That's what women do. You're so right about that. You're so right about that. And then we pass it on to everybody else, put it to use. That's right.I don't think I realize that women make up 80, you know, do that 80% of the health decisions. That's an incredible number. It's a huge number, but it pales in comparison to the fact that women don't understand our consumer buying power and health care falls in within that category. Right. Yeah.And so I found when I first started talking about that number and about our influence, most women were were really shocked because on a day-to-day basis, we completely underestimate what we're capable of. Well, that stops now. I know. Not here. Not with you and me, but this book, Unbreakable.I'm super excited about it. I I feel like I already know women I'm going to gift it to because there are gems in here that we all need for many, many years. You've written a lot of books. Why this book? Now, you know what?
I think there's a myth in this country that aging is a is an inevitable decline from the vitality of our youth that we're always looking over our shoulder to remember to some kind of frailty of old age. That there's a view that's an inevitable, but I know that's not true. My own research has proven that the national zeitgeist is is pivoting now towards towards active aging and yet I find many people are still confused and I find that 70% of people make no daily investment in their health and mobility and on top of the fact that you and I are both deep into the menopause conversation and women do not age like men. Everybody ages in a slow steady decline until women lose their estrogen and it is cataclysmic paradigm changing. It is analogous to adolescence which we all remember.
You know I I love to coin words and I coined this word the mencence meaning why do we expect it to be anything at less than cataclysmic like it was when we came into our hormones. So it is when we are exited by our hormones. And I think if we think of it like that, it it makes more sense, right? Instead of saying, "Why is this happening? What's happening to me?
I don't understand it." Because when you say it like that, it it it kind of it does this curve, you know, where you understand where it is. This is where you've been and and this is where it is. But but then I worry about the downward part and it shouldn't be the downward part. And that's what you're saying. It should level it should level out or go up.
Well, when you think about what we did in adolescence, it it may have hit us like a brick. Yes. We figured it out and we had a marvelous life. Our 20s, our 30s, our beginning of our 40s. That's the way I view this.
It may hit us like a brick. Hopefully not. Hopefully going forward we've done enough work that it's going to be another life phase. But even if it hits you like a brick, it is not a slow steady decline. It can be healthy, vital, active, joyful.
But not if we just let physics and gravity take over. It requires a continual investment. And why shouldn't it be? Because at my age, I am gunning for another 40 years, which is as long as I've been an adult. I have been an adult for 40 years.
I'm going to be a different kind of adult for 40 more years if I have my way. That's the framework we have to think about. Why would I decline for 40 years? And that's what people have to understand because I do think that there is that we look it's it's societal, it's cultural, it's all those things, but most people don't think when they hit 50 or 60, but 50 that there's another 40 years of that could be really fabulous that it doesn't have to be cuz when you said the word fragility, I went because I know what the word means now. I that word never crossed my lips before and now over the past 5 years I've said the word fragility way too many times and I I can really visualize it.
What do you think Gen X has gotten wrong about fitness in general? We were brought up on the tales of the cardio only right where you know bless her heart Jane Fonda Richard Simmons. Yes. Bless our hearts. I mean I was a teenager and I'm out there doing that stuff.
Right. Me too. I had my leg warmers on. And you had all the outfits and Richard Simmons saying you grew it, you lose it. Right.
So, but we came off the tail end of that and what we took away was be skinny and little. Yep. We took away cardio is the only answer for you. That was about it. We didn't take away we have to have sleep and restoration.
Relationships matter. Smart nutrition is more than not eating. Right. We we came away with two messages that do not serve us. Yeah.
Now, right, what are those two messages? The two messages we came away with was run it off and don't eat. Isn't that unbelievable? And it would almost be a badge of honor to get through a day where you've worked out and haven't had anything but lettuce, right? Isn't that crazy?
Yet, we were expecting high performance lives, but we were literally treating ourselves like we didn't matter. So, I think we came into this time like that. And then when menopause changes our very chemistry and physiology, we're wondering why that doesn't work anymore. Well, honestly, it never really did work because we all ended up skinny fat. Yeah, that's exactly right.
That's exactly right. And so, we're starting lifestyles we never did before. But the reality is, I'm working I'm working for the baby booming women who are left out. I'm working for our generation who are going to get this right. But I'm really working for my four millennial daughters, right?
Who I have young millennial daughters are in their 30s, but the 44 year olds who are the old millennials, I'm working so that they don't hit the same wall that I hit in 10 years. Did you hit a wall? Oh my god, Tamsen, I hit a wall, but I didn't know what it was. I mean, I was night sweating. I was brain fogging, right?
I think I've told you I couldn't remember the the nouns in the O. Give me the thing that does the thing. I mean, I am in the middle of a big procedure and I can't say, "Hand me the Atson. I need the Coker. Where's the Debbie?" These are all surgical tool names.
But it didn't come to you at all. I said, "Give me the thing that I need." You know what it is. Oh my gosh. And I didn't know. So many things changed.
And until I got serious about learning about it, and until I, you know, I was toying with, oh, I don't know what I don't know and don't believe about hormones until I was sitting on the back porch at a barbecue in Atlanta where I was living at the time. What a menopausal hot flashing woman was doing sitting on the back porch outside at a barbecue. I don't think it all sounds very like not not, you know, symptomatic. But but Kathy, this nurse friend and I were talking and she's like, "Oh, Vonda, I got a guy." I'm like, "What do you mean you got a guy? I've got this hormone doctor in Chicago.
You've got to call him." Because there were there was nobody to treat me. So, we're all calling this secret guy in Chicago. But you're a doctor. And I am Tanzen. And no one's there.
And you had nobody to talk to. Nobody. No. And I talked to my OB who is the best in Atlanta and bless her heart I was given a photocop. It's like a mimograph.
I mean it wasn't even a photocopy like a mimograph with some facts. Yeah. I am going to figure this out because there's no way I'm going to live like this. So I started becoming a scholar and self-educating because doctors are not taught. Even obinis are not taught.
Internal medicine doctors are not taught. Let alone a bone doctor where 94% of my field is men who were born without the privilege of ovaries. Nobody's teaching orthopedic residents about menopause, right? Nothing. Not one thing.
Even though they should know because osteoporosis is an orthopedic problem, right? Muscle, tendon, ligament frailty is an orthopedic problem, but nobody teaches them. And so I'm doing I'm doing my best with that right now. It may take a minute, but I became a self scholar. I figured this out.
I finally read estrogen matters like the Bible. You spoke on the FDA panel. Can you explain why as an orthopedic surgeon and longevity doctor hormone therapy is such an important topic for you? First, I want to frame what I say by the fact that I believe that every woman is a sentient being with with agency. So even though I do come across very strongly and I see very little reason not to make this decision, I recognize that it's still every woman's decision.
While everyone wants to continue to argue about brain health, does estrogen replacement replace fill the estrogen receptors that code our brain? Obviously, but people still want to argue about the clear evidence that started within 10 years. Most guidelines now talk about using menopause hormone therapy to prevent heart disease to the tune of 40%. Okay, there is no argument. The data are so clear that estrogen can be used to prevent osteoporosis and bone death in women.
It's FDA approved for that. And yet, it's never talked about. Now, in the last year, I see people picking up bone as a subject while I'm screaming it from the mountain tops. 70% of all hip fractures occur in women. 70%. The minute, snap my fingers, the minute you fall and break your femur, you have a 30% chance of dying. 50% of the time you will never go home. And your family is ma left to make the decision because you're you can't take care of yourself anymore.
Your family is left to make the decision. Do you hire somebody full-time to live with you and take care of you? Well, that's cost prohibitive. Do you move in with your child or your niece or nephew? Most people say to me, "I don't want to be a burden to my family." Do you move into assisted living?
Twothirds of all people in assisted living are women. Do you know how much that costs a month? 7 to $15,000. So what you have to do is use your life savings down to the point where you're a popper and get Medicaid all because you broke your hip. Osteoporosis mean it literally from the Latin means holy bones. Loss of of bone strength is entirely preventable.
But it doesn't start when we're 65 when the US insurance industry will finally pay for a DEXA scan. It starts when we're teenagers. It continues when we're 30. And I repeatedly beseeat people to build better bone while we still have hormones on board because the number one way to get control of bone health is to have estrogen on board. If we have a woman who's in her 30s right now listening, is she in an incredible place to be Oh my god.
Ideally. So it is estimated that we reach peak bone mass, the most bone we're going to build between 15 and 25 extends up to 30. So, I personally think that we should all be getting some kind of bone measurement, whether it's a DEXA scan or an ultrasound REM scan for bone quality as a baseline then because I kid you not, every woman coming into my orthopedic office, no matter what her age, gets a DEXA scan. And I have 20 year olds and 24 year olds and 30year-olds who come in with poor bone density and they don't even know it. And they've never built enough bone as a young woman.
If you carry that, you just assume you're fine, you're young. But if you come in with low bone density and we and it levels off, declines about 1% a year like a man until you reach pmenopause, within this 5 to seven years of pmenopause, you're going to lose 15 to 20% of your bone density because of the mismatch that comes when we don't have estrogen. OMG. So, what do we do? What do Where do we We help.
Oh my god. When we're let's say we're Let's talk to the young millennials right now. You want to do that? Yeah. Because I feel like Yes.
I need you to talk to them. I need you to talk to them because they're important because you have four daughters who are millennials. But you hit your peak bone mass by the age of 30. 30. Yes. It doesn't mean it's too late though, right?
It doesn't mean it's too late. There's never an age when we cannot build bone density. But you want to start from the highest level so that as we have the natural decline, we're not declining from osteopenia. We're declining from amazing bone density. Right?
So what do I want 30-year-olds to do? I want you to look at your mother or your grandmother. Are they shrinking? What does that mean? That means that they have enough osteoporosis that their vertebrae are collapsing.
So if your mama used to be 5'6 and now she's 5'3, she's lost 3 in of bone height probably due to osteoporosis because part of bone health is genetic. So the first thing a young woman can do is look at her female relatives. What happened to them? Do you have a grandmother who broke her hip? If you're 30 but you had a fracture, you fell off the the curb or you fell and broke your wrist.
Fracture after 20 p predicts future fracture. It does. No matter how it happened. Oh yeah. Unless you wrap your car around a tree height of course.
But lower impact like falling from a standing position, falling off the curb, your dog pulls you down, you break a bone after 20, that's a predictor. If Why is that a predictor? Because you have a low bone density. Because even low energy situations are enough force to break your bone. Wow.
So if you see that your mother or your aunt or your grandmother is shrinking or somebody broke a bone, what does that tell you? That tells you genetically you need to be paying attention. There can be a pred a genetic predisposal because sometimes bone density has a component in that. So we can't ignore that shrinking going on. It's one of the risk factors.
I can't afford to shrink. I'm 53 and I know what are we going to do? 49 booster seats for this table. So, it's one of the risk factors that your doctor can use to get you a bone density early. So, if you are in your 30s and you have a family history, my mother is shrinking, she broke a bone, my family has a history of osteoporosis. Please order me a bone density and it can be coded in a way that insurance would pay for it.
Listen, if your insurance won't pay for it, save some Starbucks money and it they cost about $90. Just save it up. Where do you go to get that? A doctor. You can get it from your primary, from your OB.
If you have an endocrinologist, you can Google online. Most gyms now have a bone density scanner. Okay, most highensity scanner we need. We need we need to figure it out. So, if you're 30, let's go through the risk factors.
We've talked about two. Another one is if you were a smoker because it was just so cool or you flipped from smoking to vaping cuz God knows that's so cool. It's poison to bones. It's a bone poison. Okay, that's a risk factor for breaking your bones.
Okay, if if you've had an autoimmune disease, if you've had asthma and had to take highdose steroids just to be healthy and breathe, those are all risk and there's there's multiple risk factors, but those are all things that should alert you at a young age that you may have a problem. What if you were what if you were a high level athlete when you were younger? Yes, how about that? So, I think there are many reasons we don't build enough bone when we don't other than genetics. One is we are a high level athlete.
We maybe we burned 7,000 to 10,000 calories a day and just didn't eat right. And maybe you never had a period for 6 to9 months. That was my case. I was a ballet dancer. I wouldn't have a period for that long and I thought yes I I had an eating disorder.
I was the same I was the same thing. I was like okay it's gone. You don't have to worry about that. I don't have to worry about it. Unbelievable.
I didn't know that I needed to worry about that. So there's that. We're underfed. It's called relative energy deficiency syndrome. It's a thing in orthopedics and there's that.
Or maybe you're not an athlete and you just want to be this little and you still don't feed yourself. Or maybe you're eating but you're so sedentary. We're ra everybody now is a digital native sitting 18 hours a day and high atapost tissue Yeah. Inhibits bone. What is high atapost tissue?
Fat. Trying to be nice about that word. Just say it, Dr. Vonda. High body fat content.
Okay? Because bone and fat communicate with each other. You think you're having more weight, so that's good for bone. It's different because because fat is secretreting its own kind of cytoine that inhibits bone growth. So it's not okay.
So what do we start what do we do if we're talking to these younger generations who actually I think are doing a lot differently than we did. Yes, that's true. Right. They are doing but there's still these things that they're maybe not thinking about because I wouldn't have been thinking about my bone density in 30 50 why would you at 50 so they are doing some things right correct they're tracking they're I think and I could be wrong but the the zeitgeist of the millennial young millennials older millennials they're investing a lot in their health that exers never did in fact I did some market research for some of my work and I did think tanks of millennial women and First, they want to investigate their own information. They want to be knowledgeable.
I love that. Frankly, they want their healthcare delivered in beautiful spaces. Who doesn't want that? I know. But they're willing to invest 25% of their disposable income to get the health they need, traditional and non-traditional.
Cuz I ask Starbucks, they they will like, "Who's paying for all this stuff you want?" Well, I will because it's important to me. So, that helps me know that they're seekers. They're curious. They're trying to be more healthy. So, know your family history, learn how to feed yourself, and if you do nothing else in your 30s, learn how to lift weights so that by the time you need to lift heavy, which is I want everybody to lift heavy for them, you have a foundation.
I spent years not knowing what was happening to my body. Menopause snuck up I love this. All right, let's dive into this because I want to get into your book. I know you have so many gems with this. You talk in the book about the time bombs of aging.
Yes. Can we go through what those are and explain why it's so important? I believe women are smart and if you give them enough information, they're going to act on it in a very different way than if you just tell them what to do. So within the aging and longevity pure science there, there are these concepts called the hallmarks of aging. They're the normal metabolic processes that change with time, right?
As your cells divide and how many radical free radicals you stray oxygen molecules just in normal living, right? There's all this waste from normal living. Well, that changes you over time and they're called the hallmarks of aging. So, I've chosen for unbreakable six of them that I think are most impactful. And I call them time bombs because although it is a normal process for our body, unless we are aware of them and get in front of them, they can accumulate to totally derail you in the future.
For instance, one of them I talk about is epigenetics. It's the concept that although we're born with a set of DNA from our parents, that it's estimated only 10 to 30% of how we age is influenced by our pure genetics. The other depending on who you read, 70 to 90% of our eventual outcome comes by the decisions we make. Well, that is fascinating because I most people say like, "Oh, it's in my it's in my jeans. I'm big boned.
It's in my genes." Whatever. Wow. So, so 80 to 90%. Yes. Most of it.
So, to me, that is not a burden. That is hope. Yes. For a different future. You are not destined to live the way your grandmother lived.
You could easily slip into that, but you can change the trajectory of your future. So, things like going out for a walk or a run or an aerobic anything changes the expression of about 9,800 proteins. It just changes because our body is so active. What genes are turned on and off, right, is due to the environmental signals, whether that environment is activity or broccoli or not smoking. If you had to say, I just need something right now to know that I can do tomorrow that is not going to be that much of a lift.
I've never worked out before. I'm not really sure. I don't even I'm trying to still understand what longevity means. I'll figure out the balance stuff later. Is it walking?
Because walking keeps coming back to me as like over and over the simplest thing past sleep which we know is important. Is walking the next thing that people can do to really become unbreakable? If we are truly starting from the couch which 70% of people in this country are I accept that we're going to accept people where they are. Walking at a brisk pace after your biggest meal timing to me matters is the one thing you can do because why? It is our core motor skill.
We have been doing it since we were one. We do not have to learn anything. It can be with or without shoes. I'm see what I'm doing. I'm trying to eliminate all the roadblocks.
Right. I love it. No, you are though. You're like, I got that one. I know you're excused.
Well, I've been a doctor for 30 years, so nobody can out excuse me. I have heard everything. And so sometimes my patients are sitting across from me and they're giving me their litany of I'm like, that's how you solve this one. These are all your solute problems and solutions. So bring it on because you can't out excuse me.
Walking 45 minutes after your biggest meal for seven days straight because in running we call that a streak. [snorts] When you do something for seven days in a row, there are people run runners who have thousands of days of streaks and they will do anything to continue their streak. So I'm transferring that from the performance side of my life into everybody everyday people life. If you do it, commit to yourself for seven days, the eighth day, you're not going to break your streak. You're you're gonna figure out that if you leave the dishes on the table, no dishes police are coming to get you and you just I know another excuse. I just heard another excuse that for you.
Why exactly is muscle so important? We think of muscle as the cosmetic things we see in the mirror at the gym, right? Show me your guns or whatever. And that that is that we think of it as locomotion. It gets us one place to another when connected to bones.
Your bone muscle. Can you show your bone? Like where I bring my femur everywhere. I like your femur. Yeah.
But you would have muscle all around. Where would the muscle be? So if this is if this is someone's leg, this is the hip. This is the knee. The quadriceps cover this.
It's gorgeous. Four hardy muscles. The hamstrings are back here, right? So this bone is surrounded by muscle, but it's a metabolic organ. It secretes proteins like irrialin and a variet many things that communicate with other parts of the body.
It's it's a communicator in our body just like bone is. Bone bone is an endocrine organ. It secretes hormones. Interestingly, I love how you explain that like I've been walking around 54 years with my body. I don't I didn't even think about like that how the muscle really covers it.
Understanding what else it's pretty it's really fascinating but you explain it in a way that I understand it I want to tell you about bone when we're done with muscle cuz it's the best story in the whole book I mean not in that book like in the book of life we're doing but the thing that makes muscle critically important is that it's where a lot of our metabolism our energy formation happens muscle is filled with a little organel is what they're called called mitochondria which is where when we eat we use our glucose and our fatty acids and our amino acids to convert to the energy of life, which is a molecule called ATP. You can't move without this Bitcoin of energy, right? The muscle does that. The muscle is the sink for all the glucose. Therefore, I tell you to walk after your biggest meal.
So, all that glucose you're digesting just doesn't go and accumulate in your fat or gum you up. It is used by the muscle to produce energy better. So muscle is this fascinating structure that's metabolic. It's mo locomotive. It's structural.
It's an endocrine organ. And yet we just think it's our biceps in the mirror. We just think it's if it looks pretty or not. I know. We don't give it a lot of chance.
But you know what it is? Let's If we look pretty, I love saying this out loud. I love me some Sarah Blakeley, but muscle is nature's Spanx. So you know, you're right about that. You're right about that.
I do. What happens if we wait too long to build strength or mobility? If we wait too long, then we increase our risk of falling. Falling can lead to death. We can not be able to live independently, which is everybody's fear.
Nobody wants to be a burden. No one wants to be dependent. So, we can lose a lot of muscle mass over time. But here's the good news. There are a lot of anecdotal examples of this, but there are a lot of science studies that show no matter what age you are, you can retrain the neuromuscular pathways that connect your muscle and make them fire better and you can actually build muscle.
So, there's never an age or skill level without consistency and starting where you are that you can't build muscle. In fact, when I first started doing muscle and I mean, I had a muscle I was part of a muscle stem cell. Muscle's been my subject a long time. When I was preparing to do some studies there, the first studies I read about were in 90-year-old men living in a nursing home in they did chair yoga, basically chair exercises and over a six-w week period they increased their functional capacity, meaning getting up and down from a chair, doing activities of daily living 150%. Fascinating.
I thought you were going to say like 16%. It totally revitalized their lives because what happens first is you retrain the neuromuscular pathways so that the way muscles in the brain work is one motor neuron intervates one bundle of muscle fibers and if they're firing sporadically, you're really weak. But when you retrain them all to fire in one big organized way, you get stronger. So it's ne So if somebody's listening right now and has never picked up a weight, has never been to the gym, doesn't even know where to begin, feels a little intimidated by it because that is really really reasonable, they can retrain their body completely and they can build muscle. It will take a minute, but absolutely.
And it doesn't take very long to notice a difference. Within about a month, you're you won't change your weight, but your clothes will fit differently, and you will get out of the chair more easily, and you won't you may not be trudging one step at a time up the stairs. If we're really in a a state of of dissealth, you will notice changes in a month. In three months, day by day, people will start saying to you, "Oh my god, what are you doing?" Isn't that amazing? It's mass.
It is amazing. I think the other thing is and you you just said this and I so I want to reiterate it. Your weight might not change. So as you're exercising, you may not notice the scale going down immediately, which is what we value because that's what we've been taught. But you will notice leaning up.
Okay? You want people to start replacing the word skinny with strong and move skinny out of there. And strong has to be what we're talking about now. Lean and lean. Lean is what lean.
I love the words. I don't even know what skinny means because you can be skinny and have no muscle mass. I mean, bless their hearts. I was once invited. God, I'm I hope I'm never I'm never going to be invited back when I say this out loud, but I was once invited by Mercedes to go to fashion week and it I'm so out of my league there, but I was observing and there are a lot of very thin people there.
But I could not find muscle definition. So, we have thin, but we're not lean. And that's when we look at body composition, we want to know what we're made of. You know, girls are taught sugar and spice and everything nice. Well, we should be taught muscle, please.
We're made out of muscle, muscle and bone and brains. How strength training help women that are parmenopause or menopause, especially with hormone health? Is there a correlation there? I don't know how to explain the mechanism of, oh, lifting is going to help balance your hormones. And I don't believe in hormone balancing actually.
I don't that's not a physiological thing. That's more of a marketing thing. But the way I think that's important to say. There's a lot of people that think that you can balance your hormones. Your body does that.
Your body, your whole body is balanced. In menopause, everything is off, right? Because your your ovaries are no longer producing estrogen. But when you're cycling, it's a balance, right? Your body perceives that it needs more estrogen, the brain will release a hormone, follicle stimulating hormone, which goes to the ovaries to mature an egg so that the egg follicle can make more estrogen.
That is hormone balancing. That happens in normal physiology. But what in menopause we're talking about is I don't even know what hormone balancing means. In menopause, we can replace or or have hormone therapy with estrogen. We need progesterone if we have our uterus.
Sometimes even without a uterus, it has a wonderful role. And women make a lot of testosterone. So I include that in the mix. Right. But in terms of balancing one on another, balancing implies that follical stimulating hormone is doing its physiological thing and it's not anymore.
Good. I'm glad I'm glad you said it because I do think it is marketing and I think it's confusing to a lot of confusing because they think they're going to hit some very salesy they think some number and then then they're going to feel great and we know it takes so much more than that. One of the biggest complaints that I hear from women is talking about belly fat. You just talked about that model. Is there a way to get rid of belly fat through strength training and the right way to work out?
I have found in myself, although it's a constant, you know, I've had less belly fat than I have now. I've had more belly fat than I've had now. So, it's a lifetime process. I don't want people to think that I'm going to tell you the recipe and then you're done forever. [snorts] But the way that I have found to recompose our bodies is to learn to lift heavy so that we're building strength. And I can talk about what that means in in yes my practice and to provide enough strategic stress in the form of high heart rate sprinting.
It's those two plus you have to be concerned with your nutrition. You have to feed the muscles you're trying to build. You can't eat all the garbage and treat your self like a garbage disposal and recompose. No, I want you to go through all those foods. We're going to do that.
Okay. Yeah, we're not you're not going anywhere. Sorry. But you know what? People are like, "What's it going to take to recompose to lean?" And in my experience and and the science bears it out.
Sprinting and lifting heavy. Sprinting. Sprinting is a heart rate mechanism. People think when I say that we're talking about Shakiri Richardson or Usain Boltz. That is so not what I'm talking about cuz that's otherworldly.
We're talking about high heart rate activity to differentiate from walking. Yes. And I'm so sorry. I've been naming them lately, but this middle of the road, middle heart rate, higher than walking, not high enough. Okay, that's fine.
Sprinting orange theory type. Okay, but everybody knows what I'm talking about when I say that. This middle range. It's not low enough to be metabolically the healthiest. It's not high enough to recompose.
But what it is, I mean, my office is in a performance center. Seven days a week on the indoor football field. There's classes that do this. You know what happens every four weeks? People are hurt because it's high enough reps, high enough sets to wear things out with not enough recovery because it's every frigin day.
Mhm. Mhm. And then for every four weeks, you're in my office with another injury that slows you down and then your brain's furious at you. And your office is the last place people want to be. No offense.
I know. I know. My office has glass floor to ceiling that looks over this football field. Wow. And I see them coming. [snorts] I've tried to change that, but people want that.
They think that sweating it out thing that they're doing seven days a week is the way pro aletes do it. That's not the way proathletes do it. So, we want them. I'm a performance doctor. Our building has a metabolic lab designed by one of the best exercise physiologists in endurance sport and there's two ranges of cardio.
There is the low heart rate base training and then there's the sprinting. It's not seven days a week in the muddy middle bat wings. I was asked to ask about these which I don't want to move around too much because I don't want that on video. But how do you do that? Is that strength training again?
Lifting heavy triceps. Triceps. Yeah. People don't want to hear that. Pull lap pull downs.
Do they want They want you to give them a different thing to do, right? Well, I'm a surgeon. We could cut it off. Okay. Okay.
Let's All right. Try triceps are fine. We talked about walking and I want to get back to it. One thing I have heard over and over, got to hit these 10,000 steps a day. Yeah, it's true, right?
You should try to do that. But is there any kind of caveat to that? 10,000 steps. I I think I think the folklore around 10,000 steps was a a Japanese marketing thing, but the science bears out about 7,000 steps a day of all movement. It doesn't have to be in one place. Like when I moved to New York for the first time, and I was much younger then, but because no, I nobody has a car.
Well, lots of people don't have I didn't have a car here. We walked everywhere. I lost about 13 pounds moving here from the pure mobility of keeping my body moving. Just life. Just life.
And that's what we're talking about, [clears throat] right? Two things I get asked about more than almost anything else on this show is hair and skin in midlife. And there are two things I've been quietly working on with my own routine. I'm excited to talk about. I've been using the I Restore show and tell them we sent you.
Give your hair and skin the upgrade they deserve so you can feel confident and refreshed. Can we go into strength training and strong? I've seen you throw weights around in the gym. I see, you know, I do all of your little challenges and tests because I think they're important and people love them and we're going to do a few of them. When it comes to resistance training, how often should we be lifting each week?
When I say heavy lifting, what I really mean is is the way we reach failure. Because no matter how we're lifting and I just think it's important to be complete because I get a lot of feedback at this point the public is I know what they need to understand because they're commenting all the time whether if you want to lift for endurance being able to do something for a long time then lift a really light weight a lot of times. I've had women come in to me and tell me that their trainers have told them to lift the tiniest weight 25 times. Well, if you lift something little 25 times, you may reach failure, meaning you can't do 26. Okay, that's a way to do it.
Failure means fatigue. I can't exhaust anymore. I did 25, I can't do 26. That's failure. If your goal is endurance, okay, you lift that way.
If your goal is hypertrophy, the biggest possible volume in the mirror, then that takes reps of 10 to 15 because that's hypertrophy, right? Hypertrophy to failure, meaning you choose a weight that you can do 15 times. You may be able to squeeze out 16, but you're not doing 17. That's what I mean when I say lift heavy. Okay?
We are going to work up to it. It may if you're not lifting at all, it may take 6 months, 9 months, a year to train your body. Learn the technique to power lift. The power, not the competition power lifts, but meaning the multi-jint, multi-muscle lifts of upper body push pull. So, some kind of bench press, some kind of press, some kind of pull, lower body push pull, squats, deadlifts.
Got it. How heavy should we be lifting then? And I know it's going to be different for everybody. Let's do another level of clarity, you know, and if you're just starting out, please just lift your body weight. Figure it out.
In in unbreakable I take I I do have some of the very beginning protocols taking you away from the couch but end up with lifting heavy. [gasps] The four power lifts we talked about upper body push pull, lower body push pull. Those are the basis. You need to cover those every week. But then you support those lifts. Let's take bench press again with the single muscle lifts and you get to do less weight with those.
So here's how it goes for bench. If it's a if it's an arm day for me, I'm going to warm up. I'm going to start with my bench press. I'm going to do four reps, four sets, meaning I may be able to do five, but I'm not doing six. It's that kind of weight to support because that's multiple joints, multiple muscles.
It's compound. It's the way we live. I support that with single muscle biceps, triceps, lats, delts, rows. Y between eight and 10. Okay.
So, those are lighter. They're single muscle supportive lifts. Eight and 10 reps. Reps. Reps.
So, not everything has to be absolutely highest. The single muscle supportive lifts can be less weight. The power lifts, the compound lifts is what most women leave out because our body works in compound motion. For instance, let's take our legs. Never in God's green earth, unless you're bracing yourself for a car accident, do you push against a structure to work your quads?That is not how it works in life. No, we're not sitting in a chair. Now, I'm not saying that's wrong. I'm just saying that's not how it works. We use our quads with squat by squatting down or by squatting down and then picking something up and standing back up like a deadlift, right?
That's how we use ourselves. We That's how we need to train ourselves. That's such a great I don't even think like that. I've been training for as long as I I mean for a very long time. People haven't been to the gym don't don't know some of these things.
When we're talking about a bench press, it's the bench that you lay down on and you have a single bar and the weights on the side. Right. Yeah. And you can do weights on the ends of bars. You can do free weights, which are those little dumbbells that you see all over the place.
But the picture to keep in mind when I talk about bench press or pulls or squats, it's think about what am I doing to push with my arms? Well, bench press is only one of the things you can do. What am I doing to pull with my arms? Well, think pull up, but there's a lot of ways to do that. And the same with it's it's the pushpull motion with the big muscle groups.
What do you think about things like Pilates? Do you think that that's important for mobility? I think it's important for mobility, but it can't be the end all be all. So, when I describe or prescribe the things we need to do for longevity, I use this acronym that I've used forever. It's called face f a ce facing your future.
And it includes F is flexibility and joint mobility. That because the natural history of our tendons, ligaments, and muscles is to shorten with time. And we need to keep them at optimum length to prevent injury, to keep them healthy. I think Pilates and yoga are amazing for that. Tai Chi is amazing for that.
But when I have someone tell me that they've just completed their 1,500th consecutive Pilates workout and that's all they do, I first marvel at that accomplishment and then I say, "That's never going to be enough." Okay? Because that's good for flexibility and mobility. It will train the small muscles. It will not build big muscle for you. So that's your flexibility and then so phase a flexibility and joint mobility.
A is aerobic. We've talked about that. C we just talked about carrying a load. Yes. Because it can be weights in the gym.
It can be buckets in your yard. It can be a log, right? You can be creative with it. And then E. E is so critical.
E is equilibrium and foot speed because you can be strong, you can have good cardio and you can still fall down and break your hip. So what is foot speed? So b number one equilibrium equals balance, right? So everybody needs to retrain their balance. But foot speed, we lose our fast twitch muscles, type two muscle fibers faster with aging than our slow twitch.
So it means that we don't react quite as fast. We don't have the ability to step over something, jump over the person. So, I just happen to work in this facility I keep talking about with an Olympic speed coach. And so, she's teaching her young athletes all the time to react fast, to jump over things, to do little fast twitch exercises, which have more to do with neuromuscular pathways than actual strength. And I have her teach I had her teach me.
I have her teach my women because we need to retain our foot speed. I know you have functional markers too and I want to hit those. I have a few quick questions. Yeah. Weighted vests for walks.
Do you recommend them for increasing the workload? Not if your expectation is building a lot of bone. Okay, that's good to know. Functional markers. You give women in this book real tools, real ways to test what's going on so we're not guessing everything.
And I know that it's so important to you as a researcher, as a physician, as a longevity doctor, as a surgeon. What are some of the different markers? I know we have the grip strength and I think we should Is that is that one of the most important ones? It's one of the top ones. One of the top.
So, can we talk about this? Yeah. So, what we did in one of the early chapters is we identified through research what the top eight predictors of longevity were. [snorts] And then we created a scale called the unbreakable assessment. And weighted each test based on how strong the data was. For instance, the number at the top of the heap is V2 max and then quickly grip strength and BMI although I don't love BMI but there is a lot of data surrounding it.
Sit and rise, how fast you can get up off the floor, walking speed. So, there's eight of them and and we give not only explanations, but howto's and there's an app with this book that's going to show you and then help you calculate what your longevity score is, not as a judgment. It's like in if if you have ever heard of when we send football players to the NFL combine, they have a bunch of tests to do so that we can know where they stand. That's all there is. This is going to show you where you stand.
Where you stand so that you can improve on these things that we tell you about in the second part of the book and then retest. Okay. Yeah. All right. Where do we stand with this?
So, grip strength is not about squeezing a tennis ball and getting your hands strong. Okay. The data on grip strength shows that it is a good surrogate for total body strength. Right? So, if you think you're going to improve your g your overall grip strength, but let's just go grab a tennis ball that you're missing the point.
You're missing the point. I know. That was so hard for me. I can't believe it. This reflects total body strength and then the studies that surround this can relate it then to strength and longevity.
So, when you use a grip strength thing, they're about $25 on anywhere, any digital place you buy them from. What you do, and usually I do it standing because it's I got to put the whole body, although it's just the hand. You grab this thing and you you got to make sounds and grip your teeth. So go ahead. Go ahead.
No judgment zone. We have to do it. We have to go and see what we get. I got 32 kg. It's probably great.
That's good. Yeah, that's excellent for women my age. You're like in a You're in heels. We want at least 20 24. 32 gets us into the excellent range. But if we're in our 20s, if we're in our 20s, we're okay.
But it it's not a judgment. It feels more pressure. Don't look. Okay. Make a face.
Squeeze it. Now, can I stop? You're good. You're 25.3. Good job.
Oh, okay. That's better. I know. Right in the middle is strong. Thank you.
I'd like to be excellent like you. Well, you know what? Just for people who did not see that. We basically have a little thing with a handle on it. It's a little plastic tool.
Yes. $25. All you're doing, it has a little digital monitor and all you're doing is squeezing this handle and it measures how many how many kilograms of pressure and it doesn't really move. It doesn't move. That's the thing. It's like isometric, meaning it you're you're putting force on it, but it's not like you're squeezing something.
And we'll put a we'll put a link down below to those so so somebody can grab them if they want to do that. Okay. You talked about some of the other functionalities. Push-ups. You went very viral for talking about push-ups, saying that women should do 10 full push-up 11.
Well, you know what? I chose 11. There's a rangeful push-ups. But here's I didn't make it up. People think I made this up.
I don't think you make things up, Dr. Randomly. The American College of Sports Medicine has fit physical fitness standards. Some of them are based on men because God knows most of the research has been done on men, but other issues based on women. So, I was thumbming through the handbook.
It's an actual handbook. And I'm like, "Oh, look at the push-up challenge." But I first thought of it, Tamsen. Yeah. Because I still like to do a couple Spartan stadium races a year. So those are the Spartan races.
You're so impressive. I remember when you first told me that. It's It's a way to keep challenging myself. I don't do well without goals. I might I just have to have something to strive for.
Those are the races that are in Legendary Stadium. So, I get the benefit of getting to go behind the Green Monster in in Fenway Park and still be racing. So, those races always have push-ups in the locker room. So, you get to go on one of these famous players little little areas in front of their locker and then you got to pound out 15 push-ups or you can't leave the room or you have to do 30 burpees. I'd rather do anything but burpees, right?
Anything but burpees. So, the first time I thought about it was a few years ago when I started doing that you got to pound out these push-ups. And then so then I'm when I was reading this book, I'm like, let's see what people can do. And here's what the reaction was. And this is not going to surprise you.
More than 90% of people took it as, oh my god, I don't know if I can do that. Let's do it. Let's try it anywhere. Michelle Obama tried it. Amy Palter, all these really [gasps] famous women were not afraid to put themselves on the line as a measure to do better.
But there were a few percentage of women who commented and I feel really not bad about myself, but bad about their own expectations of themselves. Said all you're trying to do is shame women. You are discriminating against women and all this negativity. And what I took that as was I am so sad that women aren't willing to try for themselves. Because I'm not saying that today, having never done one push-up, you're a failure if you don't do 11.
I'm saying that's a goal to work towards. You are worth the daily investment in your health. And I think as women, we were never taught to be worth that investment in some cases. Oh, we're taking care of everybody else. Exactly.
And that's and that's where that comes from. So I hope that that message, you know, I hope that we continue to chip away at that message at at a faster pace than, you know, than we have. What does standing on one leg [snorts] tell us? From about the age of our late 20s, the the neuromuscular pathways that I keep talking about that help us fire muscles or help us balance start to degrade such that we can't stand on one leg. Right?
Well, why is that important? Because lots of daily activities require us to reach over and if we reach over loss our balance and fall that's when disaster happens. We can totally retrain our balance. So I suggest people practice brushing your teeth on one leg doing this funny little exercise called balance reach which you're standing on one leg and you're just reaching with your other toad you're a dancer towards 12 towards three towards six. And you just do that 10 times a few times a day and it just retrains our balance and it's so essential so we can improve balance too.
I think what I love about the book is that you can improve everything. It doesn't just have to be all at once. Well, I like people to layer on behaviors. You asked me much earlier, what's the one thing? What's the two things?
Because people get overwhelmed with programs. Yes, I agree. We are building a lifestyle. We are not building a program. The things you learn in the second section of this book, hopefully you will continue to do and modify for ever.
It's not a six-week program because that infers an end. So, if we're starting with walking and then we layer on lifting or we layer on understanding how much protein we need to eat, how not to eat sugar until it fries you from the inside out. Or an example I'll give the way I approach people is sometimes people come to me in dishalth or I describe it as fine you know they're fine I'm fine but they then read all this stuff about longevity and all the gadgets and they want to go skip all the way to the future to the things that may or may not have been tested in humans usually animals. So my approach is health optimization then I after we're optimized then we bring in lots of the kinds of stuff we do in peak performers like the athletes I take care of and only then will we endeavor into the gadgets that may or may not work for people. So an example of what we're talking about of layering is part one we're optimizing for cardio.
We're learning to do the base training and the sprinting. When we've got that as a lifestyle, then in performance, maybe we add in V2 training. What's V2 training? So V2 training is another level of workout. And it's hard, so we don't start with it off the couch.
V2 max is the best measure of our overall fitness. It tells us how efficiently we're diffusing oxygen from our blood through our lungs. And the reason it's important for longevity is there becomes a line called the frailty line after which your V2 max your fitness is so low you cannot get up from a chair by yourself. That's when you go into assisted living. It's called the frailty line.
It's the the numbers are 15 and 18. 18 for men, 15 for women. You never want to get there. So how do we not get there? Well we can train it. Mhm.
We can build physical fitness across a lifespan. We can identify by the unbreakable score. Oh my gosh, I'm doing great. My V2 max is 50. Or, oh my gosh, I'm midlife and my V2 max is 28.
I need to get on this. Because every decade, you will decrease your V2 max 10%. So if you're 50 with a V2 max of 50 and you decrease 10% per year, I mean per decade, you're never going to reach the frailty line, even at 97. I see. But if we start out at 28 or or low V2 max, and we do nothing about it, we're going to reach the frailty line really quickly in our late7s.
I just love that you have the layers on of things, you know, and that and that makes it more attainable. It is so attainable. A frozen shoulder, what is it? How long does it last and what can you do about it? Frozen shoulder or the medical term is adhesive capsulitis is a condition of the capsule is the inside skin of the shoulder.
It's highly sensitive to inflammation. So frozen shoulder is a highly inflamed internal lining of the shoulder that comes anytime you're highly inflamed. Men can get frozen shoulder usually because they have uncontrolled diabetes. Women too. But in midlife, in the population that we're talking about, like why would you get frozen shoulder, right?
It's because estrogen is a powerful anti-inflammatory. [snorts] And without the presence of estrogen or without enough estrogen, our tissues become highly inflamed. Sometimes you can feel it. You feel inflamed. The shoulder responds first. There's four stages.
Bless its heart, a frozen shoulder. The first is just excruciating pain. Mhm. You're like, "What happened? I didn't fall down.
I didn't hit myself. I didn't lift heavy. What's going on?" Excruciating pain followed quickly by loss of motion. I have women come in a week later, 10 days later, and they can can't lift their arm. I And they fail the do the hook my bra test, which I made up.
You can't hook your bra. Yeah. You can't internally rotate, which is what this motion is. That you lose first. That progresses through inflammatory cycles and one of my colleagues Joanne Hannifan has actually biopsied shoulders.
It goes through four stages. It can take two years to defrost. Yes. Number one, when your shoulder hurts and you haven't had any injury and suddenly it won't move, you get to a physical therapist as soon as possible because you can move this joint. Most women are tough.
We're like, I'm gonna sit this one out. Six weeks later, our arms don't move. Number one. Number two, if you haven't made your menopause hormone therapy decision, this is a good time to do it because we can help reverse this or prevent this. Number three, if you are suffering like you suffered, it is one of the instances where I will give steroid injections.
I don't love them for people in general, but sometimes you just got to get over the edge. Food, protein, let's just talk about it because you said you cannot put junk into your body. And hope you have some kind of great performance. Women are conditioned to not eat. I have lots of when I interview my patients about eating the the common habit is maybe you'll have coffee for breakfast, maybe some kind of carby thing and then a salad for lunch plus or minus protein and then sometimes that's it.
That's less than 1,000 calories a day and less than 60 grams of protein. If we want to feed the muscle that we're trying to build, if we want to have enough energy for daily activity and not feel exhausted every afternoon, we actually have to feed ourselves. To lose weight, you have to feed yourself. How much is how much is too much for protein? When we're talking about macros, right?
Carbohydrates, protein and fats. I focus mainly on protein because it's the thing we don't get enough of. People are going to get enough carbs and fat. I prescribe a gram of protein per ideal pound because we're not just trying to survive. It is not the RDA, the recommended day minimum allowance.
Thank you for simplifying that because I feel like I was trying to do all these equations. I'm like, I don't know how much. Well, you can do equations if you want. I mean, I don't have any capacity. The literature, you know, you can scrape together the literature and and support I know.
Support86 g per pound. Who's doing that math? Not me. Not me. And then we don't absorb all of it.
Okay. So, one gram per pound ideal pound. And then if you get close to that, you know, if you get over a 100 grams a day, you're probably good. Broken up into at least 30 gram sessions because it takes 30 grams to stimulate a muscle protein synthesis. [snorts] Women in general need a little protein before they work out. Should you eat protein before you work out?
Yeah, about 15 grams. Stacy Sims is a big proponent of that. You probably talked to her. But we need to tell our bodies we're doing something. Fasting is not I'm not a big fasting enthusiast.
I am a timed eating enthusiast, but we need to feed our activity instead and I think instead of making ourselves scrape together because we're trying to be high performance, not just survivors. You spoke in front of the FDA. Yes, I did. I marveled at your words. For people that are not aware of it, just a little background on it, we have been part of a a campaign, a movement, a conversation to unbox menopause and remove the blackbox label warning from vaginal estrogen, which pretty much has been deemed safe for women.
How did you feel the FDA reacted? How did you feel that was? Was that a mo a special moment for you? Can you just bring me to that? All those things.
Number one, women's health can be politicized. I don't think it should politics should be a barrier to women being able to make choices. So, I am thankful that that group was convened to have a conversation because without a public conversation, it's just decisions being made by non-women behind doors, right? So what the FDA does, the current FDA commissioner called together a large group of researchers and clinicians and not everybody accepted which is their right but the 10 of us that did accept I want people to know we had multiple planning meetings. We just didn't show up.
We took this very seriously. We planned what each expert was going to say because we had obgynes, we had researchers, we had cardiologists, we had urologists, internists and an orthopedic surgeon. So we we had full complements of expertise. We had five of the most long-standing researchers in menopause history there. They had done 40 years of work.
And then we had five of us who are in the MENO universe right now educating women doing the current clinical research to bring a modern perspective. And the 10 of us collaborated so well together because we're standing around the goal of changing an entire paradigm of women's health. We each had five minutes. We presented the data. We presented patients stories to humanize this story because data can be hard and cold.
But when I tell you, I told the story of a patient of mine, Miriam, and her hip fracture story. When you humanize this, I think it makes us move faster. And then we took questions. I think we're going to move the needle. We're going to start with vaginal estrogen unboxing it because the blackbox warning, the box warning on vaginal estrogen has no research merit.
Vaginal estrogen does not cause heart attacks, stroke, cancer. All the things in that skull and crossbones box is just thrown on there from other places within the men within the hormone universe. I thought it was an amazing conversation and of course there was discourse in the room. Sure, there were people who refused to re-evaluate the Women's Health Initiative data because they wrote the Women's Health Initiative data. And you know what? [snorts] They may never come around, but we're going to move around that.
But in terms of my own career, I was teasing my husband that being on big stages with you like at your Las Vegas event and the and the Sydney opera house event. I said to him, he's like I said, those are the Super Bowls of my career. And he looked I know it feels like that it is work. It's like pentimate work, but he's like every day Vonda is the Super Bowl of your career when you get people out of pain. And I thought that was such a wise distinction.
That gave me such chills that you're he's so right. Yeah. Dr. Vonda, why is bone so important to talk about? You know, just in the way that we think of muscle as purely working out, we think of we don't think of bone until we break one, unless we're looking in the mirror at our gorgeous cheekbones, right?
The reality about bone, I'm just going to tell you one thing simple that's going to blow your mind. Bone is a metabolic organ. It is a endocrine organ. It produces proteins. Let's talk about one, two.
It produces a protein called osteocalin that goes to the brain and helps the brain make neurons. Osteocalin goes to the pancreas and helps your pancreas secrete insulin, to the gut, to the muscle to help glucose metabolism. In men, it goes to the testicles and helps sexual health. So just when you think of bone as the strong silent type, not talking to anybody but itself, bone is the master communicator. And if I were designing a good design, I would make the communication points everywhere you need them from the top of our head to the bottom of our pinky toe.
And lo and behold, bone is just like that. There's another hormone that I don't talk about that much from bone, LCN2 that goes to the brain and tells you to stop eating. Bone is critically important in the energy balance of our body. And why wouldn't it be? Because bone is the storehouse of our body.
I had no idea. Isn't it fascinating? It's fascinating. And in these long bones, the femur in our pelvis, that's where all your blood cells are made. So just when you think bones are just holding you up, they are the critical communicators, storehouses, manufacturers of our whole bodies.
So why wouldn't we pay attention to them? I mean, it makes you have a whole different respect for when you're thinking about that and touching. Gosh. Okay. I know that's fascinating.
It's really fascinating. I'm 61. I play pickle ball three times a week. It's a great workout, but I only have time to do weights once a week. Is pickle ball enough?
Pickle ball is great for your brain. It's great for your cardio, but I would rather you trade one pickle ball day for another work, another weightlifting day. Okay. Well, that's is that almost like the plat Pilates or pickle ball is a little bit more? Pickle ball is is a high cardio intensity.
Okay. And that's the purpose of it. You're not you're not building muscle playing pickle ball. Okay. Two more rapid fire.
I'm noticing a lot of cellulite on my legs lately. I'm only 35. Is that normal in any way to get rid of it? Cellulite is both genetically predisposed and has to do with fat content. So, if we're worried about the non-getic part of it, we're going to recompose.
We're going to build muscle. We're going to we're going to lose the fat hanging around. I've always lifted weights and I feel just as strong as I did in my 30s, but I've noticed now in pmenopause, my recovery is terrible. I'm sore all the time. Anything I can do?
That's a good question. We have to remember that estrogen is an anti-inflammatory and the soreness you feel might be slower recovery which then will take maybe more protein in your diet, better hydration. Think about are are there any micronutrient gaps but it also might be arthoral of pmenopause because of your menopause hormone decision. Dr. Vonda, what does unbreakable mean?
Unbreakable is the mindset backed up by the actions that we can live healthy, vital, active, joyful, long into the foreseeable future and age with power, not frailty. Thank you so much. Where can people find you? So, you can find me every day on Instagram, Dr. Vanderight, Dr.
Vanderight. You can find me online on my YouTube channel and lots of speaking everywhere. You just have to Google me. Wonderful. Thank you so much.
I feel like I have a million more questions I could always ask you. You're just really, really special. Thank you. Thank you. All right.
So, I have some serious work to do. First on my push-ups, also on the grip strength here, but I love this conversation. Dr. [clears throat] Vonda Wright makes it so clear. Getting strong is not just about the gym. It's about longevity.
It's about confidence. And it's about taking care of your future self. I hope this episode inspired you to move a little differently this week or just think differently, lift heavier, or start again. If you like this conversation, I would love if you could take some time to leave a review. It really does help us bring you more incredible guests like this one.
And if you have questions you want me to ask in a future episode or guest you'd like to hear from, send us an email podcast@tamsonfidel.com. I'll see you in the next episode.
