The Longevity Doctor: The 5 Simple Tests That Predict How You'll Age

Summary

The Tamsen Show: "The Longevity Doctor: The 5 Simple Tests That Predict How You'll Age"

Host: Tamsen Fadal
Guest: Dr. Vonda Wright, Orthopedic Surgeon & Longevity Specialist
Date: July 2, 2026

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Episode Overview

In this energetic and actionable episode, Tamsen Fadal welcomes Dr. Vonda Wright—leading orthopedic surgeon and longevity expert—to discuss why aging does NOT have to be a slow decline, how most of how we age is within our own hands, and which five simple, science-backed tests can predict and improve how well we age. With clarity, humor, and research, Dr. Wright breaks longstanding myths about women and fitness, highlights the critical role of muscle and bone health, and shares both the practical habits and the mindset shifts necessary to become “unbreakable” at any age.

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Key Discussion Points & Insights

1. Why Focus on Women and Longevity in Midlife

• Women as Health Decision-Makers:

  • “Women make 80% of all the health decisions in this country for themselves and everyone we touch.” (Dr. Wright, 02:45)
    Women carry enormous influence in family and community health, yet often underestimate their own capability and impact.

• The Myth of Inevitable Decline:
  Dr. Wright challenges the cultural narrative:

  • "Aging is not an inevitable decline. ... I'm gunning for another 40 years, which is as long as I've been an adult." (06:42)
    Advocacy for seeing midlife as a powerful, even ascendant phase—especially for women.

2. The Two Toxic Fitness Messages Gen X Internalized

• “Run it off and don’t eat.” (08:13)
  The legacy of '80s fitness culture (Jane Fonda, Richard Simmons) taught women cardio was king and thin was best—ignoring sleep, recovery, nutrition, and strength training.

• Dr. Wright admits these strategies never really worked: "We all ended up skinny, fat." (08:47)

3. Menopause, Hormones, and the “Menolescence”

• Menopause as a Second Adolescence:
  "Everybody ages in a slow, steady decline until women lose their estrogen. ... It is cataclysmic, paradigm-changing. ... I coined this word: the menolescence." (04:26)
  Menopause is a transformational, not merely declining, phase.

• Hormone Therapy as a Lifesaving Option:
  Dr. Wright outlines the strong scientific support for estrogen therapy in prevention of osteoporosis and heart disease, emphasizing it as an under-discussed, FDA-approved option. (11:45–14:33)

• Osteoporosis as a Gendered Epidemic:
  "Osteoporosis—holy bones—literally means loss of bone strength and is entirely preventable.” (13:24)
  The consequences are financially and physically severe after a fracture. Prevention and early detection are key.

4. Bone Health is Set (and Lost) Early—and it's Never Too Late

• Peak Bone Mass:
  "It's estimated we reach peak bone mass between 15 and 25, extends up to 30." (14:39)
• First Steps for Younger Women:
  Know your family history of fractures/shrinking, get a baseline bone scan, avoid smoking and under-fueling, build muscle through weight training. (15:53–20:43)
• Risk Factors:
  Family history, personal history of fractures after age 20, smoking, autoimmune diseases, high-level sports with under-fueling, and sedentary lifestyles. (16:07–20:43)

5. Muscle: Nature’s Spanx and Your Key to Metabolism

• Why Build Muscle?
  Muscle is a metabolic, structural, and endocrine organ—crucial for energy, glucose use, and overall health.
  “Muscle is nature’s Spanx.” (31:19)

• Never Too Late to Get Strong:
  Research shows even 90-year-olds can significantly improve strength and function through resistance exercises.
  "Within about a month, you won't change your weight, but your clothes will fit differently..." (33:31)

• Replace 'Skinny' With 'Strong':
  “I don’t even know what skinny means...Strong is lean.” (34:34)

6. Time Bombs of Aging: Hallmarks and Hope

• Epigenetics: You Control Your Destiny
  Only 10–30% of aging is set by genetics; up to 90% is shaped by our habits and environment.
  “Most of how we age is in our hands.” (26:13)

• Time Bombs / Hallmarks
  Dr. Wright reframes normal aging processes as "time bombs"—issues that, without intervention, can derail long-term health. (24:57–27:04)

7. The Power of Simple Habits & Layering

• Start With Walking:
  Walking briskly for 45 minutes after your biggest meal—for seven days straight—is the best “first step,” especially for beginners.
  "Walking at a brisk pace after your biggest meal...is the one thing you can do." (27:29)

• Strength Training Matters at All Ages:
  Whether gym-based or at home, gradually progress from bodyweight to compound lifts.

  • For endurance: Light weights, 25 reps to failure.
  • For hypertrophy/strength: 10–15 reps (or to failure at 4–6 reps for power lifts). (43:17–46:59)
  • Frequency: Ideally, 2–3 times per week as possible; don’t neglect for cardio alone.
  • Support Lifts: After key compound moves, do targeted muscle work (e.g., biceps/triceps for arms). (46:06)

• The F.A.C.E. Framework ("Face Your Future"):

  • F: Flexibility & Joint Mobility (e.g., Pilates/Yoga—good, but not enough alone)
  • A: Aerobic Training (walking, sprints)
  • C: Carry a Load (resistance/weights or real-life objects)
  • E: Equilibrium & Foot Speed (balance and agility, retrained with practice) (47:45–50:01)

8. The Five Simple Longevity Tests (and a Few More!)

Dr. Wright gives women concrete lenses for self-assessment:

• Key Functional Markers (50:36–52:10):

  1. VO2 Max (top predictor of longevity)
  2. Grip Strength (buy a handheld dynamometer, test and track)
     • 20–24 kg is good for women, 32 kg is excellent. (52:42–53:21)
  3. BMI
  4. Sit and Rise Test (floor to stand)
  5. Walking Speed
  • Others: Number of pushups (11 is the target), one-legged balance, and body composition.

  Notable quote:

  “Grip strength is not about squeezing a tennis ball and getting your hands strong... it is a surrogate for total body strength.” (51:49)

9. Nutrition: Protein and Practical Advice

• Most women undereat, especially on protein.
• Guideline:
  One gram of protein per ideal body pound per day, broken up into at least 30g servings. “You actually have to feed yourself to lose weight.” (63:56)
• Before workouts:
  15g protein pre-exercise is optimal. (65:08)

10. Myths & FAQs Addressed Rapid Fire

• Pilates/Yoga: Excellent for mobility but not muscle mass alone.
• 10,000 Steps: 7,000+ daily is good—original number was marketing.
• Weighted Vests: Not necessary for bone health unless prescribed.
• Pickleball/Pilates/Cycling: Excellent for heart/brain, but do not replace direct strength training.
• Cellulite/Body Fat: Some is genetic, but muscle-building and losing fat helps.
• Slowed Recovery in Perimenopause: May be due to less estrogen; check protein intake, micronutrients, consider hormone therapy. (72:14)

11. The Psychology of Aging Powerfully

• Mindset & Agency:
  “Unbreakable is the mindset backed up by the actions that we can live healthy, vital, active, joyful, long into the foreseeable future and age with power, not frailty.” (72:50)

• Dr. Wright’s Challenge to Listeners:
  Every woman is "worth the daily investment"—start small, build layers, and pursue strength, not just slimness.

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Notable Quotes & Memorable Moments

• On women’s power:
  “Women underestimate what we’re capable of...but that stops now.” (04:09)

• The menolescence analogy:
  "It is analogous to adolescence, which we all remember...so it is when we are exited by our hormones.” (04:26)

• On fitness culture’s 1980s damage:
  “We came away with two messages that do not serve us now: run it off and don’t eat.” (08:12)

• On strength vs. skinny:
  "Strong is lean. I don’t even know what skinny means because you can be skinny and have no muscle mass." (34:34)

• On VO2 max and frailty:
  "There becomes a line called the frailty line, after which your VO2 max, your fitness is so low, you cannot get up from a chair by yourself." (59:22)

• On mindset and layering habits:
  “We are building a lifestyle, we are not building a program.” (57:56)

• On the essential nature of bone:
  “Bone is a metabolic organ. It is an endocrine organ. It produces proteins…” (69:24)

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Timestamps for Essential Segments

| Segment/Topic | Timestamp | |--------------------------------------------------|-----------------| | Why focus on women’s health/decision influence | 02:45 | | "Menolescence" - menopause as adolescence | 04:26-05:39 | | Gen X and cardio-only myths | 07:27-08:49 | | Hormone therapy and osteoporosis | 11:45-14:33 | | Bone health timeline: teens to 30s | 14:39-20:43 | | Muscle’s role: metabolism, health, "Spanx" | 29:07-31:19 | | Strength-building at any age | 31:40-34:03 | | Epigenetics & control of aging | 26:13-27:29 | | Starting with walking (first habit) | 27:29-29:01 | | Strength vs. cardio - how to train | 43:17-46:59 | | F.A.C.E. longevity acronym | 47:45-50:01 | | The 5 (8 total) simple longevity marker tests | 50:36-52:10 | | Grip strength test explained | 52:10-53:21 | | Protein, nutrition, and fueling muscle | 63:13-65:31 | | Q&A: Pickleball, cellulite, recovery, etc. | 71:20-72:47 | | What "unbreakable" means | 72:50 |

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Conclusion: Takeaways for Listeners

Dr. Vonda Wright dispels the myth of an inevitable slow decline in aging—especially for women—and gives accessible, science-based tools and mindset shifts to invest in strength, mobility, and agency at every age. Every woman can start now, wherever she is: walk, lift, check functional markers, eat enough protein, and believe the second half can be your best half.

Memorable final thought:
“Unbreakable is the mindset backed up by the actions that we can live healthy, vital, active, joyful, long into the foreseeable future and age with power, not frailty.” (72:50)

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For more, find Dr. Vonda Wright at @drvondawright, and check out her new book and longevity assessment app.

Recommended action:
Layer in one new strength-building or walking habit this week, and consider testing your grip strength or another simple marker of future health.

Transcript

[A]

Foreign.

[B]

Hi friends. I am so glad you're here with me today. Welcome back to the Tamsen Show. I've told you this before, over and over again, but one of my biggest goals this year is to work out for my future self, not for who I am right now. I want to be a jacked 80 year old running circles around people half my age. And the reason I believe it's possible, truly is because of Dr. Vonda Wright. She is a leading orthopedic surgeon and longevity doctor and she does not believe aging has to be a slow decline. She believes you get a say in all of it. So I'm putting this one back in front of you because it's the conversation that made me start training for the woman that I want to be decades from now. And I know it's possible. After this conversation, you're going to see your body in a whole new way and understand that most of how you age is in your own hands. It's not just genetics. And the one simple thing that you can start today that quietly changes where you land years from now. I really want you to have the confidence that your strongest and most capable self may still be ahead of you and that she's worth investing in right now. Before we get started. As always, and I hate asking this, but could you please leave a review of the Tamsen show? It helps us out so much and helps these conversations reach the women who need it. Okay, let's get into it. This show is sponsored by MIDI Health. Menopause doesn't happen overnight. It happens over years of nights. Hormones start shifting long before your period ends and most doctors aren't trained to spot it. That's why MIDI Health exists and it's why I tell every woman I know about them. MIDI is the only virtual care clinic built specifically for women navigating midlife hormonal changes from perimenopause through menopause. And yes, visits are covered by insurance. Book your first virtual Visit [e-mail] Tamsen that's joinmidi.com Tamsen DSW Semi Annual Sale starts now.

[A]

Twice a year. Tons of deals going fast. It's all or nothing. A designer shoe warehouse will give you something to brag about. Like 40% off clearance in all DSW stores or an extra 10% off [e-mail] don't sleep on these savings. Find shoes that get you at prices that get your budget DSW. Let us surprise you.

[B]

Dr. Vonda, it's so good to see you.

[A]

Thank you so much for having Me.

[B]

Well, I'm excited you're here one, because I have a thousand questions for you. Not only from me, but from people who knew that I was gonna be doing this interview. But as a leading orthopedic surgeon, a longevity doctor, that is really helping women age with power. You have worked with some of the top athletes in the world. Why did you decide to focus on women in midlife?

[A]

I have been passionate about women since I was a cancer nurse in the early 90s. And then in 2012, I read some data that I hadn't known. It said that women make 80% of all the healthc decisions in this country for themselves and everyone we touched. My goal as a doctor has always been to change the way we age in this country. That's been the driving mantra of my orthopedic practice. I realized if I really wanted to do that, I had to put a special emphasis on the decision makers, on the influencers. Because think about our daily life. If yours is like mine, health and getting advice on what doctor to go to and who to see and what to do. Your entire book was about gathering the data for women. That's what women do.

[B]

You're so right about that. You're so right about that. And then we pass it on to everybody else. Everybody else put it to use.

[A]

That's right.

[B]

I don't think I realize that women make up 80, you know, do that, 80% of the health decisions. That's an incredible number.

[A]

It's a huge number. But it pales in comparison to the fact that women don't understand our consumer buying power. And healthcare falls in within that category. And so I found when I first started talking about that number and about our influence, most women were really shocked because on a day to day basis, we completely underestimate what we're capable of.

[B]

Well, that stops now.

[A]

I know. Not here, that stops now.

[B]

Not with you and me, but this book, unbreakable. I'm super excited about it.

[A]

Thank you.

[B]

I feel like I already know women I'm gonna gift it to because there are gems in here that we all need for many, many years. You've written a lot of books. Why this book now?

[A]

You know what I think there's a myth in this country that aging is an inevitable decline from the vitality of our youth, that we're always looking over our shoulder to remember to some kind of frailty of old age, that there's a view that's an inevitable. But I know that's not true. My own research has proven that the national zeitgeist is pivoting now towards active aging. And yet I find many people are still confused. And I find that 70% of people make no daily investment in their health and mobility. And on top of the fact that you and I are both deep into the menopause conversation and women do not age like men. Everybody ages in a slow, steady decline until women lose their estrogen. And it is cataclysmic, paradigm changing. It is analogous to adolescence, which we all remember. You know, I, I love to coin words, and I coined this word the menolescence, meaning why do we expect it to be anything less than cataclysmic, like it was when we came into our hormones? So it is when we are exited by our hormones.

[B]

And I think if we think of it like that, it, it makes more sense.

[A]

Right.

[B]

Instead of saying, why is this happening? What's happening to me? I don't understand it. Yeah, because when you say it like that, it kind of, it does this curve, you know, where you understand where it is, this is where you've been and this is where it is. But then I worry about the downward part and it shouldn't be the downward part. And that's what you're saying, shouldn't be the downward part. It should level out or go up.

[A]

Well, when you think about what we did in adolescence, it may have hit us like a brick. Yes, we figured it out and we had a marvelous life. Our 20s, our 30s, our beginning of our 40s. That's the way I view this. It may hit us like a brick. Hopefully not. Hopefully, going forward, we've done enough work that it's going to be another life phase. But even if it hits you like a brick, it is not a slow steady decline. It can be healthy, vital, act of, joyful, but not if we just like physics and gravity take over. It requires a continual investment. And why shouldn't it be? Because at my age, I am gunning for another 40 years, which is as long as I've been an adult. Isn't that I have been an adult for 40 years, I'm gonna be a different kind of adult for 40 more years if I have my way. That's the framework we have to think about. Why would I decline for 40 years?

[B]

And that's what people have to understand, Because I do think that there is that we've. Look, it's societal, it's cultural, it's all those things. But most people don't think when they hit 50 or 60, but 50, that there's another 40 years that could be really fabulous that it doesn't have to be. Because when you said the word fragility, I went, oh, because I know what the word means now. That word never crossed my lips before. And now over the past five years, I have said the word fragility way too many times. And I can really visualize it. What do you think Gen X has gotten wrong about fitness in general?

[A]

We were brought up on the Tales of the Cardio only right where, you know, bless her heart. Jane Fonda. I was just gonna say Richard Simmons.

[B]

Yes.

[A]

Bless her hearts. I mean, I was a teenager and I'm out there doing that stuff, right?

[B]

Me too. I had my leg warmers on and

[A]

I had all the outfits and Richard Simmons saying, grew it, you lose it.

[B]

Right?

[A]

But we came off the tail end of that. And what we took away was be skinny and little. We took away cardio is the only answer for you. That was about it. We didn't take away. We have to have sleep and restoration. Relationships matter. Smart nutrition is more than not eating right. We came away with two messages that do not serve us now.

[B]

What are those two messages?

[A]

The two messages we came away with was run it off and don't eat.

[B]

Isn't that unbelievable? And it would almost be a badge of honor to get through a day where you've worked out and haven't had anything but lettuce.

[A]

Right?

[B]

Isn't that crazy?

[A]

Yet we were expecting high performance lives, but we were literally treating ourselves like we didn't matter. So I think we came into this time like that. And then when menopause changes our very chemistry and physiology, we're wondering why that doesn't work anymore. Well, honestly, it never really did work because we all ended up skinny, fat.

[B]

Yeah, that's exactly right. That's exactly right.

[A]

So we're starting lifestyles we never did before. But the reality is I'm working for the baby booming women who are left out. I'm working for our generation who are gonna get this right. But I'm really working for my four millennial daughters, right. Who I have young millennial daughters are in their 30s. But the 44 year olds who are the old millennials, I'm working so that they don't hit the same wall that I hit in 10 years.

[B]

Did you hit a wall?

[A]

Oh my God, Tamsen, I hit a wall, but I didn't know what it was. I mean, I was night sweating. I was brain fogging. Right. I think I've told you I couldn't remember the the nouns in the or. Give me the thing that does the thing. I mean, I am in the middle of a big procedure and I can't say, hand me the Atzen, I need the Coker. Where's the Debakey? These are all surgical tool names.

[B]

But it didn't come to you at all?

[A]

I said, give me the thing that I need. You know what it is?

[B]

Oh my gosh.

[A]

And I didn't know. So many things changed. And until I got serious about learning about it and until I, you know, I was toying with, oh, I don't know what I don't know and don't believe about hormones until I was sitting on the back porch at a barbecue in Atlanta, where I was living at the time, what a menopausal hot flashing woman was doing sitting on the back porch outside at a barbecue. I don't know, I was thinking, it

[B]

all sounds very like not, you know, symptomatic.

[A]

But Kathy, this nurse friend and I were talking and she's like, oh, Vonda, I got a guy. I'm like, what do you mean you got a guy? I've got this hormone doctor in Chicago. You've got to call him because there was nobody to treat me. So we're all calling this secret guy in Chicago.

[B]

But you're a doctor.

[A]

I know Tamsen.

[B]

And no one's there. And you had nobody to talk to.

[A]

Nobody. And I talked to my OB, who is the best in Atlanta and bless her heart, I was given a photo. It's like a mimeograph. I mean it wasn't even a photocopy. Like a mimeograph with some facts. I am going to figure this out because there's no way I'm going to live like this. So I started becoming a scholar and self educating because doctors are not taught, even OB gynis are not taught internal medicine. Doctors are not taught, let alone a bone doctor. Where 94% of my field is men who were born without the privilege of ovaries. Nobody's teaching orthopedic residents about menopause, right?

[B]

Nothing.

[A]

Not one thing. Even though they should know. Because osteoporosis is an orthopedic problem, right? Muscle, tendon, ligament, frailty is an orthopedic problem, but nobody teaches them. And so I'm doing my best with that right now. It may take a minute, but I became a self scholar. I figured this out. I finally read it. Estrogen matters like the Bible.

[B]

You spoke on the FDA panel. Can you explain why as an orthopedic surgeon and longevity doctor, hormone therapy is Such an important topic for you.

[A]

First, I want to frame what I say by the fact that I believe that every woman is a sentient being with agency. So even though I do come across very strongly and I see very little reason not to make this decision, I recognize that it's still every woman's decision. While everyone wants to continue to argue about brain health, does estrogen replacement replace fill the estrogen receptors that coat our brain? Obviously. But people still want to argue about the clear evidence that started within 10 years. Most guidelines now talk about using menopause hormone therapy to prevent heart disease to the tune of 40%. Okay. There is no argument. The data are so clear that estrogen can be used to prevent osteoporosis and bone death in women. It's FDA approved for that. And yet it's never talked about. Now in the last year, I see people picking up bone as a subject while I'm screaming it from the mountaintops. 70% of all hip fractures occur in women. 70%. The minute snap my fingers, the minute you fall and break your femur, you have a 30% chance of dying. 50% of the time, you will never go home. And your family is left to make the decision. Because you can't take care of yourself anymore. Your family is left to make the decision. Do you hire somebody full time to live with you and take care of you? Well, that's cost prohibitive. Do you move in with your child or your niece or nephew? Most people say to me, I don't want to be a burden to my family. Do you move into assisted living? Two thirds of all people in assisted living are women. Do you know how much that costs a month? 7 to $15,000. So what you have to do is use your life savings down to the point where you're a pauper and get Medicaid, all because you broke your hip. Osteoporosis, it literally from the Latin means holy bones. Loss of bone strength is entirely preventable. But it doesn't start when we're 65, when the US insurance industry will finally pay for a DEXA scan. It starts when we're teenagers. It continues when we're 30. And I repeatedly beseech people to build better bone while we still have hormones on board. Because the number one way to get control of bone health is to have estrogen on board.

[B]

If we have a woman who's in her 30s right now listening, is she in an incredible place to be?

[A]

Oh, my God. Building ideally. So it is estimated that we reach peak bone mass, the most bone we're going to build between 15 and 25, extends up to 30. So I personally think that we should all be getting some kind of bone measurement, whether it's a DEXA scan or an ultrasound REM scan for bone quality as a baseline then, because I kid you not, every woman coming into my orthopedic office, no matter what her age, gets a DEXA scan. And I have 20 year olds and 24 year olds and 30 year olds who come in with poor bone density and they don't even know it, and they've never built enough bone. As a young woman, if you carry that, you just assume you're fine, you're young, but if you come in with low bone density and it levels off, declines about 1% a year like a man, until you reach perimenopause. Within the five to seven years of perimenopause, you're going to lose 15 to 20% of your bone density because of the mismatch that comes when we don't have estrogen. Omg.

[B]

So what do we do? What do we. We help.

[A]

Oh, my God.

[B]

When we're.

[A]

Let's say, let's talk to the young millennials right now.

[B]

Yeah.

[A]

You want to do that?

[B]

Yeah. Because I feel like. Yes, I need you to talk to them. I need you to talk to them because they're important. Because you have four daughters who are millennials, but you hit your peak bone mass by the age of 30.

[A]

30, yes.

[B]

It doesn't mean it's too late, though, right?

[A]

It doesn't mean it's too late. There's never an age when we cannot build bone density. But you want to start from the highest level so that as we have the natural decline, we're not declining from osteopenia, we're declining from amazing bone density. Right. So what do I want 30 year olds to do? I want you to look at your mother or your grandmother. Are they shrinking?

[B]

What does that mean?

[A]

That means that they have enough osteoporosis that their vertebrae are collapsing. So if your mama used to be 5 6, and now she's 5 3, she's lost 3 inches of bone height, probably due to osteoporosis, because part of bone health is genetic. So the first thing a young woman can do is look at her female relatives. What happened to them? Do you have a grandmother who broke her hip? If you're 30, but you had a fracture, you fell off the curb, or you fell and broke your wrist. Fracture after 20 predicts future fracture, no

[B]

matter how it happened.

[A]

Oh, yeah, Unless you wrap your car around a tree. High, of course, but lower impact, like falling from a standing position, falling off the curb. Your dog pulls you down, you break a after 20. That's a predictor.

[B]

Why is that a predictor? Because you have a low bone density.

[A]

Because even low energy situations are enough force to break your bone.

[B]

Wow.

[A]

Yeah.

[B]

So if you see that your mother or your aunt or your grandmother is shrinking or somebody broke a bone, what does that tell you? That tells you genetically, you need to be paying attention.

[A]

There can be a genetic predisposal because sometimes bone density has a component in that. So we can't ignore that shrinking going on. It's one of the risk factors.

[B]

I'm five three now.

[A]

I know. What are we gonna do?

[B]

I don't know.

[A]

I'm four' nine.

[B]

I'm gonna need booster seats for this table.

[A]

So it's one of the risk factors that your doctor can use to get you a bone density early.

[B]

So if you are in your 30s

[A]

and you have a family history. My mother is shrinking. She broke a bone. My family has a history of osteoporosis. Please order me a bone density. And it can be coded in a way that insurance would pay for it. Listen, if your insurance won't pay for it, save some Starbucks money. And they cost about $90. Just save it up.

[B]

Where do you go to get that? What doctor?

[A]

You can get it from your primary, from your ob. If you have an endocrinologist, you can Google online. Most gyms now have a bone density scanner.

[B]

Okay. Most high bone density scanner, we need.

[A]

We need to figure it out. So if you're 30, let's go through the risk factors. We've talked about two. Another one is if you were a smoker because it was just so cool, or you flipped from smoking to vaping because. Because God knows that's so cool. It's poison to bones. It's a bone poison.

[B]

Okay?

[A]

That's a risk factor for breaking your bones. If you've had an autoimmune disease, if you've had asthma and had to take high dose steroids just to be healthy and breathe. Those are all risk. And there's multiple risk factors, but those are all things that should alert you at a young age that you may have a problem.

[B]

What if you were a high level athlete when you were younger? Yes.

[A]

How about that? So I think there are many reasons we don't build enough bone when we. We don't, other than genetics. One is we are a high level athlete. Maybe we burn 7,000 to 10,000 calories a day and just didn't eat right. And maybe you never had a period for six to nine months. That was my case. I was a ballet dancer. I wouldn't have a period for that long.

[B]

And I thought, yes, I had an eating disorder. I was the same thing. I was like, okay, it's gone. I don't have to worry about that.

[A]

I don't have to worry about it.

[B]

Unbelievable thinking.

[A]

I didn't know that I needed to worry about that. So. So there's that. We're underfed. It's called relative energy deficiency syndrome. It's a thing in orthopedics. There's that. Or maybe you're not an athlete and you just want to be this little and you still don't feed yourself. Or maybe you're eating, but you're so sedentary. Everybody now is a Digital Native sitting 18 hours a day. And high adipose tissue inhibits bone.

[B]

What is high adipose tissue?

[A]

Fat. Trying to be nice about that word? Just say it.

[B]

Dr. Vonda.

[A]

It's a high body fat content.

[B]

Okay.

[A]

Because bone and fat communicate with each other. You think you're having more weight, so that's good for bone. It's different because fat is secreting its own kind of cytokine that inhibits bone growth. So it's not. Okay, so what do we start?

[B]

What do we do if we're talking to these younger generations who actually, I think, are doing a lot different, they're doing better.

[A]

Yes, that's true.

[B]

They are doing. But there's still these things that they're maybe not thinking about because I wouldn't have been thinking about my bone density and 30. 50.

[A]

Why would you. Yeah, at 50. Exactly, exactly.

[B]

So they are doing some things right. Correct. They're tracking.

[A]

They're, I think, and I could be wrong, but the zeitgeist of the millennial. Young millennials, older millennials, they're investing a lot in their health that Xers never did. In fact, I did some market research for some of my work, and I did think tanks of Millen. And first, they want to investigate their own information. They want to be knowledgeable. I love that, frankly. They want their health care delivered in beautiful spaces. Who doesn't want that? I know, but they're willing to invest 25% of their disposable income to get the health they need. Traditional and non traditional. Because I ask their Starbucks, they will like, who's paying for all this stuff you want? Well, I will, because it's important to me. So that helps me know that they're seekers, they're curious, they're trying to be more healthy. So. So know your family history, learn how to feed yourself and if you do nothing else in your 30s, learn how to lift weights so that by the time you need to lift heavy, which is I want everybody to lift heavy for them, you have a foundation.

[B]

Something I started taking seriously a few years ago is body skin care. Not just the face body, because I noticed my skin from the neck down was not getting the same attention and it was showing. Summer makes it worse. The sun, the heat, the air, all of it pulls moisture out and leaves skin feeling tight and dry in a way that my regular lotion was not fully addressing. I started adding a body serum as a step before my lotion. It changed everything. And the one I keep coming back to is Osea's Hyaluronic Body Serum. Osea is pronounced O Sia and they have been making clean clinically tested skin care for 30 years. This serum is a weightless gel powered by five molecular weights of hyaluronic acid, which means it delivers hydration at multiple levels of the skin, not just the surface. This it's clinically shown to boost hydration by 161% after just one use. My skin feels completely different and it's holding the moisture throughout the day instead of feeling dry again by noon. It is also soothing enough for sensitive skin and has the National Eczema association seal of acceptance, which tells you everything about how clean and gentle the formula actually is. Osea's Hyaluronic Body Serum is a multi layer hyaluronic powered hydration for the entire body. And right now we have a special discount just for you. Get 10% off your First Order site wide with code [e-mail] that's code TAMSEN at O S E A MALIBU.com it's summer now, and I don't know about you, but my sleep has already been a whole situation. Long, hot nights lying there wired. All I want to do is drift off. And the thing is, I was doing all the right things. Cool room, no phone. But the thing that's made the biggest difference is what's on my nightstand. Magnesium. Summer quietly drained your magnesium. Every time you sweat a hot afternoon, a workout, you lose it. And magnesium is exactly what your body needs to recover and relax and get a restful night's sleep. I keep Magnesium Breakthrough by Bio Optimizers on my nightstand. And it is one of the things I would not Go without. What makes it different from the magnesium most people are taking is that it combines multiple bioavailable forms of magnesium in one capsule instead of just the one or two you find in most supplements. So your body actually absorbs and uses it the way it's supposed to. Here's what you get when you go to bioptimizers.com tamson and use code TAMSEN, 15% off your entire order. A free travel size bottle of Masimes Bioptimizer's best selling digestive enzyme added to your order automatically when you use our exclusive code. That's a $20 product free on top of your discount. This is a limited time offer and while supplies last, you cannot get this on Amazon. You can't get it in stores. The offer exists in one place. My link, my code. That's it. Bioptimizers breakthrough science results. You can feel I love this. All right, let's dive into this because I want to get into your book. I know you have so many gems with this. You talk in the book about the time bombs of aging.

[A]

Yes.

[B]

Can we go through what those are and explain why it's so important?

[A]

I believe women are smart and if you give them enough information, they're going to act on it in a very different way than if you just tell them what to do. So within the aging and longevity pure science, there are these concepts called the hallmarks of aging. They're the normal metabolic processes that change with time. Right. As your cells divide and how many free radicals you stray. Oxygen molecules just in normal living. Right. There's all this waste from normal living. Well, that changes you over time. And they're called the hallmarks of aging. So I've chosen for unbreakable six of them that I think are most impact and I call them time bombs because although it is a normal process for our body, unless we are aware of them and get in front of them, they can accumulate to totally derail you in the future. For instance, one of them I talk about is epigenetics. It's the concept that although we're born with a set of DNA from our parents, that it's estimated only 10 to 30% of how we age is influenced by our pure genetics. The other, depending on who you read, 70 to 90% of our eventual outcome comes by the decisions we make.

[B]

That is fascinating because most people say like, oh, it's in my, it's my

[A]

genes, I'm big boned, it's in my genes, whatever.

[B]

Wow. So 80 to 90%.

[A]

Yes. Most of It So to me, that is not a burden, that is hopeful. Yes, for a different future. You are not destined to live the way your grandmother lived. You could easily slip into that. But you can change the trajectory of your future. So things like going out for a walk or a run or an aerobic, anything changes. The expression of about 9,800 proteins, it just changes because our body is so active. What genes are turned on and off, right. Is due to the environmental signals, whether that environment is activity or broccoli or not smoking.

[B]

If you had to say, I just need something right now to know that I can do tomorrow. That is not gonna be that much of a lift. I've never worked out before. I'm not really sure. I don't even. I'm trying to still understand what longevity means. I'll figure out the balance stuff later. Is it walking? Because walking keeps coming back to me as like over and over. The simplest thing past sleep, which we know is important, is walking. The next thing that people can do to really become unbreakable.

[A]

If we are truly starting from the couch, which 70% of people in this country are, I accept that. We're gonna accept people where they are walking at a brisk pace after your biggest meal. Timing to me matters is the one thing you can do because why? It is our core motor skill. We have been doing it since we were one. We do not have to learn anything. It can be with or without shoes. See what I'm trying to do? Eliminate all the roadblocks, right?

[B]

I love it. No, you are though. You're like, I got that one. I know your excuse.

[A]

Well, I've been a doctor for 30 years, so nobody can out. Excuse me. I have heard everything. And so sometimes my patients are sitting across from me and they're giving me their litany of. I'm like, that's how you solve this one.

[B]

These are all your solute problems and solutions.

[A]

So bring it on. Because you cannot. Excuse me. Walking 45 minutes after your biggest meal for seven days straight. Because in running we call that a streak. When you do something for seven days in a row. There are people, runners who have thousands of days of streaks and they will do anything to continue their streak. So I'm transferring that from the performance side of my life into everybody everyday people, life. If you do it, commit to yourself for seven days. The eighth day, you're not going to break your streak. You're going to figure, figure out that if you leave the dishes on the table, no dishes, police are coming to get you, and you Just kind of another excuse.

[B]

I just heard another excuse at that. Why exactly is muscle so important?

[A]

We think of muscle as the cosmetic things we see in the mirror at the gym. Right. Show me your guns or whatever. And it is that we think of it as locomotion. It gets us one place to another when connected to bones. Your bone, Muscle without bone.

[B]

Show your bone.

[A]

I bring my femur everywhere.

[B]

I like your femur. But you would have all around. Where would the muscle be There?

[A]

Yes. So if this is someone's leg, this is the hip, this is the knee. The quadriceps cover this. It's gorgeous. Four hardy muscles. The hamstrings are back here, Right? So this bone is surrounded by muscle, but it's a metabolic organ. It secretes proteins like irisin and galanin and a variety of many things that communicate with other parts of the body. It's a communicator in our body, just like bone is. Bone is an endocrine organ. It secretes hormones.

[B]

Interestingly, I love how you explain that. I've been walking around 54 years with my body. I didn't even think about that. How the muscle really covers it, understanding what else, it's really fascinating. But you explain it in a way that I understand it.

[A]

I want to tell you about bone when we're done with muscle, because it's the best story in the whole book. I mean, not in that book, like in the book of life.

[B]

No, we're doing bone.

[A]

But the thing that makes muscle critically important is that it's where a lot of our metabolism, our energy formation happens. Muscle is filled with a little organelle, is what they're called, called mitochondria, which is where when we eat, we use our glucose and our fatty acids and our amino acids to convert to the energy of life, which is a molecule called ATP. You can't move without this bitcoin of energy, right? The muscle does that. The muscle is the sink for all the glucose. Therefore, I tell you to walk after your biggest meal. So all that glucose you're digesting just doesn't go and accumulate in your fat or gum you up. It is used by the muscle to produce energy better. So muscle is this fascinating structure that's metabolic, it's locomotive, it's structural, it's an endocrine organ. And yet we just think it's our biceps in the mirror.

[B]

We just think it's if it looks pretty or not.

[A]

I know we don't give it a lot of chance, but you know what it is? If we look pretty, I Love saying this out loud. I love me some Sara Blakely, but muscle is nature's Spanx. So you know, you're right about that.

[B]

You're right about that. I do. What happens if we wait too long to build strength or mobility?

[A]

If we wait too long, then we increase our risk of falling. Falling can lead to death. We can not be able to live independently, which is everybody's fear. Nobody wants to be a burden. No one wants to be dependent. So we can lose a lot of muscle mass over time. But here's the good news. There are a lot of anecdotal examples of this, but there are a lot of science studies that show no matter what age you are, you can retrain the neuromuscular pathways that connect your muscle and make them fire better and you can actually build muscle. So there's never an age or skill level without consistency and starting where you are that you can't build muscle. In fact, when I first started doing muscle, and I mean I had a muscle, I was part of a muscle. Stem cell muscle's been my subject a long time. When I was preparing to do some studies there, the first studies I read about were in 90 year old men living in a nursing home. They did chair yoga, basically chair exercises, and over a six week period they increased their functional capacity, meaning getting up and down from a chair, doing activities of daily living, 150%.

[B]

That's fascinating. I thought you were gonna say like 16%.

[A]

No, it totally revitalized their lives because what happens first is you retrain the neuromuscular pathways so that the way muscles in the brain work is one motor neuron innervates one bundle of muscle fibers. And if they're firing sporadically, you're really weak. But when you retrain them all to fire in one big organized way, you get stronger.

[B]

So if somebody's listening right now and has never picked up a weight, has never been to the gym, doesn't even know where to begin, feels a little intimidated by it because that is really, really reasonable. They can retrain their body completely and they can build muscle.

[A]

It will take a minute, but absolutely. And it doesn't take very long to notice a difference. Within about a month, you won't change your weight, but your clothes will fit differently and you will get out of the chair more easily. And you may not be trudging one step at a time up the stairs. If we're really in a state of dis health, you will notice changes in a month, in three months, day by day, people will start Saying to you, oh my God, what are you doing? Isn't that amazing?

[B]

It is amazing. I think the other thing is, and you just said this, and I want to reiterate it, your weight might not change.

[A]

So as you're exercising, you may not notice the scale going down immediately, which is what we value because that's what we've been taught. But you will notice leaning up.

[B]

Okay, you want people to start replacing the word skinny with strong and move skinny out of there. And strong has to be what we're talking about now.

[A]

Strong is lean.

[B]

Strong and lean.

[A]

Lean is what? Lean. I love the words. I don't even know what skinny means because you can be skinny and have no muscle mass. I mean, bless their hearts. I was once invited. God, I hope I'm never, I'm never going to be invited back. When I say this out loud, but I was once invited by Mercedes to go to fashion Week and I'm so out of my league there. But I was observing and there are a lot of very thin people there, but I could not find muscle definition. So we have thin, but we're not lean. And that's, that's when we look at body composition, we want to know what we're made of. You know, girls are taught sugar and spice and everything. Nice. Well, we should be taught muscle. Please. We're made out of muscle. Muscle and bone and brains.

[B]

How does strength training help women that are perimenopause or menopause, especially with hormone health? Is there a correlation there?

[A]

I don't know how to explain the mechanism of, oh, lifting is going to help balance your hormones out. I don't believe in hormone balancing. Actually, I don't. That's not a physiologic thing, that's more of a marketing thing.

[B]

But the way I think that's important to say. There's a lot of people that think that you can balance your hormones.

[A]

Your body does that. Your body, your whole body is balanced. In menopause, everything is off, right? Because your, your ovaries are no longer producing estrogen. But when you're cycling, it's a balance, right? Your body perceives that it needs more estrogen, the brain will release a hormone follicle stimulating hormone which goes to the ovaries to mature an egg so that the egg follicle can make more estrogen. That is hormone balancing. That happens in normal physiology. But in menopause we're talking about is. I don't even know what hormone balancing means. In menopause we can replace or have hormone Therapy with estrogen. We need progesterone if we have our uterus. Sometimes even without a uterus, it has a wonderful role. And women make a lot of testosterone, so I include that in the mix. Right. But in terms of balancing one on another, balancing implies that follicle stimulating hormone is doing its physiological thing and it's not anymore.

[B]

Good. I'm glad you said it because I do think it is marketing and I think it's confusing to a lot of people. It's very confusing because I think they're

[A]

gonna hit somebody and it's very salesy.

[B]

They're hit a perfect number and then they're gonna feel great. And we know it takes so much more than that. One of the biggest complaints that I hear from women is talking about belly fat. You just talked about that model. Is there a way to get rid of belly fat through strength training and the right way to work out?

[A]

I have found in myself, although it's a constant, you know, I've had less belly fat than I have now. I've had more belly fat than I've had now. So it's a lifetime process. I don't want people to think that I'm going to tell you the recipe and then you're done forever. But the way that I have found to recompose our bodies is to learn to lift heavy so that we're building strength. And I can talk about what that means in my practice. And to provide enough strategic stress in the form of high heart rate sprinting. It's those two. Plus you have to be concerned with your nutrition. You have to feed the muscles you're trying to build. You can't eat all the garbage and treat yourself like a garbage disposal and recompose.

[B]

No, I want you to go through all those foods. We're going to do that.

[A]

Okay.

[B]

Yeah, we're not. You're not going anywhere. Sorry.

[A]

But you know what? People are like, what's it going to take to recompose, to lean? And in my experience, and the science bears it out, sprinting and lifting heavy.

[B]

Sprinting.

[A]

Sprinting is a heart rate mechanism. People think when I say that we're talking about Shaqiri Richardson or Usain Bolt, what I'm talking about, because that's otherworldly. We're talking about high heart rate activity to differentiate from walking.

[B]

Yes.

[A]

And I'm so sorry I've been naming them lately. But this middle of the road, middle heart rate higher than walking. Not high enough.

[B]

Okay, that's fine.

[A]

Sprinting orange theory type. Okay. But everybody knows what I'm talking about when I say that.

[B]

I do know.

[A]

It's this middle range. It's not, not low enough to be metabolically the healthiest. It's not high enough to recompose. But what it is, I mean, my office is in a performance center seven days a week on the indoor football field. There's classes that do this. You know what happens every four weeks? People are hurt because it's high enough reps, high enough sets to wear things out with. Not enough recovery because it's every friggin day. And then every four weeks you're in my office with another injury that slows you down and then your brain's furious at you.

[B]

And your office is the last place people wanna be. No offense.

[A]

I know, I know. My office has glass floor to ceiling that looks over this football field.

[B]

Oh wow.

[A]

And I see em coming. I've tried to change that. But people want that. They think that sweating it out thing that they're doing seven days a week is the way pro athletes do it. That's not the way pro athletes do.

[B]

So we want the metabolic.

[A]

I'm a performance doctor. Our building has a metabolic lab designed by one of the best exercise physiologists in endurance sport. And there's two ranges of cardio. There is the low heart rate base training and then there's the sprinting. It's not seven days a week in the muddy middle.

[B]

Bat wings. I was asked to ask about these, which I don't want to move around too much because I don't want that. But how do you do that? Is that strength training again?

[A]

Triceps. Triceps.

[B]

Yeah. People don't want to hear that.

[A]

Pull downs.

[B]

Do they want. They want you to give them a different thing to do. Right?

[A]

Well, I'm a surgeon. We could cut it off.

[B]

Okay, okay, let's. I mean there is.

[A]

All right.

[B]

Triceps are fine. We talked about walking and I want to get back to one thing I have heard over and over. Got to hit these 10,000 steps a day. It's true. Right. You should try to do that. But is there any kind of caveat to that?

[A]

10,000 steps? I think the folklore around 10,000 steps was a Japanese marketing thing. But the science bears out about 7,000 steps a day of all movement. It doesn't have to be in one place. Like when I moved to New York for the first time and I was much younger then, but because nobody has a car. Well, lots of people don't have. I didn't have a car here. We walked everywhere. I lost about 13 pounds moving here from the pure mobility of keeping my body moving.

[B]

Just life.

[A]

Just life. And that's what we're talking about, right?

[B]

This Monday.com ad was created by a team of people and AI agents. Reese, our content agent, wrote the copy based on our best practices, like mentioning Monday.com three times.

[A]

That was the second.

[B]

Johnny, our coordination agent, built the timeline and kept everyone alive. Olivia, our human creative director, stayed in the loop because agents are great, but they don't always know when a joke lands. She had one note tell listeners it only takes minutes to build an agent. So minutes. Create your own AI agent. Today on Monday.com this show is sponsored by Midi Health. Every day I hear from women who think they're losing their minds. Can't sleep, can't focus, crying in the carpool line for no reason. They've been to three, four, five doctors and walk down out with different theories and zero answers and not one of them says the word perimenopause. Because here's the truth. Menopause doesn't happen overnight. It happens over years of nights. Hormones start shifting long before your period ends and most doctors aren't trained to spot it. That's why MIDI Health exists and it's why I tell every woman I know about them. MIDI is the only virtual care clinic built specifically for women navigating midlife hormonal changes from perimenopause through menopause. It was created by women for women and the clinicians are menopause experts and hormone trained specialists who actually listen. No one should tell you it's all in your head. No more being told this is just something you have to live with. Your MIDI clinician will build a personalized care plan with safe FDA approved options, hormonal and non hormonal, based on what you actually need. And yes, visits are covered by insurance. Book your first virtual Visit [e-mail] Tampa that's joinmidi.com Tamsen can we go into strength training? And strong. I've seen you throw weights around in the gym. I see. You know, I do all of your little challenges and tests because I think they're important and people love them.

[A]

They do.

[B]

And we're gonna do a few of them. When it comes to resistance training, how often should we be lifting each week?

[A]

When I say heavy lifting, what I really mean is, is the way we reach failure. Because no matter how we're lifting and I just think it's important to be complete because I get a lot of feedback at this point, the public is. I know what they need to understand because they're commenting all the time whether if you want to lift for endurance, being able to do something for a long time, then lift a really light weight. A lot of times I've had women come into me and tell me that their trainers have told them to lift the tiniest weight 25 times. Well, if you lift something little 25 times, you may reach failure, meaning you can't do 26. Okay, that's a way to do it.

[B]

Failure, meaning fatigue. I can't do it anymore.

[A]

I did 25. I can't do 26. That's failure. If your goal is endurance, okay, you lift that way. If your goal is hypertrophy, the biggest possible volume in the mirror, then that takes reps of 10 to 15 because that's hypertrophy. Right? Hypertrophy to failure, meaning you choose a weight that you can do 15 times. You may be able to squeeze out 16, but you're not doing 17. That's what I mean when I say lift heavy. We are going to work up to. If you're not lifting at all, it may take six months, nine months, a year to train your body, learn the technique to power lift. The power, not the competition power lifts, but meaning the multi joint, multi muscle lifts of upper body push, pull. So some kind of bench press, some kind of pressure, some kind of pull, lower body push, pull, squats, deadlifts.

[B]

Got it. How heavy should we be lifting then? And I know it's going to be different for everybody.

[A]

Let's do another level of clarity, you know, and if you're just starting out, please just lift your body weight. Figure it out. In unbreakable, I take, I do have some of the very beginning protocols taking you away from the couch, but end up with lifting heavy. The four power lifts we talked about, upper body push, pull, lower body push, pull. Those are the basis. You need to cover those every week, but then you support those lifts. Let's take bench press again with the single muscle lifts and you get to do less weight with those. So here's how it goes for bench. If it's an arm day for me, I'm going to warm up. I'm going to start with my bench press. I'm going to do four reps, four sets, meaning I may be able to do five, but I'm not doing six. It's that kind of work weight to support, because that's multiple joints, multiple muscles. It's compound. It's the way we live. I Support that with single muscle. Biceps, triceps, lats, delts, rows between 8 and 10. So those are lighter. They're single muscle supportive lifts.

[B]

8 and 10 reps, reps, reps.

[A]

So not everything has to be absolutely highest. A single muscle supportive lifts can be less weight. The power lifts, the compound lifts, is what most women leave out because our body works in compound motion. For instance, let's take our legs. Never in God's green earth, unless you're bracing yourself for a car accident, do you push against a structure to work your quads. That is not how it works in life. We're not sitting in a chair now. I'm not saying that's wrong. I'm just saying that's not how it works. We use our quads with squat by squatting down, or by squatting down and then picking something up and standing back up. Like a deadlift. Right. That's how we use ourselves. That's how we need to train ourselves.

[B]

That's such a. I don't even think like that. I've been training for as long as I. I mean, for a very long time. People haven't been to the gym. Don't know some of these things. When we're talking about a bench press, it's the bench that you lay down on and you have a single bar and the weights on the side, right?

[A]

Yeah. And you can do weights on the ends of bars. You can do free weights, which are those little dumbbells that you see all over the place. But the picture to keep in mind when I talk about bench press or pulls or squats, it's think about what am I doing to push with my arms? Well, bench press is only one of the things you can do. What am I doing to pull with my arms? Well, think pull up. But there's a lot of ways to do that. And the same with. It's the push, pull motion with the big muscle groups.

[B]

What do you think about things like Pilates? Do you think that that's important for mobility?

[A]

I think it's important for mobility, but it can't be the end all, be all. So when I describe or prescribe the things we need to do for longevity, I use this acronym that I've used forever. It's called face, F, A, C, E. Facing your future. And it includes F is flexibility and joint mobility. Because the natural history of our tendons, ligaments and muscles is to shorten with time. And we need to keep them at optimum length to prevent injury, to keep them healthy. I think Pilates and Yoga are amazing for that. Tai chi is amazing for that. But when I have someone tell me that they've just completed their 1500th consecutive Pilates workout and that's all they do, I first marvel at that accomplishment. And then I say, that's never gonna be enough. Enough.

[B]

Okay.

[A]

Because that's good for flexibility and mobility. It will train the small muscles. It will not build big muscle for you.

[B]

So that's your flexibility.

[A]

And then, so phase A, flexibility and joint mobility. A is aerobic. We've talked about that. C, we just talked about carrying a load.

[B]

Yes.

[A]

Because it can be weights in the gym, it can be buckets in your yard, it can be a log. Right. You can be creative with it. And then each E. E is so critical. E is equilibrium and foot speed. Because you can be strong, you can have good cardio, and you can still fall down and break your hip.

[B]

So what is foot speed?

[A]

So, number one, equilibrium equals balance. Right. So everybody needs to retrain their balance. But foot speed, we lose our fast twitch muscles, type 2 muscle fibers faster with aging than our slow twitch. So it means that we don't react quite as fast. We don't have the ability to step over something, jump over the purse. So I just happen to work in this facility I keep talking about with an Olympic speed coach. And so she's teaching her young athletes all the time to react fast, to jump over things, to do little fast twitch exercises, which have more to do with neuromuscular pathways than actual strength. And I had her teach me. I have her teach my women because we need to retain our foot speed.

[B]

I know you have functional markers, too, and I want to hit those. I have a few quick questions.

[A]

Yeah.

[B]

Weighted vests for walks.

[A]

Do you recommend them for increasing the workload? Not if your expectation is building a lot of bone.

[B]

Okay, that's good to know. Functional markers. You give women in this book real tools, real ways to test what's going on. So we're not guessing everything. Yeah.

[A]

Yeah.

[B]

And I know that it's so important to you as a researcher, as a physician, as a longevity doctor, as a surgeon. What are some of the different markers? I know we have the grip strength, and I think we should. Is that. Is that one of the most important ones?

[A]

It's one of the top ones.

[B]

One of the top. So can we talk about this?

[A]

Yeah. So what we did in one of the early chapters is we identified through research what the top eight predictors of longevity. And then we created a scale called the Unbreakable Assessment and weighted Each test based on how strong the data was. For instance, the number at the top of the heap is VO2 max. And then quickly, grip strength and BMI. Although I don't love BMI, but there is a lot of data surrounding it. Sit and rise, how fast you can get up off the floor, walking speed. So there's eight of them.

[B]

And.

[A]

And we give not only explanations, but how tos. And there's an app with this book that's going to show you and then help you calculate what your longevity score is. Not as a judgment. It's like if you have ever heard of. When we send football players to the NFL combine, they have a bunch of tests to do so that we can know where they stand.

[B]

That's all there is. So this is going to show you where you stand. Where do you stand?

[A]

So that you can improve on these things that we tell you about in the second part of the book. And then read test.

[B]

Okay.

[A]

Yeah.

[B]

All right. Where do we stand with this?

[A]

So grip strength is not about squeezing a tennis ball and getting your hands strong.

[B]

Okay.

[A]

The data on grip strength shows that it is a good surrogate for total body strength. Right. So if you think you're going to improve your overall grip strength, but let's just go grab a tennis ball, that you're missing the point. We're missing the point.

[B]

I know. That was so hard for me. I can't play.

[A]

This reflects total body strength. And then the studies that surround this can relate it then to strength and longevity. So when you use a grip strength thing, they're about $25 on anywhere, any digital place you buy them from what you do. And usually I do it standing because I gotta put the whole body, although it's just the hand. You grab this thing and you gotta make sounds and grip your teeth.

[B]

So go ahead, Go ahead. No judgment zone. We have to do. Do it.

[A]

We have to go and see what we get. I got 32 kilograms.

[B]

It's probably great.

[A]

That's good. Yeah, that's excellent.

[B]

For women my age, you're like during

[A]

heels, we want at least 20, 24, 32 gets us into the excellent range. But if we're in our 20s. If we're in our 20s, we're okay. But it's not a judgment.

[B]

It feels more pressure. Don't look.

[A]

Okay. Make a face.

[B]

Squeeze it now. Can I stop? You're good.

[A]

You're 25.3. Good job.

[B]

Oh, okay. That's better. I know.

[A]

Right in the middle of straw.

[B]

Thank you.

[A]

Yes.

[B]

I'd like to be Excellent. Like you.

[A]

Well, you know what, Just for people

[B]

who did not see that, we basically have a little thing with a handle on it.

[A]

It's a little plastic tool. Yes, $25. All you're doing, it has a little digital monitor and all you're doing is squeezing this handle and it measures how many kilograms of pressure and it doesn't really move.

[B]

It doesn't move. That's the.

[A]

It's like isometric, meaning you're putting force on it, but it's not like you're squeezing something.

[B]

Yeah. And we'll put a link down below to those so somebody can grab them if they want to do that.

[A]

Yeah.

[B]

Okay. You talk about some of the other functionalities. Push ups. You went very viral for talking about push ups, saying that women should.

[A]

Well, you know What? I chose 11.

[B]

There's a range of push ups, but here's.

[A]

I didn't make it up. People think I made this up.

[B]

I don't think you make things up, Dr.

[A]

Von randomly. The American College of Sports Medicine has physical fitness standards. Some of them are based on men because God knows most of the research has been done on men, but other is based on women. So I was thumbing through the handbook. It's an actual handbook. And I'm like, oh, look at the push up challenge. But I first thought of it Tamsin, because I still like to do a couple Spartan Stadium races a year. So those are the Spartan races.

[B]

You're so impressive. I remember when you first told me

[A]

that it's a way to keep challenging myself. I don't do well without goals. I just have to have something to strive for. Those are the races that are in Legendary Stadium. So I get the benefit of getting to go behind the Green Monster in Fenway park and still be racing. So those races always have pushups in the locker room. So you get to go on one of these famous players little areas in front of their locker and then you gotta pound out 15 pushups or you can't leave the room or you have to do 30 burpees. I'd rather do anything but burpees.

[B]

Right. Anything but burpees.

[A]

So the first time I thought about it was a few years ago when I started doing that. You gotta pound out these pushups. And then so then when I was reading this book, I'm like, let's see what people can do. And here's what the reaction was. This is not going to surprise you. More than 90% of people took it as, oh my God, I don't know if I can do that. Let's do it. Let's try it anywhere. Michelle Obama tried it. Amy Poulter. All these really famous women were not afraid to put themselves on the line as a measure to do better. But there were a few percentage of women who commented, and I feel really not bad about myself, but bad about their own expectations of themselves, said, all you're trying to do is shame women. You are discriminating against women. And all this negativity. And what I took that as was, I am so sad that women aren't willing to try for themselves. Because I'm not saying that today, having never done one push up, you're a failure if you don't do 11. I'm saying that's a goal to work towards. You are worth the daily investment in your health.

[B]

And I think as women, we were never taught to be worth that investment.

[A]

In some cases, oh, we're taking care of everybody else.

[B]

Exactly. And that's where that comes from. So I hope that that message, you know, I hope that we continue to chip away at that message at a faster pace than we have. What does standing on one leg tell us?

[A]

From about the age of our late twenties, the neuromuscular pathways that I keep talking about that help us fire muscles or help us balance start to degrade such that we can't stand on one leg. Right. Well, why is that important? Because lots of daily activities require us to reach over. And if we reach over, loads our balance and fall, that's when disaster happens. We can totally retrain our balance. So I suggest people practice brushing your teeth on one leg, doing this funny little exercise called balance reach, which you're standing on one leg and you're just reaching with your other toe. You're a dancer towards 12, towards 3, towards 6, and you just do that 10 times, a few times a day. And it just retrains our balance and

[B]

it's so essential so we can improve balance too. I think what I love about the book is that you can improve everything. It doesn't just have to be all out.

[A]

Well, I like people to layer on behaviors. You asked me much earlier, what's the one thing? What's the two things? Because people get overwhelmed with programs.

[B]

I agree.

[A]

We are building a lifestyle, we are not building a program. The things you learn in the second section of this book, hopefully you will continue to do and modify forever. It's not a six week program because that infers an S. So if we're starting with walking and then we layer on lifting or we layer on understanding how much protein we need to eat, how not to eat sugar until it fries you from the inside out. Or an example I'll give the way I approach people is sometimes people come to me in dis health, or I describe it as fine. You know, they're fine, I'm fine. But they then read all this stuff about longevity and all the gadgets, and they want to go skip all the way to the future, to the things that may or may not have been tested in humans, usually animals. So my approach is health optimization. Then I, after we're optimized, then we bring in lots of the kinds of stuff we do in peak performers, like the athletes I take care of, and only then will we endeavor into the gadgets that may or may not work for people. So an example of what we're talking about of layering is part one. We're optimizing for cardio. We're learning to do the base training and the sprint. When we've got that as a lifestyle, then in performance, maybe we add in VO2 training.

[B]

What's VO2 training?

[A]

So VO2 training is another level of workout, and it's hard, so we don't start with it off the couch. VO2 Max is the best measure of our overall fitness. It tells us how efficiently we're diffusing oxygen from our blood through our lungs. And the reason it's important for longevity is there becomes a line called the frailty line, after which your VO2 max, your fitness is so low, you cannot get up from a chair by yourself. That's when you go into assisted living. It's called the frailty line. The numbers are 15 and 18. 18 for men, 15 for women. You never want to get there. So how do we not get there? Well, we can train it. We can build physical fitness across a lifespan. We can identify by the unbreakable score. Oh, my gosh, I'm doing great. My VO2 Max is 50. Or, oh, my gosh, I'm midlife and my VO2 Max is 28. I need to get on this, because every decade you will decrease your VO2 max 10%. So if you're 50 with a VO2 max of 50 and you decrease 10% per year, I mean, per decade, you're never going to reach the frailty line even at 97.

[B]

I see.

[A]

But if we start out at 28 or low VO2 max and we do nothing about it, we're going to reach the frailty line really quickly, in our late 70s.

[B]

I just love that you have the layers on of things and that makes it more attainable.

[A]

It is so attainable.

[B]

A frozen shoulder. What is, how long does it last and what can you do about it?

[A]

Frozen shoulder, or the medical term is adhesive capsulitis, is a condition of the capsule is the inside skin of the shoulder. It's highly sensitive to inflammation. So frozen shoulder is a highly inflamed internal lining of the shoulder that comes anytime you're highly inflamed. Men can get frozen shoulder, usually because they have uncontrolled diabetes. Women too. But in midlife, in the population that we're talking about, like, why would you get frozen shoulder? Right? It's because estrogen is a powerful anti inflammatory. And without the presence of estrogen or without enough estrogen, our tissues become highly inflamed. Sometimes you can feel it. You feel inflamed. The shoulder responds first. There's four stages, bless its heart, a frozen shoulder. The first is just excruciating pain. You're like, what happened? I didn't fall down, I didn't hit myself, I didn't lift heavy. What's going on? Excruciating pain followed quickly by loss of motion. I have women come in a week later, 10 days later, and they can't lift their arm. And they fail the hook my bra test, which I made up. You can't hook your bra.

[B]

Yeah.

[A]

You can't internally rotate, which is what this motion is that you lose first. That progresses through inflammatory cycles. And one of my colleagues, Joanne Hannifan, has actually biopsied should shoulders. It goes through four stages. It can take two years to defrost. Yes. Number one, when your shoulder hurts and you haven't had any injury and suddenly it won't move, you get to a physical therapist as soon as possible because you can move this joint. Most women are tough. We're like, I'm gonna sit this one out. Six weeks later, our arms don't move, number one. Number two, if you haven't made your menopause hormone therapy decision, this is a good time to do it because we can help reverse this. Or pre. Number three, if you are suffering like you suffered, it is one of the instances where I will give steroid injections. I don't love them for people in general, but sometimes you just gotta get over the edge.

[B]

Food, protein.

[A]

Yes.

[B]

Let's just talk about it. Because you said you cannot put junk into your body garbage and hope you have some kind of great performance.

[A]

Women are conditioned to not eat. I have lots of. When I interview my patients about eating, the common habit is Maybe you'll have coffee for breakfast, maybe. Maybe some kind of carby thing and then a salad for lunch. Plus or minus protein. And then sometimes that's it. That's less than 1,000 calories a day and less than 60 grams of protein. If we want to feed the muscle that we're trying to build, if we want to have enough energy for daily activity and not feel exhausted every afternoon, we actually have to feed ourselves to lose weight. You have to feed yourself.

[B]

How much. How much is too much for protein?

[A]

When we're talking about macros, right. Carbohydrates, protein and fats, I focus mainly on protein because it's the thing we don't get enough. People are going to get enough carbs and fat. I prescribe a gram of protein per ideal pound because we're not just trying to survive. It is not the rda, the recommended minimum allowance.

[B]

Thank you for simplifying. Because I feel like I was trying to do all these equations. I'm like, I don't know how much.

[A]

Well, you can do equations if you want.

[B]

I mean, I don't have any capacity.

[A]

The literature, you know, you can scrape together the literature and grams. One gram per pound. I know. Support 0.86 grams per pound. Who's doing that math?

[B]

Not me.

[A]

Not me. And then we don't absorb all of it. Okay, so one gram per pound. Ideal pound. And then if you get close to that, you know, if you get over 100 grams a day, you're probably good broken up into at least 30 gram sessions. Because it takes 30 grams to stimulate muscle protein synthesis. Women in general need a little protein before they work out.

[B]

Should you eat your protein before you work out?

[A]

Yeah, about 15 grams. Stacy Sims is a big proponent of that. You probably talk to her. But we need to tell our bodies we're doing something. Fasting is not. Not. I'm not a big fasting enthusiast. I am a timed eating enthusiast. But we need to feed our activity, I think instead of making ourselves scrape together because we're trying to be high performance, not just survivors.

[B]

You spoke in front of the fda.

[A]

Yes, I did.

[B]

I marveled at your words. For people that are not aware of it, just a little background on it. We have been part of a campaign, a movement, a conversation to. To unbox menopause and remove the black box label warning from vaginal estrogen, which pretty much has been deemed safe for women. Everybody, how did you feel the FDA reacted. How did you feel that was. Was that a mo. A special moment for you? Can you Just bring me to that.

[A]

All those things. Number one, women's health can be politicized. I don't think it's politics should be a barrier to women being able to make choices. So I am thankful that that group was convened to have a conversation because without a public conversation, it's just decisions being made by non women behind doors. Right? So what the fda, the current FDA commissioner called together a large group of researchers and clinicians and not everybody accepted, which is their right. But the 10 of us that did, except I want people to know, we had multiple planning meetings. We just didn't show up. We took this very seriously. We planned what each expert was going to say because we had OB gynaes, we had researchers, we had cardiologists, we had urologists, internists and an orthopedic surgeon. So we had full complements of expertise. We had five of the most long standing researchers in menopause history. They had done 40 years of work. And then we had five of us who are in the menno universe right now educating women doing the current clinical research to bring a modern perspective. And the 10 of us collaborated so well together because we're standing around the goal of changing an entire paradigm of women's health. We each had five minutes. We presented the data, we presented patients stories to humanize this story because data can be hard and cold. When I tell you, I told the story of a patient of mine, Miriam, and her hip fracture story. When you humanize this, I think it makes us move faster. And then we took questions. I think we're going to move the needle. We're going to start with vaginal estrogen, unboxing it. Because the black box warning, the box warning on vaginal estrogen has no research merit. Vaginal estrogen does not cost. Heart attack, stroke, cancer, all the things in that skull and crossbones box is just thrown on there from other places within the meno, within the hormone universe. I thought it was an amazing conversation. And of course there was discourse in the room. Sure, there were people who refused to reevaluate the Women's Health Initiative data because they wrote the Women's Health Initiative data. And you know what? They may never come around, but we're going to move around that. But in terms of my own career, I was teasing my husband that being on big stages with you, like at your Las Vegas event and the Sydney Opera House event, I said to him, he's like, I said, those are the super Bowls of my career. And he looked, I know, it feels like that it Is worth work. It's like, penultimate work. But he's like, every day. Vonda is the super bowl of your career when you get people out of pain. And I thought that was such a wise distinction.

[B]

That gave me such chills. He's so right.

[A]

Yeah.

[B]

Dr. Vonda, why is bone so important to talk about?

[A]

You know, just in the way that we think of muscle as purely working out, we don't think of bone until we break one. Unless we're looking in the mirror at our gorgeous cheekbones. Right? The reality about bone. I'm just gonna tell you one thing simple. That's gonna blow your mind. Mind. Bone is a metabolic organ. It is a endocrine organ. It produces proteins. Let's talk about 1, 2. It produces a protein called osteocalcin that goes to the brain and helps the brain make neurons. Osteocalcin goes to the pancreas and helps your pancreas secrete insulin to the gut, to the muscle to help glucose metabolism. In men, it goes to the testicles and helps sexual health. So just when you think of bone as the strong, silent type, not talking to anybody but itself, bone is the master communicator. And if I were designing a good design, I would make the communication points everywhere you need them, from the top of our head to the bottom of our pinky toe. And lo and behold, bone is just like that. There's another hormone that I don't talk about that much from Bone, LCN2, that goes to the brain and tells you to stop eating. Bone is critically important in the energy balance of our body. And why wouldn't it be? Because bone is the storehouse of our body.

[B]

I had no idea. Isn't it fascinating? It's fascinating.

[A]

And in these long bones, the femur in our pelvis, that's where all your blood cells are made. So just when you think bones are just holding you up, they are the critical communicators, storehouses, manufacturers of our whole bodies. So why wouldn't we pay attention to them?

[B]

I mean, it makes you have a whole different respect for when you're thinking about that and touching.

[A]

I know.

[B]

Gosh, Okay.

[A]

I know.

[B]

That's fascinating. It's really fascinating. I'm 61. I play pickleball three times a week. It's a great workout, But I only have time to do weights once a week. Is pickleball enough?

[A]

Pickleball is great for your brain. It's great for your cardio. But I would rather you trade one pickleball day for another work, another weightlifting day.

[B]

Okay, well that's. Is that almost like the pilates or pickleball's A little bit more.

[A]

Pickleball is, is a high cardio intensity.

[B]

Okay.

[A]

And that's the purpose of it. You're not, you're not building muscle playing pickleball.

[B]

Okay. Two more rapid fire. I'm noticing a lot of cellulite on my legs lately. I'm only 35. Is that normal in any way to

[A]

get, get rid of it? Cellulite is both genetically predisposed and has to do with fat content. So if we're worried about the non genetic part of it, we're going to recompose, we're going to build muscle, we're going to lose the fat hanging around.

[B]

I've always lifted weights and I feel just as strong as I did in my 30s. But I've noticed now in perimenopause my recovery is terrible. I'm sore all the time. Anything I can do? That's a good question. Question.

[A]

We have to remember that estrogen is an anti inflammatory and the soreness you feel might be slower recovery which then will take maybe more protein in your diet, better hydration. Think about are there any micronutrient gaps? But it also might be arthralgia of perimenopause because of your menopause hormone decision.

[B]

Dr. Vanda, what does unbreakable mean?

[A]

Unbreakable is the mindset backed up by the actions that we can live healthy, vital, active, joyful, long into the foreseeable future and age with power, not frailty.

[B]

Thank you so much. Where can people find you so you

[A]

can find me every day on Instagram. Rvonderright drvonder Wright, you can find me online on my YouTube channel and lots of speaking everywhere. You just have to google Wonderful.

[B]

Thank you so much. I feel like I have a million more questions I could always ask you. It's really, really special. Thank you. Thank you. All right, so I have some serious work to do first on my push ups. Also on the grip strength here. But I love this conversation. Dr. Vonder Wright makes it so clear. Getting strong is not just about the gym. It's about longevity, it's about confidence and it's about taking care of your future self. I hope this episode inspired you to move a little differently this week. Or just think differently, lift heavier or start a new again. If you like this conversation, I would love if you could take some time to leave a review. It really does help us bring you more incredible guests like this one. And if you have questions you want me to ask in a future episode or guest you'd like to hear from, send us an email podcastamsonfadell.com I'll see you in the next episode. Insurance isn't One size fits All. That's why customers have enjoyed Progressive's Name youe Price Tool for years now. With the Name youe Price Tool, you tell them what you want about pay and they'll show you options that fit your budget. So whether you're picking out your first policy or just looking for something that works better for you and your family, they make it easy to see your options. Visit progressive.com find a rate that works for you with the name your Price tool Progressive Casualty Insurance Company and Affiliates Price and Coverage Match Limited by state

[A]

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