Speaker: [00:00:00] Exactly 70 percent of Alzheimer's is in women. Most osteoporosis is in women. The [00:00:05] number one killer of women is cardiovascular disease, from microvascular disease, which we can prevent [00:00:10] with estrogen.
Speaker 2: Pharmaceutical industry will make less if women are healthier.
Speaker 3: Dr. [00:00:15] Vonda Wright is a double board certified orthopedic surgeon, an internationally recognized authority [00:00:20] on active aging and mobility, dedicated to helping people not just add years to their [00:00:25] life, but life to their years.
She's redefining what it means to stay strong at every age. [00:00:30]
Speaker: I have clinics full of people who have never heard of perimenopause. Are we gonna [00:00:35] wait until 40 percent of women have fractures because we let [00:00:40] their bones disappear at a rate of 20%? Or are we gonna tell the [00:00:45] 40 year olds? Let's find out what you built when you were young.
Let's optimize your [00:00:50] hormones and never let you lose your bone in the first place.
Speaker 2: What are the [00:00:55] top four hormones that women should track? You're [00:01:00] listening to The Human Upgrade with Dave Asprey.[00:01:05]
Is it true that how fast you walk predicts your death better than [00:01:10] cholesterol?
Speaker: You know, studies show, especially as it pertains to preparation for surgery and [00:01:15] outcomes, that your functional mobility and how fast the [00:01:20] muscles below your belly button propel you actually can predict outcomes, [00:01:25] not only for aging, but for surgery outcomes.
Speaker 2: Don't a lot of women, though, have a [00:01:30] problem if you deliver it by C section? Isn't that muscle kind of cut?
Speaker: Well, you know, C [00:01:35] sections actually cut through 6 to 8, uh, layers. I'm not an OB [00:01:40] GYN y, but this fan and steel incision across the inferior portion of our abdomen goes [00:01:45] through 6 to 8 layers. And although they're sewn back with the, the, uh, [00:01:50] The thought is, and I often say this, and we have programs for this in our office, [00:01:55] is that the 10 months after the 9 months actually are [00:02:00] incredibly important for not only rebuilding and restrengthening the [00:02:05] pelvic floor, which is like a basket of skeletal muscle, but also [00:02:10] reconditioning the abdomen.
And if you have a diastasis, which is where your [00:02:15] rectus abdominus muscles actually physically come apart, Those can come back [00:02:20] together, but it gives you a mechanical disadvantage for six to [00:02:25] nine months. So it's not something that you can just passively let nature take [00:02:30] over. I like my women to really invest time and rebuilding that, [00:02:35] uh, functional motion.
Speaker 2: Having had a hernia, a very small hernia [00:02:40] repair about three years ago that directly affects the lower pelvic [00:02:45] floor the recovery from that's been really interesting where, [00:02:50] you know, some of those muscles just get turned off and I noticed changes. I've always had really strong [00:02:55] hip mobility on the left side.
It got jacks. I've been doing a lot of functional movement to bring him back and it [00:03:00] feels like a lot of women. In fact, the majority of women have kids now are doing it. Um, C [00:03:05] sections, despite the medical risks from that. So if they're not doing proper rehab [00:03:10] of their lower pelvic floor, we're having some serious long term aging problems, [00:03:15] right?
Speaker: Well, let's talk about two of the things you just said, the turning off of muscles and the long term [00:03:20] effects. So, I'll give you another example. When anyone, man, woman, um, two [00:03:25] examples. Let's say you tear your ACL. [00:03:30] Within one week of hearing the pop, right, that's the classic ACL. We heard a pop, my [00:03:35] knee became swollen.
The quad muscle receives [00:03:40] information from the joint that it's injured and shuts down because the body's not [00:03:45] stupid. So within a week or so, we have 25 percent or [00:03:50] more quad muscle atrophy. Another example of that is the [00:03:55] glutes. Low back pain is endemic in this country. People sit a lot. We're not [00:04:00] working out enough.
I mean, 70 percent of people in our country do no purposeful [00:04:05] exercise. And so When we get low back pain, again, body's not [00:04:10] stupid, it's shutting down the glutes that are really hard to recover. [00:04:15] So imagine, in the example of carrying a weight on our [00:04:20] pelvic floor for nine months or cutting through the layers in a fan and steel incision, [00:04:25] Our muscles are going to atrophy.
So this long term [00:04:30] recovery that you've experienced, even from a smaller incision than a [00:04:35] phantosteel, I keep saying that that's the guy's name who, who named the incision after him, but that's what it's called in [00:04:40] medicine. Women need to give themselves grace that it's not going to happen overnight, [00:04:45] but it requires a lot of hard work because the long term sequelae.
[00:04:50] If we want to get really granular, no matter how tuned in you are, [00:04:55] how obsessed we are with our aging process or the hacking processes, [00:05:00] you must reinvest time because a high portion of [00:05:05] women are incontinent, and you see that in every Arena. Think [00:05:10] of, I don't know if you've ever watched the, um, box jumpers that happen.[00:05:15]
I mean, they're box jumping the fittest athletes in the world. And [00:05:20] if you've had a child, you can have stress incontinence, which can be retrained, [00:05:25] but only if you pay attention to it.
Speaker 2: Yeah, sneeze peeing is a thing so [00:05:30] many friends have mentioned. And I'm like, what is that? I don't seem to have that, obviously.
And [00:05:35] Since it's such a common thing, how hard is it to retrain those muscles? [00:05:40] Like, what do you do?
Speaker: So it's more than just simple Kegels, right? Everyone's taught, Oh, do some [00:05:45] Kegels. Sometimes we need to be taught [00:05:50] to engage our cores and our glutes for the first time. I know plenty of fit [00:05:55] people whose glutes don't fire because you can get by without it.
[00:06:00] So. Everyone needs to be taught how to feel your glutes, how to engage them [00:06:05] for the pelvic floor. It's more of a sucking in feeling. It's [00:06:10] like a, as a true Kegel than a squeezing, like women are [00:06:15] taught to do a Kegel by squeezing their urethral sphincter together. It's more of [00:06:20] a sucking in, a contraction, raising your pelvic floor.
And [00:06:25] it takes time. Sometimes the pelvic floor is so shut off [00:06:30] that they're actual physical therapists. In fact, the head of my physical therapy department [00:06:35] is a pelvic floor therapist. And it takes manual therapy, which is [00:06:40] what it sounds like, to re engage the pelvic floor. But here's [00:06:45] something that the other 49 percent of your audience will be interested in.
Men can [00:06:50] have pelvic floor dysfunction too. Oh, it's common. Yeah, very common. And it's [00:06:55] painful. And you're like, why is this hurting me? Or why aren't things responding? Pelvic floor weakness. [00:07:00] So it's not just an, an XX problem. It can also be an [00:07:05] XY problem. It's, it's not paid enough attention [00:07:10] to the same way that we're paying attention to common weightlifting, right?
Speaker 2: [00:07:15] It's interesting. I did get pelvic floor weakness after the surgery [00:07:20] and I have recovered it. I would say 90%. But I have [00:07:25] access to all the tools and all the experts out there, so I'm pretty lucky that way, but a lot of people I [00:07:30] think they do it and I can tell you that if I didn't know what I know and have [00:07:35] access to the right people in tech, I would have had left hip mobility issues [00:07:40] that would have gotten worse and worse and then 15, 20 years from now, I would have needed a new hip.[00:07:45]
Speaker: Well, and let's talk about, I love that you're bringing up all these things. People usually [00:07:50] don't ask me about the orthopedic side of my life, so I'm thrilled that you are, but the reality is You're very well [00:07:55] trained. I'm incredibly well trained, right? So, and, and elite sports medicine is what I've [00:08:00] done all my life.
But it's interesting, you were very specific. My left [00:08:05] hip motion, what people don't realize is that for locomotion, [00:08:10] Our body needs a certain amount of motion. If we can't get it from the lumbar [00:08:15] spine, we're going to steal it from a hip. Or if our SI joint is, [00:08:20] is seized up, we're going to steal it from a hip.
On the other side of it, [00:08:25] if our hip doesn't move, if your left hip will not go through a full range of motion, you [00:08:30] will steal it. You will steal motion from your low spine, your [00:08:35] symphysis pubis, your SI joints. So, When I [00:08:40] prescribe exercise, people think I'm going to stop at aerobic and I call [00:08:45] weightlifting carrying a load, but I start with range of [00:08:50] motion, joint mobility, because we're not doing anything effectively unless our [00:08:55] joints move.
Speaker 2: It makes me so happy that you're bringing this up, especially in the context of women and [00:09:00] hormones and aging. Part of what we're doing at Upgrade Labs is an [00:09:05] AI functional movement assessment,
Speaker 3: where
Speaker 2: you lift up your hip and a computer watches you and [00:09:10] lift up your leg and your shoulders, and we score you.
Is one side better or worse than the other? If it is, [00:09:15] that is going to get you as you age, and that means you need remedial work in order to [00:09:20] strengthen the side or figure out What muscles are turned off and can you [00:09:25] explain how a muscle gets turned off? Cause I've had to deal with a lot of that and it [00:09:30] makes no sense.
What do you mean turned off and muscles there what's happening?
Speaker: A muscle's there, but for a muscle [00:09:35] to operate at its most optimal capacity, it has [00:09:40] to be at a proper length, right? Because if you think about muscle [00:09:45] at the very cellular level, there are sheets of fibers. [00:09:50] that slide back across each other based on whether calcium is attached to the [00:09:55] myosin or not.
So this is how a muscle works. It doesn't work so well [00:10:00] when it's already totally aligned. It doesn't work at all. When [00:10:05] the fibers are not overlapping, so you must have optimal overlap of the muscle [00:10:10] fibers so that when the nerve stimulation comes from your brain down a motor [00:10:15] neuron into the, to the batch of muscle fibers that it innervates, that you get the [00:10:20] contraction and relaxation in an organized way, not [00:10:25] in a disruptive way, not in a short way.
So when we're talking about joint [00:10:30] motion, it's incredibly important for proper muscle function. [00:10:35] Muscle will stop being receptive to the stimuli that it's getting [00:10:40] if it can't move through a range of motion. If you're really, really tight. If your muscle is not at [00:10:45] proper, it's got nowhere to go, it's going to stop and without stimulation, [00:10:50] it will atrophy, right?
So it's this continuous [00:10:55] dynamic interplay between muscle, the nerves that [00:11:00] stimulate it, the bone that the muscle is attached to. I mean, people [00:11:05] think of the body, or we speak of the body, you probably [00:11:10] don't, but, but medical people in general as a part of the body. A heart, a lung, [00:11:15] or the musculoskeletal system as a tendon, a ligament, but the [00:11:20] reality is the musculoskeletal system, every tissue [00:11:25] comes from the same stem cell, the mesenchymal stem cell.
They're all cousins. They [00:11:30] speak the same language. They secrete hormones that talk to each other, so why [00:11:35] wouldn't we think that when the neuromuscular pathway is not working, [00:11:40] or the muscle's too tight. That the bones can't move. Does that make sense?
Speaker 2: [00:11:45] It totally makes sense. And it's so different than most people think about aging.
Like, [00:11:50] Oh, I'm walking and it hurts. And it must be because the muscle's tight. But it's quite [00:11:55] often because one other muscle around that isn't doing its job and it's [00:12:00] totally invisible to you. And then a good, a good therapist or a physician will work with [00:12:05] you and they'll poke on that muscle and you can't move your leg.
Speaker 3: Yeah. Yeah.
Speaker 2: And to me, it was really [00:12:10] vexing, but what the therapists will do, functional movement people, you know, they'll tap on the muscle just so [00:12:15] there's a nerve signal, and then you learn how to use it again. But how does that [00:12:20] work lower pelvis? I mean, you're supposed to be like tapping on your lower pelvis.
Is that?
Speaker: So that's what internal [00:12:25] pelvic therapy is. I mean, you, you enter. Uh, like you're having a [00:12:30] vaginal or prostate exam, tapping on those muscles, pressing on those muscles so that [00:12:35] your body feels them. Because on an average day, do you feel your pelvic floor? I don't. I [00:12:40] mean, you may be more in tune with it than I do.
But until somebody, because you've had [00:12:45] to rehab it, right? So until somebody taps on it, stimulates [00:12:50] it, And then you feel it, your brain will catch on pretty quickly, but sometimes [00:12:55] that's what it takes. And don't worry people, it's done in the privacy of a room, it's not in a [00:13:00] gym, this is a medical PT procedure, but sometimes [00:13:05] necessary.
But when you think about, I love that that in your [00:13:10] practices that you do functional motion assessment. In fact, uh, you may not know this, or you [00:13:15] probably have it on your schedule, one of your One of your businesses opened in the same building [00:13:20] as my office, so you're having this grand opening, so is that great?
That's incredible, wouldn't that be lovely? [00:13:25] Yeah, Lake Nona.
Speaker 2: Oh my gosh, yeah, Lake Nona, I was just there in Florida. [00:13:30] Exactly. That's incredible.
Speaker: But I love that you're doing functional modes of assessment, because if you don't [00:13:35] mind, I'm going to give you an example of why that matters from my own example, [00:13:40] right?
So Yeah. When I ramp up my running, I will [00:13:45] always, always, this is an example of compensatory motion and things not firing. [00:13:50] I will always develop left Achilles tendonitis [00:13:55] and right hip flexor pain. Now, why is that? Here's here. [00:14:00] Here is what people don't get because if you just go and you don't [00:14:05] know about the kinetic chain and functional motion, somebody's gonna work on [00:14:10] your hip.
And somebody's going to work on your Achilles tendon, which they may have to do. [00:14:15] But in a functional motion assessment, they would discover in me that my [00:14:20] left great toe, because I'm a stiletto wearing orthopedic [00:14:25] surgeon, yes, and I was a former dancer, my left great toe does not have full [00:14:30] range of motion.
It has arthritis. So instead of when my heel [00:14:35] strikes, bear with me people, heel strike, and I roll through, [00:14:40] I don't roll through the middle of my left foot. Because my left great toe is [00:14:45] stiff, I roll through the outside, which prevents, bear with me, [00:14:50] my tibia from internally rotating. It prevents, [00:14:55] therefore, the next link, my femur, from internally rotating, which [00:15:00] prevents my glute from activating.
That is the kinetic chain. Isn't that [00:15:05] amazing? Because I don't have motion in my toe, my Achilles [00:15:10] Gets pounded. My left glute is not turned on, so my right [00:15:15] side has to compensate, including my hip flexor, to keep my pelvis stable. [00:15:20] It is so important that you do a functional motion assessment. [00:15:25]
Speaker 2: Now, we seem like we have some related issues.
All of my stuff started [00:15:30] because I did a yoga pose, crow, and I kicked back to plank, and [00:15:35] I injured my toe. Oh! And it just wouldn't heal. And over time, it started [00:15:40] calcifying. Yes, so I couldn't push through my right big toe and I did all the [00:15:45] stem cells. Nothing would fix it Finally I had to go in and rebuild the joint [00:15:50] and I did a whole podcast episode on you know They cut the bone and reshaped the thing.
It was [00:15:55] a huge pain in the ass, but at least it can move again The reason I got the hernia on the [00:16:00] left lower pelvis is because I couldn't use my right toe and I was compensating too much stress there, which turned off my [00:16:05] left glute, which made my right shoulder raise more than it should. So the whole body is this [00:16:10] big S curve.
No one talks about this. So we have this weird pain and we don't [00:16:15] understand. You probably should have functioning feet and ankles, which is the, the focus for everything, but [00:16:20] you wear stilettos and you know better. I do!
Speaker: But you know what? Word to the [00:16:25] wise, I wear stilettos for two reasons, for three reasons.
I'm going to tell people listening, like, how [00:16:30] can she get away with it? Number one, you have to have pretty normal feet. [00:16:35] If you're at the pool side and your wet footprint doesn't [00:16:40] look like a stereotypical foot, it looks flat or it looks. You have [00:16:45] to have pretty normal feet to get away with it. Number one.
Number two, I was a freaking ballet dancer. [00:16:50] I'm as strong as a bull. You cannot expect to put one on, heels on, [00:16:55] and get away with it once a week, once a month. It's just your body's not strong enough. Those are [00:17:00] the two main reasons. So, I forgot the third one. But oh, because [00:17:05] I just want to, Dave, I just
Speaker 2: want to, right?
Founder, that is the most [00:17:10] honest answer. There's nothing wrong with doing something that you want to do, even if it's [00:17:15] not perfect, because it was fun. Like, that's completely okay.
Speaker: It's part of my old age bad [00:17:20] assery, Dave. I mean, I don't know why you want to, what you want when you're 97, but I want to [00:17:25] be doing what I want to do, when I want to do it, and if it's wearing heels, I'm gonna, [00:17:30] Do whatever to get there.
So, isn't that funny? Same
Speaker 2: here, but I'm, I'm hoping [00:17:35] that when I'm 97 wearing heels isn't on my personal agenda, but
Speaker: Yeah, whatever your, [00:17:40] whatever your equivalent is, you know.[00:17:45]
Speaker 2: So you're talking about making it to 97 or way beyond. Is it [00:17:50] true that perimenopause is really just cougar puberty?
Speaker: Oh, [00:17:55] Let's talk about parenth listen, I've never heard it say I
Speaker 2: just saw that on Instagram [00:18:00] today and made
Speaker: me laugh. Well, let's see. I call this whole period, let's [00:18:05] compare it to adolescence or puberty.
Yeah, okay. But you know [00:18:10] what? In a mindset way, maybe it is. We are so free when this happens. But it is [00:18:15] nothing to fool around with. And I wish that every single person, your listeners are probably all [00:18:20] tuned in. But, but I'm going to tell you most women in this country, I still am practicing. I have [00:18:25] clinics full of people who have never heard of perimenopause.
So I call the [00:18:30] whole thing the menolescence because we have lived through [00:18:35] adolescence, right? That cataclysmic, we come into our hormones and [00:18:40] we're like different people. It is the same with metalescence, except [00:18:45] we are losing our native estrogen because our ovaries [00:18:50] are retiring. But here's the deal. In the spirit of prevention, in [00:18:55] the spirit of growing older, Because aging is the most natural thing we do, [00:19:00] but not aging old, right?
Speaker 2: Right.
Speaker: I just got, [00:19:05] yesterday, I'm in this place I am now because yesterday I testified before the [00:19:10] FDA on the merits of estrogen therapy for women. And they thought I was going to talk [00:19:15] about, yes, they thought I was going to talk about estrogen to prevent fractures in old [00:19:20] women. And I am, because I'm sick of putting metal.
You know, ladies, but [00:19:25] listen, people, you need to make your hormone optimization decision in your early [00:19:30] 40s before you go through this [00:19:35] intense period of aging, which happens around 40, 45, and you're [00:19:40] already on a downhill slope. There is no. Organ in our body from [00:19:45] our brain to our bone to our heart that do not have [00:19:50] estrogen, alpha and beta receptors.
So why? Let's take bone because I was screaming, not [00:19:55] screaming, very calmly talking to the FDA about, are we going to wait [00:20:00] until, until, listen, are we going to wait until 40 [00:20:05] percent of women have fractures because we [00:20:10] let Their bones disappear at a rate of 20 percent or are we going to [00:20:15] tell the 40 year olds, let's find out what you built when you were young.
Let's [00:20:20] optimize your hormones and never let you lose your bone in the first [00:20:25] place. I could make the same argument for every body [00:20:30] part. Look how passionate I get about this day because here's what we're doing to women. We're saying, [00:20:35] Oh, you know, you're going to be fine. [00:20:40] Just. Age naturally? Well, okay.
What's [00:20:45] more natural than having the hormones that you began with? So, [00:20:50] here's the deal, though. Just Consumer alert, I think [00:20:55] every woman is a sentient being with agency and you [00:21:00] get to choose, but I refuse to let you choose based on fear, [00:21:05] W H I, versus fact. And so, the first step [00:21:10] in, in mastering your mental lessons is becoming literate.
You have to [00:21:15] become an expert in yourself. Please. You have to investigate. [00:21:20] I mean, it's like when I'm at your conferences and these expos are filled with all this [00:21:25] stuff. People are so curious. They're asking hard questions. [00:21:30] They're investigating, right? That's what I expect for you when you're making your [00:21:35] hormone decision.
Because if you know what you're gonna do and you start before [00:21:40] you lose your brain, before you lose your bone, before your heart goes down the [00:21:45] clicker, That is the best time to get in front of it.
Speaker 2: Wow, I, [00:21:50] I couldn't agree more. The, the crime against women of [00:21:55] letting them go through paramenopause without any good [00:22:00] advice, and the data is so clear, and I put a lot of this in my longevity book, [00:22:05] if you go on bioidentical hormone replacement, starting at paramenopause, your [00:22:10] risk of everything bad for the rest of your life goes down.
And it's not very [00:22:15] expensive. to keep yourself young. And it's really expensive to reverse your age. [00:22:20] So I have to ask, given that the FDA is under new ownership, [00:22:25] uh, we should, if we can call it that, um, was it any different than it would have been a [00:22:30] few years ago? Because your message basically says pharmaceutical industry will make less if [00:22:35] women are healthier.
It seems like they'd be fundamentally opposed as an arm of the pharmaceutical industry. Was your [00:22:40] message more received now?
Speaker: Uh, we were invited by them. We didn't [00:22:45] burn the castle.
Speaker 2: Excellent.
Speaker: 10 of us, well 20 of us were invited, 10 of us showed [00:22:50] up. There were the legends of women's health who have written the research for [00:22:55] 40 years and have been trying to scream from the mountaintops.
We have [00:23:00] re evaluated, re evaluated the WHI and there is RISA GOLUBOFFA, HOST [00:23:05] Virtually no reason to withhold this, right? So they were there. [00:23:10] And then there were 4 or 5 of us that are leading the charge now. There were two [00:23:15] urologists, I'm an orthopedic surgeon, there was an internist, laying out the data in our [00:23:20] perspective fields, about how we're gonna help women live longer better.
Because the [00:23:25] reality is, Dave, women are already winning the longevity race. Meaning we're living [00:23:30] 4 HOST Well, you know what you guys are living better and I'm happy to talk about that. [00:23:35] We're already winning in terms of years, but we are the dead last [00:23:40] losers when it comes to quality of life. Like Alzheimer's.
[00:23:45] Exactly, 70 percent of Alzheimer's is in women. Uh, most osteoporosis is in [00:23:50] women. Women, the number one killer of women is cardiovascular disease from my experience. from [00:23:55] microvascular disease, which we can prevent with estrogen. So, so, [00:24:00] but, and women live in this fear, but they also live in this, Dave. And I, I certainly hope none [00:24:05] of the people listening, man or woman, will allow this to go on.
But women [00:24:10] say to me every day in my clinic, they say a lot of things to me, but they [00:24:15] say You know what, Doc? I didn't want to come in today [00:24:20] because I have a really high pain tolerance. As if we should be wearing some badge [00:24:25] that says, I will suffer because that's what's expected of me. [00:24:30] I have a really high pain tolerance and I didn't want to come in.
But one of [00:24:35] my messages is that We don't have to suffer in silence for [00:24:40] years. But when you think about your own mother or grandmother, I think about mine. [00:24:45] It makes so much more sense. How [00:24:50] did my robust grandmother who raised 10 children and had three businesses [00:24:55] dissolve into a frail woman that we had to help around?
How did my own [00:25:00] mother, same immigrant, came here with less than a thousand dollars. So [00:25:05] smart and vital. Shrink and become shorter than me. And you know what, but we can [00:25:10] prevent that. So when we talk about Cougar puberty, [00:25:15] if we give women back their hormones. They are going to [00:25:20] continue to have brains.
They're going to be continued to be sexually vital. [00:25:25] They're not going to start being, they're not going to be anxious and re enraged all the [00:25:30] time. I mean, re I'm getting so off topic, but Dave research has [00:25:35] shown uh, Louise Newsome did a survey of her thousands of patients in, in [00:25:40] England. Up to 70 percent of the women she surveyed thought that their [00:25:45] menopause directly affected their midlife divorces.
This is real. [00:25:50] Of course, men don't know that their women are not rejecting them as people, [00:25:55] but it cuts like razor blades to have sex when your vagina is atrophying. So there are [00:26:00] so many reasons. See what you did. You got me going, Dave. There is good work [00:26:05] to do in this.
Speaker 2: Mission accomplished.
Speaker: Yeah, so, yeah, [00:26:10] menolescence is the psychological, the [00:26:15] physical, the hormonal, the social transition [00:26:20] that doesn't have to be an end point of suffering.
The [00:26:25] women like me, I mean, I've been Been through this more than a decade ago. I have [00:26:30] mastered this, right? The women like me who have gotten in front of it, gotten our [00:26:35] education, know what to use, continue to exercise in a crazy [00:26:40] way the wisdom of our age allows us to be more authentic than we've ever been in [00:26:45] our entire lives.
More sure of ourselves and just. Out to conquer [00:26:50] the world, but you're never going to get to mastery if you don't get to your hormone [00:26:55] decision first.
Speaker 2: Some of the happiest, most powerful [00:27:00] people I know are women who went through perimenopause with appropriate [00:27:05] bioidentical hormone support. Just like you said, they've got wisdom, they know what they like, [00:27:10] they own it, and they're, they're in such a good place.
And you contrast that with someone who's, [00:27:15] I'm just anxious and tired all the time and like, look at your DHEA, [00:27:20] look at your pregnenol, it's so easy. What are [00:27:25] the top four hormones that women should track?
Speaker: Let's start up [00:27:30] here, right? I suggest if you care about the 30 percent of collagen that [00:27:35] you're going to lose, In your face and skin that you [00:27:40] think about estradiol or estriol for your [00:27:45] face.
You know what? I started doing this in secret more than 12 years ago when I was
Speaker 2: you, [00:27:50] that's really cutting edge 12 years ago. Wow.
Speaker: Well, because I mean, you know, listen, I'm curious [00:27:55] and I'm smart and I'm like, if I'm putting this cause it, when I started on hormones. [00:28:00] I had to go to the secret guy in Chicago that I mean, it wasn't commonplace, [00:28:05] right?
So I'm calling up the secret medicine guy and he gave me a [00:28:10] compounded estrogen for systemic use, which I don't use anymore, but I'll tell you. So I'm, I have [00:28:15] this cream. I'm thinking I got to put it somewhere. Why don't I put it on my face? [00:28:20] And my, my esthetician, I know, the esthetician I went to, she's [00:28:25] like, what are you doing?
Cause you're pretty old and this stuff is working. So number one, [00:28:30] estriol, estradiol formulated for your face. Now here's the deal. It's a very low [00:28:35] dose. It is not systemic doses. It was not probably okay that I was putting my [00:28:40] systemic dose on my face. Really low dose. Number two, systemic [00:28:45] estradiol. Systemic estradiol, it's my opinion, is best [00:28:50] delivered transdermally because there are no first pass effects through [00:28:55] your liver.
Like, if you take a pill, A, it's conjugated estrogen from horse, [00:29:00] horse's urine. Number two, it has a first pass effect, meaning it has to [00:29:05] go through your gut. The blood will then go through your liver. The liver will take out all the stuff. [00:29:10] Your blood clotting factors will be affected. It's still the right choice for many [00:29:15] women, but not for this woman or not for my patients.
So I prescribe and take [00:29:20] transdermal estradiol, which means a patch or a cream. The [00:29:25] third kind of estrogen, and then I'll get to the other ones, the third kind of estrogen that I [00:29:30] think every woman in midlife needs is vaginal And [00:29:35] perineal estrogen, because the genitourinary syndrome of menopause [00:29:40] is real, and when sex hurts like razor blades, or you're [00:29:45] having bladder infections, 30 percent of the time people will die of urosubstance and [00:29:50] chronic recurrent bladder infections, that prolapse of their uterus, [00:29:55] because we talked about pelvic floor.
So, well treated by [00:30:00] vaginal estrogen and the data show that it is safe for [00:30:05] everyone, including women who have breast cancer, have been treated [00:30:10] for breast cancer, have been secured from breast cancer. The data [00:30:15] shows there's a new study this year, vaginal estrogen, the three kinds of estrogen. You [00:30:20] can also for gyne, genital urinary syndrome of menopause.
Use [00:30:25] DHEA. It's also a great solution. Fourth hormone, if you [00:30:30] have a uterus, if you have a uterus, you must protect your [00:30:35] uterine lining with micronized progesterone, not synthetic progesterone, [00:30:40] progestins. Micronized progesterone. It's a pill. 100 milligrams, [00:30:45] usually, every night. And by the way, it helps you sleep.
I do, if I get [00:30:50] in bed, and I don't take it, I get out of bed. Because it helps me sleep so well.
Speaker 2: [00:30:55] Oral progesterone is a gift, not quite at that dose, but even for men, it's really important.
Speaker: [00:31:00] Dave, my husband's going to kill me. He was having trouble sleeping. I put him on it.
Speaker 2: [00:31:05] Yeah, it totally
Speaker: works. It totally works.
And then finally, I am a big, [00:31:10] big believer in testosterone for women, and why wouldn't I be? Yes, so
Speaker 2: important. [00:31:15]
Speaker: It's like, I forget the movie, where, I just [00:31:20] forget it, but it's a perfect scene. It's in black and white. And then the camera rolls [00:31:25] and it's suddenly technicolor vibrance. That is what testosterone feels [00:31:30] like to me.
It, like, gave me this thing back that I've always been. The dullness came [00:31:35] off. And women have to be careful. I mean, we have to keep track of [00:31:40] testosterone levels. I'm a big fan of transdermal [00:31:45] testosterone. Mainly because I don't like the results of an overshoot. [00:31:50] You cannot control what you get in a pellet, or how your body is going to metabolize it.[00:31:55]
And so it is not uncommon. to overshoot [00:32:00] and, and shoot your testosterone up into male levels. And that's fine if you're trying to transition, [00:32:05] but not everybody wants those changes, right? I mean, so [00:32:10] we need female testosterone less than about a hundred. And so with, you know, and I've [00:32:15] seen. I've seen pellet testosterones up in the 400s and it's miserable until you [00:32:20] absorb it.
Speaker 2: So much knowledge there. And the best place to put a [00:32:25] topical testosterone for women would be on the vulva, right?
Speaker: Well, you can put it there. I happen, [00:32:30] you can put it on any fatty place. I happen to put it on my inner thigh. They call
Speaker 2: that scream cream because of the [00:32:35] vascularization. Yeah,
Speaker: yeah.
Speaker 2: I mean, it, it has beneficial effects, uh, [00:32:40] for women, but you can put it anywhere you want.
Speaker: Yeah, women have erectile tissue, [00:32:45] just like men. People don't know that, but they do. We do. So. Oh, yeah.
Speaker 2: You also [00:32:50] mentioned topical estrone and estradiol, uh, for the face, and that it's not [00:32:55] systemically absorbed. I have a really good skin on my face, don't I?
Speaker: You look good from [00:33:00] here.
Speaker 2: Well, I have filters on, I'm kidding, but I, I do, and, um, [00:33:05] One of the reasons is I use a very low dose.
Good for you! [00:33:10] Right? I'm kind of a leader in longevity, so I, I know this stuff, but very few guys will do it because you're [00:33:15] afraid it's systemic, but the data's very clear, it's not systemic, it's just local, and you start doing that a month later, [00:33:20] like, what is going on with your skin? I'm like, my skin is looking better than it has in a long time, and it always looked pretty good, because I have [00:33:25] access to every toy there is and all this stuff.
So
Speaker: Dave, I love that [00:33:30] because it just goes to show what the data say you're, [00:33:35] you're not transitioning to a woman. It's only, it's 0. 03 milligram. It's [00:33:40] so tiny doses. Yeah.
Speaker 2: It's
Speaker: just local. Oh, I love that you're [00:33:45] doing that.
Speaker 2: And we, we just did a, another episode of the show where we talked about men using [00:33:50] up to one milligram of estrogen.
Because of [00:33:55] the cardioprotective effects and the libido effects in men. And it's not enough to have any feminization [00:34:00] whatsoever. So,
Speaker: well, isn't it funny? Can I be a little political for you [00:34:05] right now? Is how funny is it that we are so able just to let men [00:34:10] experiment on themselves and we're not worried about you crumbling.
But we [00:34:15] cannot get the box label off estrogen for women when there is [00:34:20] no data in the first place to support it. What's up? With that, with that [00:34:25] horrible misogyny that we're going to control women, but we let men just experiment. [00:34:30]
Speaker 2: Well, that wasn't really something a doctor let me do. Cause, and also for men, like [00:34:35] are the black box warning for testosterone, which lowers your risk of dying for [00:34:40] men from everything, that had a black box warning until about what, three months ago.
So it was [00:34:45] like, FDA, we didn't hire you guys to tell us what hormones to use. Like, shut the F up and [00:34:50] get out of my life. If you want to provide advisory stuff, I don't care, but don't you regulate it? [00:34:55] And, and so, it's funny, for women, like, I don't want to take testosterone, I'd be too manly. And men are like, I don't [00:35:00] want to use the estrogen, I'd be too female.
Like, women have more testosterone [00:35:05] than estrogen. Like, you have to have some. Well,
Speaker: listen,
Speaker 2: they're not
Speaker: sex hormones. They're just [00:35:10] like thyroid and, you know, cortisol. They're just chemicals. [00:35:15] Your body doesn't know that we care so much about what's assigned to one person or [00:35:20] another.
Speaker 2: And you have to get the right levels for your biology.
And, and I think this is a [00:35:25] bit personal because your, your description of like the, the lights coming back on, the colors [00:35:30] returning. When I was 26, my testosterone levels were lower than my mom. And I've had her [00:35:35] lab tests from the same lab. You felt like
Speaker: terrible, you felt terrible. Oh, I felt horrible.
Speaker 2: 300 pounds, my thyroid was low too.[00:35:40]
And I went on testosterone and got my thyroid working. And [00:35:45] within three days of that, I'm like, Oh my God, this is how I was supposed to be feeling. [00:35:50] So that low T, which is now an epidemic in men and women, [00:35:55] It's so big because it's not about libido, which is nice. It's about [00:36:00] desire to do things that matter.
And it's tragic when you see someone who has, you know, [00:36:05] 40 or 50 years of life experience, who's just like, I can't, I just don't care. And it's not they don't [00:36:10] care, it's that they don't have the testosterone to care, and they don't have all the important [00:36:15] estrogen effects, which also are in the brain, right?
So it's just about having young people [00:36:20] hormones when you're a hundred.
Speaker: Yeah. Well, you know what? I have four millennial sons. Sons, and [00:36:25] I have told them all, get your baseline testosterone now so that [00:36:30] when you are 50, we can elevate your testosterone to your [00:36:35] level. Because when I test men's testosterone now, which I do, because when [00:36:40] men come into my clinic with multiple tendon, multiple ligament problems, I test their [00:36:45] testosterone.
And. They may be within the guides of [00:36:50] normal, and we said 250, or 350, which is really low, [00:36:55] but they may have been. 1050 when they were younger, right?
Speaker 2: Right. [00:37:00]
Speaker: So that's why with my own family, my own sons, I'm like, we're going to get a tested and we're going to put [00:37:05] that in our back pocket so I can elevate you to what you were when you were [00:37:10] young.
Speaker 2: Wow. Literally, three hours before we recorded [00:37:15] this, um, Axo. Health, which is the, the lab testing part of [00:37:20] Upgrade Labs I had them send someone to my house, my 18 year old daughter's here, and so we're getting [00:37:25] her hormones run to see where they are, so now we know. Right. And she, [00:37:30] she's learning to be comfortable with needles, you know, not, not the most fun thing, [00:37:35] but she's willing to do it because she's seen, you know, what I've seen that biohacking might have [00:37:40] some merit, uh, which is kind of cool.
But if you know, you're [00:37:45] young, vibrant levels, they could be radically different than the person next to you.
Speaker: [00:37:50] Right. I would love for every woman, if I'm setting policy, [00:37:55] the very minute. If you decide to have children, that you are done with [00:38:00] children and their weaned and everything. We need to know what your [00:38:05] hormones settle back to so in the future we can know that [00:38:10] information, right?
And now I don't personally prescribe perimenopausal hormones based on [00:38:15] levels, but I think it's important to know when we felt our best [00:38:20] what we were. And that's just my philosophy as a physician.
Speaker 2: I like to [00:38:25] treat symptoms as a non physician, which says, you know, if your body [00:38:30] needs more testosterone to feel good than we think is the right level, let's just treat until you feel good.[00:38:35]
Unless you start to
Speaker: transition, I mean, Some people don't like those changes. Yeah,
Speaker 2: [00:38:40] if you're if you're growing a mustache and that's not your vibe granted But it rarely [00:38:45] happens And you back off if it does unless it's a pellet because pellets [00:38:50] don't happen. I was gonna say
Speaker: Oh, thank you for clarifying creams.
You can go up and down [00:38:55] daily actually Pellets you're stuck and i'm not okay dave We've said a lot of things on this [00:39:00] program already, but clitoral megaly is real and it's irreversible. So if you don't want [00:39:05] that You
Speaker 2: Okay, there's a group of 40, 000 women on Reddit right [00:39:10] now who are intentionally doing clitoral [00:39:15] enlargement.
Really? Oh yeah, they're putting a low dose of testosterone, one drop, right on [00:39:20] the clit and the hood. Yeah. They're using a little pump, and they're reporting [00:39:25] incredibly explosive orgasms, and they're saying, I've got more nerves, I've got more blood [00:39:30] flow, I'm really happy. And it's only, you know, a little bit bigger.
They're not, you know, growing two inch [00:39:35] things or whatever, but that may not be a bad thing to have a little bit more blood flow, they're just [00:39:40] saying.
Speaker: Interesting to think about, actually.
Speaker 2: Yeah, I haven't experienced that myself for obvious [00:39:45] reasons, but like, hey, if I had that kind of equipment, I'd probably hack it too.
It's not like I [00:39:50] don't
Speaker 3: That's
Speaker 2: interesting. You know, there, there's also, one of my company's [00:39:55] wasabi method does shockwave therapy. And we make a device that works on women and men. It [00:40:00] helps with pelvic floor stability, but Mm hmm. It will grow more blood vessels and [00:40:05] nerves in men or women when you use it, you know, around the recreational [00:40:10] zones.
Yeah. And, you know, there's all these different technologies for, uh, for [00:40:15] women around restoring the thickness of tissue. There's stem [00:40:20] cells, there's, there's RF, there's LEDs, electrical stimulation, there's the [00:40:25] topical stuff you just talked about. So it's almost, we're to the point where. [00:40:30] If you are in a place in life where you can invest in your health, and [00:40:35] you have thin walls, you have pain on sex, you have lack of lubrication, all those things [00:40:40] are eminently hackable, starting with hormones, probably first, then pelvic floor [00:40:45] strengthening, and then maybe you need a little stimulation to get the tissues to [00:40:50] thicken or to have more blood flow, and the difference in quality of life and quality [00:40:55] of relationship is so big, but most people don't even know this stuff exists.
And, and I [00:41:00] love that you're talking about it together with the muscle conversation.
Speaker: Well, and I'm certainly [00:41:05] glad that you started in that order. I, I, I treat, I treat a lot of people who [00:41:10] come to me for longevity. And what I find is that many people have [00:41:15] listened and they, and they're very curious, but they want to start on the [00:41:20] outside of what we already know works.
So I always start with health, [00:41:25] health optimization. And so you said hormones first, and then you [00:41:30] said muscle second, and then you started delving into, can we [00:41:35] augment tissue? Can we use lights? And, and I love that [00:41:40] sequence because I don't think skipping ahead to mechanics will ever be better. [00:41:45] And replacing your hormones and working on your muscles.
I mean, you need a little [00:41:50] endurance to, if you're, if your parts are all working, you need a little endurance, right? So muscles matter.[00:41:55]
Speaker 2: Let's assume your [00:42:00] hormones are in place and you know, you maybe you, you, Made the [00:42:05] mistake of listening to Peter Atiyah who is afraid of testosterone therapy, but he's telling you that [00:42:10] VO2 max and exercising like 20 hours a week is the only way to die at the same age you were [00:42:15] going to die, but at least die healthy.
So what's up with the obsession with VO2 [00:42:20] max?
Speaker: So you know what the in scientific, in the science world, VO2 [00:42:25] max is the best predictor of longevity. And I'm going to tell you [00:42:30] why. There is a line. called the fragility line. It [00:42:35] is the line when your VO2 max is low enough that you cannot live [00:42:40] independently, meaning you can't get up from a chair, which means you're not getting off the toilet, which means you're probably not cooking food.[00:42:45]
For men, it's 18. For women, it's 20. For women, it's 18. For men, it's [00:42:50] 15. So, let's put that in comp your people know this, but an amazing [00:42:55] VO2 max is 40 to 50, right? For mere mortal athletes like me, [00:43:00] for for world class athletes who were born with special protoplasm, they're [00:43:05] usually 75 or more, like the Tour de France people.
But here's why [00:43:10] It matters, and I'm going to tell you why I don't think it's the only thing that matters, to your point. Last time I got [00:43:15] my VO2 max tested, I was 50, and it was about 50. Let's [00:43:20] use round numbers, because I was, I've always been an athlete, an endurance athlete. So, [00:43:25] we will lose 10 percent of that per decade if we do nothing, if we do not [00:43:30] reinvest.
So, 50, it was 50. 60, it's going [00:43:35] to be 45, 70. It's going to be 40 ish, [00:43:40] 70. You see where I'm going. I am never crossing, even at 90 [00:43:45] crossing the fragility line. But if we start out in midlife at [00:43:50] 30, because we've been sitting on our butts our whole life, or we're too digital or whatever it you've been [00:43:55] sick your whole You will very quickly cross the fragility line [00:44:00] before.
Your 70s or 80s. So in that sense, I [00:44:05] think it's very useful to know what it is and to train for it. But, here's the [00:44:10] deal, when I prescribe it, I prescribe it after health optimization. [00:44:15] For health optimization phase, cause my phases go health optimization, [00:44:20] peak performance cause I'm an elite sports doctor and so I pull in all the techniques I [00:44:25] use with my athletes and then finally, finally, longevity, [00:44:30] let's do all the stuff that's been tested on rats, right?
So, in my health [00:44:35] optimization phase. We're not doing VO2 max training, we're [00:44:40] walking and twice a week we're sprinting, right? We're, we're max [00:44:45] men. We're getting to get the max out of the minimum because that's all people will do for me. I think more [00:44:50] importantly, and you've had so many guests about this, you gotta build the [00:44:55] muscles below your belly button.
We are designed to move. If we [00:45:00] sessile, um, mushrooms. We would have a [00:45:05] mushroom stalk with our brain on top. That's not how we're designed. [00:45:10] So, so, we gotta build some muscle, and so I always tell people, take your [00:45:15] hormones, build your muscle, walk, until we [00:45:20] optimize. Only when we optimize, Do I then train people how to train [00:45:25] their VO2max?
Cause it's just hard and people don't want to do shit anyway. Oh, I [00:45:30] just swore on your podcast.
Speaker 2: Oh, you can, you can swear. Um, it just, it means that you're a [00:45:35] highly trained doctor. I mean, I'm an orthopedic
Speaker: surgeon. We all do.
Speaker 2: What surgeons don't [00:45:40] swear? Come on.
Speaker: Yeah, yeah.
Speaker 2: No, but here's the thing about VO2max.
Yeah, it's an important [00:45:45] marker, but we have this idea that, oh, it's hard to train it. Yeah. In 15 minutes a [00:45:50] week. Yes. Yes. And that's not very much time. We have technology [00:45:55] using AI that will increase your VO2 max by 12%. That's at Upgrade Labs. And it's just an AI [00:46:00] bike. There's another 10 to 12 percent available with another technology we have there.
The [00:46:05] metabolic trainer. But it's, it's intermittent hypoxic therapy. So for people who don't want to go beat [00:46:10] themselves up, you know, sweating all over the place, um, Then, [00:46:15] well, you could sit here for a half hour and breathe through a mask and get 12 percent and five minutes, three [00:46:20] times a week, you could do something mildly hard and combined, that's about a 20 percent increase [00:46:25] in VO2 max, which is enough.
In fact, that's probably going to get from like eight hours of Zone 2 training. I don't [00:46:30] have eight hours and I don't like Zone 2 training. I'll do it if I have to. I don't have to. So, I just [00:46:35] want women who are listening and men. No VO2max matters, and then do [00:46:40] something about it, but it doesn't have to be going out there and beating yourself up unless you like that, [00:46:45] and take the time you save and do some squats or some functional movement, right?[00:46:50]
Speaker: You know what, Dave? I find, I'm, and this is, it's genetic. I mean, we are [00:46:55] built to survive. I just, for the majority of people that [00:47:00] I serve, not, not all of them, it's hard to be consistent. [00:47:05] So if you're offering ways for people to get it in and get it over with, [00:47:10] that's a good, that's a good outlet, because I even count the steps walking up and down my [00:47:15] hallway in my clinics, because I'm going to count everything, so I don't have to do extra, [00:47:20] right?
I mean, I'm not, yeah.
Speaker 2: And, you know, we, we all want to do well and there's only [00:47:25] so many hours. Okay, do you want to spend a half hour cooking proper food, which is going to drive your bone [00:47:30] density and your muscle mass and things like that? Or did you want to skimp on that so you could do [00:47:35] more exercise, but then, you know, eat at a restaurant that didn't do it right?
So I'm always trying to say, well, [00:47:40] how do I get the biggest bang for the buck? Because I have a few companies and I have a life and. [00:47:45] All this, and perfection is not required, but hormones are [00:47:50] required, right?
Speaker: I, that is the line I fall on. Yes, it is. Yes, it is. [00:47:55] And you know what, personally, the reason I'm so vehement about spreading the [00:48:00] gospel to the 40 ish es, that's what I call them, is because I sure wish I would have done it [00:48:05] earlier.
I didn't know. It's been over a decade. And so when I went through this, [00:48:10] nobody was talking about it, right? That's, you know, what, [00:48:15] what could I could have been so much even more like masterful of this had I done [00:48:20] it earlier because I just, I don't want, I have millennial daughters in [00:48:25] law. I don't want them to suffer like I did.
Speaker 2: Yeah, I had a lot of the [00:48:30] diseases of aging before I was 30, which at the time sucked, but it did, it did make me an [00:48:35] expert in longevity. Yeah, it worked
Speaker: for you, right? It worked.
Speaker 2: Yeah, but man, I, I just, I don't want [00:48:40] to go back to that. Yeah. Yeah. I see friends who don't, who don't do the basics and like, man, you don't know where [00:48:45] you're going.
There's some other, some other weird stuff that, that I don't talk about very [00:48:50] much, but I've seen you talk about. What's velocity training? And what does that have to do with longevity? [00:48:55]
Speaker: Yeah, so, uh, when we talk about weight training, and I get a lot of criticism [00:49:00] out there about this because I prescribe for people low reps, high [00:49:05] weights.
And there's a method to my madness. Listen, I had a woman come in to me the other day who [00:49:10] was told. To lift very lightweights 25 times for [00:49:15] two sets and I said, okay, well, what's our goal is our [00:49:20] goal? Endurance, okay If your goal is endurance, then you lift the [00:49:25] lightest thing you can forever and you'll build some endurance is your goal [00:49:30] Hypertrophy like bodybuilders.
Do you want big bulging and they look great. Of [00:49:35] course you want those that is a different set of reps [00:49:40] I, as the orthopedic surgeon who puts rods in bones when you become [00:49:45] frail, I want you to have strength in what strength [00:49:50] means in one movement, right? Strength means I can lift something heavy, [00:49:55] and I want you to have power, which is strength over time, strength [00:50:00] with motion, so that you can move.
Do not fall down so that you can get out of the [00:50:05] way, so that you can use your power to get up. That requires, [00:50:10] strength requires, fewer reps, fewer sets, but heavier [00:50:15] weights. If we want power, Then we have to train [00:50:20] for the fact that we lose type 2 muscle fibers first. And [00:50:25] when we don't have estrogen, then we lose the anabolic stimulus that those have.
[00:50:30] So we have to train our bodies and we do it with speed. So when I'm [00:50:35] training, uh, I don't really love this, but, but my, when I was first [00:50:40] training in powerlifting, we mastered the powerlifts, we mastered [00:50:45] the low reps, high weights, and then When I was taught this, it was, [00:50:50] we are going to go down regular. Let's do a squat.
We're going to go down regularly, and then [00:50:55] we're going to explode up like really tempo lifting [00:51:00] that will then add the. Strength over time [00:51:05] element that will train us in power. We don't look quite as [00:51:10] heavy when we do that. We cut back on the, on the really heavy weights because we're [00:51:15] adding that component of explosive power.
You can get at this by box [00:51:20] jumping. Lots of people, whether they're in my clinic or on the internet with me, they're really afraid of [00:51:25] jumping. It never occurred to me before I showed people, I jump a 24 inch [00:51:30] box right now. People are afraid of that. So you can get [00:51:35] at it with plyometric drumping, or you can get at it with increasing tempo [00:51:40] with lifting.
Speaker 2: You talked about bone density as well. When you're doing that velocity training, you [00:51:45] flex the bones a little bit, which causes them to become more dense if you have the [00:51:50] right minerals and the vitamin D and K2 and all that kind of stuff, right?
Speaker: So bones [00:51:55] respond. Bones are not static. Pillars. We think of them that way.
The, [00:52:00] I like to tease, they're the, people think they're the strong, silent type, not saying [00:52:05] anything. But actually they are talkers. They are talking all the time, [00:52:10] communicating. What they are also doing is adjusting to the load, not by just [00:52:15] bearing the load. They are bending under it. And we can see in a femur [00:52:20] bone, which is shaped like this, the femoral head, the femoral neck, we can see the [00:52:25] trabecular lines.
in the bone on an x ray following the stress [00:52:30] lines so that when you step on your hip for an instant it goes like that a [00:52:35] millisecond it goes like that and that teaches the bone to lay down in those arcs [00:52:40] of stress right so that's what you're talking about we're not only [00:52:45] impacting the bones we're
Speaker 2: It's an [00:52:50] important part of staying young for a very long time is having bones and fascia and [00:52:55] muscles that work and the kind of training you're talking about it.
It's so important [00:53:00] after you have at least enough muscle mass in order to be useful. There's something else that seems to [00:53:05] be a problem. And we talked about it a little bit earlier. You know, some of your muscles can just sort of get [00:53:10] turned off, and then your brain does not address them. What do we know about micro [00:53:15] instability and fall risk as a brain signal, not necessarily a body weakness?
Speaker: [00:53:20] You know, there's this phenomenon within weightlifting called beginner's gains, right? [00:53:25] Suddenly go from lifting no weights. You're like, Oh my God, I'm so strong. That is [00:53:30] retraining of your neuromuscular pathways because the way motor neurons work is one [00:53:35] nerve goes down and it ends kind of like this and it innervates [00:53:40] one.
bunch of muscles. So what we're doing when we're first learning to lift [00:53:45] and putting a lot of load across, we're actually retraining that [00:53:50] neuromuscular pathway so that it's more efficient. You recruit more muscle bundles [00:53:55] with a single stimulation. So much of the functional [00:54:00] gain that we get when we begin lifting Uh, is that neuromuscular [00:54:05] pathway?
In fact, when I first started doing longevity research, I was reading some of the [00:54:10] original studies. There was this researcher named Maria Fiatarone, and her studies were [00:54:15] done, uh, in 90 year old men living in a nursing home. She did a bunch of [00:54:20] chair exercises and, and really low key stuff, but what she got was [00:54:25] 150 percent increase in their function.
They could get up, they could walk around, they [00:54:30] L is retraining their neuromuscular pathways.
Speaker 2: Some people think, oh, that this, [00:54:35] this isn't possibly real, but there's two examples. One is you see a Shaolin [00:54:40] trained monk somewhere doing one finger pushups with no visible muscle [00:54:45] mass, but somehow there's incredible strength.
And then you see Anatoly. on YouTube. [00:54:50]
Speaker: I
Speaker 2: love this guy. He looks relatively [00:54:55] normal and he's lifting things that people three times his muscle and I can't wait. [00:55:00] So the neurological side of strength is incredibly important. But here's the question [00:55:05] for longevity. What's more important strength or muscle mass?
[00:55:10] Strength I think so too. It's about strength and power and you can have a [00:55:15] giant bicep or have a smaller bicep as long as your strength is there. That's going to keep [00:55:20] you young longest. And there's probably some upper limit. We're having too much [00:55:25] muscle mass. In relation to strength isn't even good for you.
There's a lot of professional bodybuilders for
Speaker: [00:55:30] very unhealthy.
Speaker 2: Yeah. Their, their heart has to deal with all that muscle that isn't actually as powerful as [00:55:35] it looks. And I'm not saying that you don't want muscle mass. You do. I'm saying you want strength more than muscle mass [00:55:40] and both would be ideal.
Speaker: I think when you're training for strength, you will gain muscle mass.
And one year [00:55:45] I gained eight pounds of muscle. As I, through menopause, I had to correct [00:55:50] myself here. And so you will gain muscle. You will. Look, you will [00:55:55] look leaner, which is what people want anyway. Right. But I [00:56:00] also think there's a certain genetic component. There's the, you know, Anatoly, he's probably a [00:56:05] genetic specimen and lifts for strength.
There's also this phenomenon. I grew up [00:56:10] on a farm in Kansas and it's called farm boys strong. These kids, [00:56:15] oh my god, they could lift a cow, but they don't look like they could lift a cow. Versus [00:56:20] the bodybuilder, you'd think could do it, but they're And listen, I'm not trying to make enemies of the [00:56:25] bodybuilder crowd, but There's a difference.
Speaker 2: Yeah, and there's there's physique [00:56:30] and then there's some other kind of strength that I think is more neurological Plus [00:56:35] muscle and fascia and bone and I'm interested in all the above.
Speaker: Yeah, [00:56:40]
Speaker 2: so I gotta ask you this You're an orthopedist.
Speaker: I am
Speaker 2: So there [00:56:45] was a time where I might have used some SARMs. These are kind of [00:56:50] research grade things.
Selective androgen receptor modulators. Wrote a big blog post about [00:56:55] it. But I put on 29 pounds of muscle in six weeks. To the point going on stage [00:57:00] at a Tony Robbins event and I packed the normal shirt I would wear for that and I blew out buttons [00:57:05] putting it on. I had to like go to the local TJ Maxx or something and find anything that would fit this dumb looking [00:57:10] blue shirt.
And I just remember like, this is crazy. Why wouldn't women just use [00:57:15] slams and put on 20 pounds of muscle in a month or two and just be done with it?
Speaker: Uh, well, [00:57:20] number one, there is no such thing as be done with it. You will, uh, you will [00:57:25] lose muscle that you don't use. Number two, that is the [00:57:30] surefire way for women to do what many women use as an excuse, [00:57:35] not to lift at all.
Bulk up, especially the story you [00:57:40] just told, because if you put on 29 pounds of muscle, [00:57:45] you're going to change your body shape, which most women want to change their body shape [00:57:50] in midlife, but to that extent, now I don't have an answer for why wouldn't they just [00:57:55] do it, but, but you would not maintain muscle if you didn't keep working out, right?
[00:58:00] There's so. You can use additives like that, but I, in my [00:58:05] opinion, it can't be the end all be all. You can't skip ahead of nutrition. You can't skip ahead of, [00:58:10] you can't skip ahead of continuing to lift weights for all the other [00:58:15] benefits. Um,
Speaker 2: You still, I mean, you're going to lose the, the, the [00:58:20] mental aspect of it and the neurological aspect of it.
If that was all you did, I'm just [00:58:25] assuming that if you're going to work out and you're doing something like that, you could work out less. And I'm not suggesting you [00:58:30] do this because what happened to me. was your muscles can grow fast, but I mean, you're an [00:58:35] orthopedist. How do tendons and ligaments respond to growth compared to muscles?
Speaker: You [00:58:40] know, tendons and ligaments, uh, don't have a real intact blood [00:58:45] supply. They get their blood supply from the peritonin and the, and the, the coating around [00:58:50] the ligaments. And they don't repair themselves very well. That's why they get, you [00:58:55] know, every time we work out and they're pulled hard. And I can only imagine what happens with 29 [00:59:00] extra pounds of muscle.
Yeah. They're going to be under a lot of stress and strain, [00:59:05] and they're going to develop a lot of these micro tears. Don't heal. And so, [00:59:10] what happens Exactly. I tore both
Speaker 2: my shoulders. That's what happened. Oh no! You had a
Speaker: point [00:59:15] to this, right? I
Speaker 2: have stem cells. I fixed them, but it was painful for a couple of years.
It sucked. [00:59:20]
Speaker: Mm hmm. It's painful, and then they're torn, and then your muscles stop responding because they're not connected to [00:59:25] anything, and then, yeah.
Speaker 2: And that said, if you were to follow any Your advice [00:59:30] and get on the right dose of testosterone. When you exercise, you'll build muscle. And if [00:59:35] you're a woman or a man who's low in testosterone, when you exercise, you just don't get results.
And then, of [00:59:40] course, you're not going to do it because you sweated, you worked hard, and You got nothing. You didn't put muscle on, right?
Speaker: [00:59:45] Well, and I am of in the camp that you have to feed your muscle. And I also get a lot of criticism [00:59:50] for this, but when I evaluate women just off the street and they're telling me they have [00:59:55] a salad, plus or minus a protein and they don't eat breakfast and they're getting less than [01:00:00] 60 grams of protein a day, I don't know where they think they're going to build their muscle from.
[01:00:05] So, Uh, from kale. Yeah, [01:00:10] let's get it from kale. But so, you know, you gotta, it's all the things to [01:00:15] truly build a sustainable system. And that's why my approach is if you're truly [01:00:20] optimized, listen, if you are so optimized and we're moving on to peak [01:00:25] performance and you are, I had, I had a guy who wanted to climb to base camp.
He was [01:00:30] 63. He thought it was the last time he was going to get there. I'm like, okay. [01:00:35] Here's the things we're going to do for peak performance, and then I'll entertain all these extra things. [01:00:40] Because he truly had done the work.
Speaker 2: Right.
Speaker: Yeah, that's just me as a [01:00:45] physician philosophy, you gotta put, you gotta build and do the [01:00:50] work.
Or else what you have so honestly said is that you're gonna hurt [01:00:55] something.
Speaker 2: Exactly. I've heard people say, you know, there's no such thing as a free [01:01:00] lunch. Which is Absolutely, provably false. You can get free lunches in lots of [01:01:05] places. So, as an adage, no, you can get a free lunch. [01:01:10] And for a unit of exercise, you can get very little results.
And for the same amount of work, you [01:01:15] can get greater results by setting yourself up for success. Hormonally, nutritionally, sleep [01:01:20] wise, like the whole thing. And it's, okay, let's do enough of that, that exercise is worth [01:01:25] it. And. Even if you didn't do the exercise, you would be better off because [01:01:30] you fixed your hormones.
And if you do both, to the point of your whole practice here, like, that's the [01:01:35] recipe for women to be really powerful.
Speaker: That's it. That's right. There's, there, you know, it's, it's [01:01:40] not one thing. Sometimes people are like, I'm going to get the one thing, or I'm going to buy the one thing. It's, I'm [01:01:45] sorry. We are a biological system.
That is not how we work.
Speaker 2: If you [01:01:50] could offer three pieces of advice to turn menopause [01:01:55] into something positive, like a metabolic renaissance, three most important things. [01:02:00]
Speaker: Number one, we are going to pivot our mindset. I call it mindset [01:02:05] mobilization. We are going to stop. Our mind will do what we tell it to do.
And if we are [01:02:10] telling it, I always look over my left shoulder. Oh, 26 was the most [01:02:15] amazing time, which we know in your life it wasn't, in my life it wasn't. Then you are [01:02:20] never going to pivot your mindset to be curious enough, to work hard [01:02:25] enough, to understand that these can be some of the best years.
Because yeah, [01:02:30] there's a lot of value to being that young, but there's so much more value once you [01:02:35] are established. You have a little bit of money. We're more settled in ourselves, right? So we [01:02:40] got to pivot our mindset and that includes building mental resilience [01:02:45] by understanding what we feel about control, right?
When you're [01:02:50] older, our hard things Hopefully no longer make us [01:02:55] feel like we have no control. I firmly believe we have agency in most [01:03:00] things. Number two, it has to do with commitment. How committed are you to being 97 and [01:03:05] doing what you want when you want, when you want it? And number three, do we view aging, [01:03:10] which can be hard for some people [01:03:15] mobilization.
It's probably the surprising [01:03:20] answer because usually it's physically better, right? Number two, uh, but I don't [01:03:25] think you're going to put in the work unless you believe you can be a badass again. I don't think you're going to do [01:03:30] it. So number two is the things we've talked about. If you choose one [01:03:35] thing other than eating well, you're going to lift weights in my opinion.
You're going to invest in your [01:03:40] muscle mass. And then number three, I guess it's another attitudinal thing, but [01:03:45] I see this all the time. I think by the time people get to you, they have [01:03:50] made it through this. But I get people when they just start and they don't believe they're worth it. [01:03:55] They believe everybody else is worth their time, their energy, their money.
And [01:04:00] so I just encourage people that you are worth the daily investment in your [01:04:05] health. And in doing so, you can take care of everybody else.
Speaker 2: Wow, that's, uh, such powerful [01:04:10] advice. I, I very much, very much resonate with that. As we're wrapping up the show, I, [01:04:15] I've come to the conclusion that we're, we're lacking our village [01:04:20] elders, you know, and, and, In my life, in my mid twenties, [01:04:25] people in their eighties and nineties mentored me in longevity.
And that's the only reason I can do the things [01:04:30] I'm doing today. And right now, so many women and men, [01:04:35] they hit sixty and their energy's gone, they can't remember anything, they're in pain all the time. [01:04:40] And they can't show up the way that they want to in the way society is [01:04:45] designed.
Speaker: Yeah.
Speaker 2: And if we're going to make it, everyone's getting older, we're not having any [01:04:50] babies.
So our only choice is to take our people as we age and turn them [01:04:55] into powerful elders. You're like, no, no, we saw the last two times you tried to run [01:05:00] that scam on us, FDA, so we're not gonna let you do it again. Things like that. So, [01:05:05] the work you're doing is, is societal. It is. Thank you. More so [01:05:10] than I think people might recognize because we have a bunch of, you know, powerful people who are [01:05:15] full of wisdom.
Energy and we'll, we'll call it peace and calmness because their [01:05:20] hormones work. That's when it's really hard to program us and get us to do things we don't wanna do. [01:05:25] And that's the world I'm working to build. I can tell you are too. And thank you for being on the show.
Speaker: It's my pleasure. I love [01:05:30] talking to you.
Speaker 2: Now, if you like this episode, there's a lot more [01:05:35] wisdom that Fonda has for you in her new book. It's called Unbreakable, and you [01:05:40] go to Dr. Vonda wright, W-R-I-G-H t.com, or [01:05:45] just look for Unbreakable Vonda. You'll find it wherever books are sold. This is important stuff. [01:05:50] And. I will suggest this for you. If you're a guy and you're with a [01:05:55] partner who is going through perimenopause, buy this book as a gift, [01:06:00] because this is precious knowledge that all women should have, and it's just not [01:06:05] evenly distributed.
It is not very expensive. to do the things she's talking about, and [01:06:10] they save hundreds of thousands of dollars in medical bills later in life. But more [01:06:15] importantly, they save all the suffering that most people, especially in the U. [01:06:20] S., go through as they age. It is entirely optional. So this is an important book, and it's worth getting for someone you care [01:06:25] about or just for yourself.
Thanks, Vonda. You're doing great work in the world.
Speaker: Thank you. I'll see you soon. [01:06:30]
Speaker 2: See you next time on the Human Upgrade [01:06:35] podcast.