108. Dr. Vonda Wright: Why Women Need a New Approach to Aging, and How to Start Now

What if the real turning point for women's health isn't menopause itself, but the decade before it? Long before the symptoms hit, your brain, bones, and heart are already changing, silently. You can train hard, eat clean, and still lose strength, bone density, and cognitive sharpness if you're not addressing the biology underneath it all. In this episode of EXTEND, I'm joined by Dr. Vonda Wright, orthopedic surgeon, researcher, and author of Unbreakable, to talk about how women can take control of midlife long before the "change." We get into what actually happens when estradiol starts to fall, why bone is an active endocrine organ (not just structure), and how to measure what really predicts longevity: VO₂ max, grip strength, sit-to-stand, and bone quality. We also discuss her FACE framework, flexibility, aerobic base, carrying load, and equilibrium, a smarter way to train for longevity that protects your brain, bones, and hormones. Dr. Vonda Wright is a double board-certified orthopedic surgeon, researcher, and author of Unbreakable. She's a leading expert in active aging and musculoskeletal longevity, known for helping midlife women build strength, preserve bone health, and optimize performance through data-driven prevention. What's Discussed: (00:00) Why Women Need to Rethink Midlife Health (05:54) The Longevity Equation: Strength, Hormones, and Prevention (17:39) The Forgotten Organ Driving Women's Aging: Bone\ (28:44) How to Build Bone Quality (Not Just Density) (34:55) Training Smarter in Midlife: The FACE Protocol for Strength and Power (44:45) How to Find Real Fitness Inspiration Online, and Filter Out the Noise Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram:@darshanshahmd https://www.instagram.com/darshanshahmd/ Learn more about Dr. Vonda Wright: Website: https://www.drvondawright.com/ Instagram: https://www.instagram.com/drvondawright

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

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:48Dr. Darshan Shah?

  Dr. Vonderwright, I'm so glad to be here with you at the Health Optimization Summit in London.

• 0:54Speaker 01

  It's funny, we talk a lot together, and to fun you to meet in another country, I'm so happy to see you and talk to you.

• 1:00Dr. Darshan Shah?

  I know, I love it, I love it that we're both speakers here, and we're both talking about our thing, and they set up a podcast studio for us so we can actually have other people hear what you're going to be talking about onstage, or what you talked about onstage already, which is what I want to bring to more people through the podcast.

• 1:18Speaker 01

  Thank you, thank you so much.

• 1:19Dr. Darshan Shah?

  I love it. So maybe we frame the discussion and the conversation we had yesterday about how women right now, in the current, you know, for most women, what ends up happening is they know about menopause and perimenopause, but you just kind of keep barreling through life until you get there, because you're told that until you get there, there's probably nothing much you can do about it or think about it, and then you end up hitting kind of like this brick wall, and then, you know, some women are just told to just deal with it and get through it. Some women are like, they have access to information, and they see a hormone replacement doctor. But it's a lot of like, doing a lot of things really late in the game.

• 2:01Speaker 01

  Yes.

• 2:01Dr. Darshan Shah?

  Right?

• 2:01Speaker 01

  Yes.

• 2:02Dr. Darshan Shah?

  And you just wrote a book called Unbreakable, about bringing the thought process much more forward, not just in just treatment, but preventative.

• 2:10Speaker 01

  Yes.

• 2:11Dr. Darshan Shah?

  Preventative care for these women, and just starting, and before preventative, proactive, right?

• 2:16Speaker 01

  Exactly.

• 2:16Dr. Darshan Shah?

  So can you unpack that a little bit for us? What does that mean?

• 2:19Speaker 01

  You know what? I think in the worlds that you and I are most of frequently in, Women are having conversations about their midlife and aging. Right. I will tell you, however, that I think that we somewhat live in a bubble because we're in this all the time. And I have patients coming into my orthopedic clinic, I still see patients once or twice a week, that actually have never heard of it. And so you can't work on something you've never really heard of. Right. Or maybe you heard of your mother going through the change. So I have people on that end of the spectrum. But then I also, very encouragingly, had two women in their early 40s last week

• 3:02Speaker 01

  come in for my more one-on-one care. And they were 43 and 46. And they're like, we are just gonna get in front of this. We have to know all the things. And I want everybody to be like those women. Yes. But I would like everyone not to start then, but to start at least as they're deciding in their 30s. Maybe they've decided to never have children. Or maybe they've decided, okay, this is enough. What's the rest of my life? Well, the rest of your life is prevention. Because what Unbreakable is trying to bring to the forefront is that men and women age differently. And that has a lot to do, not with just the hallmarks of aging, which I call the time bombs of aging, because they can literally explode your life if we don't get in front of them.

• 3:48Speaker 01

  But not just due to those, but the differences in our hormone behavior. And the reason I say hormone behavior is that men have estrogen, progesterone, and testosterone, just like women do, but they behave different. Men may peak out at 30 and have just slow, steady decline until midlife, where there might be a more significant. But by and large, we're on top of that. Yeah. For women, you have your estrogen, progesterone, and testosterone. And then, all of a sudden, there is this seismic shift in production of the primary regulator, which is estradiol, as the ovaries have so few eggs left

• 4:32Speaker 01

  that there's just not enough follicle, or eggshell, if you will, to produce the levels of estrogen that our bodies are used to. And when that happens... Women's aging changes in a seismic way. Yeah. Our brain is covered with estrogen receptors. And the work of a scientist named Robbie Brinton shows that the brain changes chemistry, physiology without estrogen. Women start having a rapid increase of microvascular heart disease. Hmm. Not the big vessel heart disease that men get, but microvascular, you may not even, most women don't even know it's happening until it's significant. And then not to mention the musculoskeletal changes. Women triple their loss of bone during perimenopause

• 5:17Speaker 01

  from about 1% a year to 3% a year. So that after the five to seven years that you're ignoring this, you've lost 20% of your bone density. Right? So what if we don't wait until the arbitrary day of menopause, the 366th day after your last period? Who even knows, right? That is an arbitrary number made up decades ago within the OB community. The aging rapidly starts happening a decade before that at least. A decade before. So the median age of perimenopause, and I air quote that because we don't really know when the ovary starts declining. We do know at 40,

• 6:02Speaker 01

  women have only 1% of their eggs left. Hmm. So it stands to reason Yep. that it's as early as 40, sometimes earlier. What if we didn't wait? Right. Until the damage was so significant, and yet usually undetected. What if the minute women decided they're done with children, or the minute a woman turns 30, she's like, okay, I'm about to enter the next phase. I'm plateauing my muscle, my bone, my brain's finally mature. What am I going to do next? What am I going to do during? I made, I like to make up words. I made up a word for this transition women go through called menalescence. Menalescence. The menalescence. With a nod to adolescence, which is chaos. But we all remember that.

• 6:47Dr. Darshan Shah?

  Right.

• 6:47Speaker 01

  Mental lessons can be that chaotic. But what if we start planning for that? We're going to become extremely literate on what's happening next. And not just like, oh, I don't know, right?

• 6:57Dr. Darshan Shah?

  Right.

• 6:57Speaker 01

  What if we learn enough about hormone optimization? That we not only know what we want to optimize, but where we're going to get it.

• 7:06Dr. Darshan Shah?

  Yes.

• 7:07Speaker 01

  So that we're not in this desperate search. Because not everybody is skilled in optimizing hormones.

• 7:12Dr. Darshan Shah?

  Sure.

• 7:12Speaker 01

  What if younger, we start setting the building an unbreakable lifestyle? So that we have the standards of how are we going to eat in an anti-inflammatory way? How are we going to lift in a way that builds strength and power? How are we going to change the way we do cardio? Because if it is your lifestyle since the time you're 30, I'm going to tell you for sure. It's easier than becoming 50 something. And all of a sudden, having to scramble to change everything. And so that's, that's what from a preventive standpoint, I would love to see the shift happen.

• 7:51Dr. Darshan Shah?

  Yes. And it's, you know, I think you mentioned a few aspects and many women don't consider because they're a little bit invisible, right? So microvascular disease of the heart.

• 8:04Speaker 01

  Yeah.

• 8:05Dr. Darshan Shah?

  You're not going to feel that. It's very hard to even understand that that's happening.

• 8:09Speaker 01

  Yes.

• 8:10Dr. Darshan Shah?

  But it is definitely happening.

• 8:11Speaker 01

  Absolutely.

• 8:12Dr. Darshan Shah?

  Brain changes as well. I think what happens over time is that you get used to the brain that you're in. And then that brain continues to change, but you kind of move with it over time.

• 8:24Speaker 01

  Yeah.

• 8:24Dr. Darshan Shah?

  And then you kind of forget, how did I think when I was 29 years old?

• 8:28Speaker 01

  Yeah.

• 8:29Dr. Darshan Shah?

  How was my brain functioning back then?

• 8:31Speaker 01

  Yeah.

• 8:31Dr. Darshan Shah?

  And you just realize things were a lot better back then, but I can't really quantify it.

• 8:35Speaker 01

  Yeah.

• 8:36Dr. Darshan Shah?

  So I think there is a little bit of a leap of faith that you have to make that you need to start early, right? And.

• 8:42Speaker 01

  I think women, when it comes to brain, you've probably heard this, women tease about mommy brain.

• 8:46Dr. Darshan Shah?

  Yeah.

• 8:47Speaker 01

  What happens? Oh, I can't remember, I have mommy brain. Well, that's hormonal. Right? And so you're able to recognize that. Something's going on.

• 8:56Dr. Darshan Shah?

  Yeah.

• 8:57Speaker 01

  But then I, I hear women really joking, I can't remember my keys. I wa- I look for my keys in the freezer, right?

• 9:04Dr. Darshan Shah?

  Yeah.

• 9:05Speaker 01

  But it's not a joke.

• 9:06Dr. Darshan Shah?

  No.

• 9:06Speaker 01

  It wasn't a joke when I forgot my nouns. And the way it feels to me, these subtle changes, because you're right, I didn't realize that I just, I did, just did a VO2 max. I'm rolling my eyes because that was not fun. And had all this Boston cardiac workup just for information.

• 9:23Dr. Darshan Shah?

  Sure.

• 9:24Speaker 01

  To find out my microvascular disease. Well, that's extensive to have to do that stuff. And most people don't have access.

• 9:30Dr. Darshan Shah?

  Right.

• 9:30Speaker 01

  Like I do, right? So they don't know. For the brain part, I can, I could feel it because the only way I could quantify it is because I'm a surgeon. You know, we have to remember a lot of stuff at all times and make quick decisions. It's almost like the tip of a knife, the tip of a spear. I felt like when I was going through this before I optimized my hormones, that instead of a sharp pencil lead, just that sharpness, like everything I had access to, I could memorize a lot of stuff at once. I could just glance at a phone number and know it without having to memorize it.

• 10:04Dr. Darshan Shah?

  Right.

• 10:05Speaker 01

  I was now working with a dull pencil lead.

• 10:07Dr. Darshan Shah?

  Yeah.

• 10:07Speaker 01

  I still had a little pencil lead, but it wasn't. So that's hard to quantify. Like that is, it's not like I'm saying, oh, I'm 6.25% worse. It's like, I've got a dull pencil lead. So I think your point is well taken.

• 10:21Dr. Darshan Shah?

  Yeah.

• 10:21Speaker 01

  It's hard to know we're preventing something if we can't even describe it very well.

• 10:26Dr. Darshan Shah?

  Yeah, it's hard to quantify it. But there are some quantifiable measures that we have access to now. You know, a lot of stuff that you talk about, like grip strength, for example. Can you maybe, let's talk about some of the physical markers of strength, power, that women can track over time, yeah?

• 10:46Speaker 01

  Well, I love this, you brought this up too, because I thought that was so important that we start somewhere.

• 10:52Dr. Darshan Shah?

  Right.

• 10:53Speaker 01

  That in Unbreakable, the whole first section of the book starts out with, this is the, this is the science of aging. You're smart people. I'm going to tell you about six of the 13 hallmarks of aging that I think are really important. So that you can put it together with what we're going to ask you to do.

• 11:09Dr. Darshan Shah?

  Right.

• 11:10Speaker 01

  And then.

• 11:10Dr. Darshan Shah?

  There's assessments.

• 11:11Speaker 01

  There's an assessment, right? We, we made my very smart data scientist and I said, here's the assignment. Here are the top eight longevity biomarkers. That have great data, I want you to analyze the papers and weigh them. What is the top one, what is the second? And then we put eight of them and teach you how to do it in the book so that you and weigh your score. So that we give you an unbreakable score, not as a criticism, but as an observation, so that when you implement the activities for physical and mental resilience, you can retest. So, number one is VO2 max, the ultimate measure of fitness. And why is that so important?

• 11:54Speaker 01

  It's so important that without reinvestment, we will lose 10% of our VO2 max per decade. So that means if we're starting with a low VO2 max in midlife, and every 10 years, we're going to lose 5%, we're going to cross something called the fragility line, which is the line after which you can't get up from a chair by yourself. Which is the line that you lose your independence and have to either move in with your kid or into a facility.

• 12:20Dr. Darshan Shah?

  Right.

• 12:20Speaker 01

  You never want to reach that.

• 12:22Dr. Darshan Shah?

  Never.

• 12:22Speaker 01

  You'll never know what you are unless you get that measured. So VO2 max, walking speed is important, sit to stand is important. Grip strength is a good measure, not because I want you to squeeze a tennis ball more, but because it's a proxy for mortality. It's estimated with a loss of 5 kilograms of grip strength in your dominant hand, it infers a 16% increase in all-cause mortality, because it's connected to how strong your whole body is.

• 12:51Dr. Darshan Shah?

  Right.

• 12:51Speaker 01

  So, you know, there are other ones like the step up test, but of all the eight, these are the ones that have some data attached to mortality, longevity.

• 13:02Dr. Darshan Shah?

  Yep. You know, the sit to stand test, in my practice, I think it's the most,

• 13:08Dr. Darshan Shah?

  when you can't do it without assistance.

• 13:11Speaker 01

  Yeah.

• 13:12Dr. Darshan Shah?

  Going down and up. You have a, almost like a, a physical shift. And I could see people physically shift in their mindset like, wait, when did I lose that?

• 13:23Speaker 01

  Yeah.

• 13:24Dr. Darshan Shah?

  Right?

• 13:25Speaker 01

  Yeah.

• 13:25Dr. Darshan Shah?

  When did I lose that ability to be able to stand up without using my arms?

• 13:29Speaker 01

  Yeah.

• 13:29Dr. Darshan Shah?

  And it really gives people a kind of moment in time, to your point, which is why I love the tests at the beginning of your book. It gives people a moment in time to know

• 13:39Speaker 01

  Yeah.

• 13:39Dr. Darshan Shah?

  that when, when they've lost something or if they're on the track to losing it. And without doing these tests, you never know. And unfortunately, you find yourself at 50 years old, unable to sit to stand with a low VO2 max, with a grip strength in the bottom 25th percentile. And by then, it's so hard to reverse this.

• 13:57Speaker 01

  It is hard. It's, you may be able to maintain, but to, you know, to really get 20 or something percent back hard. I love that you said that about, there's this, can I even do? I mean, people kind of do this. They're looking around, can I even do this? Wait, how do I sit down without my hands? I mean, there's, there's some thought involved. And it's shocking to people.

• 14:18Dr. Darshan Shah?

  Vonda, you know what else is shocking? Jumping.

• 14:21Speaker 01

  Oh, it is. People are afraid to jump.

• 14:24Dr. Darshan Shah?

  People are afraid to jump from the floor to a box.

• 14:27Speaker 01

  Yes.

• 14:27Dr. Darshan Shah?

  Cause they, they think in their brain, they're gonna fall.

• 14:31Speaker 01

  They're gonna trip.

• 14:31Dr. Darshan Shah?

  Right. People don't know how high they can jump or not.

• 14:34Speaker 01

  And so jumping up is very fear laden. Even when I say, okay, so don't jump up, jump down. People haven't jumped in a while. It's the same reaction when I encourage people from a cardiac standpoint to sprint. Because everybody thinks of the track sprinting, which less than 1% of people do. It's really a heart rate measure. But it is funny to me when I first read that, that less than 1% of adults go fast.

• 15:02Dr. Darshan Shah?

  Right.

• 15:02Speaker 01

  Like sprint.

• 15:03Dr. Darshan Shah?

  Sprint, right?

• 15:04Speaker 01

  It's not because they can't, it's because they don't and then they can't, right?

• 15:10Dr. Darshan Shah?

  Exactly.

• 15:10Speaker 01

  They don't, then they can't.

• 15:12Dr. Darshan Shah?

  Right.

• 15:12Speaker 01

  Or they're like, wait a minute, I haven't sprinted for a while.

• 15:15Dr. Darshan Shah?

  I might fall, I might trip on myself.

• 15:17Speaker 01

  I might pull something.

• 15:18Dr. Darshan Shah?

  Yes.

• 15:19Speaker 01

  And you might, if you haven't done it for 50 years, 30 years, whatever. But this mindset we're talking about.

• 15:25Dr. Darshan Shah?

  Yeah.

• 15:25Speaker 01

  We just give up one thing at a time.

• 15:27Dr. Darshan Shah?

  Exactly. That's my point exactly. You give up one thing at a time until you forgot you even gave it up.

• 15:33Speaker 01

  Right.

• 15:33Dr. Darshan Shah?

  And then you end up not being able to do those things. And that's when you become frail.

• 15:37Speaker 01

  Yeah, exactly. And frailty can happen not just to 89 year olds. You know, I've had 57 year olds break their hip. Interestingly, because they were in general frail. So it can happen if we're not paying attention to ourselves.

• 15:54Dr. Darshan Shah?

  You know, I'm in my 50s.

• 15:55Speaker 01

  Yes.

• 15:56Dr. Darshan Shah?

  I go on these health retreats that people come to. And many other people are also in their 50s. And it's very surprising to me how many people have not jumped or sprinted or done some of the things that we've talked about.

• 16:09Speaker 01

  Yeah.

• 16:10Dr. Darshan Shah?

  For many years, often even for like 20 years.

• 16:13Speaker 01

  Yes, exactly.

• 16:14Dr. Darshan Shah?

  And you have to, it's almost like taking them back to PE class in high school to get them to do these things.

• 16:19Speaker 01

  Adult PE. That might be a thing, actually.

• 16:22Dr. Darshan Shah?

  It should be a thing, right? Yeah, because unfortunately, we do lose these things way too early now. And to your point, 30 is a really good age to get started on this journey of prevention, for men and women, but especially for women. Because women do have that kind of massive drop off in their hormones, right? So we talked about strength. We talked about jumping and maintaining abilities. What about bone health? How do women maintain bone health?

• 16:49Speaker 01

  You know what? I was so thankful when I was originally on your podcast, I had just started trying to make bone sexy.

• 16:56Dr. Darshan Shah?

  Yeah.

• 16:57Speaker 01

  Or I say sexy again, it's really probably never sexy. But because bone is the forgotten critical component to aging. Because you may do all the brain exercises you want. You may have been in the gym and you've got some decent muscle mass. But if you don't have, or, and people, we already said, people don't jump and skip. So you might not have the agility not to fall down. Okay. And if you fall down and break, even if you've got good muscle and good brain, it's changing your life forever. Yeah. Because if you fall and break your hip, for instance, I like to do this now. The minute you fall and your femur fractures, it's a 30% chance of dying. Oh, 30% chance of dying.

• 17:39Speaker 01

  And that is, people do comment on this when I say this on the internet. But yes, that is for people in their 70s and 80s, but we're all gonna be that age. Yeah. And 50% of the time, you don't go home because you've lost so much function or you're so dysfunctional at that point, that's how you fell down in the first place. So what is the choice then? The choice is hire somebody full-time, that's hard to afford. Move in with your kid. Everybody says to me, I don't want to burden my kids. Well, let's get after it then with our bones. Move into a facility which eats up your life savings and then you have to go on Medicaid. And that's not a pretty picture, right? So bones are critical, but, and we think of them as structural. We like I-beams in a building.

• 18:23Speaker 01

  I, I love to say that, and, and they do that. They give us human form. Without bones, literally, your skin and muscle is just a heaping pile of metabolic tissue. Exactly. It's like a chicken breast on a table. It's, but with bones, you have structure. You're recognized as a human. Right. But it's so much more than that. Bones are the storehouse of all the minerals in your body. When your body needs calcium, phosphorus, everything, you just dissolve some bone and that's where you get it from. So bones are also, people don't realize, they're the incubator of all your baby blood cells. Right. Yep, in your pelvis, in your long bones. So when we take stem cells, for instance, mesenchymal stem cells from your pelvis. Yeah.

• 19:06Speaker 01

  Sometimes from the tibia, but that's a miracle of bone. But bone is an endocrine organ secreting hormones that talk to everybody. And if I were designing a person, why wouldn't I make bone the communication highway? Cause you've got it from the top of your head to the bottom of your toes. So we may have talked about the hormone osteocalcin before. Yes. I think I've heard you speak about it before. It's a hormone the bone makes, crosses the blood-brain barrier, stimulates bone-derived neurotrophic factor to build better brain, right? It is intensely associated with normal metabolism, both glucose and insulin resistance. In men, it contributes to the making of testosterone. But that's not all.

• 19:51Speaker 01

  There's another hormone I started talking, because there's so many hormones that bone makes. Another one I started talking about lately called LCN2 directly works in the brain on satiety. Now, why would the bone be interested in you being full after a meal? It's because the bone is a storehouse of nutrients. Of course, it's going to have a connection with how much you eat. Do you need to eat more? Gut absorption, there's a direct relationship between the bone and the gut that's being worked out right now. So the more we learn about bone, the more fascinating it is. And so it's not just structural, it's everything.

• 20:30Dr. Darshan Shah?

  Yeah, so many connections beyond just keeping structure in your body.

• 20:34Speaker 01

  That's right.

• 20:35Dr. Darshan Shah?

  And you know, the more I think about the human body, literally every organ is communicating with every other organ all the time. And when one organ starts to fail, the others do as well.

• 20:45Speaker 01

  Yeah.

• 20:46Dr. Darshan Shah?

  Unfortunately, we think a lot about like the heart failing and the brain failing. We know that these diseases like heart attacks and Alzheimer's occur. But we don't have a lot of attention around our bones failing us. And the bone failure often precedes brain failure by decades. And so maintaining healthy bone can really promote the health of other organs as well.

• 21:10Speaker 01

  And I think bones surprise people.

• 21:11Dr. Darshan Shah?

  Yeah.

• 21:12Speaker 01

  I mean, even today in the expo, very healthy looking women who work out have come up to me because I know I talk about this and told me they're osteopenic.

• 21:22Dr. Darshan Shah?

  No.

• 21:23Speaker 01

  And they're really devastated by that.

• 21:24Dr. Darshan Shah?

  Right.

• 21:25Speaker 01

  Because they thought they were doing everything right.

• 21:26Dr. Darshan Shah?

  How do healthy, this is a great question for me, for you. And it's kind of a rhetorical question, but how do healthy women have bad bones?

• 21:34Speaker 01

  Yeah, let's talk about that.

• 21:35Dr. Darshan Shah?

  Yeah, because you know, and let me define a healthy woman. Someone who is of normal body weight, even looks lean, spends maybe an hour on the treadmill every day.

• 21:45Speaker 01

  Yes.

• 21:46Dr. Darshan Shah?

  And you know, maybe she's trying to eat mainly a diet of keto or something like that, you know, you know, you kind of can visualize the woman I'm talking about.

• 21:58Speaker 01

  Doing all the things.

• 21:58Dr. Darshan Shah?

  Doing all the things. How does that person end up osteopenic?

• 22:01Speaker 01

  Well, That's why they're so disappointed.

• 22:04Dr. Darshan Shah?

  Right.

• 22:05Speaker 01

  And what we have to remember is that osteoporosis, which is holy bone, when translated from whatever that is Latin, manifests later in life, but it is a disease of young people. Because bone, a density reaches peak mass in your late twenties and thirty, by thirty. So what are the reasons you might not build bone density? Because it matters where you're starting. Well, I can think of a lot of reasons that young girls, still living in a world where they are taught to be teeny tiny, don't eat enough. Bones need food. They need minerals and protein. So maybe we're not eating enough.

• 22:47Speaker 01

  Or maybe we are, we're fifty-four years into Title IX right now. So we have generations of young female athletes.

• 22:56Dr. Darshan Shah?

  Sure.

• 22:57Speaker 01

  Many young female athletes are amenorrheic for decades. Right? I was. I was an athlete. I wouldn't have periods for six to nine months. And at that time, I'm like, yes. So much less to worry about. What I did and realized is that it was critical for my bones to have the estrogen that I was, would have been making, blah, blah, blah. So there's a whole generations of young women who don't build bone because they're amenorrheic, for whatever reason. And then frankly, we are a digital, there's nobody who's not a digital native anymore, being born. And so if you spend your life sedentary, which is part of the fact that we have so many children that are obese and have diabetes, well, if you're that sedentary, you're not maximizing bone density

• 23:42Speaker 01

  because you're not running around and jumping. So you're, all that to say, there are many reasons that we're starting behind the eight ball.

• 23:49Dr. Darshan Shah?

  Yeah.

• 23:49Speaker 01

  And then you enter your period, if you choose to have children of fertility. I always have to hedge when I say this because then I get a lot of angry male about, "Listen, it takes about 500 milligrams of calcium a day to build a baby."

• 24:04Dr. Darshan Shah?

  Yes.

• 24:04Speaker 01

  And protein, where do you think your body's gonna get that? Because it's prioritizing this baby. They're gonna get it from you.

• 24:11Dr. Darshan Shah?

  From your muscle.

• 24:11Speaker 01

  They're gonna take your muscle, they're gonna take your bone. And there is such a thing as the osteoporosis of pregnancy. Now, women are designed to rebuild that after pregnancy. But think about, you guys have children. You're so tired, you're so busy, you may or may not eat. If you choose to breastfeed, which I'm a big proponent of, I breastfed for a year. If you are not eating enough protein and calcium, you're gonna still leach 500 milligrams of calcium a day and not rebuild for years. And then if you have another baby, because you know, women are having children later. If you spend between 30 and 40 having children,

• 24:54Speaker 01

  that's a long time to go without bone rebuilding.

• 24:57Dr. Darshan Shah?

  Yeah, absolutely.

• 24:59Speaker 01

  So then we reach the perimenopause years and we haven't built enough bone. We've used our bone for our children and haven't rebuilt it. And then you're gonna lose 15 to 20%. That is how women arrive in midlife seemingly healthy with bad bones.

• 25:15Dr. Darshan Shah?

  Right, got it.

• 25:16Speaker 01

  I think it makes total sense when you lay it out, bone health like that.

• 25:19Dr. Darshan Shah?

  It does, absolutely. You know, there's a device, when you walk into this conference, that measures your bone

• 25:25Speaker 01

  Quality.

• 25:26Dr. Darshan Shah?

  Quality.

• 25:26Speaker 01

  Yes.

• 25:27Dr. Darshan Shah?

  Okay, so for many years, for me, the only way as a physician I could visualize the health of someone's bone was the DEXA scan.

• 25:36Speaker 01

  Yes.

• 25:37Dr. Darshan Shah?

  Right? So can you talk about how women can utilize the DEXA scan and also some of these newer measurements of bone quality?

• 25:45Speaker 01

  Yes.

• 25:46Dr. Darshan Shah?

  And are you using those in your practice?

• 25:47Speaker 01

  I am. And I actually talk to those people a lot and build programs for them, for bone. So here's the thing, so DEXA scan tells us bone density, which uses X-ray, not a high dose, not really much dose at all. But it tells us the mineralization of bone. How much mineralization have you made? The other side of bone health is how the bone performs under stress and strain. What's the quality of bone? Because if you, every time you take a step, at a very microscopic level, the bone bends a little. And then it reach, it reach, it's because it's not just hard. It's a living tissue. And so in the femur, for instance, which looks a lot like my, if you're watching this,

• 26:31Speaker 01

  if you're not, my right arm with the wrist bent. There's a femoral head and a shaft. Every time you take a step, it does this a little bit.

• 26:39Dr. Darshan Shah?

  Oh, okay.

• 26:40Speaker 01

  Such that the bone is laid down in something called trabecular lines. If you look at an X-ray, you can see the arches where the body has put the most bone, where the tension is. DEXA scan will tell you mineralization. The ultrasound technologies such as the REM scan tell you quality. How much are you able to respond to the tension?

• 27:05Dr. Darshan Shah?

  Interesting.

• 27:05Speaker 01

  So you may have poor mineralization, but still have adequate bone health because it can withstand a lot of stress and strain. Now, you would want both.

• 27:15Dr. Darshan Shah?

  Yeah.

• 27:16Speaker 01

  Right? And so bone density is not the entire picture via a DEXA scan, but it's what we've had for years. It's what all the research has been done on. So we know with osteoporosis that you have a 50% chance of a fracture. And so we can quantify that. The data with bone quality is still being built, although most of us at this point thinks it's, it's an important nuance in bone health to have.

• 27:48Dr. Darshan Shah?

  This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting-edge technology. I actually founded Next Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Next Health using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Next Health measure thousands of biomarkers and put into place

• 28:33Dr. Darshan Shah?

  a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www.nex.health to check it out.

• 28:46Dr. Darshan Shah?

  So the next question from there is building bone density

• 28:51Speaker 01

  Yep.

• 28:51Dr. Darshan Shah?

  versus building bone quality.

• 28:54Speaker 01

  Bone quality.

• 28:54Dr. Darshan Shah?

  Yes. How does someone focus on bone quality? Say your bone quality score comes out low with one of these REM scans. How does someone build that up?

• 29:02Speaker 01

  You know what? That is where I think that the jumping practices are most important. Yeah, we want to give the bone the environment that we're going to need it to perform in. So there are studies that show that jumping and producing four times body weight, which walking is 1.2 to 1.5 times body weight. Running is 2.5 or so. So you really need the impact of jumping. It takes about an eight inch step. It doesn't have to be the 24 inch box, just eight, which is eight inches is about the step in your house.

• 29:36Dr. Darshan Shah?

  Yep.

• 29:37Speaker 01

  I just posted a few weeks ago, I was doing this to demonstrate it on the steps of the New York Public Library. It doesn't have to be fancy. It's not fancy. Just jump down because you then are introducing mechanical stimulus. You're causing your bone to bend a little and recovery, telling your bone, oh, I'm going to need some more trabeculae laid down in these tension points. So it becomes those practices that are very important for quality of bone.

• 30:08Dr. Darshan Shah?

  So after watching your videos, I started doing that.

• 30:10Speaker 01

  Did you?

• 30:10Dr. Darshan Shah?

  I started running upstairs and slamming my feet down on the stairs and almost like obnoxiously.

• 30:15Speaker 01

  Did Nancy think you're mad? Like, what are you mad about?

• 30:19Dr. Darshan Shah?

  Exactly, yeah. So running up and downstairs and just kind of slamming your feet down and jumping off of things.

• 30:25Speaker 01

  Jump rope will work.

• 30:26Dr. Darshan Shah?

  Jump rope, right?

• 30:27Speaker 01

  If you want to do fun, if you're afraid you're going to trip, get a cordless jump rope.

• 30:31Dr. Darshan Shah?

  Yes.

• 30:31Speaker 01

  Yeah, just do the make yourself jump.

• 30:34Dr. Darshan Shah?

  Yeah.

• 30:34Speaker 01

  Because you know what? All these things where I introduced hopscotch back to the world a few weeks ago because we need to not just jump up and down, but multi-directional is best. We used to play that as children. Just go in multiple directions. It's all play, Darsha.

• 30:49Dr. Darshan Shah?

  It is.

• 30:50Speaker 01

  It's because we were talking about running, hopping and, you know, even skipping if you don't want to sprint or sprinting and jumping. We just need to watch what our kids do. They've got it right, right? We give up all these healthy things.

• 31:03Dr. Darshan Shah?

  I'd venture to guess that 90% of adults can't even remember the last time they jumped. Or hopped or any of this stuff, you know? And so definitely need to keep that in our, in our routines. And not just when you're working out, like you can run up and downstairs anywhere, anytime, all day long. Exactly. In fact, like, you know, I think it's another great benefit to taking the stairs. Right?

• 31:28Speaker 01

  Besides cardiovascular.

• 31:30Dr. Darshan Shah?

  Right?

• 31:31Speaker 01

  Yeah.

• 31:31Dr. Darshan Shah?

  You're actually building bone health.

• 31:33Speaker 01

  Yeah.

• 31:33Dr. Darshan Shah?

  Right?

• 31:34Speaker 01

  You know, and I love that you brought that up because when, when we sit here and talk about all these behaviors, it seems like an overwhelming amount of stuff. But literally you fit this into your day, right? It's not extra. It's just you walk a different way. You climb a different way.

• 31:50Dr. Darshan Shah?

  Exactly. Exactly. So scans like the bone quality scan, but where do people get that from? It doesn't seem like it's ubiquitous yet, but do you think it's going to become more?

• 32:01Speaker 01

  I do. In, in the UK where we are, in Australia, they're everywhere. So listeners, they're everywhere. In the UK, they're making a big push to bring them in and understandably. Some of the units are portable. You don't need the big GE DEXA scan setup.

• 32:19Dr. Darshan Shah?

  Yes.

• 32:19Speaker 01

  And the special, I tried to put a DEXA scanner into my personal office, my orthopedic office, and it took a special electrical line. I had to rewire the wall. This is so much more easy. So they're trying hard. So right now it's hard for me to say, go to these 12 places or go to these hundreds of places. But you know, give them five years.

• 32:39Dr. Darshan Shah?

  Yeah, and they'll be, they'll be everywhere. And do you actually get like a quantification numbers? You can see, you know, I'm here right now and I'm doing these jumping practices, et cetera. And I'm getting better.

• 32:50Speaker 01

  Yeah. And, and this is easier to do every six months, for instance, but they give you a bone quality score. And the interesting thing is they also produce a T score like a DEXA scan. You get both in one report.

• 33:01Dr. Darshan Shah?

  Oh, that's incredible.

• 33:02Speaker 01

  It is.

• 33:03Dr. Darshan Shah?

  Yeah, I want to look into getting them at all of our next health clinics because I think if you can get both the T score and the quality score.

• 33:09Speaker 01

  That's right.

• 33:09Dr. Darshan Shah?

  It's such an important, super important measurement that we don't have.

• 33:13Speaker 01

  And then they can do the Unbreakable program to build better bone. We're making a plan for your business.

• 33:19Dr. Darshan Shah?

  I love it. Yeah. And so let's talk about the Unbreakable Plan. Can you give people like a little flavor of what that is? And then they can get your book to read more about it.

• 33:28Speaker 01

  Of course. So it goes without saying that we have to be concerned with an anti-inflammatory, high-protein way of eating. That when I talk about Unbreakable Standards, we are need to be less sweet, unsugared, unsweetened, as I like to say. You know, and take our carbs. I am not anti-carb, especially for training. But they have to be of fiber, right? The only time you need quick sources of sugar is if you're actually in a race somewhere and you just, right? So that's baseline because, you know, for we've been talking about bone a lot. Bone, the enemy of bone is inflammation, right? So even your diet's important. So anti-inflammatory, high-protein way of eating. I don't even like the word diet. It's just how I eat, right?

• 34:11Speaker 01

  And then when we take action physically, there's an acronym that I use that I've used for years to help midlife people remember what they need to do. So it's F A C E, face your future. Because we're all good at cardio. We're getting the message about lifting, but what we forget is F, flexibility and range of motion. The natural history of the collagen in our tendons, ligaments, and muscles is to increase their covalent bonding with age and they get tighter and tighter and tighter.

• 34:41Dr. Darshan Shah?

  Oh, okay.

• 34:42Speaker 01

  That's when you lose joint motion. You become hunched over. You begin to shuffle, you become a shuffling walker, not a striding walker. We can maintain the health of our tendons, ligaments, and muscles by investing in mobility programs so our joints stay fluid. That's where Pilates, yoga, specific joint mobility programs come in.

• 35:05Dr. Darshan Shah?

  Yeah.

• 35:05Speaker 01

  If that's all you're doing, and I've said this many times, making many Pilates people angry, it's never going to be enough. It's important, but never enough. So that's F. A. Aerobic, our heart disease kills more men and women than anything else in the country. It's still really critical, but probably not in the way we've always done it, which is right in the middle of the heart rate zones. It's not low enough that it's metabolically optimized. And it's not hard enough that you're going to stimulate your mitochondria, your satellite stem cells. So, but I see people doing it right here in the middle a lot. In fact, there's whole brands of gyms built around this.

• 35:46Dr. Darshan Shah?

  Yep.

• 35:46Speaker 01

  So what I had, I do, I prescribe to my people is, and this is based on the science of Enrico San Milan, who is, who's an endurance physiologist.

• 35:57Dr. Darshan Shah?

  Who has a lab in your-

• 35:58Speaker 01

  Who has a lab in my building.

• 35:59Dr. Darshan Shah?

  Clinic, yeah.

• 36:00Speaker 01

  Base training at low heart rates, three hours a week, broken up into 45 minutes. So that's just brisk walking. You can do it on any apparatus, rowing, elliptical, whatever, but lower heart rate. Then twice a week, we're just gonna gun it. We're gonna sprint. Back to this conversation, but don't be afraid. It's only for 30 seconds.

• 36:21Dr. Darshan Shah?

  Right.

• 36:22Speaker 01

  Then you completely recover and then do it four times.

• 36:25Dr. Darshan Shah?

  Yeah.

• 36:26Speaker 01

  It's not that hard. You feel like a badass when you're done. Now for the aerobic, in Unbreakable, my first goal is to optimize people's health. But when people are all tuned up, then I go to peak, then I add peak performance type things like we do for athletes. And only then is when I choose to add on VO2 max training. Using the Norwegian protocol, it's one of the protocols, because it's not that fun.

• 36:52Dr. Darshan Shah?

  No.

• 36:53Speaker 01

  But it's four minutes as fast as you can go, with only four minutes of recovery. So it's, it's hard work, but-

• 37:00Dr. Darshan Shah?

  Four by four protocol.

• 37:00Speaker 01

  Four by four protocol, once a week. But that, so that's how we do it.

• 37:05Dr. Darshan Shah?

  Yeah.

• 37:05Speaker 01

  Right? That's cardio. F A C, carry a load, meaning weightlifting. Now, when you weightlift, you gotta know why you're doing it. In Unbreakable, I'm talking about building strength and power. We need to be strong as we age and we need to have power. It's not to say that lifting for, for endurance is wrong.

• 37:29Speaker 01

  Lifting for endurance is picking up the mambi pambi pink weight and doing it 30 times so that you fail after 30 times. Yeah. There's nothing wrong with that if your goal is endurance. It's not my goal. Hmm. There's nothing wrong with lifting for hypertrophy, which is the big muscle, Yeah. tearing up muscle, healing the muscle, building bigger muscle. Nothing wrong with that. But that range is 10 to 15 reps. Our goal is strength and power. So we're going to work up from wherever we're starting to lifting really heavy weights, low reps to failure. It's always to failure. You have to condition your ligaments and tendons. You have to get your form really well. This is where I think of all the lifting techniques, you probably need to hire a strength and conditioning coach to teach you first.

• 38:14Speaker 01

  And I did, and it was critical, right? So that is, in the literature, a range of three to six. I'm going to tell you as a, I don't have to tell you as a clinician, but in general, people need specific instructions. They do. So I prescribe four reps, four sets of really heavy lifting in the compound lifts. Push pull with the upper body, push pull with the lower body. And then you supplement with the single muscle lifts Yes. at slightly higher reps, right? It sounds like a lot. I can accomplish this in 30 minutes in the gym. Absolutely, yep. That's how to lift for strength. And then finally, F A C E, equilibrium, which is balance. I'm teaching people to stand on one leg when you're brushing your teeth.

• 38:58Speaker 01

  Do the balanced reach. And foot speed. I also happen to have a Olympic agility coach, foot speed and agility coach in my building. And she has taught me and all the people I take care of agility drills, like you see athletes doing, to rebuild the coordination for our type 2 muscle fibers. Right. And you know, the interesting thing is when you first start doing these alternating drills, heel toe, heel toe, your brain stops you. It's a little hard to coordinate because you're rebuilding those coordinating pathways. So imagine in a real life situation when you're about to fall and you haven't had to had a coordinated pathway. You're not going to catch yourself. Right. Versus if you have, you're like, got it. Yes.

• 39:43Speaker 01

  So F A C E are the four components of building physical resilience. In midlife.

• 39:50Dr. Darshan Shah?

  That's such an incredible kind of structure paradigm for people to build their movement exercise routines out of. And what I think everyone needs to get out of this is that going to the gym is fantastic, right? Thank God you're going to the gym two or three times a week, but really it needs to be structured around these four pillars of exercise. Because, you know, we see it all the time. And I think 90% of the people that go to the gym, they go for 30 minutes. Half of that time is spent running and zone three on the treadmill. The other half is spent on maybe some machines or dumbbells.

• 40:27Speaker 01

  Yeah.

• 40:27Dr. Darshan Shah?

  Doing single muscle exercises, never to failure. And your time is so, everyone's time is so valuable.

• 40:34Speaker 01

  So important.

• 40:35Dr. Darshan Shah?

  Right? You can use the same amount of gym time and restructure it to give you so many more benefits.

• 40:41Speaker 01

  Yeah.

• 40:42Dr. Darshan Shah?

  And so I love in your book how you give people like the workout program.

• 40:46Speaker 01

  Yeah.

• 40:46Dr. Darshan Shah?

  This is how you do it. So it's not, it's, you don't have to DIY it. It's in your book.

• 40:51Speaker 01

  It is.

• 40:52Dr. Darshan Shah?

  It's there. Show it to your trainer. You know, I am a big advocate of using trainers, but you have to also, trainers don't have all this knowledge either, unfortunately, right?

• 41:01Speaker 01

  There's no standard training for a trainer.

• 41:02Dr. Darshan Shah?

  There's no standard training for trainers. They don't have the, you know, God bless them, we need trainers, but we really need to modernize the way they structure.

• 41:11Speaker 01

  Yeah.

• 41:12Dr. Darshan Shah?

  Your exercise routines. And so arming them with your book, with the program, especially if you are, even a man or a woman, and you're 40 years old, it needs to be restructured.

• 41:24Speaker 01

  Oh, the face protocol is for men and women. I treat men and women. This book just happens to be for women. And here's an interesting little caveat is the heavy lifting program in my book is my last heavy lifting program prior to writing the book. So it's not just theoretical. I mean, it's, I actually did it. It's the last one, then you have to turn in the book and start a new one. But I just think that's helpful to know. That is, I'm just not making stuff up.

• 41:51Dr. Darshan Shah?

  No.

• 41:52Speaker 01

  I've done all of these things. I've tested it on myself and then we published an app with the book that shows myself and another midlife, powerlifting woman, the exercises.

• 42:03Dr. Darshan Shah?

  Right.

• 42:04Speaker 01

  Yeah.

• 42:05Dr. Darshan Shah?

  And so by reading the book and getting the app, you can reform your exercise program into being so much more valuable for the amount of time units you spend in the gym.

• 42:14Speaker 01

  Who wants to waste their time? Who wastes time for that?

• 42:16Dr. Darshan Shah?

  Exactly, yeah. And I go to a little gym in my town that I live in and I look around all the time. I see so many people just wasting time, you know? And it's not just like being on their phone. It's even the exercises that they're doing.

• 42:30Speaker 01

  Well, and I have people, my office is in a giant performance facility and I look out over an indoor football field and I say this enough, they probably are angry at me for saying that, but I see people seven days a week grinding it out in the middle ranges of the exercise spectrum. And people are sweating out there, but they get very frustrated that they don't see results. It's because they're working in the messy middle. It's not light enough that you're not going to get hurt and it's not intense enough that you're going to do some value. So you end up getting hurt and not seeing many results and that's frustrating.

• 43:10Dr. Darshan Shah?

  It's so true. It's so true because you end up spending a lot more time in the middle, which increases the chance you're going to get hurt.

• 43:17Speaker 01

  Yeah, over reps. That's what I mean. It's a lot of reps and you're not seeing results. So yeah, it's hard. So you do more.

• 43:23Dr. Darshan Shah?

  Absolutely. Yeah, it's so true. Well, this has been so fantastic again, as always, Dr. Wright. And where can people, besides the book Unbreakable and your app, where can they find you and hear more from you?

• 43:36Speaker 01

  So I'm every day on Instagram. I do have a YouTube page, which has hundreds of videos. I rarely talk about it, but if you want to see me in long form, it's on YouTube. Just search my name, you'll find me.

• 43:48Dr. Darshan Shah?

  I love it. It's been such a pleasure working with you and getting all the advice that you bring to us. It's so valuable. Thank you so much.

• 43:54Speaker 01

  My pleasure. Thanks for having me.

• 43:58Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.