Strong Is Ageless: How to Age with Power, Strength & Science with Dr. Vonda Wright

Dr. Mindy Pelz 0:02 On this episode of The Resetter podcast, I bring you Dr. Vonda Wright, and we are going to talk about menopause and the musculoskeletal system. And it's a really cool conversation for a variety of reasons, but one of them is, you're going to want to get a pen and a pad of paper, because has she got some incredible ways that we can keep our muscular skeletal system strong, healthy and functioning well into our hundreds. So let's talk about who Dr Wright is. So she is an orthopedic surgeon. She has worked with a lot of elite sports teams. She had this isn't her first book. She actually has a book coming out. She's done several books, and she has literally been in the trenches with athletes, non athletes, women, men, for years. And what I love about Dr Wright, and why I wanted to bring her to you, is she now has mastered a formula for musculoskeletal health and menopause. So what you're going to learn in this conversation is you're going to learn that when estrogen goes down, this is the beginning of things like injuries from our activities, joint replacement, osteoporosis, and there are some really simple ways that we can start to prevent this. And it doesn't matter if you're 70 and hearing this, or you're 30 and hearing it, she has some really smart strategies for making sure that we prevent osteoporosis, we prevent hip replacement, and that we stop injuring ourselves so so we go through that. We also spent a lot of time talking about nutrition and what do we need to know about the way we eat for our musculoskeletal system, we broke down every single exercise you could think of. I we went from Pilates to yoga to rucking to weight lifting to how often should you be weight lifting to what kind of muscle? Muscles are you? Are you trying to activate when you weight lift? So it, you know, a lot of times when I bring you all podcasts, there's a lot of theories and philosophies and mindset. This one is application, and I'm really excited to bring it to you. She has a new book coming out called unbreakable. We will leave links for it. I highly recommend that you grab a copy and sit back and enjoy the her, her humor, her straightforwardness I absolutely loved, and it's just a really profound and fun discussion that I know is going to help you move your health forward and give you a new vision of what fitness can look like as we age so dr, Vonda Wright and unbreakable, enjoy. Welcome to the resetter podcast. This podcast is all about empowering you to believe in yourself again, if you have a passion for learning, if you're looking to be in control of your health and take your power back, this is the podcast for you. Dr. Mindy Pelz 3:34 I am just so excited to have this conversation with you. So Dr. Vonda Wright 3:37 welcome. Thank you. And you know what I have to tell you, like so many of the digital world, I feel like I've known you for years, so I'm really so happy to sit across a desk from you. Dr. Mindy Pelz 3:48 Yeah, thank you. I have to tell you that I think the menopausal conversation has been really interesting to watch how it has transpired, and I always say we went from a cultural hush to cultural chaos, and then somewhere along this like emergence, I saw your work, and I was like, Yes, well, let's talk about the musculoskeletal system and how it changed. Because not only did I have major injuries as an athlete going through my menopausal experience, but I had a practice full of menopausal women that I didn't really understand what was going on until people like you really emerged and taught us so. So thank you. I'm so happy you wrote this Dr. Vonda Wright 4:31 book. Pleasure, my pleasure. Yeah. Okay, Dr. Mindy Pelz 4:35 so here's the first heart space. What I want to know is, what is it like to be a female orthopedic surgeon. Let's just start off with that. Oh, my God. Dr. Vonda Wright 4:44 So, you know, we're the fun people in medicine, right? Everybody going to, all the guys going to orthopedic surgery. 94% are guys. Now, when I trained so, so long ago, there were 3% so between, you know. Then and Now we've doubled, which means it's going to take us 150 years to God, I've never Dr. Mindy Pelz 5:07 fast a little more. Dr. Vonda Wright 5:08 We're trying really hard, but so 94% guys, and we're the fun guys, right? Because we're all the old athletes, where they're the engineers, but even they're fun engineers, and we get to do fun things, by and large, except for this, musculoskeletal oncologists and some of the pediatric stuff, most of what we do is fun and aspirational. Imagine I have spent my life making people walk again. Speaker 1 5:35 Yes, right shoulders again, yes. Well, every Dr. Vonda Wright 5:39 time one of my golfers that I fix his shoulder does a hole in one. I'm like, you know, that's mine. So it's really aspirational. It's Dr. Mindy Pelz 5:48 beautiful. Dr. Vonda Wright 5:50 But what an honor. You know? I mean, for for for doctors, it's such an honor. People trust us with a lot of important things, sometimes the first time they meet us, and that's a that's an honor, that's sacred, and so, yeah, so we're the fun people, but we take what we do so seriously, like you can imagine academic meetings, there are these big debates on where the two millimeters we put the ACL screw. I'm like, You're from an outsider. You're like, it's two millimeters, right? But Dr. Mindy Pelz 6:25 it's really, wow, wow. So were you in practice and doing surgeries on both men and women and then seeing like a trend in menopausal women? Is it like I would think, you know, my my husband just had hip replacement surgery, and I was like, I was like, did anybody take a picture of his hip? Like, exactly, I would have been in there watching, if they would have let me watch. Because I wanted to, like, see how, where it had degenerated and all that. So I would think, if you had the opportunity to open up a lot of menopausal women's hips and shoulders that you saw something most of us didn't see. So Dr. Vonda Wright 7:04 my practice, just to answer the first question and then tell you how I got into where I am now, is, you know, I'm a fellowship trained sports doctor, so my job is not only that sports surgery, but I'm a team doctor, so meaning that I'm the guy on the field and all the football I was the head football doctor for University of Pittsburgh and all their Olympic sports teams. And so there's the team doctor side of that. And the reality is, most of the teams I took care of were men's athletics. I had a few female teams, rugby teams, but just the way it worked out. But in 2012 Mindy, I read a statistic that women make 80% of all the healthcare decisions in this country for themselves and everyone we touch, and it just a light bulb went off, because we're 51% of the population, and therefore 50% of my all my patients, athlete or not, were women. And so when I went through my own menopause more than a decade ago, it hit me, I tell the story 40 best shape of my life. I had a baby. I'm training for all kinds of things. I've got, God knows, I'll never get back to it. 19% body fat. And then 47 about killed me, right? And I became a scholar, not only of women, but of menopause. And really it's such a deep dive, I consider myself an expert, especially within the lane of musculoskeletal because here's what women would say to me once I started listening with menopausal ears. I'm sure you've heard this in your own practice. I don't know what happened. Yep, think I'm falling apart. Yep, yep. Do you know what else I might be going crazy because I talked to my other doctor about it, and they said, nothing's wrong with you. You're just getting old. Yep. Here's the part that killed me, and this is what really keeps me so focused, they say to me without prompting. But you know what? I didn't want to come in today because I have a very high pain tolerance, like it's a button, right? Yeah, right. Pain tolerance, but Doc, I just can't take it anymore, and in a very defeated way. And I'm a musculoskeletal doctor, but people are weeping because it's so hard. So I decided once I started listening with those ears, the ears that come with experiencing it. I love that academic, right? It's more than reading in an orchestra study, I lived it, and musculoskeletal syndrome and menopause was one of my biggest symptoms, right? I couldn't get out of bed. So painful. Wow, and we can talk about all those things. That is when I really became committed to exposing what affects 80% of all women, at almost the same rate as hot flashes, night sweats and brain flu. Dog is the musculoskeletal syndrome of menopause, yep, yep, Dr. Mindy Pelz 10:03 yeah. And so let's launch from there. If, as women are listening to this, I feel like there's some like, golden rules we need to follow when we go into our perimenopausal years, like, are there things that we should we should start doing differently? I can tell you for me, I was a ex tennis player in college, and I turned me into a runner, and all of a sudden, at 43 I was injury upon injury upon injury. And it took me several years to figure out, oh, wait, something has shifted as my hormones have shifted, and so I had to change the way I worked out. So what are some of those ground rules that we need to know when you're going into menopause as far as your musculoskeletal system goes? Dr. Vonda Wright 10:52 Well, I think it's helpful to know that muscle, tendon, ligament, bone, fat, satellite, stem cells, cartilage, disc, annulus in the back. You know, they are all from the same stem cell, so they're all going to respond, in a cousin like way, to estrogen. Every one of those tissues has estrogen, alpha and beta receptors on them that keep them healthy. Cartilage. For instance, the matrix is like a mesh, if you will, with estrogen receptors and without estrogen sitting there, the matrix starts to fall apart such that here's men before 50 have more arthritis. Women after 50 without estrogen have rapid increase in arthritis in the hips, the knees, the hands. So the first thing women have to know going through what I call, I call this thing, I like to make up words, so I call this transition the metal lessons, to be, yeah, to be reminiscent of the chaos of adolescence, like people get that, right? Oh, that's that's good, yeah, metal essence is awesome. We're exiting our hormones the way we came into them, and total chaos. Number one thing to go into is to recognize this is different, right? The same things are not going to work. Now that worked, then this is a different life stage to embrace, so in every tissue in the musculoskeletal system. So it follows that, for instance, if your tendons and ligaments naturally with age increase, these are, these are supposed to be collagen fibers, covalent bonding and get tighter, and then they don't have estrogen to help repair the micro tears. We're going to have more tendonitis, on top of the fact that estrogen is a huge anti inflammatory. It works directly on the immune system. It modulates immune cytokines. We're more inflamed, so the micro environment's hot and bothered. We have less regenerative capacity, and just the natural aging. We're getting tighter, so we're more prone to things like tennis elbow, Achilles tendonitis, and so just recognizing, oh, my God, it's not the same. I can't just rest for two days. I have to have a mobility practice to stretch out my tendons right, to to keep my joints moving so the synovial fluid continues to be produced, and we don't dry up like A Raisin in the Sun, right? Yep. So recognition. What Dr. Mindy Pelz 13:42 age do you think that starts at? Yeah, you Dr. Vonda Wright 13:44 know what perimenopause, on average in this country is about 45 however, it can be much earlier. It can be 35 right? I and it all comes down to and your listeners know this to the fact that by about age 40 we have one to 3% of our eggs left, right? So we're not producing enough estrogen, and by the time it catches up, or people recognize that they're like, they're about 45 with complete cessation of our menstruation, on average in this country, about 52 right? But I call the decade between 35 and 45 the critical decade to get your shit together. Here's why, here's why. Because I wish I had done it. Yeah, me too. Me too. Because I don't know about you. You were an athlete. I was an athlete. If I saw I was gaining a little weight or I was sore, it was a really quick fix for me. Yep, and I'm, you know what? This is so ironic. I am a musculoskeletal aging researcher. I don't think I thought it would ever happen to me. Oh, yeah, that's interesting. But if you're listening, please recognize that between 35 and 45 535. You still have all your hormones. By and large, you've got this youthful vigor. 45 you're going to start to be chaotically perimenopause when things change. Let's make sure we have learned what's coming. Let's make sure we establish a standard of our nutrition, right? Because when we get to 45 or even later, 52 when menopause happens, if we're suddenly having to create six or seven new lifestyle things, it is so like, people are like, What should I do now, Vonda, and if they're 55 I'm like this, and listen, right, right, right. But at 35 if we layer in, how are we going to have an anti inflammatory diet? How are we going to eat enough protein? And what does that even mean? If we think about, okay, at 35 How do I start lifting in a way that's going to help me stimulate muscle protein synthesis and not just hold endurance right? I think starting early and layering on the lifestyles by the time we get to be perimenopausal, when hormones may or may not be helping us at all our endogenous hormones. It's not such a shock. It's not so hard, yeah. So that was Dr. Mindy Pelz 16:33 yeah, no. It's I really like getting ahead of it. I think that is a really important point. And it was interesting. As you were talking, I was thinking, yeah, that when I was 43 that's how I found fasting, because I, like you, anytime I needed to drop a few pounds, I would just put a couple more hours in each week on the, you know, running, and it would make it go, yeah, run a little more. But then the injury kept piling upon injury upon injury, and I was like, What is going on, and so I that's when I learned about fasting. I was like, Oh, wait, I can actually get my weight to drop doing it that way. Yeah. What's interesting about what you're saying is that you're using nutrition like most people would use supplements, or they would use medication, like, I love this idea of like, bringing it in in the beginning, so that you can keep that a good foundation of inflammation down. And then my question is, collagen, is it? Would it be worth it to to eat collagen, rich foods, especially in those early, early perimenopausal years? Dr. Vonda Wright 17:37 Well, I think the best state on collagen, and I'm not an expert, but I think the best data on collagen happens to be surrounding bones and muscle actually. Okay, yeah. And so, you know, there's some data that you can increase bone density one to 2% a year by supplementing with the right kind of collagen. Imagine entering the critical decade maxed out on everything with the best bone density right before losing your estrogen with the best muscle, yeah, and so pulling in all the tools. I don't think it's one thing. I think, yeah, if I look at the and I'm I mean, we're both deep into the longevity community. We both appear at these same things. And I think what happens sometimes is we think one gadget is going to do it for us, right, right, shiny tool. And that's not my experience as a clinician. It is this constant. It's this ecosystem. As we like to say, it's not one little thing you turn on with the switch. Well, that's why I talk about it like this, Dr. Mindy Pelz 18:37 yeah. You know, I, I was doing it all the biohacking, everything for so many years, and one day it hit me, I don't think you can hack a woman's body. You can't, like hack into it. You have to harmonize it. It's not a body that's hackable, and it's a body that needs love and nourishment and needs a rhythm to it. And so I really work in a rhythmic Dr. Vonda Wright 19:04 when you think about a month, there's a rhythm of our complexity, hormones up, hormones down. We exchange different versus, you know, men get their testosterone and it slowly declines. And so you may be more inclined to hack that right. Unknown Speaker 19:20 That's another topic. Dr. Vonda Wright 19:23 I've made several comments. I really do love men. I'm married, Unknown Speaker 19:28 but yeah, right, there we go. Dr. Mindy Pelz 19:32 Yeah. Well, it's our moment too. We're having our moment. We're finally, finally getting to stand on our soapbox and scream from the rooftop. So, okay, so we've got nutrition. You're going to make some nutrition changes. Okay, what else could I do as I'm going through this transition Dr. Vonda Wright 19:48 so in the critical decade? Please, please, please, please, use Pilates and yoga as your movement. I sing. Yeah, but your meat and potatoes has to be building muscle mass, yeah, yeah, while you still have your estrogen, I say, do it while you have estrogen, do a while. You can do it later. You sure can. And I'm working my butt off to try. And I know you are too, yeah, your endogenous estrogen is is easier to make muscle with as a stimulus. So learn to lift. You don't have to lift heavy when you're 30. You should. It depends what you want. If we want to go into prescription of lifting, people criticize me a lot because I mostly talk about heavy lifting. I don't care how you lift, but it depends why you're lifting. So if you're if you're younger, and you want to build endurance, then lift for endurance. Do tons of reps with the lightest weight possible, to 25 to failure. I would never do that. How boring is that? But anyway, that's a lot of joint motion. That's a lot of joint method if you want hypertrophy, which is what people in their 30s and or generally want, well, that's a mid range rep set as a solidly post menopausal woman like me, I am lifting for strength and power, which requires heavier lifts, so in the younger years, which is what you've asked me about, let's build a foundation so our knows how to lift hypertrophy, so you know the form, so that as you progress and need that strategic stress of lifting heavier, you don't have to start At zero off the couch, because that's a lot. Dr. Mindy Pelz 21:42 Yes, yes, yeah, I would definitely say I fell in the camp in the 40s. I because I love to run. I fell into and I love yoga, so I fell in that camp. And when I went to go lift weights, when I lifted weights in my 20s, in college, because we had to it was like, I could look at a barbell and poof, I got like, muscle now I'm like, I'm like, two years ago, I'm 55 two years ago, I went into the I hired a trainer. I was like, I need to build muscle. Oh, my God. We were working so hard for so many months. And then I would look in the mirror, and I'm like, it feels like I'm doing nothing. So it Yeah, so I think you're really on to something. If you don't, if you, if you, you would say 40s, late 30s, like, switch away from your cardio and and really look at weight lifting. Is that what you're saying is, like, the critical time period, Dr. Vonda Wright 22:39 I think cardio is important. They do two separate things, right? We want a big we want a strong cardiovascular engine. Listen, disease kills is the number one killer of men and women. I'm not seeing abandoned cardio. What I am saying, though, is it cannot be the only thing you do. I'll tell you, from an orthopedic doctor standpoint, and I'm sorry runners, when I say this, and I was a runner, I've run multiple yep, I get it. We get i If I hear one more runner telling me they don't lift with their legs because they run, oh God, that is a surefire way to end up in my clinic with some kind of butt pain because your glutes don't fire, or or because you've got pelvic instability, and instead of running in a straight line, you're running like a weeble, right? Are you running as a single leg sport? You have to be able to balance in a, in a in a mini squat, without falling over to run well, otherwise you're adjusting all the time. So when I So, when I say cardio is important, but if we're looking at it from a health span and longevity, I want you to this is just how I prescribe it. There's many ways to do it, unless you're training for a big race, unless you're a training athlete, again, running another marathon, 80% of the time send spending base training so we build mitochondrial flexibility. We're burning fat. We're at our lactate threshold 20% of the time. And I'll tell you, this is not based on my research. It's based on there's a researcher here in my building that trains Tour de France athletes, yeah. Oh, wow. So, so 80% of the time based training 20% of the time, we are gunning it as fast as it's safe for our heart, so that we get so that give our bodies that positive stress, working in that high zone to stimulate all the all the muscle protein synthesis and cardiac function. But we don't do that all the time, and that's what I see. The injured people coming into my office spend a lot of time at the highest, highest zones, and they're injured every three weeks, and then they have to recover, and then their brain's angry, no dopamine. So I'm not saying cardiac is not important. It's not the only thing anymore. Dr. Mindy Pelz 25:00 Sure, but, and what I hear you saying is, and if you're gonna do it, do some sprints, get the get the max cardiovascular and then get your butt to the gym and start lifting weights. Yeah, yeah. So with lifting weights, what are you a fan of, like, max amount of weight for eight reps? Or is there like, and is there like a formula you Dr. Vonda Wright 25:21 follow. So when we're lifting for strength and power, the strength and again, I'm about to I'm framing what I'm saying. Because now I Unknown Speaker 25:35 you can say, no, let it go. Let it out. Let Dr. Vonda Wright 25:38 it out of all the bros hopping out of the woodwork and telling me that, that I don't know what I'm talking about because, but listen, I've been, I've been in the locker rooms of the best athletes, training with their trainers, yeah, writing my own things, reading, I know what I'm taught. So yeah, I'm just, I'm just responding in my own head, this Dr. Mindy Pelz 25:56 internal, course, I love it. I'm watching what you're doing. I know it's beautiful. Dr. Vonda Wright 25:59 So listen, I prescribe power lifting, upper body, push, upper body, pull lower body, push and pull for the four power lifts. So bench press, some kind of pull, dead lift and squat. Those are the lifts that I want you to lift to failure, but to get to failure in a lift range of three to six now. Oh, nice. I've been do I've been taking care of people so long that I know for sure they want to be they want a specific instruction. So I have chosen four it's what I do. It's what my strength conditioning coach taught me to do, four reps to failure. So what does that mean? I can pound out four reps. I can if I'm bench pressing, I can do five like this. But if I try six, one arm's coming down and I'm dumping the weights off, right? Four reps, four sets for each of the power lifts. Now that's not the whole story, but power lifts are complex. They do multiple joints. They involve your core, everything right to support that lift. I then on bench day, will do the supportive lifts, biceps, triceps, lats, delts, eight to 10 reps. I'm not trying love that until I Yeah. So that is the framework that, okay, that I use for midlife women, plus the core. So that basic framework builds strength. Dr. Mindy Pelz 27:29 Okay, when? How many days a week are we talking because you're doing the main muscles, Dr. Vonda Wright 27:34 minimum of two. I'd love people to carve out four days, but two Dr. Mindy Pelz 27:41 and what would it? Would it look like two days of the power lifting and two days of the supportive lifting? Dr. Vonda Wright 27:47 No, so it's one power lift a day, if you're doing four days a week, one day and the supportive lifts to go. And there's some overlap, for instance, on a deadlift, deadlift supports might be some plyometrics might be some steps, not step ups with a weight. Might be some doublet squats might be some hamstrings and her muscles love variety. So it's, it's usually not the same thing for six weeks or so, but, but it's so that's how I do strength. Now, when you that may take six months to build up through from nothing. It may take nine months to get this form down. I had to expect nobody to go from couch to heavy lifting. It's a progression, but once we're solid in that, once we've been doing it for a while, if we want power, which is strength over time, then we add in some tempo lifting. Meaning, I hate this when my strength guy makes me do it, 123, down. Oh, yeah, I hate that. Closing up. I'm like, This is torture, but that's going to get me off the floor. When I'm on the floor, that power is going to keep me safe, right? Because we lose our type two muscle fibers with age, so building power the plyometric type things, that's what that's all for, not to torture us. Dr. Mindy Pelz 29:10 You also bring up a really good point, and something that my athletic brain had to think about in my 40s is that the purpose of working out became very different and right. Like I, like you mentioned dopamine earlier, like the pushing myself out of breath gave me the dopamine high, and I started not running as much because I kept getting injured. And so then all of a sudden, I had to call it forward movement exercise, because I thought if I called it, if I called it walking, I was criticizing myself. I was like, Are you seriously walking? And then the other part of my brain was like, No, I'm moving forward. It's a forward movement exercise. But then I realized that right left, right left movement was really calming to the nervous system. So all of a sudden, forward movement became my like, you know, Xanax. And so I really. Re patterned everything but strength training. What's interesting about strength training for most not maybe in your 40s, but if you start, if you're listening to this, and you're in your 50s, you're 55 it's not like you're going to do all this heavy lifting and look in the mirror and have bulging muscles. You're going to have security as you continue, and maybe you will, but it does for me, I've noticed it doesn't have the same visual effect, but where I notice it is when I'm standing in line and all of a sudden my posture feels better. Or you brought up the point, I reached down to pick something off the ground, and I'm like, Oh, wow, I'm can pop back up. So can you, can you talk a little bit about what we could expect if we follow a strength training protocol that might be as satisfying as looking in the mirror and seeing a muscle Dr. Vonda Wright 30:51 well? So here's what happens. The only people who pop out muscles like you're thinking are, I mean, some some people are genetically that way. You may work out forever, and it's just part of your cytoplasm. People with very low body fat, right? Will expose their muscles, right? You may have look at Discus Throwers or shot put throwers. Those are really muscular people, but they also have a lot of body fat, so they don't you don't see the definition, but what you will feel if you're a midlife woman, is your clothes will fit better, leaner profile, because you know you'll you'll burn some of the visceral fat. And I wrongly say, but I just for ease, I say we're exchanging fat for muscle, but it makes us leaner. When we get on a body composition, we're leaner. Makes our clothes fit better, because I say muscle is nature Spanx, hmm, that's beautiful. Really goes away a little bit, and so those are still satisfying, right? Yes, agreed. If I want to be really cut and lean, that is hard body builder work. You got to build by eating more calories to build the muscle, and then you don't look like you're lean at all. And then you got to suck all that off. And unless you're trying to do that, yep, what's the goal? I always return to, what are we working for? Right? I am working for strength and power along the way, my clothes fit better. I'm I'm leaner, I'm not quite as jiggly. I don't have to wear Spanx, right? So not that I don't like Sarah Blakely, I sure do. Dr. Mindy Pelz 32:34 I was gonna say, you know, hopefully Sarah's not listening. Dr. Vonda Wright 32:37 You, Sarah. I'm just trying to build some muscle. Yeah, Dr. Mindy Pelz 32:44 yeah. You bring up a really important point, because when I was in my 20s, I think most of us, when we were in our 20s and 30s, use cardio to get the same effect. You're saying, hey, when you go into menopause, use weight lifting to get the same effect you were trying to get in cardio in your 20s and 30s, is that? Is Dr. Vonda Wright 33:02 that accurate? And the fact of the matter is that you can have a big cardio engine and still not be strong in old age, can't, still get open the pickle jar, right? Maybe a lifelong runner, and still become frail because you can't, because you can't get up out of a chair, because running doesn't build the same kind of muscle that lifting does in the lower body. Dr. Mindy Pelz 33:27 No. And what about grip strength? You know, we have all these studies on how grip strength is a predictor of longevity, yeah. And what I've noticed in the weight lifting was that you're there's you have to hold the bar, you have to pull yourself up like there's a natural increase in your hand strength, and that has to be beneficial. Do we what do we know about grip strength and and its purpose through menopause? Dr. Vonda Wright 33:55 Yeah, you know what? There's a nd. Those studies are population studies. They're not done in athletes, not particularly in women per se. But what it showed is people who have had a better grip strength. I think the number in women is over 30 pounds of grip strength. Men over 50. I believe, if I'm remembering my numbers, well, it just infers, oh, better overall strength. It's not saying that you bench a certain amount of pounds. It just means, in general, you have upper body strength, which is always less than lower body strength. Remember, those are in populations. Those are population studies. What do we know about our population in the United States? At least 70% of people do no form of organized exercise at any time. So I think it's a predictor of longevity and frailty. Kind of a party trick, if you ask me, yeah, I wouldn't be satisfied I have a grip strength of whatever, over 35 that's not the end all be all. It doesn't mean I can stop working, Dr. Mindy Pelz 34:55 right? So I shouldn't buy one of those grip strength or like i. Only 20s, Dr. Vonda Wright 35:01 and I show people, I'm like, let's see what you can do. It's an awareness. You go to a group strength to 20, and you think, you're okay, you're not, yeah, Dr. Mindy Pelz 35:11 yeah. Okay. So we've got nutrition, we've got strength training our nd, we, I think we've said it. But you know, I'm curious if you strongly feel we should stop the long distance running, the spark racing, the cross fitting like is, all of that off the table as we go through this. Dr. Vonda Wright 35:32 No, I don't think I am not the orthopedic surgeon that is ever going to tell you to stop running, because it's going to give you arthritis. Number one, there's no data, no data at all. I am never going to stop you from from wanting to achieve a goal. I do spar races. I mean, I still, I mean, one of my my first Spartan Race was several years ago, as at that time, I was 56 and someone actually said that I was giving a speech, and as I walked on the introducers like and she ran her first Spartan Race at 56 and I started thinking, what does that have to do with it? I am right. I am capable. I believe that I'm going to try it and not die. So no, I am not saying but what I'm saying is you need to train differently, and you need to harness the wisdom of your age not to be a jackass out there. And just think that because you were 20 and could do it, you can do it now, right, right? You unless you've been training for that, keeping your tendons and ligaments springy, building muscle mass, feeding your body. Don't expect it to respond like it did the morning you woke up from partying the night before and you ran a race that doesn't happen at our age. No, right? So, yeah, Dr. Mindy Pelz 36:49 what about rucking? Rucking is making quite I'm sure you're getting asked this all the time. And I, I'll, I'll tell you my behind the scenes. I, I watched all the rucking, and I watched all the women that were rocking, and I the first thing I thought is, Are you fucking kidding me? I can't just go for a run. I can't just go for a hike. Now, I kind of put a goddamn weighted vest on like I was, like, I'm rebelling against this. You are. And then I put and Speaker 2 37:17 then I put one on. I loved it. What did you Dr. Vonda Wright 37:22 love about it? Dr. Mindy Pelz 37:23 Well, so at the time, I was living in LA, and our neighborhood had a really, like, steep hill, and so if I put it on and I walked up the hill, I had the same cardiovascular impact that I did as if I was running a sprint on it on a track, yeah, so, but I didn't have the joint jamming, and I got the high, and I got all of it, so then I was addicted. Dr. Vonda Wright 37:49 So I am so glad you said that, because the data are, you know, come on, the data on whether it builds bone density or kind of plus minus, really small. It's big in the it's really big in the menopause circles, and I'm never gonna encourage women not to do it, if it makes them feel like they're achieving something. But if it's the end of all and cure all, weighted vest, maybe they increase your bone density one to 3% consistently. But you know why I like it? Yeah, tell me. So I have a 20 pound weighted vest, exactly what you found. I can get the same work out at less intensity. My heart rate goes it's about 10 extra beats per minute. With this, with this, I wear a full vest, 10 extra beats per minute. I'm feeling all like badassery because I'm wearing this vest. But you know what the vest I have? I wear a rucksack vest. It has these little ties on the side. It does something to my nervous system. Oh, so it's like a hug, yes, like a it's like, you know you're upset, okay, hug from behind. Yes, calming my nervous. I don't know if that's real, yes, and I feel that, so it's a calming of my nervous system. Now it's, Dr. Mindy Pelz 39:11 I'm so happy you said that, because I thought the same thing. I came back and I was like, I am so happy and so calm, and I don't know what's going on. And I thought I it reminded me when my kids were in kindergarten, I remember there was a kid that was would act up in the in class all the time. Well, actually, what the mom did is she brought in a bunch of weighted frogs, like those, like, like frogs, like stuffy frogs, but they were heavy, like a bean bag. And it was a parent participation class, and she said, If Joey acts up, put a frog on his shoulder. And I remember at the time thinking that really like that's really going to help Joey in his in his tantrum. And then one day, I was in class, and Joey acted up, and I pulled a frog out and I put it on his back. And sure enough, he quieted. And. And then I started putting frogs on my these weighted frogs on my kids and on the I'm like, let's calm everybody down. And so when I put the wrecking vest on, I thought the same thing. It's like a weighted blanket. It's like a car. And at a time when our nervous system is so frazzled, yes, it gives you that added sense of security. Yes, some. And you know what, one day I was just wearing it around the house, cleaning the house. Oh, my daughter's like, Oh, you're wearing your vest. I'm like, it Dr. Vonda Wright 40:28 just does something to calm me. That Speaker 2 40:33 is, somebody needs to come up with, like, a funny meme where, like, a menopausal woman is, like, highly agitated, then she puts a rocking vest on. It's like, Dr. Mindy Pelz 40:44 yeah, it's really, I don't think it gets enough credit for that. And I went back to go look at the evolutionary explanation for why rucking might be helpful to menopausal women. And if you go and you look at like, you know, people like Kristen Hawkes, who's the champion of the grandmother hypothesis, and has studied the Hadza tribe. What the grand the post menopausal women do in the Hadza tribe is they go for a walk every day to go forage for food, but they take the kids, like the toddlers, like the four and five year olds that couldn't go out and hunt and aren't really staying at home with the women who are nursing and pregnant. And they would put them on their back, and they would walk with them. Yeah, they're talk. I mean it. When you study the grandmother hypothesis, you realize that we are fitness wise, not meant to perish. We're actually meant to be even better than ever, yeah, but it is. And then she would get a bunch of tubers. She would put them on her head, so she was constantly weighting herself, which is an evolutionary design. Dr. Vonda Wright 41:49 Interesting. It makes sense. You know, it really makes sense. And it makes I just he made me think I have this gorgeous 40 pound grandson. Put him on your back. Put him on my back. I lift him up to the Yeah, swing sets. So it makes so much sense, doesn't Dr. Mindy Pelz 42:06 it? Yeah, yeah. He's he can go, he can be your strength training, and then you're getting oxytocin with him. Like the whole thing is amazing. Okay, anything else we need to know about? Yeah, okay, please tell me pull Dr. Vonda Wright 42:19 it out. So when I prescribe exercise to midlife people we talked about the acronym I use is face again, I find people like, yeah, it's great. F is flexibility and joint mobility. I know this will ring with you, because we have to keep our tendons and ligaments long and we have to keep our joints moving through a full range of motion. Otherwise they get dried out, all rusted out, and we become the hunched over, shuffling people. So that's f is aerobics. He is carrying a load we talked about. But E, we've got to spend time on equilibrium and foot speed. I physically teach the women that come to here to be with me physically, foot speed. I have this, I have this Olympic track and field speed coach here in this place where I work, we teach our women the same methods that we teach Olympic athletes to move our feet fast. And why do we need to do that so when we're trying to trip, we don't fall down. We have enough foot speed to get over the bag that I trip on nearly every day by my desk, or not to fall off the curve, so that we do not have the fatal fall. We're alive and well we trip over something. Yep, we break our hip and we have a 30% chance of dying at one year. It's foot speed, it's balance. So Dr. Mindy Pelz 43:47 what does that you know that just happened to my 85 year old mom? She fell over on a box and fracture and osteoporotic, fractured her shoulder, had to have reverse shoulder surgery, and I you know your parents can be really good models of what you don't want to age like. And I thought about that her balance can be really off. So what does foot speed look like? Like? Is it like? Do I Do I need to take up, like, salsa dancing or, or, can I salsa Dr. Vonda Wright 44:15 to work on all of this, including your brain salsa. But foot speed looks like, imagine, imagine sitting on a box, sitting on a plyo box, and just on the ground going like this, real fast. Dr. Mindy Pelz 44:31 Oh, just like we call it, you know, I used to do p 90x forever, and he called it football sprints, Dr. Vonda Wright 44:39 where you're like, exactly agility. Or sometimes we use hexagons, and we just go, foot out, foot in, foot in, oh yeah. You know what I'm going to introduce back. I just made a reel about this. I am going to introduce hopscotch back to this. Oh, hopscotch is so fun. It's jumping, it's lateral motion. Play. Play is so good for us. Yes, I want to, when I post that, I want to see you hopscotching, because Dr. Mindy Pelz 45:07 when, yeah, oh my God, and then you get to act like a kid, which is gonna now bring in, like, dopamine and serotonin. So wait, but, but you could do even more, like you could do everything on the play yard. Was great. So we had hopscotch, and then we had monkey bars. Yeah, have you ever tried doing the monkey bars as an adult? It's Yes, Dr. Vonda Wright 45:26 Martin race, and it's very hard. Okay, it's very hard, but that's grip strength, that's upper body strength. Yeah, I'm not good at doing a rope, but I can do the rings. Yeah, Dr. Mindy Pelz 45:37 it's so it's and what about jump rope? Would jump rope be good. Dr. Vonda Wright 45:42 Yeah, good for foot speed and jumping because for those of you listeners that don't know, bone builds when we translate biomechanical impact, literally bashing your bones to biochemical signals that, oh, we need to build some bone osteoblasts, jump roping, jumping up and down, plyo boxes, a mini tramp can work. NASA uses mini tramps. If your knees are killing you, get in a pool and jump in a pool, right? I'll take anything to build your bones, but, but four times body weight jumping is, what the papers say. That Interesting, yeah. So Dr. Mindy Pelz 46:24 what about vibration plates? Dr. Vonda Wright 46:26 Yeah, like power plates. Have some research that shows that the small vibrations, I forget, the hertz, 50 hertz can that going up your bones can stimulate osteo, the osteoblast, to build bone. Dr. Mindy Pelz 46:41 And so, if we love your acronym of face, so if we follow the face strategies, Speaker 2 46:48 if we, is that when we, if we, I was gonna say, face ourselves, we face ourselves. Dr. Mindy Pelz 46:53 Is that a recipe, not just for keeping your posture strong and your moods good, but is it a recipe for preventing osteoporosis. Dr. Vonda Wright 47:03 Impact in the form of cardio can prevent osteoporosis lifting definitely, we can increase our bone density up to 13% a year by a consistent heavy lifting program because of the, again, the mechanical pull on bones and then the way equilibrium and foot speed works is to prevent the fatal fall. So all the feasts is how I encompass all the all the types of mobility that we need in midlife. Because, listen, when I was 20, I got away with cardio and I didn't lift that much, but like you did. I my balance was good, my flexibility was good, but now we need to pay attention to those four Dr. Mindy Pelz 47:48 things. Yeah, I think, I think that's so beautiful. Okay, what I want to come back to collagen and creatine, because I do know the connection that as estrogen goes down, those two go down as well. Are you? You had mentioned you, my sense in what you said before is you're not a huge supplement fan. Dr. Vonda Wright 48:07 Is that? Did I misread you? I have a short stack. I don't have 62 things Excellent. Tell me stack. We must have enough calcium. But I prefer calcium be taken in food. I prefer such as, such as, believe it or not, salmon poached with the bones, like in a can, like fresh, fresh, canned salmon or sardines, mushrooms, prunes and figs, all dairy. I mean, when you add those up, you can get 18 Milli, 1800 milligrams of calcium, pretty well if you're eating amazing. Yeah? Supplement, vitamin d3, obviously magnesium, 500 milligrams in the form of l3 n8 or glycinate, not citrate, people, unless you want diarrhea, because that's what we give in the hospital to relieve. Listen, yeah, magnesium citrate, a little green bottle does the trick, creatine. I take 10 grams of creatine a day. Five, is what we started with. And then that paper recently came out with Alzheimer's cognitive function with 20. So I'm like, Okay, I'll just up it to 10. Yeah? So 10 of creatine. Really good, really good research with muscle and brain. What else? Lots of protein. I take a few longevity type supplements. I don't take the whole stack that people can. I take a form of NMN so that my body will build nd plus, okay, measure my intracellular nd plus. With a, there's a there's a lab called ginfinity, owned by a science of scientists a friend of mine. So that I also take five satin because I am really interested in senescent cells, increasing the load of senescent cells, which for your listeners, are those cells which are neither living nor dying. Eating they're just too damaged to die, so they're spewing out all kinds of cytokines. So 510, comes from berries, strawberries. You can't get enough by eating strawberries, but a lab out of Vale, led by Johnny HRD has done tons of research showing we can decenescent cell load with these beautiful, yeah, these simple supplements thinking, what else I'm I'm visualizing my Are Dr. Mindy Pelz 50:26 you? Yeah, are you a big fan of, oh, count your your like, do I need to get 30 grams at every single meal? Or are you just like, hey, just eat protein. Dr. Vonda Wright 50:35 Well, eat protein. I'm a big fan of a gram per pound. Here's why. Here's why. I can support with research, up to point seven, three, 2.86 grams per pound. But I'm a clinician, and I'm telling you, nobody's doing that math, right? Yes, thank you. Yeah, nobody's doing it. And number two, we don't absorb it all. Yes, so, so. But I think we need enough protein. I find most women are under protein. They eat a salad with nothing, dressing soup. I call it the box, and the lettuce is Dr. Mindy Pelz 51:13 all I love that. Would you? Would you? What would you say to a vegetarian? Dr. Vonda Wright 51:19 You know what? Here's what I say to you. Think about bowls. Bulls are com bovine are completely made of muscle. It is possible to build muscle eating only vegetables. You just have to eat all the freaking time, right? Oh, yeah. So many calories, three and a half cups of northern white beans to get the same protein in a little cup of yogurt. It can be done. Number one, that being said, you have to be mindful of your essential amino acids. You're probably not going to get the branched chains the the other six amino there's nine essential amino acids. But you know, you know this, you got to be very careful if you're only eating plants, Dr. Mindy Pelz 52:02 yeah, yeah, you have to be really intentional. That's what that is. I mean, I, I was a vegetarian in my 20s, yeah, I was, oh, horrible. I was injured all the time. I was a competitive athlete. I gained a bunch of weight because I was just doing carbs all the time, and I didn't, it took me a long time because I had read a diet for a new America by John Robbins, and I was like, oh my god, we're hurting the animals. And so then I decided, and then I just became sicker and sicker. Until about 25 I was like, I'm done. I need to go back to eating meat and things. Things got a lot better. So, but I have a lot of empathy for people who are like, well, I don't want to eat animals, I and I and and we do need plants. We need to eat plants. But at the end of the day, I think if you're looking at muscle in general, it needs a lot of protein, and it's hard to get Yeah, so And do you think osteoporosis is preventable? Dr. Vonda Wright 52:59 So here's my take on it. The short answer is yes, but it doesn't start in midlife. We lay down maximum bone density between about 15 and 25 some will extend it to 30. I do bone densities on everybody, either by DEXA scans or rems, which is ultrasound, and I have 22 year olds and 30 year olds with terrible bone density. So either we So number one, we can prevent it if we lay down enough bone initially and get a high peak bone mass. But men like that don't, because we are taught to be small and not eat, or maybe we are athletes and we're not refeeding enough, so we're not having periods for nine months. I used to not have periods for months because I was a ballet dancer and oh, wow, oh yeah. That's the worst. That's the worst. And then so we need to lay down bone to prevent then what happens when we're making babies? We take 500 milligrams of calcium from our bones a day to make a baby, and now we're programmed to rebuild that, but only if we're eating well enough, only if we have time to rebuild, and don't have a baby every year for so that's the that's the motherhood loss of of calcium. And then at 45 we start losing our estrogen. There is a normal aging decline in bone density that happens in men and women, but for women, without the stimulation of estrogen, which balances bone breakdown and bone we precipitously will lose 15 to 20% so that's why Mindy, I want people to start in the critical decade. It's so smart because to prevent osteoporosis in women who have already lost 20% rolling a boulder up a hill, it's much harder than winging. Going to happen, getting in front of it, putting all the things in place, and never losing it in the first place. Now, if you have lost it, like if you're osteopenic, your your t score is down to below minus one, but not yet osteoporotic. You can rebuild that. We jump. We eat protein, yeah, we lift weights heavy. We do all the things you can reverse osteopenia and then osteopenia. Yeah, you have to think about whether you want to use medications. Dr. Mindy Pelz 55:32 Yeah. It's interesting because my 85 year old mom has had two hip replacements, a shoulder replacement, and she's awesome. Yeah, she's bionic, and she's osteo product. And so my sister, my sister's in like, 58 we we spend a lot of time, like, talking about, how do we not end up like mom and and so it isn't, it is interesting. I love this idea of doing it early, even though I'm out of that critical period. Yeah, I do. I just am curious. I mean that for me, the rocking, one of the things that inspired me was what I had seen in the research on wrecking and osteoporosis. Dr. Vonda Wright 56:11 I don't want to give your people the thought that it's too late ever is that too late? Your body will always respond, always. You know, even my mother's 86 and she's building Speaker 2 56:24 muscle. You know, it's amazing. That is amazing. Do a real with her. Dr. Vonda Wright 56:28 Oh, she's amazing, yeah. What Dr. Mindy Pelz 56:31 about hip replacement? Do you think, I mean, that's a pretty in vogue surgery right now? Is it? Is it preventable? Dr. Vonda Wright 56:38 So listen, I think I've already said that arthritis rapidly progresses in women over 50 because of the loss of estrogen. It's preventable if we get in front of the estrogen problem. It's preventable if we don't develop the arthritis that comes by carrying around an extra 50 or 100 pounds. Right? Interesting, because cartilage is very sensitive to load. In fact, in our cartilage lab at I was at the University of Pittsburgh, we used to kill cartilage by just dropping a weight on it. Right? It's very sensitive that sense, it's preventable. But in my career lifetime, the attitude on total joints has changed completely. Oh, yeah, we used to wait until the last minute. Get it. Get it at the last very minute, suffer for 20 years, lose all your muscle mass because you only get one set. Now we know that by sentencing people to sitting around for 20 years until they're old enough, we're sensitive, we're sentencing them to sedentary Death Syndrome. So I am much more apt to send a 50 year old who have destroyed their knees due to trauma or sports or something like football, to get knee replacements, knowing that we might have to revise them in 20 years. Yeah, I've given him or her 20 years of active life. Does that make Dr. Mindy Pelz 58:03 sense? Yeah. Oh, yeah, yeah. I've totally changed my opinion on on joint replacement after just having so many people in my life go through it and watching them and going, wait that that really looks like it kind of worked. So yeah, so you're right, the technology has changed. Where do you think HRT fits into the musculoskeletal profile of of a menopausal woman? Like, would you sit with every 40 year old and just say, yes, you have to get on HRT. Like, is it a must in order from a musculoskeletal lens? So Dr. Vonda Wright 58:40 my my statement is, every woman is a sentient being with agency to decide. But I insist, yes, I insist, however your decision be made based on facts, not fear, not fear of the whi, but the facts of what we know from RE analysis of data. That's where I stand on that, that being said, every musculoskeletal tissue has estrogen receptors. So if I want to maintain muscle and bone and tendon and ligament and cartilage, I want enough of it around. And I'm going to tell you for sure, Mindy in my patients and in my own life, the minute or the the month that I started with hormone optimization, my arthralgia went away, my body didn't hurt anymore, and I could get out of bed. And for the women out there that suffer from frozen shoulder, which is influence just everybody, inflammation of the shoulder capsule as a critical part of decreasing that, that inflammation that just takes over your your shoulder joint. So is it mandatory? Hormones are never mandatory. Do I demand people make the decision based on facts and make an intelligent decision? Yeah, and if you decide that you just want no part of it, like. 90% of women do, well, that's your decision. There are consequences to every decision that you make with agency. Dr. Mindy Pelz 1:00:07 Yeah, that's that's really well said, though, one of the ways I always explain it is that it's definitely a personal, personal choice and but it doesn't give you a free pass from lifestyle changes. And yeah, I think, I think a lot of women were like, oh, okay, well, I can just stop suffering and eating my big mac and skimping on sleep and not working out, and I'll rub some cream on me and I'll be fine. And I think, I think hopefully, as a collective world, we're starting to see that different. Dr. Vonda Wright 1:00:37 Yeah, it's not one thing, right? It takes an evil system. Dr. Mindy Pelz 1:00:41 Yeah, yeah, so, so, dream with me as we finish this up, dream with me for a moment. If, if people hear conversations like this, they read your book, they start to approach menopause from such a different angle than our mothers did and our grandmothers did. What the piece that I haven't visually been able to master. In my mind is, where do you think we'll be at 80? What do you think 80 will look like aging if we follow your formula, Dr. Vonda Wright 1:01:12 80 will be we get to do what we want to do when we want to do it, without having to ask somebody to help us, unless we want to that that's my 8097, whatever I live to goal. I may choose to ask for help, but I don't want to have to. It's Dr. Mindy Pelz 1:01:33 beautiful. That's beautiful. How long do you think I just have to add this extra thing? How long do you think the musculoskeletal system can thrive like the human body. They say is you can live to 120 Do you think you can if you follow regiments like what you're teaching? Do you think you can physically Thrive well into your hundreds? Dr. Vonda Wright 1:01:53 I think so, as long as you haven't traumatized your joints as a young person, right? I you know, I was a football doctor. I had very young men with very old knees from the trauma, yeah? So if we do constant maintenance, we're reinvesting, we're feeding this vessel. I think our bodies are meant to last. Dr. Mindy Pelz 1:02:15 Yeah, I love that. Dr. Mindy Pelz 1:02:16 And I think that, I mean, that is the message that needs to get out, because we need to re pattern in our brains how we've see aging. And the only model, visual model we have right now is our mothers, and then we of course, have our grandmothers. But there's this whole new wave of of aging that's coming, and I think we need more to point out that more and more about just how the body was built to thrive, even into our hundreds. So Dr. Vonda Wright 1:02:43 tell you for sure, that has been the guiding light of my career to change the way we age in this country. Dr. Mindy Pelz 1:02:49 I just love that. Well, I'm excited for your book. How do people get it? Where do where do they go buy it? Dr. Vonda Wright 1:02:55 It's available everywhere now for sale. There's a website, the unbreakable book.com. So it is all the goodies on it, the unbreakable book. I hope everybody loves it. Dr. Mindy Pelz 1:03:07 Yeah, it's a it is a great name. When I first saw it come through my socials, I was like, Ooh, that's a good name for for for a book. So well, well done on that. And we'll leave links for everybody. And what I have to ask you, what's your favorite chapter? Do you have a favorite chapter or section of the book? Dr. Vonda Wright 1:03:26 I like the stories I tell throughout. But you know what I love? I was I just got done recording it on audio book I really loved. There's one chapter that's all about this conversation. It pulls everything about aging into the menopause conversation. Amazing, Dr. Mindy Pelz 1:03:46 amazing. That chapter. Well, I can't wait to read it, and I'm just so happy that you're like bringing your information out. I think it's so easy as doctors, for us to just get stuck, stuck in our little clinics. And the benefit of social media and books is that you get your knowledge, but they don't. They aren't necessarily in your clinic. So, yeah, yeah, thank you. I've really enjoyed this. And good luck, good luck with the book. And everybody go get it. We should all be we should have, like, one bookcase that just has all the menopausal books, yeah, because you can't have too many Speaker 1 1:04:22 so yes, thank you cheering you on, Vonda, thank you for this conversation. Dr. Vonda Wright 1:04:26 My pleasure. Dr. Mindy Pelz 1:04:29 Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it, so please leave us a review, share it with your friends and let me know what your biggest takeaway is. You. Transcribed by https://otter.ai