

Dr. Vonda Wright 1:21:16 Mm-hmm

Dr. Rangan Chatterjee 1:21:16 ... Inigo.

Dr. Vonda Wright 1:21:17 Yeah.

Dr. Rangan Chatterjee 1:21:17 Um, again, Steven's one of the world's leading sports scientists, and I think he might have coined the 80/20 training term, I think.

Dr. Vonda Wright 1:21:24 Oh, good. Yeah

Dr. Rangan Chatterjee 1:21:25 From when he observed it in, uh, a lot of elite athletes.

Dr. Vonda Wright 1:21:28 Exactly. That's what they do.

Dr. Rangan Chatterjee 1:21:30 Yeah.

Dr. Vonda Wright 1:21:30 Yeah.

Dr. Rangan Chatterjee 1:21:31 But again, he was just sharing with m- when he came on the show, that actually you don't see a cortisol spike-

Dr. Vonda Wright 1:21:37 Mm

Dr. Rangan Chatterjee 1:21:37 ... so you, you d- it's easy to recover from that stuff.

Dr. Vonda Wright 1:21:40 That's right.

Dr. Rangan Chatterjee 1:21:41 'Cause you share in the book actually that in your younger years-

Dr. Vonda Wright 1:21:44 Mm-hmm

Dr. Rangan Chatterjee 1:21:44 ... you went all in on high-intensity interval training.

Dr. Vonda Wright 1:21:47 Oh, yeah, 'cause I'm impatient.

Dr. Rangan Chatterjee 1:21:49 Yeah. And actually, you were sharing a lot in the research book where actually as you get older, you don't wanna be doing that five, six days a week. It can actually start to be counterproductive.

Dr. Vonda Wright 1:21:58 Well, because it's not low intensity enough to allow for recovery, and it's not high intensity enough, sprint intervals, to really change physiology. So my office, uh, is in this gorgeous performance center, and I see class after class on the indoor football field of medium-intensity circuit training where people are out there busting it. They are working really hard, but they're not high enough to be sprinting, and they're certainly not in a low, low heart rate cortisol state. And so what happens is they don't get the results they want.

Dr. Rangan Chatterjee 1:22:36 Hmm.

Dr. Vonda Wright 1:22:37 They're working hard. They don't get the results they expect, and they're injured a lot.

Dr. Rangan Chatterjee 1:22:42 Hmm.

Dr. Vonda Wright 1:22:42 Every three weeks or so, which, and then they have to take time off, and their brains go crazy because they don't have the dopamine spikes. So 80% low heart rate, and then twice a week I sprint. Sprinting is not running on a track like Sha'Carri Richardson. Sprinting is a heart rate function, meaning getting it up as high as it can go, your own personal heart rate can go. So, and, but you do that for very short bursts.

Dr. Rangan Chatterjee 1:23:11 Mm-hmm.

Dr. Vonda Wright 1:23:11 For 30 seconds, complete recovery, whatever that takes you. It takes me two to three minutes, four times. That sprinting is so good for your muscle-derived stem cells. It's so good for your mitochondrial function. Um, and it's high enough heart rate, um, that frankly it's great for your brain.

Dr. Rangan Chatterjee 1:23:34 Hmm.

Dr. Vonda Wright 1:23:34 You feel like kind of a fr- pardon me, but brat- badass when you hop off the treadmill after sprinting, right?

Dr. Rangan Chatterjee 1:23:40 Hmm.

Dr. Vonda Wright 1:23:41 So that's how I do my cardio. Um-

Dr. Rangan Chatterjee 1:23:45 So hold on, 10 to 15 minutes maybe of this dynamic warmup, so mobility and-

Dr. Vonda Wright 1:23:49 Yep

Dr. Rangan Chatterjee 1:23:49 ... flexibility on most days.

Dr. Vonda Wright 1:23:50 Yeah, most days.

Dr. Rangan Chatterjee 1:23:51 Three hours of this low intensity aerobic training-

Dr. Vonda Wright 1:23:56 Yep

Dr. Rangan Chatterjee 1:23:56 ... either walking home-

Dr. Vonda Wright 1:23:57 Mm-hmm

Dr. Rangan Chatterjee 1:23:58 ... or on a treadmill.

Dr. Vonda Wright 1:23:59 Yes.

Dr. Rangan Chatterjee 1:23:59 Twice a week-

Dr. Vonda Wright 1:24:01 Yep

Dr. Rangan Chatterjee 1:24:01 ... you're doing SIT, sprint interval training.

Dr. Vonda Wright 1:24:04 After my walk.

Dr. Rangan Chatterjee 1:24:06 After your walk. So your walk is warming you up.

Dr. Vonda Wright 1:24:08 So I'm totally warmed up.

Dr. Rangan Chatterjee 1:24:09 Totally warmed before-

Dr. Vonda Wright 1:24:10 That's right

Dr. Rangan Chatterjee 1:24:10 ... you start sprinting.

Dr. Vonda Wright 1:24:11 That's right.

Dr. Rangan Chatterjee 1:24:12 And what I love about this is, is kind of echoing, particularly on this SIT point, what Stacy Sims said when she came on, uh-

Dr. Vonda Wright 1:24:19 Exactly. Exactly

Dr. Rangan Chatterjee 1:24:19 ... recently.

Dr. Vonda Wright 1:24:20 Mm-hmm.

Dr. Rangan Chatterjee 1:24:21 Um, I have some female friends-

Dr. Vonda Wright 1:24:25 Mm-hmm

Dr. Rangan Chatterjee 1:24:25 ... and family members in my life who I-

Dr. Vonda Wright 1:24:26 Mm-hmm

Dr. Rangan Chatterjee 1:24:26 ... would say are active, who walk regularly-

Dr. Vonda Wright 1:24:32 Yes

Dr. Rangan Chatterjee 1:24:33 ... but don't do sprint interval training. Can you make the case to me, and hopefully then to them, why, yes, walking and being generally mobile-

Dr. Vonda Wright 1:24:50 Yeah

Dr. Rangan Chatterjee 1:24:50 ... is very good-

Dr. Vonda Wright 1:24:51 Mm-hmm

Dr. Rangan Chatterjee 1:24:51 ... but why would you say that they're not getting the full benefits of movement unless they're having this stimulus to their system?

Dr. Vonda Wright 1:25:01 You know, we, it's just not intense enough to signal the, the metabolic pathways to cause the muscle satellite cell replication and the burning of fat at, in, that you get for sprinting, or the mitochondrial division. But if you want a purely-Purely, um, aesthetic reason in my own life and in that of the people that I care for, it is the sprint intervals and the heavy lifting that recomposes you to lean. Because if we're trying not to be skinny fat but lean, it is the sprinting and the lifting that will get you there. Because working out in the middle zone is not gonna get you lean-

Dr. Rangan Chatterjee 1:25:52 Yeah

Dr. Vonda Wright 1:25:52 ... interestingly. It's why we have a lot of great marathon runners, but they're, they have a lot of fat mass.

Dr. Rangan Chatterjee 1:25:59 Yeah.

Dr. Vonda Wright 1:25:59 Right?

Dr. Rangan Chatterjee 1:25:59 You actually said in the book, actually, I found this, um, like, very honest of you. You were open, saying, "Listen, I've, I've... I was doing, uh, the baseline cardio, and I was doing strength training," but it was when you added in the sprint interval training-

Dr. Vonda Wright 1:26:13 Yes

Dr. Rangan Chatterjee 1:26:13 ... that you really saw the change in your body. And you shared in the book that at that time, you think that is what got you down to 22% body fat.

Dr. Vonda Wright 1:26:21 Absolutely. I went from, uh, a, at... When I was writing this book, um, I had come off the time when I, I gained 20, 30 pounds during perimenopause, which was unheard of for me. I was an athlete, and so I had always been so thin that I didn't ha- I had 19% body fat when I went-

Dr. Rangan Chatterjee 1:26:39 Was that hard for you?

Dr. Vonda Wright 1:26:41 Gaining that weight?

Dr. Rangan Chatterjee 1:26:42 Yeah.

Dr. Vonda Wright 1:26:42 Oh my God. I was at the critical decision point of whether I buy a new wardrobe. Could I still fit into all these things that I had invested in at a certain size, or was I gonna have to do what so many women decide to do, which is get the next two or three sizes up? And I just decided, "I know the science. I am worth the investment. I'm gonna get this done." And so, uh, I did. And over about a six to nine-month period, using the things you're asking me about, is, is how I cite in the book. I gained eight pounds of muscle. I lost all this body fat. I was leaner, and aesthetically I loved it.

Dr. Rangan Chatterjee 1:27:22 Yeah.

Dr. Vonda Wright 1:27:22 And you know what, that, that goes up and down. That's why s- give yourself grace. I'm on a book tour now. I'm not doing four or five days a week, but I will again-

Dr. Rangan Chatterjee 1:27:32 Yeah

Dr. Vonda Wright 1:27:32 ... when it settles down.

Dr. Rangan Chatterjee 1:27:33 So the, the sprint interval training is 30 seconds of something.

Dr. Vonda Wright 1:27:38 Something.

Dr. Rangan Chatterjee 1:27:38 It doesn't have to be literally sprinting.

Dr. Vonda Wright 1:27:41 Running. No, no.

Dr. Rangan Chatterjee 1:27:41 It could be the battle rope or-

Dr. Vonda Wright 1:27:43 Or vertical, or the alpine thing, or the rowing, or-

Dr. Rangan Chatterjee 1:27:47 Yeah, something as fast as you can-

Dr. Vonda Wright 1:27:50 Yes, to get your heart rate up

Dr. Rangan Chatterjee 1:27:51 ... for 30 seconds.

Dr. Vonda Wright 1:27:52 Mm-hmm.

Dr. Rangan Chatterjee 1:27:52 And then what do you do?

Dr. Vonda Wright 1:27:53 Completely recover. So I'll give you my example. So I do this on a treadmill. Um, to get- to do base training on a treadmill, I currently do four to five incline, four to five speed, and that will keep my heart rate about 130. When I am done, then I punch this treadmill up to 11. Now, I'm not a very tall person, so for me, I'm just trying not to fly off the back of this treadmill, but I'm moving so fast that my heart rate goes up over 180, and I can sustain that for about 30 seconds. Then I'm grabbing the side rails, and I completely turn the treadmill down to two, and I just walk. And it takes me two to three minutes to get my heart rate back down to, and I start again when I'm about 140. Um, and then I punch it up again, and I'll do another 30 seconds. That's how it goes for me.

Dr. Rangan Chatterjee 1:28:47 And what, how many 30 seconds?

Dr. Vonda Wright 1:28:48 Just four times.

Dr. Rangan Chatterjee 1:28:49 Four.

Dr. Vonda Wright 1:28:49 Yeah.

Dr. Rangan Chatterjee 1:28:49 I mean, that's not that much, is it?

Dr. Vonda Wright 1:28:51 It's not terrible. You can do anything for 30 seconds, and once you've done two, you're like, "Okay, I've only got two more."

Dr. Rangan Chatterjee 1:28:58 Yeah. And you do that twice a week.

Dr. Vonda Wright 1:29:00 Twice a week.

Dr. Rangan Chatterjee 1:29:01 And I think the final part is resistance training.

Dr. Vonda Wright 1:29:04 Yes. So, uh, I think all kinds of resistance training can be helpful, but it depends what your goals are. So I often have women tell me that they've been instructed, and I often say flippantly, uh, "Put down the namby-pamby pink weights."

Dr. Rangan Chatterjee 1:29:22 [laughs]

Dr. Vonda Wright 1:29:22 Well, okay, so if someone has handed you a three to five-pound weight and said, "Lift it 30 times," that is good for endurance. You will fail after 30 times of lifting a s- very small weight. If your goal is endurance, fine, you do that. That's not our goal in midlife and beyond. That is not gonna help you live independently. If your goal is purely hypertrophy, which is what we tend to do when we're younger, looking at our big muscle mass in the mirror and damaging our muscle enough that we grow and recover with bigger muscles, that is a failure range of 10 to 15 reps-

Dr. Rangan Chatterjee 1:30:01 Mm-hmm

Dr. Vonda Wright 1:30:02 ... times four sets. There's nothing wrong with that if that's your goal. My goal in midlife is not to have the biggest muscles. Now, do I build muscle? Yes, I do. Can I get lean? Yes, I can. Our goal in midlife and beyond is strength and then power. Strength to be able to get up off the floor. Power, not to trip, to be able to catch yourself, to have some-

Dr. Rangan Chatterjee 1:30:25 Mm

Dr. Vonda Wright 1:30:25 ... fast twitch muscle, right? So strength is built with higher weights, lower reps, and you probably heard this from Stacy Sims.

Dr. Rangan Chatterjee 1:30:34 Mm.

Dr. Vonda Wright 1:30:34 We agree on many things. So that means a weight, a, a rep range of three to six. Now, I've been a clinician a long time. I have found I cannot give people ranges.

Dr. Rangan Chatterjee 1:30:47 [laughs]

Dr. Vonda Wright 1:30:47 It's too confusing. They want to be really good instructions, so there's no confusing. So the rep range that I work around myself and with the people I work with is four reps to failure, four sets. Now, listen, if you're starting from the couch, it may take you six months, nine months.

Dr. Rangan Chatterjee 1:31:05 Mm.

Dr. Vonda Wright 1:31:05 It may take you getting lifting lessons so that you're hinging correctly. That's how you move your hips.

Dr. Rangan Chatterjee 1:31:13 Mm-hmm.

Dr. Vonda Wright 1:31:13 You're stacking your joints. You're giving your tendons and ligaments time to adjust. But once you get there, we're gonna lift heavy, which is low reps, four sets.So that you fail at that high rep. That is in the four compound lifts, meaning a compound lift is using multiple joints. So upper body is some kind of bench press, it's some kind of pull, like a pull-up. For the lower extremity, it's some kind of squat and some kind of deadlift. That's not all you do, but that's the basis for what you do. So on a, a lift day for me, if we're talking about my lift, when I'm lifting four times a week, I'll do two to three leg days, and I'll do a, a one to two arm days, depending how the week goes. So if it's a bench press day, I'm gonna do four sets, four reps, heavy. Here's what it looks like. I can do it four times. I may be able to do five, but I'm not doing six without dumping the weights off, 'cause it just, that's when I fail.

Dr. Rangan Chatterjee 1:32:22 Mm.

Dr. Vonda Wright 1:32:23 And then you support that with the single lift, single muscle lifts, biceps, triceps, lats, delts-

Dr. Rangan Chatterjee 1:32:30 Mm

Dr. Vonda Wright 1:32:30 ... with slightly higher reps, 8 to 10.

Dr. Rangan Chatterjee 1:32:32 Mm.

Dr. Vonda Wright 1:32:33 And then core any day of the week, right? So I usually do one, one body part. If it's a Saturday and I have hours that I can kill in a gym, then I will do both cardio and lifting on one day.

Dr. Rangan Chatterjee 1:32:48 Yeah.

Dr. Vonda Wright 1:32:48 Yeah.

Dr. Rangan Chatterjee 1:32:49 Well, thank you for sharing that, Vonda. It's, it's very insightful to hear what you do.

Dr. Vonda Wright 1:32:53 Yeah.

Dr. Rangan Chatterjee 1:32:54 What about a woman who might be listening to this and is thinking, "Well, Vonda, I'm on board with what you're saying. I've realized that I need to take ownership of my health, and I need to move more than I currently do-

Dr. Vonda Wright 1:33:07 Yeah

Dr. Rangan Chatterjee 1:33:07 ... but I can't stand gyms."

Dr. Vonda Wright 1:33:09 Sure.

Dr. Rangan Chatterjee 1:33:10 Right?

Dr. Vonda Wright 1:33:10 Mm-hmm.

Dr. Rangan Chatterjee 1:33:10 If they say that to you, what do you say to them?

Dr. Vonda Wright 1:33:13 Well, if you're, if you're literally starting from the couch, then body weight will work for you initially, learning how your body moves. And I, and I put that in the book.

Dr. Rangan Chatterjee 1:33:24 Yeah, you do.

Dr. Vonda Wright 1:33:24 I put a start program in the book 'cause I realize people are starting from different places. If you're ready for heavy lifting, which we will all get to eventually, and you cannot stand a gym for whatever reason, then that probably means you're gonna have to buy a rack for your garage. 'Cause... Or, okay, let's... Or unless you wanna lift with logs in your backyard or filling up five-gallon buckets of water and carrying it around. It's harder to get 45 pounds of weight-

Dr. Rangan Chatterjee 1:33:53 [laughs]

Dr. Vonda Wright 1:33:53 ... in your garage without actual racks of weight.

Dr. Rangan Chatterjee 1:33:56 But I guess you could do, for example, you know, you were almost tripping up, like me, on the way into the studio, these sandbags that I have, right?

Dr. Vonda Wright 1:34:03 Yes. You could.

Dr. Rangan Chatterjee 1:34:04 So a sandbag, depending on how much weight is in there-

Dr. Vonda Wright 1:34:07 Mm-hmm

Dr. Rangan Chatterjee 1:34:07 ... of course, is heavy.

Dr. Vonda Wright 1:34:09 Yeah.

Dr. Rangan Chatterjee 1:34:11 You know? So one thing I'll often do is, you know, get the sandbag-

Dr. Vonda Wright 1:34:15 On your shoulder

Dr. Rangan Chatterjee 1:34:16 ... on my shoulder and go up and down, and then sprint up and down the garden, throw it up in the air, reach to pick it up again.

Dr. Vonda Wright 1:34:22 Yeah.

Dr. Rangan Chatterjee 1:34:22 Uh, I also try and do that a lot when my kids are around, so that-

Dr. Vonda Wright 1:34:26 So they see it. [laughs]

Dr. Rangan Chatterjee 1:34:26 Yeah, they see it, and often I'll go, "Oh, Daddy, can I, can I do it?" So I'm like, "Yeah, yeah. Sure, sure."

Dr. Vonda Wright 1:34:31 Sure.

Dr. Rangan Chatterjee 1:34:31 Funnily enough, I have bought two more when I-

Dr. Vonda Wright 1:34:34 [laughs] Ears perked up.

Dr. Rangan Chatterjee 1:34:34 And I've actually put the right amount of sand in it for your weight.

Dr. Vonda Wright 1:34:38 [laughs]

Dr. Rangan Chatterjee 1:34:38 Not that I try and tell them that, but th- they just happen to be there.

Dr. Vonda Wright 1:34:40 How clever of you.

Dr. Rangan Chatterjee 1:34:41 But, um, that's... Like, when, when we separate movement into all these different things, right-

Dr. Vonda Wright 1:34:48 Yeah

Dr. Rangan Chatterjee 1:34:48 ... I think for people like you and me, who are super motivated around movement, that works. But I think for some people, I don't think they're gonna necessarily go, "Well, I'm gonna go to the gym three times a week. I'm gonna do this two times. I'm gonna do this." Though... So I guess I'm trying to make sure that these core principles which you write about so beautifully, I wanna make sure that people listening actually take action-

Dr. Vonda Wright 1:35:14 Yes

Dr. Rangan Chatterjee 1:35:14 ... even if they can't stand the gym.

Dr. Vonda Wright 1:35:17 So listen, I will take anything except sitting around. So if you will never go to a gym, and you do not wanna buy a rack for your, for your garage, okay, I'll take a lot of planks. I'll take sandbags across your waist with bridges. That's great for your butt. We just can't do five pounds. We're gonna have to get a lot of big sandbags, which you can. Um, I'll take you doing pull-ups on the, on the bars in your backyard, your children's bars in the backyard.

Dr. Rangan Chatterjee 1:35:45 Yeah.

Dr. Vonda Wright 1:35:45 I'll take that. Um, I'll take you climbing your stairs with your 40-pound sandbag on your-

Dr. Rangan Chatterjee 1:35:52 Mm.

Dr. Vonda Wright 1:35:53 I'll take anything except sitting around. But what I've outlined is this, is just things that scientifically and with the people that I serve work-

Dr. Rangan Chatterjee 1:36:04 Yeah

Dr. Vonda Wright 1:36:04 ... to build muscle, to, to increase cardiac health. But literally, I'll take anything other than sitting around. 'Cause I know if anybody tells you just to sit around or, or rest to feel better, they're literally telling you to go die in a corner.

Dr. Rangan Chatterjee 1:36:20 Yeah. One of my favorite pages in your book-

Dr. Vonda Wright 1:36:24 Mm

Dr. Rangan Chatterjee 1:36:24 ... is page 27.

Dr. Vonda Wright 1:36:25 [laughs]

Dr. Rangan Chatterjee 1:36:26 And the reason why is that on page 27, you have three beautiful images.

Dr. Vonda Wright 1:36:34 Yeah.

Dr. Rangan Chatterjee 1:36:35 And they are MRI scans of people's thighs.

Dr. Vonda Wright 1:36:40 Yes.

Dr. Rangan Chatterjee 1:36:41 Do you wanna just talk us through those three images? And again, on the-

Dr. Vonda Wright 1:36:44 Mm-hmm

Dr. Rangan Chatterjee 1:36:44 ... YouTube version, I'm gonna try and pop that up on screen-

Dr. Vonda Wright 1:36:46 Please do, yeah

Dr. Rangan Chatterjee 1:36:47 ... because I honestly believe that seeing those images will directly motivate someone to change their behavior. I really do. Certainly for me, I'm active, but I'm looking at that going, "I need to be more active," right?

Dr. Vonda Wright 1:37:00 [laughs]

Dr. Rangan Chatterjee 1:37:00 Because I want a muscle like that when I'm 70.

Dr. Vonda Wright 1:37:03 And that was the intent of this picture series. Then when I submitted the paper for publication, one of the reviewers said, "Ah, the picture's unnecessary." And I said, "This picture is so necessary I will not publish with you unless you publish it."

Dr. Rangan Chatterjee 1:37:15 Well, I'm-

Dr. Vonda Wright 1:37:15 So here it is

Dr. Rangan Chatterjee 1:37:16 ... I'm glad you did.

Dr. Vonda Wright 1:37:16 Yes.

Dr. Rangan Chatterjee 1:37:17 'Cause it w- it wouldn't have had the impact-

Dr. Vonda Wright 1:37:18 No

Dr. Rangan Chatterjee 1:37:18 ... just reading the words.

Dr. Vonda Wright 1:37:20 No, it wouldn't have had-

Dr. Rangan Chatterjee 1:37:20 It wouldn't.

Dr. Vonda Wright 1:37:20 No. So what the picture shows is if you imagine, uh, going to the store and buying a ham, like for Christmas, and it has a bone in the middle, and the muscle surrounding it-That's what a slice with an MRI through a human thigh looks like. So imagine this round slice with perfect muscles. You can tell that there's gorgeous lean muscle-

Dr. Rangan Chatterjee 1:37:49 Mm-hmm

Dr. Vonda Wright 1:37:49 ... like a flank steak across the top of the bone. Gorgeous lean muscle in the back, your hamstrings, with very little peripheral fat.

Dr. Rangan Chatterjee 1:37:58 Mm-hmm.

Dr. Vonda Wright 1:37:58 You know, the pinchable fat on your leg.

Dr. Rangan Chatterjee 1:37:59 Yeah.

Dr. Vonda Wright 1:38:00 Very little of it. When I looked under a microscope, the 40-year-old triathlete, and, and it wasn't just one picture, it was a whole series of people, but there was very little fatty infiltrate, or we call that marbling.

Dr. Rangan Chatterjee 1:38:14 Mm-hmm.

Dr. Vonda Wright 1:38:14 You know? Very little marbling. So essentially, if you have to summarize that picture, the 40-year-old triathlete was a flank steak. Lean. Then in the control group, we had people that had sat around for a variety of reasons for 35 years. Listen, the central picture, you can barely tell their muscle.

Dr. Rangan Chatterjee 1:38:37 Yeah.

Dr. Vonda Wright 1:38:37 You lost all your muscle architecture. You lost muscle volume. They're grossly infiltrated with fat. You can see the white streaking.

Dr. Rangan Chatterjee 1:38:45 Yeah.

Dr. Vonda Wright 1:38:45 And there is a thick rind of peripheral fat. I call that a Wagyu beef.

Dr. Rangan Chatterjee 1:38:51 Yeah.

Dr. Vonda Wright 1:38:51 It's like the marbling you see in a Wagyu beef. But that is not the story. The story is the third picture-

Dr. Rangan Chatterjee 1:38:59 Yeah

Dr. Vonda Wright 1:38:59 ... which is a slice of a 70-year-old triathlete, who if you didn't know better, you would think I just took the next slice in a 40-year-old thigh. Beautiful architecture, gorgeous retential of muscle mass, very little fatty infiltration, and very little peripheral fat. And here's the beautiful thing. When we tested the strength of these people-

Dr. Rangan Chatterjee 1:39:22 Mm-hmm

Dr. Vonda Wright 1:39:22 ... we did not find a statistically significant decrease in strength until mid-60s. So what this tells us, this study was trying to answer the question, can we retain our lean muscle mass with recreational type exercise across the lifespan? And the answer is yes.

Dr. Rangan Chatterjee 1:39:41 Yeah. It, it's remarkable that you cannot at first glance tell any difference-

Dr. Vonda Wright 1:39:46 Yes

Dr. Rangan Chatterjee 1:39:46 ... between the MRI of the 40-year-old triathlete-

Dr. Vonda Wright 1:39:50 Yeah

Dr. Rangan Chatterjee 1:39:50 ... and the 70-year-old triathlete. And it goes back to what you said at the start, right? What the, the bit I quoted to you. What we call normal aging is actually normal aging for stressed out, undernourished people who are not intentionally building muscle.

Dr. Vonda Wright 1:40:05 Mm-hmm.

Dr. Rangan Chatterjee 1:40:05 This shows very clearly that if you stay active-

Dr. Vonda Wright 1:40:08 Mm-hmm

Dr. Rangan Chatterjee 1:40:09 ... right, and you prioritize movement in your life, you can have very similar muscle architecture in your 70s as you can in your 40s.

Dr. Vonda Wright 1:40:19 Yes.

Dr. Rangan Chatterjee 1:40:20 It is so-

Dr. Vonda Wright 1:40:21 Stunning

Dr. Rangan Chatterjee 1:40:21 ... so inspiring to see that.

Dr. Vonda Wright 1:40:23 Yeah.

Dr. Rangan Chatterjee 1:40:24 And it's also actually at the same time, on one hand it's inspiring, and on the other hand, it's depressing. It's depressing how many people-

Dr. Vonda Wright 1:40:34 Oh

Dr. Rangan Chatterjee 1:40:35 ... have that middle image, how many people in their 70s have lived a sedentary life and have got this horrible muscle architecture. And here's the reality. People think that that just affects their muscles.

Dr. Vonda Wright 1:40:50 No.

Dr. Rangan Chatterjee 1:40:50 No, that affects every single system in your body. It even affects, as you well know, your cognition.

Dr. Vonda Wright 1:40:55 Yes. This person in the center that I've described has osteosarcobesity. Let's break that down. A person who has a lot of fat surrounding all their muscle is obese-

Dr. Rangan Chatterjee 1:41:14 Mm-hmm

Dr. Vonda Wright 1:41:14 ... by definition. A person who has lost their functional muscle, they have low muscle mass, they have lost a lot of their good function, that is sarcopenia-

Dr. Rangan Chatterjee 1:41:23 Mm-hmm

Dr. Vonda Wright 1:41:24 ... which kills people. Plus, if you look at the bone, the study was not looking at bone, but the bone in this picture has, is very brittle looking.

Dr. Rangan Chatterjee 1:41:33 Mm-hmm.

Dr. Vonda Wright 1:41:33 It has a very thin cortex. That's osteoporosis. You can have each one of these in isolation, but what I find by taking x-rays of hundreds of people's legs a month, is that people present with obesity plus low muscle mass plus low bone density, and it's not one plus one plus one. It's one plus one plus one equals mi- I'm making this up, but a million because of the crosstalk between-

Dr. Rangan Chatterjee 1:42:01 Yeah

Dr. Vonda Wright 1:42:01 ... organs.

Dr. Rangan Chatterjee 1:42:02 Yeah. I wanna get to hormones-

Dr. Vonda Wright 1:42:05 Okay

Dr. Rangan Chatterjee 1:42:05 ... shortly. Before we do that, though, I just wanna finish off on movement.

Dr. Vonda Wright 1:42:10 Yeah.

Dr. Rangan Chatterjee 1:42:10 And I wanted to talk about VO2 max.

Dr. Vonda Wright 1:42:12 Okay.

Dr. Rangan Chatterjee 1:42:13 Right? Because, again, one of my other favorite chapters is this almost self-assessment chapter-

Dr. Vonda Wright 1:42:18 Yes

Dr. Rangan Chatterjee 1:42:18 ... where I know we mentioned DEXA scans before and what people can do, but you go through the kind of self-assessment process that people can do on themselves, even if they don't want to see a doctor-

Dr. Vonda Wright 1:42:31 Yeah

Dr. Rangan Chatterjee 1:42:31 ... or pay any money for anything-

Dr. Vonda Wright 1:42:32 Mm-hmm

Dr. Rangan Chatterjee 1:42:32 ... which I think is, is really, really awesome. But in terms of really trying to get this idea through to people that what you do in your 20s and your 30s and your 40s impacts your 70s, your 80s, and your 90s, I love the way you've described VO2 max and the frailty line.

Dr. Vonda Wright 1:42:53 Yes.

Dr. Rangan Chatterjee 1:42:53 Okay, so could you just outline-

Dr. Vonda Wright 1:42:54 Mm-hmm

Dr. Rangan Chatterjee 1:42:54 ... what is VO2 max?

Dr. Vonda Wright 1:42:56 Mm-hmm.

Dr. Rangan Chatterjee 1:42:56 What is the frailty line?

Dr. Vonda Wright 1:42:57 Yeah.

Dr. Rangan Chatterjee 1:42:58 And therefore, what are the implications for us in our lives?

Dr. Vonda Wright 1:43:03 VO2 max is the best measurement of your overall fitness. It's cardiovascular fitness. It actually measures oxygen diffusion, which means passage from your, from the blood in your heart to your lungs. It's, and therefore measures how fit you are. The, the higher your VO2 max, the more fit you are. And now endurance athletes, like, uh, Tour de France athletes, they're just genetically specimens. I mean, and their VO2 max is just outrageous, like 95.Most people, for their fitness level to be great, it's considered in the 50s to 60s of, of this measurement. Um, what happens is with time and disuse, our VO2 max will decline 10% a decade. And so you may think, "Okay, great, I'm not trying to be a endurance athlete. Why does that matter?" Because there is a line which you have cited, the fragility line, where you are too frail, you have so little fitness, you cannot take care of yourself. Meaning, once you have so little fitness, you cannot get up from a chair by yourself, you gotta live with somebody or you gotta move into a home. So our goal is to never pass the fragility line. So if we're gonna lose 10% of our VO2 max if we don't reinvest in it-

Dr. Rangan Chatterjee 1:44:33 Yeah

Dr. Vonda Wright 1:44:33 ... now we can build VO- But let's say you're not gonna make the effort. You will lose 10% per decade. So if you start out with a low VO2 max in midlife, say 30, 25, take 10% away per decade, at some point in your life you are likely to pass the fragility line and not be able to get up from a chair and not be able to take care of yourself. For men and women, the line is 15 to 18. So we, you know, great is 50. If we pass 15 to 18, we're not getting up from a chair and living independently. We can work on that by a different type of exercising protocol called the Norwegian protocol, which is going as fast as you can in an aerobic activity for four minutes, and then recovering, but only for four minutes. And by using the Norwegian protocol one time a week, you can build your VO2 max.

Dr. Rangan Chatterjee 1:45:31 Mm.

Dr. Vonda Wright 1:45:31 So it's not that all hope is lost if you find yourself in midlife with poor fitness. But again, it's like bone, you're starting behind the eight ball.

Dr. Rangan Chatterjee 1:45:41 Yeah. I guess the central message there is, is that although it's not inevitable that we're going to become frail as we get older, it is inevitable that there are gonna be some changes in your body.

Dr. Vonda Wright 1:45:57 Absolutely.

Dr. Rangan Chatterjee 1:45:58 And that's the normal process of aging.

Dr. Vonda Wright 1:46:01 Normal.

Dr. Rangan Chatterjee 1:46:01 And of course, there's many things we can do to improve things. We can stay active.

Dr. Vonda Wright 1:46:07 Mm-hmm.

Dr. Rangan Chatterjee 1:46:07 We can do it in, you know, this kind of hybrid-type training-

Dr. Vonda Wright 1:46:10 Yep

Dr. Rangan Chatterjee 1:46:11 ... regime that you're outlining-

Dr. Vonda Wright 1:46:13 Yep

Dr. Rangan Chatterjee 1:46:13 ... which is gonna reduce the rate of decline.

Dr. Vonda Wright 1:46:16 Yes.

Dr. Rangan Chatterjee 1:46:16 But there is going to be some decline. You know, in your 80s you're probably not gonna sprint as fast as-

Dr. Vonda Wright 1:46:22 Oh

Dr. Rangan Chatterjee 1:46:22 ... in your 20s, right?

Dr. Vonda Wright 1:46:23 Yes. And when I describe this, it's not because I'm a Pollyanna that believes there's never gonna be a decline.

Dr. Rangan Chatterjee 1:46:28 Yeah.

Dr. Vonda Wright 1:46:28 But I have plenty of individual patients and populations that I've studied. When you invest in your health and mobility every single day, you're going to age in a different way.

Dr. Rangan Chatterjee 1:46:39 Yeah.

Dr. Vonda Wright 1:46:39 Now, what happens if you didn't start until your mid-50s? There are also now more anecdotal examples all over the internet of people who have started in their 60s and 70s and made profound changes in their body composition-

Dr. Rangan Chatterjee 1:46:57 Yeah

Dr. Vonda Wright 1:46:57 ... in their health.

Dr. Rangan Chatterjee 1:46:58 I think I've heard Inigo San Milan talk about someone in their 60s who started to do zone two training-

Dr. Vonda Wright 1:47:06 Mm-hmm

Dr. Rangan Chatterjee 1:47:06 ... in their 60s.

Dr. Vonda Wright 1:47:08 Mm-hmm.

Dr. Rangan Chatterjee 1:47:08 But maybe six hours a week of zone two training.

Dr. Vonda Wright 1:47:10 Mm.

Dr. Rangan Chatterjee 1:47:10 And now in their late 80s, they're, I think, breaking world records, right?

Dr. Vonda Wright 1:47:15 It's amazing.

Dr. Rangan Chatterjee 1:47:16 It's remarkable-

Dr. Vonda Wright 1:47:17 Yeah

Dr. Rangan Chatterjee 1:47:17 ... the body's capacity to change.

Dr. Vonda Wright 1:47:18 Yes.

Dr. Rangan Chatterjee 1:47:19 But I guess the summary point of that VO2 max stuff for me is that there is gonna be some decline-

Dr. Vonda Wright 1:47:24 Of course

Dr. Rangan Chatterjee 1:47:25 ... as you get older. There is something called the frailty line.

Dr. Vonda Wright 1:47:28 Mm-hmm.

Dr. Rangan Chatterjee 1:47:28 And therefore, and you actually have a table in the book which shows people this.

Dr. Vonda Wright 1:47:32 Mm-hmm.

Dr. Rangan Chatterjee 1:47:32 But you can actually just back plot this and go, actually, if you wanna be living independently in your 80s-

Dr. Vonda Wright 1:47:39 Yes

Dr. Rangan Chatterjee 1:47:39 ... you're gonna need a VO2 max of this.

Dr. Vonda Wright 1:47:42 Yes.

Dr. Rangan Chatterjee 1:47:43 Therefore, in your 40s, your VO2 max should probably be in the region of this.

Dr. Vonda Wright 1:47:50 Ex- It's like a-

Dr. Rangan Chatterjee 1:47:51 Do you know what I mean? It's, it's-

Dr. Vonda Wright 1:47:51 ... DEXA scan. Let's find out where we are.

Dr. Rangan Chatterjee 1:47:53 Exactly.

Dr. Vonda Wright 1:47:54 If we need the motivation, and you're coming in with a VO2 max of 25 when you're f- when you're 40 or 50, we got a little bit of work to do, but it's not inevitable. We shouldn't use it as-

Dr. Rangan Chatterjee 1:48:05 Yeah

Dr. Vonda Wright 1:48:05 ... "I'm, I'm never gonna do it." It, it should be a motivating factor.

Dr. Rangan Chatterjee 1:48:10 So FACE is a great acronym. There's loads there we've covered, and of course the book goes through in detail. And of course, anything is better than nothing.

Dr. Vonda Wright 1:48:18 Yes.

Dr. Rangan Chatterjee 1:48:18 There's perfection, and there's also make progress from where you are. Let's now talk about hormones.

Dr. Vonda Wright 1:48:25 Okay.

Dr. Rangan Chatterjee 1:48:25 Right? Because right at the start, Vonda, you mentioned how there's a precipitous drop in estrogen for women in perimenopause. In your book, you also make the case that to you, estrogen is the elixir of longevity.

Dr. Vonda Wright 1:48:42 Yes.

Dr. Rangan Chatterjee 1:48:43 Does it necessarily follow, then, that all women need to replace their estrogen?

Dr. Vonda Wright 1:48:51 Here's how I position this. I believe that every woman is a sentient being with agency to make her decision, but I insist that that decision be made based on facts and not fear. And here's what I mean. Prior to the 2002 Women's Health Initiative study, which was a study done by the National Institutes of Health in the United States, more than 40% of women in the US, I don't know the, the, uh, European numbers, but, uh, 40% were optimizing their estrogen by replacing it because of the known effects it has on bone and muscle and heart and brain.After the Women's Health Initiative was published with the data that has been now strongly refuted as a travesty, the current number is between 2 and 4%, not because estrogen is bad for you, but because of the fear that was released from that study that made a blanket statement, which turns out to be nuanced and not true, that you will have a high incidence of breast cancer. You can't put that genie back in the bottle. Generations of women still today come into my office, and when I start talking about it, they just automatically say, "I can't do that. It causes cancer," to which I have to walk back, "Well, here are the data. You are free to make your own decision." S- so if we go to that data, do you mind if I name the one piece of data?

Dr. Rangan Chatterjee 1:50:31 Please.

Dr. Vonda Wright 1:50:31 So out of that-

Dr. Rangan Chatterjee 1:50:31 Hey, take your time. This is really important.

Dr. Vonda Wright 1:50:33 It's critical.

Dr. Rangan Chatterjee 1:50:33 And I know people listening are gonna wanna know your perspective on this.

Dr. Vonda Wright 1:50:36 Yeah, so the Women's Health Initiative was designed, and it's-- and a lot of good work has come out of it, but not this piece of work, not this particular question. W- was-- the question initially was heart disease as it relates to, uh, giving hormones. Now, at that time, because of when it was, the hormone they used was conjugated equine estrogen, which is a synthetic form, or which is a form that comes from pregnant horse urine. Um, now what we're talking about when I advise people to, um, consider estrogen replacement, we al- we also have the options of transdermal using patches, so it's not only these pills made out of horse's urine. But in the, in the WHI, they were asking the question, does a estrogen replacement increase cardiovascular disease? So they recruited older women. The women in this study were in their 60s, uh, on average. Here is the data that they found. They stopped the study early, called a press conference. Dr. Russeau, the head of the study, uh, called a press conference, from reading about that time and talking to people who were actually there, without consulting the study group of other doctors, and announced that the study was being stopped because estrogen caused breast cancer. Here are the data. In the women who did not take estrogen, the incidence of new breast cancer diagnosis was 3 out of 1,000. 3 out of 1,000. For the women in the study group who were given estrogen and sometimes synthetic progestins if they had a uterus, the incidence was 3.8 per thousand. So the difference between control group and, and study group was 0.8 women per thousand. Less than one woman per thousand was subsequently diagnosed with breast cancer. Now, listen, I am not making light, because one is one. One woman is one woman. I was a cancer nurse. I get it. I was taking care of, in my youth, women struggling with this. But for one woman in 1,000, estrogen was taken away from generations of women, just blanketly taken away, and in the same study, there was no increase in cancer deaths.

Dr. Rangan Chatterjee 1:53:16 Mm-hmm.

Dr. Vonda Wright 1:53:17 So instead of making this blanket statement, which has now affected women for generations, from which we have a high incidence of frailty in women and suffering, for what? So I think every woman gets to make her decision. If 0.8 is enough for you to not wanna be on it, that's your decision. But I personally, and the women I w- I take care of, I value my brain too much to let it starve to death. I value my heart too much to allow myself to develop 30 to 40% more microvascular disease. I don't wanna lose any more bone than I've had to lose.

Dr. Rangan Chatterjee 1:54:01 Mm-hmm.

Dr. Vonda Wright 1:54:01 And I feel like myself again.

Dr. Rangan Chatterjee 1:54:03 Mm-hmm.

Dr. Vonda Wright 1:54:04 Because my brain is back. I am stronger than I've ever been, and it is all the things I'm doing-

Dr. Rangan Chatterjee 1:54:10 Yeah

Dr. Vonda Wright 1:54:11 ... but it's also because I've given my body back what it's always had, which is estradiol, which is the, the compound our ovaries make; progesterone, because I have a uterus; and once we're settled out on that, I often discuss testosterone use with women. Because the reality is women make more testosterone than we make estrogen. It's a hormone, not a male hormone.

Dr. Rangan Chatterjee 1:54:38 Mm-hmm.

Dr. Vonda Wright 1:54:39 And so I think every woman has the right to make those decisions.

Dr. Rangan Chatterjee 1:54:42 Yeah. Thank you for sharing that.

Dr. Vonda Wright 1:54:45 Mm-hmm.

Dr. Rangan Chatterjee 1:54:46 It's really interesting for me to hear your own experience and, of course, that of many of the patients you've seen over the years.

Dr. Vonda Wright 1:54:55 Yes.

Dr. Rangan Chatterjee 1:54:56 And yes, the fallout of the WHI study has had huge implications-

Dr. Vonda Wright 1:55:02 Yes

Dr. Rangan Chatterjee 1:55:02 ... across society, and particularly for women, for, for a number of years now. Going back to the start of this conversation, when you were explaining that estrogen declines, so every woman is gonna have a decline in estrogen-

Dr. Vonda Wright 1:55:21 It's inevitable

Dr. Rangan Chatterjee 1:55:22 ... and there are estrogen receptors all over the body-

Dr. Vonda Wright 1:55:25 Mm-hmm

Dr. Rangan Chatterjee 1:55:25 ... including the brain.

Dr. Vonda Wright 1:55:26 Mm-hmm.

Dr. Rangan Chatterjee 1:55:28 So help me understand this from your perspective, that on the face of it, that would imply that all women would benefit from estrogen supplementation.

Dr. Vonda Wright 1:55:42 Mm-hmm.

Dr. Rangan Chatterjee 1:55:43 At the same time-I think if we look around the world, we see clearly that there are certain communities around the world where women don't seem to report the same number of symptoms-

Dr. Vonda Wright 1:55:57 Hmm

Dr. Rangan Chatterjee 1:55:57 ... through menopause.

Dr. Vonda Wright 1:55:59 Mm-hmm.

Dr. Rangan Chatterjee 1:55:59 And that there are women in their 70s and 80s who seem to be thriving-

Dr. Vonda Wright 1:56:04 Mm-hmm

Dr. Rangan Chatterjee 1:56:06 ... having not replaced their estrogen. And again, this, I- I've seen so many women have their lives transformed-

Dr. Vonda Wright 1:56:14 Mm-hmm

Dr. Rangan Chatterjee 1:56:15 ... once they start taking hormones.

Dr. Vonda Wright 1:56:16 Yeah.

Dr. Rangan Chatterjee 1:56:17 But I find that interesting to go, what is it?

Dr. Vonda Wright 1:56:19 It's a struggle. What is that, right?

Dr. Rangan Chatterjee 1:56:20 What is going on?

Dr. Vonda Wright 1:56:21 Mm-hmm.

Dr. Rangan Chatterjee 1:56:21 Because also, you mentioned before about how women, if you're breastfeeding and you're not careful about, uh, replacing those nutrients, you could be losing a lot of your bone structure. And as you were describing that, Vonda, I was thinking about the modern world, and in particular, the modern Western world, where actually now women are having to do so much. Now, you know, there used to be a time in many cultures, and even in Western culture, where women would be supported during pregnancy and in the early years, right? While they were breastfeeding, the family would support them and go, "Actually, this is a time where we need to really take care of the mother and the baby, make sure the mother has time to rest, that we're also..." Do you know what I mean? And that, that-

Dr. Vonda Wright 1:57:08 I do. I've read about it in books, but I've never seen it in my life.

Dr. Rangan Chatterjee 1:57:11 E- exactly.

Dr. Vonda Wright 1:57:12 [laughs]

Dr. Rangan Chatterjee 1:57:12 And it does... And of course, it's very hard now in these, in the modern world where people are often not living near their parents-

Dr. Vonda Wright 1:57:18 Yes

Dr. Rangan Chatterjee 1:57:18 ... or their family.

Dr. Vonda Wright 1:57:19 Mm-hmm.

Dr. Rangan Chatterjee 1:57:20 Often two parents in a two-parent family-

Dr. Vonda Wright 1:57:22 Yeah

Dr. Rangan Chatterjee 1:57:22 ... are working.

Dr. Vonda Wright 1:57:23 Yes.

Dr. Rangan Chatterjee 1:57:23 There's a pressure, particularly in the United States, for women to get back to work really, really quickly. So I wonder, and I, I have this question in my head all the time, what is going on? Is it that in those other cultures, yes, we think they're doing well, but had they been given estrogen, they would be doing even better? Or is there something about the stress load in our modern Western world which is exacerbating these issues?

Dr. Vonda Wright 1:57:53 Interesting.

Dr. Rangan Chatterjee 1:57:54 I don't know. I, I, and I just want to put it to you very respectfully.

Dr. Vonda Wright 1:57:57 Yeah.

Dr. Rangan Chatterjee 1:57:57 You know, have you thought about that? Because I can't quite square the circle there.

Dr. Vonda Wright 1:58:02 I think there are a lot of factors. I love this conversation. When we talk about longevity, women are winning that race.

Dr. Rangan Chatterjee 1:58:09 Mm-hmm.

Dr. Vonda Wright 1:58:10 In, in most countries, women live four to six years longer than their male counterparts. So f- in terms of sheer numbers of years, women win that race. But women suffer longer. Women are used to feeling pain-

Dr. Rangan Chatterjee 1:58:23 Mm

Dr. Vonda Wright 1:58:23 ... such that women come to my office with a, and without provocation, they say to me, "You know, I didn't want to come here today because I have a really high pain tolerance."

Dr. Rangan Chatterjee 1:58:34 [laughs]

Dr. Vonda Wright 1:58:34 And like a badge, because we have pain in menstruation. We have pain with childbearing. We have aches and pains when we lose our estrogen and our whole body hurts, and they can't get out of bed. We just assimilate that as the-

Dr. Rangan Chatterjee 1:58:46 Mm-hmm

Dr. Vonda Wright 1:58:46 ... natural course of having two X chromosomes. And they say, "I didn't want to come, I have a high pain tolerance, but I just couldn't take it anymore." So maybe s- some of what we're thinking of, well, we never used to feel menopause, is just the natural acceptance of pain in women.

Dr. Rangan Chatterjee 1:59:03 Yeah.

Dr. Vonda Wright 1:59:04 Another part of it could be the modern stresses that we have. We don't live in the... At least in Western world, we don't live in the same kind of community-

Dr. Rangan Chatterjee 1:59:15 Mm-hmm

Dr. Vonda Wright 1:59:15 ... that we used to. You know? We don't... Many times we don't live with our parents or live in p- close proximity.

Dr. Rangan Chatterjee 1:59:21 Yeah.

Dr. Vonda Wright 1:59:21 Right? Um, I'm gonna tell you for sure that, uh, when I left home at 18 to go to university, uh, I was gone for 22 years. Not continuously.

Dr. Rangan Chatterjee 1:59:32 Mm-hmm.

Dr. Vonda Wright 1:59:32 I saw my parents, but I never lived with them again. And I falsely thought that when I had my daugh- my last child at 40, I would... I used to say stupid things like, uh, "Oh, it doesn't take a village to raise a child," blah, blah, blah. I was so wrong, such that when I had her at 40 and my parents retired and moved, that community of support-

Dr. Rangan Chatterjee 1:59:56 Mm

Dr. Vonda Wright 1:59:56 ... was the only way I could have gotten it done. So I see what you're saying about the stress-

Dr. Rangan Chatterjee 2:00:02 Mm-hmm

Dr. Vonda Wright 2:00:02 ... and the increased inflammation that comes with that, that leads to pain and more brain loss and lo- more bone loss. Maybe that's what we're seeing. But even in very supportive cultures, maybe women are just used to suffering-

Dr. Rangan Chatterjee 2:00:18 Yeah

Dr. Vonda Wright 2:00:19 ... and, and don't want to mention it, or there's a lack of understanding of what's going on. 'Cause it doesn't mean that frailty doesn't exist.

Dr. Rangan Chatterjee 2:00:26 Yeah.

Dr. Vonda Wright 2:00:26 I see it in every culture that comes to see me, 'cause I live in a very diverse community.

Dr. Rangan Chatterjee 2:00:31 Mm-hmm.

Dr. Vonda Wright 2:00:32 Every elderly woman I see is frail.

Dr. Rangan Chatterjee 2:00:36 I love that. I love that perspective. And I love the fact that over the last few years there's a whole number of powerful, strong female women like yourself-

Dr. Vonda Wright 2:00:47 Mm-hmm

Dr. Rangan Chatterjee 2:00:47 ... like Stacy Sims, and, you know, Lisa Mosconi-

Dr. Vonda Wright 2:00:51 Yes

Dr. Rangan Chatterjee 2:00:51 ... Louise Newson, you know, Anita-

Dr. Vonda Wright 2:00:53 Mm-hmm

Dr. Rangan Chatterjee 2:00:53 ... Amukachi. You know, l- loads of people who are trying to raise awareness-

Dr. Vonda Wright 2:00:57 Yeah

Dr. Rangan Chatterjee 2:00:57 ... of the importance of female health, and actually-

Dr. Vonda Wright 2:01:00 Mm-hmm

Dr. Rangan Chatterjee 2:01:00 ... we put up with stuff for ages we don't need to anymore. And perhaps as a man, it's harder for us to see things like this-

Dr. Vonda Wright 2:01:07 Mm-hmm

Dr. Rangan Chatterjee 2:01:07 ... because, you know, my experience of the world is through a male body.

Dr. Vonda Wright 2:01:11 Sure.

Dr. Rangan Chatterjee 2:01:11 Right? So I can hear about the stuff that women have had to put up with and women have put up with. I can try my best to empathize. I think I'm pretty good at empathizing, but of course, I don't know what that's like because I'm not a woman.

Dr. Vonda Wright 2:01:24 Right. Well, I think, I think for, for this understanding to become full s- to become common, to reach a critical mass, we must have the collaboration of the men that we work with-

Dr. Rangan Chatterjee 2:01:36 Mm

Dr. Vonda Wright 2:01:36 ... and live with. It's an... I, I think the message will be spread s- more easily, so much that... You know, my poor husband, I drug him onto my own podcast so that he could-Talk to the world about what men need to know

Dr. Rangan Chatterjee 2:01:54 Mm-hmm

Dr. Vonda Wright 2:01:55 ... in, now to understand the people they love, to prevent midlife marriage failure after 25 years. Because unless we understand what's going on, you may not understand why your normally placid wife is suddenly enraged and, you know-

Dr. Rangan Chatterjee 2:02:10 Mm-hmm

Dr. Vonda Wright 2:02:11 ... has a fork in her hand aimed at you.

Dr. Rangan Chatterjee 2:02:13 Yeah.

Dr. Vonda Wright 2:02:13 Or there has to be an elevated understanding.

Dr. Rangan Chatterjee 2:02:17 Vonda, I loved chatting to you. Um, I, I really do think this book is fantastic. It's such a thorough and well-rounded practical guide-

Dr. Vonda Wright 2:02:27 Thank you

Dr. Rangan Chatterjee 2:02:27 ... for someone who wants to empower themselves-

Dr. Vonda Wright 2:02:30 Yeah

Dr. Rangan Chatterjee 2:02:30 ... and take control of their health. One that we've not really gone into, which is, as, when you arrived today, I sort of shared was one of my favorite things in the book, is there's a chapter on mindset and a chapter on resilience.

Dr. Vonda Wright 2:02:42 Yes.

Dr. Rangan Chatterjee 2:02:43 And just to sort of bring this conversation to a close, in the mindset section, you talk about a vision statement and why you think it's really important for every woman who goes on this journey to have their own vision statement. What's your vision statement?

Dr. Vonda Wright 2:03:02 You know, I have a vision for, um, being able to do what I wanna do when I wanna do it at all times. It doesn't matter if I'm my age now or if I'm 97, I want to have that independence. Because if I'm that independent, then I'm gonna have the fullness of life that I've worked for my whole life. I'm gonna have the fullness of relationship in an equally, um, giving relationship. I won't be just a taking. You know, my children, hopefully I'll be giving back as much to them as, as they're giving to me in my old age, right? And so I just want that independence. And to have that vision, it takes active pursuit now. It's just not gonna happen.

Dr. Rangan Chatterjee 2:03:49 Mm-hmm.

Dr. Vonda Wright 2:03:49 Um, and all the visions that, and this is what I teach people, have to be based on your values. Who are you? What do you wanna be? What do you really value in life? And from that you can build your vision, because otherwise, if you don't have that, these are just six-week programs. These are just more things to do without the end purpose.

Dr. Rangan Chatterjee 2:04:11 Yeah. The book is called Unbreakable: A Woman’s Guide to Ageing With Power. And right at the end of this conversation, which I have thoroughly enjoyed-

Dr. Vonda Wright 2:04:22 Aw, thank you

Dr. Rangan Chatterjee 2:04:25 ... for that woman who has been listening-

Dr. Vonda Wright 2:04:29 Mm

Dr. Rangan Chatterjee 2:04:30 ... who your words have sparked a little bit of interest.

Dr. Vonda Wright 2:04:34 Mm-hmm.

Dr. Rangan Chatterjee 2:04:34 They have started to see themselves differently.

Dr. Vonda Wright 2:04:37 Mm-hmm.

Dr. Rangan Chatterjee 2:04:37 They've started to go, "Well, wait a minute. Yeah, Vonda's right, actually. I have neglected myself. I have put everyone else first. I've not looked after my bone health. I've not looked after my physical health. I've never done anything for me, but now I see, Vonda, why it's so important."

Dr. Vonda Wright 2:04:55 Mm-hmm.

Dr. Rangan Chatterjee 2:04:56 For that woman who hasn't done much before but wants to get started-

Dr. Vonda Wright 2:05:01 Mm-hmm

Dr. Rangan Chatterjee 2:05:01 ... what are your final words to her?

Dr. Vonda Wright 2:05:05 What I want you to know about this whole process and this book, before anything else, is that you are worth the daily investment in your health. You have worth. That means that you can focus on yourself. You can prioritize these things ahead of everyone else you love and serve, because you are worth it. You were created and made and have value. Until you believe that, you will continue to neglect yourself.

Dr. Rangan Chatterjee 2:05:38 Vonda, thank you so much for coming on the show.

Dr. Vonda Wright 2:05:40 My pleasure.

Dr. Rangan Chatterjee 2:05:41 If you enjoyed that conversation, then I think you are really going to enjoy this one.

Dr. Vonda Wright 2:05:46 When we talk to women about what they think is a normal calorie intake, especially active women, they're like, "Oh, well, I eat 15 to 1,800 calories a day." That is not enough