Transcript of Episode 525: Dr. Vonda Wright: Fitness Over 40 and the Strength Habits That Prevent Physical Decline

Hi, guys. It's Tony Robbins. You're listening to Habits and Hustle. Crush. It.

Is joint pain, muscle loss, and slowing down really just part of getting older? I should hope not. In this Habits and Hustle episode, I'm joined by orthopedic sports surgeon Dr. Vonda Wright to get real about what actually drives physical decline and why the body's critical Decade sits between mid-30s and mid-40s. We also get into why running doesn't destroy your knees, why real performance decline happens much later than we've been led to believe, and why muscle is about survival and capability, not esthetics or vanity. If you care about staying strong, independent, and physically capable as you get older, this episode will challenge how you think about training and what actually matters. So sit tight and stay tuned. All right, you guys, I have a very special guest. I always say we have a very special guest, but this time, I'm always like, this time. No, but I'm really excited about you. We have Dr. Vonda Wright on the podcast today. Her new book is called Unbreakable. Newish, Newish. A Woman's Guide to Aging with Power. But it's actually not just a women's guide. To be honest. It should actually be called A Guide to Aging with Power.

But we'll get into that. We've been trying to have Dr. Vonda on for a while, but the schedules were not really coinciding. But we are so happy to have you. So thank you for being on Habits and Hustle.

Thanks for having me.

Oh, gosh, it's a real pleasure. And what we were saying before we even started, which I find to be. It's actually kind of. It's kind of sad that I'm so impressed by this. But you are a practicing doctor.

Yes.

So many people sit in the chair that you're in right now, and they don't practice. They've stopped practicing many years ago, and they kind of just do the media stuff. And when I. When I actually meet somebody who does the job that they are talking about day to day, it's a. It's a breath of fresh air.

You're like, whoa.

Yeah, it really is, actually. So, I mean, can we just. Can you kind of just kind of go back to who you are, what your, you know, kind of just your. A little bit of your journey and what kind of brings you here today?

So you're right. I am a practicing orthopedic sports surgeon. And so my entire career, I've gotten to take care of athletes and active people of all ages and skill levels. And while doing that. And so the surgery I do every Wednesday. I did it last Wednesday, I'll do it next Wednesday.

Just one surgery or you.

No, no, no.

Multiple Wednesday.

A full day.

Yeah. Okay.

And so is largely arthroscopy. So, you know, big surgeries through teeny, tiny apertures. In fact, listen to this. When I do knee surgery now, most of my knee surgery is done through needles. We don't even cut people anymore.

Wow.

The cameras we use, the high definition cameras are on wires. And so it just takes going in through a needle. So what it does for people like you hurt your knee, and it's clicking and painful and we go, we take out the little part that's hurting you, you will be walking out of the hospital. You could have been awake during the surgery if you wanted the most. People want to be a little sedated, but you will need no narcotics, and your knee isn't swollen up from all of the fluid that we use to do regular arthroscopy. So this kind of high tech needle scoping that I do is so good for people and so that. See how excited I get about surgery that I've been doing 25 years.

25 years.

Yeah. I've been a. I've been a surgeon 25 years. It's. And then what's interesting. So, you know, sports surgery is what I do, but my research, and thus writing a book like this has always been about musculoskeletal aging. From the laboratory where we were looking at muscle stem cells and how to make them rejuvenate to what's the best treatment to keep you in your own joints and not have to send you off for a metal joint. So that's always been my research focus. But about 13, 14 years ago, I really added this third bubble to this Venn diagram of me of taking care of the whole woman. Now, it doesn't mean I don't take care of men. I still take care of men and women athletes. But really focusing on how women age and what makes us different because men and women are different down to a cellular level, you know, do you remember that book, Men are from Mars, Women are from Venus? Yeah. About how we respond to things to a cellular level. That's true.

See, that's interesting. You know, Stacy Sims, I'm sure you know who she is. She has this tagline that got super famous and viral. Like, you know, women are not little men are not small men. Which is interesting because we've been kind of been treated like small men our whole, you Know how we get treated with even, like the kind of exercise and workouts we do, what we eat and how. Even I got all these questions, but the cold plunge and all the things. And I'd love to get your perspective. What I find so interesting about you, though, when I really did a deep dive was, yes, you do all this orthopedics, like you're a surgeon, but you used to be a cancer doctor.

I was a cancer nurse.

A cancer nurse. That's what I meant, a cancer nurse. And then you went back to medical school at a late age.

Isn't that interesting?

Yes.

Yeah.

And I find that. I found that to be really interesting. So what made you like, can you talk? I'm just. I'm just really curious.

Let's go back is what you're asking.

How did you go from being a cancer nurse and then kind of pivot into being a surgeon? Yeah. And by the way, that's like 12 years extra of school, isn't it?

Oh, my God, it sure is.

Yeah.

Thank you for noticing. It was a long time.

Yeah.

But you know what I think? Would I do it again if I could do what I do now? Sure, I'd do it again because I'm very happy doing what I do now. So I got out of college and with one of those really useful degrees like biology, and thank God there was a nursing shortage. So there's a. There's a university in Chicago where I'm from called. It's called Rush University now. It was called Rush Presbyterian St. Luke's whereas if you had a legitimate college degree in three years, you could study really hard and get a bachelor's degree in nursing and a master's degree in three years. So I was very young. I was 23 years old. I had the energy to go to school all day, sleep in the library and, you know, go work on a floor at night. So in three years, I got a bachelor's degree in nursing and then became a cancer nurse. And so then my job, and I love that you're asking me to tell this story because you cannot be a 23 year old young woman treating women in the struggle of their lives. At that time, cancer care was all done in the hospital, not very much outpatient like it is now.

So every month for six months, a woman would come in and get her chemotherapy. She would be in the hospital for a week. And it was a model of care at that time called primary nursing. Meaning if I was your nurse for the first month you were there, I was your nurse every month. You were there. And so you can envision how over a six month process where I am your primary caregiver and you are in the struggle of your life, the influence that kind of relationship would have on a young woman.

Oh, absolutely.

And so, you know, I saw many women leave the hospital victorious and live full lives. And I saw many women never leave the hospital because it was just not to be for them. But it taught me so much about the worth of a woman and how strong she is and the fact that you're just trying to be normal. So all night long we're shopping on QVC together. As I'm hanging her kibo, she's clicking the. She's doing whatever she would normally do. Right.

Wow.

But you know what it did? It means that in my current house, I may or may not have replaced the other lady's curtains because sometimes things don't matter to me.

Right. No, exactly.

Because I've seen women dying in my hands and I just think sometimes there's something more important to think about.

Right, so you're more like. So you've always. Well, obviously you're very compassionate and empathetic. I mean, people don't. Can't do that job, especially at that age.

Yeah.

And even when you speak in general, you can tell you actually genuinely care.

Sometimes I cry. Don't make me cry.

Okay. I'll try not to. Okay. But I mean, I mean, that's not. That's. But that's what I'm saying. Like, you obviously have a big heart. You can't do a job like that and not care. And not care.

Yeah.

So what made you stop doing that?

Right, Good question.

Go into the rest of the stuff.

Like, so I was really young, but I was. I learned really quickly. And so after about three years on the floor, I was promoted to help run the Rush Cancer Institute. And about four years into that, I realized that I learned what I was going to learn. And I was only 26 years old or something, so I started thinking, what am I going to do the rest of my life? And I could go into peer research and spend my life in a laboratory, but I can't do that because I need to take care of people. Or I could have gone into business. Business was hiring nurses all the time. But I can't do that because I need to take care of people. And so medical school allowed me to do good research and take care of people. And so I went back, took the classes I needed, and then thankfully got into the University of Chicago, which is a really great Medical school.

So you went. You went, by the way, that's what you're. You're kind of like always. It's one of the best.

Yeah, it's one of the best. Yeah.

If not. If not the best.

I don't know if it's the best, but it's. At the time it was in the top 10 medical school.

What's better? I mean, by the way, people think, always a Harvard. That's like. Right.

It's a really good school.

I think it's ranked number one, isn't it?

I don't know. I don't want to misspeak, but it certainly is a really good medical school. And I feel so thankful and fortunate to have been to go there because, you know, I'm used to being a smart gal, but I go to University of Chicago and all these kids are so freaking smart.

Yeah.

Amazing. So I just soaked it all in and. But it becomes very apparent in medical school who's going to become a surgeon and who's going to become a medical doctor, because we think differently.

Really?

Yes. Medical doctors in general, this is such a gross generalization. But in general, people go into medicine fields, absorb data differently, they process it differently, they make decisions over a longer period of time. Surgeons, we assimilate data quickly. We make decisions quickly, we activate the decisions quickly because we've got to go to the or so, right?

You're decisive.

We're decisive. We just process data differently. But thank God for the medical doctors, right? Thank God that they're the assimilators. We're the dis. We make quick decisions. And I'm. That I assimilate data, I make a decision, and then I'm thankfully very good with my hands, so it all fit together for me.

So then. Okay, so then, because your book, I was kind of saying at the beginning, it could be for anybody because it was a lot of the things that you talk about. But do you specialize in women then? Like, do you operate only on women? You operate in everybody. So what made you kind of write a book that was kind of more towards women, focus on women, and even, like, get into this path of, like, writing books and doing speaking and like, if you were a. You were obviously a very successful surgeon, what kind of made you then kind of go this direction?

So with my research on musculoskeletal aging, when I got out of my fellowship in the early 2000s, I realized.

But was there.

Hold on.

Was there a pivotal moment where you're like, you know what? I really need to, like, do deep dive on this muscular aging situation. Like, did something happen to you or someone that you know or.

I think it happened because I realized that there was nobody studying it.

Oh, okay.

That I saw in my own life that my dad, who's 86 now, I cannot remember a day in my life where he was not out running. He's an endurance athlete, right? And as he aged, I just was at races with him. And in the. I tell this story that when I was a child, it was safe enough in Kansas, where we had a farm. He could just take me to a 5k, leave me by the flagpole and go off, run the race and come back. And then there was this lady in my town who was so frigging old, we would all wait for her to come in from this race and anticipate her coming, and then we would cheer her on, only to find out as an adult that her name is Millie. Millie was 60 years old, which is so not old these days.

Wow.

But when I was a child in the 70s, we could not fathom old people being athletic, Right?

That's true.

And so as then I saw my dad aging, and I realized nobody was answering these questions. I thought, I have got. So there was this myth in society that aging is this inevitable decline from vitality to frailty, and there's nothing you can do about it. But in the back of my mind, I knew about Millie and I saw my dad, and I'm like, that can't be true. And so if I did research that took this variable of sedentary living, which is the real killer, if I took that variable away, what were we capable of? And so my research group and I. My research group at University of Pittsburgh was called Prima, the performance and research initiative for master's athletes. So 40 and over people, we found over a series of 15 years of research that you can retain your muscle mass. And there's a very famous picture on the Internet. People pop it up all the time. The three that look like steaks. But that's my research. Nobody even cites me anymore.

Can you talk about that? Because I think some people probably don't know I saw it, but.

So we answered that. I'll talk about it. We answered that research. Can you retain your muscle mass? Yes. Can you retain your bone? Yes. Can you. At what age do we really slow down? I looked at race times, and it's mid-70s. It's not 50, it's mid-70s. Hold on.

What?

Isn't that fascinating?

What age do we really slow down? And the answer is in the set, in your 70s.

Yes, I can explain that study too. Because people think at 50, when Hallmark sends out the rest in peace cards, that life is over. The reality is that for people who are chronically active, our study found that there is less than 2% decline in. I studied runners from 10,000, from 100 meters to 10,000 meters and I looked at their racing times and these are all competing athletes in the national Senior games. You have to be 50 and over to compete in these games and you have to have won your state games to be at the national level. So what I found was between 50 and mid-70s, you declined in your time, less than 2% a year. So that means that the guy who won the mile race in my study, one of them just a random 50 year old, won it in 5 minutes and 34 seconds. The 70 year old who won his mile race won it in seven minutes. So he's not winning it in 15 minutes, he's winning it in seven minutes, which is fast even for a 40 year old person. Right. So this inevitability of slowing down is what happens when you're either injured and your cartilage gets ripped off your bones as a young athlete or you're just too friggin sedentary.

Right. So that is the kind of work we were doing, just showing that this, the, the inevitability of decline is more dependent on your lifestyle than on true biology.

So basically the whole saying like a body in motion stays in motion.

That's correct.

Is totally accurate.

The physics of it is totally accurate. Right?

Yeah.

And so this study that, the muscle study that you see popping up on the Internet all the time, it's three pictures of muscle. There's a picture of a 40 year old thigh, a 75 year old thigh and a 70 year old thigh. And the 40 and the 70 has gorgeous muscle architecture. Frankly, if you want to put a common word to it, I always call it a flank steak. Really lean, not fatty, infiltrated, very thin, peripheral fat. So you have a 40 year old triathlete, a 70 year old triathlete, who looks almost the same as the 40. But my control group in this study were such sedentary people sitting around. The picture I show in the middle has muscle architecture that is so marbled it looks like wagyu beef. Like that is not healthy muscle. We eat that, but that is not healthy. There are thick rinds of fat under the skin, between the skin and the muscle and the bone. When you look at the bone in the middle, it has very thin Cortex or the outer ring. So Sitting around for 35 years takes you from lean to, I call it rump roast.

But the medical term for it is osteo, meaning poor bone quality, sarco, meaning bad muscle quality. Besity, osteosarcobesity, too much fat, not enough muscle, not enough bone. And that is the state of people in this country. This metabolic disaster we have going on has more to do with sedentary living than almost anything.

I think that's crazy. So the 70 year old who was active and the 40 year old that was active almost look exactly the same.

Almost identical. They're not, but they're almost identical.

So what would you say, percentage wise, would they look different?

The infiltration of fat on the 70 year old is statistically different. But looking at the two slices with the naked eye, you can't perceive a difference.

So what is the difference? It's not as firm, not as lean. Like, what would be the difference?

Not quite as lean. The 70 year old is not quite as lean. When I tested the actual people, they're not quite as strong.

Why?

Well, there is a loss over time of type 2 muscle fibers, the fast twitch muscles. So we lose power. Right. Even with the maintenance of good muscle mass, we don't generate as much power as we once did. But that is not an excuse to just let it go.

No. And also what you're saying is it's not that much of a loss that people think. So people think you're going to be this like frail or flabby person. Maybe you're 10% less so.

You know what, there are other studies not done by me show that lifting weights infers a 20. Seriously, lifting infers a 20 year advantage such that an 80 year old who lifts weights is as strong as a 60 year old who doesn't, and that can make the difference between falling down and dying or remaining capable.

Well, I was going to ask you because we're talking about these endurance athletes and there's a lot of, I mean, you tell me if this is a myth or not, but there's a lot of chatter about the fact that when you're a runner, you're breaking, you're basically, you're breaking your lean, you're, you're breaking down lean muscle mass. Yeah, you're, you're being really difficult, you're being hard on your joints, your mobility. That's what causes flabbiness, all the things.

Yeah.

What would you say to people who then say cardio is bad or endurance training is bad? If since you see this all the time.

Yeah. Well, number one, I think it's important to realize for people to hear from me and other people saying it, that there is no evidence that running itself causes arthritis. The actual act of running does not cause arthritis. What causes arthritis or joint breakdown is traumatic injury. I used to be the head football doctor for the University of Pittsburgh and I had 20 year old lineman whose knees were just crushed. They looked like 70 year old people because they had twisted. You get a 300 pound guy against a 300 pound guy and their cartilage can't withstand it. Right. So trauma or being chronically heavy will wear out cartilage. Right. Our joints bear seven to ten times body weight. So if we're bearing an extra hundred pounds of body weight, that's an extra thousand pounds of pressure across a cartilage layer. Cartilage is the slicker than ice coating of the end of the bone. It literally is slicker than ice until it starts to be ruined by excessive weight or trauma. So running itself only produces 2.5 times body weight on average and it itself doesn't cause arthritis. But why do runners break down so often?

I do say publicly and runners hate me for this, but it's okay. I've passed through the stage where I only did marathons and was that kind of person. Runners break down and I see them in my clinic every three weeks or so. Runners who only want run are the weakest athletes that I have because running does not generally activate the glutes. If you are only running and you're not feeding, you're going to break down the very muscle that you're trying to build. Now, I cannot explain why that genetically amazing people like some of the Kenyans who win all these races, or these genetics running specimens, that has to be genetics and the cytoplasm they're born with. But for average people, we need to feed our bodies to build the muscle that's going to keep us on the road. We need to. When runners come into me, for instance, with knee pain, anterior knee pain, their patellas are jiggling all over and I try to stand them on one leg because I examine the whole person. I find that many times their glutes are so weak that standing on one leg, their pelvises are tilting and their knees are falling into this position called valgus.

I laugh for a friend. Okay, go on.

Because remember a thief, thousand steps a mile. A runner is on one leg in a 30 degree squat. And if you can't do this at that one time in my office in an un. In a controlled situation because your glutes aren't firing and you're. You're just weak. Think what it's doing. The repetition of a thousand steps a mile.

Oh yeah. So basically it's just a repetition. So like what I was going to.

It's bad mechanics. It's repetition and it's weakness.

So would you recommend. So I would think that you would say. And you tell me cross training is the best form of exercise.

Amazing. So in the original books that I wrote so long ago, it was all about runners must cross train. Here's how you do it. Runners must dynamically warm up. At the time when I started writing, runners just went out the door and didn't warm anything up. Now they've gotten smarter and people have designed entire dynamic warmups for runners and lifting programs. Because the idea is to get to stay on the road and not have to come into my office every three weeks with knees that are. The patellas aren't tracking well or you've. Or your. Your IT band on the side of your leg is so painful because your glutes are not support or sciatica.

I have sciatica right now. Sciatica is terrible.

It's terrible, right?

Is it just from overwork is overuse. Isn't that just from overuse?

Tight hamstrings, weak core. Although I can't imagine you have a weak core.

But I. Listen, I mean this is the thing, right? Like, I think running is my prior priority. Everything else I'll do is like secondary because the running is like. For me, I call it brain training.

It's for your brain.

It's my brain. Because nothing will like click. Yeah. My dopamine that way. And get my brain activated the same way. So it's really hard for me. That's why I think running is my number my. The number one exercise on long slow runs.

Your thing or sprinting.

So what I'll do is I will not run outside because now because of injury, I'm so scared because it's something that's so important to me that I'll only run on a treadmill. Even though. Even though it's boring as anything, but it still activates my brain. So it's good enough for me. But I will weight train and I will do all the other things.

You'll do the other things?

I'll do the weight train. I'll do all the stuff I can't stand because just to quasi balance it. But not to the same level. Like people are always like, what do you do. What do you do? Like, I'll do all the. I'll cycle, I'll bike.

Yeah.

But if I don't run, I also think the running is the gateway drug for me for everything else. If I even run, like 20 minutes a day, I have so much more energy and so much more productive that I can work out, do the other thing. I can work out for 10 hours afterwards. Yeah. If I didn't do that one thing, that one, like, session of running, I would be much more lethargic. Is that normal? Have you heard this before?

Well, I've experienced it my best. My best brain work happens on a run with no music. Really solve world peace. Yeah.

Interesting. So, like, I understand that, actually, because you're thinking of all the things.

Right. I wish I had a piece of paper.

No, I do watch what I do have my. Because my best ideas come from, like, when I'm like, running.

Because you got so much blood flow through your brain, you're like, oh, my God, it's there. That's what I was trying to figure out.

So I read this thing, or I saw you talk about this. Was it on a TED talk? Multiple talks, where you're saying the keys to, like, longevity in general. And I totally. I was like, this is why I loved you. This is the. One of the things I saw, like, she's my lady. You said jump. Jump training.

Jumping, please.

Yes, it was jumping heavy weights.

Yes.

Super important. People are scared of it. And base training, right? Is that what you said?

Low heart rate, base training with intermittent sprint intervals.

Okay, so if someone only had 20 minutes a day, three days a week, that's it. That's it. What would you tell them to do?

Lift heavy. To steal from Stacy Sims.

Yeah, lift heavy. 20 minutes, three times 20 minutes.

Because no.

No flexibility, no cardio, no nothing. Mobility, I should say. Well, you can also say, no, that's not enough.

You can say, 20 minutes is never going to be enough. But if that's all I've got, if you're saying that's it, because the rest of the time I'm chained to chair, I'm going to say, well, let's get you a different life, buddy.

100%. And by the way, before you even answer the question, what I don't get is people are on the phone all day. There's no excuse for them to be sitting at a table. No one's watching you. You could be walking.

I love that you said that because I challenge people from stages to send me pictures in their boardrooms. Doing wall squats or can you take all your calls walking, please?

Oh, by the way, I refuse to do zooms with staring at you. I only do them for like an introductory call. If I don't know the person, I don't. I. There's no need for me to stare at you for 45 minutes after that and waste. Like to me, you could be walking around.

I could be walking around, cleaning out my closets and talking anything.

Or I could be walking. I, I have this like all these non negotiables. Like, I won't get into a car if it's two miles or under, everywhere. Even in la, even I will not get in a car. I will walk everywhere. That's good, you're a New Yorker. Listen, anywhere, I wouldn't care if it's a meeting, if it's a dinner, if it's a cocktail party, if it's two miles or under, I am walking my ass to that place. Because, because to me that's like, you got to. I have these like, frameworks that I have to work within, but I find that's, that's the killer. Like, people are just, they're just sitting around all day.

Absolutely. I mean, think about. I had a, I had an assistant once when I was doing trauma at Pittsburgh, and she said to me, I mean, bless her heart, she said to me, vonda, I don't walk. And I believed her because she drove her car into the garage, there was a door of the parking garage into our office. We, she sat at the desk, we were there all day in the car back. I believed her.

Yeah, right.

So if we have 20 minutes a day and the rest of our day is like that, okay, then you're gonna lift weights.

Okay, let me, let me change. I'm gonna give you another scenario. If someone can say, okay, I have 20 minutes five days a week, okay.

Then you're gonna lift heavy twice and you're gonna lift with your legs. Sorry. Because the legs, the muscles below your belly button are the most important for not falling, for metabolic function. They're the biggest in your body. It's not that I'm ignoring your arms, but your arms are not going to kill you if you fall. They'll hurt if you break your shoulder, but they're not going to kill you. It's your spine, your hip, and, well, it's your femoral neck that's going to kill you. So two days a week you're going to lift heavy with your legs and then you're going to do sprint intervals the other Day, you're going to get your heart rate up really high. I would want you to walk during the day in base train, but if we've only got three days a week and we've only got that much.

Five days.

Oh, five. Oh. Oh.

We changed it.

Oh, good. So we're gonna lift heavy twice a week, and we're gonna. We're gonna walk three days a week and at least one day of the week, preferably two. At the end of the walk, you're gonna sprint because we need to get your heart rate up really high because they do two separate things. BASE training is just great for metabolic flexibility.

Explain what that is. I don't think people understand the word training. Yeah.

So it's the idea that you're working at a low enough heart rate that the mitochondria, the energy organelle, the part of your cells that is responsible for making energy, has the most flexibility to flip in and out of using fat. And then if you increase your work a little more, it's going to flip to carbs without producing a lot of lactic acid. And it just. It is the most metabolically flexible portion of. But it's not enough. Right. I do want you once or twice a week to air quote sprint, meaning it doesn't have to be on a track. It can be on an alpine machine, a rower with a kettlebell. We're going to get your heart rate up as high as you can bear. Mine goes up to 186. As high as I can bear for 30 seconds and then completely recover two, three, sometimes four minutes and do that four to six times because it's that really intense work that is amazing for mitochondrial replication, for. For the prolonged metabolic burn you get after a heavy workout like that, for your brain stimulation. So there's a lot of advantages to sprinting with a high heart rate.

So if that's all we've got, five days a week, we're going to lift heavy twice, we're going to walk the other days, and at least once of those other days, we're going to add sprinting to the end of it.

So you're saying then I'm surprised you said twice and not four times a week.

Sprinting four times?

No.

Oh, lifting.

Lifting heavy four times a week. And then.

And walking.

No, I would say walking. What I would say part of your day is when you're working is like, oh, is to.

I didn't know we could do that.

Yeah.

Okay, well, we're gonna.

If now you're gonna change everything.

Oh, we have A standing desk. We take all our phone calls. I mean, so don't. For instance, in my office, I see patients on Tuesdays and Thursdays. I have this long hallway and I've counted the steps at one point. I don't sit down all day on purpose.

On purpose.

The only time I'm sitting down is if you're my patient. I sit down and I have a conversation. But then I'm up and I'm walking all day and I'm pushing my little cart with my computer. Eight hours I'm walking up and down this hallway all day. On purpose.

On purpose.

I don't even sit to eat. It's very uncouth of me, but I just carry this food on a fork because I'm not sitting down.

I'm the same way. Okay, Would you say that incline walking is better than running then?

You know what? I don't know the actual data on that. But you know what's. I've tried this lately. And if I am, for instance, for my base training, I try to keep my heart rate about 1:30ish. I find, of course I find this, that if it takes me an incline of 4 and a half speed of 4 and a half ish to do that, that if I increase the incline to 13, I can walk much slower and I get it over quicker. But I feel my glutes firing. So I think it hits my body in a totally different way than if I'm just walking on a relatively flat surface.

Oh, God, no.

Yeah.

So would you say then to do the incline, walk the high incline or just confuse it and do it sometimes one way, sometimes another way?

I think the body likes confusion. As long as the heart rate's stays at the range. I actually don't carry how you get it there. You could be doing handstands, keeping it at 1:30.

You know what, I'd be curious with you because you're, you're an actual orthopedic surgeon. What is your take on weighted vests then?

Oh, let's talk about weighted vests.

Yes.

So let's, let's. I wear a weighted vest. I wear about a 20 pound weighted vest because what I have found is it increases my workload by about 10%. Meaning that again, back to the base training. If I, without weighted vest, at our incline of 4 or 5 and a speed of 4.5, if I'm wearing a weighted vest because of the increase in workload from carrying 20 extra pounds, I don't have to go as fast and I don't have to use quite so much incline, but my heart rate gets up. Right. I think that's the beauty of weighted vests, is to increase the workload you're doing to make you work harder, doing the same activity.

Right.

Does wearing a weighted vest create enough impact that you're going to build better bones? I have not been able to find any data that shows that weighted vest plus weightlifting is great for your bones, but weightlifting alone is great for your bones. Right. So that's the value I see of weighted vest. I think it adds workload to people. It's great for. It's great for anybody, but definitely great for people. I call adult onset exercisers, meaning just getting off the couch for the first time, afraid of getting hurt by increasing intensity. It's a really simple way to get in the intensity club without hurting yourself is to put a little load on.

Yeah.

I also think it's really interesting. I mean, it comes from the military rucking and heavy things come from military type environments. And so I also think it's good at that. I started wearing a 20 pound weighted vest not after it became so popular in the women's world, but because I do spartan races and we have to wear weighted vests going up and down. Let's clarify. I do spartan races in stadiums. I don't do the big open field ones. I. I do what are called spartan stadion races, which in Fenway Park. Or you do Buccaneers stadium. Yeah. Or. Yeah.

I hope Joe desena's listening.

I know he's my neighbor. He may. Yeah. Oh, really?

He'll be happy to hear this. He's always trying to get me to do all of that.

You should come with us.

I've only done one and he's an animal, that guy.

He is.

But I'm going to try that. You should. Stadium ones.

Yes. They're so much fun. Because I would never have the opportunity to get his in Lake Nona, Florida. We're very good friends. In fact, do you know what we do every summer?

What?

Oh, we're so addicted. Our poor children.

Oh, I know what he did with those. He wanted my children to go to camp.

I sent my daughter to death camp. It's the camp where you have to sign there is a chance your child will die. I'm like, oh, sure, yeah, okay. But you know what?

It.

It was fantastic. And so every summer I go for a week and I sit there with Courtney, his wife, and we watch the kids.

But really.

But he then starts talking to you and all of a sudden you've got £60 on your back, walking up the mountain. And he's like, he's like, vonda, you're, you're a responsible adult. Lead these kids up the mountain to old Jake's cabin or whatever it's called. And so somehow he connives us. But anyway, that's how I ended up in Spartan races.

I was gonna say when you said Spartan, I knew you had a Joe connection. I had a feeling because I live.

In the same town. We're not actual neighbors. We live in the same town. And he can't challenge you so many times without me going, okay, I'll do it just to get you to stop. But then I did it and it's a complete brain badassery thing. Like I didn't know how to climb up a 30 foot rope ladder and flip my leg over. And I didn't know, I didn't know how to get over an eight, eight foot wall. I didn't know how to lift 100 pound sandbag. But you figure it out.

You just said the magic word. You figure it out.

You figure it out.

So to me, what all this also does, it gives people a sense of self confidence that they are stronger and we're capable.

And that is something I want women, when they close this book to have hope that they don't have to have a miserable decrepit future. That by investing every day in the capacity we have. Because what I can't figure out is why in a gym, women, people pick up the 5 pound mamby pamby weight and do it 35 times until they fail.

Because there's a lot of people who think that that's like that repetition, like Pilates for example, right? That that's enough.

If your goal is endurance, okay, but that's not my goal at this age. My goal is strength and power. But we go to the gym and we underestimate what we're capable of. We go home and we pick up the 40 pound grocery sack or I have a 40 pound grandson for God's sake. And we're up on the, in the, in the playground, we forget how much, how capable we are in life.

Absolutely.

And we go to the gym.

And I think also women have this like scare, their fear of being bulky. That's still something. And so that's why Pilates is so popular. Because people think, oh, if I do Pilates, then I won't, I won't get bulky. What is your take on Pilates?

I think it's fascinating, right? I've done it a few times. I've Seen the videos of football teams, stronger than God, people not being able to do Pilates. I think it is great for flexibility, for the small core muscle strength. It's not great for big core posterior chain. But the Pilates culture is such that women, I don't know, I don't count how many times I lifted in my life. But it's Pilates culture to say I've done 3150 Pilates classes. Holy cow. Good for you. That's amazing. That's consistency right there. So my take is it's fine for flexibility, joint range of motion and some steadiness of your core. But if we are trying to be strong and powerful and not become frail and fall down and die from a fall in our kitchen, you have to put some work in, you have to put some lifting work into that, in my opinion.

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So let's start with the first question. At what age should we become serious about our health? And so I have this timeframe that I talk about all the time called the critical decade. And for me answering this question is 35 to 45. Because we know there was research that came out last year that there are two critical inflection points with aging, biologic aging, 44 and 60. So at about that time, around 40 is when women start noticeably losing their estrogen and start into the whole perimenopause time. Right. So I call 35 to 45 the critical decade to get your health standards together. Even if you've never done it before, that is the time, because you're still youthful enough that the big inflection points of aging haven't started.

Right.

For women, you still have a lot of your hormones. Even though at 35, OBs start to like to call us geriatric mothers, high risk, whatever, because of the aging of our ovaries. But we still have enough hormones to make profound differences in our physiologic reserve. Because what happens during perimenopause is hormones are so chaotic. And then definitely in menopause, when we're not producing estrogen anymore, it becomes harder. That being said, I have lots and lots and lots of examples of women in their 50s building a lot of muscle. I did that. You know, my story is, at 40, I was in the best shape of my life. I had my youngest child. I was training for triathlons at 40 when OBS called me geriatric mother. Thank you, geriatric mother. At 40. In fact, I went to the high risk OB doctors because I'm like, you know, I'm 40. I'm kind of old. They're like, you're the healthiest mother we had in today.

Wow. So you were 40 when you had your first child?

Yeah, my 18 year old. I'm the mother of a blended family of six children. I acquired five amazing young people in my marriage and then I had one.

So amazing.

Yeah, at 40. So I was rolling along, doing the career thing, best shape of my life. Had a baby. And then I hit perimenopause about 47, and I really thought I was going to die. And I did all the things. I gained the weight, I lost the muscle mass and.

But were you still. Were you still lifting weights?

I wasn't lifting weights between not lifting heavy. You're doing the math. I was running and biking and doing that kind of thing.

All the cardio stuff.

All the cardio. I hadn't lifted heavy since high school. And the only reason I lifted Olympic lifting in high school is because the football coach was giving the boys 200 pound club shirts and I wanted one. And he's like, well, if you come lift all summer and squat 200 pounds, I'll give you a shirt. So there I was, Olympic lifting all summer, and I got myself the stupid shirt, right? So I learned how to lift like that.

Wow.

But I hadn't Done it. I went right back to running. So at 47, when I was going through this and I decided I have got to get in front of this because at that time, it's more than a decade ago, no one was talking about this. So I learned to lift heavy and I took lessons. I think this is something I'm criticized about online all the time. Like you can expect people to go out and know how to lift. No, I don't expect it. I had to hire a strength and conditioning coach that trained me for a year so that I knew how to power lift, that I could hinge correctly, that I knew how to progressively overload and not hurt myself. And I think that's a great. We're coming up on the holidays. Let's buy somebody some strength conditioning.

That's a great investment in yourself.

Investment, right. Instead of another toaster, for God's sake.

You know what I find so interesting? You say this, right? It is the same people who will buy like 20 sweaters and you know, get their hair done once a week or do all these things that like really mean nothing in the grand scheme of things for your overall life. Your life. And by the way, your appearance. Because you could wear the nicest outfit and have the most beautiful blown out hair. But if you don't look fit, you, if you're not lean and if you're not lean and fit, doesn't matter what you could wear a burlap sack. You know, like when you're fit, you can wear anything. Your hair can look disheveled, you can look disheveled. It doesn't matter. Because the thing that I think is the hottest is someone who like looks fit and looks like they take care of themselves.

Well, and I kiddingly say, but not really kidding, that muscle is nature's Spanx.

That's. I love that.

I love me some Sarah Blakely, but I'm not going to wear Spanx. If I need to, then I need to get back in a gym.

By the way, I am so happy to hear you say this. Yeah. Because why are we relying on like a pair of Spanx to make us look good in an outfit?

Well, and it's not to say when I sit here I probably don't have cellulite, but that's genetic, you know, whatever.

Listen, I, I. Spanks aren't going to help that and maybe they will, but it's, it's cheating. And so, you know, I mean, I feel like I don't. And also like it is cheating. Like I feel like. Yeah, you know, What? Maybe that is an indication that you should start working out more.

So the response we're going to get.

Oh, I'm going to get.

So what's going to happen? 90% of people are going to be. Are going to leave comments like they're right. We just need to invest in our health every day. 10%, because this is what happens, are going to say, why are you shaming women? I am. You're not. I am not shaming women. I just believe so much in the capacity of women to change the trajectory of their lives that I refuse to accept frailty.

By the way, I also think things are like, things are non negotiables. Like my walking anything under two miles from. For me personally, I don't want to wear a girdle to look a certain way. No, I'm serious. And you can call whatever you want. You know what I mean? But I get it. Like, I'm not. This is not about saying that someone can't wear a girdle.

Can't wear a girdle.

I'm just saying I think that, you know, if we eliminate these, you know, easy, easy ways out and this is going to get me into the next talk topic I'm going to talk to you about, which is GLP1s and peptides. We're not even there yet, but that's all we're saying. Yeah. So if you love wearing these things, skims, just do it. Just do it. Yeah. I'm gonna get like, bashed. I know, right now.

I know. We both are. It's okay. I'm not shaming you, but I do like hearing you.

What did you say exactly? That was a great. Yes, it is, though.

It is.

And I also think that, like, I, I think it's one of these things that I think we're all hypocrites in general because I think that there was this whole, this whole movement of body positivity, you know, like body.

I'm.

I'm so happy at any, at any size. Well, then GLP1s became extremely popular and all the people who were shouting from the rooftop that they're. They love being heavy and overweight. To me, I'm just saying this because it's unhealthy, basically. I don't care how you look, what you do, what you. But I'm just saying then also, all these GLP ones become popular and everybody is now like, nobody's. No one's fat anymore. There's no. Everyone's over, like, over skinny now.

Yeah.

Like, it's the Same people who are yelling about it, who then when they were able to, like, figure out a way to lose the weight, they did. So whatever happened to the body positivity that kind of went out the window? That's gone. And now being skinny is, like, the thing.

I just think we should be honest about it. Right. That's very wrong with wanting to look good. Right?

Yes.

And in other interviews I've done, they're like, okay, let's just. If I'm truthful, the host is saying to me, if I'm truthful, part of this is because I like to look good. Well, so do I. I'm as vain as they come.

Well, I think most people are, but people don't want to admit it.

Like, that's authentic.

Just be honest. Yeah. I mean, are we doing this for our health? Yes.

Yes. And. And it makes me look better, and the dresses fit better. Yeah. So.

And I like to feel. I like to look. I like to feel fit.

Well, you know what I like to feel is like a badass.

Yeah.

Nothing feels more badassery than lift, than squatting heavy, sprinting hard, or finishing a spartan race. And maybe I'm the only one who needs that to feel like a badass. Not.

That's my whole point. You're not, like, why are we, like, pretending that, like, and, like, here we are, like, even with this whole thing, like, we're. Both of us are, like, pussyfooting around what we said about the spanx or the girdle because we're so nervous that someone's gonna, like, get upset with us.

They will, but it just happens.

But the truth is, that's what everyone. Not about that particular thing, but, like, why can't people just, like, admit that they want to look as good as they can and there's nothing wrong, and there's nothing wrong with it. And fortunately, the. The stronger and fitter you are, physically makes you feel more confident and more mentally, like, it makes you feel better about yourself.

It does.

And it's not a bad thing.

No, no. In fact, I think I was just talking earlier about a sign of success for executives or people leading companies. Well, we tend to measure it in cars and money and whatever exits. Oh, there's another billion dollar exit. I think a real sign of success is being able to maintain your health.

I think that's the number one thing. That's why they have this whole thing about health is wealth. Because without that, by the way, what else matters?

Yeah.

You have nothing. And it's not about, like, you can still like, we're not saying you got to be like a 10 out of 10. We're just saying, like, take whatever you have and try to. And try to be strong and healthy and look as best you can.

Not everybody has to be a pro athlete. You just have to invest every day.

In your health and try to be the best version that you can. Okay, so let's get into GLP1s now. And peptides. What do you think of this whole phenomenon?

I think what's interesting is that GLP1s, as you know, are not new. The research has been around for a very long time. What's new is the iterations right now, the three in one. And, and. But what is also new is the commonness of it. So I think done well, meaning done with intake enough protein, take, let's say taking GLP1s, taking GLP1s for weight loss or for. Or for stabilizing metabolic chaos in your body has to be done while eating enough protein, while lifting weights so that as you see the scale drop, you really don't see a decline in your muscle. Because I have both kinds of people in my practice. I don't give GLP1s, but I have people coming to me who have done it both ways. One who are carefully managed with appropriate doses, who are eating 130 grams of protein a day or whatever their weight requires of them and are lifting all the time. And so what you see on their body composition is a re. Almost a remodeling. We maintain our muscle mass while we decrease body fat percentage. I also had a woman the other day who had no management.

She just got the medication and she was losing weight, which she was thrilled about, but she was losing so much muscle as she was losing fat. There was no regulation. Nobody had told her how to manage her macros. And I think that's irresponsible.

Yeah.

So I think there are indications for it, but it has to be done.

Well, do you think there's. Do you think that people are relying on it too heavily now as a crutch?

As a crutch? Well, let me phrase it this way. I don't have this problem, so I don't understand what it is, but so many people have told me that what it does is it eliminates the food buzz in their brain.

Yeah, the food noise, the obsession in.

Their brain about every thought is about food. Because I have had really fit people who come to me to manage their inflammation or something, and we'll draw their inflammatory markers and they're off the charts. Just. Cause they're just so revved up inside. And we'll talk about how they eat and they will do fine all day fighting the food noise until about 9 o' clock at night. And they just can't. There's no more willpower left.

Yeah, the willpower is gone.

And they're just gorging themselves on every carb and unhealthy thing they can find. And they're frustrated that they can't make the athletic gains they want. And so they weren't on GLP1s, but that was the. Some of the. My own patients teaching me about the buzz of food noise that they cannot overcome.

Right. And it does. I think it would help with that. I have heard that. But do you believe that? Because they say all these like secondary things is the inflammation and all these other things. And since you are, you know, you talk a lot about women, the perimenopause and menopause. Is it a tool that you suggest for women who are going through menopause? Does it help with your, with, with going through menopause or perimenopause as a tool?

I think it can be a tool in the toolbox to assist with getting in front of insulin and sensitivity. Because what happens is our lipids change. Our. I mean, I noticed this with me. Our fasting glucose goes up, for instance. My fasting glucose. I wear a cgm, my fasting all the time. Yeah. Because I started it as a three month experiment and I'm so addicted to my data that I wear it all the time and I know exactly what carbs are going to do to me and I know the spike and the. It's obsessive a little. Really? Yeah. But so what happens in perimenopause is our metabolic, our metabolism changes and we start redistributing fat from periphery to the viscera. That's why we're not this shape anymore. We're a little bit like this shape. And visceral fat is very dangerous. And so there are times when women are doing all the things they're lifting, they're watching and they just can't recompose their bodies. And so I think in that case it's a good tool that can be paired with making a hormone optimization decision. I am of the mindset that even though I take hormones and I've decided to do that, that every woman is sentient and you get to make your own choice.

Right. You have agency to decide that, but you get to decide based on facts, not fear. Right. And so in the Same way you get to decide whether you're going to use the tool of a GLP one. But I'm very opposed to using the tool of a GOP one if you are also not lifting and you are also not eating enough protein to maintain your muscle mass. Because, remember, we've talked about it a lot. I am the orthopedic surgeon that meets you in the emergency room when you have lost all your muscle mass, when you have lost all your bone density because you've starved yourself, or you're not lifting or you're not jumping, and you're just letting time take you down the pathway. I am the one that meets you crumpled up in the bed with a femur fracture. And I don't want to see anybody I love or like or even met in that situation because it's excruciating. And the statistics about death and disability are staggering. You had asked me earlier, at what time, at what time in life should we start to get in front of this? I say 35, because we have a long Runway.

We know that we need to get in front of our bone density and our muscle mass younger. So that as we age and we have the natural decline in our. The hallmarks of aging are real biologic processes. But the better baselines we start at, the more we have to work with, even if we're reinvesting every day in muscle mass, every day in jumping.

Well, why is jumping so important? Yeah.

So the way bones work, so we don't think about bones. I'm on a rampage to get people to think about their bones. Bones, when you think about it, are the only thing that make us look like a human being. Without our bones, we're just a pile of muscle and metabolic tissue just pile on the ground like Jabba the Hutt.

Right. And bones are not talked about enough.

Bones are not. But. And so sometimes people think, oh, bones are silent. They're just structural. They're the backbone of your life. Well, actually, they are the backbone of your life. They are. Bones are not silent. Bones are metabolic organs that secrete hormones. They are master communicators from the top of our heads to the bottom of our toes. And I'll give you a couple examples. Bone secretes a hormone called osteocalcin that goes to your brain and helps you build neurons. It stimulates the production of a cytokine called bone derived neurotrophic hormone. Builds better brains. Bone does that. It collaborates with your muscle and your pancreas to regulate glucose and insulin, your metabolism. Bone does that if you're a guy, osteocalcin from your bone goes to your testicles and helps you make testosterone. There's another hormone bone makes called LCN2, that is critical for telling you when you're not hungry anymore. Well, why would bone be interested in metabolism? Well, it's because it's the storehouse of your body. All the minerals your body needs for all the chemical reactions are stored in your bones. Need a little calcium, go get it from your bone. Need a little phosphorus, go get it from your bone.

Right, so it's a structural. It is an endocrine organ. It is a storehouse. It's also an incubator. Our bones and our pelvis and our long bones, like our femurs, make all of our little baby blood cells. Isn't that fascinating?

Wow.

Bones are inherent to everything they do. And they're constantly talking to the muscle. Muscle secretes myokines. These myokines aren't just talking to themselves. They talk to the bone. Bone talks to the muscle. Bone and muscle talk to the fat. Fat's an endocrine organ. It releases a hormone called leptin. Everybody's talking, and yet we sit out here thinking, oh, bones are just holding us up if we think about our bones at all. So I'm trying to get people to be more interested in their bones. Make bones sexy for the first time, because here's how bones work. Why am I talking about jumping all the time? Bones are so smart that we don't just get one set for a lifetime. They are constantly breaking down and rebuilding. It's called remodeling. And there are two main cells that do that. The osteoclast, that's breaking down bone, releasing all the chemicals your body needs. And osteoblasts that are rebuilding, and they're in harmony until we lose our estrogen, and then we start breaking down more. The majority signal for your bone to build is biomechanical signaling, which is a fancy word for impact jumping, mainly jumping stomping. We did studies that showed that the jumping sports, as you would expect, are more critical for maintaining bone density across a lifespan.

Others of my colleagues have done studies on NCAA athletes and found, oh, lo and behold, the gymnasts have the best bones. Right? Duh.

Because of all the jumping of the jumping.

So studies have shown that jumping 20 times a day takes the biomechanical stimulus, turns it into biochemical signals to tell the osteoblasts, the building cells to build better bone. She's jumping again. We need strong Bones build better bone. And so 20 jumps a day, multi directional. Couple months ago, I reintroduced hopscotch to the world because three in a row jump side to side.

So true.

Yeah, right. Children's children get it right.

That is, if we just go back to what we did as a child, we would be so healthy.

Walk and jump, Walk and jump.

What about doing it on a. Like a trampoline?

Yeah. You know, NASA does that when astronauts come back from space and have to rebuild bone. There are data that rebounding trampolines can produce enough impact to help you. Not enough. We need to. Really? Yeah, we need impact 4 times body weight. So walking is 1.5 times body weight. Running is about 2.5 times body weight. Jumping off an 8 inch step is 4 times body weight. So just jump off your bottom step. Although I did a retreat recently at Canyon Ranch, and they had us jumping just on the floor on a force plate and even jumping up and down and landing impolitely, not like a dancer with no sound, but just landing generates four times body weight.

So you actually jumping up and down, like on your grass is better than jumping on a trampoline?

Yeah, yeah.

For bone density.

For bone density. Jumping on your concrete pool deck is better than grass. Grass is probably better than trampoline.

So. Really. Because the concrete's so hard. Hard.

Yeah. That's the point.

That's the point. But isn't that hard on your ankles or your knees?

It can be. You know, people say that to me, and if you haven't jumped in years, it's okay to just do heel rises and thud down. It's okay to pull out your step aerobics thing and jump off the tub. It's okay to work.

I love that.

How old am I that I remember that?

I love step aerobics. That was great. That's such a bad. Should come back. That's so interesting. So I would think that the rebounder, the trampoline, like, I have like a million trampolines around my house.

I saw a big one.

I have a big one for my kids because I also thought it was easier for like, for low impact, for your knees, for your hips and for your joints.

That's the right thought. But bones don't need low impact. Bones need 4 times body weight to have enough signal to tell the osteoblasts, oh, it's time to lay down some bone. Wow.

So 20 jumps. That's it?

That's it. You can break it up 10. 10. So you can do that or you can do 10 minutes. Of jump training three times a week. There's studies on both sides of it, but you just need to jump. So it can be boring, like jumping jacks or jumping up and down, or you can get a weighted jump rope and work your arms and your legs.

I do that too. I try to jump, like with a, with a jump rope. A minute or two a day.

Yeah, that's good. You're probably getting hundreds of jumps in.

I'm getting a lot of jumps in, but like, it's bad on my ankles. Like, that's the thing. Like, how do you prevent injury while doing some of these things? Because that is a thing. Right. Like if you're some. Like what I was going to ask you is like, over time, maybe this is just in my head, but someone who's been very active for their whole life is much more prone to injury than someone who's never done anything. And then they start to work out because the wear and tear of your body. I feel like for me, example, like, I may look more fit than Joe Blow, but I have like a sciatica. I have an ankle problem. I have like, I had the. I had all these things. Right. Because of all the activity.

Yeah.

Versus someone like a friend of mine, like I said, who hasn't really done much. So they don't have any injury. So aren't they going to last longer in life? Aren't they going to have more longevity, really? Because their body's not like badly beaten like mine is.

It depends how metabolically unhealthy she is. Because if we did her body composition, she might be 45% fat versus, you know, a healthy body composition with 25% fat. Right.

So it's not apples to apples.

It isn't. You can't compare it so with, you know, what I deal with. I'm married to an old pro athlete with 18 surgeries. So he is definitely an example of using his reps up early in life.

Right.

That being kind of athlete was he. He's a. A professional hockey player. Oh, so there is something. Yeah, no, it's from Boston. Oh, yeah. Close enough, Close enough. So there is something to this reps in this trauma thing. But I think most of us, myself, mere mortals like me, that sometimes we get injured, we just ignore it and we don't rehab well enough. And so let's say you have, you have your hip hurts or your back hurts. Well, our body's not stupid. If we have back pain, we've got sciatica. It's going to shut off your glute you're telling me. Yeah. And then if we don't rehab that back, we never regain the strength back. It predisposes us to future injury. So if your ankle is painful, then we need to get you on some band, work some footwork to restrengthen all those muscles so that you don't twist it again or whatever happened. So it becomes a. So for those of us that have been active across a lifespan and tear big muscles and stuff, we just have to recover them, you know, That's a.

Really good point, actually. So then if we're not taking care of these injuries.

Yes.

And then they become chronic.

They do. And our motion patterns change the gate. We compensate. Yeah. Yeah.

So I got to look after the sciatica.

You do.

I'll talk to you after.

Hamstrings, core work.

Yeah, I know all the things, but I don't know how to do those things. Well, no, because my brain, like get. I get so annoyed. I'm like, I don't want to do it.

I don't want to do that. It's too easy.

Yeah. Like, I want to go run, you know? Yeah. So people with sciatica, should they not run sciatic runners?

Remember, you have weak glutes. And so if running aggravates your sciatica, I would spend a lot of time making sure your glutes are firing. Getting your single leg strength.

Yes.

To the place it needs to be. Because running is a single leg sport. Thousand steps, a mile on each leg.

Yes. You said that at the beginning. I didn't want to hear it. If there's one exercise someone should be doing, what would that be?

Do I only get ones? Probably squats or deadlifts. Probably squats over deadlifts, Squats or single leg squats. One at a time.

That's hard.

Yeah, yeah.

So how do you train someone to if someone's only doing one exercise? Single leg squats are like the hardest thing in the world.

Well, you would just start with body weight. I would start with a bench. And I wouldn't start with single leg. I'd start with two legs. Just even see if they can bend their hips and have enough ankle motion. And if you're really starting out, you could start double leg squats to a bench. Like getting up from a chair. I mean, that's actually the best one to do. That's a squat right up and down, touch your rear end on a chair, and then when you feel comfortable with that, do it without the chair. Then add 5, 10 pounds in a sumo Squat or.

Oh, I'm talking about a single squat. That's a great way to train a single squat.

It is also, but I wouldn't. If someone fresh off the couch with no notion of how their body works, I would start with two legs and then when we have some body competence and proprioception going, switch to one leg only.

Because I think when people train like a squat, like people are always dominant on one side and they're always gonna let that one side get stuck.

Do the work.

Yeah. So that's why I always think tr. Single leg or single anything, it like forces you to like activate your, the right muscle. That's why I say so.

Getting there is really critical. If people are starting from nowhere, then.

You just got to oh yeah, where they are.

I know.

You can't just start where you are now. Do a pistol squat.

Oh, how about that?

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Let's talk about supplements. If you can only take one supplement, what would you say?

One regular supplement, not longevity type supplement, probably vitamin D. Oh, not long.

There's an okay, you can add it. You can say a longevity Supplement as well.

So nmn, which will. Your body will turn into nad, which is an energetic.

Okay, now I gotta push back here. Okay, here we go. See? Do you know what NR is?

Yes. It takes two reactions for NR to be turned into NAD in your body versus NMN is one reaction. So I'm not opposed to NR either. However, what I am opposed to is whole NAD plus because the body needs to make its own.

Exactly. So I thought. And you're the doctor that say I take something, I take true. Do you know what Truniagen is?

Yes, I've seen that brand.

Okay, so it's a precursor.

So it tells you two reactions from NR to get to nad. It's a precursor.

It's a precursor.

Yeah.

And I thought it was really good because it goes into your cells quicker and it can fit like, I don't know the proper. It's smaller, so it actually penetrates. And I heard that NMN doesn't.

Well, so I test this.

Yeah, tell me, I'm curious.

So there's a company I use, I guess we'll advertise for them called Ginfinity. And they test, test intracellular NAD plus. It's the only way to really know whether what you're taking is elevating your levels.

Yeah.

So the first time I tested my NAD plus, I was exhausted every day at 3 o'. Clock. You know, my day was over at 3 o' clock. And a normal level of NAD plus intracellularly is about 60 in young people. Mine was at 18. So I started supplementing with NMN and retested and I was back up into my 50s and I could feel the difference in energy. So my only response to does NMN create nad? Is the experience of me and the people I treat. Because I test it.

Right. That's interesting though. I find there's a whole camp of people who like NMN and there's people who like nr and then lots of.

People taking IV NAD plus, which I don't think gets into the cell.

Well, this is what I was going to say. All the IVs, they're very popular.

And then they have first pass liver function and probably are sucked out of the blood anyway.

So you don't recommend those?

I don't. I. I recommend the precursors. So your body makes its own. Because NAD plus works intracellularly.

Yeah. What I find interesting, we're like 10 years ago, no one talked about NAD. What, how did this become a thing? Like, did you notice like a, like, like an evolution of how longevity became like Kind of like a sexy topic in a way.

Well, it's funny you asked me that because I start started writing books in 2004. The first one was called Fitness After 40. And at that time it was all about the research that I do now. 40 year olds couldn't stand the number 40.

Right.

So I had to rebrand to thrive because I had a bunch of products and Dick's Sporting Goods. 40 year olds couldn't stand the number 40. So nobody wanted to talk about aging or longevity. It wasn't cool then. And so I have seen this progression to exactly your point. Now we're all about if you're not 40, you're actually not cool yet. You're still a. All my 30 year old children have yet to arrive.

Yeah, yeah, exactly.

Yeah.

Well, I also feel like the 60 is the new is the new 40.

Oh yeah. Thank God. Because I'm like, I'm not, I can't run out of time yet.

I know. And I feel like the older I get, like, I'm like, where did the time go? Like, I feel like it goes by much faster once you hit 40. I feel I do too. You know, it's, I don't know where the last 10 years went. What about like sauna versus cold plunge for women? Do you believe in the cold plunge? Because there's a lot of controversy around that for women.

If I believe Stacy Sims, cold plunges are best for men. Right. Because we tolerate, we tolerate cold less. Well, I do like sauna. I, I'm not a big fan of infrared sauna. I like the really hot finished sauna. Studies producing high levels of growth hormone. I don't get in them often enough.

But you know what's interesting? Like I feel like Stacy who said, said this to me too, that women love heat, they don't love cold, and that's and are for hormone purposes. Now what you're saying about the infrared sauna, again, they don't get hot enough.

They don't get hot.

They don't get hot at all. I got to keep that thing on for an hour just to get it to like a place where I can.

Feel like I'm doing something.

I agree. But then they say also that, that that's bad for your brain.

Really?

That's what they say. You're the doctor.

Well, I'm not an expert on science.

I know. Well, we'll ask another side.

Yeah, I've read the Finnish studies that say the hot saunas, hot dry saunas do the trick.

I, I that but all the research has been on the hot sauna.

Yeah.

Yeah.

Okay.

A couple more questions gets back to the supplements. Zombie cells. So which are the ones that you. Yeah, let's talk about that.

How.

Let's get into the supplements for that and everything else. Zombie.

So what are zombie cells? There are four destinations of cells in your body. We have stem cells, which are meaning that they retain their ability to become anything under stimulation. So stem cells become mature cells and do their job. So a mesenchymal stem cell will become a muscle. A muscle mature muscle cell doing its job. When the mature muscle cell has done its job, it's replicated enough. It's created enough reactive oxygen species that it's just tired and needs to die. It turns on genes to undergo programmed cell death. That is the natural history. There are some of these cells that are so damaged from the life they've lived that they cannot turn on the genes to program cell death. These are the zombie cells that circulate around not doing their good job, not dying. So they're just spewing off noxious cytokines. That and high accumulation of these populations of zombie cells have been attributed to increased rates of cancer and inflammation. So there's a big push to eliminate this senescent cell load, which can totally be done with lifestyle and all the things we've talked about. It can also be done with a. With a category of supplements.

Fisetin Quesir 10, which I always mispronounce, but they're derived from. They're. They're derived from strawberries and berries. You just. It's like resveratrol. You can't get enough of it from the grape leaves, so you have to take it. So there's another scientist that I collaborate with in Vail whose entire work is on senescent cells. And he has actually done the before and after senescent cell load measuring of giving just regular doses of fisetin. And you can significantly decrease the senescent cell load with that herbal remedy.

Really? And so how often do you take that?

Every day. Just, you know. And it's a standard brand that you can buy off Amazon because that's what he had to do for his research. He's like, I need a steady source. We're gonna verify it contains fisetin. And that's what he used in all his exc. Experiments.

So fisetin.

Fisetin.

I can just find it on Amazon.

Yeah, I'll show you.

Really? I love that.

Yeah.

And then foods. We didn't even cover foods yet. Nutrition. Is there something that we should be eating every day, that we're not eating, that people are like, are overlooking.

I think people in general, at least my patients, when I question them, don't know how much they're eating and they don't know what they're eating. Part of that is because so much of our food comes in containers. Yeah, it's like 62 ingredients. It's not a piece of broccoli, it's not a chicken breast.

Right.

So that's what I find more than anything is that people just have no idea what they're consuming. And so when I start to work, I have a, both an orthopedic practice and a longevity practice. And the longevity one also helps women in midlife and menopause. So one of the things we start with is tracking everything we eat for three week days and two weekends. Just so with a free food tracker, I mean you can get them for free just so you know what you're consuming.

Right.

Because I find people in two camps. Either I had a woman eating 700 calories a day the other day and you know, 60 grams of protein because she's not that hungry. Well, you're starving, that's why you're not hungry. And so but she, but we're going to count what she's eating so that she has an awareness of, I mean, she probably has 700 more calories to go before she even begins to be in deficit. I mean, too many calories. And then I have people on the other hand, which is probably the most of the population, which thinks they're doing okay, but doesn't realize the calorie load that they're eating from the volume of food that they're eating, what a real portion size is.

These are all like things that, you know, it's basically the basics. It's so basic and people are still not aware of the basics. They're dealing with the minutia, but not the most fundamental things that actually move the needle.

Exactly. So in Unbreakable, I talk about the fact that people come to me fine. I'm like, how are you feeling? Fine, I'm fine. But then they come in that state of non optimized health and want to go to the really complex rat data, longevity stuff.

Totally.

And skip everything in between. So sorry guys, if you come to me, we're going to optimize your health, right? We're going to get all, everything firing in all cylinders. And then when we're doing that, then what do we do? Because I'm a sports doctor, we can Apply the high performance things that we do with athletes and then when we're at peak performance and you're feeling great and okay, then I'm open to discussing with you the risks and benefits of things that only have rat data so that you enter this world eyes wide open.

Yes.

But I will not skip to that. I mean you need to find another doctor if that's what you want.

Good for you. Yeah, because also that stuff, they make so much money off of this stuff. Yeah, all of the peptides and all the things but.

And they're hard to source. Safely.

Very hard to.

Yeah.

Can you talk about that? Because I know a lot of people who are getting these things like off of the Internet.

Off the Internet, out of the trunk of some gym guy car and Yes. I mean you don't know where that bottle came from. You don't know what that really is. Is it sterile? You're injecting it. What's the real dose? Because even for longevity doctors, we have this group called longevity doctors and that we're all board certified doctors of some specialty, internists, surgeons, whatever. It is hard. We were just talking about the other day, where is the most reputable place to get peptides if you're choosing to use them? It is very hard for those of us in the know. So where it came from, the thing I most often ask for is BPC157. Where did that come from? That came from the bodybuilding weightlifting world, Army Ranger world, where we're just looking for all kinds of good solutions for people who are really performing at a high level. Well, it trickles down as everyone wants to emulate that. And so I have parents asking me to give that to their teenagers trying to heal. Do I think anecdotally it can make you feel better? Well, there are no data for me to quote to you, but I certainly have a lot of people who swear that it's a miracle.

But if you want me to discuss it, then I'm going to discuss the fact that there's no safety data in humans.

Really? Even for BPC 157 there is not.

A big body of data. The most prevalent studies are in rats, which if that's fine with you, go in eyes wide open. And I have some people who choose to do that. But then it becomes. Who you getting it from? Yep, the guy out of the trunk of his car. Buyer beware.

That's really scary. I almost everybody I know who's into biohacking longevity is on this. Everyone's taking BPC 157 for the joints and inflammation.

For the recovery. All the recovery or the everybody peptide for your skin?

I mean yes, the copper peptides. The other one.

Wouldn't that be amazing if it worked and I could source it appropriately but I just am at a loss.

Oh, this is so fascinating. How about like trizepatide and the new one retro, the glp, The GLP ones that are compounded.

Oh well there are some things that I'm not opposed to for compounding but if there is an FDA approved, regulated, you know, it's in the pill because it's tested or you know, it's in the injectable because I think you should do that. Not the compounding. Pharmacies are bad but you just, it depends on the quality of the pharmacy.

And I think that people don't know.

And people don't know, they're just trying. I honestly think most people are just trying to do the best thing.

Yeah, yeah. Well so would you suggest then not a compound if you can like that? Yeah, yeah. But those peptides, man, that is scary.

And do I think we will learn enough that they become safer that we have safety data? I mean let's hope so. Let's hope we can get studies funded to at least have safety data. Yeah, we just, we just don't. So that's my position on it. And I mean it's weird for me to be in the longevity space and be so cautious but I am a practicing surgeon and I'm never going to hurt you.

Guess what? That's what I like about you. Well number one, you're like a real, a doctor doctor and that's really important because I think we need, we need more. More of you.

Yeah.

And if you really look at it, and again I'm going to get bashed here. A lot of the people who are pushing this stuff, they're actually not even real doctors. They have, they put doctor in front of them. But like you were saying. But they're not, they didn't finish residency, they're not an md. And that's what also like, it's like it's, they're, they're selling, it's false advertising. So people then think psychologically. Oh a doctor told me to do it right when maybe, maybe you should check the credentials.

I think, I think it's important for people to go in eyes wide open.

Yeah.

So let's just review for one and a half seconds what it means to be a board certified doctor. The highest qualifications you can have within the medical system is to have the board certified credential, which means you finish medical school, which any Tom, Dick and Harry who gets in can finish. Right, Finish medical school. The next step is to finish a residency, which means you do three to seven extra years learning how to apply the medical school knowledge to real people. Only then are you able to practice alone. And then you take two to three exams to become board certified for orthopedics. That means that we have to take two written exams and we have this horrible interview exam where we sit across from a panel of old surgeons and they quiz you on your management. But you know why we do that? Not to torture young surgeons, but to ensure that the public is safe and that the people giving them care have had the most training possible. So there's a reason that board certification matters to real doctors.

That's really important. I'm glad that you said that. It's very important because people skip this whole. That whole part.

Yeah.

And that's what I feel to be very dangerous, especially in the world we live in where information is free and everyone. There's so much of it. So they say, like.

And chat, GPT, hallucinates and chat and oh my God.

And there's so many AI now that like, it's really, really, really difficult. So you really have to do your research properly. Yeah. Yeah. Okay.

Smart.

Vonda right? Dr. Vonda. Right. The book is called Unbreakable A Women's Guide to Aging with Power. But really for anybody, I think. Yeah. Again, I really enjoyed having you on the show.

Thank you for having me.

Thank you. Where can people find you every single day?

I am on Instagram.

I was gonna say.

Yeah, I sure hope people go find me there. And I have a website, Dr. Vonda Wright.

And they should do your quiz.

I have an eight part assessment in this book where you can really see where you stand from a longevity standpoint. Please invest in yourself by reading this book.

I know it's a really good book and I'm going to do. I haven't done the quiz, but I'm going to do the quiz. Oh, good, good.

Perfect.

Thank you for being here. Thank.

You, Sam.