How to Stay Mobile, Independent & “Unbreakable” As You Age with Dr Vonda Wright #588

Bone health is something most of us don’t think about until much later in life, but the reality is that the foundation for strong, healthy bones is built decades earlier – and what we do in our 20s, 30s and 40s can make all the difference to our health and strength in later years. Today, I’m delighted to welcome Dr Vonda Wright. Vonda is an orthopaedic surgeon and internationally recognised authority on active ageing and mobility. She believes that with mobility, smart nutrition and building relationships, we can harness our own power to control 70% of our health and ageing. Vonda specialises in sports medicine and is one of only a few female orthopaedic surgeons in the United States. She currently serves as the inaugural Chief of Sports Medicine for the Northside Hospital Orthopaedic Institute and is the founding director of the Performance and Research Initiative for Masters Athletes (PRIMA). She is also the author of several books, including her latest, Unbreakable: A Woman’s Guide to Ageing With Power, combines cutting-edge science with practical tools to help us protect our bones and our future health. In this fantastic conversation, we discuss: Why osteoporosis isn’t just a disease of old age, but one that begins much earlier in life, often decades before the first fracture. The idea of the “critical decade” – why our mid-30s to mid-40s are such a pivotal window for building bone strength, especially for women approaching menopause. The key lifestyle factors that influence bone density, from nutrition and protein intake to resistance training and impact exercise, and why it’s never too late to start. How scans such as DEXA and REMS can give a clearer picture of bone quality and help us take action before problems arise. The cultural and societal pressures that shape women’s health behaviours, and how these can sometimes work against long-term bone resilience. Simple, practical strategies for protecting your bones at every stage of life, supporting independence, mobility and confidence as we age. Vonda also shares her vision of ageing with strength, independence and vitality, and why she believes we can all take proactive steps to remain “unbreakable”. As Vonda explains, we have more control over our bone health than we might realise - and that knowledge should feel both comforting and empowering. Caring for our bones is really about caring for our future selves. By taking simple, consistent steps today, we can build the strength and confidence to live the way we want for years to come. I hope you enjoy listening. Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Thanks to our sponsors: https://www.betterhelp.com/livemore https://www.vivobarefoot.com/livemore https://join.whoop.com/livemore Show notes https://drchatterjee.com/588 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  I think the first reason people begin to decline is this bias or this myth we believe that aging is an inevitable decline and that there's something abnormal about it. If you believe that there's absolutely nothing you can do about the future, then you're going to resign yourself to the first time you feel an ache or a pain. That's just getting old, I guess I'll just accept it. But I say quite frequently that aging alone is the most natural thing we do and it's how we handle the passage of time that matters.

• 0:36Rangan Chatterjee?

  Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better, Live More. When was the last time you thought about the health of your bones? You see, bone health is something that most of us don't tend to think about until much later on in life. But the reality is that the foundation for strong, healthy bones is built much, much earlier. And the sooner you start to build this foundation, the better. This week's guest is Dr. Vonda Wright.

• 1:17Rangan Chatterjee?

  Vonda is an Orthopaedic surgeon, chief of sports medicine at Northside Hospital Orthopaedic Institute, and the founding director of Prima, the Performance and Research Institute for masters athletes. Vonda is also an internationally recognized authority on active aging and mobility and the author of several books, including her latest, Unbreakable: A Woman's Guide to Aging with Power. In our conversation, we discuss why osteoporosis is not just a disease of old age, but one that begins much earlier in life, often decades before the first fracture, the idea of the

• 2:00Rangan Chatterjee?

  critical decade, and why our mid-30s to mid-40s are such a pivotal window for building bone strength, especially for women approaching menopause.

• 2:11Rangan Chatterjee?

  The key lifestyle factors that influence bone density, from nutrition and protein intake to resistance training and impact exercise. How scans such as DEXA and REMS can give a clearer picture of bone quality and help us take action before problems arise. The cultural and societal pressures that shape women's health behaviours and how these can sometimes work against long-term bone resilience. And of course, we cover plenty of simple, practical strategies that you can use to protect your bones at every stage of life. As Vonder explains, we have so much more control over our bone health than we might initially think.

• 2:55Rangan Chatterjee?

  And that knowledge should feel both comforting and empowering. Caring for our bones is really about caring for our future selves. And by taking simple, consistent steps today, we can build the strength, independence and confidence to live in the way that we want for many years to come.

• 3:22Rangan Chatterjee?

  When you look around across society, what are some of the common things people are doing that are perhaps resulting in them neglecting their bodies and therefore increasing the speed at which they age?

• 3:38Speaker 00

  I think there are a couple of factors that may be surprising and then several that are obviously not. But I think the first reason people begin to decline without even realising it is this bias or this myth we believe that aging is an inevitable decline and that there's something abnormal about it. But I say quite frequently that aging alone is the most natural thing we do from the minute of our conception to the moment of our death. And it's how we handle the passage of time that matters. But if you believe that there's absolutely nothing you can do about the future. Then you're going to resign yourself to the first time you feel an ache or a pain,

• 4:22Speaker 00

  or the first time you come up against a no as, well, that's just getting old. I guess I'll just accept it. And what I find people doing is giving things up one at a time until they don't recognize it. I'll give you some examples. So believing the myth that it's inevitable is, I think, a primary motivator. The second motivator I see is that sometimes people don't believe they're worth the effort. Maybe everybody else is worth the effort, particularly for women. Like the neglect, the self neglect comes because we're not neglecting others. We're investing all of our energy externally and not redirecting anything internally.

• 5:07Speaker 00

  And so those being primary drivers I see in the stepwise allowing decline.

• 5:16Rangan Chatterjee?

  It's interesting, this idea about mindset or beliefs. You know, if we believe, if we get the message from the world around us that getting older means frailty, means weakness, means you have to give up the things that you don't want to give up necessarily, then of course your behaviors are going to follow

• 5:39Speaker 00

  That's right.

• 5:40Rangan Chatterjee?

  your beliefs. And there's so many things about your new book, Unbreakable, that I really, really enjoy. I think it's beautifully written. And in the introduction, you actually say, I contend that although we certainly undergo some life stage changes, what we call normal aging is actually normal aging for stressed out, undernourished people who are not intentionally building muscle, not attending to their hormonal health, and not prioritizing mobility.

• 6:13Speaker 00

  Exactly. And what I mean by that is if you go back to the medical literature, there was a study, and there are many studies like this, there was a study called the Health ABC in the United States funded by our National Institutes of Health that took a cohort of 70 year olds and just watched them age over a decade.

• 6:35Speaker 00

  These were people straight out of the population. Well, what do we know about people in the world and in the United States in particular? Is that more than 70% of them do not invest any energy, any day, in mobility or health habits. So if we're watching a population of people to see how they age, and they're truly just a random sample of the population, then you are sampling sedentary people who make very little effort to age in a different way. So I state that so clearly is because I contend, and why we formed the research group at the University of Pittsburgh called PRIMA,

• 7:17Speaker 00

  the Performance and Research Initiative for Masters Athletes, is because I wanted to see what we were capable of if we took the variable of sedentary living out of the way. So we began studying active people, not professional masters age athletes, but people over 40 who are consistently active. Many of them were podium-type age group athletes, meaning, you know, winning the 50-year-old podium. So they were invested, but not pros. And what we found was very different than we find in the population. We found over 15 years, we can retain muscle mass and bone density and brain function.

• 8:02Speaker 00

  And so when I say that we don't really, truly know the state of healthy, active aging, it's based on facts, not fiction.

• 8:12Rangan Chatterjee?

  Yeah. So in terms of what people can do then as they get older, we're going to get into all the detail, but top line, right at the top for people, what are some of the things that you want people to consider doing as they get older? As I say, we'll get into all the detail, but just top line, what are some of those things you want people to be focusing on as they get older?

• 8:35Speaker 00

  Number one, mindset mobilization. We have to quit worshiping our youth. Number two, we have to work hard at building mental resilience. Aging is not for sissies. It can get hard. So we have to build the mental resistance to stay in the process. Number three, we need to build physical resilience. And part of this book is all about that. How do we know where we are physically and then use the science-backed ways to build physical resilience? And then I firmly believe and encourage people to form groups of at least five to

• 9:14Speaker 00

  travel this road with you towards an aging process that is vibrant. Because, you know, experts in social theory and relationships will say that we are the product of the five people we spend the most time with. And if those five people are naysayers of health and aging, if they are naysaying in your ear, what are you doing out there trying to get healthier? It's going to hold you back. So as a broad outline, those would be the things I identify.

• 9:44Rangan Chatterjee?

  I love those. This book is primarily focused on women.

• 9:52Speaker 00

  Hmm.

• 9:53Rangan Chatterjee?

  I'm a man.

• 9:55Speaker 00

  Yes.

• 9:56Rangan Chatterjee?

  In my 40s.

• 9:57Speaker 00

  Yes.

• 9:58Rangan Chatterjee?

  What is it you would like me to take from reading this book?

• 10:00Speaker 00

  You know what? This book is specifically through the vision and voice of women, but many of the principles are directly applicable, especially the mindset principles to men. But listen, all men are from women. All men were at one point in a woman's womb, right? So you must have a mother figure. Many men are partnered with women. You have sisters. You are in working relationships with women. The more understanding men have of the differences between what happens as a man ages and a woman ages, there will be a greater understanding and ability to work together and even probably

• 10:42Speaker 00

  save a lot of midlife marriages because of an understanding that women go through a completely tumultuous time that is of not their choosing. It's just biology.

• 10:52Rangan Chatterjee?

  Yeah, I love that. I mean, I believe that to be the case. I believe books like this can actually save many marriages.

• 10:58Speaker 00

  Exactly.

• 10:59Rangan Chatterjee?

  And I think it is very relevant. To men.

• 11:02Speaker 00

  Yes.

• 11:03Rangan Chatterjee?

  Even though, you know, the strapline is a woman's going to age with power. I really enjoyed reading it. And of course, I'm married.

• 11:11Speaker 00

  Yes, you are.

• 11:13Rangan Chatterjee?

  I helped look after my elderly mum. So some of these things that you talk about, I have seen what happens if people don't pay attention. I have a daughter.

• 11:24Speaker 00

  Yes.

• 11:24Rangan Chatterjee?

  And I've heard you talk about the importance of bone health and how we get to our peak bone density, maybe at 25 or 30. And so this book has already made me think about, well, what is my daughter doing right now at 12 years of age that's going to ensure she's putting force and pressure through her bones to make sure she has the maximum bone capacity that she can have. So, yeah, yes, it's for women. It's also just as relevant to men.

• 11:51Speaker 00

  I love that you say that because, you know, particularly in reference to your daughter, it's my intention, I have, I have two daughters and four daughters in law. It is my intention that they never suffer because you're, so that your 12 year old and my 17 year old and my 31 year old will know what's going to happen, build solid bases of muscle and bone and, and brain health in their youth, know what's going to happen as estrogen walks out the door, and know where to have the resources. Because what's happened to certainly baby booming women, certainly generation X women,

• 12:31Speaker 00

  which we do not want to happen to the oldest millennial women who are 43, 44, is the hitting the wall phenomenon, not being yourself, cataclysmic changes. So for your 12 year old and my 17 year old, my vision and motivating factor is that they will never feel this.

• 12:50Rangan Chatterjee?

  Yeah. Let's take a big picture view, right? You mentioned the differences between women and men. Of course, there are many differences.

• 12:59Speaker 00

  Completely.

• 13:00Rangan Chatterjee?

  But I saw you speak a couple of days ago in London, and you put out some very provocative images. They're very, very thought provoking. And one of them that I'm going to make sure we pop up on screen on the YouTube version of this conversation is how men and women's hormones change through their life. And the thing that I really took from this image was this idea that men have a gradual decline in testosterone over a number of decades.

• 13:32Speaker 00

  Yes.

• 13:33Rangan Chatterjee?

  Whereas women have this sharp precipitous decline in estrogen during perimenopause.

• 13:40Speaker 00

  That's right.

• 13:41Rangan Chatterjee?

  Could you speak to that and speak to these more broad differences? And why so many women go through what you went through, I think, at 47, which you can perhaps explain at some point.

• 13:51Speaker 00

  Yes, I will.

• 13:52Rangan Chatterjee?

  But just take us through what those differences are and how they manifest for us in terms of the quality of our lives.

• 13:58Speaker 00

  So let's start back at the first big bump in the road for everyone who lives, which is adolescence, right? We come into our hormones. We all expect that to be an awkward stage. We describe it as that. We describe it as all these body changes. It's something that we readily accept. And then after puberty, we enter our twenties. And by 30, our brains are fully formed, right? We mature our brains in our late twenties. Same with bone and muscle, such that we reach peak, all of those tissues, by the time we're 30. At that point, we hit a little bit of a plateau, but then start for men to decrease their testosterone

• 14:41Speaker 00

  in a very slow, linear way, as you've described. Now, at some point in their 50s and early 60s, I see this because I have active men in my orthopedic practice. Sometimes men do get low enough on their testosterone that they're like, I am exhausted. I don't feel like myself. I'm popping tendons all over the place when I'm trying to do good work. And so we'll measure their testosterone and it may be very large deltas different than what it was when we know what younger men are. So even for men, for my sons in their 30s, I'm asking them to get their testosterone checked in their youth. Because when I test you again in your 50s, you may have a testosterone that's within

• 15:24Speaker 00

  the air quote "normal range", which in the United States, the normal range is 250 to 1,050.

• 15:34Rangan Chatterjee?

  That's a big normal range.

• 15:35Speaker 00

  It's a big normal range. And so you may find at 50 that your testosterone is 600, which is still normal, but you may have been 1,000 and you're going to feel that. So even for men, being aware of your hormonal change, but that is not what happens for women. Women, after we reach our estrogen, every month, we have this cyclical pattern of high and low estrogen that begets our menstrual cycle, which is normal. Our estrogen plateaus in our 30s, however, by the time we reach 40, and this is why this all happens.

• 16:15Speaker 00

  Estrogen is predominantly made in women in the follicle or like the eggshell of our eggs, right? Here's the miracle of life. Every woman, your daughter, my daughter, me, your wife, were born with all the eggs we are ever going to have across our lifespan. So if we think about this in the universal sense, we're carrying generations of people at our birth. Isn't that fascinating? Oh, my God, to think about it like that. But when we're born, we have several million. And over time, we lose a lot every month, such that by the time we're 40,

• 16:56Speaker 00

  it's estimated that we have 1% to 3% of those eggs left. So it's harder to produce enough estrogen.

• 17:04Rangan Chatterjee?

  So women have lost 97% to 99% of the eggs that they were born with by the age of 40.

• 17:11Speaker 00

  That's right. And if the eggs are producing the estrogen that you need, once you have so few eggs left, estrogen starts to decline, which makes our brain a little urgent to have more estrogen. So it produces a hormone called follicle stimulating hormone, which tries to ramp up this egg process. And it becomes hormonally a little chaotic. Like if you measured a woman's hormones in the morning on one day and the morning of the next day, they could be completely in different ranges during the perimenopausal time. Well, that fluctuation in hormone levels is why women first start saying things like,

• 17:56Speaker 00

  "I just don't feel like myself." Or they'll say things like, "I am doing the exact same thing I've always done, but I'm gaining weight." Or "I'm not able to progress in my workouts." Or it's when the most common manifestations of perimenopause happen. Night sweats, brain fog, can't remember nouns. These changes that are due to estrogen. Because here's what people forget. Not only are we at 1% of our eggs, which produce the estrogen by the time we're about 40, estrogen, progesterone, and testosterone are not sex hormones.

• 18:37Speaker 00

  They are hormones, like thyroid stimulating hormone, like growth hormone, like every communicating molecule we have. I say that to say, there are estrogen receptors, like little baskets to hold the estrogen on every organ system in the body, from the brain to the gut, to muscle, to bone. So.

• 19:02Speaker 00

  If these receptors are not being filled with the normal estrogen, nothing that they cause downstream is going to happen. Thus the brain fog, thus the heart palpitations, thus the night sweats, or things that people don't consider, but my group and I wrote a paper on last summer, the musculoskeletal syndrome of menopause, where women, I had this, their entire bodies hurt because estrogen is a profound anti-inflammatory. So it seems like a lot, and it is. And so, men are slowly declining in their testosterone. Women have this precipitous drop.

• 19:44Speaker 00

  I kiddingly say estrogen walks out the door, she slams the door, she never looks back, right? And we feel that until the time when the arbitrary day, I firmly believe that the day of menopause, the 366th day after our last period, when we say, oh, she's in menopause, it's an arbitrary number.

• 20:10Rangan Chatterjee?

  It's just one day, isn't it?

• 20:12Speaker 00

  It's one day. You've been losing estrogen for five to seven years, sometimes a decade. And then after that day, you're post-menopausal for 40 years. And so this is the reason men and women age differently. To circle the conversation back, it's because of the differences in our hormones.

• 20:33Rangan Chatterjee?

  Yeah. So essentially, are you saying that when a woman, of course, there's multiple possible factors that contributes here, but generally speaking, when a woman in her mid, late 30s, maybe early 40s, suddenly feels life is a bit more of a struggle, the things that they used to do are no longer working so well. You're basically saying that for some of those women, the precipitating event is...

• 21:06Rangan Chatterjee?

  That decline in estrogen.

• 21:08Speaker 00

  Yes, there is a normal, natural aging process. And in the book, I talk about what I call the time bombs of aging. They're actually the hallmarks of aging. We know aging happens at a cellular level, but women have stacked on top the loss of estrogen. Do you mind if I give you a couple of organ examples?

• 21:28Rangan Chatterjee?

  Oh, take your time.

• 21:29Speaker 00

  In the brain, for instance, the work of Lisa Moscone has shown that the brain is covered, literally covered with estrogen receptors.

• 21:39Speaker 00

  The work of Robbie Brinton, a brain scientist, has shown that without estrogen sitting in those receptors, the brain literally starves and changes its chemistry. That's why it manifests as brain fog. We can't find our keys. We can't remember why we walked into a room. For me and many other women, I forgot nouns. Imagine this, I tell this story all the time, and I want to tell everybody, my brain is back. It's as good as it ever was because of the estrogen that I take now. But when I, in my critical decade, before I became an expert on this, I would walk into the operating room and I would know exactly what I was going to do and I was going to know exactly how to do it.

• 22:24Speaker 00

  But I forgot the name of the piece of equipment that picks things up. And I would say to my scrub tech, I need the thing, for those of you listening, I'm, I'm doing a pincing motion. I need the thing that does this thing. I needed an atson, which is a, which is a force up. I could, I knew exactly what I was doing, but I lost my nouns and I frankly thought that I was getting dementia. So I start Googling early signs of dementia. Think how frightening that is for a brain person. Yeah, my, I'm a brain person. My brain's the best part of me. There's that, many women experience that.

• 23:00Speaker 00

  And I don't think it ends there. These mechanisms are not clearly worked out, but there must be a reason that 70% of all people with Alzheimer's are women. It can't just be coincidence. I think we're going to work out the mechanisms to find that although multifactorial, it has to do with estrogen sharply declining. So that's the brain. The heart has an increase of 30 to 40% of microvascular disease. When men's hearts have have disease, it's in the big, major vessels. For women, it's in the much smaller vessels, so it goes undetected a lot of times. But we know that estrogen plays a critical role in heart health. If we get to musculoskeletal health,

• 23:44Speaker 00

  which is obviously where I live, there's a natural rate of decline of bone for men and women of about 1% a year in their bone density. During perimenopause, that precipitously increases to 2% to 3% a year, so that over five to seven years, 10 years, you can lose 20% of your bone density. So if you've never built enough bone as a child and now you're going to lose 20% of it predictably, that's why 70% of all hip fractures are in women. Muscle is the same way. We will lose 8% to 10% of our muscle mass in the decades surrounding perimenopause. The list goes on and on and on.

• 24:28Speaker 00

  And so when I say men and women age differently, the most direct contributing factor, lifestyles being equal, has to be, at least in part, due to our estrogen.

• 24:39Rangan Chatterjee?

  Yeah, it's interesting. Simply calling estrogen a sex hormone is so limiting, isn't it? These labels we put on these things, and I feel medicine's done this in many different places. Actually, there's been unintended consequences, right? So by viewing estrogen purely as a sex hormone,

• 25:02Rangan Chatterjee?

  We therefore don't think about the effects of estrogen on the brain or the heart or the bone. And you could sort of make the same case like with exercise, right? Or physical activity. How for many years in society, it was about weight. Physical activity is what you need to do to maintain a healthy weight. And I would say, I think over the last five or 10 years, realizing that your muscles aren't just dumb muscles sitting there, they're also important for your hormones and all kinds of communication molecules around the body. And then yesterday, I was watching this beautiful 30 minute video on your YouTube channel about bone.

• 25:43Speaker 00

  Yes.

• 25:43Rangan Chatterjee?

  And I was thinking, this is the same thing with bone, right? Like muscle has had a PR job over the last five years where we now understand that muscle is important for so much more than our physicality.

• 25:54Speaker 00

  Yes.

• 25:55Rangan Chatterjee?

  And I feel with that video and in this book, you're almost giving this kind of new marketing to bone, saying, hey, bone isn't just your structure.

• 26:03Speaker 00

  That's right.

• 26:04Rangan Chatterjee?

  Bone does so many other things.

• 26:07Speaker 00

  Absolutely. And I'm so glad you're giving time to this on this podcast because it is now a vision and mission of mine to help people understand and care about their bones. I mean, it's Fashion Week and around the world right now. And that's about the only time we think about bones. This, oh, gorgeous cheekbones. Look at our wrist structure. Or when we fracture, obviously. Bones are seemingly silent until they break. And then they're screaming because that's excruciating. But the reality is, bones have so many functions in the body. From structure, sure, they're structural. Otherwise, you know, think about it. I love to say this out loud, that without bones, muscle that we're all in love with is just

• 26:52Speaker 00

  this heaping pile of metabolic tissue like a chicken breast on the counter. It does nothing but lay there. But with bone, you have structure. It gives you human form. It gives you locomotion. But it is a master communicator.

• 27:08Speaker 00

  Bone produces a multitude of hormones, one of which I talked about on that video you're referencing called osteocalcin. Yeah. Osteocalcin is released by the bone. It goes to your brain. It causes your brain to secrete bone-derived neurotrophic factor, which builds better neurons. So bone is helping you build a better brain? Yes. It goes to your muscles and helps with glucose absorption. It goes to your pancreas for insulin release and resistance. In men, it goes to the testicles and helps you produce testosterone. There are gut, bone, brain axes.

• 27:50Speaker 00

  There are bone, gut axes that are only being worked out. And not only do they talk to the rest of the body, but they are intimately talking to muscle and fat. Because the musculoskeletal system, fat, tendon, ligament, bone, muscle, muscle stem cells are all from the same stem cell originally, the mesenchymal stem cell. They're all cousins. Why wouldn't they talk to each other? And do so in a way that coordinates the whole body. And so not only is it a master, a structural master communicator, it is the storehouse of all the minerals we need for our body to function, the calcium, the phosphorus, a lot of collagen.

• 28:35Speaker 00

  Bone is made out of collagen. When your body needs it to live, it will take it from the storehouse. It's not abnormal to resorb bone. What's abnormal is a disconnect between reabsorption and rebuilding. Because we use the products we store in our bone. It is also, believe it or not, the incubator of all of our blood cells. All of your blood cells are made in your pelvis. And when you're young, in your long bones. So if we were going to do a stem cell therapy on you, we would get your stem cells from your pelvis. Isn't that fascinating that bones are doing all these things? And listen, if I were designing a human being, why wouldn't I make bone the master communicator?

• 29:20Speaker 00

  Because we have bone from the top of our skull to the bottom of our pinky toe. It's a highway for communication. But you're right. We never think about it unless we're thinking about fracture.

• 29:33Speaker 00

  And it's funny, people say bones are silent. Bones are not silent, but we just can't hear them until they break. And I'm going to tell you, from being in the trauma bay many years, it's excruciating. And I never want someone to have to deal with it. But we think about it, especially bone health with aging, because as we lose our bone density and break big bones like the femur, or you know, the top of the femur is the hip.

• 30:03Speaker 00

  Especially in women, men break their bones too. Let's just talk about this.

• 30:13Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker. Everyone around you seems to be coming down with something. And suddenly that well being you felt in the summer seems a long time ago. I certainly know that feeling. And that's why at this time of year, I remind myself to lean into the fundamentals. And one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous improvement

• 30:58Rangan Chatterjee?

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• 31:43Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker. Everyone around you seems to be coming down with something. And suddenly that well being you felt in the summer seems a long time ago. I certainly know that feeling. And that's why at this time of year, I remind myself to lean into the fundamentals. And one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 32:26Rangan Chatterjee?

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• 33:05Rangan Chatterjee?

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• 33:19Speaker 00

  Two million men in the United States have osteoporosis. It's not just a disease of women, but more prevalent in women. 70% of all hip fractures, which is the biggest bone in the body, happen in women. The instant, literally the instant, snap your fingers, the instant you break that bone, you have a 30% chance of dying in the next year. I mean, that's great, isn't that? That is a great statistic that if we could think about our 12 year old and our 17 year old daughters that we have, to get their bone so strong at peak mass that they never reach that point.

• 33:57Rangan Chatterjee?

  Yeah.

• 33:58Speaker 00

  So 30% of the time Aunt Miriam, who's a story I told to the FDA in the United States recently, as we're trying to change the thoughts about estrogen. Thirty percent of the time she's gonna die. And if you live fifty percent of the time, you will not return to the home that you came from because you don't have the functional strength or you can't get up from a chair anymore. So bone is, that kind of fracture is not only a personal pain, it's a family and social dilemma. What do we do with mom? Right? Do we hire a full-time caregiver? That's expensive. Do we have her move in? You know? In some cultures, and I'm Chinese in my culture,

• 34:43Speaker 00

  that's what would happen. I mean, my parents live with me because that's just what we do. But in many cultures, that's not what you do. You find a place for your parents to live. Well, if you find a place for your parents to live, that is prohibitively expensive, many places. And so in the United States, you must use your life savings to pay for that at the rate of five to fifteen thousand dollars a month until you're a popper. And that's when the Medicaid.

• 35:11Rangan Chatterjee?

  Yeah.

• 35:12Speaker 00

  Who wants to be in that situation?

• 35:14Rangan Chatterjee?

  The difficulty is, Vonda, is that, I mean, as you were talking there, I got flashbacks to when I qualified as a doctor. So my first job at the Royal Infirmary of Edinburgh in 2001, when I came out of medical school, was as a junior house officer, which is what we called it back then, in the orthopedic wards.

• 35:35Speaker 00

  Oh.

• 35:35Rangan Chatterjee?

  At the Royal Infirmary. And I can still remember, I think the first two months of my placement was doing orthopedics.

• 35:42Speaker 00

  Yeah.

• 35:43Rangan Chatterjee?

  And I just, I can just remember the ward. And it was mostly women.

• 35:47Speaker 00

  Yes.

• 35:48Rangan Chatterjee?

  Frail, older women who had neck and femur fractures.

• 35:52Speaker 00

  Yes.

• 35:53Rangan Chatterjee?

  Right? And I didn't know then what I know now. Of course, I was a junior doctor, just coming out of medical school. But I can look at that now. You know, through a different lens from everything you just shared, why it affects women so much. This is huge. But how do you get a woman in their late 30s, who is in what you call the critical decade, which you can perhaps explain in a moment, to actually care about this neck of femur fracture that they might get at 75? Because that seems like, oh, yeah, whatever, you know.

• 36:28Speaker 00

  I'll deal with it.

• 36:28Rangan Chatterjee?

  I'm still active. I can still pick the kids up and I can still see my girlfriends at the weekend. And, you know, how do you get someone in their 30s or 40s to care about those bone density implications later on in life? It's difficult, isn't it?

• 36:46Speaker 00

  It's so hard because there's a temporal disconnect. There's this, there's this banking idea. I learned it from my bankers that they experience called temporal disconnect. On average, they cannot get the average person to save $10 for their, for their pension, right? It's the same in health. I cannot get people motivated in their youth for their old age. So for the women and men in the critical decade, which I call 35 to 45.

• 37:15Rangan Chatterjee?

  I love that. Is it just for women though? Or is it for men as well?

• 37:18Speaker 00

  No, it's for men. It is time to get your proverbial health standards in check. Because if you build a lifestyle where you're eating a non-inflammatory, high protein diet so that you're able to build, or if you're eating it all, many women decide not to eat enough. We can talk about that. If you've got your food down, and it doesn't mean you can't live and have an occasional, you know what, I had a piece of chocolate before I walked in here. I'm not talking about austerity. The standards of nutrition, a muscle building practice, a cardiovascular building practice, it's a lifestyle to you. It is not a burden if that's just the way you live.

• 37:59Speaker 00

  The critical decade is the time to get that in order before you lose your hormones. Right? For women, once you hit your mid 40s, now you're adding that burden that we already discussed.

• 38:12Rangan Chatterjee?

  Yeah, it's almost as if we can kind of get away with things until our mid 30s, right?

• 38:17Speaker 00

  That's right.

• 38:17Rangan Chatterjee?

  Yeah, there are health promoting things to do, but even if you don't do them.

• 38:22Speaker 00

  You'll skim by.

• 38:23Rangan Chatterjee?

  You still seem to get by, or a lot of us do in our 20s and early 30s. But then there does tend to come a point in most people's lives where it's like, wait a minute. If I don't pay attention to this.

• 38:37Speaker 00

  Yes.

• 38:37Rangan Chatterjee?

  There are consequences. And of course, hormones are one of the big reasons for that. I can't get this idea out of my head about how do we get people to care about their bones early on in life and build that foundation to protect them later on in life. And I know from hearing you speak that you do DEXA scans with a lot of your patients.

• 39:00Speaker 00

  All of them.

• 39:00Rangan Chatterjee?

  Now, interestingly enough, in the NHS, the National Health Service here in the UK, it's not that easy to get a DEXA scan, right? You have to meet certain criteria.

• 39:10Speaker 00

  Yeah.

• 39:10Rangan Chatterjee?

  But let's just flip it. If we were designing something from scratch and going, okay, bone health is important, but we need men and women to really focus on their bone health early on in life.

• 39:25Speaker 00

  Yes.

• 39:25Rangan Chatterjee?

  Teenagers in their 20s, in their 30s, how are we going to get them to do that? Oh, well, what if every single 20 year old got a DEXA scan? And then we could show them, this is the state of your bone health. Is that a good idea? Is it a flawed idea? How would you put all that together for me?

• 39:45Speaker 00

  I think in this day and age, data drives people. And so I have proposed that. Um, we get a DEXA scan which measures bone density, which is the mineralization. And if it's available where you are, which it is in the UK and Australia, when we're getting them in the US. An ultrasound, uh, which tells bone quality. And here's why that's important. Every time you take a step, the bone will bend a little. When it, you, when you put more pressure on it and it bends too much, it'll break, right? So we need to know the quality of the bone. You tell that with a REMS ultrasound scan, which are available here.

• 40:27Speaker 00

  We should have that in our critical decade. You know, we peak out at 30, let's get it between 30 and 40, just like you get a mammogram. So that we know where we're starting, because here's the deal. If I get, I get these scans on people and I find 30 year olds with very bad bone because they've never built it. Well, then we can do all the things to build better bone, including hormone optimization, jumping around, muscle building, a smart, high protein nutrition. Because research finds that you need a, for the best fracture prevention, a 10 year lead.

• 41:10Speaker 00

  It's okay to start these things when you're 55 or 60, but it's better if it's your lifestyle.

• 41:16Rangan Chatterjee?

  Is it like an MOT? Well, I don't know if you have MOTs. An MOT is something we have in the UK. So if your car is over three years old, it has to undergo an annual MOT.

• 41:27Speaker 00

  Exam, yeah.

• 41:28Rangan Chatterjee?

  Okay, so to, to check that it's roadworthy and if there's anything problems with your tires or, I don't know, the wipers, you know.

• 41:36Speaker 00

  Ironic that we do it for cars.

• 41:38Rangan Chatterjee?

  Yeah.

• 41:39Speaker 00

  We do it in the United States when we, every year we get our, uh, uh, new tag and you have to have an emissions test.

• 41:45Rangan Chatterjee?

  Yeah.

• 41:46Speaker 00

  Yeah.

• 41:46Rangan Chatterjee?

  But what this, so, so what I'm thinking is, I think I heard, did you say you've, you've seen 24 year olds with osteopenia?

• 41:52Speaker 00

  Completely.

• 41:53Rangan Chatterjee?

  Okay, so this is alarming, right? So, and this perhaps goes into the more societal piece over what conditioning women have been exposed to for many years and what women think they need to do in order to look a certain way. But why is it, I mean, do you remember that 24 year old with osteopenia? What, why did she have poor bone density in her twenties?

• 42:17Speaker 00

  I've given this a lot of thought and, and. The first thing I'm going to say is that we think of osteoporosis and bone health as a disease of old ladies. Osteoporosis is a disease of young ladies that manifests when you're old. You begin this problem when you're young. And why is that? Well, number one, still, despite all the progress we've made, women are still taught to be teeny tiny and take up no space and not eat a lot of food. Women think that they're going to be healthiest if they don't eat a lot. And even though we've made progress, I'm, I am not against GLP-1s at all.

• 42:57Speaker 00

  They have some profound metabolic effects, but I fear that we're tipping the, the needle back to skinny is better without using those with high protein and lifting practices. And we can talk about that. But the mantra that women must be skinny and not eat leaves many women with not enough materials and maybe not menstrual cycles and estrogen production in their youth. So that's number one. Number two, on the other side of the coin, we have had 54 years of rising equality in women's sports. It's the World Cup right now, right? The Rugby World Cup in the world.

• 43:39Speaker 00

  And we've got great athletes, but what happens as a sports doctor, I'll tell you that if you're burning 10,000 calories a day as a woman on the soccer pitch, on the football pitch, that you have to replace that with something besides gummy worms. And, and you have to eat that many calories. And that's just not the culture of women to have training tables like it is for men. So maybe you're not eating enough and you're little. Maybe you're exercising so much and not replacing enough. And then the third reason I think we're seeing it is everybody's a digital native right now. Gone are the days. We were not digital natives. We did not grow up with a cellphone.

• 44:23Speaker 00

  It came later in our, in our growing up. All of our children now are scrolling despite our, our best efforts for long periods of time. We are no longer safe just to send our kids out to play for hours and hours. They're more sedentary, so they're not bashing their bones and building bone. So you get to the peak building years, not having built peak bone.

• 44:48Speaker 00

  And then, so that accounts for the 20 year olds and the 24 year olds. I had a physics PhD student who was skinny fat, meaning she was thin as a rail, but she was sedentary and she did not have lean muscle mass and nor did she have high bone density. I have athletes in my clinic who are trying their best, but they're amenorrheic, meaning no periods for six to nine months because they have relative energy deficiency. And with low energy, your body goes into survival mode and doesn't produce, I mean, you're not, your body doesn't want you to have a child when you're starving, which is what your body thinks you are. And so it doesn't cycle. I mean, does, that makes so much sense.

• 45:30Rangan Chatterjee?

  Yeah. And I guess also, one thing we're seeing across many countries now is a rise in eating disorders. Yes, in men and, in boys and girls and men and women, but of course, if you're a woman and you've had an eating disorder and for a period of time have not been properly or adequately nourishing your body for whatever reason, which of course, we need to sensitively address, that's going to have an impact.

• 45:57Speaker 00

  Yeah.

• 45:57Rangan Chatterjee?

  It's quite interesting that, I think you mentioned there was a PhD student in her twenties and she was thin, skinny fat, I think you described it. And she was performing well, right? So, you know, what's interesting about that for me is that that individual probably thinks life's fine. I'm skinny, I'm the way I want to look, I'm able to study, but perhaps my lifestyle, without me realizing, has neglected my bones. And as you say, of course, you know, the kids today are digital natives and it's something my wife and I are constantly talking about with our kids. I mean, my daughter's 12 and

• 46:37Rangan Chatterjee?

  She got into netball about three years ago and so she probably plays five times a week. And I'm delighted because she enjoys playing, her friends are there, so there's this big social component. I'm thinking, actually, you know what? If I think about netball through the lens of bone health, there's a lot of impact, a lot of jumping, a lot of speed. I think this is good.

• 47:04Speaker 00

  Multi-directional jumping, perfect.

• 47:07Rangan Chatterjee?

  Yeah, and I'm thinking this is good, right? Because there's a social component for her. And as a side effect, she's getting all of this great movement in.

• 47:17Speaker 00

  Yes.

• 47:18Rangan Chatterjee?

  I think the difficulty for me would be is, well, if she wasn't into netball, actually, and I know a lot of parents face this, if their children don't enjoy a particular sport, they could hear a podcast like this and think, well, hold on a minute. What are my kids actually doing to build their bone density? I mean, they go to school, they come back, they're on screens, or whatever it might be. I mean, this is urgent, isn't it?

• 47:43Speaker 00

  It's critical. And to that, if a parent is recognizing that their kid isn't playing netball, or my youngest daughter was a ballet dancer, she's not in the studio 20 hours a week.

• 47:56Speaker 00

  I am a firm believer, and I say this with the most love in my heart for mothers and fathers. I am the mother of a blended family of six children, so I get raising children.

• 48:07Speaker 00

  From a very youngest age, kids will do what we show them.

• 48:11Rangan Chatterjee?

  Yeah.

• 48:12Speaker 00

  So if you want healthy children, you must be healthy yourself. They will grow up knowing that juice will rot their teeth and is bad for them. They will get down on the floor with you and play on a foam roller. And I don't say that in any kind of judgment. I say that with the reality of that many children in my life and now three grandchildren who will do whatever I'm doing. So if we want healthy children, let's show them. So if your daughter's peers don't play this sport, which I think is just so fantastic. Maybe it becomes a family affair.

• 48:50Rangan Chatterjee?

  Yeah.

• 48:51Speaker 00

  And it becomes what the family does. We do some kind of fun thing together that, oh, by the way, it just happens to involve jumping and running and walking.

• 49:00Rangan Chatterjee?

  Hey, kids love jumping and doing that stuff.

• 49:04Speaker 00

  Oh, playing.

• 49:04Rangan Chatterjee?

  They don't necessarily need to know that when you jump, you're putting sheer force to your bones and the osteoclasts are getting stimulated. And like, sure, someone to do, maybe my kids have heard that from me, but in general, like, kids like to jump around.

• 49:18Speaker 00

  And you know, when I'm advising adults right now, one of the things when we're talking about building better bone is I'm encouraging people to jump. And I'm, and when I'm talking about the cardio that I prescribe, I'm asking them to sprint. Well, when we think of the passage of time, we were talking about this earlier, people give up one thing at a time and don't even realize they're doing that. And the fun play activities that kids just do, like jumping and running that are so healthy, they give up one at a time. But if it's a family affair and it's just what our family does, maybe they won't give it up as soon. And it'll get the parents back into those behaviors that will build their bones.

• 50:01Rangan Chatterjee?

  Going back to this idea that women and men age differently.

• 50:05Speaker 00

  Yes.

• 50:07Rangan Chatterjee?

  I'm really interested as to what happens when a woman gets pregnant.

• 50:12Speaker 00

  Oh.

• 50:12Rangan Chatterjee?

  Because I know that can have an impact on bone health.

• 50:16Speaker 00

  Completely, yes.

• 50:16Rangan Chatterjee?

  And breastfeeding can as well. So can you just talk us through that? Because again, I think it's empowering to realize the impact of those things.

• 50:25Speaker 00

  Yes.

• 50:26Rangan Chatterjee?

  And therefore what we can do on the other end.

• 50:29Speaker 00

  Completely love that you brought that out because if we talk about that bone as a lifespan pursuit, we just talked about the young women. Then when women enter their fertility years, when they're choosing to have children, or if you don't, bones are still of concern to you. But during pregnancy. We are building a baby from ourselves. The baby's not eating itself. The baby is eating the mother. Either through the nutrients coming in, or if there's not enough, from her muscle, from her bone. Takes about 500 milligrams of calcium a day to build a baby. Where are we getting that? We're either absorbing it from the gut and then passing it to the baby, or we're resorbing the mother's bone.

• 51:09Rangan Chatterjee?

  And just for people who don't know what resorb means?

• 51:11Speaker 00

  Yes, it means that there's a, the way bone works, just as a bone building primer, how bones work, our bones are constantly doing something called remodeling, meaning taking a little bit away, building a little bit up. It's two different cell types. The osteoclast with a C is taking bone away, and then you use all the minerals that you've harvested. And then the osteoblast, B, blast, is building bone. And in normal circumstances, with enough hormones, that is a pretty equal process. Homeostasis, balance. Those are all synonyms. If your body requires more than you're able to build or replace, you will get in bone deficit.

• 51:55Speaker 00

  That can happen during pregnancy if we're not getting enough nutrition. The mother's body will prioritize the baby and resorb what it needs, regardless of what happens to the mother, such that there is a phenomenon called the osteoporosis of pregnancy. It's a documented medical phenomenon because women can lose a significant amount of bone density. Now, here's the good thing. Our bodies know this is gonna happen. And we are, we are designed to rebuild that bone post-pregnancy, but only if we eat enough. Mothers get busy. Sometimes they don't have time to take a shower, let alone eat, right? Pile on top of that breastfeeding.

• 52:39Speaker 00

  Now, I always like to have the caveat, based on responses I've got, that I am all for breastfeeding for women who choose to do it. I breastfed my youngest child for a year. I think it was that important. Where are we get, again, it's the same argument. Where are we getting the nutrients from? It takes 500 milligrams of calcium a day to make enough milk for a baby. We're going to take that from our bones. So every time your baby latches on, in addition to drinking water, we have to be thinking about replacing our calcium, our magnesium, our phosphorus, so that we don't end up in deficit. Because now with women, millennial women delaying childbirth into their early 30s,

• 53:22Speaker 00

  mid 30s, we're entering the critical decade, right? So we have less time to build bone back. And then what if we're having children more rapidly at an older age? And so we may never have time to build back. I just want people, women, to be aware, right? Because you can correct that. But if you never correct that, and then we've already talked about what happens in perimenopause, losing 15 to 20% of your bone density. Do you see how this can add up across a lifespan such that it is not, it is even more common for women truly in their menopause years?

• 54:03Speaker 00

  At this conference we were at, I had many women come up to me afterwards and say, you know what, I thought I was doing everything right. They're doing all the lifestyle things, but they go and get this DEXA scan or this REM scan and their osteopenic or osteoporotic. And they're so disappointed because they thought they were doing everything right now. Well, they may be, but maybe they didn't build enough bone in their youth.

• 54:30Rangan Chatterjee?

  Yeah, it's so interesting. You know, as you're talking now, I'm thinking about my wife. So my wife breastfed both of our kids, which is what she wanted to do and she was able to. I recognize that not every woman can.

• 54:43Speaker 00

  Can or wants to.

• 54:45Rangan Chatterjee?

  But let's say there was four years of breastfeeding. Given what you've just said, that's four years where my children, our children, were taking whatever they needed from my wife's body.

• 55:01Speaker 00

  That's right.

• 55:02Rangan Chatterjee?

  And potentially leaching her bones for calcium.

• 55:06Speaker 00

  It sounds terrible when we say it like this.

• 55:07Rangan Chatterjee?

  In order to sustain theirs.

• 55:10Speaker 00

  That's right.

• 55:11Rangan Chatterjee?

  Right? Now.

• 55:14Rangan Chatterjee?

  You know, in the context of you just saying what you said, which is at this conference we were both at this weekend in London, we're both speakers at this conference, wonderful conference, so many women said, I thought I was doing everything right. I didn't realise there was an issue with my bones until I got the DEXA scan. So, without knowing anything about my wife, would you say, actually, that's someone who might be a good candidate for a DEXA scan?

• 55:40Speaker 00

  I'm gonna order it for her myself.

• 55:42Rangan Chatterjee?

  Okay, so you think it's unimportant because?

• 55:44Speaker 00

  I do. What is the downside of knowing where we stand?

• 55:47Rangan Chatterjee?

  Yeah.

• 55:48Speaker 00

  Because it might serve as motivation. We might find out she's perfect.

• 55:51Rangan Chatterjee?

  Yeah.

• 55:52Speaker 00

  Good for her, we're gonna keep going on the course. We might find out that there is an opportunity to get in front of this before she's 55. You know, this is the time to find out. And that's what I want people to do, is find out. Here's, here are all the reasons, I mean, there are dozens of risk factors for osteoporosis besides loss of estrogen and aging. But if your mother is shrinking, you know, my mother used to be as tall as me and now she's down mid-head, right? If your mother is shrinking, if you notice you're shrinking, if you thought smoking was cool and smoked at any time in your

• 56:33Speaker 00

  life, smoking is poison to bones. If you had an illness, a chronic illness where you were required to take a lot of steroids, from asthma to cancer, or any of the autoimmune diseases, there are dozens, or if you had a fracture after 20, fracture is the number one predictor of future fracture. These are all risk factors for osteoporosis and poor bone health. Those are reasons to march into your doctor and say, I have a risk factor for a bad bone and I want to know. If you were skinny fat your whole life, if you have recovered from a, from a eating disorder, that, these are all reasons. We do not have

• 57:18Speaker 00

  to sit idly by and cross our fingers and hope.

• 57:21Rangan Chatterjee?

  Yeah.

• 57:21Speaker 00

  That our bones are gonna be okay at 65 when finally a DEXA scan will be paid for, you know?

• 57:29Rangan Chatterjee?

  I think we also have to, look, I'm sort of semi-familiar with the healthcare system in America, but of course, I know the UK one much better. I'm really off the view these days that the NHS, our National Health Service, cannot and will not be there for all of these issues. It simply cannot pay for all of this stuff for everyone.

• 57:52Speaker 00

  That's right.

• 57:53Rangan Chatterjee?

  And I think we're sort of waiting for this time where it gets funded well enough whereby all of us can have this. I don't think that's coming.

• 58:02Speaker 00

  Yes.

• 58:02Rangan Chatterjee?

  And I don't say that because I want it to not be there. Yes, it would be great if all of this stuff could be funded, but I think at some point we have to start recognizing that the NHS is going to be there and it's going to be fantastic at some things, acute problems, or I shared with you, we were just from the fracture clinic this morning because my son fell a couple of weeks ago, well, four and a half weeks ago, broke two bones in his wrist. We got great care from the NHS. They X-rayed him, put him in a cast, we've gone and had a review. That stuff I think the National Health Service is fantastic at. But I do think, and of course, not everyone can afford this, but if you're someone who's

• 58:43Rangan Chatterjee?

  concerned, it may be that we have to take this into our own hands and go, actually, what is the cost of me not doing a DEXA scan? Right? Because you outlined it before. What if it's 72, you're with that break, and then it's your kids who are having to decide, are we going to put mum in a home, going to pay for care, are we going to decimate all the life savings, whatever it might be. These are real things that are happening.

• 59:09Speaker 00

  Yes.

• 59:09Rangan Chatterjee?

  And it's just going up, up, up. So this whole idea of cost as well, it goes back to what your banking friends were saying, right? We can't really see it. We can't really see it. I don't know how much a DEXA scan is here. Let's say it's £200, right? And of course, not everyone has £200, but we don't see it where actually that £200 spent could literally save you tens of thousands of pounds in the future.

• 59:35Speaker 00

  Exactly, in the future. Exactly. So I always encourage people to do exactly what you've said, like, Well, I have a comment about your health system and my health system in the United States. I have come to understand, even based on the way we bill, the job by and large of the US healthcare system is to get you out of the hospital alive, to make sure you don't end up dead in the hospital, and to take care of acute problems. There is not the time, I'm a practicing surgeon. My practice is a third in terms of volume as it was, because I am trying to take whole person care. But the average doctor in a fast running clinic does not have that luxury, right?

• 1:00:16Speaker 00

  So it sounds like here and in the US, we're just doing acute care and catastrophic care. I think people are responsible for their own health. I think we can't leave all the decisions to a clinician, or all the prevention to a clinician. So this is one example. For instance, I encourage people, in the United States, you can get a DEXA scan for about $99, which is not a zero fund, is not a zero number. But think of how much we spend on a cup of coffee at Starbucks. And I'm not zeroing out Starbucks. But the fancy coffee that I no longer buy there costs $7.18. If I do that every day, that's a DEXA scan.

• 1:01:01Speaker 00

  Can we please stop piddling away? And just save it for a month, and you'll get yourself a DEXA. And I realize that that may be a privileged thing to say, but every single person has something. And save it for six months.

• 1:01:15Rangan Chatterjee?

  But let's say, let's even say that someone cannot afford that, right? Let's go to the practical things, because one of the, you know, I went for a walk this morning, I was thinking about, there's so much to cover from your book, and I thought, we'll never get through it all. But I thought, we must go into bone health, because I think bone health has been undervalued.

• 1:01:34Speaker 00

  Completely.

• 1:01:35Rangan Chatterjee?

  And even, I've heard a lot of your interviews, and I think it's easy to focus on, you know, muscle, and the strength training, and the VO2. And that's all great, and we're going to get to that. But I do think bone needs to be raised in our awareness. So I really wanted to make sure we focused here. A lot of this book is talking about the incredible benefits of movement. And of course, you have this wonderful acronym FACE, right? Which is brilliant. Flexibility, mobility, aerobic activity, carrying a load, and equilibrium and fast speeds. But if we simply look at it through the lens of bone for a minute. And yes, for people who can get a DEXA scan to see where they're at, great.

• 1:02:20Rangan Chatterjee?

  Even if you can't, or you won't, there are things that you can do to improve your bone health, right? So when it comes to movement, what kinds of things can we do that will directly improve the health of our bones?

• 1:02:40Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something, and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling, and that's why at this time of year, I remind myself to lean into the fundamentals. And one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc, and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 1:03:23Rangan Chatterjee?

  improvement and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens, and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, plus free vitamin D3 and K2 and AG1 Welcome Kit with your first AG1 subscription order. That's $87 in free gifts for first time subscribers. All you have to do is head to drinkag1.com/livemore to claim this offer before it ends.

• 1:04:10Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling and that's why at this time of year, I remind myself to lean into the fundamentals and one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years and one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 1:04:53Rangan Chatterjee?

  improvement and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, plus free vitamin D3 and K2 and AG1 welcome kit with your first AG1 subscription order. That's $87 in free gifts for first time subscribers.

• 1:05:32Rangan Chatterjee?

  All you have to do is head to drinkag1.com/livemore to claim this offer before it ends.

• 1:05:45Speaker 00

  Yes, let's just assume you're losing bone density. Let's make it a given.

• 1:05:49Rangan Chatterjee?

  Okay.

• 1:05:50Speaker 00

  That's a good, that is a good place to start. Men and women are going to lose bone density, blah. Here are the top things to do for your bone. Number one, optimize your hormones. Estrogen is so critical for bone health in the regulation of these two cells I was talking about earlier, that it will help rebalance the, the breaking down of bone and the building of bone. Number two.

• 1:06:19Speaker 00

  Building muscle. Number three, and often forgotten, is the E of the FACE acronym. Equilibrium and foot speed. Because you may be fine sitting in a chair. You may be fine walking around. But if you lose your balance, we are neuromuscular pathways controlling balance start to degrade in our twenties. Such as you reach for something, you lose your balance, you topple over.

• 1:06:44Rangan Chatterjee?

  In our twenties.

• 1:06:44Speaker 00

  Yes, but it completely totally, totally retrained. And we can talk about that. But we have to reestablish our balance. So that we don't trip over our dog, or our rug, or just try to pick something up and fall over. Because you'll be fine before you fall. And then you have the fatal fall. Or the, you know, your child has had a month in a cast. It takes three months for an adult to heal a fracture because of our biology. Think of the inconvenience of that, even if it's a minor fracture. So, retrain our balance. And number two, in that F A C E equilibrium, is the long forgotten foot speed. Meaning

• 1:07:25Speaker 00

  we lose our type two muscle fibers, which is our fast twitch fibers. And so I train people in speed and agility. You know, it's all those things we see athletes doing, hopping over cones, jumping over little hurdles. Even I was teaching a US celebrity how to do toe taps and heel taps, and then alternate them really quickly. Because we lose the neuromuscular coordination that helps us jump over our work bag that sits by our desk and trips us every day, right? We may be fine until we lose our balance and fall down.

• 1:08:06Rangan Chatterjee?

  Yeah.

• 1:08:06Speaker 00

  So, we can't forget to do that in our, in our general mobility, but specifically for bone, if we're talking about it.

• 1:08:14Rangan Chatterjee?

  Yeah. See, it's interesting, things like swimming and cycling.

• 1:08:18Speaker 00

  Mm hmm.

• 1:08:19Rangan Chatterjee?

  Fantastic aerobic activities. But I say, personally, in my own life over the last years, I've really been thinking about weight bearing activities. And if I have limited time to move, and I'm making more and more time to move as I get older, I'm

• 1:08:39Rangan Chatterjee?

  Let's, we'll, we'll come to strength shortly, but in terms of more, I guess, what you would call in inverted commas aerobic activities, I really focus on walking and running.

• 1:08:50Speaker 00

  Yes.

• 1:08:51Rangan Chatterjee?

  Don't get me wrong, I like cycling, I like swimming, but I'm thinking, yeah, but those things are not really putting load through my joints.

• 1:09:00Speaker 00

  They're not.

• 1:09:00Rangan Chatterjee?

  Right? So they're great, but they're not loading my joints, whereas walking and running are literally putting pressure through my joints. So I personally am prioritizing those. As a sports medicine specialist, as an Orthopaedic surgeon, what's your take on that?

• 1:09:17Speaker 00

  I agree. I am not against swimming, great for aerobics.

• 1:09:20Rangan Chatterjee?

  Yeah, for sure.

• 1:09:21Speaker 00

  I am not against cycling, aerobics and building butt corn hips muscles. But if you're concerned about building better bones, not only is walking fine, it produces about 1.5 times body weight with the steps. Running is fine, about two and a half times body weight. To, to build better bone, we need four times body weight.

• 1:09:44Rangan Chatterjee?

  Okay.

• 1:09:45Speaker 00

  So if we really want to get after it, we're gonna jump. And we're gonna, we're gonna jump at least off an eight inch step, because that will produce four times body weight and impact, because this is the way bones work chemically. The biomechanical impact of you landing hard on both feet from an eight inch height and then jumping up straight in the air and landing again, that biomechanical impact becomes through little channels of fluid in your bone, biochemical signal that tells the building cells, oh, I better lay down more bone, she's jumping around again. So the impact becomes the biochemical

• 1:10:26Speaker 00

  signal to build bone. But it has to be intense enough. So when you jump off, when you're running, I would stop and jump up and down 10 to 20 times.

• 1:10:40Speaker 00

  Or you can do it all at one time, three days a week, you can spend 10 minutes jumping in multi-directions. I just posted reintroducing hopscotch to the world, right? Because it's multi-directional play jumping. So that's what I would add. And there are lots of studies to substantiate that. In fact, one that I published in this research group, looking at what kind of activity, number one, answering the question, can we maintain our bone density by being active across the lifespan? The answer to that study was yes. The subsequent study was, well, okay, what kind of activity maintains

• 1:11:21Speaker 00

  bone density best? And it seems logical, but we were studying the senior Olympics, which is Olympics for people over 50. We found, not surprisingly, that the jumping sports like volleyball, basketball, because of the impact, maintained bones better than the swimming, the running, the badminton, the bowling.

• 1:11:46Rangan Chatterjee?

  That's really interesting.

• 1:11:47Speaker 00

  Isn't that fascinating?

• 1:11:47Rangan Chatterjee?

  And just a point to clarify. So many people these days are jumping on trampolines or on rebounders. Now, what's interesting on those, of course, there's give when you land. So I'm guessing that you're saying, no, no, you must make sure it's against a hard surface?

• 1:12:03Speaker 00

  If you have a choice, if you are not so arthritic that you can barely move, please impact on against a hard surface. That being said, NASA has some good evidence that when they bring astronauts back down from the space stations, they use rebounders.

• 1:12:19Rangan Chatterjee?

  Right.

• 1:12:20Speaker 00

  You know, and it can be beneficial. But all things being equal, if you can jump on a hard surface, jump on a hard surface.

• 1:12:26Rangan Chatterjee?

  Yeah. Okay, I love that. And of course, skipping ropes are brilliant as well for this.

• 1:12:30Speaker 00

  Skipping, just skipping on a track. I mean, that kind of impact, getting your knees up really high adds some impact.

• 1:12:38Rangan Chatterjee?

  Okay. So let's zoom out again and go, well, one of the themes of this conversation is this idea, this central idea from your book, that our body doesn't fall apart with age, it falls apart from neglect.

• 1:12:50Rangan Chatterjee?

  You've spoken about the hormonal changes that happen in a man's life and in a woman's life and why in that critical decade, thirty five to forty five, particularly for women, hormones fall off a cliff and it has a consequential impact on multiple aspects of our health, brain, heart, musculoskeletal system, whatever it might be. And we've just gone deep into bone health, the impacts on bone health and the sort of things that we can do to help improve it. Okay. But then if we just take that broader theme in general about how we don't have to age with frailty, we can age with vitality.

• 1:13:31Speaker 00

  Yes.

• 1:13:33Rangan Chatterjee?

  A big part of your book is around movement. In fact, I think chapter two is literally making the case for movement. So could you make the case for movement? Explain to us why? We've all heard that exercise is good for us, but just build that case for us about movement. Why is it so important that we move in a variety of different ways, particularly as we get older?

• 1:13:59Speaker 00

  So if we have hypertension, high blood pressure, there's a pill for that. If we have diabetes, metabolic disorder, there are a variety of pills for that. If there is heart disease, a pill for that. But there is one pill, one activity, one set of skills that treats everything and that is movement.

• 1:14:26Speaker 00

  Baseline. In fact, it is so critical in so many diseases that I wish I had made this up, I didn't, but there's a professor out of Columbia University in Missouri in the United States that coined the word sedentary death syndrome. It is the thirty three chronic diseases that we die from, including heart disease, that are directly impacted by the amount of movement we do. So how does that work? So. Let's just take skeletal muscle contraction, movement. Skeletal muscle contraction produces a cytokine, a hormone called iressin that is directly

• 1:15:08Speaker 00

  related to glucose metabolism, insulin resistance. I've already talked about the way the bone talks to the brain and the muscle and the pancreas. So anytime we're moving our body, it's not just locomoting us, it's changing us chemically on the inside. When I recommend people sprint at the end of their cardio workout, literally get your heart rate way up, that will change the number of mitochondria, which are the powerhouse units in our cells. It will help stimulate the division of something called satellite muscle stem cells, which

• 1:15:51Speaker 00

  are called satellite cells. Mobility in the form of exercise causes the transcription and changing of body molecules of more than 9,800 molecules every time you go out for a run. It's signaling your DNA to express the genes that you need to stay healthy. It's just fascinating that that one modality, mobility, can change us at a cellular level. It can change us at a tissue level. Here's an experiment we did in the labs with my partners that I had at University of Pittsburgh. Mobility is actually the fountain of youth for our stem cells.

• 1:16:33Speaker 00

  So what the experiment was this, we took little old lady mice, a little old lady mouse is two years old, she's old, she's just sitting back in her cage waiting for her next meal. So we sampled her muscle and we took out a few of her little muscle stem cells. And what did we find? We found that her muscle stem cells in sedentary living were dying. Dying cells, it's an active process. You turn on something called programmed cell death. They were dying. They had lost their round plumpness. Healthy cells are round like a grape. They were more like a branch. They were spindly and they were no longer reproducing or producing growth factors.

• 1:17:16Speaker 00

  That's what these little old stem cells were doing. Then we took these girls. And I spent a lot of money buying mouse treadmills. It's unbelievable how much mouse treadmills cost. But I bought some and we put these girls on the mouse treadmills and they were just like the rest of us. They didn't want to run, but we encouraged them to do so. Twice a day for two weeks, we ran these girls on treadmills and then we re-sampled their stem cells. The spindly dying stem cells were now plump, like grapes again. They were producing growth factors. They had turned off programmed cell death. So the simple act of mobility changed our stem cell function and rejuvenated it.

• 1:17:59Speaker 00

  It was a signal to these mice bodies, these murine model, that we're not dead. We're living. So down to the cellular level. So, and that's what I'm trying to explain to people in the book and give them. I mean, I think my readers are smart. They need to know why, not just go do this program. We can change our mitochondria. We can change the expression of our genes. We can change the amount of inflammation in our body by regulating glucose metabolism and insulin sensitivity and really have profound changes of the hallmarks of aging by simple activities that become how we live, not just programs.

• 1:18:44Rangan Chatterjee?

  Yeah, I love the bit sort of halfway through the book where you move on to the next section where you've covered exercise in detail. And there's this beautiful chart where you've got listed all the time bombs of aging, DNA change and damage, mitochondrial dysfunction, senescence, fuel gauge malfunction and stem cell exhaustion. And then you cross-reference that with different kinds of exercise. And basically you follow that chart, you go, wait a minute, if you do this hybrid training program that you outline in your book, you are basically going to make sure you've hit every one of those sex. So all of the.

• 1:19:25Rangan Chatterjee?

  Sort of physiological changes in your body that are driving aging in a perhaps unhealthy way, or a faster than needed way.

• 1:19:35Speaker 00

  Yeah.

• 1:19:36Rangan Chatterjee?

  Hybrid training targets them all. It's very, very inspiring, isn't it?

• 1:19:41Speaker 00

  It is. You can hit all the boxes by doing this very simple lifestyle.

• 1:19:45Rangan Chatterjee?

  You're obviously such a passionate proponent of this. You've, you, you know, you're really worried at 47 and what the hell was going on with your body and your brain.

• 1:19:56Speaker 00

  Mm hmm.

• 1:19:56Rangan Chatterjee?

  And you've really turned things around where, you know, I saw you the end of the day in London, you probably had a jet lag, whatever. You were on fire on stage, your passion, your energy. I think that's why you're having such an impact in the world. It's not just what you're saying, it's how you're saying it. So I guess my question to you is, at this stage in your life, are you able to share with us what a typical week of training or movement looks like for you?

• 1:20:28Speaker 00

  Sure.

• 1:20:29Rangan Chatterjee?

  And I appreciate that may not feel achievable for someone who's about to start, but I wonder if we could start off with what you do.

• 1:20:36Speaker 00

  Yeah.

• 1:20:36Rangan Chatterjee?

  And then we can perhaps wind back to someone who's never done any of this before, or where they can start.

• 1:20:40Speaker 00

  Yes.

• 1:20:44Speaker 00

  And number one, I want people to give themselves grace. Because sometimes when people say what I'm about to say, they're like, oh, I could never. It's not about that. Start where you are. And I'll give you the example, I'm on a book tour right now. I am really busy in different time zones. So I am not doing everything that I would normally love to do. And I'm going to give myself grace. It's the period of life and not judge myself for it. But ideally, this is what I do.

• 1:21:16Speaker 00

  I have a flexibility and mobility practice, meaning I am trying to stretch out my tendon, ligaments and muscles nearly every day. This is where, I don't do Pilates or yoga, but if you do, this is where that comes in to be marvelous. I do a dynamic warm up every day, which gets every joint, every set of tendons and ligaments around my major joints. Moving, right? So daily flexibility and mobility.

• 1:21:45Rangan Chatterjee?

  10 minutes?

• 1:21:46Speaker 00

  You know, it is just a series and it's outlined in the book, The Dynamic Warmest. It's just a series of 10 things that if I do the inchworm motion, it warms up my ankles, my knees, my hips. If I do hamstring extensions, it gets my hips and my knees.

• 1:22:04Rangan Chatterjee?

  First thing in the morning is that when you tend to do it?

• 1:22:05Speaker 00

  No, I do it before I work out.

• 1:22:07Rangan Chatterjee?

  Before you work out?

• 1:22:08Speaker 00

  I do. I put it all together.

• 1:22:10Rangan Chatterjee?

  Yeah, that's interesting. And the only reason I ask is because I do mobility every day, but it's part of my morning routine. So I'll get up.

• 1:22:18Speaker 00

  Yeah.

• 1:22:18Rangan Chatterjee?

  I'll, at the moment, I'm really into meditation, so I'll meditate. And then it's in my living room, which has got a carpet on the floor. So straight afterwards, I'll probably spend five, 10 minutes just doing a whole variety of mobility exercises. I almost feel like it's waking up all of my joints for the day ahead. So you do it before you work out. I do it first thing in the morning, but you're doing-

• 1:22:39Speaker 00

  It doesn't really matter.

• 1:22:40Rangan Chatterjee?

  Yeah, some form of mobility to keep all the joints moving. Okay.

• 1:22:43Speaker 00

  That's right. And then when it comes to, and we'll just use this acronym that you, that you mentioned, F, that's F, A, aerobic. I used to be the marathon running, middle distance, getting my heart rate into middle zones all the time, as so many people did. I now use an 80/20 method. 80% of the time, I am in lower heart rate, base training, heart rate zone, which is very metabolically efficient. It helps my mitochondria be flexible with what fuel source I'm using, whether it's protein, carbs, or fat. And it burns more fat than the middle distance, middle high intensity exercising that I'll talk

• 1:23:27Speaker 00

  about in a minute. So 80% of the time. So that is three hours a week, broken up into 45 minute sessions. I choose to do mine either by walking home from work, which is two and a half miles, or I have a treadmill in my room upstairs.

• 1:23:42Rangan Chatterjee?

  So four 45 minute sessions a week in what's typically these days called zone two training, which is basically low- Heart rate training.

• 1:23:51Speaker 00

  And I, and I came to that based on the research of Inigo San Milan, who is a physiologist for the Tour de France. So he has a lab in my building, so I use his method. And I, I have the privilege of having my lactate threshold, which is telling me where my heart rate is, uh, done on it with finger sticks. If you can't do that, then you can estimate it. Um, many wearables estimate it, but you could take your age minus, one eighty-one minus your age will give you a range of heart rate.

• 1:24:22Rangan Chatterjee?

  But you also, and you do share this in the book, that for people who don't want to get that technical and don't want to do lab testing.

• 1:24:28Speaker 00

  Yeah.

• 1:24:29Rangan Chatterjee?

  It's, it's basically a lot easier than you think.

• 1:24:32Speaker 00

  Oh, it's brisk walking.

• 1:24:33Rangan Chatterjee?

  Yeah, it's brisk walking. It's basically where you can still talk, but if there was a person on the phone chatting to you, they would also know that you were working a little bit.

• 1:24:42Speaker 00

  Yeah, you would be breathless.

• 1:24:44Rangan Chatterjee?

  Yeah.

• 1:24:44Speaker 00

  Yeah. And, and by the end of doing that, I break a little sweat because I can feel my metabolism revving up.

• 1:24:50Rangan Chatterjee?

  So, so you try and do about three hours of that a week?

• 1:24:52Speaker 00

  That's correct. And that's when I listen to podcasts.

• 1:24:55Rangan Chatterjee?

  Yeah.

• 1:24:55Speaker 00

  Or I learn something.

• 1:24:56Rangan Chatterjee?

  So it's relatively, in inverted commas, easy training, relatively.

• 1:25:01Speaker 00

  Yeah.

• 1:25:01Rangan Chatterjee?

  You're burning fat, it's good for your metabolic flexibility.

• 1:25:04Speaker 00

  That's right.

• 1:25:05Rangan Chatterjee?

  The other thing, which I think a lot of people don't realize about that form of training is that it doesn't spike your cortisol.

• 1:25:11Speaker 00

  Right.

• 1:25:11Rangan Chatterjee?

  And which is just incredible. I had Professor Stephen Siler, who's also at the same Elkhurst Inigo.

• 1:25:16Speaker 00

  Yeah.

• 1:25:17Rangan Chatterjee?

  Um, again, Stephen's one of the world's leading sports scientists. And I think he might have coined the eighty twenty training term.

• 1:25:24Speaker 00

  Oh, good, yeah.

• 1:25:25Rangan Chatterjee?

  From when he observed it in a lot of elite athletes.

• 1:25:28Speaker 00

  Exactly, that's what they do.

• 1:25:30Rangan Chatterjee?

  Yeah. But again, he was just showing me when he came on the show that actually you don't see a cortisol spike. So you, you, it's easy to recover from that stuff.

• 1:25:40Speaker 00

  That's right.

• 1:25:41Rangan Chatterjee?

  Because you share in the book, actually, that in your younger years, you went all in on high intensity interval training.

• 1:25:47Speaker 00

  Because I'm impatient.

• 1:25:48Rangan Chatterjee?

  Yeah. And actually, you were sharing a lot of the research book where actually as you get older, you don't want to be doing that five, six days a week. It can actually start to be counterproductive.

• 1:25:58Speaker 00

  Well, because it's not low intensity enough to allow for recovery. And it's not high intensity enough sprint intervals to really change physiology. So. My office is in this gorgeous performance center and I see class after class on the indoor football field of medium intensity circuit training where people are out there busting it. They are working really hard, but they're not high enough to be sprinting and they're certainly not in a low, low heart rate cortisol state. And so what happens is they don't get the results they want. They're working hard, they don't get the results they expect and they're injured a lot. Every three weeks or so, which, and then they have

• 1:26:43Speaker 00

  to take time off and their brains go crazy because they don't have the dopamine spikes. So 80% low heart rate and then twice a week, I sprint. Sprinting is not running on a track like Shakiri Richardson. Sprinting is a heart rate function, meaning getting it up as high as it can go, your own personal heart rate can go. So, and, but you do that for very short bursts, for 30 seconds, complete recovery, whatever that takes you. It takes me two to three minutes, four times. That sprinting is so good for your muscle derived stem cells.

• 1:27:25Speaker 00

  It's so good for your mitochondrial function and it's high enough heart rate that frankly, it's great for your brain. You feel like kind of a, pardon me, but badass when you hop off the treadmill after sprinting, right? So that's how I do my cardio.

• 1:27:44Rangan Chatterjee?

  So hold on, 10 to 15 minutes maybe of this dynamic warmup. So mobility and flexibility on most days.

• 1:27:50Speaker 00

  Most days.

• 1:27:51Rangan Chatterjee?

  Three hours of this low intensity aerobic training.

• 1:27:55Speaker 00

  Yep.

• 1:27:56Rangan Chatterjee?

  Either walking home or on a treadmill.

• 1:27:58Speaker 00

  Yes.

• 1:27:59Rangan Chatterjee?

  Twice a week.

• 1:28:00Speaker 00

  Yep.

• 1:28:00Rangan Chatterjee?

  You're doing SIT sprint interval training.

• 1:28:04Speaker 00

  After my walk.

• 1:28:06Rangan Chatterjee?

  After your walk. So your walk is warming you up.

• 1:28:08Speaker 00

  Totally warmed up.

• 1:28:09Rangan Chatterjee?

  Totally warm before you start sprinting.

• 1:28:10Speaker 00

  That's right.

• 1:28:11Rangan Chatterjee?

  And what I love about this is it's kind of echoing, particularly on this SIT point, what Stacy Sims said when she came on recently.

• 1:28:22Rangan Chatterjee?

  I have some female friends and family members in my life who I would say are active, who walk regularly.

• 1:28:32Speaker 00

  Yes.

• 1:28:33Rangan Chatterjee?

  But don't do sprint interval training.

• 1:28:38Rangan Chatterjee?

  Can you make the case to me and hopefully then to them? Why? Yes, walking and being generally mobile is very good. But why would you say that they're not getting the full benefits of movement unless they're having this stimulus to their system?

• 1:29:01Speaker 00

  You know, it's just not intense enough to signal the metabolic pathways to cause the muscle satellite cell replication and the burning of fat that you get for sprinting or the mitochondrial division. But if you want a purely, purely aesthetic reason in my own life and in that of the people that I care for, it is the sprint intervals and the heavy lifting that recomposes you to lean. Because if we're trying not to be skinny fat, but lean, it is the sprinting and the lifting that will get you there.

• 1:29:45Speaker 00

  Because working out in the middle zone is not going to get you lean, interestingly. It's why we have a lot of great marathon runners, but they have a lot of fat mass.

• 1:29:58Rangan Chatterjee?

  Yeah.

• 1:29:59Speaker 00

  Right?

• 1:30:00Rangan Chatterjee?

  You actually said in the book, actually, I found this very honest of you. You wrote in saying, listen, I was doing the baseline cardio and I was doing strength training, but it was when you added in the sprint interval training that you really saw the change in your body. And you shared in the book that at that time, you think that is what got you down to 22% body fat.

• 1:30:21Speaker 00

  Absolutely. I went from, when I was writing this book, I had come off the time when I gained 20, 30 pounds during perimenopause, which was unheard of for me. I was an athlete. And so I'd always been so thin that I didn't have, I had 90% body fat in my life.

• 1:30:39Rangan Chatterjee?

  Was that hard for you?

• 1:30:40Speaker 00

  Gaining that weight?

• 1:30:41Rangan Chatterjee?

  Yeah.

• 1:30:42Speaker 00

  Oh, my God. I was at the critical decision point of whether I buy a new wardrobe. Could I still fit into all these things that I had invested in and a certain size? Or was I going to have to do what so many women decide to do, which is get the next two or three sizes up? And I just decided, I know the science, I am worth the investment, I'm going to get this done. And so I did. And over about a six to nine month period, using the things you're asking me about is how I cite in the book. I gained eight pounds of muscle, I lost all this body fat, I was leaner, and aesthetically, I loved it. And you know what? That, that goes up and down. That's why I say, give yourself grace.

• 1:31:27Speaker 00

  I'm on a book tour now. I'm not doing four or five days a week, but I will again.

• 1:31:31Rangan Chatterjee?

  Yeah.

• 1:31:32Speaker 00

  When it settles down.

• 1:31:33Rangan Chatterjee?

  So the sprint interval training is 30 seconds of something.

• 1:31:37Speaker 00

  Something.

• 1:31:38Rangan Chatterjee?

  It doesn't have to be literally sprinting. It could be the battle rope or...

• 1:31:43Speaker 00

  Or vertical, or the Alpine thing, or the rowing, or...

• 1:31:47Rangan Chatterjee?

  Something as fast as you can.

• 1:31:49Speaker 00

  Yes, to get your heart rate up.

• 1:31:50Rangan Chatterjee?

  For 30 seconds. And then what do you do?

• 1:31:53Speaker 00

  Completely recover. So I'll give you my example. So I do this on a treadmill. To do base training on a treadmill, I currently do four to five incline, four to five speed. And that will keep my heart rate about 130. When I am done, then I punch this treadmill up to 11. Now, I'm not a very tall person. So for me, I'm just trying not to fly off the back of this treadmill. But I'm moving so fast that my heart rate goes up over 180. And I can sustain that for about 30 seconds. Then I'm grabbing the side rails and I completely turn the treadmill down to two. And I just walk. And it takes me two to three minutes to get my heart rate back down to, and I start

• 1:32:37Speaker 00

  again when I'm about 140. And then I punch it up again and I'll do another 30 seconds. That's how it goes for me.

• 1:32:46Rangan Chatterjee?

  And what, how many 30 seconds?

• 1:32:48Speaker 00

  Just four times.

• 1:32:49Rangan Chatterjee?

  Four. I mean, that's not that much, is it?

• 1:32:51Speaker 00

  It's not terrible. You can do anything for 30 seconds. And once you've done two, you're like, okay, I've only got two more.

• 1:32:57Rangan Chatterjee?

  Yeah. And you do that twice a week?

• 1:32:59Speaker 00

  Twice a week.

• 1:33:00Rangan Chatterjee?

  And I think the final part is resistance training.

• 1:33:04Speaker 00

  Yes. So...

• 1:33:08Speaker 00

  I think all kinds of resistance training can be helpful, but it depends what your goals are. So I often have women tell me that they've been instructed, and I often say flippily, "Put down the manby pamby pink weights." Well, okay, so if someone has handed you a three to five pound weight and said, "Lift it 30 times," that is good for endurance. You will fail after 30 times of lifting a very small weight. If your goal is endurance, fine, you do that. That's not our goal in midlife and beyond. That is not going to help you live independently. If your goal is purely hypertrophy, which is what we tend to do when we're younger, looking at our big muscle mass in the mirror and damaging our muscle enough

• 1:33:53Speaker 00

  that we grow and recover with bigger muscles, that is a failure range of 10 to 15 reps times four sets. There's nothing wrong with that if that's your goal. My goal in midlife is not to have the biggest muscles. Now, do I build muscle? Yes, I do. Can I get lean? Yes, I can. Our goal in midlife and beyond is strength and then power. Strength to be able to get up off the floor. Power not to trip, to be able to catch yourself, to have some fast twitch muscle, right? So, strength is built with higher weights, lower reps. And you've probably heard this from Stacy Sims. We agree on many things.

• 1:34:35Speaker 00

  So, that means a rep range of three to six. Now, I've been a clinician a long time. I have found I cannot give people ranges. It's too confusing. They want to be really good instructions, so there's no confusing. So, the rep range that I work around myself and with the people I work with is four reps to failure, four sets. Now, listen, if you're starting from the couch, it may take you six months, nine months. It may take you getting lifting lessons so that you're hinging correctly. That's how you move your hips. You're stacking your joints. You're giving your tendons and ligaments time to adjust.

• 1:35:18Speaker 00

  But once you get there, we're going to lift heavy, which is low reps, four sets.

• 1:35:25Speaker 00

  So that you fail at that high rep. That is in the four compound lifts, meaning a compound lift is using multiple joints. So, upper body is some kind of bench press. It's some kind of pull, like a pull up. For the lower extremity, it's some kind of squat and some kind of deadlift. That's not all you do, but that's the basis for what you do. So on a lift day for me, if we're talking about my lift, when I'm lifting four times a week, I'll do two to three leg days and I'll do a one to two arm days, depending how the week goes.

• 1:36:05Speaker 00

  So if it's a bench press day, I'm going to do four sets, four reps, heavy. Here's what it looks like. I can do it four times. I may be able to do five, but I'm not doing six without dumping the weights off because it just, that's when I fail. And then you support that with the single lift, single muscle lifts, biceps, triceps, lats, delts with slightly higher reps, eight to 10. And then core any day of the week, right? So I usually do one, one body part. If it's a Saturday and I have hours that I can kill in a gym, then I will do both cardio and lifting on one day.

• 1:36:47Rangan Chatterjee?

  Yeah.

• 1:36:48Speaker 00

  Yeah.

• 1:36:49Rangan Chatterjee?

  Well, thank you for sharing that, Vonda. It's very insightful to hear what you do.

• 1:36:53Speaker 00

  Yeah.

• 1:36:54Rangan Chatterjee?

  What about a woman who might be listening to this and is thinking, well, I'm on board with what you're saying. I realize that I need to take ownership of my health and I need to move more than I currently do.

• 1:37:06Speaker 00

  Yeah.

• 1:37:07Rangan Chatterjee?

  But I can't stand gyms.

• 1:37:09Speaker 00

  Sure.

• 1:37:09Rangan Chatterjee?

  Right? If they say that to you, what do you say to them?

• 1:37:13Speaker 00

  Well, if you're, if you're literally starting from the couch, then body weight will work for you initially, learning how your body moves. And I, and I put that in the book.

• 1:37:24Rangan Chatterjee?

  Yeah, you do.

• 1:37:25Speaker 00

  I put a star program in the book because I realized people are starting from different places. If you're ready for heavy lifting, which we will all get to eventually, and you cannot stand a gym for whatever reason, then that probably means you're going to have to buy a rack for your garage. Cause, or, okay, let's.

• 1:37:42Speaker 00

  Or unless you want to lift with logs in your backyard or filling up five gallon buckets of water and carrying it around. It's harder to get forty five pounds of weight in your garage without actual racks of weight.

• 1:37:56Rangan Chatterjee?

  But I guess you could do, for example, you know, you were almost tripping up like me on the way into the studio. These sandbags that I have, right?

• 1:38:03Speaker 00

  Yes, you could.

• 1:38:04Rangan Chatterjee?

  So a sandbag, depending on how much weight is in there, of course, is heavy.

• 1:38:09Speaker 00

  Yeah.

• 1:38:10Rangan Chatterjee?

  You know, so one thing I'll often do is, you know, get the sandbag.

• 1:38:15Speaker 00

  On your shoulder.

• 1:38:16Rangan Chatterjee?

  Shoulder and go up and down and then sprint up and down the garden, throw it up in the air, each pick it up again. I also try and do that a lot when my kids are around, so.

• 1:38:25Speaker 00

  So they see it?

• 1:38:26Rangan Chatterjee?

  Yeah, they see it and often I go, oh daddy, can I, can I do it as well? I'm like, yeah, yeah, sure, sure. Funny enough, I had bought two more.

• 1:38:33Speaker 00

  Here's for you.

• 1:38:34Rangan Chatterjee?

  And I've actually put the right amount of sand in for your weight. Not that I try and tell them that, but they just happen to be there.

• 1:38:40Speaker 00

  How clever of you.

• 1:38:41Rangan Chatterjee?

  But that's like, when we separate movement into all these different things, right? I think for people like you and me who are super motivated around movement, that works, but I think for some people, I don't think they're gonna necessarily go, well, I'm gonna go to the gym three times a week, I'm gonna do this two times, I'm gonna do this. Though, so I guess I'm trying to make sure that these core principles, which you write about so beautifully, I want to make sure that people listening actually take action, even if they can't stand the gym.

• 1:39:16Speaker 00

  So listen, I will take anything except sitting around. So if you will never go to a gym and you do not want to buy a rack for your, for your garage. Okay, I'll take a lot of planks. I'll take sandbags across your waist with bridges. That's great for your butt. We just can't do five pounds. We're gonna have to get a lot big sandbags, which you can. I'll take you doing pull ups on the, on the bars in your backyard, your children's bars in the backyard. I'll take that. I'll take you climbing your stairs with your 40 pound sandbag on your I'll take anything except sitting around.

• 1:39:55Speaker 00

  But what I've outlined is this is just things that scientifically and with the people that I serve work.

• 1:40:04Rangan Chatterjee?

  Yeah.

• 1:40:04Speaker 00

  To build muscle, to to increase cardiac health. But literally, I'll take anything other than sitting around. Because I know if anybody tells you just to sit around or or rest to feel better, they're literally telling you to go die in a corner.

• 1:40:20Rangan Chatterjee?

  Yeah. One of my favorite pages in your book is page 27.

• 1:40:26Rangan Chatterjee?

  And the reason why is that on page 27, you have three beautiful images.

• 1:40:33Speaker 00

  Yeah.

• 1:40:35Rangan Chatterjee?

  And they are MRI scans of people's thighs.

• 1:40:39Speaker 00

  Yes.

• 1:40:40Rangan Chatterjee?

  Do you want to just talk us through those three images? And again, on the YouTube version, I'm going to try and pop that up on screen.

• 1:40:46Speaker 00

  Please do.

• 1:40:48Rangan Chatterjee?

  I honestly believe that seeing those images will directly motivate someone to change their behavior. I really do. Certainly for me, I'm active, but I'm looking at that going, I need to be more active. Right? Because I want a muscle like that when I'm 70.

• 1:41:02Speaker 00

  And that was the intent of this picture series. And when I submitted the paper for publication, one of the reviewers said, ah, the picture is unnecessary. And I said, this picture is so necessary, I will not publish with you unless you publish it. So here it is.

• 1:41:15Rangan Chatterjee?

  I'm glad you did.

• 1:41:16Speaker 00

  Yes.

• 1:41:16Rangan Chatterjee?

  Because it wouldn't have had the impact just reading the words.

• 1:41:19Speaker 00

  No.

• 1:41:19Rangan Chatterjee?

  It wouldn't.

• 1:41:20Speaker 00

  No. So what the picture shows is if you imagine

• 1:41:26Speaker 00

  going to the store and buying a ham, like for Christmas, and it has a bone in the middle and the muscles surrounding it. That's what a slice with an MRI through a human thigh looks like. So imagine this round slice with perfect muscles. You can tell that there's gorgeous lean muscle, like a flank steak, across the top of the bone. Gorgeous lean muscle in the back, your hamstrings, with very little peripheral fat. You know, the pinchable fat on your leg, very little of it. When I looked under a microscope. The 40-year-old triathlete, and it wasn't just one picture, it was a whole series of people.

• 1:42:09Speaker 00

  But there was very little fatty infiltration, or we call that marbling, you know? Very little marbling. So essentially, if you have to summarize that picture, the 40-year-old triathlete was a flank steak, lean. Then in the control group, we had people that had sat around for a variety of reasons for 35 years, listen, the central picture, you can barely tell their muscle. You lost all your muscle architecture, you lost muscle volume. They're grossly infiltrated with fat. You can see the white streaking.

• 1:42:45Rangan Chatterjee?

  Yeah.

• 1:42:45Speaker 00

  And there is a thick rind of peripheral fat. I call that a wagyu beef.

• 1:42:50Rangan Chatterjee?

  Yeah.

• 1:42:51Speaker 00

  It's like the marbling you see in a wagyu beef. But that is not the story. The story is the third picture, which is a slice of a 70-year-old triathlete, who if you didn't know better, you would think I just took the next slice in a 40-year-old thigh. Beautiful architecture, gorgeous retention of muscle mass, very little fatty infiltration, and very little peripheral fat. And here's the beautiful thing, when we tested the strength of these people, we did not find a statistically significant decrease in strength until mid 60s. So what this tells us, this study was trying to answer the question,

• 1:43:32Speaker 00

  can we retain our lean muscle mass with recreational-type exercise across the lifespan? And the answer is yes.

• 1:43:40Rangan Chatterjee?

  Yeah, it's remarkable that you cannot, at first glance, tell any difference between the MRI of the 40-year-old triathlete and the 70-year-old triathlete. And it goes back to what you said at the start, right? The bit I quoted to you, what we call "normal aging" is actually "normal aging" for stressed-out, undernourished people who are not intentionally building muscle. This shows very clearly that if you stay active, right? And you prioritize movement in your life, you can have very similar muscle architecture in your 70s as you can in your 40s.

• 1:44:19Speaker 00

  Yes.

• 1:44:19Rangan Chatterjee?

  It is so, so inspiring to see that.

• 1:44:23Speaker 00

  Yeah.

• 1:44:24Rangan Chatterjee?

  And it's also actually, at the same time, on one hand, it's inspiring.

• 1:44:30Rangan Chatterjee?

  And on the other hand, it's depressing. It's depressing how many people

• 1:44:34Speaker 00

  Oh.

• 1:44:35Rangan Chatterjee?

  have that middle image. How many people in their seventies have lived a sedentary life? And have got this horrible muscle architecture? And here's the reality. People think that that just affects their muscles. No, that affects every single system in your body. It even affects, as you all know, your cognition.

• 1:44:55Speaker 00

  Yes. This person in the center that I've described has osteosarcoebesity. Let's break that down. A person who has a lot of fat surrounding all their muscle is obese by definition. A person who has lost their functional muscle, they have low muscle mass. They have lost a lot of their good function. That is sarcopenia, which kills people. Plus, if you look at the bone, the study was not looking at bone, but the bone in this picture has, is very brittle looking. It has a very thin cortex. That's osteoporosis. You can have each one of these in isolation.

• 1:45:38Speaker 00

  But what I find by taking X rays of hundreds of people's legs a month is that people present with obesity plus low muscle mass plus low bone density. And it's not one plus one plus one. It's one plus one plus one equals me, I'm making this up, but a million because of the crosstalk between organs.

• 1:46:02Rangan Chatterjee?

  Yeah. I want to get to hormones.

• 1:46:05Speaker 00

  Okay.

• 1:46:05Rangan Chatterjee?

  Shortly. Before we do that, though, I just want to finish off on movement.

• 1:46:09Speaker 00

  Yep.

• 1:46:10Rangan Chatterjee?

  And I want to talk about VO2 max.

• 1:46:12Speaker 00

  Okay.

• 1:46:12Rangan Chatterjee?

  Right? Because again, one of my other favorite chapters is this almost self-assessment chapter where, I know we mentioned DEXA scans before and what people can do, but you go through the kind of self-assessment process that people can do on themselves, even if they don't want to see a doctor or pay any money for anything, which I think is, is really, really awesome. But in terms of really trying to get this idea through to people that what you do in your twenties and your thirties and your forties impacts your seventies, your eighties and your nineties. I love the way you've described VO2 max and the frailty line.

• 1:46:52Speaker 00

  Yes.

• 1:46:53Rangan Chatterjee?

  Okay, so could you just outline what is VO2 max? What is the frailty line?

• 1:46:57Speaker 00

  Yeah.

• 1:46:57Rangan Chatterjee?

  And therefore, what are the implications for us in our lives?

• 1:47:03Speaker 00

  VO2 max is the best measurement of your overall fitness. It's cardiovascular fitness. It actually measures oxygen diffusion, which means passage from your, from the blood in your heart to your lungs. It's, and therefore measures how fit you are. The, the higher your VO2 max, the more fit you are. And now endurance athletes like Tour de France athletes, they're just genetically specimens. I mean, and their VO2 max is just outrageous, like 95. Most people, for their fitness level to be great, it's considered in the 50s to 60s of, of this measurement.

• 1:47:47Speaker 00

  What happens is with time and disuse, our VO2 max will decline 10% a decade. And so you may think, okay, great, I'm not trying to be an endurance athlete. Why does that matter? Because there is a line which you have cited, the fragility line, where you are too frail, you have so little fitness, you cannot take care of yourself. Meaning, once you have so little fitness, you cannot get up from a chair by yourself, you gotta live with somebody, or you gotta move into a home. So our goal is to never pass the fragility line.

• 1:48:27Speaker 00

  So if we're gonna lose 10% of our VO2 max, if we don't reinvest in it, now we can build real, but say you're not gonna make the effort, you will lose 10% per decade. So if you start out with a low VO2 max in midlife, say 30, 25, take 10% away per decade, at some point in your life, you are likely to pass the fragility line and not be able to get up from a chair and not be able to take care of yourself. For men and women, the line is 15 to 18. So we, you know, grade is 50. If we pass 15 to 18, we're not getting up from a chair and living independently.

• 1:49:07Speaker 00

  We can work on that by a different type of exercising protocol called the Norwegian protocol, which is going as fast as you can in an aerobic activity for four minutes and then recovering, but only for four minutes. And by using the Norwegian protocol one time a week, you can build your VO2 max. So it's not that all hope is lost if you find yourself in midlife with poor fitness. But again, it's like bone, you're starting behind the eight ball.

• 1:49:41Rangan Chatterjee?

  Yeah, I guess the central message there is, is that although it's not inevitable that we're going to become frail as we get older, it is inevitable that there are going to be some changes in your body.

• 1:49:57Speaker 00

  Absolutely.

• 1:49:58Rangan Chatterjee?

  And that's the normal process of aging.

• 1:50:00Speaker 00

  Normal.

• 1:50:01Rangan Chatterjee?

  And of course, there's many things we can do to improve things. We can stay active, we can do it in, you know, this kind of hybrid type training regime that you're outlining, which is going to reduce the rate of decline.

• 1:50:15Speaker 00

  Yes.

• 1:50:16Rangan Chatterjee?

  But there is going to be some decline, you know, in your 80s, you're probably not going to sprint as fast as in your 20s.

• 1:50:22Speaker 00

  Yes, and when I describe this, it's not because I'm a Pollyanna that believes there's never going to be a decline, but I have plenty of individual patients and populations that I've studied. When you invest in your health and mobility every single day, you're going to age in a different way.

• 1:50:39Rangan Chatterjee?

  Yeah.

• 1:50:39Speaker 00

  Now, what happens if you didn't start until your mid 50s? There are also now more anecdotal examples all over the internet of people who have started in their 60s and 70s and made profound changes in their body composition, in their health.

• 1:50:58Rangan Chatterjee?

  I think I've heard Inigo Somalán talk about

• 1:51:02Rangan Chatterjee?

  Someone in their 60s who started to do zone two training in their 60s, but maybe six hours a week of zone two training. And now in their late 80s, they're, I think, breaking world records.

• 1:51:14Speaker 00

  It's amazing.

• 1:51:15Rangan Chatterjee?

  It's remarkable, the body's capacity to change.

• 1:51:18Speaker 00

  Yes.

• 1:51:19Rangan Chatterjee?

  But I guess the summary point of that VO2 max stuff for me is that there is going to be some decline.

• 1:51:24Speaker 00

  Of course.

• 1:51:24Rangan Chatterjee?

  As you get older, there is something called the frailty line. And therefore, and you actually have a table in the book which shows people this. But you can actually just backplot this and go, actually, if you want to be living independently in your 80s, you're going to need a VO2 max of this.

• 1:51:42Speaker 00

  Yes.

• 1:51:42Rangan Chatterjee?

  Therefore, in your 40s, your VO2 max should probably be in the region of this.

• 1:51:50Speaker 00

  It's like a DEXA scan. Let's find out where we are.

• 1:51:53Rangan Chatterjee?

  Exactly.

• 1:51:53Speaker 00

  If we need the motivation and you're coming in with a VO2 max of 25 when you're 40 or 50, we get a little bit of work to do, but it's not inevitable. We shouldn't use it as, I'm, I'm never going to do it. It should be a motivating factor.

• 1:52:09Rangan Chatterjee?

  So FACE is a great acronym. There's loads there we've covered. And of course, the book goes to it in detail. And of course, anything is better than nothing. There's perfection and there's also make progress in where you are. Let's not talk about hormones.

• 1:52:24Speaker 00

  Okay.

• 1:52:25Rangan Chatterjee?

  Right? Because right at the start, Vonda, you mentioned how there's a precipitous drop in estrogen for women in perimenopause. In your book, you also made the case that to you, estrogen is the elixir of longevity.

• 1:52:41Speaker 00

  Yes.

• 1:52:43Rangan Chatterjee?

  Does it necessarily follow then that all women need to replace their estrogen?

• 1:52:51Speaker 00

  Here's how I position this. I believe that every woman is a sentient being with agency to make her decision. But I insist that that decision be made based on facts and not fear. And here's what I mean. Prior to the 2002 Women's Health Initiative study, which was a study done by the National Institutes of Health in the United States, more than 40% of women in the US, I don't know the European numbers, but 40% were optimizing their estrogen by replacing it because of the known effects it has on bone and muscle

• 1:53:36Speaker 00

  and heart and brain. After the Women's Health Initiative was published, with the data that has been now strongly refuted as a travesty, the current number is between 2 and 4%. Not because estrogen is bad for you, but because of the fear that was released from that study that made a blanket statement, which turns out to be nuanced and not true, that you will have a high incidence of breast cancer. You can't put that genie back in the bottle. Generations of women still today come into my office, and when I start talking about it, they just automatically say, "I can't do that. It causes cancer," to which I have

• 1:54:19Speaker 00

  to walk back, "Well, here are the data. You are free to make your own decision." So if we go to that data, do you mind if I name the one piece of data?

• 1:54:30Rangan Chatterjee?

  Please, hey, take your time. This is really important.

• 1:54:32Speaker 00

  It's critical.

• 1:54:33Rangan Chatterjee?

  And I know people listening are going to want to know your perspective on this.

• 1:54:36Speaker 00

  Yeah, so the Women's Health Initiative was designed, and a lot of good work has come out of it, but not this piece of work, not this particular question. Was, the question initially was, heart disease as it relates to giving hormones. Now, at that time, because of when it was, the hormone they used was conjugated equine estrogen, which is a synthetic form, or which is a form that comes from pregnant horse urine. Now, what we're talking about when I advise people to consider estrogen replacement, we also have the options of transdermal, using patches. So it's not only these pills made out of horse's urine. But

• 1:55:21Speaker 00

  in the WHO, they were asking the question, "Does estrogen replacement increase cardiovascular disease?" So they recruited older women. The women in this study were in their 60s on average.

• 1:55:40Speaker 00

  Here's the data that they found. They stopped the study early, called a press conference. Dr. Rousseau, the head of the study, called a press conference from reading about that time and talking to people who are actually there without consulting the study group of other doctors and announced that the study was being stopped because estrogen caused breast cancer. Here are the data. In the women who did not take estrogen, the incidence of new breast cancer diagnosis was three out of a thousand.

• 1:56:19Speaker 00

  Three out of a thousand. For the women in the study group who were given estrogen and sometimes synthetic progestins if they had a uterus, the incidence was 3.8 per thousand. So the difference between control group and and study group was 0.8 women per thousand. Less than one woman per thousand was subsequently diagnosed with breast cancer. Now, listen, I am not making light because one is one. One woman is one woman. I was a cancer nurse. I get it. I was taking care of in my youth, women struggling with this.

• 1:57:01Speaker 00

  But for one woman in a thousand, estrogen was taken away from generations of women, just blanketly taken away. And in this same study, there was no increase in cancer deaths. So instead of making this blanket statement, which has now affected women for generations, from which we have a high incidence of frailty in women and suffering.

• 1:57:32Speaker 00

  For what? So I think every woman gets to make her decision. If point eight is enough for you to not want to be on it, that's your decision. But I personally and the women I take care of, I value my brain too much to let it starve to death. I value my heart too much to allow myself to develop thirty to forty percent more microvascular disease. I don't want to lose any more bone than I've had to lose. And I feel like myself again because my brain is back. I am stronger than I've ever been. And it is all the things I'm doing.

• 1:58:10Rangan Chatterjee?

  Yeah.

• 1:58:10Speaker 00

  But it's also because I've given my body back what it's always had, which is estradiol, which is the compound our ovaries make, progesterone, because I have a uterus. And once we're settled out on that, I often discuss testosterone use with women. Because the reality is women make more testosterone than we make estrogen. It's a hormone, not a male hormone. And so I think every woman has the right to make those decisions.

• 1:58:42Rangan Chatterjee?

  Yeah. Thank you for sharing that. It's really interesting for me to hear your own experience and of course, that of many of the patients you've seen over the years.

• 1:58:55Speaker 00

  Yes.

• 1:58:56Rangan Chatterjee?

  And yes, the fallout of the WHI study has had huge implications across society and particularly for women for a number of years now. Going back to the start of this conversation, when you were explaining that estrogen declines. So every woman is going to have a decline in estrogen.

• 1:59:20Speaker 00

  It's inevitable.

• 1:59:21Rangan Chatterjee?

  And there are estrogen receptors all over the body, including the brain. So help me understand this from your perspective that

• 1:59:32Rangan Chatterjee?

  On the face of it, that would imply that all women would benefit from estrogen supplementation.

• 1:59:42Speaker 00

  Mm hmm.

• 1:59:43Rangan Chatterjee?

  At the same time, I think if we look around the world, we see clearly that there are certain communities around the world where women don't seem to report the same number of symptoms through menopause.

• 1:59:59Speaker 00

  Mm hmm.

• 2:00:00Rangan Chatterjee?

  And that there are women in their seventies and eighties who seem to be thriving having not replaced their estrogen. And again, this, I, I've seen so many women have their lives transformed once they start taking hormones.

• 2:00:16Speaker 00

  Yeah.

• 2:00:17Rangan Chatterjee?

  But I find that interesting to go, what is it?

• 2:00:19Speaker 00

  It's a struggle. What is that?

• 2:00:21Rangan Chatterjee?

  What is going on? Because also you mentioned before about how women, if you're breastfeeding and you're not careful about replacing those nutrients, you could be losing a lot of your bone structure. And as you were describing that, Vonda, I was thinking about the modern world and in particular, the modern Western world, where actually now women are having to do so much. Now, you know, there used to be a time in many cultures and even in Western culture where women would be supported during pregnancy and in the early years, right? While they were breastfeeding, the family would support them. They go, actually, this is a time where we need to really take care of the mother and

• 2:01:03Rangan Chatterjee?

  the baby, make sure the mother has time to rest, that we're also, do you know what I mean?

• 2:01:08Speaker 00

  I do. I've read about it in books, but I've never seen it in my life.

• 2:01:11Rangan Chatterjee?

  Exactly. And it does, and of course, it's very hard now in these, in the modern world where people are often not living near their parents or their family. Often two parents in a two parent family are working.

• 2:01:23Speaker 00

  Yes.

• 2:01:24Rangan Chatterjee?

  There's a pressure, particularly in the United States, for women to get back to work really, really quickly. So I wonder, and I, I have this question in my head all the time, what is going on? Is it that in those other cultures, yes, we think they're doing well, but had they been given estrogen, they would be doing even better? Or is there something about the stress load in our modern Western world, which is exacerbating these issues?

• 2:01:53Speaker 00

  Interesting.

• 2:01:54Rangan Chatterjee?

  I don't know. And I just want to put it to you very respectfully. You know, have you thought about that? Because I can't quite square the circle there.

• 2:02:02Speaker 00

  I think there are a lot of factors. I love this conversation. When we talk about longevity, women are winning that race. In in most countries, women live four to six years longer than their male counterparts. So in terms of sheer numbers of years, women win that race. But women suffer longer. Women are used to feeling pain such that women come to my office with and without provocation. They say to me, you know, I didn't want to come here today because I have a really high pain tolerance and like a badge, because we have pain in menstruation. We have pain with child bearing. We have aches and pains when we lose our estrogen and our whole body hurts and they can't get out of bed.

• 2:02:44Speaker 00

  We just assimilate that as the natural course of having two X chromosomes. And they say, I didn't want to come. I have a high pain tolerance, but I just couldn't take it anymore. So maybe some of what we're thinking of, well, we never used to feel menopause, is just the natural acceptance of pain in women.

• 2:03:02Rangan Chatterjee?

  Yeah.

• 2:03:04Speaker 00

  Another part of it could be the modern stresses that we have. We don't live in the, at least in Western world, we don't live in the same kind of community that we used to, you know? We don't, many times, we don't live with our parents or live in close proximity. Right?

• 2:03:23Speaker 00

  I'm going to tell you for sure that when I left home at 18 to go to university, I was gone for 22 years, not continuously. I saw my parents, but I never lived with them again. And I falsely thought that when I had my daughter, my last child at 40, I used to say stupid things like, oh, it doesn't take a village to raise a child, blah, blah, blah. I was so wrong, such that when I had her at 40 and my parents retired and moved, that community of support was the only way I could have gotten it done. So I see what you're saying about the stress and the increased inflammation that comes

• 2:04:04Speaker 00

  with that, that leads to pain and more brain loss and more bone loss. Maybe that's what we're seeing. But even in very supportive cultures, maybe women are just used to suffering

• 2:04:17Rangan Chatterjee?

  Yeah.

• 2:04:19Speaker 00

  and don't want to mention it, or there's a lack of understanding of what's going on. Because it doesn't mean that frailty doesn't exist. I see it in every culture that comes to see me, because I live in a very diverse community. Every elderly woman I see is frail.

• 2:04:35Rangan Chatterjee?

  I love that. I love that perspective. And I love the fact that over the last few years, there's a whole number of powerful, strong female women like yourself, like Stacey Sims, and Lisa Moscone, Louise Newsom, Anita, you know, loads of people who are trying to raise awareness of the importance of female health. And actually, we put up with stuff for ages. We don't need to anymore. And perhaps as a man, it's harder for us to see things like this, because, you know, my experience of the world is through a male body.

• 2:05:10Speaker 00

  Sure.

• 2:05:11Rangan Chatterjee?

  Right? So I can hear about the stuff that women have had to put up with and women have put up with. I can try my best to empathize. I think I'm pretty good at empathizing. But of course, I don't know what that's like, because I'm not a woman.

• 2:05:23Speaker 00

  Right. Well, I think for this understanding to become full, to become common, to reach a critical mass, we must have the collaboration of the men that we work with and live with. It's a, I think the message will be spread more easily so much that, you know, my poor husband, I drug him onto my own podcast so that he could Talk to the world about what men need to know. Not to understand the people they love, to prevent midlife marriage failure after 25 years, because unless we understand what's going on, you may not understand why your

• 2:06:06Speaker 00

  normally placid wife is suddenly enraged and, you know, has a fork in her hand aimed at you, or there has to be an elevated understanding.

• 2:06:17Rangan Chatterjee?

  Well, no, I love chatting to you. I really do think this book is fantastic. It's such a thorough and well-rounded practical guide for someone who wants to empower themselves and take control of their health. One that we've not really gone into, which is when you arrived today, I sort of shared was one of my favorite things in the book is there's a chapter on mindset and a chapter on resilience.

• 2:06:41Speaker 00

  Yes.

• 2:06:42Rangan Chatterjee?

  And just to sort of bring this conversation to a close, in the mindset section, you talk about a vision statement and why you think it's really important for every woman who goes on this journey to have their own vision statement. What's your vision statement?

• 2:07:01Speaker 00

  You know, I have a vision for being able to do what I want to do, when I want to do it, at all times. It doesn't matter if I'm my age now, or if I'm 97. I want to have that independence, because if I'm that independent, then I'm going to have the fullness of life that I've worked for my whole life. I'm going to have the fullness of relationship in an equally giving relationship. I won't be just taking, you know, my children. Hopefully, I'll be giving back as much to them as they're giving to me in my old age, right? And so I just want that independence. And to have that vision, it takes active pursuit now.

• 2:07:47Speaker 00

  It's just not going to happen. And all the visions that in this, what I teach people have to be based on your values. Who are you? What do you want to be? What do you really value in life? And from that, you can build your vision. Because otherwise, if you don't have that, these are just six-week programs. These are just more things to do without the end purpose.

• 2:08:10Rangan Chatterjee?

  Yeah. The book is called Unbreakable, A Woman's Guide to Aging with Power. And right at the end of this conversation, which I have thoroughly enjoyed.

• 2:08:22Speaker 00

  Oh, thank you.

• 2:08:25Rangan Chatterjee?

  For that woman who has been listening,

• 2:08:30Rangan Chatterjee?

  who your words have sparked a little bit of interest. They have started to see themselves differently. They start to go, well, wait a minute. Yeah, Vonda's right, actually. I have neglected myself. I have put everyone else first. I've not looked after my own health. I've not looked after my physical health. I've never done anything for me. But now I see, Vonda, why it's so important. For that woman who hasn't done much before, but wants to get started, what are your final words to her?

• 2:09:05Speaker 00

  What I want you to know about this whole process and this book, before anything else, is that you are worth the daily investment in your health. You have worth.

• 2:09:19Speaker 00

  That means that you can focus on yourself. You can prioritize these things ahead of everyone else you love and serve, because you are worth it. You are created and made and have value. Until you believe that, you will continue to neglect yourself.

• 2:09:37Rangan Chatterjee?

  Vonda, thank you so much for coming on the show.

• 2:09:40Speaker 00

  My pleasure.

• 2:09:45Rangan Chatterjee?

  Really hope you enjoyed that conversation. Do think about one thing that you can take away and apply into your own life. And also have a think about one thing from this conversation that you can teach to somebody else. Remember, when you teach someone, it not only helps them, it also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday 5. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I'd be

• 2:10:27Rangan Chatterjee?

  consuming, and quotes that have caused me to stop and reflect. And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatge.com/friday5. Now, if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics: happiness, food, stress, sleep, behaviour change and movement, weight loss, and so much more. So please do take a moment to check them out.

• 2:11:10Rangan Chatterjee?

  They are all available as paperbacks, ebooks, and as audiobooks, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family, or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week, and please note that if you want to listen to this show without any adverts at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health.

• 2:11:51Rangan Chatterjee?

  Making lifestyle change is always worth it, because when you feel better, you live more.