47. Dr. Vonda Wright: Future-Proof Your Bones—Why Strength Training is Non-Negotiable

Bone health is often overlooked until a fracture happens—but by then, the damage has already been done. What most people don't realize is that bones are not just structural; they play a critical role in metabolism, hormone regulation, and long-term vitality. In fact, emerging research shows that osteoporosis and bone loss start much earlier than expected, even in people in their 30s and 40s. So how can you build and maintain strong bones that support your health for a lifetime? In this episode, we uncover the hidden endocrine role of bones, how they influence everything from testosterone to brain function, and why strength training is essential—not just for muscle, but for bone density and metabolic health. We also explore the early warning signs of osteoporosis (including in young adults), the overlooked lifestyle factors that accelerate bone loss, and the latest breakthroughs in hormone therapy for skeletal strength. To guide us through the science, I'm joined by Dr. Vonda Wright, an orthopedic surgeon, author, and longevity expert specializing in musculoskeletal health. With decades of experience treating elite athletes, weekend warriors, and aging populations, Dr. Wright is redefining how we think about movement, mobility, and skeletal longevity. If you want to future-proof your bones, prevent fractures, and stay strong well into old age, this episode is packed with insights you won't want to miss. We Also Discuss: (00:00) Doctors Discuss Health, Longevity, and Teaching (09:28) Revolutionizing Healthcare and Education (16:25) The Astonishing Role of Bones (31:06) Functional Movement and Mobility Training (44:05) Optimizing Bone Health Through the Lifespan (58:15) Optimizing Health Through Science and Hormones (01:12:11) Measuring Senescent Cells and Longevity (01:26:30) Anticipation for Upcoming Book Launch Thank You to Our Sponsors: TruNiagen: Whether you are looking to stay sharp, feel more energized or simple age better, go to https://www.truniagen.com/ IFit: If you are looking to elevate your home gym fitness experience with the best in fitness tech, choose IFIT. Go to https://www.ifit.com/ Nexthealth: NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Vitaboom: Vitaboom: For supplements you can trust and wellness solutions tailored to your health, visit https://vitaboom.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Vonda Wright Website: https://www.drvondawright.com Instagram: https://www.instagram.com/drvondawright Facebook: https://www.facebook.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.

• 0:50Dr. Darshan Shah?

  Your bones are more than just a framework of your body. They're actually dynamic, living tissues that play a crucial role in your longevity, your metabolism, and even your hormone regulation. Unfortunately, many of us don't think about our bone health until it's way too late. So how can you protect your bones, prevent fractures, but also maintain strength and help your metabolism and your hormones? To break it all down, I'm going to be joined today with Dr. Vonda Wright. She's a powerhouse and a renowned orthopedic surgeon, longevity expert specializing in musculoskeletal health. In this episode of Extend, we're going to dive into the surprising role of bones in overall health, longevity, and why mobility and strength training are essential for longevity,

• 1:33Dr. Darshan Shah?

  and how your lifestyle today determines your bone density decades from now. We're going to explore the connection between your bone health and your hormones, and the hidden risks of osteoporosis, even in younger adults, and why many people aren't doing enough right now to future-proof their bodies. Dr. Vonda Wright is an orthopedic surgeon. She's a researcher and an author dedicated to redefining aging through science-backed movement strategies. With years of experience working with athletes, professionals, and aging populations, he has pioneered a proactive approach to musculoskeletal health that keeps people active for life. And we're going to be talking about her protocols today. So whether you're a fitness enthusiast, a longevity seeker, or just want to build a body that lasts, this conversation is going to be packed with insights

• 2:16Dr. Darshan Shah?

  to help you move better, live longer, and stay strong at any age.

• 2:27Dr. Darshan Shah?

  Dr. Vonda Wright, it's such a pleasure to have you fly out here to do this with me.

• 2:31Speaker 01

  Thank you. I'm so thrilled to see you. You know, you have this positive energy. It just lifts me up every time I see you.

• 2:36Dr. Darshan Shah?

  Oh, that's so sweet of you. So, we met at the Longevity Doctors Conference.

• 2:40Speaker 01

  That's right.

• 2:40Dr. Darshan Shah?

  Which, for the listeners who don't know, that's a group of about 200 of us now, I think, that have come together as physicians who are super interested in health span and longevity, which I'm so excited to be a part of that group.

• 2:53Speaker 01

  Me too.

• 2:53Dr. Darshan Shah?

  And I've met you in person because I've been watching your Instagram clips, I feel like, since like 10 years now you've been doing this.

• 3:00Speaker 01

  It's been a little while, it has.

• 3:01Dr. Darshan Shah?

  Yeah. You've been such a tremendous force for helping people get healthy.

• 3:06Speaker 01

  Thank you.

• 3:07Dr. Darshan Shah?

  And I really appreciate you bringing your medical knowledge to the public in such a digestible way. So, I really, I really love everything you've done. And, you know, you're an orthopedic surgeon.

• 3:18Speaker 01

  I am.

• 3:19Dr. Darshan Shah?

  And I'm a surgeon as well, although I've definitely cut back a lot from my surgical days.

• 3:25Speaker 01

  I think it gives us a common mindset. There's something about our brains that are similar.

• 3:30Dr. Darshan Shah?

  Yeah, definitely. You know, I think being a surgeon definitely gives you an appreciation for this incredible miracle of our human body and our biology, right?

• 3:41Speaker 01

  Yes, exactly. I'll never get tired of anatomy, or, you know, I still go and sometimes dissect with medical students because you're right, what a miracle we are.

• 3:52Dr. Darshan Shah?

  It's incredible. And the gross anatomy, but also like the cellular anatomy.

• 3:56Speaker 01

  Even better.

• 3:57Dr. Darshan Shah?

  It's even better, right?

• 3:58Speaker 01

  Even better, yeah.

• 3:59Dr. Darshan Shah?

  This is mind blowing.

• 4:02Speaker 01

  Well, this is not the answer to the question, but I'm so fascinated by that, that this says a lot about how I spent my time in college. I made an entire library on Saturday nights on the electron microscope we had at the micron level.

• 4:18Dr. Darshan Shah?

  Wow.

• 4:18Speaker 01

  Of, I mean, I dissected a mouse to do it, but how fascinating, because the body at the micron level is art.

• 4:27Dr. Darshan Shah?

  It is.

• 4:27Speaker 01

  The villi in the gut, the tail on a sperm, the nucleus and all the organelles surrounded in the cytoplasm. I mean, wait, if you ever had the opportunity to see it, listeners, wow, you will not want to look away.

• 4:43Dr. Darshan Shah?

  Electro microscopy blows me away, just as much as, you know, like the Hubble Space Telescope and what you can see in the universe.

• 4:51Speaker 01

  It is like that, except on two different scales, right?

• 4:54Dr. Darshan Shah?

  Yeah, yeah. How did you have access to an electron microscope?

• 4:57Speaker 01

  Well, you know what? I went to this teeny tiny liberal arts college in Chicago called Wheaton. But one of the donors had donated a electron microscope, which for people listening means that we coat the specimens in gold. And then we're able to see them in 3D. Like, I'm looking at you, or now 4D ultrasound that we have for babies. But at the time, it was the only way to see in 3D because regular microscopes see in 2D.

• 5:23Dr. Darshan Shah?

  Right.

• 5:23Speaker 01

  So with this special microscope, you see circumfractually the villi, for instance, of a stomach. And so I had access because, you know, all the good senior science students got access. But I decided then that I needed a library of a mammal.

• 5:41Dr. Darshan Shah?

  Wow.

• 5:41Speaker 01

  And it's just, I still have all the original negatives. I had to think about that word. We don't even use negatives anymore, but.

• 5:49Dr. Darshan Shah?

  That's incredible. Yeah, this was before there was even digital film.

• 5:53Speaker 01

  There was no digital photography. Says how old I am.

• 5:57Dr. Darshan Shah?

  But it is mind blowing that electron microscopy existed before digital photography did.

• 6:03Speaker 01

  Yes.

• 6:04Dr. Darshan Shah?

  Yeah, this technology is mind blowing. And so from very early in your career, you had this appreciation of the body at a microscopic cellular level.

• 6:15Speaker 01

  I did.

• 6:15Dr. Darshan Shah?

  And then you went macro and now you operate on muscles and bones and joints all the time. It's such a deep understanding that you have of the human body.

• 6:26Speaker 01

  I do, and I think more importantly than an understanding of the physiology, of the biomechanics. We're all into that with orthopedics and. What I have come to understand in my career, and it's part of why I spend so much time teaching the public, which I got to, that's a whole nother story, we can get into the, the, uh, heat I took for wanting to teach the public so many years ago. Now it's commonplace, but it was not common when I started out. But even more than understanding the human body, I think the point of view that I sometimes talk about in my Instagram, the point of view that I bring to teaching the public comes really from the fact that my first career in medicine was as a cancer nurse.

• 7:10Dr. Darshan Shah?

  Right, I remember that.

• 7:11Speaker 01

  Yeah, and you cannot work, look into the eyes, I don't know how many patients you treated over your career, but I kind of added it up, and I've treated over a hundred thousand people. And so, I think you can learn a lot in a book. I think you can learn a lot by research, but you will agree with this, as a surgeon, you cannot know as much about people as you can when a hundred thousand of them have sat across from you. And you're, you and I have the same philosophy, we're treating people as a whole person, not just as a knee or a shoulder, but, but what does this mean to them? And I think I learned that perspective when I was treating people with cancer, pushing chemo in the middle of the night. It wasn't

• 7:51Speaker 01

  just the transactional approach of pushing chemo toxins, even though they cure people. It was, what does this mean to them? Why are we flipping through QVC or H, uh, shopping channels in the middle of the night? We are, because that, to that person, meant that they were just being, trying to be normal in the most abnormal situation. So, that point of view colors why I teach people, my approach to whole person care, and why I think the perspective of a doctor or a surgeon that has looked across the bed or table at a hundred thousand people means something.

• 8:30Dr. Darshan Shah?

  Yeah, absolutely. Yeah, I look back at my, you know, I practiced for thirty years in surgery as well, and you realize too, that every human is so different. And you have all these people, like, social media influencers, talking about health, shouting from the rooftop, that this is the one way you should eat, or the one way you should exercise, right?

• 8:50Speaker 01

  Yeah.

• 8:50Dr. Darshan Shah?

  And, and these people have obviously not talked to more than twenty people in their life. And so, when you see- You know, people like you and I that have talked to hundreds of thousands, and you realize what can really help one person can actually harm somebody else. You've got to find where this person is.

• 9:07Speaker 01

  Yeah.

• 9:07Dr. Darshan Shah?

  On many different spectrum to really understand how that person needs to be taken care of, right?

• 9:14Speaker 01

  Exactly, exactly. And that's what's so beautiful about precision medicine and next health and the approach of longevity doctors realizing that down to the cellular level, we are all different. It's not just X, X chromosome different, X, Y chromosome different, which it is, I'll tell you. You know, in our stem cell lab, we found that the same stem cell, muscle drive stem cells are now satellite cells. When we stimulated stem cells from an XX person, they reacted very different than an XY origin.

• 9:44Dr. Darshan Shah?

  Wow.

• 9:45Speaker 01

  Male, female, yes, down to the cellular level. So why wouldn't that be true then all the way up to the macro level?

• 9:51Dr. Darshan Shah?

  Right.

• 9:52Speaker 01

  Yeah.

• 9:53Dr. Darshan Shah?

  Yeah, women and men are not just different because of some anatomy and one hormone.

• 9:57Speaker 01

  Right.

• 9:58Dr. Darshan Shah?

  It's down to a cellular.

• 9:59Speaker 01

  It's a cellular difference. It's a genetic difference and as it should be.

• 10:03Dr. Darshan Shah?

  So powerful. That's a powerful realization. So you had mentioned that you got some heat for teaching the public. And I think I know what you're talking about, but I'd love for you to tell me a little bit more about that story.

• 10:15Speaker 01

  Yeah, so I got out of my fellowship, I don't know, 2005 or something, a long time ago. And I immediately realized that if I saw 100 patients a week or did surgery on X amount or whatever the number was at that time, those were the only people that I would be able to teach what it truly meant to take care of themselves. And that's not a very big number in my mind. But then at that time, Instagram wasn't even a thing until 2010 or 11. And at that time, maybe it was Facebook or I don't even remember. It's been so long ago. But I realized the power of digital media. I realized that if I went on a TV show, 5.5 million people would hear me say

• 10:58Speaker 01

  that getting up off the couch would save their life versus 100 people in my office. So I put up a website. I wrote a book, which helped me then get onto digital stages or TV stages. And it was so appalling to, I come from the biggest academic houses in the country, right? I really am so fortunate, this education I've had, the ivory tower of ivory towers. It was so appalling that a doctor would come out of the ivory tower and not just talk to other doctors, because we do that, right? We publish in journals. Mm hmm. Do you know how many people read the best journal articles? Yeah. Fifty percent of articles are never read by anybody except the scientists who publish

• 11:43Speaker 01

  them. Even in the British Medical Journal and JAMA and all the big ones, they estimate, these are their data, only 10,000 people read them. Yeah. So if you spent five years doing a groundbreaking study that could help millions of people, but you're so proud that you can't go out and tell the people, who are you really helping? Right. So I was doing that, and the story that my chairman told me when I was told to cease and desist was that all the other chairman got together, threw up my website and said, what is this young doctor doing? She must stop. And so I was drug before a tribunal of hospital lawyers. You're kidding. Who said, this is not what we do in academia, blah, blah, blah, you must stop.

• 12:28Speaker 01

  And I said, well, here's why I do it. I said, and I'm pretty sure you didn't pay for my medical education. This is my brain and I'm going to use it. And they pretty much said, no, we own your brain. So I was a young surgeon at the time. I had just finished my fellowship. I had just had a baby. And so I'm thinking, holy cow, what's going to happen to me? So I slowed down a little bit, but I decided that people were worth saving and if I could have a message. So I kept writing books. I kept going public. And do you know now, it's such an irony. I mean, if you don't do this, right? Yeah. And I try to teach other doctors that if you want to teach people, if you want to stop complaining about influencers with no education educating your patients, then

• 13:13Speaker 01

  you got to get out there. Yeah. And tell the truth and interpret the data. Explain these statistics. You have to be present, otherwise you have no room to criticize what people are trying to do, which is just feel better. Absolutely. So. That was a little scare when I was a young surgeon, but right now I would have reacted in a totally different way.

• 13:33Dr. Darshan Shah?

  Yeah.

• 13:34Speaker 01

  You know, but 30 years later, you can have that hindsight.

• 13:37Dr. Darshan Shah?

  Yeah.

• 13:37Speaker 01

  But isn't that interesting?

• 13:39Dr. Darshan Shah?

  So interesting, but I remember like when I graduated, I graduated from fellowship 2002.

• 13:43Speaker 01

  Yeah.

• 13:43Dr. Darshan Shah?

  Mayo Clinic, like talk about ivory.

• 13:45Speaker 01

  Ivory of ivories, yes.

• 13:47Dr. Darshan Shah?

  And the mindset back then was that this was knowledge that needed to be protected and controlled.

• 13:53Speaker 01

  Gate kept.

• 13:53Dr. Darshan Shah?

  Gate kept, right. And you're educating the public and having the public ask questions of doctors was considered taboo, like, yeah, why would you ask a question of doctors?

• 14:05Speaker 01

  Yeah.

• 14:06Dr. Darshan Shah?

  Training.

• 14:06Speaker 01

  Yeah.

• 14:07Dr. Darshan Shah?

  And it's, it was such backward thinking as we know now by the power of retrospection. But back then, that's how we were taught.

• 14:13Speaker 01

  Isn't that interesting? I think that's hard for young, young anybody to, to fathom.

• 14:18Dr. Darshan Shah?

  Right.

• 14:19Speaker 01

  That, that, that was the atmosphere, but thankfully we've moved past that and, and you have real clinicians like you and I sharing what we know. I think it's public knowledge. We just have to interpret it for people.

• 14:30Dr. Darshan Shah?

  Absolutely. You know, sometimes through this podcast, I have people stop me.

• 14:34Speaker 01

  Mm hmm.

• 14:35Dr. Darshan Shah?

  Cause they recognize me.

• 14:36Speaker 01

  Yes, of course.

• 14:36Dr. Darshan Shah?

  When I travel, like I learned this from your podcast and it changed the course of my health.

• 14:41Speaker 01

  Yes.

• 14:42Dr. Darshan Shah?

  And it's so, they would have never learned this stuff if we don't talk about it. Have you read Marty Makary's book?

• 14:47Speaker 01

  Oh, my gosh. Yes. And I've spoken to him.

• 14:50Dr. Darshan Shah?

  Yes.

• 14:50Speaker 01

  Amazing work. Yeah.

• 14:52Dr. Darshan Shah?

  Yeah. If, if anyone's curious about kind of the trajectory of medicine and why we are where we are today.

• 14:59Speaker 01

  Mm hmm.

• 14:59Dr. Darshan Shah?

  It's a really great book, I think, to.

• 15:01Speaker 01

  I think it does.

• 15:02Dr. Darshan Shah?

  I read it and everything just made sense and why it's so important that we need to change how we think about healthcare.

• 15:08Speaker 01

  I think so, but it also brings to mind, especially his book and this thing I just said, that I want to offer people an understanding of why doctors focus on disease care.

• 15:19Dr. Darshan Shah?

  Yes.

• 15:20Speaker 01

  Right now, because you're, we had just talked about this off camera, you're, you're going to publish a book about your method.

• 15:28Dr. Darshan Shah?

  Yeah.

• 15:28Speaker 01

  And separating, but I, in defense of our peers.

• 15:32Dr. Darshan Shah?

  Right.

• 15:33Speaker 01

  There is no way in God's green earth to take good care of people in 10 minutes per visit.

• 15:39Dr. Darshan Shah?

  Exactly.

• 15:40Speaker 01

  But that is what your insurance companies, that you are paying a lot of money to allow us. And it's all coded. It's not like a mystery how you're reimbursed. I can, I can tell you, when I explain to business people and lawyers, that here's what I think the value of my 22 years of formal education, 25 years of clinical history and helping you make the right decision is worth, and it's not astronomical, sometimes it's not even as much as a massage therapist is, is charging, right? And yet, the insurance company chooses to pay me, to value me at one-fifth of that? Business people are appalled, because that's not the way business or law works.

• 16:21Dr. Darshan Shah?

  Exactly.

• 16:22Speaker 01

  Yeah. So when we say, doctors are focused on disease care, it's not because they don't love people, or they didn't spend 22 years of their youth being trained. It's because, to keep the lights on, you have to do that kind of volume, which doesn't serve anybody, does it?

• 16:41Dr. Darshan Shah?

  Absolutely. Yeah. And it's sad, because unfortunately, you know, doctors have bills to pay too. They have to.

• 16:48Speaker 01

  The truth.

• 16:49Dr. Darshan Shah?

  You have employees, you have, you have to pay the billing service, the bill, the insurance, and argue with them.

• 16:54Speaker 01

  Interestingly.

• 16:55Dr. Darshan Shah?

  And then, all you can do is make it up in volume. And whenever you try to make something up in volume, obviously, you just can't spend the time.

• 17:03Speaker 01

  You can't spend the time.

• 17:04Dr. Darshan Shah?

  So that's why, you know, what we were talking about off-camera, is I really believe that we need to form a brand-new system that is not our disease care system.

• 17:12Speaker 01

  Yeah.

• 17:13Dr. Darshan Shah?

  It's one focused on health, reversing chronic disease, where people take control of their health, and they have a responsibility to themselves to do this. And part of that is education, and listening to your Instagram channel, your podcast, and, you know, all of our colleagues that we talk about. I think it's so critical that people do this, because otherwise, they're just gonna get frustrated, consistently and constantly with the health cares, with the disease care system.

• 17:38Speaker 01

  Why isn't it what we need? Why can't we get it? Well, there's many reasons.

• 17:41Dr. Darshan Shah?

  Exactly. So I want to ask you about your career specifically, and let's start educating our listeners here about, you know, as an orthopedic surgeon, I think people think of ortho as they're the bone surgeons. But really, like you said, it's biomechanics, it's muscle, bone, circulation, fat, all of it and how it interacts together.

• 18:05Speaker 01

  Yes, it is. So the musculoskeletal system is bone, muscle, fat, tendon, ligament, cartilage, stem cells, muscle-derived stem cells. So it's a system of interrelated parts that sometimes we think is just a one-off. Oh, you got some bones, these people have some muscles. But that's not how the body sees it at all.

• 18:28Dr. Darshan Shah?

  Yeah, and even by volume, our muscles and our bone make up most of the volume of our body.

• 18:34Speaker 01

  That's right.

• 18:34Dr. Darshan Shah?

  And they arguably do some of the most work of our body at a cellular level as well.

• 18:40Speaker 01

  That's right. You know, people think commonly, you just think of muscle, like I call it the cosmetic muscle you see at the gym mirror, and then bone that holds up the muscle. And while that is, and it helps you move the locomotion portion of bone muscle. And that's the most evident, and that's what people think about. And if you notice your bones at all, it's because maybe you have beautiful cheekbones, or you have delicate wrists. I mean, I think of all the social things we say about bones.

• 19:09Dr. Darshan Shah?

  Yeah, and people don't even think about their bones until they break it.

• 19:12Speaker 01

  They don't. They don't. But let's change that. So, you know, we think of bones as the strong, silent type. They're just standing back. They're doing their own thing. They're not bothering anybody, you know. The fact of the matter is, bones are not only structural, they are where all of our immune system are made, in the pelvis and the long bones, right? They are protectors. They protect all of our soft organs, our pelvis, our chest, right? They are master metabolic communicators. And nobody thinks about the fact that one of the bone cells, called an osteoblast, which is the kind that builds bone,

• 19:56Speaker 01

  Secret's a hormone called osteocalcin. Osteocalcin travels to the brain and stimulates the production of neurotropins that build neurons in the hippocampus.

• 20:08Dr. Darshan Shah?

  Wow.

• 20:08Speaker 01

  Yes. It interacts with muscle to help glucose metabolism. It interacts with the pancreas to help insulin release. And if you're a man, it interacts with the lytic cells in the testicles to help you make testosterone. So that is only one small example of how bones, with one of the hormones they secrete, is a master communicator. And why wouldn't we be designed this way? You have bones from the top of your skull to the bottom of your little pinky. Why wouldn't we use that as a resource versus just the structural girders that hold up muscle, which frankly would just be a quivering mass of metabolic tissue, right? Without bones, muscles are just a pile of deboned chickeners.

• 20:52Speaker 01

  I mean, so people don't think of bones this way.

• 20:55Dr. Darshan Shah?

  Right.

• 20:56Speaker 01

  And the interaction they have with so many other organ systems.

• 21:00Dr. Darshan Shah?

  It's, you know, so interesting because I recently had a podcast with Dr. Gabrielle Lyon, and she was talking about how muscles secrete myokines, which are also endocrine.

• 21:11Speaker 01

  Yes.

• 21:12Dr. Darshan Shah?

  And bones are endocrine, as we're learning from you.

• 21:14Speaker 01

  Uh huh.

• 21:15Dr. Darshan Shah?

  And I think, you know, this whole concept that only our endocrine organs secrete hormones to communicate is very misguided.

• 21:24Speaker 01

  You mean like the pituitary and the thyroid and the adrenals, right? Yes, so misguided.

• 21:29Dr. Darshan Shah?

  Every piece of our biology is communicating to every other piece of our biology through these signals. And you mentioned calcit...

• 21:36Speaker 01

  Osteocalcin from the bone. Even fat releases leptin, which acts on bone, which acts on muscle. I mean, I like to think of muscle and bone and fat in three circles, and the arrows of their crosstalk are going both ways between osteo... if we just choose one hormone per organ, osteocalcin, leptin, myosin, they all talk to each other.

• 22:01Dr. Darshan Shah?

  And what are they telling each other?

• 22:03Speaker 01

  So leptin is talking to the bone and helps stimulate osteoblasts to lay down. Actually, that's opposite. Too much leptin, i.e. too much fat, decreases osteoblasts.

• 22:18Speaker 01

  Function so that we know that that people with obesity, you would think because of the added weight, you would have more bone. And you know, there is this weighted vest phenomenon with added weight. But the truth is that because on a metabolic level, you are building less bone, bone density is affected. We talked about all the ways that osteocalcin is this miracle substance that affects so many organs. And in the same way, myelin from muscle helps stimulate bone formation, not only through the mechanical pulling of the muscle and the tendon on the bone, but at a biomechanical level. So there's the hormone level they interact. But at the physical level, we're we're taught and Gabrielle talks about this all the time,

• 23:01Speaker 01

  taught to build muscle to build bone. Well, the fact that's only one of the mechanisms, right? The the pulling of the muscle against the tendon through Moore's law, which is biomechanical stimulation is translated via bone cells into biochemical stimulation. So when you're bouncing up and down on something, I teach all of my people to jump around and have a jumping practice. That stimulates osteoblasts to build more bone.

• 23:30Dr. Darshan Shah?

  Hmm, got it.

• 23:32Speaker 01

  See how all these things, it's it's hormonal, it's mechanical.

• 23:37Dr. Darshan Shah?

  Right.

• 23:37Speaker 01

  Isn't that fascinating?

• 23:38Dr. Darshan Shah?

  It's absolutely fascinating. Yeah, it's really fascinating to me that bones are responsive to the overall state of the other organs as well.

• 23:49Speaker 01

  That's right.

• 23:50Dr. Darshan Shah?

  They're not just static, like you mentioned, that just sit there and just hold us together.

• 23:54Speaker 01

  Yeah.

• 23:54Dr. Darshan Shah?

  They're constantly responding.

• 23:56Speaker 01

  Well, and I think people are fascinated when I say things out loud, like you think you get one set of bones for a lifetime, you actually replace your entire bone volume every 10 years.

• 24:07Dr. Darshan Shah?

  Oh, wow.

• 24:08Speaker 01

  So the same cells are not there present. It's a dynamically changing system. So you know, for instance, think about if you've ever broken a bone or had a bad ankle sprain or something, or Anytime you are immobile, what you'll see is disuse alone will cause disuse osteopenia, which is loss of bone, right? Because our body is so conserved and so interested in homeostasis, it thinks to itself, oh, you're not using that ankle. Let's pull the minerals from that bone to use in other parts of our body, right? So I'm just fascinated by the whole system.

• 24:50Dr. Darshan Shah?

  Yeah. I think one of the things that you've talked about in other podcasts I've heard of you is the MRI scan of someone who exercises into their sixties and seventies and someone who doesn't.

• 25:01Speaker 01

  Right.

• 25:02Dr. Darshan Shah?

  And the stark difference between using it and losing it.

• 25:05Speaker 01

  Well, it's especially true in the musculoskeletal system. So with the study you're referring to, we published a scientist named Brett Goodpasture and I spent a lot of years actually doing this study that took MRI slices of my most of my musculoskeletal aging work was looking at what happens if we take the variable of sedentary living out of the equation. Because I contend to you that most studies we have in the medical literature that have to do with what happens as we age has is a picture of sedentary aging.

• 25:39Dr. Darshan Shah?

  Right.

• 25:40Speaker 01

  Right? Because seventy percent of people in this country do not do any organized activity any day. And that's just the way it is. That is not a judgment. That is a fact. So when you take sedentary living out by studying masters athletes, I only studied active people, not pro athletes, but mere mortal athletes like me, right? Just keeping busy, doing Spartan races. What I found was in that particular study that you could retain your lean muscle mass across your lifespan. And so there's a very famous picture on the internet. I should have named it. I should have copyrighted it. But it has a life of its own.

• 26:18Dr. Darshan Shah?

  It now does.

• 26:18Speaker 01

  But it has changed the lives of so many people because personal trainers pop it up all the time. But what it shows is the cross sectional anatomy of a 40 year old triathlete. Gorgeous muscle, right? It looks like a ham.

• 26:32Dr. Darshan Shah?

  Right.

• 26:33Speaker 01

  Gorgeous muscle, thick bone cortex, no fatty infiltration. This is not a wagyu beef. This is a flank steak.

• 26:40Dr. Darshan Shah?

  Right.

• 26:40Speaker 01

  Then the next picture and everybody out in the audience is going, I've seen this picture. Is a person who sat around for thirty-five years, just a sedentary desk guy, thick grinds of peripheral fat, disorganized muscle tissue with gross fatty infiltration, thin bone cortices, and then right next to it, there's a picture of a seventy-year-old triathlete. And when you compare the forty to the seventy-year-old active person, you might think that I just took the next slice in the picture, right? I didn't. That's an actual seventy-year-old. But what it shows us is that our bodies are capable of so much more than we give it credit for. We are not the victims of the passage of time. We are the victims of sedentary living.

• 27:23Speaker 01

  Or not really the victims, we're the, we're the arbiters of sedentary living, right? It's our fault we're sedentary. And that, and I say that in only the most loving doctor way. I want you to feel better. You can walk towards feeling better, right?

• 27:38Dr. Darshan Shah?

  Yeah.

• 27:39Speaker 01

  So.

• 27:39Dr. Darshan Shah?

  Yeah, yeah, it's, it's mind-blowing, the effects of sedentary behavior and how, number one, it sneaks up on most people, I think. I did a whole, I did two episodes on sedentary behavior and how to counteract it. But, you know, our caveman ancestors, they were not sedentary. They, they spent a big portion of their day walking around.

• 28:00Speaker 01

  Yeah, hunting and gathering, finding food. Well, and, you know, our brains, I mean, obviously, you can look out, we're in this gorgeous place. At some level, our brains know we're not in a cave. But in the brainstem level, or I don't think our brains know what's going on. If we're sitting there, our brains probably think, okay, it's a cold winter day in a cave. We need to conserve. We're gonna slow down metabolism, we're gonna store up fat.

• 28:28Dr. Darshan Shah?

  Right.

• 28:29Speaker 01

  Because our body is, is designed for survival, right?

• 28:33Dr. Darshan Shah?

  That's so true. I never realized that, that being sedentary, our brainstem, it's still acting like it's, in caveman days, it's trying to conserve the energy.

• 28:43Speaker 01

  That we're in modern day, gorgeous, right, high-tech.

• 28:47Dr. Darshan Shah?

  Yeah, that makes total sense. So just practically, you know, I think most people out there, they're probably they're working from home or they have a job and they it's an eight hour job,

• 28:56Speaker 01

  Yeah.

• 28:57Dr. Darshan Shah?

  five days a week. How do people defeat the negative consequences of being sedentary practically?

• 29:03Speaker 01

  Yeah, it's really and there's so much data on this and it's not my data, but so much data that you cannot get over the hump of eight, 10, 12 hours sitting around because when you think about it, we sit eight hours at our job. We drive sitting down an hour each way. So that's 10 hours. We sleep in a horizontal position, hopefully eight hours. So what is that 18? So and then I guarantee nobody's very few people are running around six hours a day. So see how this adds up?

• 29:33Dr. Darshan Shah?

  Right.

• 29:34Speaker 01

  We're really sedentary.

• 29:35Dr. Darshan Shah?

  Yeah.

• 29:36Speaker 01

  Most of the time. So in a work day, I was thinking about this the other day, my office, when I see patients, I have it's like many clinics, there's a hallway, there are rooms and I don't sit down. I run up and down that hallway all day. So I'm counting my steps. I'm like, okay, I'm like a train engineer.

• 29:53Dr. Darshan Shah?

  Yeah.

• 29:54Speaker 01

  Walking up and down the train, not the captain who sits in a chair all day. So I'm getting some steps in. But what we can do at a desk is I challenge people to have your meetings. And people have sent me pictures of this after I say it, doing wall squats.

• 30:09Dr. Darshan Shah?

  Oh.

• 30:09Speaker 01

  Nobody cares if there are chairs in the room. Challenge your whole group to pull up a wall or nobody knows what you're doing when you're taking a phone call. You can be pacing, you can be walking around because I think there's a misunderstanding that you have to be all out at all times for exercise to matter. It doesn't. Every step matters. I tell people to fidget, run to the copier 25 times, you know, get up and down, get a standing desk. It seems all so simple and it's all out there. But I am really serious. The more mobility you have, every step matters on your journey to a thousand, you know, a thousand steps a mile.

• 30:46Dr. Darshan Shah?

  Yeah, no, that's so true. Some of the things that I've incorporated in my personal life are I have a timer on my desk, like an actual egg timer.

• 30:55Speaker 01

  Really?

• 30:56Dr. Darshan Shah?

  I set it to 45. Every 45 minutes, I do a five minute exercise snack.

• 30:59Speaker 01

  That's great.

• 31:00Dr. Darshan Shah?

  And from the research I've read, have you read a lot about the exercise snack research?

• 31:04Speaker 01

  Well, I've. I wouldn't say a lot, a few papers. I know it works.

• 31:10Dr. Darshan Shah?

  Yeah.

• 31:10Speaker 01

  Yeah.

• 31:11Dr. Darshan Shah?

  Yeah, I think, I think from what I've seen, it really works. Just three to five minutes every forty five seems to kind of be the magic bullet to counteract the negative consequences of sedentary behavior. And then you mentioned steps. I think

• 31:25Speaker 01

  Yeah.

• 31:25Dr. Darshan Shah?

  seven, eight thousand seems to be the right number. I have a walking desk. I love it. It doesn't work for everybody, but I love it.

• 31:31Speaker 01

  So are you able to concentrate?

• 31:34Dr. Darshan Shah?

  Yeah, better.

• 31:35Speaker 01

  Really?

• 31:35Dr. Darshan Shah?

  Better because I have more blood flow.

• 31:37Speaker 01

  Yeah.

• 31:37Dr. Darshan Shah?

  More focused.

• 31:38Speaker 01

  Because I think the objection to that is that people are like, how am I going to concentrate on deep work? Well, I'm sure it's a learned habit. You get used to it, right?

• 31:46Dr. Darshan Shah?

  Exactly. And I think, you know, I'm a big believer of N of one experiments. Like, just because you hear your friends say, I can't concentrate, or it's hard for me to work. I can find you the same number of people that they actually work better on a walking desk. And you're not going to know until you do it yourself and try it, is my content for people. Right, exactly.

• 32:10Dr. Darshan Shah?

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• 32:49Dr. Darshan Shah?

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• 33:29Dr. Darshan Shah?

  What about other ways of being less sedentary? Like at home, for example. You know, we talk a lot about work and not being sedentary, exercise, snacks, walking desks, walking meetings. But I think a blind spot for people is the amount of time they spend sedentary at home, actually. So do you have any tips there?

• 33:48Speaker 01

  Well, I did put a walking treadmill in my living room in front of the TV. I'm not sure how my husband felt about it, but I did do it. I think that we don't do hard things. If it's too far to the gym, if it's, if it's, there's no equipment around, or if it's, I just think you have to make it as easy as possible. So don't load up and carry everything upstairs all at once. Carry one thing at a time. Just make it the habit. Don't plop down at six o'clock and sit there until nine thirty, until you're ready to go to bed. Although I am raising my hand, Sundays, that's all I've got left. I've had a big O R day, that's all I've got. But I mean, I just think, you know what all this says? It's not about rules.

• 34:31Speaker 01

  It's about being conscious of being purposeful of investing in your mobility. I mean, and, and I don't think you and I say any of these things as, as, oh, my gosh, there's so many rules, you're not doing enough. We know we're not doing enough, but it's not a punishment. It's just how can you incorporate these things in all that you do? Yeah.

• 34:53Dr. Darshan Shah?

  Right. Yeah, and definitely, I think it's hard to start, but it gets easier as you do it more frequently, and you make a habit out of it.

• 35:02Speaker 01

  It becomes the lifestyle.

• 35:04Dr. Darshan Shah?

  Exactly.

• 35:04Speaker 01

  When I teach people the lifestyle, which I've come to now called the unbreakable lifestyle, at first, it sounds like a lot. And initially, it is a lot. But I, I tend to layer on habits for people. If we have done nothing forever, then the first commitment we're going to make is we're going to walk seven days in a row after our largest meal. That's it. We're just going to get up from our biggest meal, lunch or dinner, we're going to leave the dishes on the table because there are no police going to come and get you when you leave the dishes on the table, and you're going to go walk. And after you've done it seven days, that's called a streak. Runners have streaks, right? You don't wanna, you don't wanna stop because you have a streak going. So you know, you start with the mobility and then you layer on learning to lift if you've never lifted before.

• 35:50Speaker 01

  And you layer on focusing on the nutrition, which we can talk about. And then something that, two things that people forget that I always build into the programming I do because I am an orthopedic surgeon. I start out all the programs with flexibility and mobility. Our joints will get stiff like a, like a rusted out old car if we don't move them through a full range of motion. And so that's where I think things like yoga and Pilates and Tai Chi and the mobility practices can be helpful. Now that, in my opinion, cannot be everything you do. But it's an important garnish to what you do. So every program needs to contain some of that. And then you have your aerobic work. It can start with walking.

• 36:35Speaker 01

  It needs to eventually include some sprinting, heart rate sprinting, not necessarily sprinting like Usain Bolt, but heart rate level activity. Then lifting heavy, which I'm sure you've spoken about on here. But then at the end, we cannot forget, we cannot forget balance and foot speed. You may have weak bones and you may have low muscle mass. But until you fall, because you trip over your work bag sitting by your desk, which I've done, or your little bitty dog pulls you down the street and you can't, or you just reach over for something and you lose your balance, you may not break. But when you fall many times, you will break. So balance, which can be totally retrained.

• 37:20Speaker 01

  And then I put people through regimens of learning foot speed, just like you would an athlete.

• 37:24Dr. Darshan Shah?

  Really?

• 37:24Speaker 01

  Yes.

• 37:25Dr. Darshan Shah?

  How do you, let's talk about foot speed a little bit. How do you, how do you teach people foot speed?

• 37:29Speaker 01

  Yeah.

• 37:30Dr. Darshan Shah?

  Or improve their foot speed?

• 37:31Speaker 01

  Yeah, you know, you can start sitting in a chair like this and you're just tapping your foot up and down like this. This seems like a simple thing, but if you don't, if you don't do this with some rapidness, if you try to do this fast enough, it takes a little bit of brain power. So foot speed. Speed not only has to do with your muscles, it has to do with your neuromuscular pathways and retraining the connection. So you know, we start simply with these little foot taps and then we'll do thigh taps and then lo and behold, if you stay with me long enough, we're having you do little hurdles and and jumping in and out of hexagons because you will get faster and next time you trip, you'll catch yourself and won't fall down and break because that is what we're trying not to do. The fatal fall.

• 38:16Dr. Darshan Shah?

  Fall, right. I like to add, well, I haven't done foot speed yet.

• 38:20Speaker 01

  Yeah.

• 38:20Dr. Darshan Shah?

  I'm going to add that to my regimen. I love that. I do a lot of box jumping, actually. I feel like jumping is something that we, right? We lose that as we age.

• 38:28Speaker 01

  Yeah.

• 38:29Dr. Darshan Shah?

  We don't really jump anymore. If you think about it after, after you're done with like college athletics, for example. And I think that's another really important skill to have. It trains legs.

• 38:41Speaker 01

  Yep.

• 38:41Dr. Darshan Shah?

  It also trains your balance.

• 38:43Speaker 01

  Mm hmm.

• 38:44Dr. Darshan Shah?

  All of it.

• 38:44Speaker 01

  I love box jumping. I do it in between my leg sets.

• 38:48Dr. Darshan Shah?

  I love that. Okay. And then you also mentioned balance training. So what are some other ways people can train their balance?

• 38:55Speaker 01

  Balance?

• 38:55Dr. Darshan Shah?

  Yes.

• 38:55Speaker 01

  The simplest way, it seems silly. I would love for everybody to send me pictures of them doing this. When you're brushing your teeth in the morning and it's a safe place, you've got the sink to grab on to. You stand on one leg. You can do tree pose or lift up one leg because the movement of your body will force your eyes and your ears and your, and your muscles to coordinate to stay upright. And you just alternate legs every other day and you will very rapidly retrain your balance. In the gym, of course, those other things you can, you can do, but that is the most simple daily practice that can retrain your balance.

• 39:33Dr. Darshan Shah?

  Excellent. I love that. And once again, just to highlight the fact that this is important because falls are usually what take a lot of elderly people out. You see this all the time in your job.

• 39:45Speaker 01

  Oh my gosh, there's a story, a patient told me, she was an ICU nurse. This is a typical story. I'm going to tell you two typical stories. How we gotta get in front of this. So I had a nurse come in as my patient and she's telling me, because I talk to people about their whole lives, right, in my office. She's telling me about her job and she, we were talking about falls and she had this eighty-nine year old lady come in and it was a sad story, but this eighty-nine year old lady was the community driver. She was driving the sixty-five year olds around to their doctor's visits, right? She was that, still had her licensed person. Didn't mean she wasn't frail, didn't mean she was little. I mean, she was, it didn't mean she was hardy. It just means that she was functioning well enough when other people weren't.

• 40:30Speaker 01

  So, we had this community driver who tripped on a step and when she fell, she broke her hip, which is seventy percent of all hip fractures are in women, and she broke four ribs. And she broke her humerus because she landed on her arm, right? So we've got two limbs and four ribs, four ribs. When you break a rib, it's extremely painful. So then her seventy year old son had to make the decision what to do with his mom and she was too frail to withstand a lot of surgery, so we put her in hospice care. So we have this community driver who was one prior to this fall, like helping so many people, living her life, one fall.

• 41:13Speaker 01

  But that, I'm telling, I'm telling you what I'm about to tell you because I am still a practicing orthopedic surgeon who has to take call. Right. And I meet women and men, but largely women, in the ER or in their hospital beds when I'm called because they've broken their hip. And this is the picture that we have got to get in front of and it doesn't start when we're sixty-five. It starts when we're forty. So I call thirty-five to forty-five, the critical decade to get your frigging. Get your stuff together. Get it together. If you've never thought about your health before, now is the time. Because this is the reality that I see and there is no hyperbole in what I'm about to say to you.

• 41:56Speaker 01

  The woman is laying in bed, crumpled up in a ball in those horrible blue gowns we put people in on the plastic mattresses in the hospital. You know it, you're a surgeon. They're crumpled up because it hurts to straighten up in bed, so they'd rather just sit still with their broken femur that I've been called to fix. They are often laying there incontinent because the pelvic floor is skeletal muscle. And when we lose 20% of skeletal muscle during menopause, we lose it in our pelvic floors. Not to mention, we've had children, most of us, right? And all those kinds of things. And we have never been offered vaginal estrogen for the gynecomastia syndrome of menopause. Urosepsis kills 30% of women, right? Bladder infections is what I'm saying.

• 42:41Speaker 01

  Broken hip, painful, laying there incontinent. The hospitalist has been called to clear her heart so that I can take her for a 45-minute procedure. It doesn't take a surgeon long, put metal in a hip. But many times, their heart disease is so bad that they can't be cleared for surgery. Heart disease is the number one killer of men and women, right? And then, because of the stress of this trauma, or because they're already demented. They have no idea what's going on. That is the future of women and some men that I see every day. And Darshen, we have got to take it seriously. One in three people in this country will end up in a nursing home.

• 43:25Dr. Darshan Shah?

  Yeah.

• 43:26Speaker 01

  Right?

• 43:26Dr. Darshan Shah?

  Right.

• 43:27Speaker 01

  And it is preventable.

• 43:29Dr. Darshan Shah?

  Absolutely.

• 43:30Speaker 01

  It is absolutely what your model is trying to get in front of.

• 43:34Dr. Darshan Shah?

  Exactly.

• 43:35Speaker 01

  Right?

• 43:35Dr. Darshan Shah?

  Yep. And you're so right, because it's actually getting worse. I feel like we're seeing more and more of this. As more and more people live a sedentary lifestyle from the very beginning.

• 43:46Speaker 01

  Yeah.

• 43:47Dr. Darshan Shah?

  Do not focus on their health.

• 43:48Speaker 01

  Yeah.

• 43:49Dr. Darshan Shah?

  The first time they even think about this is when they get a hip fracture, for example. And now it's too late. And like you said, it's just really sad to see people in this situation that is absolutely, I would say probably for 99.9% of the people that are in that situation, they could have prevented it.

• 44:08Speaker 01

  And do you know what they say to me in their lucid moments?

• 44:10Dr. Darshan Shah?

  What do they say?

• 44:11Speaker 01

  I'm thinking mainly of this, a man, an executive, he was a high-powered executive, king of his castle, right, king of the world. They're laying there in this place. And what they want me to understand, anyone listening to understand, is that they were not always like this.

• 44:27Dr. Darshan Shah?

  Right.

• 44:28Speaker 01

  They were once like you and me.

• 44:29Dr. Darshan Shah?

  Uh huh.

• 44:30Speaker 01

  And this is not how they see themselves.

• 44:32Dr. Darshan Shah?

  Right.

• 44:32Speaker 01

  But this is how they have found themselves, due to years and disuse and not enough prevention, right?

• 44:39Dr. Darshan Shah?

  Exactly.

• 44:40Speaker 01

  And I think that's a really hard pill to swallow. This is not how I've always been. And so that's why I say things like, we have, when you still, women especially, when you still have your hormones, thirty-five to forty-five, let's get it together. Because then you can have the biggest effect over the long term.

• 44:58Dr. Darshan Shah?

  And you never need to get to that spot.

• 45:00Speaker 01

  And you never have to. I mean, the, my research that I did on musculoskeletal aging, taking the variable of sedentary living out of the equation, those athletes, I started my studies at forty. It went all the way up to a hundred and three. It's an entire population of people who have demonstrated to us that we have more control over the trajectory of our aging. We are not victims and, and do not have to let aging time bombs explode in our lives.

• 45:30Dr. Darshan Shah?

  You know, your study, that picture, has been a game changer for so many people. It was for me as well.

• 45:35Speaker 01

  Yeah.

• 45:36Dr. Darshan Shah?

  To just see from an MRI perspective, a cross-section of the thigh, what's possible. It is possible to be eighty years old and have the musculoskeletal system over forty-year-old.

• 45:45Speaker 01

  Well, and not only that, we did a series of studies. We showed that we can maintain bone density.

• 45:51Dr. Darshan Shah?

  Right.

• 45:52Speaker 01

  We showed that we can maintain our frontal cortex. We did one of the first studies, looking at retention of brain function as, in chronic exercise. So it's all things, which is now very commonly accessible knowledge, but there continues to be a gap.

• 46:07Dr. Darshan Shah?

  Yes.

• 46:08Speaker 01

  We know what we should do, we don't do it. We know what we should do, we don't do it. And sometimes, admittedly, that's situational. There are food deserts in every city. We're the only place to get anything to eat is a bodega, not to mention processed, right? I mean, there are real societal things we have to turn around, not to mention just pivoting to realize we're worth the investment in ourselves every day.

• 46:31Dr. Darshan Shah?

  I mean, you know, I think it's important to also highlight, though, that we're talking about making changes in your 30s and your 40s. However, it's also not too late, even if you have found yourself at 60, 65 to reverse this trend, right?

• 46:44Speaker 01

  Oh, it's never too late. Some of the very first aging research, functional aging research by Maria Phia Turone was done in 90-year-old men living in a nursing home. She's put them in chairs, did exercises, and they increased their function by 150%, largely by retraining their neuromuscular pathways. But it just shows the capacity of our bodies. There are pictures all over the internet right now. Susan Giede, Train with Joan, to mention a few. One of my favorites, Banana George Blair, who was a banker, who was capable of retiring at 55 and decided he was gonna live this tremendous future life. So he was my patient when I was in New York, and he is deceased now. He died at 92.

• 47:29Speaker 01

  But he, when I met him, he maintained three homes, Cypress Gardens, one in New York, one in Paris. He would slalom ski in Florida every day he was there. And when he got too old, they would crank him out of bed, they would give him his ski pole, and he would still be on the water.

• 47:49Dr. Darshan Shah?

  Wow.

• 47:50Speaker 01

  So there are, you know, there's a whole organization called Growing Boulder who tells the stories of people growing better as they age. So if you just need inspiration, you just gotta look around a little bit. I mean, I think of my own 85-year-old father, who is a lifelong exerciser. He's an endurance athlete, and his last marathon was at 68. He got a total hip at 72, but he still walks six miles a day, and I have to tell my neighbors not to run him over, because he's out there on the street, right?

• 48:23Dr. Darshan Shah?

  Right.

• 48:23Speaker 01

  Yeah.

• 48:24Dr. Darshan Shah?

  Yeah. Yeah, I think the use it or lose it. Phrase just absolutely applies. And so I think it's important to start very early, as you mentioned, and just keep doing it, just keep moving forward. My parents are also in their eighties.

• 48:36Speaker 01

  Yeah.

• 48:36Dr. Darshan Shah?

  And they're traveling right now internationally.

• 48:39Speaker 01

  Nice.

• 48:39Dr. Darshan Shah?

  And, you know, I think they've always lived a life of constant movement, physically and mentally.

• 48:45Speaker 01

  Yeah.

• 48:45Dr. Darshan Shah?

  And I think it's important to do both, right?

• 48:48Speaker 01

  Yeah, completely.

• 48:49Dr. Darshan Shah?

  And I'm gonna definitely add the the foot speed to my training.

• 48:52Speaker 01

  Please, please do that.

• 48:53Dr. Darshan Shah?

  Thank you for adding that. So let's hone in a little bit on the bones.

• 48:57Speaker 01

  Yes, let's do bones.

• 48:58Dr. Darshan Shah?

  You're, you have so much to say about this because I think it's incredibly important and often ignored part of our health speak, no matter, even if you are a health enthusiast, not too many people talk about their bone health. And I'd love for you to give us your perspective on how does one start thinking about this? How do you even know where you are with your bone health? And some of the tools and tips you give to your patients to really, you know, make this part of their consciousness?

• 49:27Speaker 01

  Well, let's frame it a little bit. So now in the, in the National Zeitgeist, lots, more people than ever are talking about midlife than has happened in the time I've been trying to get them to talk about midlife. But in particular, people are becoming aware that when estrogen walks out the door and doesn't look back in women during the time of perimenopause to menopause, women can lose 20% of their bone density in five years. It's like that, right? If we start with this middle point, because we're gonna talk about the lifespan of bone, but if we taught, start at this middle point, which is very common right now, the first thing to notice is that women don't even know this is happening.

• 50:05Dr. Darshan Shah?

  Right.

• 50:05Speaker 01

  Because bones, until you break them, don't hurt you.

• 50:08Dr. Darshan Shah?

  Right.

• 50:08Speaker 01

  The reason you may have new onset startling low back pain is maybe that's because you have osteopenia in your vertebral column, right? So that can hurt. So we lose 20% without even knowing it, and that leads to the kind of stories I just told you, unless we get in front of it. But here's what we need to know. We have 110 million millennials, who are, the oldest of which are turning 44. I have had millennials come into my office with low bone density. The youngest I've ever had is a 24 year old. Who I did a DEXA scan on because I'm a doctor who gets DEXA scans on everybody. Even if insurance says they'll only pay for it for 65.

• 50:52Speaker 01

  65 is too late, people. Let's get a baseline bone density, even if you go down to your local gym. Which lots of gyms do bone density now with full on DEXA scanners. Figure out where you are because here's the deal. There are many, many young women in particular, who never lay down enough bone. I think that's for many reasons, but here's three. Number one, they are a digital generation who spend most of their time sitting in a chair and never are told to go out and run around and don't come back in. Right? Like you and I probably weren't. Right? Number two, we are, we're in 54 years of Title IX, which is the law that equalized sports playing at the college level. You had to have equal number of male athletes as female athletes.

• 51:37Speaker 01

  And so more women were doing sports. At the, so high levels of activity. At the same time, when we were still living under the cultural mantra of women had to be as big as my pinky. So we had, we have entire generations of women who are highly active, living in relative energy deficit. You do not, meaning you don't have periods for six or nine months. I did that. I was a dancer. I was thin. I did not lay, well, I have great bones now, but many women do not lay down enough bone in their youth. Right? So you, you come into your 30s, maybe never having laid down enough bone for any of those reasons.

• 52:20Speaker 01

  And then when you have children and you decide to breastfeed, now I want to stop and have a caveat. I think breastfeeding is incredibly healthy and that everybody should try to do it if they can do it. But here's what you need to know. You cannot starve yourself while you are doing that because you will lose 20% of your bone density in the first six months of breastfeeding. If you don't, every day make sure that you are replenishing the 500 milligrams of calcium that you lose by producing milk. Right? You're busy people, people, little people need you. You need to feed yourself, right? Because then if you're having your children in rapid succession, you may never rebuild enough bone. So we don't build enough bone in our youth. Then we may lose some as we're having children.

• 53:06Speaker 01

  Now, the caveat, just so we don't get mean letters, is that if you do pay attention to your bones while you're breastfeeding, you will rebuild it in six months. It's, it's not a problem, but you can't forget about your bones. Then we have menopause. When we're gonna lose it, when estrogen walks out the door and you can, you no longer control your osteoclasts, which is the part of cells that breaks down bone. This is a setup for poor bone health.

• 53:33Dr. Darshan Shah?

  For sure.

• 53:34Speaker 01

  But our bones are totally capable of rebuilding. So the recipe, the building better bone programs that I just capsulize just so it's easy, right? Let's get a bone density. Let's figure out where we are. Let's build a jumping program. Let's lift heavy weights. We must impact our bones. It's, walking is not going to build bone for you. There are studies that show that a weighted vest or a weighted belt, as I like, as I've designed a weighted belt, I like because it doesn't, it doesn't pressurize the thoracic spine. It's all where we need it. That has been shown to add on. Jumping impacts lifting heavy weights, not mamby pamby pink weights.

• 54:17Speaker 01

  Heavy weights, the Lift More study showed that lifting heavy enough, so you're lifting five reps, five sets, or as I like to prescribe, four reps, four sets, which is heavy. Under supervision, it takes some training, can rebuild bone. On top of smart nutrition, anti-inflammatory nutrition, chronic inflammation breaks down bones. So we need, bones are 50% protein, so we need a high protein diet. We need vitamin D, K2, we need magnesium. Maybe we sprinkle in some selenium and boron and some prunes, right? That is how we rebuild bone. You can do it. Studies have shown we can rebuild bone in up to six months, right? It's not inevitable that we're going to go downhill. But it does take a practice.

• 55:02Speaker 01

  You know, I think of this in the same way as yogis think of their practice. They always describe their, their work as a practice. This is a practice.

• 55:10Dr. Darshan Shah?

  Yeah, absolutely. It's such an awesome protocol. I love that.

• 55:14Speaker 01

  Yeah.

• 55:15Dr. Darshan Shah?

  A couple of questions I have about the protocol is where does calcium supplementation fit in all of this?

• 55:20Speaker 01

  Yeah, well, I'd rather people get calcium from whole foods.

• 55:23Dr. Darshan Shah?

  Yeah, I agree.

• 55:23Speaker 01

  Yeah. So I only know of one brand out there that gives you a whole food calcium supplement. It tastes like dates. It's, it's an actual whole food. If there's no way in God's green earth you're going to get that, then okay, you can take some Tums, but I prefer you eat it and it takes you to be conscientious, right? So I generally don't recommend calcium supplements. What was your other question?

• 55:45Dr. Darshan Shah?

  Yeah, that, and I completely agree with that. I think one of the first things that my patients ask me when they have a low bone density is, well, aren't you going to give me a calcium supplement? I'm like, absolutely. That's the last thing you're going to do. Look at your diet first and let's get it from that. Because I think it's also been shown in many studies that calcium supplementation actually doesn't really help bone health. It's more the vitamin D, getting it from the diet, high protein, and like you said, impacting your bones with exercise. Just walking isn't going to be enough.

• 56:16Speaker 01

  It's not enough impact.

• 56:16Dr. Darshan Shah?

  Right, absolutely.

• 56:17Speaker 01

  That's right.

• 56:17Dr. Darshan Shah?

  And for women especially, men and women, but let's talk about women first. Where does hormone replacement therapy fit into your protocols?

• 56:26Speaker 01

  Yes. My position on hormones is that every person is a sentient being. I mean, I measure testosterone in men too, and we can talk about that, but every person is a sentient being with agency. You get to choose whether you go on hormone replacement therapy or not. Right now, only 4% of all people who are eligible are doing it. But here is my position on it as your orthopedic surgeon. I believe that estrogen, and if you need a progesterone and sometimes testosterone, is the elixir of longevity for women. From a bone standpoint itself, one in two women, it's either going to be me or my best friend, one in two women are going to have an osteoporotic fracture in their lifetime.

• 57:11Speaker 01

  And if you break your hip, 70% of hip fractures are in women, you'll die 30% of the time. That is not hyperbole. That is the data. So from a bone standpoint. I believe that estrogen is supported for bones in postmenopausal women, and as early as you want to start, frankly. So, having said that unequivocally, I then throw in, and while the world is arguing with each other about its effect on the heart, which there is solid data that estrogen prevents cardiovascular disease, while they're arguing about its effect on brain health, when Lisa Moscone has shown that the brain is full of estrogen receptors, right?

• 57:53Speaker 01

  While the world is, any subject, depression, any of the symptoms, they're arguing, I will save the 50% of people in this world that are going to have a fracture by prescribing estrogen if they want it. I just insist that people make the decision based on science and not fear. I cannot tell you, people know who they're coming to when they come to see me, how many of them will say, oh, my Aunt Minnie's sister Maude had breast cancer. I can't do it. And there is no further from the truth. That kind of family history does not have an effect on your decision making, right? If you decide, which it is your right to do, not to replace your hormones, there's still the five things that we laid out

• 58:38Speaker 01

  that can completely change the trajectory of your health. So, if you choose just to do hormones and don't do these five, you're not going to make much progress either. It is, it is a system of activity and food and, and hormones, in my opinion.

• 58:54Dr. Darshan Shah?

  Very eloquently said, absolutely. I think we need to move on as a medical profession from the villainization of hormone replacement therapy, which was so misguided and has led to a generation of women that have very frail bones.

• 59:10Speaker 01

  Yeah.

• 59:10Dr. Darshan Shah?

  And it's sad to see, though, that the medical establishment is not moving on from that, despite the massive amount of data that we have showing it's healthy for men and women to consider hormone replacement therapy. I think there's also this aspect of hormone replacement therapy, though, that, you know, some people are just getting it online and not even interacting with a physician to help them manage the different complexities of it, which I think gives it a bad name as well.

• 59:38Speaker 01

  Right, to our earlier point that every person is individual and requires precision care. It's not like you can just have a uniform algorithm. Every person needs to be considered individually. I think, you know, the, the reason why the medical establishment has not progressed rapidly is because it's not taught in medical school. It's not even taught in OB-GYN or primary care residencies, let alone surgery. Such a unicorn even talking about it in surgery. But I'm also interested in, in hormones in men. When I have a man coming into my orthopedic office, he's ripped his biceps tendon, he has multiple tenderness injuries, right? Or he just doesn't feel as strong, or all of a sudden,

• 1:00:23Speaker 01

  I start testing testosterone, even in young men. If you have multiple tenderness injuries, something is going on with your hormones.

• 1:00:31Dr. Darshan Shah?

  Yeah, that's so true. I think men also are encouraged to not use testosterone and try to get it up naturally, which is of course what we want to do. But you're an N of one, do all the natural things. Go lift heavy weights, get your vitamin D, eat a high protein diet. Creatine is a supplement I'm a big fan of.

• 1:00:53Speaker 01

  I love creatine.

• 1:00:54Dr. Darshan Shah?

  But we still can't get you up above 250, you need to do something.

• 1:00:58Speaker 01

  Yeah, yeah, exactly. And, but it has to be done in a supervised way.

• 1:01:04Dr. Darshan Shah?

  Absolutely.

• 1:01:04Speaker 01

  Because if you're a re, a man in a reproductive, well, men are always reproductive, but who still wants to build a family? You can't just do that without realizing the consequences. So that's why it takes supervision and not just buying it off the internet, which is pretty easy to do these days.

• 1:01:21Dr. Darshan Shah?

  Yeah. And we have multiple dosage forms now. You know, there's oral, there's, and Clomiphene, which stimulates your natural production of testosterone, et cetera. And so you really need to work with a skilled physician that number one is a believer that it's going to help you, and number two has been doing it for a long time. I think it's extremely important. And is checking your markers.

• 1:01:43Speaker 01

  Yeah, to see how high you're going. Well, and to separate, for those listening, although you have a very intelligent Audience that we're not talking about the kind of trouble people got in in the, you know, past Cold War Olympics where that anabolic steroids, we're not talking about that kind of, that's why testosterone also has a pretty bad name, right? That's why there's still a black box label for women is from that era, not because it's bad for women, right?

• 1:02:08Dr. Darshan Shah?

  Right.

• 1:02:08Speaker 01

  Interesting, right?

• 1:02:09Dr. Darshan Shah?

  So interesting.

• 1:02:15Dr. 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

• 1:02:59Dr. Darshan Shah?

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

• 1:03:13Dr. Darshan Shah?

  This episode was also brought to you by Vitaboom. Vitaboom is a revolutionary company that sends you a custom supplement protocol based on your needs using blood-based biomarkers. You could either send them your latest blood test, or they will send you a finger stick test for blood analysis. Vitaboom then curates and ships you an extremely convenient monthly box of daily supplement packs that have your custom protocol in them. What's great is that they also provide all the best brands like Timeline, TruNiagen, and many others for your custom daily packs. I love mine especially for travel, since I don't have to bring 10 bottles of supplements

• 1:03:54Dr. Darshan Shah?

  with me and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to vitaboom.com and check it out.

• 1:04:07Dr. Darshan Shah?

  What about some of the medications you can take that they give to people who are osteoporotic to help them rebuild their bones? What do you think about some of the newer ones there?

• 1:04:16Speaker 01

  You know what I think? A, it's complex. The bone has a multiple pathways where you could intervene. You can intervene at the osteoclast. You can intervene in the precursors. And each of the drug classes does it in a different place. The, it seems, because I usually send people to an endocrinologist, it's so complex to do it. It seems that the first line are the bisphosphonates, which work on the osteoclast. I encourage women that I take care of who are early midlife in their 40s. I encourage everyone, but especially early midlife. They come to me with these devastating, or I get it, and they have devastating DEXA scans, like minus 2.5, minus 3.5 I had the other day in the lumbar spine. That is a compression fracture waiting to happen.

• 1:05:01Speaker 01

  If they have not done the hormone decision, if they have not implemented the lifestyle, I start with that. Let's get our ducks in order. Let's give your body back what it's always had. Let's see if we can increase 2% to 3% over the next six months and get you in the right direction. If they're already doing those things, I say we cannot just let you continue to lose bone density. You should consider a bisphosphonate, and I'll refer you to get that. I mean, everything has risk factors, but hard times call for hard decisions.

• 1:05:37Dr. Darshan Shah?

  And I think also, you know, like you said, they, there's a role for them, but it shouldn't be the primary and only reactive role to a low bone density.

• 1:05:46Speaker 01

  I think it's wrong to just prescribe that without the other counseling that you or I would give.

• 1:05:51Dr. Darshan Shah?

  I agree, yeah. So I'm actually getting my DEXA scan today. It's January. Every January I get a DEXA scan.

• 1:05:58Speaker 01

  Good for you!

• 1:05:59Dr. Darshan Shah?

  And one of the most underutilized tests in modern medicine, I think. One of the most important, super cheap, no more, I think mine's 50 bucks, right?

• 1:06:09Speaker 01

  Yep.

• 1:06:09Dr. Darshan Shah?

  And you don't get insurance to cover it until you're 65, like you said, but everyone should pay for this.

• 1:06:15Speaker 01

  Save your Starbucks money and go get a DEXA scan, please.

• 1:06:18Dr. Darshan Shah?

  You'll learn so much because you learn about not just your bone health, you learn about your muscular status, you learn about your visceral fat, which is something that we need to.

• 1:06:25Speaker 01

  Where you're carrying fat.

• 1:06:26Dr. Darshan Shah?

  Right, exactly. And so it's one of those things that everyone should really consider getting if they can do it. And they're not that hard to find anymore. There's companies like even I just saw a website, dexascan.com, bodiespec.com, fitnesscity.com, where they find all the DEXA scanners in your city and they put them on a map and you just pick one and you make an appointment right there on the website.

• 1:06:47Speaker 01

  Yeah, I love that. I really do.

• 1:06:49Dr. Darshan Shah?

  It's very easy to get a DEXA scan. And sadly, you'll have to do this for yourself. There's not too many doctors like you or I that will even.

• 1:06:58Speaker 01

  Will order them.

• 1:06:58Dr. Darshan Shah?

  Right, because they don't even know how to read them, I think, a lot of times. And so I think it's important for everyone to take, once again, agency on their health.

• 1:07:06Speaker 01

  Yeah.

• 1:07:06Dr. Darshan Shah?

  And this is one of the things that they should all, every listener should think about getting one of these, right?

• 1:07:11Speaker 01

  Absolutely. And at what age? At least by 40.

• 1:07:15Dr. Darshan Shah?

  Men and women, right?

• 1:07:16Speaker 01

  Absolutely.

• 1:07:17Dr. Darshan Shah?

  And there's a small amount of radiation. So obviously, if you're pregnant, you don't want to do this.

• 1:07:21Speaker 01

  It's very small. The tech doesn't even wear a radiation gown. They're walking. So it's very low radiation. And so, I mean, I think weighing fracture versus a pinch of radiation, it's not really an argument.

• 1:07:35Dr. Darshan Shah?

  I agree. I agree. What other tools are you using in your clinical practice that you find very useful for your patients?

• 1:07:42Speaker 01

  So when I have someone who comes in really serious to make change, because I find sometimes people do and people don't, right? So if we want to design a full program with the tools that I have available, we'll draw standard labs, we'll draw a more complex panel that includes things like advanced inflammatory markers. I like to look at senescence. Now, I would love to look at senescence using PCR, but that's not always available. So I use Betagal as an alternative. I want to look at the senescent load. I look at intracellular NAD plus, just looking at energy stores. So we draw those basic. It's not everything that can be done in the world, but it's a great starting point for most of the. People I take care of.

• 1:08:25Speaker 01

  Then because I I have my office in a place with a metabolic lab, we do lactate threshold testing. Fantastic. So that when I'm prescribing for people, I want you to do eighty percent of your cardio at your lactate threshold, which is the point where your body is metabol- switches from metabolizing fat to metabolizing carbs. For eighty percent of our cardio, I don't, I would rather keep you in this low heart rate range to build metabolic flexibility, to get your mitochondria as flexible as possible, switching between its its three energy sources. Eighty percent, so if I, the the little formula that you can do is one eighty one minus your age.

• 1:09:07Speaker 01

  That works for the average person, but if you really want to know, you just get on a treadmill, we prick your finger, we do lactate threshold, and we'll tell you at one thirty, for instance, you are at your your fat max, you're maximally burning fat for energy. We're going to do that three times a week. So we do lactate threshold. I love doing VO two max as a baseline test, and here's why. This is something most people don't know either. And sometimes we think of VO two max as, you know, like the Tour de France guys. It's only for really high level athletes. Well, it kind of hurts to do, so maybe that's why. You really, and and for those of you who've never done it, you work hard until you think you're going to pass out, right?

• 1:09:51Speaker 01

  But what it tells you is your true fitness level, the diffusion of oxygen. And why that's important is because we know that with time, every decade, we have the potential to decrease our VO two max ten percent. And why does that even matter? Well, there is a line called the fragility line. It is eighteen in men, sixteen in women, and how that translates is if your fitness is below those levels, VO two levels, you cannot live independently because you can't get up from a chair. You can't walk to the bathroom, right? So we never want to reach that. So here's how the numbers goes. I'll give you my example. The last time I did it, when I was fifty, my VO two max was forty five, which wasn't

• 1:10:36Speaker 01

  bad. So then, if that's fifty, by sixty, if I do nothing, I'll be down to forty. Square numbers, whole whole numbers, so it's easy math. By the time I'm seventy, forty, thirty five, eighty, thirty, ninety, twenty five.

• 1:10:54Speaker 01

  I'm not crossing the fragility line. So it's important to know where we start. Because if we're a sedentary person who's never spent any time on their cardiovascular fitness, which don't get me started because we build our mitochondrial load as a child. So we're a sedentary child like I see in so many malls around here. Where we've never been fit, running around breathless. We're setting ourself up because if we start, think about it, you start with a VO2 max of 30 or 25 in midlife. You're getting to the frailty line very quickly.

• 1:11:28Dr. Darshan Shah?

  Yeah, that's so true.

• 1:11:29Speaker 01

  It's true. So I measure VO2 max just to know where we are. I'm trying to prevent injury in people.

• 1:11:35Dr. Darshan Shah?

  Yep.

• 1:11:35Speaker 01

  Right? Injury is the number one reason people stop being active. And, and so I put people in a, in the center of a mat. We have three 60 degree cameras. It's called Dari Motion. And we put them through a series of movements and I can tell that your ankle doesn't have enough motion to allow you to squat. Or you're compensating, this hip doesn't have enough motion. And you know, that, that helps us understand why you always get the same pain when you're ramping up exercise. Your left Achilles tendon hurts, your right hip flexor hurts. Well, it's because of this imbalance or something. So those are some of the things that I do when people are serious about wanting to make change. And then we build them a plan.

• 1:12:18Speaker 01

  And it seems like a lot, I mean, not to mention nutrition. It seems like a lot, but again, we layer on interventions. We start with one that feels most comfortable to them. And then we layer them on because what happens is you showed me you're a beautiful recovery space. What happens is when you have the base, the, the lifestyle that we've described, the better, building better bones lifestyle, the five things. It's not hard anymore because it's just how you live. Sometimes people, when I'm out to eat, they'll watch what I eat. They're like, what's she eating? Cause I know what she believes that she, and they're like, oh, it's so hard. And I'm like, it actually, it's not hard because it's just how I eat, right? That's when my goal last year was to layer on a sauna.

• 1:13:02Speaker 01

  Because of the health benefits of sauna. And once that's a habit, maybe I'll layer on something else. So just because people don't have to do everything at one time. It's overwhelming.

• 1:13:12Dr. Darshan Shah?

  Yeah, I love that. Can I ask you about the beta galactase test that you do for the senescent cells? Beta gal, right. Can you talk a little bit about what that test is testing for?

• 1:13:22Speaker 01

  Yeah.

• 1:13:23Dr. Darshan Shah?

  Why it's important and what can you do about it?

• 1:13:25Speaker 01

  So many years ago now, and they keep expanding. Papers were written describing the hallmarks of aging. Started with six, now I think there's 13. Senescence is one of the hallmarks of aging. And what does that mean? Well, in our bodies, cells have four destinations. You can be a stem cell, which means you are pluripotent. You have the capacity under the correct environment and correct hormonal stimulation to become anything. It's like when mesenchymal stem cells can become bone, fat, or muscle, depending on the stimulation. Right? So stem cells. Then you have mature cells, the bone, the muscle, the fat cells.

• 1:14:06Speaker 01

  Doing their job, as a cell does its job and divides, it accumulates damage. There's waste and there's free radicals, inflammation that happened. When a cell has done their job long enough and they've accumulated enough damage, they are supposed to turn on the genes that lead to apoptosis, which is programmed cell death. Death in a cell is an active process. Just doesn't happen. But there is a population called senescent cells that are neither living nor dying. They are so damaged, they cannot turn on the genes for apoptosis. They're circulating around, spewing out a variety of noxious cytokines and a heavy senescent load.

• 1:14:53Speaker 01

  Can lead to enough cytokines that it stimulates cancer, rapid aging, high levels of inflammation. So we want through our lifestyles, through the way we eat, to decrease our senescent load. You can measure absolute senescent cells by cell surface markers using PCR. And that's very expensive. Some labs will do it. Or you can measure the level of this molecule called beta-gal as a substitute for your senescent load. So I do that in my people. And frankly, in in unprogrammed people, people just walking off the street like, I gotta do something. Senescent load is so high.

• 1:15:35Speaker 01

  And when I explain to people that these zombie cells are neither living nor dead, but they're just wreaking havoc. It's a scary thing for people. So we change nutrition, anti-inflammatory nutrition. We do all the things we've already talked about. I like to add a supplement called Phytin. You love that, or Qusertin, right? There's a lab out in Vail that's done a lot of work on Phytin and measuring senescent load. It's a lab of Johnny Huard. And you can really decrease senescent load with all the ways we've talked about. So it's just something we do.

• 1:16:09Dr. Darshan Shah?

  Yeah, and part of, you know, this new longevity landscape.

• 1:16:13Speaker 01

  Yeah.

• 1:16:13Dr. Darshan Shah?

  I think a lot of people think, well, this is high tech and this is all, it might not be proven science, but we know the utility of this. And it actually does lead to longer health spans. If you can clear some of these senescent cells. So, yeah, once every two or three months, I'll do a supplement, a senolytic supplement that I like from a company called Qualia. They have a, they have a really good blend of Phytin and Qusertin.

• 1:16:39Speaker 01

  Oh, it's a, it's a, it's a mixed. I might check that out. Yeah.

• 1:16:43Dr. Darshan Shah?

  Yeah, and it just comes in like a little two week kind of protocol. Because you don't want to be on these all the time, right? And so you want to do it as a protocol. And beta-gal is a great way to measure. Fasting, I've found, not for everyone, but for some people, when they do like a three day fast, can reduce their senescent load. I don't know if you've tried that.

• 1:17:04Speaker 01

  You know what? I will occasionally, or once a month or so, do a 24 hour. I've never tried to do a three day.

• 1:17:11Dr. Darshan Shah?

  Yes.

• 1:17:12Speaker 01

  How's that feel?

• 1:17:13Dr. Darshan Shah?

  It's hard.

• 1:17:14Speaker 01

  Yeah.

• 1:17:14Dr. Darshan Shah?

  There's, I had Dr. Vulture Longo on this show. He's developed a five-day fast that is fasting mimicking. So you get the same benefits, but you get to take in things like 500 or 600 calories of food. And the system is called ProLon. And so that's also been helpful for a lot of patients. I think there's definitely some really good science. And metagal's been an incredible biomarker to test and see who it's going to work on. Right? So a lot of times people are skeptical and then we'll do a metagal and then we'll do a fasting protocol and measure after. And so that's helpful.

• 1:17:50Speaker 01

  I think that's an important point, that when they're, when we are capable of measuring the delta, we should measure it. Right? I also, I thought where you were going to go with the evidence, because you're right. And in longevity medicine, there's, there's more thinking outside the box than a randomized controlled trial. But I have become surprisingly and more and more open to the thought of, in Chinese medicine and Ayurvedic medicine, these are 5,000-year-old philosophies. And how can all of that be wrong? So I become, I was asked this recently at a, at a biohacking conference.

• 1:18:34Speaker 01

  Somebody got up almost to challenge me. They're like, so allopathic surgeon, you're surrounded by all these people. And, and I truthfully answered that I think we have to be more open to 5,000 years of philosophy and history. And it has nothing to do with religion. It has to do with the, the herbal part of it, the, the medicine part that comes from nature. Do you think that?

• 1:19:00Dr. Darshan Shah?

  My dad was an Ayurvedic physician.

• 1:19:01Speaker 01

  He was?

• 1:19:02Dr. Darshan Shah?

  Yes. So I grew up with Ayurveda.

• 1:19:04Speaker 01

  Yeah.

• 1:19:05Dr. Darshan Shah?

  I also did some formal Ayurvedic training as well with Deepak Chopra and his institute down there. And I'm a huge believer in

• 1:19:15Dr. Darshan Shah?

  Understanding that there's definitely something there. It might not work for everybody, or just even be the right thing for someone to try. But if you do these little mini experiments on yourself and you actually see movement in the way you feel, or biomarker like beta-gal, or even your wearable device, like there's sometimes I'll do some Ayurvedic treatments and my HRV will get better. And so if it's working for you, why not use this, right? Because the level of harm is actually very low and the level of potential benefit is actually very high. So, yes, I think it's something that even though we don't have a randomized controlled trial for, you and I were both raised in medicine the same way.

• 1:19:56Dr. Darshan Shah?

  If there's not a randomized controlled trial, not even think about doing it. And now I think we've both come full circle to understanding that not everything needs a randomized controlled trial. Randomized controlled trials are great for the pharmaceutical industry.

• 1:20:09Speaker 01

  Yes, because we're protecting against new molecules, maybe, right?

• 1:20:14Dr. Darshan Shah?

  Exactly, right. Yeah, but they are horrible for nutrition advice, advice on exercise, et cetera. We can do the best we can, but when you have multi variables that you're trying to study, the randomized controlled trial kind of falls short there. So, no, that's really great mindset that I think both of us have gotten into and I'm trying to get more physicians to get into that mindset.

• 1:20:35Speaker 01

  I think it's just an unknown, right? It's an unknown.

• 1:20:38Dr. Darshan Shah?

  Exactly, exactly. So I want to ask you, your clinic is in Atlanta, right?

• 1:20:43Speaker 01

  Actually, it's in Orlando. I moved it to Orlando.

• 1:20:46Dr. Darshan Shah?

  You did, okay. Where in Orlando?

• 1:20:48Speaker 01

  You know what? It is in this enclave of creative thinkers called Lake Nona. You know this place, right?

• 1:20:57Dr. Darshan Shah?

  I've been to Lake Nona.

• 1:20:58Speaker 01

  Yes. Deepak comes there all the time. In fact, in my building, there's the Deepak Chopra Mind Body Zone, right? So I specifically moved to this place because it's filled with innovative thinkers, like minded people. And I thought at this point in my career, I wanted to be surrounded by that kind of creativity and aspirational living.

• 1:21:21Dr. Darshan Shah?

  I love that. You know, I toured Lake Nona because we were looking at opening a next health there. And we probably will open a clinic there at some point.

• 1:21:29Speaker 01

  Yeah.

• 1:21:29Dr. Darshan Shah?

  And they do a conference every year.

• 1:21:31Speaker 01

  Yeah, the Impact Forum. It's coming up, actually.

• 1:21:34Dr. Darshan Shah?

  Yeah, it is. Are you speaking at it?

• 1:21:36Speaker 01

  You know, this is the first year in 12 years I am not. And I'm speaking in actually Australia, which is very exciting.

• 1:21:43Dr. Darshan Shah?

  That's exciting.

• 1:21:43Speaker 01

  But I love the Lake Nona Impact Forum, and that's why you were there, is because it brings together innovators in health. And I swear to you, that is where health is predicted, is the first time many years ago now, that I heard about the importance of mental health. Right? It was the first time, just three years ago, that they had multiple sessions on, I always mispronounce this, psilocybin, mushrooms, right?

• 1:22:13Dr. Darshan Shah?

  Psilocybin.

• 1:22:13Speaker 01

  Psilocybin. And at the time, I'm not, I'm, I said, what? But, but, you know, somehow, three to five years ahead of what's going to be out there, Lake Nona Impact Forum talks about it. And so imagine living in a place where that's the atmosphere.

• 1:22:33Dr. Darshan Shah?

  Yeah, no, that is, that is amazing that you're there. And I can't wait to be out there myself one of these days with one of our clinics as well. It's definitely the perfect spot for it.

• 1:22:41Speaker 01

  It's the perfect spot.

• 1:22:42Dr. Darshan Shah?

  Yeah. And you still have a clinical practice in surgery as well, right? So are you traveling or are you doing everything in Orlando?

• 1:22:50Speaker 01

  So I only operate in Orlando. And so my practice, my fellowship is in sports medicine.

• 1:22:57Dr. Darshan Shah?

  Right.

• 1:22:57Speaker 01

  So my career has been shoulder, hip and knee arthroscopy. I was one of the first hip arthroscopists in the country, which is a, you know, putting cameras in hips. I love technology. So now I'm doing my scopes with needles. We don't even make incisions. We use needle scopes. That's a technology out for. Arthrax, which is fascinating. But what it does for patients is there is no narcotic use. There is rapid recovery and you don't have to have general anesthesia. All the positives, right? So I still do surgery and then I have this bespoke longevity practice. And then because of this rise in the conversation about menopause, I also take care of women

• 1:23:41Speaker 01

  who are in menopause and want me to to distill the confusion and build programs for them and help them just feel like themselves again.

• 1:23:51Dr. Darshan Shah?

  Wow, that's fantastic. You have a really incredible, all encompassing practice that is focused on.

• 1:23:58Speaker 01

  The whole person.

• 1:23:58Dr. Darshan Shah?

  The whole person, yes. And really, you know, I love the focus on musculoskeletal and how important it is in your practice as well. I haven't heard of too many people doing the 360 camera.

• 1:24:11Speaker 01

  The Dari Motion.

• 1:24:12Dr. Darshan Shah?

  The Dari Motion, yes.

• 1:24:13Speaker 01

  Yeah, well, it's great to have the technology available. There are some apps that will do it, but what happens is people try to do the best they can and they go too hard, too fast, too soon. They end up in my office. It takes three to six weeks to feel better and then their brain's angry at them because they're not getting the exercise dopamine and their body's angry with them because they've gotten out of shape. And so if we can prevent that, especially in I treat a lot of weekend warriors who can just try to fit it in. So we're just going to keep people healthy and, you know, I treat a, I treat a probably more than I should of retired professional athletes.

• 1:24:54Speaker 01

  My husband's a professional, was a professional athlete and so keeping those old athletes together.

• 1:25:00Dr. Darshan Shah?

  Yes.

• 1:25:00Speaker 01

  Is part of what I, so it's fun. It's everything.

• 1:25:03Dr. Darshan Shah?

  It's everything.

• 1:25:04Speaker 01

  It's everything.

• 1:25:04Dr. Darshan Shah?

  Yeah, I remember the facility now, now that you've been here, like known, I remember they had the Dari Motion camera.

• 1:25:09Speaker 01

  That's right.

• 1:25:10Dr. Darshan Shah?

  I think Indigo San Milan worked with them on their V2 Max testing.

• 1:25:13Speaker 01

  That's right. It's his lactate threshold test we use.

• 1:25:16Dr. Darshan Shah?

  His lactate threshold test. So that's a really great program that you've put together. So how can people find you if they would love to come into your clinical practice?

• 1:25:24Speaker 01

  So. In the universe, you can find me at Dr. Von der Wright, which is my website, D R Von der Wright, on Instagram every day. Today, I'll be educating about something at Dr. Von der Wright. But I think I am the right doctor for an orthopedic patient who has aspirational goals. I am not the right doctor for you if you just want me to help you sit still, right? Even if your problem is arthritis. So if that's your goal, then I might be the right doctor for you. But on the longevity side and the menopause side, I am the right doctor for you if you want to be treated like a whole person. I am going to build you a musculoskeletal program.

• 1:26:09Speaker 01

  We're gonna not just do the blood work or because I'm so fortunate to be a musculoskeletal doctor and have done the musculoskeletal research, it's an entire package for you because you're a whole person. You're not just one thing.

• 1:26:23Dr. Darshan Shah?

  And you've written some books in the past?

• 1:26:25Speaker 01

  I have. I've written several books in the past, not textbooks. I just wrote one on raising a healthy youth athlete. We didn't even talk about that today, but it's been a large part of my sports career on taking care of masters athletes, but then several healthy aging books. But the one I'm very excited about coming up is being released in November. Look for it. It's called Unbreakable: Go Strong, Live Long, Age With Power.

• 1:26:49Dr. Darshan Shah?

  Oh, I love that.

• 1:26:50Speaker 01

  And it's the musculoskeletal approach to longevity and aging.

• 1:26:54Dr. Darshan Shah?

  Oh, I can't wait for that book to come out in November.

• 1:26:57Speaker 01

  In November, but but if you go to my website, we have a waitlist, so you cannot miss it.

• 1:27:02Dr. Darshan Shah?

  Great. Well, we'll definitely make sure we get this podcast out to people before then.

• 1:27:06Speaker 01

  Thank you.

• 1:27:06Dr. Darshan Shah?

  And and your Instagram is incredibly educational. I love the bite sized pieces of knowledge that you spread out there. Well, Dr. Wright, it's been an absolute pleasure to have you on this show. Thank you so much for joining me today.

• 1:27:20Speaker 01

  Oh, it's an honor. I love I love your positive energy.

• 1:27:23Dr. Darshan Shah?

  Thank you. I love yours as well, and I can't wait to see you in Lake Nona next time when I'm out there. And definitely want to have you back on again.

• 1:27:30Speaker 01

  Thank you.

• 1:27:30Dr. Darshan Shah?

  After your book comes out, maybe we can talk more about about Unbreakable.

• 1:27:34Speaker 01

  Yeah, let's talk about it.

• 1:27:35Dr. Darshan Shah?

  Thank you.

• 1:27:35Speaker 01

  Thanks.

• 1:27:41Dr. Darshan Shah?

  I always love talking to Dr. Wright. She is such a wealth of information. So to summarize that episode, here are my 10 top takeaways. Number one, prioritize your bone health early. Women can lose up to 20% of their bone density within the first five years of menopause. Men can also lose a significant amount of their bone as well after andropause. So it's crucial to start monitoring your bone health with scans like a DEXA scan by age 40 to establish a baseline and take proactive measures to maintain your bone density. Number two, you want to engage in weight-bearing exercise. So to build and maintain your bone density, incorporating weight-bearing exercise like jumping and lifting heavy weights and resistance training are critical.

• 1:28:26Dr. Darshan Shah?

  Walking alone is insufficient for your bone health. Aiming for exercises that create impact on your bones and stress the bones is what really keeps your bone healthy and regenerating. Number three, understanding the role of your hormones is critical. Hormone replacement therapy can be beneficial for men and women experiencing menopause or menopause. Estrogen plays a vital role in bone health for women. Discussing the potential benefits and risks of HRT with a healthcare provider who is experienced with the benefits hormone replacement therapy can help all women and men make informed decisions. Number four, adopt an anti-inflammatory diet. Nutrition significantly impacts your bone health.

• 1:29:07Dr. Darshan Shah?

  Focus on a diet rich in protein, vitamin D and K2, magnesium, and anti-inflammatory foods. This can help reduce chronic inflammation, which is detrimental to your bone density. Number five, incorporate flexibility and balance into your training routine. Regularly practicing flexibility and balance exercises like yoga or Tai Chi can help maintain your joint health, but also prevent falls. Simple activities like standing on one leg while brushing your teeth can help you enhance your balance and your stability and prevent falls later on in life. Number six, monitor your load of senescent cells. So these are the zombie cells that secrete toxic substances to the neighboring cells. There's a new test called the beta galactosidase,

• 1:29:51Dr. Darshan Shah?

  and this level can help you assess your senescent cell load and implement lifestyle changes. Number seven, utilize new technology to monitor your health. Dr. Wright highly recommends leveraging wearable devices and advanced testing, like VO2 max testing and lactate threshold testing, to monitor your fitness levels and your metabolic health. Understanding how your body responds can help you tailor an exercise program effectively. Number eight, combat sedentary behavior by engaging in regular movement. Set a timer to remind yourself to take a short break every 45 minutes, and stand, stretch, or walk around. This can help mitigate the negative effects of prolonged sitting and sedentary behavior. Number nine, embrace lifelong learning and adaptation. Health is a lifelong journey,

• 1:30:36Dr. Darshan Shah?

  so stay informed about new research and practices and health and wellness by listening to podcasts like this one, and be open to adapting your lifestyle as you age. And number 10, foster a supportive community. Surrounding yourself with like-minded individuals who prioritize health and wellness is key. Engaging in group activities, whether you're a fitness class goer or going to health seminars, can help motivate you and give you accountability in your journey towards better health and longevity. Thank you, everyone, for joining me. If you know someone that might be curious about their bone health, please send this episode to them. I look forward to speaking more on our next episode of the Extend Podcast.

• 1:31:15Dr. 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.