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

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 and therefore increasing the

speed at which they age?

>> 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

going to 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

step-wise

allowing decline.

>> It's interesting this idea about

mindset or beliefs. You know if we

believe

if we get the message from the world

around us that getting older means

frailty means weakness means you have to

give up the things

>> that you don't want to give up

necessarily then of course your

>> behaviors are going to follow that's

right

>> your beliefs and there's so many things

about your new book Unbreakable that I

really really enjoy. I think it's

beautifully written

>> and in the introduction you actually say

I contend that although we certainly

undergo some life stage changes

>> 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.

>> 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 M's athletes is

because I wanted to see what we were

capable of if we took the variable of

sedentary living out of the way. Mhm.

>> So we began studying active people, not

professional M's age athletes, but

people over 40 who were consistently

active. Many of them were podium type uh

age group athletes, meaning you know

winning the 50year-old uh podium. So

they were invested but not pros. And

what we found was very different than we

find in the population. We've 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 aging,

it's based on facts, not fiction.

>> Yeah. So, in terms of

what people can do then as they get

older, we're going to get into all the

detail, but top line right at the top

for people

What are some of the things that you

want people to consider doing as they

get older? As I say, we'll get into all

the detail, but just top line, what are

some of those things you want people to

be focusing on as they get older?

>> 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

sciencebacked 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

>> 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. 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

going to hold you back. So, as a broad

outline, those would be the things I

identify.

>> I love those.

>> This book is primarily

focused on women.

>> I'm a man.

>> Yes.

>> In my 40s.

What is it you would like me to take

from reading this book? You know what

this book is specifically 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.

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. It's just biology.

>> 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.

>> Exactly.

>> And I think it is very relevant to men.

>> Yes.

>> Even though, you know, the strap line is

a woman's guide to aging with power,

>> I really enjoyed reading it

>> and of course I'm married.

>> Okay. Um I I help look after my elderly

mom. So some of these things that you

talk about, I have seen what happens

>> if people don't pay attention. I have a

daughter.

>> Yes. 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. And so this book has already made me

think about well what is my daughter

doing right now at 12 years of age

that's going to 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. 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 four daughters-in-law. It is my

intention that they never suffer because

you're that so that your 12-year-old and

my 17-year-old and my 31year-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 12year-old and my

17-year-old,

my vision and motivating factor is that

they will never feel this.

>> Yeah.

>> Let's take a big picture view, right?

You mentioned the differences between

women and men. Of course, there are many

differences.

>> Completely,

>> but I saw you speak a couple of days ago

in London

>> and you put up some very provocative

images. They very very thoughtprovoking

>> and one of them that I'm going to make

sure we pop up on screen on the YouTube

version of this conversation is how

>> men and women's hormones change

>> through their life.

>> 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.

>> Yes. Whereas women have this sharp

precipitous decline in estrogen

>> during pmenopause.

>> That's right.

>> Could you speak to that and speak to

these more broad differences and why so

many women

>> go through what you went through I think

at 47 which you can perhaps explain at

some point but just take us through what

those differences are and how they

manifest for us in terms of the quality

of our lives. 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 we describe

it as that we describe it as uh all

these body changes it's something that

we readily accept and then after puberty

we enter our 20s and by 30 our brains

are fully formed right we mature our

brains 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 am exhausted. 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 in their youth because when I

test you again in your 50s, you may have

a testosterone that's within the air

quote normal range,

which in the United States the normal

range is 250 to a,50.

>> That's a big normal range.

>> 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 a thousand and you're going to 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 eggshell of our

eggs, right? Here's the miracle of life.

Every woman, your daughter, my daughter,

me, your wife, were born with all the

eggs we are ever going to have across

our lifespan. So, if we think about this

in the universal sense, we're carrying

generations of people at our Isn't that

fascinating? 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.

>> So, so women have lost 97 to 99% of the

eggs that they were born with.

>> Yes.

>> By the age of 40.

>> That's right. And it and if the eggs are

producing the estrogen that you need

once you have so few eggs left uh

estrogen starts to decline which makes

our brain a little urgent

>> to have more estrogen. So it produces a

hormone called follical 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 permenopausal

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 pmenopause happen,

night sweats, brain fog, can't remember

nouns that 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 going to

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

muscularkeeletal syndrome 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.

>> It's just one day, isn't it?

>> It's one day. you've been losing

estrogen for for a 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.

>> 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 maybe early 40s

suddenly feels life is a bit more of a

struggle. The things that they used to

do

>> are no longer working so well. Mhm.

>> You're basically saying that for some of

those women, the precipitating event is

that decline in estrogen.

>> 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?

>> Oh, take your time. in the brain. For

instance, the work of Lisa Moscone has

shown that the brain is covered,

literally covered with estrogen

receptors.

The work of Robbie Brenton,

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 want to 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 be in my critical decade

before I became an expert on this,

I would walk into the operating room and

I would have known exactly what I was

going to do and I was going to 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 an anatson,

which is a which is a forcep.

>> 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. 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 going to work out the

mechanisms to find that although

multiffactorial, 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. 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

muscularkeeletal health, which is

obviously where I live, there's a

natural rate of decline of bone for men

and women of about 1% a year in their

bone density. During pmenopause, that

precipitously increases to 2 to 3% a

year. So that over 5 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 going to

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 pmenopause. The list

goes on 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.

>> Yeah, it's interesting. Simply calling

estrogen a sex hormone is so limiting,

isn't it? These labels we put on these

things.

>> And I feel medicine's done this in many

different places. Actually, there's been

unintended consequences, right? So, by

viewing estrogen purely as a sex

hormone, we therefore don't think about

the effect of estrogen on the brain or

the heart or the bone.

>> And you can sort of make the same case

like with exercise, right? Or physical

activity. How for many years in society,

it was about weight. physical activity

is what you need to do to maintain a

healthy weight.

>> And I would say I think over the last

five or 10 years realizing that your

muscles aren't just dumb muscles sitting

there, they're also

>> important for your hormones and all

kinds of communication molecules around

the body. And then yesterday I was

watching this beautiful 30-inute video

on your YouTube channel about bone.

>> Yes.

>> And I was thinking this the same thing

with bone, right? Like muscle has had a

PR job over the last 5 years where we

now understand that muscle is important

for so much more than our physicality.

>> And I feel with that video and in this

book, you're almost giving this kind of

new marketing to bone saying, "Hey, bone

isn't just your structure."

>> That's right.

>> Bone does so many other things.

>> 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 and around the world right

now and that's about the only time we

think about bones is oh gorgeous

cheekbones. Look at our wrist structure

or when we fracture. Obviously, bones

are seemingly silent until they break

and then they're screaming because

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

osteocalin.

>> Yeah.

>> Yeah. Osteocalin 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. And not only do they talk to

the rest of the body, but they are

intimately talking to muscle and fat

because the muscularkeeletal system,

fat tendon ligament bone muscle

muscle stem cells are all from the same

stem cell originally, the mezenymal 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 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 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 going to do a stem cell therapy

on you, we would get your stem cells

from your pelvis.

>> Isn't that fascinating 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

>> until they break.

And I'm going to 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. Me 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.

>> Yeah.

>> So 30% of the time, Aunt Miriam, who is

a story I told the FDA in the United

States recently as we're trying to

change the thoughts about estrogen,

30% of the time she's going to 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.

I mean, my parents live with me because

that's just what we do. But in many

cultures, that's not what you do. You

have 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 of5

to $15,000 a month until you're a

popper. And that's when the Medicaid who

wants to be in that situation.

>> 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 at the Roy Infirmary. And I can

still remember I think the first two

months of my placement was doing

orthopedics.

>> Yeah.

>> And I just I can just remember the ward

and it was mostly women.

>> Yes. frail older women who had necaurma

fractures.

>> Yes.

>> Right. And I didn't know then what I

know now. Of course I was junior doctor

just came out of medical school but

>> I can look at that now

you know through a different lens from

everything you just shared why it

affects women so much. This is huge. But

how do you get

a woman

>> in their late 30s who is in what you

call the critical decade which you can

perhaps explain in a moment

>> to actually care about this necur

fracture that they might get at 75

because that seems like yeah whatever

you know I'm still active I can still

pick the kids up and I can still see my

girlfriends at the weekend and 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?

>> 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

temporal disconnect. On average, they

cannot get the average person to save

$10 for their 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.

>> I love that. Is is it just for women or

is it for men as well?

>> It's for men. It is time to get your

proverbial health standards in check

because if you build a lifestyle where

you are 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. 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

>> if that's just the way you live. My

family and I have been wearing Vivo

barefoot shoes for over 12 years, and

there is no way that I would go back to

wearing cushion shoes. The human foot is

a masterpiece, but modern footwear has

disconnected us from our natural

movement. And barefoot shoes are a tool

to restore that primal link. Vivo

barefoot strips away the unnecessary. No

thick foam, no elevated heels, just

thin, flexible protection that lets your

feet move in the way that nature

intended. When your feet can feel the

ground, your body naturally moves

better. Now, Vivo offer a fantastic

range of shoes, office shoes, athletic

shoes, but also amazing winter boots

like the Trackr Forest, my current

favorite, which is super comfortable,

warm, and also has amazing grip. I can't

recommend them enough. If you want to

give them a try, please do use Vivo's

online sizing tools to ensure that you

find your own perfect fit. To get 20%

off your first order and enjoy a 100day

money back guarantee, visit

vivobarefoot.com/livemore.

Click on the link in the description box

below or scan the QR code on screen.

I've been wearing a Whoop band for about

a year now and it has had a

transformative impact on my health and

well-being. I've gained so many

different insights. How different types

of exercise or life stress affect my

recovery, how different evening routines

affect my sleep, and overall it's helped

me understand my own body much better.

Whoop is the only wearable that turns

your health and fitness data into

personalized guidance. And I'm pleased

to announce that the all new Whoop band

is now here, 7% smaller and with 14 plus

days of battery life. The all new Whoop

includes so many exciting new features,

including hormonal insights and on

demand ECG readings, but I think for me,

my own personal favorite is Healthspan.

And seeing this regularly helps motivate

me and keep me on track with my habits.

Now, I've been a medical doctor for over

20 years. I think it's really important

to use the Whoop data as a tool to help

guide you, not as something to dictate

your life. Honestly, I don't think

health wearables are necessarily for

everyone, but for some people like me,

they can be absolutely game-changing. If

you join Whoop right now, they are

giving my audience the allnew Whoop 5.0

device. Plus, they are giving you the

first month completely free. And if

you're still not sold yet, there's also

a 30-day money back guarantee, so you

can try it out for free. Go to

join.woop.com/live

more.

>> 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.

>> Yeah. It's almost as if we can kind of

get away with things until our mid30s,

right? So

>> yeah, there are healthpromoting things

to do. But even if you don't do them,

>> you'll skim by,

>> you still seem to get by or a lot of us

do in our 20s and early 30s.

>> But then there does tend to come a point

in most people's lives where it's like,

wait a minute,

>> if I don't pay attention to this, there

are consequences. And of course,

hormones are one of the big reasons for

that.

>> 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,

>> all of them.

>> Now, interesting enough, in the NHS, the

National Health Service here in the UK,

>> it's not that easy to get a DEXA scan,

right? You have to meet certain

criteria.

>> Yeah.

>> 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. Yes.

>> 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

>> and then we could show them this is the

state of your bone health.

>> Is that a good idea? Is it a flawed

idea? How would you put all that

together for me?

>> 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 when

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

REM's 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.

>> Is it like anote? Well, I don't know if

you have.

>> Anote is something we have in the UK.

So, if your car

>> is over 3 years old,

>> it has to undergo an annualote.

Okay. So, to to check that it's roadw

worthy and if there's anything problems

with your tires or

>> I don't know the wipers, you know.

>> Ironic that we do it for cars. Yeah,

>> 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.

>> Yeah.

>> Yeah.

>> So, so what what I'm thinking is I think

I heard did you say you've you've seen

24 year olds with osteopenia?

>> Completely.

>> 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 for many

years and what women think they need to

do in order to look a certain way.

>> But why is it I mean do you remember

that 24 year old with osteopenia? What

why did she have

>> poor bone density in her 20s? I've given

this a lot of thought and and the first

thing I'm going to 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 teenytiny and take up no

space and not eat a lot of food. women

think that they're going to be

healthiest if they don't eat a lot. And

even though we've made progress,

um

I'm I am not against GLP1s 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.

Gone are the days we were not digital

natives. We did not grow up with a cell

phone. 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 to just send our kids out to

play for hours and hours.

They're more sedentary, so they're not

bashing their bones and building bone.

So you get to the peak building years

not having built peak bone.

>> Mhm.

>> 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 amenoric, meaning no periods for

six to nine months because they have

relative energy deficiency. And with low

energy,

>> your body goes into survival mode and

doesn't produce.

>> I mean, you're not it your body doesn't

want you to have a child when you're

starving, which is what your body thinks

you are. And so, it doesn't cycle. I

mean, does that makes so much sense?

>> Yeah. And I guess also one thing we're

seeing across many countries now is a

rise in eating disorders.

>> Yes, in men and in boys and girls in men

and women. But of course,

>> if you're a woman and you've had an

eating disorder and for a period of time

have not

>> been properly or adequately nourishing

your body for whatever reason, which of

course we need to sensitively address.

>> That's going to have an impact.

>> Yeah. It's quite interesting that I

think you mentioned there was uh a PhD

student in her 20s

>> and she was thin, skinny fat I think you

described and she was um performing

well, right? So, 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 want to look.

I'm able to study.

>> But perhaps my lifestyle without me

realizing has neglected my bones. And as

you say, of course, you know, the kids

today are digital natives, 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 net ball

about 3 years ago, and so she probably

plays five times a week

>> and I'm delighted because she enjoys

playing. Her friends are there, so

there's this big social component. I'm

thinking

>> actually, you know what? If I think

about net ball through the lens of bone

health,

>> there's a lot of impact, a lot of

jumping, a lot of speed.

>> Um, I'm think this is good.

>> Multidirectional jumping.

>> Perfect.

>> Yeah. And I'm thinking this is good,

right? Because

>> there's a social component for her

>> and as a side effect, she's getting all

of this great movement in.

>> Yes. I think the difficulty for me would

be is well if she wasn't into net ball

actually and I know a lot of uh parents

face this if their children don't enjoy

a particular sport they could hear a

podcast like this

>> and think well hold on a minute

>> what are my kids actually doing

>> to build their bone density I mean they

go to school

>> they come back they're on screens or

whatever it might be

this is urgent isn't it

>> it's critical and to that if a parent is

recognizing izing that their kid isn't

playing net ball 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.

>> Yeah.

>> 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. 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

so fantastic,

maybe it becomes a family affair.

>> Yeah.

>> 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.

>> Hey, kids love jumping and doing that

stuff.

They don't necessarily need to know that

when you jump you're putting sheer force

through your bones and the osteoclasts

are getting stimulated and like sure

someone do maybe my kids have heard that

from me but in general like kids like to

jump around

>> 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 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.

Going back to this idea that women and

men age differently.

>> Yes.

>> I'm really interested as to what happens

when a woman gets pregnant.

>> Oh.

>> Because I know that can have an impact

on bone health and breastfeeding can as

well. So

>> can you just talk us through that

because again I think it's empowering to

realize

>> the impact of those things

>> and therefore what we can do on the

other end. Completely love that you

brought that out 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.

>> And and just for people who don't know

what resorb means,

>> yes, it means that there's a the way

bone works just as a bone building

primmer, 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

>> and in normal circumstances with enough

hormones that is a a pretty equal

process. Homeostasis balance 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

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 going to 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 going to take that from

our bones. So every time your baby

latches on, in addition to drinking

water, we have to be thinking about

replacing 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, mid30s,

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 pmenopause, losing 15 to 20% of your

bone density. Do you see how this can

add up across a lifespan such that it is

not it is even more common for women

truly in their menopause years. I at

this conference we were at 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,

>> but they go and get this DEXA scan or

this REM scan and they're osteopenic or

osteoporotic and they're so disappointed

>> because they thought they were doing

everything right now. Well, they may be,

but maybe they didn't build enough bone

in their youth.

>> Yeah. It's so interesting. You know, as

you're talking there, I'm thinking about

my wife. So, my wife

breastfed both of our kids, which is

what she wanted to do, and she was able

to. I recognize that not every woman

>> can want to.

>> Mhm.

>> But let's say there was four years of

breastfeeding.

>> Mhm.

>> Given what you've just said, that's four

years

>> where

my children, our children were taking

whatever they needed. Yes.

>> From my wife's body.

>> That's right. and potentially leeching

her bones for calcium.

>> It sounds terrible when we say it like

this

>> in order to sustain theirs.

>> That's right.

>> Right. 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 were 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. Mhm.

>> So, without knowing anything about my

wife, would you say actually that's

someone who might be a good candidate

for a DEXA scan?

>> I'm going to order it for her myself.

>> Okay. So, you think it's that important?

Because

>> I do. What is the downside of knowing

where we stand?

>> Yeah.

>> Because it might serve as motiv. We

might find out she's perfect.

>> Yeah.

>> Good for her. We're going to 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

>> mid, 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, smoking is poison

to bones. If you had 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 want to know

if you were skinny fat your whole life.

If you h 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

>> that our bones are going to be okay at

65 when finally a DEXA scan or will be

paid for." You know,

>> I think we also have to look, I I I'm

I'm sort of semifamiliar with the

healthare system in America, but of

course, I know the UK one much better.

>> 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. It simply cannot pay for

all of this stuff for everyone.

>> That's right. 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.

>> And and I I don't say that cuz 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 going to be

there for and it's going to be fantastic

at some things. acute problems or I

shared with you we were just from the

fracture clinic this morning because my

son fell a couple of weeks ago well

>> four and a half weeks ago broke two

bones in his wrist

>> we got great care from the NHS they

x-rayed him put him in a cast we've gone

and had a review

>> that stuff I think the national health

service is fantastic at

>> I do think and of course not everyone

can afford this

>> but if you're someone who's concerned it

may be that we have to take this into

our own hands and go actually

>> what is the cost of me not doing a DEXA

scan

>> right 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 going to put mom in a home

going to pay for care are we going to

decimate all the life savings whatever

it might be these are real things that

are happening 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?

>> We we don't we can't really see it. We

can't really I don't know how much a

debt a 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 in the future.

>> 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

health care 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 fastunning 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. And I'm

not zeroing out Starbucks, but the fancy

coffee that I no longer buy there costs

$7.18.

Yeah,

>> 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 de and I realize that

that may be a privileged thing to say,

but every single person has something

and save it for six months.

>> Yeah. But let's say let's let's even say

that someone cannot afford that, right?

Let's let's go to the practical things

because one of the you know, 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 we must go

into bone health because I think bone

health has been undervalued

>> completely

>> and even I' 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 V2 max and that's all

great and we're going to get to that

>> but I do think bone needs to be raised

in our awareness so I really wanted to

make sure we we focused here.

A lot of this book is talking about the

incredible benefits of movement and of

course you have this wonderful acronym

face right 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.

>> 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? So, when it

comes to movement, what kinds of things

can we do that will directly improve the

health of our bones?

>> Yes. Let's just assume you're losing

bone density. Let's make it a given.

That that's a good that is a good place

to start. Men and women are going to

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 face 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

neuromuscular pathways controlling

balance start to degrade in our 20s.

Such as you reach for something, you

lose your balance, you topple over

>> in our 20ies.

>> Yes. But it can be totally re 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 cuz you'll be

fine before you fall and then you have

the fatal fall or the you know 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 minor fracture. So retrain our

balance. And number two in that FACE

equilibrium is the longforgotten 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,

>> 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 by our desk and trips

us every day, right?

>> We may be fine until we lose our balance

and fall down.

>> Yeah.

>> So, we can't forget to do that in our in

our general mobility, but specifically

for bone if we're talking about it.

Yeah.

>> See, it's interesting. Things like

swimming and cycling

>> are fantastic aerobic activities. But

>> I say personally in my own life over the

last years, I've really been thinking

about

>> weightbearing activities.

And if I have limited time to move and

I'm making more and more time to move as

I get older.

I'm

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.

>> Yes,

>> 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.

>> They're not

>> right. 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, as an

orthopedic surgeon. What's your take on

that?

>> Um, I agree. I am not against swimming.

Great for aerobics. 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 1.5 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.

>> Okay? So, if we really want to get after

it, we're going to jump. And we're going

to we're going to jump at least off an 8

in step because that will produce four

times body weight and impact because

this is the way bones work chemically.

The biomechanical impact of you landing

hard on both feet from an 8 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 when you're running, I would

stop and jump up in town 10 to 20 times

or you can do it all at one time. Three

day three days a week. You can spend 10

minutes jumping in multi-direction. I

just uh posted um reintroducing

hopscotch to the world, right? Because

it's multidirectional play jumping.

>> 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

the 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 50

>> we found not surprisingly that the

jumping sports like volleyball,

basketball

because of the impact maintained bones

better

>> than the swimming, the running, the the

bad mitten, the bowling. Um,

>> that's really interesting. Isn't that

fascinating?

>> And can 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 when you land. So, I'm

guessing that you're saying, "No, no,

you must make sure it's against a hard

surface.

>> If you have a choice, if you are not so

arthritic that you can barely move,

>> please impact on against a hard

surface." Um, that being said, NASA has

some good evidence that when they bring

astronauts back down from the space

stations, they use rebounders,

>> right?

>> 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.

>> Yeah. Okay. I love that. And of course,

skipping ropes are brilliant as well for

this.

>> Skipping, just skipping on a track. I

mean, that kind of impact, getting your

knees up really high adds some impact.

Okay. 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.

>> You've spoken about the hormonal changes

that happen in a man's life and in a

woman's life. Why in that critical

decade 35 to 45 particularly for women

>> hormones fall off a cliff and it has a

consequential impact on multiple aspects

of our health brain heart muscular

system whatever it might be

>> and we've just gone deep into bone

health

>> the impact on bone health and the sort

of things that we can do

>> to help improve it.

>> 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.

>> Yes.

>> A big part of your book is around

movement.

>> I think chapter two is literally making

the case for movement.

>> 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,

>> but just build that case for us about

movement. Why is it so important that we

move in a variety of different ways,

>> particularly as we get older?

>> 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 prof 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

uh a a cytoine, a hormone called irri 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.

>> So, anytime 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 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 9800

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'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 2

years old. She's old. 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. You turn on something

called program 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. 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 want to run, but

we encouraged them to do so. 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. 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 mal mice bodies, these

murine model that we're not dead, we're

living. And ex

>> so down to the cellular level.

>> So and that's what I'm trying to re to

explain to people in the book and give

them I mean I think my readers are

smart. They need to know why, 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.

>> Yeah.

>> 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.

>> 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, DNA

change and damage, mitochondrial

dysfunction, scinessence, fuel gauge

malfunction and stem cell exhaustion and

then you cross reference that with

different kinds of exercise

>> and basically you follow that chart. you

go, "Wait a minute. If you do this

hybrid training program that you outline

in your book, you are basically going to

make sure you've hit every one of those

six."

>> Yes.

>> 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.

>> Yeah.

>> Hybrid training targets them all. It's

very very inspiring, isn't it? is you

can hit all the boxes by doing this very

simple lifestyle.

>> You're obviously such a passionate

proponent of this. You've

>> you you know you were really worried at

47 and what the hell was going on with

your body and your brain

>> and you've really turned things around

where you know I saw you the end of the

day in London. You probably had a jet

lag whatever you were on fire on stage.

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.

>> It's how you're saying it. This is a

paid advertisement for better help. Now,

all of us need support from time to

time, but of course, not everyone in our

life is a trained therapist. I have been

a medical doctor for over 23 years and

have seen time and time again the

transformative effects when people are

able to talk regularly with a trained

therapist.

For many of us, the problems in our

lives mount up and stay inside our

heads. We get triggered by comments from

other people, and we don't realize how

much our past experiences

are affecting our present day

interactions.

Yes, it's great to get support from our

friends or the hairdresser or the

barista, but sometimes it can be really

helpful to go that one step further and

talk to a trained therapist about things

like our relationships, our mood, and

clinical issues like anxiety and

depression.

With BetterHelp, you can get regular

guidance from a credentialed therapist

online. One of the most important things

about choosing a therapist is making

sure you get the right one for you. One

of the things I love about BetterHelp is

that they do the initial matching work

for you. A short questionnaire helps

identify your needs and preferences. If

you aren't happy with your match, you

can switch to a different counselor at

any time at no extra cost. And you can

also pause your subscription whenever

you like. With over five million people

supported to date all around the world,

BetterHelp is now also available in the

UK with thousands of counselors who have

expertise in a wide range of

specialtities.

With a 4.9 out of five rating based on

over 1.7 million client reviews,

BetterHelp makes counseling affordable

and convenient. My listeners get an

incredible 10% off their first month at

betterhelp.com/livemore.

That's betterhp.com/livemore

or click on the link in the description

box below or scan the QR code on screen.

Hey guys, I really hope you're finding

this useful. If you are and you want

more content like it, please 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

ebook and as an audio book, 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?

>> Sure.

>> 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 you do. Yeah.

>> And then we can perhaps wind back to

someone who's never done any of this

before where they can start.

>> Yes.

Um,

and number one, I want people to give

themselves grace

because sometimes when people say what

I'm about to say, they're like, "Gh, I

could never." It's not about that. Start

where you are. 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 am not doing everything that I

would normally love to do. And I'm going

to 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 a dynamic warm-up every

day which gets every joint, every set of

tendons and ligaments around my major

joints moving, right? So, daily

flexibility and mobility.

>> 10 minutes.

>> You know, it's just a series and it's

outlined in the book, The Dynamic War.

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

>> first thing in the morning. Is that when

you tend to do it?

>> No, I do it before I work out.

>> Before you work out.

>> I I put it all together.

>> Yeah, that's interesting. And the only

reason I ask is because I do mobility

every day, but it's part of my morning

routine. So, I'll get up.

>> Yeah.

>> 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 5 10

minutes just doing a whole variety of

mobility exercises. I almost feel like

it's waking up all of my joints for the

day ahead. So, you do it before you work

out.

>> I do it first thing in the morning, but

doesn't really matter.

>> Yeah. Some form of mobility to keep all

the joints moving. Okay.

>> 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 8020 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

highintensity exercising that I'll talk

about in a minute. So 80% of the time,

so that is 3 hours a week broken up into

45 minute sessions. I choose to do mine

either by walking home from work, which

is 2 and a half miles, or I have a

treadmill in my room upstairs. So four

45 minute sessions a week in what's

typically these days called zone 2

training which is basically low heart

rate training.

>> And I and I came to that based on the

research of Indigo San Milan who is a

physiologist for the tour to France. So

he has a lab in my building. So I use

his method

>> and I 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.

>> But you also, and you do share this in

the book, that for people who don't want

to get that technical and don't want to

do lab testing.

>> Yeah.

>> It's it's basically a lot easier than

you think.

>> Oh, it's brisk walking.

>> Yeah. 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.

>> Yeah. You would be breathless.

>> Yeah.

>> Yeah. And and by the end of doing that,

I break a little sweat cuz I can feel my

metabolism revving up.

>> So So you're trying to do about 3 hours

of that a week.

>> That's correct. And that's when I listen

to podcasts. Yeah. Or I learn something.

>> So it's relatively an inverted commas

easy training relatively.

>> You're burning fat. It's good for your

metabolic flexibility.

>> 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,

>> right?

>> And which is just incredible. I had

professor Steven Siler who's also the

same ilk of indigo.

>> Yeah.

>> 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

>> from when he observed it in a lot of

elite athletes.

>> Exactly. That's what they do.

>> Yeah. But again, he was just sharing

with me when he came on the show that

actually you don't see a cortisol spike.

So you you

>> it's easy to recover from that stuff.

>> That's right.

>> Cuz you share in the book actually that

in your younger years

>> you went all in on high intensity in

sport training

>> cuz I'm impatient.

>> Yeah. And actually you were sharing a

lot of the research book where actually

as you get older you don't want to be

doing that five six days a week. It can

actually start to be counterproductive.

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.

>> They're working hard. They don't get the

results they expect and they're injured

a lot

>> every 3 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

Shakiri 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

>> for 30 seconds,

complete recovery, whatever that takes

you. It takes me 2 to 3 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.

>> You feel like kind of a pardon me, but

badass when you hop off the treadmill

after sprinting, right?

>> So that's how I do my cardio.

>> Um,

>> so hold on. 10 to 15 minutes maybe of

this dynamic warm up. So mobility and

flexibility on most days. Most days

>> three hours of this low inensity aerobic

training either walking home or on a

treadmill.

>> Yes.

>> Twice a week you're doing sit sprint

interval training.

>> After my walk.

>> After your walk. So your walk is warming

you up.

>> Totally warmed up.

>> Totally warm before you start sprinting.

>> That's right. And what I love about this

is it's kind of echoing particularly on

this SIT point what Stacy Sims said when

she came on recently.

>> Um

>> I have some female friends and family

members in my life who I would say

>> are active

who walk regularly.

>> Yes.

>> But don't do sprint interval training.

Yes.

>> Can you make the case

to me and hopefully then to them

>> why

yes, walking and being generally mobile

is very good,

>> but why would you say that they're not

getting the full benefits of movement

unless they're having this stimulus to

their system? 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 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 going to get

you lean.

>> Interestingly, it's why we have a lot of

great marathon runners, but they're they

have a lot of fat mass.

>> Yeah. Right.

>> You actually said in the book, actually,

I found this um like very honest of you.

Europ saying, "Listen, I've I I was

doing uh the baseline cardio and I was

doing strength training, but it was when

you added in the sprint interval

training 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."

>> Absolutely. I went from uh at when I was

writing this book um I had come off the

time when I I gained 20 30 pounds during

pmenopause which was unheard of for me.

I was an athlete and so I had always

been so thin that I didn't have I had

19% body fat.

>> Was that hard for you

>> gaining that weight? Yeah.

>> 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 and

a certain size? Or was I going to 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 8 pounds of muscle. I lost all

this body fat. I was leaner.

And aesthetically, I loved it. And you

know what? That

that goes up and down. That's why I give

yourself grace. I'm on a book tour now.

I'm not doing four or five days a week,

but I will again when it settles down.

>> So, the the sprint interval training is

30 seconds of something

>> something.

>> It doesn't have to be literally

sprinting. It could be the battle rope

or

>> or vertical or the alpine thing or the

rowing or

>> something as fast as you can.

>> Yes. To get your heart rate

>> 30 seconds and then what do you do?

>> 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 2 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.

>> And what how many 30 seconds?

>> Just four times.

>> Four. I mean, that's not that much, is

it?

>> 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."

>> Yeah. And you do that twice a week.

>> Twice a week.

>> And I think the final part is resistance

training.

>> 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 fliply, uh, put down the

Mambby pami pink weights. Well, okay.

So, if someone has handed you a 3 to

five pound weight and said, "Lift it 30

times."

That is good for endurance. You will

fail after 30 times of lifting a very

small weight. If your goal is endurance,

fine, you do that. That's not our goal

in midlife and beyond. That is not going

to 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

>> 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 fast twitch muscle, right? So

strength is built with higher weights,

lower reps.

>> And you probably heard this from Stacy

Sims. 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. 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. It may

take you getting lifting lessons so that

you're

>> hinging correctly. That's how you move

your hips. You're stacking your joints.

You're giving your tendons and ligaments

time to adjust. But once you get there,

we're going to 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 going to 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 because it just that's when I fail.

>> And then you support that with the

single lift, single muscle lifts,

biceps, triceps, lats, delts with

slightly higher reps, eight to 10

>> 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.

>> Yeah.

>> Yeah.

>> Well, thank you for sharing that, Vonda.

It's it's very insightful to hear what

you do.

>> Yeah.

>> 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.

>> Yeah.

>> But I can't stand gyms. Sure.

>> Right. If they say that to you, what do

you say to them?

>> 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. I put a start

program in the book because 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

going to have to buy a rack for your

garage cuz or okay, let's

or unless you want to lift with logs in

your backyard or filling up five gallon

buckets of water and carrying it around,

it's harder to get 45 lbs of weight in

your garage without actual racks of

weight. 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?

>> Yes, you could.

>> So a sandbag, depending on how much

weight is in there, of course

>> is heavy.

>> Yeah.

>> You know, so one thing I'll often do is,

you know, get the sandbag

>> on your shoulder and go up and down and

then sprint up and down the garden,

throw it up in the air each time, pick

it up again.

>> Uh I also try and do that a lot when my

kids are around. So, yeah, they see it

and often I go, "Oh, daddy, can I can I

do it?" So, I'm like, "Yeah, yeah, sure.

Sure."

>> Funnily enough, I have bought two more

when and I've actually put the right

amount sand in for your weight. Not that

I try and tell them that, but they just

happen to be there.

>> Clever of you.

>> But, um, that's like when we separate

movement into all these different

things, right? 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 going to

necessarily go, well, I'm going to go to

the gym three times a week. I'm going to

do this two times. I'm going to do this

though. So, I guess I'm trying to make

sure that these core principles which

you write about so beautifully.

>> I want to make sure that people

listening actually take action even if

they can't stand the gym.

>> So, listen, I will take anything

except sitting around. So, if you will

never go to a gym and you do not want to

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 going

to have to get a lot 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. I'll take that. Um, I'll take

you climbing your stairs with your 40 lb

sandbag on your 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. Yeah.

>> To build muscle to to increase cardiac

health. But literally, I'll take

anything other than sitting around cuz 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.

>> Yeah.

One of my favorite pages in your book is

page 27.

>> And the reason why is that on page 27,

you have three beautiful images.

>> Yeah.

And they are MRI scans of people's

thighs.

>> Yes.

>> Do you want to just talk us through

those three images? And again on the

YouTube version, I'm going to try and

pop that up on screen 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?

Because I want a muscle like that when

I'm 70C. And that was the intent of this

picture series. And when I submitted the

paper for publication, one of the

reviewers said, "Ah, the picture is

unnecessary." And I said, "This picture

is so necessary. I will not publish with

you unless you publish it." So here it

is.

>> I'm glad you did cuz it w it wouldn't

have had the impact just reading the

words. No, it wouldn't. 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 muscles 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 like a flank steak across the top

of the bone. Gorgeous lean muscle in the

back, your hamstrings with very little

peripheral fat. You know, the pinchable

fat on your leg, 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,

>> 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. You lost all your muscle

architecture. You lost muscle volume.

They're grossly infiltrated with fat.

You can see the white streaking.

>> Yeah.

>> And there is a thick rind of peripheral

fat. I call that a wagoo beef.

>> Yeah. It's like the marbling you see in

a Wagu beef.

But that is not the story. The story is

the third picture, 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, we did not

find a statistically significant

decrease in strength until mid60s. 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.

Yeah, it it's remarkable that you cannot

at first glance tell any difference

between the MRI

>> of the 40-year-old triathlete 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. This shows very clearly

that if you stay active,

>> right, and you prioritize movement in

your life, you can have very similar

muscle architecture in your 70s as you

can in your 40s.

>> Yes.

>> It is so so inspiring to see that.

>> Yeah.

>> 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

>> oh

>> 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. No, that affects every

single system in your body. It even

affects, as you all know, your

cognition.

>> Yes. This person in the center that I've

described

has osteo

sarcobesity.

Let's break that down. A person who has

a lot of fat surrounding all their

muscle is obese

>> 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

>> 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. 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 1 plus 1 plus

one. It's 1 plus 1 plus 1 equals

>> may I'm making this up but a million

because of the cross talk between

organs.

>> Yeah. I want to get to hormones shortly.

Before we do that though, I just want to

finish off on movement.

>> Yeah.

>> And I want to talk about V2 max.

>> Okay.

>> Right. Because again, one of my other

favorite chapters is this almost self

assessment chapter 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 or pay any

money for anything, 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 V2 max

and the frailty line.

>> Yes.

>> Okay. So, could you just outline what is

V2 max? What is the frailty line and

therefore what are the implications for

us in our lives?

The O2 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 and

your heart to your lungs. It's and

therefore measures how fit you are. The

the higher your V2 max,

the more fit you are. And now endurance

athletes like uh tour to France

athletes, they're just genetically

specimens. I mean, and their V2 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

V2 max will decline

10% a decade and so you may think okay

great I'm not trying to be an 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 got to

live with somebody or you got to move

into a home. So, our goal is to never

pass the fragility line. So, if we're

going to lose 10% of our V2 max if we

don't reinvest in it, now we can build

real, but let's say you're not going to

make the effort. You will lose 10% per

decade. So if you start out with a low

V2 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, grade

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 V2 max. 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 eightball.

>> 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 going to

be some changes in your body.

>> Absolutely. And that's the normal

process of aging. And of course, there's

many things we can do to improve things.

We can stay active. We can do it in, you

know, this kind of hybrid type training

regime that you're outlining,

>> which is going to reduce the rate of

decline. Yes.

>> But there is going to be some decline.

You know, in your 80s, you're probably

not going to sprint as fast as in your

20s.

>> Yes. And when I describe this, it's not

because I'm a polyiana that believes

there's never going to be a decline, 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. 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 in their health. I think

I've heard Inigo Saman talk about

someone in their 60s who started to do

zone 2 training in their 60s but maybe

six hours a week of zone do training and

now in their late 80s they're

>> I think breaking world records it's

remarkable the body's capacity to change

>> but I guess the summary point of that V2

m stuff for me is that there is going to

be some decline

>> of course

>> as you get older there is something

called the frailty line And therefore,

and you actually have a table in the

book which shows people this,

>> but you can actually just backplot this

and go actually if you want to be living

independently in your 80s, you're going

to need a V2 max of this.

>> Yes.

>> Therefore,

>> in your 40s, your V2 max should probably

be in the region of this.

>> Ex. It's like a scan. Let's find out

where we are. Exactly. If we need the

motivation and you're coming in with a

V2 max of 25 when you're when you're 40

or 50, we get a little bit of work to

do, but it's not inevitable. We

shouldn't use it as I'm I'm never going

to do it. It it should be a motivating

factor.

>> 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.

There's perfection and there's also make

progress from where you are. Let's not

talk about hormones, okay? Right.

Because right at the start, Vonda, you

mentioned how

there's a precipitous drop in estrogen

for women in pmenopause.

In your book, you also make the case

that to you estrogen is the elixir of

longevity.

>> Yes.

>> Does it necessarily follow then that all

women need to replace their estrogen?

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 numbers 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.

So, so if we go to that data, do you

mind if I name the one piece of data?

So,

>> hey, take your time. This is really

important and I know people listening

are going to want to know your

perspective on this.

>> Yeah. So the women's health initiative

was designed and it's and a a lot of

good work has come out of it but not

this piece of work not this particular

question

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 ecoin 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 we also have the options

of transermal using patches. So, it's

not only these pills made out of horses

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. Rouso, the head of the

study, uh, called a press conference

from reading about that time and talking

to people who are 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 three out of a thousand.

Three out of a thousand. For the women

in the study group who were given

estrogen and sometimes synthetic

progesterines if they had a uterus, the

incidence was 3.8

per thousand. So the difference between

control group and and study group was8

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 a thousand, estrogen

was taken away

from generations of women. Just

blanketly taken away. And in this same

study, there was no increase in cancer

deaths. Mhm.

>> 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. If8 is enough for you

to not want to be on it that's your

decision. But I personally and the women

I 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 want to lose any more

bone than I've had to lose.

And I feel like myself again

>> because my brain is back. I am stronger

than I've ever been. And it is all the

things I'm doing. Yeah. 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. And so I think every

woman has the right to make those

decisions.

>> Yeah. Thank you for sharing that.

>> 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.

>> Yes.

>> And yes, the fallout of the WHI study

has had huge implications

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

going to have a decline in estrogen.

>> It's inevitable

>> and there are estrogen receptors all

over the body including the brain. Mhm.

>> 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. Mhm.

>> 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

>> through menopause

>> and that there are women in their 70s

and 80s who seem to be thriving

>> having not replace their estrogen. And

again, this I I've seen so many women

have their lives transformed once they

start taking hormones,

>> but I find that interesting to go, what

is this

>> struggle? What is that?

>> What is going on? 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

>> I do I've read about it in books but

I've never seen it in my life

>> exactly 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 or their family

>> often two parents in a two parent family

are working 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 Eastern, they would

be doing even better. Or is there

something about the stress load in our

modern western world which is

exacerbating these issues?

>> Interesting.

>> I don't know. I And I just want to put

it to you very respectfully. You know,

have you thought about that? Because I

can't quite square the circle there.

>> I think there are a lot of factors. I

love this conversation. When we talk

about longevity,

women are winning that race.

>> In in most countries, women live four to

six years longer than their male

counterparts. So, in terms of sheer

numbers of years, women win that race,

>> but women suffer longer. Women are used

to feeling pain such that women come to

my office with 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 and like a

badge. Because we have pain in

menration. 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

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 some

of what we're thinking of well we never

used to feel menopause is just the

natural acceptance of pain in women.

>> Yeah.

>> 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 that

we used to you know we don't many times

we don't live with our parents or live

in close proximity right

>> um

>> I'm going to 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 I saw my parents but I

never lived with them again

>> and I falsely thought that when I had my

do 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 was the only way I

could have gotten it done. So, I see

what you're saying about the stress and

the increased inflammation that comes

with that that leads to pain and more

brain loss and lower more bone loss.

Maybe that's what we're seeing. But even

in very supportive cultures,

maybe women are just used to suffering.

>> Yeah.

>> And and don't want to mention it or

there's a lack of understanding of

what's going on because it doesn't mean

that frailty doesn't exist. I see it in

every culture that comes to see me cuz I

live in a very diverse community.

>> Every elderly woman I see is frail.

>> 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, like Stacy Sims

>> and you know Lisa Moscone, Louise Nu,

you know, Anita Muki, you know, loads of

people who are trying to raise awareness

>> of the importance of female health and

actually 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 because, you know, my

experience with the world is through a

male body. Sure. 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.

>> Right. Well, I think I think for for

this understanding to become full to

become common to reach a critical mass,

we must have the collaboration of the

men that we work with and live with.

It's an I I think the message will be

spread

more easily. so much that you know my

poor husband I drugg him onto my own

podcast so that he could talk to the

world about what men need to know

>> in to understand the people they love to

prevent midlife marriage failure after

25 years because unless we understand

what's going on you may don't understand

why your normally placid wife is

suddenly enraged and you know has a fork

in her hand aimed at you or

>> there has to be an elevated

understanding.

>> I love chatting to you. Um I I really do

think this book is fantastic. It's such

a thorough and well-rounded practical

guide for someone who wants to

>> empower themselves and take control of

their health.

>> One thing 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.

Yes.

>> 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?

>> You know, I have a vision for

um

being able to do what I want to do when

I want to 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 going to have the fullness of life

that I've worked for my whole life. I'm

going to 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 going to happen.

>> Um and all the visions that and this

what I teach people have to be based on

your values. Who are you? What do you

want to 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.

>> Yeah. The book is called Unbreakable, a

woman's guide to aging with power. And

right the end of this conversation,

which I have thoroughly enjoyed,

>> a thank you

>> for that woman who has been listening,

>> who your words have sparked a little bit

of interest. They have started to see

themselves differently. They start 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

>> for that woman

who hasn't done much before but wants to

get started.

What are your final words to her?

>> 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.

>> Vonda, thank you so much for coming on

the show.

>> My pleasure.

>> If you enjoyed that conversation, then I

think you are really going to enjoy this

one.

>> 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-,800 calories a day.

That is not enough.