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

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[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

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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

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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