The Truth About Creatine & Exercise! 30% Of People Will Die From This! The Healthy Ageing Doctor

Runners who only run are hurt a lot and it's usually due to emotion imbalance so I always do this test to show them whether your butt muscles are strong enough to keep your pelvis straight and whether you're strong enough to keep your knee from falling into this position I look like I'm drunk or something how are you doing this with your heels on Dr vond Wright is a leading orthopedic surgeon and Longevity expert leveraging her expertise with Elite athletes to revolutionize the way we move eat and train to live longer stronger and better I'm on a rampage to make bones sexy again because in the United States at least 50% of women will get osteoporosis along with 2 million men now osteoporosis is low bone density and studies show that people with low bone density have higher cognitive decline it increases your risk of fracture if you break your hip 50% of the time whether you're a man or a woman you will not return to preall function and 30% of the time you will die and there's a lot that causes bone fragility such as aging not building enough bone in our youth it's our sedentary Lifestyles the myth that women have to be teeny tiny and it's even things like a woman breastfeeding will lose 20% of her bone density in the first 6 months but it's not inevitable and I will lay out a lifestyle that I call unbreakable it's about muscle bone nutrition but the most important part is mindset I'm very very excited uh just to pause that is there a link between menopause and brain density yes and it's because of the plummeting of estrogen which is critical for muscle bone tendon ligament fat and without it it can have dire effects so you need to know the following this has always blown my mind a little bit 53% of you that listen to the show regularly haven't yet subscribed to the show so could I ask you for a favor before we start if you like the show and you like what we do here and you want to support us the free simple way that you can do just that is by hitting the Subscribe button and my commitment to you is if you do that then I'll do everything in my power me and my team to make sure that this show is better for you every single week we'll listen to your feedback we'll find the guest that you want me to speak to and we'll continue to do what we do thank you so much [Music] Dr vonder Wright yes for anyone that's unaware of what you do and who you do it for what do you do and who do you do it for so you know in as a sports doctor over the years we've learned how to take really high- performing athletes you know those are who are winning all the time who need to continually get better and better and better at their craft and over the 30 years of my career we've gone from really focusing on how they train the periodization of their training to the last time I uh was at the University of Pittsburgh I was the medical director of the UPMC Lemieux sports complex which is where the Pittsburgh Penguins are housed and it had gotten so uh scientific they had a full-time Chef every meal from breakfast lunch dinner every meal on the planes were prepared because when it comes down to split-second agility top of brain thinking every little bit counts and so in the 30 years of my of my medical career it's gone from just learning more about performance science of how to train to how to feed people to how to recover people so instead of doing for instance I think Dara Torres was talking about her uh Olympic runs in her 40s right she trained much differently when she was 24 and in her 40s after she had had a child it was much more about recovery not as much hours in a pool so I take all those things that we've learned over this course of my career and now apply them not only to athletes but to people like you and me who were in high performance jobs I need to be tip toop in every sphere of my life as you do and how do we eat better recover better take the principles of performance that we've learned from athletes into high performers and even mere mortal athletes like me I love of my work involves like cognitive performance making sure my brain is sharp when it needs to be yes how much of your work crosses over into the cognitive realm you know I am not a brain scientist myself but I am fortunate to be surrounded by people who are expert in that so from my own perspective I've come to appreciate at a much deeper level personally um as well as professionally the role of sleep in fact we've talked about my previous books from the early 2000s before and when I wrote those books Mobility was King I wrote only about mobility and then as I progressed in my career I got deeper deeper deeper into nutrition and then I would say okay nutrition is number one and Mobility is second but at this phase of evolution of sleep science and knowing how restoring the brain and providing adequate time and nutrients I put sleep first sleep and Recovery first because you can't do any of these other things without a r well recovered brain in fact somebody asked me the other day about timing of working out and is it always necessary to do it in the morning like that's the Mantra get up go do your workout and my answer to that was you have to know how your brain works for instance my brain is best between 5:00 a.m. and 2: p.m. that is when I'm going to get all my deep work done I'm going to be creative I'm going to think after 2 p.m. I could build you a house I can continue operating but if I'm going to write a book it's going to be early so I do not work out in the morning because I'm not going to waste that brain energy on physical activity when I need it for this deep work so that's the way I apply brain science but I I'm so lucky to be surrounded in in the place I am now with people who put eegs on your head and map your brain and tell you which brain Pathways you're too stressful on and and which brain Pathways we can train and you can train the physical brain like a muscle you can train the physical brain like a muscle yeah so there's this company called nestry that I just happen to have access to and they put EEG helmets on my Precision longevity clients and we map their brains and look at for instance here's an example things that are habitual take very little brain injury uh energy even if we need a lot of brain energy they become so habitual our brain turns away uh energy from them versus things we're learning or things we're stressed about we devote so much energy to that so once they this company Maps our brains then they have this training program where it's almost like getting your your cognitive brain out of the way and let your subconscious brain reapply energy to the pathways that you actually need that you you've begun to to ignore and it makes you more efficient and I'm being an adequate in explaining it but brain scientists believe that you can retrain the brain like a muscle and devote energy to neurop Pathways so I know we do this to athletes to try to squeeze performance out of them when you use that term Precision longevity what does that mean so you know after the understanding of human DNA knowing what we're truly made of it pushed us out of a time in medicine where we've been for the last 150 years which is Observe and one size fits nobody now that we've sequenced the human genome we can develop Health Plans your health plan my health plan it's not generic here's an example when I have people who want to talk to me about living healthier longer and we and we draw a set of biomarkers it's not 6,000 biomarkers it's just a set of about 23 that are Beyond regular labs and I see that for instance maybe stevenh you have a high load of senescent cells well I'm going to specifically design your Gap nutrition according to what you need you might not need anything for inflammation because maybe your inflammation labs are good but historically what we would have done is say okay let's just give everybody the same formula but now we are able to devise what your body needs at your time I do the same thing with exercise I never say let's have you do 150 minutes of moderate exercise because I have access to lactate threshold testing where you're walking on a treadmill running on a treadmill or on a bike every four minutes we're pricking your finger and I can tell exactly what when your mitochondria the little energy storehouses in your cells go from burning fat to burning Caro carbohydrates and that place is called the fat Max and that is when your mitochondria your energy organel are most efficient and that's where we want to work out 80% of the time so that's just an example of how I'm going to tell you what heart rate you need to work out in I'm going to tell you how to get fill the gaps in your nutrition instead of just doing broad guidelines because that's the state-of-the-art right now when you think about personalization I was thinking also not just about the individual but different phases of life and how maybe in my my 20s there's a certain set of things I need to be thinking about more so than in my 30s my 40s and my 50s and my 60s is that a useful way to think about it are there different things we need to be thinking about in different seasons of our life or is it the same things in every season well I love that question and the one one word answer is yes every season of our life is different let's take bones for instance we build build build build bones yeah until in women we're about 28 and uh men 30 we reach Peak bone mass we then reach a plateau where we keep our bone density and then in women it begins to plummet due to hormonal influences for men men usually maintain their bone density until their 70s when they plummet unless they have a metabolic problem an autoimmune disease or having had the need to take a lot of steroids and then you see a big difference at 50 so in Bones that's a good example how every few decades our bones are reacting differently muscle is the same way we know that we can gain muscle at any time in our lives but we do it most easily until we're about 30 right we also know of uh changes in the way our gut functions as we age having to do with absorption and the uh the ability of the microvilli in our gut to absorb nutrients and different kinds of nutrients women in midlife for instance need vitamins that are something called methylated which means broken down a little more because our gut function is less efficient so every phase of our aging were different well on that point of bones that that sounded like you were saying men's bones maintain their density longer and women don't why why is that and is that linked to menopause well men uh because of the influence of testosterone and the genetics of having um XY chromosomes build more bone initially thicker cortices more more absolute poundage of Bones and so um and then because of the plummeting of estrogen which is critical for bone health women lose bone faster than men such that after about age of 40 when we get to that Plateau women start to lose bone density about 20% by the time they get to their menop pause and um that can have dire effects for women but that is all due to the role of estrogen on controlling bone density so is this inevitable is the loss of bone density inevitable for women it is not in um in 2004 we studied a very large group of Masters athletes meaning athletes uh 40 and older in the National senior games which is Olympics for uh people of that age demographic and the National games you have to have won your State Games to qualify so these were pretty highlevel recreational athletes so we did a study looking at their bone density across time and the first thing the first study we found was that with chronic exercise such as these people did you can maintain your bone density at a very high proportion into your 80s the second question we asked was okay if we know we can do that what exercise is really important for that and so we divided Sports up into uh bounding Sports where the bones were being impacted like like basketball running um volleyball anything when you come down hard on your bones versus swimming bowling the less biking and we found that bashing your bones impact was as important in maintaining bone density as things you can't control like your age whether you're born with XX chromosomes or XY chromosomes family history so impacting bones causing them to build up over time is critically important for maintaining bone density so to answer your question is loss of bone density inevitable loss of estrogen is inevitable loss of bone density doesn't have to result in osteoporosis fracture and Frailty so I want to get into why that's happening but just to pause there because a lot of people don't think bones are that important oh like I think a lot of people see our bones as just some thing that yeah we can't influence you don't think of them like muscles muscles I go to the gym I can expand my muscles I can get strong but with bones it feels like they're static you know so how how would you refute that so that I start caring about my bones and what is the cost if I don't care about my bones well you know what I'm on a rampage for this year that to bring to make bones sexy again CU here from a very superficial level is why we should care and then I'll tell you from a more scientific level you know we only think of our bones usually in a couple times like you look in the mirror and somebody tells you oh your bone structure is magnificent look at this model's bones and or uh and we're all touching our cheekbones or we think about them when we hear about a great archaeologist who's just discovered a new people group and we can tell from our bones how they lived how they died how healthy they were in fact in that setting bone is the last remnant of your whole life it endures the longest I mean the hisory the history you talk about in your bones outlives anything muscle goes away skin goes away everything except your bones which remain that's fascinating right but the other reason we even think about our bones is when they break right when they bones people think bones are silent like a strong silent type just hanging back until they break and then they're screaming at you right and and causing Frailty and here's some bone stats because the real answer to the question is coming one in two women will have an osteoporotic fracture in her lifetime so it's either me or your partner or me or your assistant right one in two will have an osteoporotic fracture women have 70% of all hip fractures hip fractures are one of the main contributors to ending up in a nursing home because you can no long walk and take care of yourself right 70% are women if you break your hip 50% of the time whether you're a man or a woman you will not return to preall function you cannot go live in that house where you raised your children you may not be able to drive and go be totally independent right and 30% of the time it's a huge number 30% of the time you will die either from the complications of the fracture from the bed rest from the in infections you get the bladder infections just the sequele of being that sedentary so those are those are not meant to scare people that is the reality that I see every day as an orthopedic surgeon on call but there are other reasons to carry about the bones because fracture is a big one bones and it makes sense nature is so conservative bones are in our body from the top of our head to our pinky toe right bones are master communicators we think of muscle which we're all talking about now and Bone and adapost and everything as as siloed organs that don't have much to do with each other except they live next to each other the fact of the matter is for instance when we're talking about the musculoskeletal system bone tendon ligament muscle fat cartilage muscle stem cells there are all all derived from the same stem cell the mesenchimal stem cell so they're not distant neighbors they're cousins and they all speak in the same language they may have different dialects I was thinking about an example of of this you know how in the UK English is the language but depending on what parish you live in or which country within the UK English sounds very different but it's the same language So within musculoskeletal tissue isue muscle and bone are not separate they are one ecosystem such that when muscle releases a protein called irisin it talks to the Bone when bone releases a protein called osteocalcin it talks to the muscle but in the case of bone osteocal if we just stick with that protein it talks to the whole body when your osteoblast s the bone building cells in your bones released osteocalcin it goes to your brain and has a neuroprotective effect by decreasing inflammation it goes to your brain and causes the synthesis of neurons in the hippocampus it goes to the pancreas and helps with insulin insensitivity it goes to the muscle and helps the muscles scoop up glucose out of the blood right if you're a man osteocal can travel to the testes and that organ the litig cells under stimulation of osteocalcin will produce testosterone so it's like a miracle and a wonder that we just think of Bones as the strong silent type that hold up our muscle because actually bone and and the proteins that it produces are Master communicators and it makes so much sense because we have bone everywhere in our bodies why wouldn't our body bodies use it like that I thought it was just a frame well and it is a frame right what's Muscle without bone just a heap a metabolic tissue right it makes us gives us our statue but it's a master Communicator the framework is almost a secondary job in my opinion the bone is releasing stuff I got this um this little analogy I'm going to put on the table in one of the one of the tubs I've got some mineral some and then this is the body yeah so could you explain to me how the the bone is releasing something into the body so we've talked about the bone being structural right it holds you up it gives you your stature we've talked about bone being a master Communicator another job of the bone is as your body's Storehouse to really really important maybe if we just talk about one of them calcium calcium is is a critical mineral in our body we need it for muscle contraction for pushing um molecules across cell membranes but we've got to store it somewhere so when we eat food our body pull our intestines pull it out of the food we eat and stores it in our bones and so our body is always sensing how much calcium how much phosphorus do we have what do we need when our body senses that we need more it goes to the Bone it tickles the osteoclastic and say osteoclast we need some more calcium the osteoclast breaks down some bone releases calcium and it goes into the body for use and then the body has enough to use the body does not just keep piling it in because hypercalcemia causes heart arhythmia it's bad right the body is perfectly in homeostasis in Balance so when the bone has released enough it sits back and keeps storing it right the calcium your body doesn't need if the bone is full it's excreted through the kidneys and this is a really fine balance between building bone releasing the storehouse of minerals into the bloodstream or saying oh we've got enough let's send it out in our urine the body is such a miracle like that so if I don't have enough calcium or some of these other minerals does that mean that my bones are going to become fragile so you know there are lots of things that go into bone fragility or osteopenia and one of them is not laying down enough bone in our youth if we T you asked me earlier about changes across a lifespan when it comes to Bone what's interesting is that I get very very young women in my clinic for 25 28 whom for various reasons I do a bone density test on and they are already have brittle bone I know it's it's it's shocking well I think that happens for a number of reasons number one we didn't build enough bone there is still a myth in this country that women have to be teeny tiny that we have to starve ourselves and when that happens many women do not have consistent menstrual cycles and estrogen which then helps us lay down bone so that's number one we don't estrogen plays a role in laying down but yes it does critical role so we're not laying down enough or maybe we're athletes we're in we Title 9 which is the law that um equalize sport for women in college is 53 years old so maybe young women are not laying down enough bone because they're expending so much energy 10,000 calories a day and then they're not refeeding in the way so they're always living in a state of energy deficit and not laying down enough bone or maybe young women are coming to my office with not enough bone because we are raising an entire generation of sedentary children who are sitting around in their basements on playing games building brains but not building bodies that is borne out by looking out of the University of Wisconsin Orthopedic researchers there studied which women's sports build the best bone and it's gymnastics it is the pounding and the feeding of those athletes that builds the best best bone so we have trouble with not enough brittle bones in adolescence because we're not building it the second place in the lifespan that we may become low in bone density and hear me people I am not saying not to breastfeed I mean I in my children I my child I breastfed for a year it's really great for babies but a woman breastfeeding will lose 20% of her bone density in the first 6 months of breastfeeding and if she's not really careful to get 500 milligrams of calcium a day in her food or through supplementation she will not build it back and then if you have children in ear in succession because many women are waiting until 30s to have their first child and then have less time we may never build backbone so that's another key point that people don't realize could be dangerous to the bones and then finally yes is this period about around per menopause starting around 45 when estrogen levels become very chaotic and then ultimately zero that can cause the rapid decline in bone density and Bone weakness that you're actually asking me about and that's because estrogen is critical for controlling the absorption this part the absorption of bone and without estrogen controlling the absorption it just keeps breaking down bone faster than the osteoblast the building cells can build it so there's an an unbalance a disregulation so I want to go into all of that starting with the point you made about um having doing Impact Sports when we're younger yeah because like people often say if you do Impact Sports when you're younger especially some of them there's other consequences like injury or hitting your head so you're saying that we should be running or jumping when we're younger to build our our bone strength absolutely to build everything oh it's you know we we uh make mitochondria most the energy of ourselves we make a lot of mitochondria in our youth if we're not active in our youth we don't have the anabolic stimulus as much to make as much mitochondria if we are sedentary children we will make bone but we will not build bone to the extent we do if we're bashing it every day and I and I think the data out of Wisconsin is a good illustration of that and is in all seasons of life if I'm 60 years old should I still be bashing that bone playing basketball abs and that's what my study from the national senior game shows that by impacting your bones across your lifespan you can change your bone density so on that point of pregnancy which was your second point there during my pregnancy after my pregnancy what do I need to be doing is it drinking milk yeah so if and this is the data I gave you was specifically for breastfeeding okay so for breastfeeding mothers uh you will lose about 500 milligrams of calcium a day as you're making milk for your child you must replace that I like people to replace their calcium with whole food right with prunes and dates and and high calcium um Dairy if you will if you simply cannot do that okay take a supplement but if you forget to do that I mean I get it I was a young mother I'm exhausted I wasn't a young mother I was a 40-year-old mother exhausted you have to be so mindful as your the baby's latching on to eat some calcium eat your yogurt eat your calcium chew from Whole Foods if you will so that you rebuild your bone which you're completely capable of doing studies show you will rebuild your bone but not if you're not aware not if you're in the I've got to lose the baby fat starving phase let's not do that you talked to about how bone has an impact on various parts of the body and I've had you talk about this phrase the bone brain axis yeah what is the bone brain AIS well if we just talk about um just choose one of the the proteins that bone makes osteocalcin so as that's released into the bloodstream one of the places it goes is into it through into the brain and it can cause it can Aid in the neuroprotective effects so what is that mean under normal metabolism we um develop free radical through du due to normal metabolism cell work um we develop oxidative stress and osteocalcin works to decrease that oxidative damage to repair cells in the brain so that's number one number two it stimulates the release of something called brain derived neurotropic protein bdnf factor which stimulates the growth of neurons in a part of the brain called the hippocampus which is involved in memory and here's here's the opposite side of it we know in people that have low bone density they also have higher brain cognitive dysfunction with age and vice versa there's an association in the literature with osteoprosis and cognitive decline and vice versa I heard you in the The Business Insider interview do describe there being a critical decade yes for bone health mhm what is the critical decade I think the critical decade for most of our health Stephen is no later than 35 to 45 for men and women that's because um we know for women that's when estrogen starts to decline or become chaotic so when we're in our 30s to 40s that is the time to get all of our health habits together it's time to get a physical to see what your Baseline labs are I think it would be critical for men and women particularly men to get a baseline testosterone so that in the future when we're thinking about supplementing testosterone we're supplementing back to your particular level because in the future let's say when you're 50 a man's testosterone could be 600 which Falls within the normal range but if he's still feeling low energy not himself a lot of tendon and ligus injuries well his young testosterone might have been 800 or a th000 so I like people to get baseline lab if they've never been to the doctor before uh around 35 all things so that we know what we're returning you to number one number two if you have been so busy with your career and stepped away from any semblance of mobility and resistance training now is the time because had I known then what I know now when I was 40 I was training for triathlons I was an aerobic athlete right I ran I biked but what I would have done then if with what I know now is I would have been lifting a lot of weight to build maximum muscle while I still had the most hormones to start at a better place because you can build muscle but it's better to start from a higher average so get some Labs make a relationship with the doctor get all your preventive screening do not uh blow that off um develop the habits that are going to carry you through a lifetime whether it's smart anti- inflammatory nutrition whether it's getting into a resistance training program building up your cardiac machine I saw that you were running a lot now and we want the highest possible V2 Max that we can as we enter into midlife because we never want as we age to cross something called the fragility line so V2 Max is the measure of it's the ultimate measure of fit how much oxygen you are capable of pulling out of the air and diffusing across your lungs into your blood world class athletes I was just at the US uh Olympic Center in Park City Utah those athletes have a V2 Max of 75 80 sometimes 90 right mere mortals are considered excellent when they have a V2 Max uh of around 50 for women around 50 so you can build V2 to Max and should in the critical decade because once we hit midlife we will decline 10% a decade if we don't consistently build it up so what does that look like so if I started at 50 50 years old my last V2 Max was when I was at when I was 50 and it was 50 it was pretty good because I was an endurance person right just in whole numbers by the time I turn 60 it's going to be 45 70 40 80 35 I never ever ever want to hit 18 if I'm a man or 16 if I'm a woman because that is the level of V2 Max when we can't get up from a chair by ourselves we when we can't walk across the room because that takes cardiac function and so the higher we get our V2 Max in our youth the more Runway we have even if we don't continue to build it up yeah I've got a family member that can't walk upstairs without being out of breath and it's so debilitating because when you have grandkids and the grandkids start running around and you want to play with them it's so sad watching this particular family member see the grandkids come the grandkids say let's play the grandkids run off and this person can't go after them so they just have to watch they literally watch the the grandkids playing in the garden because they can't play with them and I think it's s such a sad thing it's one of my big motivators to try try and stay healthy is just to be able to extend my health span that's right so that I can be healthier hopefully until the day that I die thatd be great but would I want to talk about running I want to talk about V2 Max to close off on the subject of Bones there's two terms that I that I want to hear one is this term osteoporosis yes now I have no idea what osteoporosis is I've heard it a couple of times in my life but I don't know if it's something I should be thinking about worried about um or what it means yes osteoporosis is the word we use to describe low bone density Okay so so the way we measure osteoporosis is uh using an x-ray called a DEA scan a dual X-ray and it just measures it Compares your bone density to that of a 30-year-old healthy person and it gives us something called a t-core so it's it's like when you're in school and you're graded on a bell curve and the center of the curve is average and that's the average for a 30-year-old when you get a dexa scan score and it's positive fan fantastic you have bones of a 30-year-old if you get a t-core on a dexas scan that's from 0 to minus1 it's okay minus one is the definition of osteopenia meaning watch out your bones are getting weak the definition of osteoporosis is minus a t-core of minus 2.5 increases your risk of fracture by 40% or more all the bad statistics that I talked to you about come with osteoporosis and how many people have osteopenia osteoporosis in over the age of 50 in America well two million men have osteoporosis interestingly isn't that interesting you don't think about it as a men's disease and uh one in two women will have an osteoporotic fracture so at least 50% of women but it's not inevitable that's why I'm so interested in in Catching people early in the critical decade it's not inevitable but it will be inevitable if we don't catch it but here's the thing that's bothersome in the United States and in many other countries uh with people I deal with you cannot get a dexa scan paid for until you're 65 by 65 the damage is done why are we waiting even with people who have had a fracture there's a gap in followup such that they should all have a dexa scan because the number one thing that predicts future fracture is past fracture so Public Service Announcement if you've had a fracture get a dexa scan even if it was a traumatic one like you had b a car accident but definitely if you have fallen if your dog pulled you down if it was a low trauma fracture get a dexa scan because then at least you'll know where you are and can then plan a course for building your bone are there any early warning signs that I might be suffering from osteoporosis or on my way to osteoporosis you know I think you can get Clues from your own family okay if your mother shrank if you if you used to be able to look your mother in the eye like me my mother looked me in the i54 and now she's way down here we lose height in both men and women due to uh compression of her spine vertebrae we lose height so if your dad shrank if your mother shrank that's a good indication that you have a family history where osteoporosis can exist or if your mother had a hip fracture or or if for some reason maybe asthma you've had to be on uh high dose steroids your whole life or an autoimmune that's very bad for bones so from a medical standpoint from a family history standpoint from a personal standpoint usually fracture what about if I'm a smoker does that have an impact on my bone health and chances yeah I'm really glad you asked that smoking is a poison to Bone healing whether it is fracture will heal more slowly in fact we have a very a much higher rate of non-union which is where we fix a fracture and it still doesn't heal in smokers we know that uh there is a big body of data within the orthopedic literature for people who have spine surgery who are smokers they are not only less healing but they're more infected so the the noxious chemicals in smoking are very bad for bone good thing I don't smoke is that smoking vaping or is it it's all vaping might be more dangerous we just don't have as much literature okay and the the last thing before we talk about running in fe2 Max and endurance and sports and all those things is the link between Alzheimer's in bone health is there a link that goes back to what we were talking about before and there's a correlation we I don't believe we worked out the causation but there's a correlation we see people with Alzheimer and people with uh dangerous osteoporosis are sometimes the same same group 30% of the time people with brain disease also of osteoporosis and it may do be due to this uh connection that we've talked about uh between the two organ systems you had an aunt that passed away from Alzheimer's I do my aunt Ida she was brilliant she was a teacher and she stopped remembering she didn't remember herself she didn't remember the farm that we were all raised on that's a really hard thing to witness um sometimes people with Alzheimer's lose the inhibition and they become angry and enraged and afraid she never did that but um but that's a hard thing to witness how how did that experience change you or change your focus or add to the sort of what reservoir of thoughts concerns reference points in your life well you know what it has done it has put an urgency and even it still is a day-to-day battle I don't want I think sometimes think people think for me personally that because I talk about these things all the time and I do lift heavy and I do the thing I live the life I prescribe for people that it's easy and it's not easy you know I just I told you IID finished this book I was writing and there was a big gap in the consistency of this lifestyle but what motivates me to get back is the question of what would it be like to live without a brain that's preserved I mean I don't know sometimes I think about if I was aging and I had to choose one would I choose an able body or an able brain isn't that hard I don't know that you do have to choose but I can't fathom what life would be like without an able brain and so for me that motivates me to lift to make my skeletal muscle secrete the uh proteins that go to the brain and build better brain to eat the foods that are not going to clog my arteries it's just as a motivator because I want to be this way until I die mhm what would you choose if you had to an able body or an able brain my it was super clear for me I'd rather have the able brain me too me too relationships that is that is the fullness of Life protect but these things are also fundamentally interconnected aren't they that's why when I look at the alimer stats around bone health I think well if you were had osteoporosis or something and you weren't moving as much maybe yeah maybe you know what a huge motivator for my patience is now that you've brought this up is Alzheimer's disease is thought of as the third phase of diabetes right and so everybody is aware of diabetes and it means you don't process sugar and you have glucose intolerance and your pancreas is no longer functioning and and the bad sequella that can come with that what people are not aware of as much at least as a people who come to my clinic is pre-diabetes and if you don't mind me diverging a little bit because it's so important to disc question you just asked me and can we prevent it and and if we got to choose what would we choose but I have people coming into my office all the time and I look at their labs and they have a fasting glucose they've had their Labs drawn they've done what we've said get in front of your critical decade they've had their fasting glucose drawn and it's 110 which is I'm going to tell you and and their hemoglobin A1c is nearing six so fasting glucose is the glucose that remains in your blood after you haven't eaten for 12 hours in a normally functioning pancreas metabolic system we want our fasting glucose to be around 85 right that's normal means we eat something insulin comes out of our pancreas the sugar is put into our muscle and then the blood sugar is around 85 if it's staying up 110 consistantly we know from the literature that you have a 70 to 100% chance of developing full-blown diabetes within 10 years but what I see in people coming into my office is I'll say did anybody ever tell you you were pre-diabetic and either the answer is no or the answer is oh yeah somebody told me they said just make a few you know focus more on your exercise and and what I think the reaction to pre the diagnosis of pre-diabetes should be is running and screaming to get healthy because if we know that with a consistent blood sugar in the pre-diabetic range and we're casually told by our healthare provider oh just go try to exercise more you know just casually approach this don't eat so many carbs that is not serious enough because we know from a preventative standpoint from a Precision longevity standpoint which is all about prevention we can prevent you from getting to diabetes in the next 10 years if we're really really serious about lifting weights about cardio Health about anti-inflammatory nutrition following so I don't view pre-diabetes as a casual thing at all because if in a 10 years you're going to get diabetes and in 10 more years you're going to have Alzheimer's disease and I could have prevented that by paying attention when I was 40 it's almost inexcusable that we're not paying more attention to it 96 million people in the United States have pre-diabetes 96 million 96 million according to the American Diabetes Association I just gave a talk at their annual convention 96 million have a preventable characteristic that we can prevent them from becoming diabetic and getting Alzheimer disease and yet it is too casually spoken of that's like almost one in three that means that there's three of us in this room so Jack's got pre pre-diabetes perhaps potentially you're an you an an urance athlete wouldn't you say I was an endurance athlete and I'm I've been I don't have it today it ran out but I'm a little obsessed with continuous glucose monitoring so I've been wearing it for about 18 months and and uh it's so interesting I told you that you know I just finished this book and I've gotten a little bit off my regular intensity and it changes my blood sugar so I run a little I because I haven't been lifting four times a week only twice a week because I haven't been sprinting twice a week like I Norm my normal regimen is I lift heavy four times a week I on the other days I do about four days of Bas training Zone too two of those days I Sprint I always eat a lot of protein that is my lifestyle and my blood sugar is 85 when I do that and I'm a midlife woman and you know the metabolic things that happen to midlife women even backing off a little bit starts to creep up my blood sugar so this is a constant daily habitual lifestyle that we all need to lead and so when I see that and someone as healthy as me when my patients show up and they casually been told that they have something that's going to kill them I don't think that's enough attention that's what I've been thinking a lot about recently is what diet is going to lead me to better cognitive performance to someone that spends a lot of my time talking yes but then also I'm on stage I'm in boardrooms and in meetings and in negotiations I'm reading emails and writing books Etc so I'm always thinking if I can just get 5% Edge well I can tell you for instance the the dietitians and chefs that make the food for the pro athletes that I've taken care of across my life they're not only eating meat they have a very well-balanced diet that includes lots of vegetables lots of high protein they they take amino acid supplements if they need to fill in the gaps right if they're not getting enough Lucine or something but they just don't go down one one pathway I haven't seen that in the Pros that I take care of he to has given me a very sharp mind has it an extremely sharp mind it's so interesting as a podcast when you sit here and you have all these conversations because some days you show up and sometimes these conversations last for four hours and your brain and mouth just don't feel like they're connected yeah and then on other days I come here like boom boom and it's automatic yeah it's like I don't have to think and it's just flowing off off my mouth and the variance the big I said so the causal factors are obviously sleep is one of them the other one is how many carbohydrates I've had in recent yes hours so if I've had a lot of carboh hydrates something you know like if I've had bread my mouth and my brain have no connection if I've had lots of sugar my mouth in my brain are completely done agreed agreed you know because of this CGM thing I found that if I only eat protein for breakfast which uh egg white omelette or you know whatever just protein that I needed a little complex carbs in order for about 10:00 in the morning to be able to function at a high level with my patients so now I've added 50 gr of carbs in the morning but that's not a lot of carbs not very much I just needed that little complex but uh interesting right and what do you eat I eat 130 grams of protein a day there's no upper limit on how much protein you can eat in a single setting I try to get at least 30 because there is a lower thresholds for 30 and so if I do that uh it takes three meals and a couple SN a day I that's a lot of volume of food so I try to eat really dense so uh a cup of Greek yogurt is like 18 grams and a really pure beef stick is another 16 so at this time I at this point I've memorized the most dense foods that I can to get that much protein it's a lot of protein it's a gram per pound it's a gram per pound and that's what I need to build muscle Studies have shown that uh eating high protein Al without lifting as much as I want myself and others to do will help maintain muscle and then I eat a lot of vegetables I don't now I hope people are not going to throw them at me but I don't eat fruit except blueberries fruit is Nature's dessert so if we're going to eat fruit eat it as dessert I eat I eat blueberries with my yogurt but um and then carbs I only eat complex carbs if I eat them at all quick one I want to talk about something we all need to take seriously which is cyber security whether you're a first-time founder facing your very first audit or a seasoned professional who's been through it all staying compliant is getting more critical than ever and more complicated I have to say and that is where vant comes in who is a sponsor of this podcast vant takes the pain out of security compliance automating the tedious but essential process of proving your business is secure across over 35 Frameworks like sock 2 ISO 271 centralize your workflows answer security questions up to 5 times faster and protect your business without losing focus on growth and this is really a critical part of this a new IDC white paper found that companies using van save over $535,000 a year and it pays for itself in just 3 months for a limited time my community gets $1,000 off vter at v.com that's van.com for $1,000 off you're um a very big advocate of muscle you know when we talk about longevity something that you continually come back to as the most important thing for people's longevity I think I would put muscle and bone near the same category because you can have all the muscle you want but if you break your hip you still have the downstream effects now you're much Les less likely to break your hip if you're strong but I think muscle or bone are really important what if you 65 years old 70 years old and you haven't got MH strong muscles right now now your muscles have um declined let's say over the last couple of decades is it too late never it's never too late it is never too late your body will always rise to the Strategic stress you place on it so there are a lot of and growing number of what used to be anomalies all over the Internet of people in their 60s 7s 80s and Beyond in a gym powerlifting becoming uh competitive bodybuilders so even if you're starting not being able to get up out of a chair over a very short amount of time 6 months a year you can reverse the trajectory of your Frailty but it takes consistency right I do wonder that I think about think about my father and he's approaching his 70s now and I don't think he's done weight training for the last 15 15 years yeah and there is a part of me that did wonder is it too late now to to start doing weight training because it's almost like a a two-sided problem in the fact that you haven't done it yes so you find it harder so you don't do it so you find it harder and then you sort of spiral down to this sedentary State well and you know what you do for that is nobody expects you to start with powerlifting squats deadlifts nobody expects that moving our body through a range of motion doing body weight progressing to free weights progressing to like kettle bells progressing to bands when once you see that your body is capable of adapting and progressing you will get there pretty rapidly I used to do this program called a start where I would take people fresh off the couch and over three months we would get them to a 5K race because 5K is a meaningful distance for people who are sedentary and over that course of 3 months we did a series of um body weight and kettle bell type exercises in a Circ followed by walking and people started with 51% body fat not being able to get through the warmup not be able to hold himself up in a plank and in three months they could plank for 2 minutes they could walk for three miles they could keep going for the entire 10-minute circuit without having to stop so there is never an age or skill level when our body will not respond to the Strategic stress you put on it so uh get a trainer for your dad if he'd accept it if he would accept it I'll call him after this if I am trying to build muscle are there a certain amount of days of the week or repetitions I need to do to build the muscle I think about this a lot when I'm out here in La I'm I'm I'm trying to make sure that I don't lose my muscle but I spend a lot of time sat down in here recording podcasts so is there a certain amount of times I need to work out that muscle before I lose it you know I was just reading this morning actually that um even with a 10 week Hiatus from let's say you're lifting consistently even with a 10we Hiatus uh you will retain muscle memory so that you don't make serious declines which is little relief to me because it's been a little while with this book so you retain muscle memory and you can quickly once you get started again get back up to the place you were um so all is not lost if you take a few days off but the minimum if we're really working at it is a couple days a week progressively lifting harder for men in midlife it's about eight reps four sets for women once we've trained to the place we can lifting heavy four reps four sets and when I say that out loud I get a lot of comments about somebody's going to get hurt well it's true but you have to work your way up to that like any sport you have to work your way towards that level because what we're trying to do by lifting heavier especially for women is replace the anabolic stimulus that estrogen was you must work hard enough estrogen creates growth we must signal our body by the intensity of our work to build muscle and lifting heavy does that so if you're starting on the couch uh start with bands start with light weights start with the Mambi pami pink weights that I rail against but don't stay there continue to work your way up in a progressive way to heavy lifting total body at least twice a week to maintain do I need to increase the weight load to build muscle because I wonder when I go to the gym sometimes you know I might be using smaller dumbbells but I'm doing more repetitions yeah is that still going to build muscle well it depends what you want so so lighter weights higher reps is uh will will uh function for hypertrophy for big bigger total muscle but not necessarily power and strength in Lo in midlife and Beyond I am Lifting for longevity EMP power so I'm not as interested as I once was in the bigness of my muscle I'm interested in can it move powerfully over times can I get up off the floor can I lift my suitcase above my head so Lifting for power is lower reps higher weights so it just depends what our goal is you may be focused on hypertrophy right now which is fine because you've not reach the critical decade so if I'm looking for hypertrophy yeah higher reps lower weights so 12 12 15 reps low weight and then if I was looking for power then maybe 6 eight 6 eight that's right how many do you do I do four you do four mhm so big weight four big weights four reps four sets interesting I didn't know that M interesting and just to give some sort of foundational knowledge as to why muscle is so important because some people still might not um be aware of the link between longevity and muscle a lot of this is to do with from what I understand glucose so it has to do with muscle as the snc for glucose uh it is a key factor in preventing insulin resistance not to mention strength staying upright not falling down causing a fracture right so muscle is a metabolic endrocrine organ it releases when it releases um you know one of the things that releases is skeletal muscle contraction by curls causes the transcription of a protein called clo which is the longevity protein about 30 years ago it was described in nature it is the protein when muscle contracts that's transcribed it works on every organ we know that it's critical for the longevity and repair of organs because mice who are born without the ability to make clo die old very young chronologically they're very young mice but they die very old mice because they have not enjoyed this protein clo we make clo by the contraction of skeletal muscle here's a study I did uh years ago that showed that I measured clo level circulating in the blood of older Masters athletes people 60 70 80 younger Master's athletes 40 and sedentary people and what I found that the highest levels of circulating cloo the longevity pro protein we're in young athletes not surprising the second highest level of longevity protein clo were in Old Masters athletes 70 80 the lowest level of longevity protein were in young sedentary people so even old athletes had more circulating cloo than young sedentary people so just the contraction of skeletal muscle can add to your longevity through this protein another Protein that's released with skeletal muscle contraction called ginin it is transcribed goes to the brain works at a place called the nucleus culus which is critical for resilience it makes you more resilient it helps you able to problem solve and then you know a very popular uh protein that is transcribed with skeletal muscle contraction is called irisin it's the exercise protein which you know it works on bone it works on fat to Brown fat from white fat to Brown fat which is has higher thermogenesis it has higher mitochondrial load it so muscle just in doing its thing not just looking pretty in a gym mirror does all these metabolic functions and so that's why we think it has such a key role in longevity so if I'm trying to protect my muscle as I age are there any supplements that I should be taking I mean do they sell cloo supplements they don't you have to make it oh F contract your own muscles well uh you need to feed your muscles I always quote people one gram per ideal pound because listen I I I'm an actual practicing person doctor and here's what I know people need really Specific Instructions and they can't be confusing so is there a range of protein people need yes there is but people can remember one gram per ideal pound so you got to feed your muscle with protein high quality protein the highest quality protein has the greatest percentage of an an essential amino acid called Lucine Lucine is not made by the body it has to be taken in from the outside it's a branch train amino acid and you get it from whey protein the best source in the universe of Lucine and whey protein is mother's milk but most of us don't drink that as adults so we get it from dairy products you can get it from plants for everybody that is a plant lover you just have a much lower percentage you have to eat a lot more of it so high quality protein number one number two there's a lot of research uh for uh creatine supplementation for both men and women when I first started being aware of creatine in 1992 it was during the Olympics I was working with a bunch of wrestlers at that time um we would give very very high doses we would cycle the creatine we would come on and off now steadily five uh grams a day will help build muscle it will help build brain it's really interesting a couple of uh months ago I asked the people in my office if they used creatine yeah and a couple of the guys put their hands up none of the women put their hands up huh and I asked them why I said why didn't use creatine they said that they thought it was for bodybuilders well it started out for bodybuilders but it's for everyone actually it's very well studied so I actually had this um debate with my girlfriend last year at Christmas time um because I was taking creatine and asked if she wanted some and she made the same comment to me that it was for bodybuilders and I she put on weight if she had it and then I said no that's not true so she Googled it and she saw that it's good for like cognitive performance skin hair muscle bone etc etc and now she takes it every day perfect I think there's a big um re-education piece to be done there because we us we almost used to think of it like uh a steroid or something and it's not at all you know what despite podcasts like this and despite me screaming from every Mountaintop I find that there still is a an incredible knowledge deficit in the general public about the principles of how to be the healthiest we can be and an even bigger Gap in the ability to take action for ourselves I mean and it's not a judgment it's simply an observation that we know what to do but we don't do it and we know what to do and we don't do it even if we see in our family someone who's going through the throws of diabetes or even on the Alzheimer's it's still not enough motivation and I think that's the real problem to solve motivation how'd you solve that sometimes sometimes we solve it by scarce right you know someone has a tremendous health problem but sometimes that's not even enough I have found that it is never going to be motivating enough to try to say okay if you do this today in 20 years you're going to be much better there's this temporal disconnect people just don't get it what they're going to be like at 70 I think we have to make you feel good every single day it's like when we were talking about your brain when you're doing heavy work and cognitive work if you can feel better every single day you'll continue the behavior not for a promise so I think that is the that is the way to talk to anybody way I talked to my patients can I make you feel better tomorrow can I make you feel like a badass cuz you lifted heavy weights today um it's hard though with things like bone you're telling someone that they need to be getting I don't know their calcium and stuff like that they think well I can't see my bones and osteoporosis is so far away that yeah it's hard until you see someone fracture or you fracture yourself I agree with you vitamin D as well as crucial isn't it for bone health I was reading that there it is it is magnesium vitamin D magnesium uh lesser known things strontium zinc Boron and micronutrients but big thing vitamin D magnesium sleep sleep talked about that a little bit as well how important that was um you mentioned that I'm running now yes you are thank you for noticing you'd never mention it and a million others are supposed to join you I noticed yes we're going to try and get a million people running that's great you're going to save a lot of lives oh thank you um but much of it because of the work that people like you do and that come on my show and inspire me to think about things like my va2 Max and I'd definitely been just weight training for the last couple of years not really thinking about my bones or my V2 Max so this has been quite a big shift for me yeah but when I think about running I definitely hated it I still hate it a little bit but I I hate and love it now which is progress what are the things I should be thinking about CU people talk to me about Runners knees and stuff like that and I don't want to get injured right but I'm running quite a lot so I hear uh from a lot of Runners that oh okay I'm going to lift with my arms because I'm running so that means my legs are going to get stronger well what I know from 30 years in practice is that Runners who only run are hurt a lot and here's why running builds a big cardiovascular engine but it does not build muscle mass below your belly generally unless you're running uphill all the time and you're building glutes but so what happens running is a single leg sport if you if you look at a gate analysis you're on one leg at a time you're never on two legs and walking you're in two legs on running you're in one leg so if this is if my hands are on someone's pelvis when we're running we can't be going like this every single stride sort of oscillating oscillating like we're walking on a catwalk in Fashion Week we want to be running like this straight well that takes tremendous glute strength butt string because it's the glutes that balance the pelvis if we were in my office and you came in with pain as a runner I would stand you on one leg to see even if in a controlled POS uh environment you could do a single leg Squat and keep your pelvis stable without your knee falling in and if you can't it just tells me that we have a lot of butt core and hip strength to do and my lower back something I think about because when I train especially I'm training for a football match at the moment oh um in the UK and I always seem to get a glute injury so I and it's all it's almost like 100% predictable that if I don't stretch properly even even if I stretch a little bit but don't stretch fully yeah when I run on that football pitch within five minutes I feel like a little it's almost like a little tear in my glute yeah almost yeah what am I doing what do you think is happening it might be useful to you as you're training to have a motion analysis to have someone stand you on one leg and look at the way that that one motion pattern is different from the other because if it's predictable like that M there's an imbalance in you and so it can likely be trained I mean I can give you an example in my life if you want to see how that works so when I run and when I increase my my speed and distances I predictably predictably get left Achilles tendinitis and I get right hip flexor sharp stabbing pain predictably that is because my left big toe from wearing high heels all my life has arthritis so when I run I don't run through the center of my foot I run through the side of my foot where your pinky is where my pinky is so instead of running through like this I run through like this puts extra stress on my achilles tendon changes my gate enough that it's tight all up through the left side of my body and my right um hip flexor is taking the brunt of that that is a motion pattern deficit that I know I have so if you were predictably getting the same injury all the single time it's probably due to Something's too tight on one side something's too weak on the other side and if you get it evaluated you could probably train it out of you you have athletes and people that come you stand on one leg to test something yeah what is that do you want to see it yes yeah let's do it so to test whether we have muscle imbalances that could cause injuries when we run because I had said Runners are very hurt athletes that I take care of this is called the Trendelenburg sign and it tells us whether your glute your butt muscles are strong enough to keep your pelvis straight and whether you're strong enough to keep your knee from falling into this position okay which is called vagus so collect yourself we're going to stand all stacked up on our left knee my left knee yeah oh gosh yep and then we're going to do some single leg squats without falling over so what happens is people drop their hip and their knee Falls like this it goes blop yeah a thousand steps a mile so you can imagine if your knee's like this a thousand steps a mile your little kneecaps getting pulled off and we can't balance we're getting our balance a thousand steps of Mile so we can train this let's do the other leg engage sit single leg squat you look like I'm drunk or something yep there you go now you're compensating but the goal in the mirror is not to have the hip drop and not to have the knee fall in I feel like this one's way stronger and that's why it was easier it it looks that way so that means this glute this rear end glute is stronger than that one that's the one that always gets injured my left one yep because it's not functioning as well and it leaves this side unprotected so what have I got to do so uh double leg squats are good but single leg step UPS single leg lunges as in like so if we had a step we would be holding a we could start with no weights like this and you're tall you could start low you could go up here I usually usually use an 18 and then when you feel comfortable and your hips not bouncing up and down take your your we weight your barbell and step up and step down okay yep y right cuz it's Single Leg so I'd have my weight and I'd be going like this MH and then I step down step down with the same foot and what am I what am I doing here I'm I I'm just you're strengthening one side at a time okay because if you step up if it and you're wobbly M then that's what's happening when you're running okay and so you can do step Downs too I mean you can come this way and then come like this okay yeah and then we do uh there are lots of things like this a good physio but if we're up here we can do things like um hip hitches where you put your leg down I am in heels today but we go down like this without going down like this yep okay thank you so much let's get the table back in your gut and my gut is the home of our digestion and it's also a gateway to Better Health but it can be hard to know what's going on in there Zoe who sponsors this podcast has one of the largest microbiome databases on the planet and one of the world's most advanced at home gut health tests their blood sugar sensor which I have in this box in front of me goes on your arm so you can see how different foods impact your blood sugar then there's the at home blood sample which is really easy and analyzes your body's blood fat and of course the famous blue Zoey cookie which tests your metabolism oh and I can't forget there's also a poo sample which is a critical step in understanding the health of your microbiome and you post it to Zoe and you get your results back which will help you to understand your body's response to different foods using your results Zoe's app will also create a personalized nutrition plan for you and this is exactly why I invested in the business so my question to you is how healthy is your gut head to zoe.com to audio your kit and find out and because you're one of our listeners use code Steven 10 for 10% off your membership head to zoe.com now I've invested more than a million pounds into this company Perfect Ted and they're also a sponsor of this podcast I switch over to using matcha as my dominant energy source and that's where perfect headed comes in they have the matcha powders they have the matcha drinks they have the pods and all of this keeps me focused throughout a very very long recording day no matter what's going on and their team is obsessed with quality which is why they Source their ceremonial grade matcha from Japan so when people say to me that they don't like the taste of matcha I'm guessing that they haven't tried perfect head unlike low quality matcha that has a bitter grassy taste perfect Ted is smooth and naturally sweet and without knowing it you you're probably a perfect head customer already if you're getting your match at places like blank Street or Joe and the juice but now you can make it yourself at home so give it a try and we'll see if you still don't like matcher so here's what I'm going to do I'm going to give you 40% off our matcher if you try it today head to perfect ted.com and use code steven4 or if you're in a supermarket you can get it at tesos or Holland and Barett or in the Netherlands at Albert Hine and those of you in the US you can get it on Amazon on the subject of OB it and weight we talked last time really fascinating thing that you said to me which stayed with me is that the more weight we're carrying the more harm it's doing to our bones in a really disproportionate way could you clarify that again but also talk to me about give me the case for keeping my body fat down as I age so what we were talking about is uh joint health yeah and the fact that every bone if in your knee for instance if your Fe if this is your femur the end of every bone has a bumper of cartilage cartilage is a matrix of collagen fibers that has cells in it and its entire job is to shock absorb so the bones don't do so much of this bones are pretty fragile but they Glide cartilage has a in physics a coefficient of friction that is less than ice so it's smoother than ice it Glides right if it's perfect cartilage is very subject to the forces of weight such that in our Laboratories when we were doing cartilage research and wanted to damage cartilage all we had to do is drop a marble on it so it doesn't take much so if we're carrying around a lot of heavy extra weight and we don't have the muscles to support that instead of muscles actually like a shock absorber and protecting our cartilage we're banging more now remember banging is good for bones it's not good for cartilage so we want to make sure that we have a healthy weight so that we're not exerting so much load because it's 7 to n we talked about last time 7 to n times uh body weight pressure across the joints and so that's why we want to compose our body and have a body composition not a weight a body composition of of more muscle than at aost tissue yeah this kind of goes back to what we were saying earlier because you can say these things but still changes still far away from many many people and I was just wondering in the people that you've seen make radical changes that you've worked with are there key things that happen we talked a little bit about someone hits Rock Bottom they get a bad diagnosis they're forced but is there is there anything else that one can do to will themselves to change to keeping a journal some kind of exercise I think it's really helpful to know as much about yourself as possible so if I'm intaking someone into a program we're going to build I don't I weigh them but what's most important is I do a body composition so that we can go through step by step and say in your current body you have I'm making these numbers up 32% body fat you have very little lean muscle so even though you may be okay with the way you look in a mirror you're skinny fat meaning you have two little muscle and too much adapost tissue and and we just and we talk about all the things we've talked about about why we need to build more muscle but when you see those numbers numbers don't lie nor are they judgments but if you're just looking in the mirror you may say oh that's okay or you may hate the little belly roll but it's not you don't hate it enough but when you see that you have very little muscle mass and a very high percentage of fat those data alone are sometimes a motivation and then if we know that we're going to redo that test in three months or six months and track changes over time that can be an added motivator besides tragedy data can be a motivator wanting to feel like yourself again in in women in midlife someone sometimes just say I just want to feel like myself again well we're different people after our estrogen goes away and so it takes a different kind of work to feel like ourselves again but at the end of the day so tools wise I think journals are are helpful tracking uh keeping a record of how you felt on a day what you did that day cgms and stuff as well anything that turns the lights on has been really that's right data cgms are you you know I learned what I was going to learn at 3 months but I've had it on for 18 months just cuz that data Spurs me on like oh I that was a really stressful o day my sugar spiked up even though I wasn't eating I must have been very high cortisol I'm releasing so much from my liver it's just informs me about the inner workings of my body but also at the end of the day you have to love yourself enough Stephen and I can't make you love yourself and I can't a number of harassments in my office cannot make make you value yourself enough to invest in yourself daily and at the end of the day that's what it's going to take I've talked quite extensively on this podcast about menopause it's really fascinating to me I think in part because I didn't even know what it was yes even it a couple of years ago probably a year and a half ago I had no idea what it was what are some of the pervasive myths about menopause that people still need to sort of get past despite everyone talking about it despite you having lots of ation about it I still find a lot of people who have never heard of Perry menopause which is the decade leading up to the day of menopause which is 365 days after your last men menstrual cycle on average in this country it's about 51 people have not heard of per menopause they've never heard of hormone replacement therapy and they don't know what to do about it and they're ashamed to talk about it because somehow needing things in this country if you're a woman have gone unnoticed for instance like oh I'm just going to suffer through my mom never talked about it so I think the myth that you have to suffer is a myth there is more known now than there's ever been about how using lifestyle to feel better I always encourage women to make their hormone replacement decision based on science and not fear and to make it early how I I encourage my patients even in the mid 40s to read the books watch the podcasts identify a clinician so when it's time for them to make their decision they've got everything um lined up and you can take hormones while you're still menstruating and there's no reason not to in fact that's what birth control is birth control is is 10 times the dose of hormone replacement therapy so under careful supervision you can make your decision very early what I want people to do uh is educate themselves I call it menopause literacy because we have a very low level of menopause literacy in this country I want them to make their hormone replacement decision meaning am I going to go on them where am I going to get them can I find a clinician to help me number three I would like them to as we talk talked about earlier build their unbreakable lifestyle develop the habits early not when they're in the throws of menopause and feeling desperate but early of lifting weights of cardio that includes base training and Sprint intervals anti-inflammatory nutrition early so that it's just the way you live so that when you're feeling so bad you're not trying to learn all these things at once and there is a significant link between menopause and bone density because you lose some of those critical hormones like testosterone like estrogen and testosterone so estrogen on Bones acts to control the cell that breaks down bones we talked about in bone health there's a cell that breaks down Bones called the osteoclast with a c and a cell that builds bones with called an osteoblast estrogen helps control the osteoclast so even in menopause when there is no estrogen we're still building bone but breaking down bone out strips building bone so replacing hormones helps rebalance bone breakdown and Bone rebuilding and if we lose our estrogen around the time of this per menopause menopause we can lose 15% of our bone density and if we don't catch it because insurance only pays for dexas scans when we're 6 5 Which is far too late in my opinion we're behind the eightball so I encourage everyone once they start going through par menopause to get a dexa scan whether they have to pay for it at their gym save up their coffee money it's worth knowing your bone status what are some of the most um obvious but pertinent muscular skeletal syndromes of menopause I'm glad you asked that in July my group and I created a nomenclature called the muscular skeletal syndrome of menopause because women were showing up in my office saying things without prompting because I I'm a doctor who listens I sit down on a stool we have a conversation I do not chart in front of you so people talk to me and out of nowhere women would say to me Doc I feel like I'm falling apart and I don't know what's going on but I feel like I'm going crazy because I've been told nothing's wrong with me and I started noticing that more and more as women started coming in with their shoulders not moving which is an entity called frozen shoulder and so as I started looking at this pattern and reading the very few studies that were done we've known for 30 years that the incidence of arthritis inflammatory arthritis in women after 50 is much higher than inflammatory arthritis in men we've known it for 30 years and as I started researching remember how I said earlier that every muscular skeletal tissue is derived out of the same type of stem cell the mesenchimal stem cell all of those tissues muscle bone tendon ligament fat muscle Drive stem cells are all sensitive to estrogen and without it several things happen there's something called arthralgia which is total body pain meaning your body hurts so much that you can't even get out of bed that was one of the biggest things I had I'm an athlete and I could barely get out of bed because I was so inflamed due to the lack of estrogen estrogen is a huge anti-inflammatory agent so I was totally inflamed my body hurt that's called arthralgia women come in and I'm not kidding they come in they say my arm won't move literally it won't move or I can't hook my bra that is due to the inflammation of losing estrogen in Asian cultures it's called the 50-year-old woman's shoulder because it happens to 50-year old women it is a sign of the inflammation of losing estrogen we know about sarcopenia the loss of lean muscle mass about 20% when you lose your estrogen we've talked about loss of bone density we have increased incidence of tendon and ligament problems Achilles tendon tennis elbow patellar tendon because the collagen fibers of Tenon and ligament have estrogen receptors on them and so everything starts to work less well without the presence of estrogen so I saw all of those things and we gathered the world's data which isn't a lot a lot more research needs to be done and we gave it a nomenclature we called it and published it as the muscul skeletal syndrome of menac cause because I tell you for sure Stephen if someone goes into their doctor's office which in this country is so restricted in the time that we can spend and says I have this and this and this and this and this six things in 15 minutes it is difficult to get through that but if someone comes with a nomenclature of I think I have the musculoskeletal syndrome of menopause my arm doesn't move blah blah blah immediately you don't have to go through a differential diagnosis of 600 things you're like oh as a doctor this paper on the musculoskeletal syndrome of menopause has currently been downloaded almost 300,000 times and to put that in context some of the biggest journals in the world medical journals in the world documented they did a a survey of how many times their best articles had been downloaded the best scientific journals their articles are downloaded about 10,000 times this muscular scal syndrome of menopause has been downloaded nearly 300,000 and it's not because yes it's a good paper the need is so great Stephen to communicate what the heck is going on with people that I made it open access meaning you don't have to pay to get this article and I encourage people to Google it it'll come up number one to print it to read it to give it to your doctors so that they can understand that you're highly inflamed that's why your total body hurts that your shoulder doesn't move because you're inflamed that your knee hurts because you have the arthritis of menopause and just to build the understanding of what is actually going on with people fascinating I didn't mean 300,000 downloads I know it's amazing it's like a New York Times bestseller bestseller research paper 30,000 p over or something crazy crazy yeah congratulations well you know what research is a team effort and and we all work together but thank you it's needed used a word there arthritis which we've not talked about yet but but used it to describe your big toe as well yes I did what is causing arthritis I don't want to get arthritis oh who does there are there are two kinds of arthritis there's an autoimmune meaning your body is identifying yourself as not yourself and that's called rheumatoid arthritis that is very different than the way I used it today which is osteoarthritis which is wear and tear arthritis okay so wear and te arthritis can happen through thousands and thousands of repetition uh on a joint uh we were talking earlier about running it's a thousand steps a mile it can happen due to trauma I have a lot of I used to take care of the University of Pittsburgh football team and I had a lot of 20-year-olds with knee arthritis because the impact was so great as linemen hit each other that they would wear out their cartilage so wear in ter arthritis osteoarthritis is loss of the cartilage layer on the end of bone it causes aching pain it causes swelling it causes stiffness uh and then to the degree that you have it we can treat you conservatively through a variety of ways or at the end of the road we can replace your joints I want to just circle back on we were talking there about the collection of symptoms that are associated with menopause and you were talking about how arthritis is a is a factor are you telling me that to avoid the muscular skeletal symptoms of menopause I should be taking hormone replacement therapy here's what I'm telling you I'm telling you that every musculoskeletal tissue has Alpha and beta estrogen receptors we know that when those sit empty you will manifest some of the muscular skeletal syndrome of menopause 80% of us do what I'm telling you is that estrogen sitting in those receptors can prevent bone loss can prevent muscle loss can decrease the inflammation of arthralgia and frozen shoulder so everyone gets to make their own decision people are thinking beings they have agency they get to make that decision to get out of pain and to prevent the musculoskeletal syndrome of menopause based on science and not fear one of the um one of the things I'm a little bit concerned about these days is back pain yeah lower back pain in particular um I read that lower back pain is the single leading cause of disability globally significantly affecting individual's quality of life and productivity which was published on the World Health Organization yeah article in 2020 lower back pain affected 69 million people globally and its prevalence is increasing due to a number of different factors one being aging but also I just think generally how we're living more sedentary lives and sitting on these chairs and stuff like that mhm back pain yeah common thing only seems to exist in the Western World I had someone come here from the who studied the hadza tribe in Africa and they don't have back pain there yeah how do they live not like this right they squat yes they don't have chairs yes well back pain is endemic in our population due to our lifestyle we're sitting here for several hours I'm probably sitting like this all hunched over at some points our our cores are relaxed we're not our our front cores are relaxed relaxed our our lower back is relaxed there's no stimulus to keep our core strong sitting in a chair and we do this 10 hours a day at least right that's number one number two then 70% of people do no meaningful exercise any time of the week so we never rebuild it so we get low back pain due to muscle weakness and another reason we get low back pain particularly in women or very elderly men is compression of our vertebrae compression fractures of our spine that can be very painful it presents as low back pain I want to differentiate for people listening the difference between low back pain and and nerve impingement that needs surgery low back pain is that aching in your low back the stiffness when you go to a doctor with low back pain there should be telling you how to get stronger sending you for physical therapy to stop smoking if you're smoking CU that poisons bones right all the lifestyle things if you have pain starting in your back but shooting down your leg like electricity down the back of your leg like literally think about how lightning would feel that is because a nerve is being impinged as it comes out of your spinal cord that is something that needs to be examined and looked at but I just want to differentiate that because a lot of people um mistake the tube to and a lot I think it was 80% of westerners will experience lower back pain and it got me thinking about standing desks and things like that do you advise people to use standing desks I do and walking treadmills um because there's so much work that we do during the days that isn't deep work we're emptying out our email we're returning some phone calls we're doing the less heavy brain heavy parts of our job all can be done standing or I've encouraged uh groups of people that I work with to hold their meetings doing wall squats just don't sit at the board table pull up a wall everybody's squat better be a pretty quick meeting because that that takes a lot of strength but to build in that kind of Mobility the only time we really need to sit is when we're solving World Peace yeah the rest of it we can stand and in fact Studies have shown that if we're trying to learn something it's better to be moving as we learn because the kinetic energy of learning is better for our brain for instance I used an example uh yesterday actually when I I was teaching people how to time manage and I said when I'm listening to long form podcasts like this I can't sit for three hours but I can walk and listen and I retain more for instance so that that been proven that if we're in exercise we retain more in terms of studying oh okay you've done a lot of studies they're so fascinating H have you got a favorite the very first one we did on Master's athletes answering the question at what age do we really slow down because if you believe Hallmark and all the uh rest in peace balloons that go around on your 40th or 50 birthday slowing down is an inevitable part of aging but the fact of the matter is and our study showed that when I looked at track and field ath in every race from 100 m to 10,000 M and I looked at the top eight finishes in every age group in every race that we do not significantly slow down until we're past 70 so between 50 and 70 the guy who won the one mile race finished it in four minutes and 34 seconds the same year of the study the kid that won the high school mile race did it in four minutes and 17 seconds the 70 70-year-old who won the one mile race did it in a little less than 7 minutes it just shows you that if we're slowing down dramatically before our 70s we've either decided not to train so hard we're just not trying anymore we've been terribly injured right and we can't but it's not because of biology because of psychology exactly no light bulb goes off we think though we think that when we experience that first twinge that first pain we start to get a little bit tied we think it's natural so we kind of relent to it we just give in and then that's that slow spiral downwards into a lifestyle which becomes self-fulfilling I guess we stop trying hard we stop playing hard because we stop trying hard because we think it's inevitable we think no aging is inevitable how we age is is up to us you're working on a book aren't you you've just handed in the manuscript for we're very very excited about this book unbreakable unbreakable go strong live long age with power and it really picks up the conversation of aging and Longevity that I've been talking about for a long time but really focuses on the longevity of women so the book is framed around the pillars of Aging which I call time bombs the time bomb of metabolic dysfunction uh the time bomb that we think means our DNA as our destiny which it is not we can modify ourselves and several others and really explain the science of what's going on and that aging is not an inevitable decline from Vitality to Frailty unless we cop to that attitude right and then the second part of the book lays out a lifestyle that I call unbreakable it's about muscle it's a bone it's about nutrition but the most a very important part is what you just said it's about attitude and mindset and so I help people set standards and goals for for what they want based on their values if I didn't Value Independence if I didn't value having my brain till the very end and all the other things that I value then my goals would be uninformed I could say oh I want to run a marathon at 80 but that's not enough unless it's connected to my values and then further along we talk about building resilience because brain resilience can be built in the same way that skeletal resilience can and I believe it takes both both of those things to progress and to age with power and then the final sections of this book really take us to the next level how do we now that we've optimized our health and decided that we are not the victims of time I don't believe that I believe we can shape our future how what do we do for Peak Performance how do we continue to squeeze performance out and what are the cool techniqu technologies that can help us I'm very very excited yay can we pre-order it yet uh not yet but you can get on my wait list on my website okay I'll link that below for anyone that's Keen to get that book I I'll be on that list as well I'll give you one is there anything else that we should have talked about that we haven't Dr vunda last week I was uh speaking at the American Diabetes Association and talking about midlife and menopause which you and I have talked about and all the metabolic changes that go on when estrogen walks out the door and we've already talked today about pre-diabetes and how we need to put on a big alarm because of all the metabolic changes that will lead to diabetes and Alzheimer's but when I look at those two things separately per menopause and all the metabolic changes and the lipid changes and the fat distribution and the insulin insensitivity and pre-diabetes they are nearly identical and what we know is that this is another alarm to sound if we have not paid attention in the critical decade of our lives and become pre-diabetic and then are a woman and lose our estrogen it compounds the normal metabolic changes that happen with insulin resistance to the loss of estrogen and after menopause women have more diabetes and therefore more Alzheimer's and so if I can back all this up and start people thinking about it when we're 35 that is work worth doing that's exactly what you're doing it's exactly what you're doing I think you know the reason I'm so compelled by menopause as well a secondary reason is because I have so many wonderful women in my life incl including my partner who yeah might not be as fortunate to be exposed to all the information that I get exposed to by doing this so many of the questions I'm asking you almost pre- preparing me to be a supporting act in her in her life she's what 32 now so you know critical critical years you know what Stephen if I could get more men to take the attitude that you've just expressed to have the Curiosity it to learn about the changes in midlife women and not only bodily changes but but attitudinal and the sexuality changes I think we could save a lot of marriages but I find that there is for the lack of knowledge there is amongst the women there is even less knowledge among the men but if it's a partnership so I think your attitude and curiosity is is laudable because I think we could save a lot of relationships if everyone felt that way yeah cuz if for me it has created a ton of empathy MH and with empathy you approach challenges differently with a different perspective yeah and there's less blame and there's more yeah I think supporting um encouragement so that's really why I think it's important as well for men to understand these things because when you start noticing differences maybe in someone in way she she's feeling or your mother or yeah grandmother or even your daughters you might not be some of those you know naive doctors who think someone's losing their mind or that they're just being different or it's their personality and you might understand that there's something deeper going on um and also something that's at least in part you can do something about absolutely which I think is the most important conclusive point we have a closing tradition on this podcast where the last guest leaves a question for the next guest with not knowing who they're leaving it for and the question left for you is how do you know when is enough I think how you know when it's enough when it becomes if it pertains to work or striving for something or is when you don't love it anymore when it becomes a grind and you don't love it that's when it's enough because it's not feeding you amen Dr Vite thank you so much for the work that you do um you're such a star and I think everybody should go follow you on Instagram because you built an incredible community over on Instagram where you give away so much of this knowledge absolutely free of charge but I also think everybody should go to your website thank you they should buy this book I know this book is um maybe they should just get on the wait list for the upcoming book as well unbreakable unbreakable um and they can get on that weight list on your website right now yes they can join your Instagram Community which I think is phenomenal it's so wonderful to see yeah um how because you know usually people have a following but I really feel like you have a community yes I see it in the comment sections I see that people are really really engaged and there as you saw from the amount of people that downloaded that paper that you published there's a real thirst and hunger for this information and I get so many messages when from the last conversation we had yeah but from these conversations generally about from women from their husbands who are so thankful for you oh like so thankful it's you know because I have lots of conversations about lots of things but this particular conversation provokes a certain type of energy that is very atypical oh you know what I mean you understand it because you feel it every day but I really feel it as well so thank you for doing the work that you do and for turning the lights on for so many people that are living in the darkness as it relates to information and that information is no doubt undoubtedly saving many millions of people's lives I hope so and that's work worth we're doing so thank you so much Dr vond thank you this has always blown my mind a little bit 53% of you that listen to the show regularly haven't yet subscribed to the show so could I ask you for a favor if you like the show and you like what we do here and you want to support us the free simple way that you can do just that is by hitting the Subscribe button and my commitment to you is if you do that then I'll do everything in my power me and my team to make sure that this show is better for you every single week we'll listen to your feedback we'll find the guests that you want me to speak to and we'll continue to do what we do thank you so much some of the most successful fascinating and insightful people in the world have sat across from me at this table and at the end of every conversation I asked them to leave a question behind in the famous Diary of a CEO and it's a question designed to spark the kind of ation that matter most the kind of conversations that can change your life we then take those questions and we put them on these cards on every single card you can see the person who left the question the question they asked and on the other side if you scan that barcode you can see who answered it next something I know a lot of you have wanted to know and the only way to find out is by getting yourself some conversation cards which you can play at home with friends and family at work with colleagues and also with total strangers on holiday I'll put link to the conversation cards in the description below and you can get yours at the diary.com [Music]