you only have to do that for 30 seconds that will burn 40% more fat than even high-intensity interval training really so it begins with Dr Vonda Wright is a renowned orthopedic surgeon and a pioneering researcher in mobility and aging through simple methods she enables people to maintain their strength all the way through till their later life we have no excuse until our mid 70s for slowing down these are MRI slices of a 40-year-old athlete we have beautiful muscle architecture but if we sit around for 35 years and have a desk job and we don't go move our muscles this is what happens Jesus my God but this is a 74y old who just invested in their Mobility four to five times a week so if you're an 80-year-old consistently lifting weights you are functionally as strong as a 60-year-old person who doesn't but I worry about joint pain is joint pain inevitable it is not but one reason people have pain is because of how much we weigh small changes in our total body weight can have profound effects on the joint pain we feel let's say this rock is 1 lb if you gain one lb you would think that this is all the amount of pressure you're going to feel but because of the mechanics what you actually feel is the weight of these bricks so you think gaining 10 lbs doesn't mean much but imagine gaining 100 lb of pressure so how should you be investing in your Mobility every day there are four components that we should try to find time for number one is quick one before we get back to this episode just give me 30 seconds of your time two things I wanted to say the first thing is a huge thank you for listening and tuning into the show week after week it means the well to all of us and this really is a dream that we absolutely never had and couldn't have imagined getting to this place but secondly it's a dream where we feel like we're only just getting started and if you enjoy what we do here please join the 24% of people who watch this channel regularly and have hit the Subscribe button means more than I can say and if you hit that subscribe button here's a promise I'm going to make to you I'm going to do everything in my power to make this show as good as I can now and into the future we're going to deliver the guests that you want me to speak to and we're going to continue to keep doing all of the things you love about the show thank you thank you so much back to the episode Dr vonder Wright you've been treating patients learning about medicine taking care of people and working in the industry you've worked in for almost 35 years now to do that yes you must have a great deal of passion you must be on a bit of a mission so my my first question to you is as you sit here today what is what is occupying your your focus your mind your passion what is that when you wake up in the morning and you think about the work you're doing and why you're doing it what is the answer to that the answer to the question of why I wake up every day and and rush into my work whether it's into the surgery or whether it's into taking care of IND individuals or writing is because I have been working under the Mantra of um I'm going to change the way we age in this country or in this world because when I started there was this steadfast belief the the national Zeitgeist has changed now but when I started there was this belief that aging was an inevitable decline from the Vitality of Youth down a slippery slope to Frailty where we would spend 20 years of Our Lives dying going to the doctor's office every 3 years and I never ever believed that I never believed it and maybe it was because when I was a child I lived at in the 70s where you could just take your kid with you to a race and my dad would do that and he he'd take me to a 5K and say wait here I'll be back in 20 minutes and I would see people in their 50s and 60s racing and they would be celebrated or or maybe it's because I started as a cancer nurse and I saw people fighting every day for their lives and I believed that that was not the destiny that we were that we were doomed to so as I progressed through my career and I started doing the research myself I realize that this myth we had in our country that or all over the world that aging had to be this inevitable decline was based on population studies and what does that mean well population studies just just look at a cohort of people and see what happens over time there's a huge study uh funded by the NIH in the United States called the health ABC for instance and they looked at a population of 70 year olds and just followed them over time well what do we know about populations of people well what we know is that up to 70% of them do not do one extra step of Mobility a day so what we know about aging has been what we know about sedentary living and so I did not believe that we truly understood how the trajectory of our aging could be for people who remained active across the course of their lives so my team and I did that original research and we proved that you can be healthy vital active joyful long into the foreseeable future much more than we gave ourselves credit for and it drives me because even over all these years 35 years 20 years of it as an orthopedic surgeon it is only now that people are beginning to pick up the mantle of prevention and not only disease care and so sometimes I sit back and I think oh my God you know I've been preparing for this time in the history of people my whole career so I am made for such a time as now so interesting because it's only in recent times I think from doing this podcast that I started to question the idea the sort of Mind virus that even I had that once I get to a certain age I just have to kind of concede to the inevitable Decline and it's only recently that I thought actually there's been a couple of people that have came here and told me about how to that that's not the case and actually it is a bit of a mind virus like the virus of that belief the impact of that belief is what causes you to give up yes and just to become frail and to stop moving and those kinds of things well because what that our brain tells us we know this I've and you've had many discussions about the connection between our brain and our body our brain will believe whatever we tell it and if our brain thinks that oh sometime 63 a light bulb goes off and we go from youthful vigor to aging and decline well then we start believing that about ourselves and you know there's a concept now that I work with all the time that really examines the difference between life expectancy in the UK life expectancy right now is 81 unfortunately in the United States at 77.6 from the from birth babies born now have a life expectancy of that much our health expectancy our health span the amount of healthiness we have is only about 63 so that gives us a huge Runway to change the trajectory and it also tells us that we're not dying at 63 we're dying on average at 81 so we can do everything we possibly can in those 20 years and we also know that 70 to 80 to 90% depending on who you believe of our health and aging is predetermined by our lifestyle choices not the genes we inherit so my mother is very thankful that I stop blaming her for all the health things that go on but but each and every person has the ability to live outside of their genetic predisposition and that is a very hopeful message that can pivot your mindset virus I I took the top sort of illnesses and diseases things like heart disease lung cancer um I can't even pronounce this one chronic obstructive pulmonary disease yeah COPD Strokes lower lower respiratory infections Alzheimer's disease type two diabetes I can't pronounce this one either col colon rectal cancers colon rectal cancers I nailed that breast cancer and prostate cancer and got the average ages that typical people typically get them then I weighted it by the amount of people that die um from each of those diseases with heart disease being the most popular and it did actually come up I used chat TPT I'm pretending I did this math myself it came up that 62.9 for years old is the exact age where on average I'm going to get one of these and I'm going to potentially die from one of these those are when they manifest you may have them before them they're not maybe you never knew it because I have people who say to me when I ask them their health history what medical problems do you have and they're like I don't have any only because they've never been to a doctor or maybe they've been diagnosed but they haven't gotten so bad that they're not spending three days a week in the doctor's office or maybe they they are sick those three categories right but your chat GPT data is correct that that is when it shows up and what does that correspond to that corresponds to when the average person retires so just when you start thinking you have time to live the life that you envision you're saddled with health problems that you have not taken care of but but think about it this way talking about this mind virus and how we need to change it um we can talk about this but I think that 40 is the most remarkable decade of a person's life and it's also the time to adult or get your ferbal explo together it's time to get it together from a health perspective well between 40 if you're just noticing your health at that time because maybe you've been working so hard and you never noticed it before you're raising other people or whatever the circumstances are between 40 and 63 you have time to course correct but if you decide at 63 to pay attention it is much much much harder and so you know part of my Mission you ask me why I wake up every morning to change the way we age in this country is to not only take care of people in my demographic my middle-aged demographic but to really get to my Millennial children and my Millennial nieces and nephews to say you have such control over your health if you just look up and pay attention what's your academic education can you run me through your s qualifications and how that pivoted and turned uh throughout your career sure I have a degree in biology uh from Wheaten college and then immediately after that uh there was such a shortage of nurses that they the UN Rush University said if you have a good Bachelor's Degree come we'll give we'll train you in another bachelor's degree in nursing and a master's degree in three years so I did and with that I went and took care of people with cancer and ran the rush Cancer Institute with the physician that was there at the time and then at 28 I decided to that through a series of decisions we can talk about that um I wanted to do great research but I still needed to take care of people because it is in my heart and soul to do that and so I went back to medical school at the University of Chicago at 28 only to choose the longest possible road which is orthopedic surgery which is an additional 11 years because it's four years of medical school 6 years of residency a year of fellowship and then I finally emerged what is orthopedic surgery oh we have yeah so orthopedic surgery is the lifetime care of the musculoskeletal system so what that includes is Bones tendons ligaments muscle adapost tissue it's the joints the from the spine to the shoulders hips the knees it's everything from cancer care of those organs through each one of those has a sub specialty hand uh foot Sports I'm a sports surgeon so I'm trained in shoulder hip and knee arthroscopy meaning I do very big surgery through very small apertures uh for athletes and active people um but this fun Orthopedic Sports career I've had of taking care of active people and athletes of all ages and skill levels extends outside of the operating Suite right I have I take care of the whole person which is unusual for an orthopedic surgeon usually orthopedic surgeons are very procedurally driven but I am whole person driven and I think that stems from at 23 years old taking care of people in the fight of their lives knowing that their whole lives are worth taking care of not just pushing chemo in the middle of the night when you say you focus on the whole person can you help me understand that cuz I think on one end of that spectrum is doing the surgery yes which you do and then is the other end of that Spectrum thinking about their I guess their psychology their emotions how they're feeling what I'll give you a few examples so if you're a uh you think of a sports surgeon taking care of young athletes so if I have a young athlete come in who I have I'll give you an example of a real person he's 19 he has been an athlete his entire life and just and been great at it right but never been hurt had the great Fortune of never being hurt until he stepped wrong he got slide tackled on the football field and he blew out his knee and his family was moving so he didn't get Immediate Care like he could have had he been in his own town so weeks later he shows up to me with a knee that's completely nonfunctioning this child who's a 19-year-old man is panicking in his brain he doesn't know why he's in so much pain why his knee won't work um psychosocially his family is in transition they don't have any of the support system and he no longer has his own team so that young man is dealing not only with the physical pain of injury he's dealing with the psychological anxiety of oh my God oh my God oh my God what just happened to my knee will I ever play again and they're dealing with the social aspects of here's a family without social support So as a whole person doctor realiz viewing this family not not only as their Sports surgeon you have an ACL tear you're meniscus teared here's how I'm going to fix it here's what we need to do before then here's the technical aspects of the surgery but how much protein are you eating because I need your body in tiptop shape to heal so I talk to my patients about their nutrition as well as their surgical but then from the perspective of I too am a mother with a lot of children thinking of myself how am I going to meet the needs of my child thinking of the mother she has no resources in this town she just moved here right trying to set them up with the the other people they will need to be surrounded with care and that approach to this individual family is exactly the surrounding them with care approach we take with professional athletes there is not one thing that is left unturned for a professional athlete we take care of them from the minute they wake up to the minute they go to bed and their family needs so this whole person care extends all the way across all types of people for a woman for instance who comes with a it's so typical for a midlife women to come in with an inflamed shoulder a frozen shoulder she'll come in because her shoulder no longer moves but knowing what I know about the life cycle of a woman and what happens in midlife before I even address the shoulder because sometimes they come insane to me without any prompting I think I'm falling apart and sometimes I think I'm going crazy cuz I didn't do it anything to my shoulder right when they say that to me we immediately start talking about well how are you sleeping are you having any hot flashes night sweat so so that I address them as a midlife woman who's lost their estrogen not just as a shoulder that doesn't work because for me that's pretty cut and dry it's the rest of it that truly is taking care of the whole person so that's what it means to me it's um it's personal to you isn't it I I feel like you have a great deal of empathy I can feel it on your on the surface of you I can see it in your face yeah where does that come from you know I think I think that I a much better listen you make people cry on this podcast and I think you're going to make me cry and I don't mean to but that kind of question I think that this unrelenting need to take care of the whole person has to have come from my time as a cancer nurse because I was only I was only 22 22 to 28 I was a cancer nurse and imagine what it's like to be so impressionable right you I got all this education but in the middle so my job was giving chemotherapy to people who were in The Struggle of their life and I'm 23 years old and chemo is pushed in the middle of the night and at the time in the '90s we did something called primary nursing which means every time that person came in if you would have come in I would have been your nurse every time you're in the hospital every month for 6 months so the kind of therapeutic relationship you develop is Meaningful and so I was 23 years old 23 to 28 the format of times of how I built my perspective on the world and I'll never forget this is the one story there's so many stories like this but this is the one story that answers that question I think why this is personal to me so I'm taking care of this woman and you know many many of the people I took care of won their battles you know they I was with them for 6 months every night some nights because people just want to feel normal I'm giving them their chemo they're watching TV and buying stuff online on the TV and I'm like why are you buying all this because they just want to feel like themselves right and many many people successfully walked out and forgot forgot our names right but not everybody did and so this one family she had been with us for six months and I don't know if you've ever been around people who are losing their battle with an illness or are are are living the last days of their lives but you can tell it's coming just by the way they breathe it is true people rally right before they die and so I knew this woman's time was coming but she had the most faithful family Stephen her family came every single day and she had a big family and we knew they were coming they were kind of loud and and we loved having them here but the night that answers this question I knew it was going to be our last night you can always tell and it was just she and I and the the light in a hospital room there's a light over the bed and then the bed so there's this light behind her and she's breathing in an agonal way but I can tell that she's waiting she knows her family is going to come the next morning so we make it through the night it's just she and I and and in the morning and this Hospital in Chicago there's a a window at the end of the hallway that faces Lake Michigan and the light starts coming in the floor lights up again and that's starting to happen it's about 7:00 and I hear the elevator Bing and it was her family coming so I step out into the hallway and this one was different they always came together every day but this time her sister was dressed in her wedding gown and the whole family with it was in their tuxedos cuz her sister was going to get married that day and they wanted her to be part of that even though there was no way she was ever going to be part of that so I I'm 23 years old I'm standing in the doorway my patient is over here her family is coming towards me and that indelibly seared in me the the balance between life and death the woman who is not going to continue her journey and her sister who is beginning her journey and I don't know how at 23 years old for that not to impact what I care about in life Stephen if you come to my house I don't give a rat's ass about my curtains or buying the shoes with the red Souls even though I can but at 23 that kind of life and death made me decide that people were worth working for and worth saving and so she had waited for them to come to her that day so she could share in the last family time they were going to have together and I don't think you come out of a situation like that without your whole life perspective being different and so even though you know I'm a sports doctor now how is that remotely as hard as being a cancer nurse I am a much better doctor now than I would have ever been had I gone straight into medicine what is that that perspective it's given you specifically that then translates to being an even better Sports Doctor how does it change how you it means that I can't view the procedure as just putting screws in the ACL or what I tried out a new ACL procedure last week it was fascinating but sometimes that is the beginning and the end that's not the beginning and the end for me how this kid it was this 19-year-old kid how this kid is going to recover in six to n months and go back to living the life he envisions how he's not going to feel abandoned by the sport that he loved or how am I going to help him find a new team because sport is is not only an individual thing it's an entire environment it's the it's the the society the kid lives in so for me it's not just the cool new technique I did on Wednesday in the O it's taking care of per that whole person through the whole journey for the next nine months the lady that you were taking care of when you were 23 years old has that impacted what how you view death yeah it has I view death we're all going to die Stephen how rapidly we get there can change how we arrive there can change how we feel about our life can change but we're all going to get there so I don't I don't view it as something to run away from at all in fact in some circumstances in some of my patients circumstances or even as an orthopedic surgeon in some of the traumas I've been involved in I think death can be kindness and death can be done with extreme dignity I don't think it's always the enemy one of the things that I think is is also um really sort of friend of mind in that image of the lady in the in the bed when her sister arrives in the wedding dress is that she had friends and family there oh my goodness and a lot of people you know right there's so much Beauty in that moment regardless of the the um the reality of what's going on there that she's losing her life but she's losing it surrounded by yeah a group of people that love her and I think for many of us I think I actually had a conversation with a good friend the other day and their their biggest fear in life is that they'll actually end up aging and dying alone because they don't have children yet and they don't have children at all they made the decision not to have children um they don't have siblings so you know I'm not scared of death I'd like to extend my health span but um when I do die I would like to have people around me that love me and that's one of the things that I think she she clearly had yeah she's he did it's funny you mention that I think about that what happens if we live so long in our quest for longevity that everybody we love or raised has already gone before us and I don't know what do I do would I hire the girl next door to sit with me take me to my doctor's appointments yeah I don't know what to do I could probably pay a few people a little bit it takes a little bit of planning so if we if we talk then about this health ban issue and your central Mission which you described at the start usually when I have these conversations I try and Hazard a guess where I should but I actually want I want you to tell me where we should be beginning if we're talking about extending our health span where where does that begin why do we need to startop this conversation that begins when your parents are raising you and they have the choice of teaching you how to eat teaching you I'm old enough that literally I got a cell phone at 38 so this is not a problem with me growing up but there's a problem now where we don't send kids out due to safety and digital to just go play and don't come in until dinner that was a real real thing when I was growing up and so what we know is children's uh mitochondrial load meaning how many of our Powerhouse mitochondria metabolic um Kingpin are really predetermined by how active we are as a child so it's really a concern for those of us interested in metab metabolic health is what are we doing when we raise our children to sit around for the first 10 years of our of their lives when they're really made to run around right so it begins with what we teach our children and I think I hear parents a lot of times saying oh my kid won't eat this or that or I can't get them to do anything and I'm not scolding them when I respond in the way I'm about to respond to you I get it I'm the mother of a blended family of six children and you can't always make your children do things but here's what I know children learn from what they see my children were foam rolling with us they learned to eat vegetables or they didn't get up from table or they learn what we teach them so the time to begin is when uh our children are little some would say the time to begin is in utero which is frightening because I might have done things differently during my pregnancy but when they're little but as they're being raised I certainly think the time to really begin is no later than your mid-30s I call between mid-30s to mid-40s with 40 being the center of that the critical decade literally we're not children anymore we've at 30 the literature says we've probably maxed our bone out we've probably maxed our muscle out wait what you mean I'm 30 I know think about you right now what do you think I've maxed my muscle out my it means that some some scientists muscle scientists believe that at 30 we've got our Peak muscle mass and unless we really invest in growing more muscle the rest of our lives like if you choose to be sedentary the rest of your lives you Peak at 30 and you're using it the rest of your life right and so same with bone bone maxes out at about 30 unless we continue to invest in it well what do we know 70% of our population is is sedentary and don't reinvest so between 35 and 45 I call it the critical decade if you've never thought about your health before Now's the Time to hone in we need Baseline Labs we need your first physical we need some your first screening exams I think men this is not policy anywhere but I think as I'm trying to replace testosterone and men in the future I don't know what I'm raising them up to I know I'm putting them with when in a within a healthy range but I would want to return you to what your testosterone was when you were a young man like you are now and not just guest I think we need first Labs first physicals um to be more of a Quantified Self just like you we were talking earlier you saw a human brain for the first time to notice our bodies so that we can take better care of them early so that we can then do the exercise prescription that I'm sure will talk about um going forward because it becomes very very hard with every decade but I think for men 40 to 50 is a an amazing decade for you for a lot of reasons for women I think between 35 and 45 is critically the time to get our stuff together before our hor hormones start walking out the door so it it's much earlier than you would suspect if you if you suspected maybe 50 is the age maybe 60 no too late not too late much harder right yeah you know what I there's this image that I saw online the other day and I saved it as a bookmark actually wasn't connected to me speaking Che but I just found it to be fting cuz it's part of this emerging picture in my mind about the importance of muscle and one of the things you said there is you think we'd reach our Peak muscle by early 30s According to some sort of muscle scientists is does that kind of correlate to what I'm seeing here I'll put this on the screen for anyone that can't see I'll link it in the description below but on this graph which we'll call figure number one graph number one are you saying to me that the peak point there is around 30 yeah and then from it's sort of downhill from there so on you know on this SC the peak if we call it 30 this is a precipitous decline it looks very hopeless that what I believe and what our research shows is that you can extend this green line into a more flat curve so that you die quickly maybe in your sleep yeah like thiso done okay instead of this steady decline over time but if we do not reinvest in our health and Mobility every day our muscle wastes our V2 Max or our cardiovascular health declines 10% per decade so it's like what happens if you have a Formula 1 car and you get it all maximized it takes one big race and then you never reinvest in it I mean our bodies are not unlike a machine when you talk about lean muscle mass what does what is lean muscle mass I know what muscles are but what's lean muscle yeah you know what I say lean muscle mass and people are like what do you mean lean versus fatty muscle mass what I'm talking about is your skeletal muscle mass we have three kinds of muscle we have smooth muscle which is what our guts are it's the peristalsis that's happening in our intestines our cardiac muscle the muscle that will that is our heart that's the cardiac muscle um and it beats unto itself it has its own electrical Rhythm the rest of the muscle in our body is striated skeletal muscle so every time you do this it's with a type of muscle called skeletal muscle we have 650 skeletal muscles it is the reason you move uh it is muscle is not only important for Locomotion but it's very metabolically active it sends off hormones that help control other processes in your body it's where most of your mitochondria which are the powerhouses of your body take glucose from your blood and turn it into energy so it has a lot of roles most of us just think about it as what you see in the mirror at the gym bigger and bigger but it serves the function of locomotion and Metabolism you did a study yes I did um and I think that's the picture I have here which talks about 2012 so what I'll put this on the screen again this is picture number two for anybody that's listening on audio and wants to see the photos um this is a pretty startling image it is um and it scares me please can you explain what it is it shouldn't scare you because you are healthy and at you are going to be mobile every day when you leave me here but so remember that study I introduced the health ABC which was an nah funded study of a group of 70y olds they just took a cohort of 7-year-olds and watched what happened over a decade yeah well they did a similar study as this uh using CAT scans I used MRIs and what they found is that uh that what they described as the inevitable decline of muscle the inevitable infiltration of your muscle with fat like marbling and I said that cannot be true that is what happened happens if you are sedentary and sit around for the trajectory of your life so because I'm a sports doctor I am surrounded by Master's athletes so I did a study of Master's athletes from 40 to 85 what this picture is is MRI slices in their mid thigh so MRIs take pictures of us using a magnet and creates these beautiful pictures so at the top picture is the MRI slice of a 40-year-old and my athletes were usually Runners are triathletes of the thigh of a 40-year-old so I'll describe this for you it's gorgeous yeah it's beautiful yes we have beautiful muscle architecture of the quadriceps on the top the hamstrings on the bottom the bone has a nice cortex there's very little peripheral fat and when I looked inside the muscle uh with a microscope and special software there was not infiltration of fat or marbling so if you want to say it colloquially this is a flank steak Yeah with no marbling this is lean muscle if we sit around for 35 years and have a desk job and we and we sit at the desk uh 10 hours a day and we don't go move our muscles we're not purposeful this is what happens we lose our muscle architecture these muscles are are almost you can't even tell what they are uh what's the age of that person this is a 74 year old now I had a large group this is one representative person in each of the groups this is the control group but the center one the muscle I'll tell you is grossly fatty infiltrated It is Well marbled it is like a Colby beef and then there's a thick rind of peripheral fat this is a picture of what we called sarc obesity meaning we have loss of muscle sarcopenia and we have obesity excess adapost tissue oh so the white area is the fatat and the middle part is the muscle musle yes and so you know you'll see people walking around with these big old thighs well the truth is um sometimes a lot of that is fatty rind but look what happens if we invest every day in our Mobility my athletes in this study were not professional athletes they were recreational people like you and me who had just invested in their Mobility four to five times a week this is the picture the third picture is a 70-year-old triathlete if you didn't know better you would say that I just took another slice of The 40-Year-Old and put it down here very little peripheral fat very little fatty infiltration and amazing muscle architecture and when we looked at the strength of this person compared to this person there was virtually no difference there was a small difference but we know from other people's studies that um lifting weights consistently infers a 20-year Advantage such that if you're an 80-year-old consistently lifting weights you are functionally as strong as a 60 year old person who doesn't and so not only does this study show us that by investing every day in our Mobility that we can retain our muscle mass that has implications for Frailty that has implications for activity and what's interesting about that picture Stephen once I published it it has taken on a life of its own it is like everywhere on the internet because the reaction is so startling with people thinking oh my God am in control of my health and aging and I couldn't be more pleased about that no it is it is Unforgettable yeah in every sense of the word I can't believe that the thing that really obviously shocks me is the 40-year-old um Cal muscles they C for thigh thigh thigh muscle Y isstring and that's a triathlete is arguably not as good as the 70-year-old triathletes I would actually say that the 7y old people no I think the 70-year-old wins and that is that is startling because I I thought that aging muscle decline the sort of syence I think it's called of the of the body and the muscles is inevitable and this is unequivocal evidence that it's not that if I make good decisions now if I become a triathlete I can have the flank stake thighs when I'm 70 what it tells you is that there is no age or time in your life when your body will not respond to the positive stress you put upon it and it takes daily investment it's not like you can store it all up and then ride on it it yeah it's so so important one of the things that's been a real Revelation for me is this idea that muscle is so critical as I get older yeah um I often think about different exercises that I should be doing as I age and you know sometimes I think about um running but I but it's I don't know I worry about joint pains and stuff yeah so I'm a bit of an upper body workout freak I just focus on my upper body um what do you think of my exercise regim what should I be adding to it to make sure that I can have the flank Stak thighs but also just a longer Health span you know what's critical uh for long-term function is being able to stay upright so it's all great that you've making big arms and have upper body strength can do pull-ups and lift your suitcase above the in the airplane thanks but what you really want to do when you're 97 is walk anywhere you want to go up and down the stairs to you know drive any car you want to and that takes lower body strength so all your biggest muscles in your body are below your belly button so if I were you and had all this trajectory of time I would work equally as hard on my my glutes my quads my hamstrings my calves every muscle below your body but not only would I work on my strength to get bigger but I would focus on Power and those are different lifting techniques right the hypertrophy aspect of growing big muscles because they look really great uh you do now and I am not a I am not a a trainer but I've done this quite a while so trainers you're welcome to add in but uh you do more reps of lighter weights because that will stimulate hypertrophy if we're truly building hypertrophy a growth of muscle bigger biceps if we're truly interested in power and Longevity which is why I lift I lift for longevity and power because I am not going to be that little old lady frail in a bed unless I can help it right I mean I'm going to help it I'm so determined um I want to be able to lift heavy so that is fewer reps but much heavier weight so number one you got to lift with your legs number two people become frail for a number of reason reasons but another reason people lose their independence is they lose their ability to balance and they're falling all the time and when you fall no matter how good your bones are you're liable to break something and so I always train my people not only in muscle building or carrying a load as I like to call it but in equilibrium and foot speed so in the in the place I put my office it's a performance center it's surrounded with all the bells and whistles of the best performance stuff and we have a Speed and Agility coach who usually works with Elite division one track athletes well I had her design foot Speed and Agility drills for midlife people because I do this all the time I put my my red work bag too close to my desk I get up quickly my bag's in the way and I trip but because I've got the foot speed I can hop over it but if I hadn't retrained that I might have tripped over it and landed on my hip and broen something so it's important as we're going forward yes I want you to increase your muscle lifting in your lower body but I want you to work on Speed and Agility drills so you stay Nimble stay a able to balance and don't fall down if you fall down if you trip to your bag what's the knock on effect of that because you just heal right I just heal yeah yeah I just I ran a Spartan Race recently and fell off an8 foot ring and didn't break so I am working towards being unbreakable in my own life that what I want to happen for you but if you're if you're not unbreakable what happens when you trip over your bag and fall is you could break your hip and then what happens yeah well if you're of any age but particularly older when you fall and break your hip 50% of the time you do not return to preall function which means you cannot live in the home you raised your children you cannot drive your car bones are bones and adults take about 3 months to to heal imagine being down for that amount of time and unfortunately in men greater than women 30% of people die in the first year from the complications of being that sick with a hip fracture so you know as your orthopedic surgeon I am desperate to prevent Frailty I am desperate to prevent you from falling and succumbing to that sequella so we got to lift weights with our rear end and our legs we got to work on our Speed and Agility think it was you that used this term the sitting epidemic what is the sitting epidemic the sitting epidemic is what we're doing in our country uh when we in every aspect of Our Lives whether we're working we're working but we're sitting at a table we're uh playing we're sitting and we're playing on our phone or watching something it is the epidemic where we're spending I don't know 10 14 hours a day sitting in this position in fact I was thinking about it if it was logist logistically possible for a three-hour interview we should go for a walk not so much but but it's the epidemic of sitting around what does sitting around do well it sends us towards a pathway of something called sedentary death syndrome I wish I had made that up but I didn't a professor out of Columbia University in Missouri made up this term that I've been using my whole career to describe what happens to us when we sit our entire lives sedentary death syndrome are the 33 chronic diseases that we die of including the top five cardiovascular disease stroke cancer um even even things like fracture that are completely impacted in a positive way by Mobility so if we could eliminate sedentary living from our lives we could probably live better and that was the whole supposition of all these studies I did in the beginning of my career at the University of Pittsburgh was to prove that if we took sedentary living out of our vocabulary that we could save our bones we Pro that with two studies our muscles we proved it with the one that you just saw we could save our brains we were one of the first to do brain studies looking at the effect of Mobility on their brain and it's a very hopeful picture it's super interesting this subject I this week had a friend of mine diagnosed with I think he'd slipped like two discs in his back or something I disc five and six or something and he sent a X-ray of his back into the group chat and I thought oh this is so interesting because I've had lots of conversations with people on my podcast about sitting and all of these things I spoke to one particular guy called David raiklin who went and studied the hadza tribe in Africa I believe which is a hunter gatherer tribe and what he found is they do sit for about 9 or 10 hours a day but they they squat they squat I knew that yes so we sit in not sitting they're squatting he told me that I think it was him and um Daniel liberman told me that they had brought brought a chair over there yeah and like these HS tribe had like never seen a chair before so when they like walked off to go to the toilet the heads were all sitting in the chair no but they they would take the chair and be like oh my God so like all the chairs were taken cuz they just loved the chairs cuz they'd like never had chairs before so the the researchers like couldn't find a chair cuz all the heads were like chilling in the chairs but typically when they they sit for 10 hours a day they're doing this little mini squat thing which means their muscles are still activated but also I think the posture in which they they squat is their backs are straight yes and it got sent me down this Rabbit Hole this weekend literally this weekend looking at why sort of 80% of Americans will complain about back problems but the hads a tribe back problems aren't even like a thing there he told me it like almost doesn't exist the idea of having a back problem but 80% of us are going to have back problems it's endemic well think about it if we weren't trying if I weren't trying to be on my best behavior I'd be sitting in this chair like this right like a c-shaped launched over my front core is completely relaxed my back core is relaxed and stretched out and so over time they just get weak in atrophy it's like laying in a bed there's no stimulus for them plus my shoulders get all hunched over and my posture becomes like this and so that's why we just sit in chairs and atrophy when you're squatting and I posted recently challenging people to see if they could do a squat like that or get up from a squat like that and the response I got was overwhelmingly oh my God I can't do that I'll work on it because we're so used to sitting in chairs they can't do like a single squ these people were saying to get down getting down people can do sometimes with falling over getting up is the problem what would you recommend yeah in order to avoid the back pains the sort of sedentary death syndrome or whatever it was called what do I do because I have to run a business I work in an office at a desk yes well you know what even simple things uh for instance I bought my assistant a standing desk because when I'm in clinic all day uh for 10 hours the choice for him was sitting at a desk or standing at his standing desk and so that can go a long way number one number two taking many blasts of Mobility right getting up running out the stairs be a fidgety person go to the copy or get steps and just be moving all the time the other thing honestly nobody knows when you're on a phone call what you're doing you could be wall squatting in fact I have challenged whole groups of people in their next board meeting to wall squat the whole time no I don't know how much thinking would go on but just adding little things like add that in you don't have to sit to take a phone call um even in a zoom meeting I mean people have seen worse than you doing a wall squat you know in the time of covid I I was wondering this morning um on my way here cuz I was in the bathroom and I dropped something on the floor can't was it might be in the toothpaste or something and I went down to pick it up and my my back is just like so tight is it like my whole I feel like my whole Bo I'm so unflexible I like went down to pick it up and the way that I go down and pick it up is you'd think I was you know I was going to say an age then but that's kind of after seeing that like this guy's got better flexibility than me but I just feel like you're stiff I'm stiff as hell and I don't know what to do about it I I think there's like a I don't know is it a joint pain joint pains that I have or is it just I don't I've don't have strong Coe it could be all those things so when I talk to people about to go to tie into the other question how should you be working out how should you be investing in your Mobility every day uh there are four components that that we should try to find time for number one is flexibility and dynamic stretching so that means is is warming up every single joint in your body every day and that can be as as simple as seriously a set of jumping jacks doing uh there's something called an inchworm where it's like a push-up position and you walk your feet up and that'll warm up your ankles your knees your hips your shoulders but going through a dynamic warm-up every day to warm up the joint putting them through demanding they go through a full range of motion and then not forgetting after you work out to static stretch we don't static stretch before we work out we static stretch after a static stretch is what we were taught in in elementary school with you know you stand against a wall you hold the stretch for 30 seconds that happens in every body part after you work out before you dynamically warm up and so that's when things like yoga and pilates and whether it's reformer pilates or uh floor Pilates or can be great for people to me that is the the salt and pepper of your workout regimen it's not just what you do it's what you sprinkle over it so that's number one flexibility a oh because the acronym I use is face just so people remember F flexibility a is aerobic right we can talk about that c is this weightlifting we talked about C carry a load e is equilibrium and balance so when you were reaching over and thinking you were so if you could still do it because you're in your 30s you still have the youthful pliability to do it imagine you're 60 now and you haven't done anything about it and nothing's moving and you reach over and you don't have the foot speed to catch yourself you fall over it happens all the time from a standing position so the way I teach people to retrain their balance literally is to stand on one foot while you're brushing your teeth every morning because the perturbation of moving your whole body requires core strength strength it requires propi reception and that's how you'll retrain that particular motion so I really need to introduce something like Pilates or yoga to my or just daily stretching okay for how long um well if you stretch every you dynamically warm up before you do anything including your weightlifting and then um the static stretching afterwards of every major muscle group whether it's your triceps or whether it's your hamstrings are critical for low back pain or your calves you hold the stretch without bouncing for 30 seconds and what you'll feel is at the end of the 30 seconds you'll kind of relax into it and you'll get more of a stretch and you only do four reps you are going to get most of the benefit of that stretching after four reps but I don't want you to only do that I find many people asking me I do Pilates in yoga is that enough for me and I say that's great but it's never going to be enough one of the other things which is related to this that people see as being inevitable is this idea of joint pain we think we kind of just get joint pain as we age is joint pain inevitable you've actually brought a big bone with you today which absolutely nobody asked you to bring but I guess this is what you car around with [Laughter] you Stephen this is a femur a femur a femur yeah this is a human femur um and I guess a femur is the it's the bone that connects your pelvis yeah to your knee oh okay so it's that big bone in my leg the big bone it's the longest bone in your body this bone you brought with you um a lot of people talk about joint pain yes is joint pain inevitable I'll give it to you because you probably know more about this stuff than I do so what is a joint a joint is the is the space that's occupied by two bones so the femur the top of it that's in your hip is a ball and it sits in a cup in your in your pelvis so two different Bones the pelvis is connected to the femur through the hip joint it goes like this right so and then on this end this end of the femur is connected to your tibia and it makes your knee right okay yep so uh is joint pain inevitable it is not do we get it with aging often so that you would think it's inevitable but it is not inevitable why do we get joint pain well every bone at the end is covered in an endcap of a structure called cartilage cartilage is a smoother than ice Matrix that cushions the bone so that you don't feel your joints one reason people have pain is because they've traumatically disrupted that cartilage and there's potholes in it like if you're a football player and you get hit hard and a piece it impacts so hard it pops off that's a traumatic cartilage injury you will have joint pain from that another reason reason we can have joint pain is not traumatic cartilage loss but because you've just done so many reps over a lifetime that you've worn it down that's called osteoarthritis and so it's not a pothole per se it's like the whole surface has been worn down with sandpaper for instance and there's just not enough of it well the reason we get osteoarthritis some of it's genetic but much of it is how much we weigh sometimes that's related especially in women to whether or not we have estrogen um we only get one set of cartilage for a lifetime unless I reconstruct your cartilage because you've been injured or something uh we get one set so we get joint pain because the cartilage has started to wear down we can get joint pain because we've worked really hard in a workout and we've just seen a lot of impact and it inflames your joint but that's usually temporary the permanent permanent is usually do to ostearthritis so so how do I if I want to work out and I want to make sure that I protect my joints so that I don't have this um permanent sort of naturally irreversible joint pain yeah is there certain workouts that I should be avoiding are there certain workouts that are more likely to give me to erode my cartilage and give me joint pain well I think principles that should be used are the principles of weightlifting with Progressive overload so if you started out cold and decided you know I'm young I'm healthy I'm just gonna uh lift to my maximum all the time you're probably going to inflame your joint your joint is not used to seeing that kinds of load joints bear 5 to 10 times body weight so if you've gone from zero to 500 lb squat that is 5,000 PBS yeah that's a lot versus if you start from zero and progressively up your body will get used to the load your bones will build your uh your cartilage won't grow but it will become more used to the pressure so the principle is um to not have aching joints is progressively go up and not just let your ego take over so you're saying that muscle helps to kind of as a suspension mechanism for the cartilage well what things project protect the joints uh being of a healthy body composition which includes weight and muscle mass right so the way muscle helps protect the joints is exactly if you said instead of pounding together like this yeah muscle acts as a shock absorber so the the bones come together more softly oh okay so for people with osteoarthritis one of the remedies for that is building muscle oh I've got um you mentioned a second ago that staying at a decent weight also helps to Stave off joint pains and that sort of erosion of cartilage and I was I was reading in your work about this pretty shocking um grab my my brick and my rock this pretty shocking stat yeah that God this is heavy you can take that okay I'm put um in your work you describe how putting on even a small amount of weight increases the pressure on our joints by a huge amount so can you explain that using this y so when we think about pressure across our joint we were we're thinking about whether we gain weight or lose weight The Joint which in this bone is a femur the femur the end of the femur is sitting against the tibia and that's what makes your knee joint when you go up and down the stairs and have pain in your knee what's happening there well if you gain one pound this rock is one pound you would think that this is all the amount of pressure you're going to feel but because of the mechanics the physics of the long bones the pressure of gravity pushing up on you what you actually feel is the weight of these bricks which is N9 lb so gaining one pound in weight one pound in weight exerts nine times the pressure on your joint so you think gaining 10 pounds doesn't mean much but imagine gting 100 pound of pressure or the reverse of that is even small changes in our total body weight one pound 10 lbs can have profound effects on the joint pain we feel so if I lose one pound I'm taking n pound taking this away h uh what some research shows that if you lose 10% of your body weight you can make a profound difference in uh the pressure your joint experiences and decrease your pain so when I prescribe treatment for arthritis here's the whole person whole person approach if I just wanted to say okay you've got arthritis I'm going to give you an injection and sign you up for surgery that might be a typical surgical approach but my Approach is we look at your nutrition we talk about an anti-inflammatory nutrition enough protein uh not eating sugar sugar is a huge inflammatory which increases your arthritis pain we talk about building muscle so that we have more shock absorption we talk about losing absolute amount of body weight so that we unload the joint in another way even before we get to any medical type treatment it's the lifestyle approaches that you can use I would have thought that if I'd put on one pound of weight I would put one pound of pressure on my joints but what you're saying is if I put on one pound of weight I'm actually putting nine pounds of pressure on my joints yes you know it has to do with the Across The Joint the physics of the lever arms of our bone so for instance in our shoulder if you put one pound in your hand the pressure felt in your arm because of this long lever arm to lift it is is 10 times so I always tell my patients who are recovering don't feel discouraged when you lift up the two-b weight it's 20 pounds on your shoulder it has to do with the the physics of pulling the weight up in the axial load it has to do with the gravity and the impact of Bones one on another you talk about these three M major mindset changes that we need to kind of um experience in order to make sure that we can be fit and healthy in our late years things like not focusing on weight loss but instead focusing on building muscle that for me is um again it's a bit of a a narrative violation because um I think as we age one of the things that we see as being in inevitable is that we are going to gain weight so most people go to war with just trying to lose specifically abdominal fat I think a lot of men are really quite obsessed with their abdominal fat why why do we need to make that mindset shift you know what and I'll take that shift even further and it's I like to frame it as we don't want to lose weight we want to uh recompose what are we made of right we want to be made of healthy muscle we we want to care about how much body what percentage of our body is fat we need fat fat has a purpose in our body or we wouldn't have it but what percentage our muscle so what happens when we just focus on losing weight and our primary method is calorie restriction what we know it is clear from from many papers that if we just calorie restrict with nothing else we will lose 25 to 50% of our weight as muscle and then that makes us metabolically less healthy because muscle is a glucose sink you know when we feed ourselves and there's sugar circulating it is taken up by our muscle with if we lose 25 to 50% as we lose weight we have less metabolic availability to get rid of all that and then when we come off our crazy calorie restrict diet the weight we gain back is 80% fat so if we are if we're troubled with yo-yo diets which so many people struggle with that they'll lose weight they'll gain weight they'll lose weight it becomes this circle as we're continuously losing more muscle so when I frame it for men and women I want them to to think of recomposing how as I'm losing fat percentage can I gain muscle and so that puts it in a different perspective I don't care what you weigh you know I'm a muscly woman I weigh more probably than people would think I would because I have lower body fat I have higher muscle content and that's what we care about and for people I always chuckle when I say this that are really interested in the way clothes fit which I am I'm as vain as they come well muscle is Nature's Spanx you may weigh more but you're Tighter and everything fits and looks better so it's not weight it's composition can we be as in shape as we were when we were 25 when we're 45 we can be different different there are lots and lots of examples all over of uh either people staying healthy I mean look at Tom Brady he's a great example right Cristiano Ronaldo is a great example my God I just saw him the other day uh playing actually in this Europe tournament I just saw him playing um there are lots of examples of that from Pro Sports now but even in mere mortal athletes they're posting all over the Internet how they have maintained or many people a light bulb turns off and they say I'm as I'm sitting on my rear end I'm as strong today as if I'm ever going to be unless I do something and we have pictures of people investing in weightlifting and high protein meals and and getting in better shape than they ever were I was in the best shape of my life when I was 40 and then I went through per menopause and thought I was going to die and now I'm 57 I'm in some of the best shape of my life I am not I'm not 19% body fat like I was when I was 40 but as a whole person this is the best it's ever been it's really interesting as a football fan a soccer fan um I know it is called football as a football fan seeing how two different players at the same age I'm thinking about I won't name names because it makes it personal but someone like Cristiano Ronaldo and I compare him to another player from my Club Manchester United he Cristiano played there at one point um who is also 41 years old whatever Cristiano is now and they look 15 20 years apart Cristiano Ronaldo carried on playing he by all accounts from things that I hear at Manchester United has the most discipline with his routine his nutrition and then another player who at the time when they both played together in their 30s they kind of looked the same physically yes but just because for some reason they let go it almost appears that they let go they got on the alcohol a little bit their diet shifted they now look like they're 15 years older than Cristiano but at 35 they kind of look the same they both had abs and it's so crazy how just a couple of years of just kind of forgetting about these simple disciplines can send your perceived trajectory of your health so widely apart whereas Cristiano he literally looks like when he saw him he did he did a penalty kick yeah I'll put a photo of of him the physique he's in up on the screen cuz whoop who are sponsor sponsor of this podcast they went out recently to Saudi Arabia I believe where he's playing and they did a topless pide interview with him and I was like Jesus my God look at that and I compare him to the his colleagues and I content to you though that that colleague yeah because he's still in his 40s if they put the time back in yeah could become ripped again um the the basics there that I need to think about in order to be a Cristiano Ronaldo as opposed to another one of his colleagues that didn't manage to stay in shape yes what are those fundamentals that you think Cristiano is hitting or from your work with athletes yeah I think that um I think we harness the power of our age the wisdom of our age so he probably works out now differently than he did when he was 25 he he probably and I don't know his routine but people like Dara Torres or uh Michael Phelps they spend more time on recovery more time on muscle work they're very systematic about their workouts they do Max men they get the maximum workout in their skill set their skill workouts they're not out on the field for four hours anymore they get an hour and a half in they work on the skills they need to do so they're smarter right number two uh nutrition is monitored from literally when uh one of my jobs at the University of Pittsburgh was as the medical director of the UPMC Lemieux Sports Complex we house the Penguins the Pittsburgh Penguins which is the professional hockey team they had a full-time chef from the minute they woke up they came in for breakfast lunch was cooked all snacks were provided even the food on the airplanes was provided so that they had this very regimented diet full of the nutrition they needed not only to fuel them but to recover them so that's nutrition nothing is a mistake uh number three they are their workouts are not only on the skilled workouts but the conditioning workouts are completely monitored I mean you're sponsored by whoop whoop takes care of a lot of athletes we know know their recovery State we know how well they slept the night before we know their response to the heavy lifting so I think that athletes at that level are able to maintain the way they are because it's a science also frankly they're genetically specimens they got this great cytoplasm they were born with sugar you don't speak very funly of it I've read a quote where you say it will destroy your body on so many levels it does so you know what I love sugar I you know I love sugar I would rather eat cookies for breakfast but I don't and and the first time I sugar detoxed after the first three days it was rough because you know sugar is addictive there's an addictive Center in our brain you know and so after three days you can gut it out and use your willpower discipline but after 3 days the fourth day you're going to your cupboard and you're standing there and you're like I don't know why I'm here well it's your brain looking for a dopamine hit of sugar so what does sugar do I am not opposed to carbs our body needs carbs it doesn't need as much as we get but we need fiber filled carbs fiber is critical in our bodies what we don't need is beet and sugar cane and honey and Agave all the simple sugars that have a a steep glycemic index meaning you eat it it's easily digested rapidly digested goes immediately to your blood your blood sugar will Spike give you some examples and then what happens is our pancreas will release insulin which will frantically try to carry it into our muscles to be used well that happens at a finite rate and when you have too much sugar circulating that overcomes the rate that it can be removed D our body stores it in fat right with a high blood glucose our body goes through a circumstance called uh glycosilation which is essentially caramelizing proteins in your body it's like you have a steak and you leave it on the grill extra long and it gets that caramelized well that state of our proteins in our body is highly inflammatory well we know High inflammation is something that contributes to chronic disease it contri this excessive blood sugar contributes to insulin insensitivity meaning our wh pancreas is trying to pop out enough insulin to get rid of the sugar that it pops out so much that we become insensitive to it there's just an overabundance so all of those reasons are why I am not opposed to complex carbs and fiber I am opposed to the highly processed sugar fill diet that is produced for us by our current food system and by the choices we make I don't blame society I don't blame our food system I blame them and the choices we make um so I that's one of the first things I recommend to my patients do you know it's the hardest thing for them to give up and they'll do everything else they'll get to a gym they'll they'll do aerobics the way I want them too but then when I say and we need to eliminate simple sugar that's when excuses come out it's interesting because yeah I mean it's difficult there's obviously a physiological sort of chemical hold that sugar has over over us but on this point of psychology and uh willpower or whatever we want to call it everything that we've discussed so far today is kind of contingent on you making a decision yes now how when you talk about the whole human how can you influence someone who might have got this far in the conversation today and they they understand everything you've said they go yeah I know that stuff I know this thing here and you I've heard that over in this book or this podcast before but for some reason I just can't can't do it can't do it can't get myself to do it maybe I'll do it for one day but then the yo-yo goes back to the bottom and there's this concept in banking called temporal disconnect it's a banking term I Came Upon it as I was writing these books initially and the concept is that Bankers Financial people want us to put a little bit away every day not for today there's no satisfaction in that for today in fact it's deprivation for today but it's for the future the concept of temporal disconnect is that you don't know who you're going to be in 30 years you're or 40 years a 70-year-old step you don't know that guy you don't care about that guy you don't even know what he's like what he's going to become so but you do know today Stephen and so you're going to take care of this guy not that guy and so that's why Bankers can't get us to invest our money in the general population right most people don't have much savings right the same is true when we apply it to our health what do we want now what's going to make me feel good now what you know can I bargain with myself that I'll do it tomorrow or this little bite's not going to hurt me right because the temporal disconnect of at 63 if I don't do something now I'm going to have chronic disease rare its ugly head that is a hard argument some people are disciplined enough to think like that that's a hard one so some of the ways to help people now is to help them identify how amazing they're going to feel now in instead of feeling sluggish sitting in a chair all day with back pain if we invest every day in Walking In Sprint intervals which is going to make us lose fat or lifting heavy which is going to put on the muscle of Spanx and make us look good and plus when you get done lifting heavy you feel like a badass right if you can make that the reward that is an easier thing to do because you are right we know what to do we just don't do it and we know what to do and we don't do it because the battle is in the five and a half inches between our ears it's not actually picking up the barbell right and so it's identifying how this is going to make me feel today not for 20 years and here's the other thing I honestly think sometimes it comes down to selfworth do I believe that I am worth the daily investment in my health or do I believe that everything else is more important than me and that's hard and I have come to understand that until you believe that you are worth the daily investment in your health Nothing Else Matters yeah it's so interesting and I think one of the things again that has been um cured that used to be a mind virus of mine was I think part of me did think when I get to 50 when I get to 60 I'll address it then yeah I if I've got um certain um health issues when I'm 60 well I'll just go to the gym then and I'll just uh yeah I'll just fix it then I'll just start becoming uh active when I'm 50 or 60 but I but that's not how any part of my life works that's not how my business or my investing Works everything is compounding now yeah so the decisions I make at 20 or 25 or 30 or your daughter's upstairs she's what she she's young she 16 the choices I start making then are sewing seeds that will flourish For Better or For Worse when I'm 60 70 and you know it's easier than doing a little bit every day that's easy you know my daughter upstairs she poor thing can't get away from knowing what the right choices are it doesn't mean that she do always does them but if she maintains this healthy lifestyle she has because she lives in our house it'll be easy every day it's a lifesty style right it's not a Monumental pivot it's just the way she lives and you know the same if if you do all the things that you know to do now it will become just the way you live it's not a high energy expenditure versus waiting until you're 50 when you're 50 PBS overweight when you have to totally rebuild all your lean muscle mass you know you're feeling like a whatever you're going to feel like that's a big pivot versus I'm just living another day doing the things I've always done this is who I am I am yeah that's one of the things that's been really helped me I think from doing this podcast is obviously I'm inundated with lots of information about health so the framework I use to decide what to take in and what to implement is just I I hear some things that my guests say and they might say oh by the way Stephen um apple juice or orange juice is full of sugar and in my head I was going oh my God I thought was healthy and then and I don't really I could take it or leave it anyway so these small sort of modifications taking these sort of very sugary Jinks out of my life as something that happened um being consistent with my workouts focusing on muscle gain thinking a lot about how I sit but also making sure I'm as active as I can be um and then the other thing actually has been supplements yes because I sit in this di of Co Studio a lot and I sit in Dragon STS little dungeon a lot I spend a lot of time sat at my desk inside without any sort of natural light so I've started taking Vitamin D supplements frequently because actually I went to the doctors did my my tests and how low was it how low was it it was very low they said everything's fine Steve you're' all good here here and here I did like the full body I did my testicles to my toes to everything my blood everything my moles whatever it might be and the the one thing he did say to me is your vitamin D levels are low so I've started supplementing is is how crucial is vitamin D for healthy I mean you know what it's a it's a hormone that affects so many organ systems it's important for your bones it's important for your immune system it's important for your brain so it's something that everyone should supplement they should get their level checked we're all low and then we should supplement up and then have it recheck so that you can have a maintenance Lo dose you usually take it with potassium to help absorption magnesium is a is another key player with vitamin D what if I want really strong bones what should I be taking uh vitamin D potassium magnesium you should be eating uh one gram of protein for every lean for every ideal body pound you have so you build muscle to um to help your bones you know there's some remote data on Boron and zinc but I'd rather you have the three that we know work to build strong bones you not only need muscle you need proper nutrition you need to I should find another term but you need to bash your bones you need to impact your bones the mechanical stress of impacting bones whether it's jumping up and down running going up and down the stairs for people with poor bone density you can use a reformer which is a which is a a trampoline um is all important for sending the biomechanical signals to your bone that you're doing work you need stronger bones that is transformed into a biochemical signal that makes your bones uh that your bone cells lay down new bone that's how you keep healthy bones across a lifespan can you grow new bone um you can yes you can actually you can can increase your t- score it's a multifactorial t- score is a score that we measure using a test called a dexa scan uh a dexa scan will tell us not only our absolute bone density but but compare us to healthy people and this dexa scans are usually used for women or older men who have fallen in fra ured but a t-core tells us what our bone density is compared to a healthy 30-year-old right assuming a 30-year-old has laid down optimal amounts of bone and we can talk about how that's becoming not true but so once we know our t-core it tells us the health of our bones um just to give us a gauge of can we rebuild so yes all the things we can lift weights we can impact our bones we can have proper nutrition if we are a woman and uh have lost our estrogen which starts in our 40s not our 50s it starts in our 40s we can make our estrogen decision as I know you've talked about before uh because estrogen and testosterone are critical in bone health and then if you show up with a t-core that shows that you have Frank osteoporosis even two million men in the United States have osteoporosis it's it's us osteoporosis is uh critical bone density uh weakness meaning a t-core of minus 2.5 so if you this is how it goes so remember in the in the tests in lower school where they would grade you on this bell curve straight up the middle is bone density at 30 and a healthy woman for instance zero any positive number for for your t-core your bone density is more than zero perfect you're all good bone density one standard deviation or minus one below a 30-year-old healthy woman is called osteopenia meaning your bone density is getting low we really got to step up our efforts a bone density number A t-core minus 2.5 is the definition of Frank osteoporosis which is Bones dangerously brittle that score plus there's this index called a fra index of R ax index which takes all your lifestyle risk meaning is your mother shrinking do you have a family history of osteoporosis did you already fracture fracture is the number one uh predictor of future fracture did you smoke your whole life did you have an illness where you had to take a lot of steroids that predispose that break down bones are you of genetic makeup where you're predisposed to bone density the fra index takes all those and calculates your risk for having a fracture in the next 10 years so a t-core of minus 2.5 and a fra index of 3.6 or three meaning I have a 3% chance of a fracture in the next 10 years those are indications for employing some of the pharmacologic uh drugs to either maintain bones or to to build bones and there's a few categories of those that I usually send people to an endocrinologist to weed out it's kind of a complex decision if I was if I was getting to that stage what kind of things would you tell me that I needed to do so if I was getting to the stage where I was minus two on that scale if you were already a minus 2.5 we would have a long hard discussion about all the lifestyle interventions nutrition lifting you can still lift uh how we're going to add Mobility uh impact how we're going to get some impact in without breaking a bone but we're also going to have a conversation about our hormone status um and we're also going to if you're already that low have a conversation about whether we use a pharmacologic augment like bisphosphonate or forteo or some of the drugs that are available to support bone density and each person man or woman has to have their individual risks assessed to know which road to go down but what we cannot do is we cannot ignore it and hope that it goes away You' you've done um so many studies and I find studies really fascinating because they're they're first first party in that regard so it's really finding things out for the first time what is your what are some of those studies that we haven't discussed that relate to our conversation today that you find most interesting yeah so let's talk about we'll start with bone because we're just talking about in Master's athletes we did two studies looking at could we Preserve Reserve bone density across a lifespan if we took the variable of sedentary living out of the equation so in the first studies that we my group did uh I we formed a group called Prima the performance and research Initiative for Master's athletes we looked at 3,000 Master's athletes you had to be 50 years old uh and uh they were competing in the National senior games which is uh like Olympics for people over 50 and these weren't just these weren't just everybody that could go these were the people who had qualified in their state games to go to the National games so we looked at 3,000 of them we did two bone studies we found the first question asked could we maintain bone density across upper age limits because we were active and what we found was that yes a very high percentage of people up even up into 85 had normal T scores but then we did a second study that we wanted to ask okay so of all the activities you could do what would make the biggest response from your bone and not surprisingly we found that impact exercise the running Sports the volleyball the the basketball Sports versus the swimming the biking the bowling for instance there's bowling in Senior Olympics um those with sports where you impact your bone that impact exercise was as predictive of bone density as things you can't control like your age your sex your genetics and so it just shows how important putting mechanical stimulus against your bone is so that was really important so even bones can be preserved we've already talked about the muscle preservation study which was fascinating the very first question I asked was to answer the question this is this virus in your brain when do we really slow down when can we say oh I'm just getting old I'm gon to slow down I based on the athletes I saw I knew that it wasn't 50 so I studied 3,000 of these athletes again I looked at all the track and field athletes I looked at athletes in the 100 meter all the way up to the 10,000 m so all distances Sprints versus long distance I looked at Finish times of the top eight finishers in every age category and here's what I found to answer the question when do we significantly slow down it's not 50 it's not 60 it is not until our mid 70s when we significantly slow down if we use athletic performance as a biomarker of Aging so what does that mean the example is this if you put a bunch of men in a one M race the 50-year-old man in the year I did the study finished that one mile race in 5 minutes and 34 seconds to put that in perspective the boy that won the Pennsylvania State high school games won his Mile in 5 17 oh wow I know 20 seconds and in in 30 40 years right how old was he 17 let's say he was 17 uh but the 50-year old winner did in 434 the 70-year-old winner of that mile race did it in seven minutes so nobody was getting lapped right so I used those times to see how much we slow down before age 70 we slow down less than 1.2% a year timing wise so after 70 there is a rapid decline in times or you get slower and slower and slower and I call that biology taking over either you don't have the mindset to work that hard anymore or you've got enough injuries that you can't work that hard anymore or you've lost enough lean muscle mass or or bone flexibility but what it tells us is that we have no excuse until our mid-70s for slowing down if we invest every day in our Mobility so it really set the stage that was my first study really set the stage for wanting to find out okay what's our muscle doing what is our bone doing the third study we did which took us five years because we matched for everything and now it's common knowledge but at the time it wasn't we asked the question well if we take sedentary living away from our brain what happens and so we had the athlete group and we had a control group that was matched for every variable except their activity level and what we found was that people who were chronically active maintained their uh mental agility and their speed of decision making and their uh physical aspects of something called the sf12 which is your perception of your physical prowess were all higher if you invested in your Mobility every day so even our brains are responsive and and we know that now there's lots of studies it's a it's something that's talked about a lot the final interest group of studies that we did before I left University of Pittsburgh was to start asking the questions of why what's going on here why well there's this protein called clo clo was uh one of the Greek gods who spun the threat of life so this protein when it was discovered was thought to play a role in longevity every organ has receptors for clo we know that mice that are genetically engineered to not be able to make clo die old very young they're chronologically very very young mice but they're physiologically very old because they lack this protein so I decided to measure clo and my athletes and compare them to sedentary people so we drew their blood we ran the Elisa study and and not surprisingly youngish 35 to 50 year old Master's athletes had the highest level of circulating clo longevity protein the second highest level of cloo in our study were people over 75 who were still athletes do you know the who the lowest clo level was sedentary 30-year-olds so if clo is the longevity protein and exercising people have the highest levels the next question was okay so what's going on how does exercise give us more long vity protein well one of my one of my colleagues Dr fabric Ambrosio did the study that showed that contraction of skeletal muscle stimulates the transcription or the making of the Clos protein so it's our body's response to the stimulus of activity that makes us make more longevity protein because our bodies believe that we are reinvesting in ourselves and not just sit sitting in a chair waiting to die but that's fascinating right interesting you I I read about study you did as well with rats and stem cells which is seems somewhat linked to this idea of muscular yes I'm glad you brought it up so it's the so remember that picture we talked about that at a tissue level that we can maintain our muscle mass so that's at a tissue level the whole flank stake we can maintain we wanted to see well what's happening at a cellular level what's happening at a stem cell level and so we we had a bunch of old lady mice they were mice oh mice mice when you're old you're two years old that is a long lifespan for a mouse these little old lady mice were sitting back in the back of their cages just hanging out waiting for their next food and we sampled a little bit of their muscle because the lab that I was a part of looked at a kind of muscle derived stem cell meaning all of our tissues have stem cells in them including muscle and and we now know those cells as satellite cells at the time in the in the early 2000s we called them muscle Drive stem cells but we took them and what do we find these little old stem cells healthy stem cells around these stem cells had started to become all spindly like tree branches they were no longer pumping out growth factor meaning they were not reproductively healthy they were not doing what they were supposed to do and do these stem cells make Muscle these are stem stem cells that are found in muscle and when stimulated produce muscle okay and so they were not dividing because they were all spindly they were not producing growth factor and death in cells is an active process they had turned on the genes that were leading to cell death so we took those little old lady mice and believe it or not you can buy treadmills for mice do you know how much a mouse treadmill costs no $30,000 you're joking I'm not it was like a big part of my whole Grant so we bought this treadmill we put the little old lady mice on here's what we found in two weeks twice a day many workouts their stem cells were fat and replicating again they were churning out growth factor and they had turned off the pr programming for program cell death so what that told us is that even at the stem cell level that we can rejuvenate stem cells by something as simple as skeletal muscle contraction and so to me that is a fountain of youth type intervention at the cellular level someone said to me on this podcast one day I'm probably going to butcher it but they said aging is the rapid pursuit of comfort and I and as you were saying that I was thinking oh that's that kind of fits that much of our aging uh is just to do with our increased pursue suit of comfort for whatever reason M um I was thinking about that this morning when we're thinking about I was thinking about you know what is the what is the minimum amount of time we have to work out to what is the min max and I thought well honestly you can probably accomplish what min max is in about 45 minutes a day so what are we doing with our other more than 90% of the time and it goes kind of goes to this what are we doing are we pursuing pleasure all day well we're working but once we're not working what's the rest of that we're just sitting around being pleasureful all day and so that's an interesting question but another way to motivate people uh is to start associating taking care of ourselves as pleasure and not or comfort and not just in the senses I'm going to get a massage or a facial which is what often we think of self-care but that's temporary right it just lasts an hour until you I often think that I get off a massage but I'm like okay that was good but what do I have to do this every day yeah so you start thinking of taking care of yourself as as pleasure putting yourself in discomfort temporary discomfort because I'm not really kidding you and you're probably the same when you churn out an upper body workout and your muscles are full of blood and you're looking in the mirror because I know you do we all do and you're like that is a good result today that's pleasureful and if we if we stop for a moment and notice how good we feel afterwards uh it's a motivation for how much we don't want to get there because I don't want to get there as much as the next person doesn't want to get there to the gym if you're a beat to be marketeer then you want to stick around for the next 30 seconds or so as a businessto business marketeer you'll know how tough it is to explain what you do I've been there too but there's a platform that gets us and that's LinkedIn I'm happy to say sponsor this podcast imagine a place where you can connect with professionals who truly understand your world that is LinkedIn ads LinkedIn ads helps you to build a meaningful relationships and drive results in a respectful environment with over a billion members including 130 million senior level Executives and 10 million C- level Executives you can Target your audience precisely by job title industry and much more LinkedIn members are always updating their profiles so your targeting stays fresh and relevant it's no surprise that LinkedIn is the highest risk returning paid social platform and Linkedin ads have kindly offered all of you a $100 credit to launch your first campaign and start reaching the right people go to linkedin.com doac c24 to claim your credit terms and conditions apply you have written a paper about a subject we haven't spoke about much yet you mentioned it briefly from your own experience you talked about going into Perry menopause and thinking you're going to die yeah there's been a lot of research that's come out and you've done a lot of work on how menopause imp impacts our muscular skeletal yes physiolog physiology I guess is the word what what do women that are and men that have a partner or a friend or a mother or whatever it might be need to know about how menopause impacts our muscular skeletal functioning yes so I think uh it is very common for people to know about hot flashes brain fog night sweats what is less commonly known is that 80% of all women going through paring menopause will experience what the term we've coined the musculoskeletal syndrome of menopause we coin that after the gyneco urinary syndrome of menopause which is five or six different things put into one category so we can talk about it more easily so in the musculoskeletal syndrome of menopause we know that 80% of women will experience it 25% of women will be devastated by it and 40% of the time when you go to the doctor and they do duee diligence and they work up they send you for Imaging nothing will be found structurally so that's why women sometimes think oh my God I'm just old I'm falling apart and am I going crazy because my doctor's telling me there's nothing structurally wrong but that's why we created this nomenclature so that women would realize that ubiquitous on every musculoskeletal tissue are receptors for estrogen just like in the brain just like in you know every other body part the muscle musculoskeletal system muscle tendon bone atap POS the inflammatory aspects are responsive to estrogen sitting in these receptors so what are the things in the muscular scal syndrome of menopause well number one is inflammation in estrogen is a huge anti-inflammatory it prevents the release of a cyto Kind inflammatory cyto kind called torosis factor and menopause just to be clear is the part part part of the symptoms is the loss of estrogen so if we if we just clarify the timeline so uh a woman's hormones are unlike men men once you're through puberty your testosterone will stay pretty steady women every month as we go through a menstrual stri cycle estrogen goes up and down when we in around these are average times around 45 it can start early like 35 but around 45 we have used up enough eggs from our week our monthly cycle that we start to become low in our estrogen and our body is trying to adjust to that our brain without estrogen gets brain fog it has a lot of receptors and nothing to go in them right once we have used up all of our eggs and we are one year from our last menstrual cycle 366 days that is the one- day definition of menopause and we live the rest of our 40 40 more years we live postmenopause without estrogen unless we supplement so in per menopause in our 40s that's why I say at 47 I thought it was going to die as estrogen is going away all these receptors that used to be filled with estrogen which would then cause all these marvelous Downstream effects all the muscle protein synthesis the bone laying down the inflammation would be kept at Bay suddenly have have no stimulus so when we're talking about inflammation estrogen is an anti-inflammatory effect it prevents the release of tum necrosis factor which is a inflammatory cyto kind I think of it like a fire or you know nuclear war something that chemicals in our body um so that gets out of control and then uh estrogen is also really important interacting with a part of our immune system called the inflam Amon so without estrogen controlling inflammation we can get something called arthralgia which is your total body hurts for no reason and this was one of my primary symptoms when I was 47 I went from being an athlete active all the time surgeon I do hauling people's bodies around to I could barely get out of bed it took me a lot to like crank out and get out of bed my whole body hurt there's nothing structurally wrong it's do the inflam inflammation of loss of estrogen another very very very common inflammat symptom of the musculoskeletal syndrome of menopause is frozen shoulder it's all over social media right now it's where it is an inflammatory State men can get it usually diabetic men it just means that you're you're inflamed so you'll present to my office with the story of doc I did nothing I didn't have an accident I didn't hit my shoulder on the closet in the middle of the night when it was dark but I woke up my shoulder is killing me and I can't move it it's it's literally like this and that's because for some reason the shoulder is very sensitive the capsule the inside skin of the shoulder very sensitive to inflammation and so people show up like that frozen shoulder can take two years to get rid of it's miserable so that's inflammation is that the the whole hook your bra tested yes yes I made this thing up you can't hook your bra right most women do this yeah the first motion you lose in Frozen shoulder is internal rotation which is what this is hooking your bra on hooking your bra you can't cuz what happens is the first thing that goes you can't do this your arm's kind of stuck at your side and then you can't lift it up and you can't do your hair so you're trying you know you're doing all this trying to imagine not being able to move your arm and when you did move your arm it's excruciating oh it's painful as well excruciating pain like women say to me I'd rather give birth again than have this shoulder so what's going on now like what's going on in the shoulder yeah there's uh there was a study done by Joe hannahan who is a mentor of mine at at hospital for special surgery who looked at the stages of of frozen shoulder and first it's just big inflammation all the inflammatory cyto kindes go and inhabit the I keep doing this the shoulder has an inside skin that surrounds the Bones called the capsule it's like a a thin sheet of paper like cellophane that gets inflamed hot and red that's painful over time the inflammatory cells of the immune system that crawl into the capsule the pain will go away but it will cause a a capsular shrinkage like this the it will actually contract so your pain your shoulder might not be as painful but it still won't move so that's why it's really critical that people come to doctors like me and we get it moving quickly we do not want it to become stocked in because it literally can take two years to defrost all due to this inflam at and we don't know why the capsule is so sensitive but we know it is so that's the inflammatory aspect of this we know that without estrogen uh we can lose uh two to 3% of our um muscle mass and rapidly during this period we have estrogen is an anabolic steroid it it's made for muscle building through the mtor system and so without that and we build less muscle and our muscle stem cells our satellite cells become decreased by 30 to 60% it's profound in a very short amount of time we know our bone about bone density we talked about that estrogen's role in the bone is to control one of the cells called the osteoclast if we talk about bone biology briefly if we have that femur imagine on one side of the cell when uh you impact your bone the bi mechanical stimulus is converted to biomecha biochemical stimulus and it says hey uh we need to build more bone so the osteoclast crawls up the cell and starts digging out minerals to release to the body to do its function what happens when you have estrogen is the osteoblast comes back up behind it and fills in that hole and builds bone estrogen helps control osteoclasts the more I learn about bone biology after all these years it seems to me that the osteoclast is a little bit of a rogue entity it's going to go uncontrolled it needs a lot of a lot of control with estrogen testosterone without those controls what happens in osteoporosis is you you can still lay down bone your osteoblasts are still working but it's out of control you're breaking down more bone than You're Building okay yep so you know inflammation you have muscle you have bone here's one we talked about arthritis earlier there are estrogen receptors on the cartilage cartil estrogen sitting on the cartilage helps maintain this spongy M spongy Matrix of cartilage that then protects your bones without estrogen the cartilage Matrix breaks down so before 50 men have more traumatic arthritis than women after 50 women can have a rapid progression of their arthritis pile on top of that the weight gain that happens to many women with the load we talked about and it's a disaster and so many women rapidly progress and need total joints which as an orthopedic surgeon is not the end all but we'd like to avoid it right so that's due to estrogen being missing from the cartilage and then finally on that point talked about weight gain there in menopause I I read that you you gained weight when you went through menopause I gained 30 lb 30b so that's equivalent to four roughly four of these bricks if each brick weighs um 7 and a half pounds which is a lot of weight to suddenly gain and when we think about the impact that that will have on your joints based on what you said earlier yeah yeah my pain was more an arthralgic pain meaning total body pain although when I had that weight on I had um knee I had pain underneath my kneecaps going up and downstairs because of the extra pressure of the my kneecaps on my femurs so does that make sense yes it does yeah that's uh yeah something that we don't I don't think I never really considered I never considered how the impact on our joints of weight gain period but then also when you go through menopause weight gain is something that I've heard about over and over and over and over again because of the loss of estrogen um and how that will then have a skeletal impact on a variety of different areas of your body but then imagine this perfect storm right you you don't feel like yourself you're tired you your joints hurt maybe your whole body hurts you're losing your muscle so that causes more impact there's no shock absorption you're losing your bone and without even realizing what's happening because it creeps up on you right and you're so busy I mean all the excuses are so busy women very rapidly find themselves at 60 and they have you know there's a syndrome called Oso osteoporotic meaning bad bones we talked about that sarob obesity loss of bone loss of muscle gain of fat you've got all three things and the morbidity and mortality of being osteoar obesity is three times what it would be if you had one alone so it creeps up on you and you can see how none of these tissues are separate from each other it just becomes this horrible storm and women are like what happened to me what's the remedy what's the remedy for that well the remedy is understanding that you can feel like yourself again and here are the steps I ask every woman going through this to do number one you must make your estrogen replacement decision I believe that that decision to replace your estrogen must be based on science and not the fear or the myths that are circulating though and I know you've had these conversations but the Women's Health Initiative study has been largely overturned U and so every woman is a sentient being with agency ability to make their own decision and they should make that decision and not just go on here say so that's number one let's make our decision if you make your decision to do that which I have done I replace my estrogen not for my hot flashes night spits and brain fog those go away frankly I do it to preserve my bone my muscle my brain and my heart that's decision number one number two you are never ever going to feel better until you decide to invest every day in your mobility and so what is mobility it is lifting heavy women have to put down the Mambi pambi pink weights that we do 20 sets of because we don't want to bulk up you're never going to bulk up unless you do it purposely we must lift as heavy as our bones will let us so for my people I've simplified it into once you have started enough that you feel comfortable moving your body we must lift four rep four sets of our major muscle groups in compound motion so push pull with your upper body bench press pull some kind of pull down and then for the lower body it's squats and deadlifts four reps four sets in a progressive manner you can start with 2 lbs but I want you to progress up and then for the accessory lifts that support the big compound lifts like for instance for my for my bench press I support that with biceps triceps lats delts eight reps four sets Okay that is the basis of lifting heavy the other thing we need to do is uh do a do our cardiovascular training with 80% base training which is lower heart rate I mean everybody's talking about zone two I happen to in in the place where my office is we have a metabolic lab um that was built by by enigo San Martin San Martino who's the guru of Zone 2 and so we use his protocol and that means that I need that I need people to do uh 60% effort three hours a week but that's not all twice a week we're going to Sprint as hard as we can and that freaks people out because we're in the Olympic trial we're in the Olympics right now and everybody thinks it's supposed to look like that like the like track and field trials what sprinting means is you just work at maximum heart your maximum 100% effort for short bursts so 30 seconds short burst hard as you can go and then you recover for 2 to three minutes so I'll give you a concrete example in my life my base training heart rate because I have the luxury of measuring it with a lactate threshold is 130 beats per minute I achieve that with an incline of four to five and a speed of about 4.2 and it's a brisk walk it's almost on the verge of having to jog for 45 minutes when I'm done with that because that's good for my cardiovascular base I punch it up to 11 and I go as hard as I can because I'm not very tall and I don't want to fly off the back of the treadmill but my heart rate goes up to about 186 and I keep it there for 30 seconds what that does that will burn 40% more fat than just uh even high-intensity interval training which is is done at about 80% that amount of effort Burns 40% more fat it is stressful enough it offsets our normal homeostasis enough that it um helps stimulate the formation of more muscle stem cells the the muscle perceives that effort and so that is the the working out portion of what we need to do and then the smart anti-inflammatory nutrition we need to get rid of simple sugar we need one gram of protein per ideal pound high quality protein what does that mean we need a very high concentration of one of the branch chain amino acids called Lucine Lucine is the most powerful amino acid stimulus of the mtor uh muscle building pathway Lucine is found in highest percentages in Whey Protein so you can get it from plant protein but just in much lower percentages whey has about 10% Lucine and we know that's important to Nature because mother's milk is mostly whey which means it has the highest amount of Lucine as we're trying to grow muscle in our babies right so Lucine is high in weight protein about 10% uh in animal protein any kind of meat is is about 8% and then beans and legumes and plants are about 6.5 so can you get enough protein from Plants sure you can you just got to eat a lot of it like a bull does what about fiber people are going crazy for fiber at the moment it seems 30 grams of fiber so that just means complex carbs your microbiome needs fiber um it it it it's a slower digestion so that we're not causing carb spikes I'm not wearing it today it's first time in about a year I haven't I am not diabetic but I have worn a continuous glucose monitor because I am just a data geek I love my data I know exactly at this point what foods will Spike my glucose and how to keep my glucose steady all day well it's been the most surprising because I I literally have just taken my continuous glucose monitor off I wore it for the last two weeks while I was filming uh TV show called Dragon's Den yeah and I gave one to all of the dragons with me and we've been talking about it every day what was the most surprising food for you that caused a glucose Spike the surprising food um well it wasn't surprising I mean I am to the degree to which my glucose spikes shot up is I am so sensitive to simple carbs I can't even look at a simple carb and it goes up to 165 which our body is meant to respond to spikes I'm not saying that you have to live like this because I have also found that when I only ate protein or most very low low low carbs that I was so low energy I would be slogging through my clinics and I just need I could feel I needed energy so now I've added sourdough to my breakfast knowing that I'll get a small Spike so that was very interesting to me how ex extremely sensitive what's a simple carb a simple carb is is sugar ice cream white bread white potatoes white pasta all the good stuff annoyingly what is the what's the most important thing that we haven't discussed in your work or the most important idea that I don't know has changed your life maybe people don't understand it or think about it enough that's foundational to having a great health span living long being healthy all of those things that maybe we haven't discussed yeah I want to address that question in a couple ways number one um you have to we talked about temporal disconnect and doing the things today that feel good today but for the future and so the way I really changed since I've been through this is uh I have thought ahead about what I want to be when I'm 97 and how did I choose 97 well I'm 57 now my daughter my youngest daughter was born when I was 40 if I want to be around to bug the heck out of her until she is my age I need to live till 97 what do I need to do to do what I want when I want when I want it like you can imagine I don't want to be told what to do do I'm a surgeon I'm usually in control of my environment and I think people just want to be in control I want to do what I want well what's it going to take if I just wait until 63 when when my health span is over to pay attention I'm never going to get there so that has really pivoted my mindset that I have to do it every day now I don't love doing it I mean I'm not going to lie to you I don't love going and working out most days but with this perspective I will but the other the other tenant that I think is so important we talked about lifting heavy we talked about Zone 2 and sprinting something I've layered on this year uh is the concept of our V2 Max and the fragility line fragility means you get older slower weaker uh you lose your functional capacity 25% of all people are frail and unable to live independently by the they're 85 not on my watch and so um the Frailty line is the cardiovascular health that you need cardiovascular capacity that you need to be independent in your own home you may not be running marathons so for men it's 18 uh milliliters of oxygen per kilogram per minute for women it's 16 so how do we figure this out I would go have my have you had your V2 Max tested uh I haven't it's torture but you should do it I think well I had a cardiovascular examination and they made me sprit on a treadmill yeah um and they were but they were looking at my how well my heart coped I don't know if they're measuring my V they didn't yeah yeah you should do it while you're young so you know your base I didn't have a mask on yeah so what it tells is your cardiovascular capacity for for exchanging oxygen from your blood to your lungs Elite athletes like the tour to France have have V2 Maxes and the above 75 sometimes 200 they're just genetic specimens um the 50th percentile for a man your age is 55 the 50 of percentile for a woman my age is 31 that's the average right that's the average 50 percentile when I was 50 I'm going to give you an example every decade we lose 10% of our V2 max if we don't do anything about it that's just the way we age 10% I can get it back there right you can work at it people who are out of shape can make bigger Deltas getting it back people are in extreme shape in the Delta smaller because they start out well so for me I'm going to give you an example so people see how this works at 50 when I was 50 I did it my V2 Max at that time was 45 so at 60 if I lose 10% let's just do big numbers I'll be down to 40 V2 Max at 70 I'll be down to 35 at 80 I'll be down to 25 I'm still above the Frailty line at 90 I'll be 20 still above the Frailty line not what I was at 50 but not frail I can still live on my own so what I've done now since the things that I've talked to you about are a lifestyle they don't take much energy because it's just how I live I've layered on V2 Max training which is a different way to do cardio training it's 4 minutes as hard as you can go torture and then you recover for 4 minutes only four minutes and then four minutes as hard as you can go the good news is you only have to do that three times or so once a week and it will work you hard enough to maintain or improve your frail your VO2 max Frailty line that's something special that you can add on once you've optimized your health once you've done the Peak Performance things we've talked about then you can add those things on okay well I better get I better get on with it then don't feel guilty yeah I need to go to the gym today but it's certainly changed my perspective on what I'll be doing in the gym and and also why I'll be doing it I think I think the why piece is so critical I think a lot about discipline and incentives and why certain behaviors occur and I wrote in my my book that um I was trying to sort of sort of simplify why some habits in my life have stuck and others haven't and then why some habits were I was a bit of a yo-yo suddenly stuck and I held them for 5 years and still to this day and and others haven't and um I kind of simp ified it down to this idea that the discipline equation starts with the strength of your why like so you've given yourself a really strong Why by having this sort of 97y old uh goal like who I'm I'm going to be when I'm 97 and then linking that to your daughter which is a pretty strong why plus the the enjoyment I get from the pursuit of the goal and then minus the friction or the like lack of Engagement from yeah the hard like if the gym is really far away if it takes too long if it if it's embarrassing is friction so if I'm going to a gym and I'm a guy there's lots of beautiful people there and I'm overweight so you know all that all of that's friction so how do you like influen that equation to increase your y make it more enjoyable or psychologically reinforcing the act of the discipline and then kill all the friction I possibly can and for me that's where the habits we're talking about today have really stuck yeah interestingly I've said shared this before but I'll share it again I was um a yo-yo gym goer my gym routine and my health strength routines were all very inconsistent theic and it was for me just see that health is the foundation of all of our Lives see that on a screen in lock that the real sort of variance between outcomes for people that got covid came down to your sort of pre-existing health and so at that point I thought oh my God like it's not my business it's not my dog it's not my girlfriend it's not my my family that matter the most actually number one the foundation in which all those things sit is my health so that became my first Foundation my non-negotiable um and hopefully as you say that'll mean that my kids when when they arrive whenever whenever I become a father um we have a dad until I'm 170 so that's the goal that's the goal we have a closing tradition on this podcast where the last guest leaves a question for the next not knowing who they're leaving it for and the question left for you is what was the last time you took an uncomfortable risk the last time I took an uncomfortable risk and what happened when I did was uh I am an academic orthopedic surgeon would which means I create big business and care and practice within big Hospital Systems so there's a big Safety Net in that but I have always been what I've called an entrepreneur meaning I'm using somebody else's money somebody else's time and but I'm building them a big business three years ago I left that comfort in a late stage of my career I left that comfort and decided I know what I'm doing I believe in myself I'm going to spend my own money and I'm going to go out on my own in private practice and I'm going to uh build these side businesses my keynote speaking my Precision longevity practices which are purely entrepreneurial Ventures and and at 57 to go out and create my own business when all I have ever known is a W2 tax form is a huge risk for me and my family but but I love that um um I am confident enough in my own capacity Stephen and my own work ethic that even if I had to go work at Starbucks to bridge the gap that I'm going to make this work and it's a it's a very freeing and and beautiful mindset to to take what I've learned this whole career and do it for myself well it certainly is working I think you'd agree right it's great it is great I mean you've galvanized a community online of many millions of people you've written some absolutely incred books all of which I'll link below and you're still doing um incredibly important work through uh YouTube and through Instagram and through all of your channels which I'll link below as well and it's very necessary work because you are your confronting a mind virus that I think can hold us back from living long happy healthy lives and uh sometimes it's just an idea right sometimes it's just an idea that can change your life and it's also conversely sometimes just an idea that can ruin your life and I think the work you're doing is replacing those potentially inhibiting ideas with much more constructive healthy positive optimistic hopeful ones and for that I thank you thank you [Music] [Music]