These are MRI slices of a 40-year-old athlete.

We have beautiful muscle architecture, but if we sit around for 35 years and have a desk job and we don't go move our muscles, this is what happens.

Jesus, my God. But this is a 74-year-old who had just invested in their mobility four to five times a week.

So if you're an 80-year-old consistently lifting weights, you are functionally as strong as a 60-year-old person who doesn't.

But I worry about joint pain.

It is joint pain inevitable.

It is not. But one reason people have pain is because of how much we weigh.

Small changes in our total body weight can have profound effects on the joint pain we feel.

Let's say this rock is one pound.

If you gain one pound, you would think that this is all the amount of pressure you're going to feel.

But because of the mechanics, what you actually feel is the weight of these bricks.

So you think gaining 10 pounds doesn't mean much, but imagine getting 100 pounds of pressure.

So how should you be investing in your mobility every day?

There are four components that we should try to find time for.

Number one is... MUSIC Dr.

Vonda Wright, you've been treating patients, learning about medicine, taking care of people, and working in the industry you've worked in for almost 35 years now.

To do that, you must have a great deal of passion.

You must be on a bit of a mission.

So my first question to you is, as you sit here today, what is occupying your focus, your mind, your passion?

What is that? When you wake up in the morning and you think about the work you're doing and why you're doing it, what is the answer to that?

The answer to the question of why I wake up every day and rush into my work, whether it's into the surgery or whether it's into taking care of individuals or writing, is because I have been working under the mantra of, I'm going to change the way we age in this country or in this world.

Because when I started, there was this steadfast belief.

The National Zite Guys has changed now, but when I started, there was this belief that aging was an inevitable decline from the vitality of youth, down a slippery slope to frailty where we would spend 20 years of our lives dying, going to the doctor's office every three years.

And I never, ever believed that.

I never believed it. And maybe it was because when I was a child, I lived in the 70s where you could just take your kid with you to a race.

And my dad would do that.

I mean, he'd take me to a 5k and say, wait here, I'll be back in 20 minutes, and I would see people in their 50s and 60s racing and they would be celebrated.

Or maybe it's because I started as a cancer nurse and I saw people fighting every day for their lives.

And I believed that that was not the destiny that we were doomed to.

So as I progressed through my career and I started doing the research myself, I realized that this myth we had in our country, or all over the world, that aging had to be this inevitable decline, was based on population studies.

And what does that mean?

Well, population studies, just look at a cohort of people and see what happens over time.

There's a huge study funded by the NIH in the United States called the Health ABC, for instance.

And they looked at a population of 70-year-olds and just followed them over time.

Well, what do we know about populations of people?

What we know is that up to 70% of them do not do one extra step of mobility a day.

So what we know about aging has been what we know about sedentary living.

And so I did not believe that we truly understood how the trajectory of our aging could be for people who remained active across the course of their lives.

So my team and I did that original research and we proved that you can be healthy, vital, active, joyful, long into the foreseeable future, much more than we gave ourselves credit for.

And it drives me because even over all these years, I've been in the history of people for 35 years, 20 years of it as an orthopedic surgeon.

It is only now that people are beginning to pick up the mantle of prevention and not only disease care.

And so sometimes I sit back and I think, oh my God, you know, I've been preparing for this time in the history of people my whole career.

So I am made for such a time as now.

So interesting, because it's only in recent times, I've questioned the idea, this sort of mind virus that even I had that once I get to a certain age, I just have to kind of concede to the inevitable decline.

And it's only recently that I thought, actually, there's been a couple of people that have came here and told me about how to...

That's not the case. And actually it is a bit of a mind virus.

Like the virus of that belief, the impact of that belief is what causes you to give up.

And just become frail and to stop moving and those kinds of things.

Well, because what that...

Our brain tells us, we know this.

I've... You've had many discussions about the connection between our brain and our body.

Our brain will believe whatever we tell it.

And if our brain thinks that, oh, sometime 63, a light bulb goes off and we go from youthful vigor to aging and decline, well, then we start believing that about ourselves.

And, you know, there's a concept now that I work with all the time that really examines the difference between life expectancy and the UK life expectancy right now is 81.

Unfortunately, in the United States at 77.6, from birth, babies born now have a life expectancy of that much.

Our health expectancy, our health span, the amount of healthiness we have is only about 63.

So that gives us a huge runway to change the trajectory.

And it also tells us that we're not dying at 63.

We're dying on average at 81.

So we can do everything we possibly can in those 20 years.

And we also know that 70 to 80 to 90 percent, depending on who you believe, of our health and aging is predetermined by our lifestyle choices, not the genes we inherit.

So my mother is very thankful that I stop blaming her for all the health things that go on.

But each and every person has the ability to live outside of their genetic predisposition.

And that is a very hopeful message that can pivot your mindset virus.

I took the top sort of illnesses and diseases, things like heart disease, lung cancer, I can't even pronounce this one, chronic obstructive pulmonary disease.

Yeah, CLPD. Strokes, lower respiratory infections, Alzheimer's disease, tattoo diabetes, I can't pronounce this one either.

Col- colon-rectal cancers?

Colorectal cancers. And now that breast cancer and prostate cancer.

And I got the average ages that typical people typically get them.

Then I waited it by the amount of people that die from each of those diseases with heart disease being the most popular.

And it did actually come up.

I used chat GPT. I'm pretending I did this math myself.

It came up that 62.94 years old.

Is the exact age where on average, I'm going to get one of these.

And I'm going to potentially die from one of these.

Those are when they manifest.

Do you may have them before that?

Oh, okay. So they're not going to?

Maybe you never knew it because I have people who say to me when I ask them their health history, what medical problems do you have?

And they're like, I don't have any.

Only because I've never been to a doctor.

Or maybe they've been diagnosed, but they haven't gotten so bad that they're not spending three days a week in the doctor's office.

Or maybe they are sick. Those are the categories, right?

But your chat GPT data is correct.

That is when it shows up.

And what does that correspond to?

That corresponds to when the average person retires.

So just when you start thinking you have time to live the life that you envision, you're saddled with health problems that you have not taken care of.

But think about it this way.

Talking about this mind virus and how we need to change it.

We can talk about this. But I think that 40 is the most remarkable decade of a person's life.

And it's also the time to adult or get your proverbial expletive together.

It's time to get it together from a health perspective.

Well, between 40, if you're just noticing your health at that time, because maybe you've been working so hard and you never noticed it before, you're raising other people or whatever the circumstances are.

Between 40 and 63, you have time to course correct.

But if you decide at 63 to pay attention, it is much, much, much harder.

And so, you know, part of my mission, you ask me why I wake up every morning to change the way we age in this country, is to not only take care of people in my demographic, my middle age demographic, but to really get to my millennial children and my millennial nieces and not fused to say, you have such control of your health if you just look up and pay attention.

What's your academic education?

Can you run me through your qualifications and how that pivoted in turn throughout your career?

Sure. I have a degree in biology from Wheaton College.

And then immediately after that, there were such a shortage of nurses that the University of Russia said, if you have a good bachelor's degree, come, we'll train you in another bachelor's degree in nursing and a master's degree in three years.

So I did. And with that, I went and took care of people with cancer and ran the Rush Cancer Institute with the physician that was there at the time.

And then at 28, I decided to, through a series of decisions, we can talk about that.

I wanted to do great research, but I still needed to take care of people because it is in my heart and soul to do that.

And so I went back to medical school at the University of Chicago at 28, only to choose the longest possible road, which is orthopedic surgery, which is an additionally loving years, because it's four years in medical school, six years of residency, a year of fellowship, and then I finally emerged.

What is orthopedic surgery?

Oh, it's playing like a ten-year-old.

Yeah, so orthopedic surgery is the lifetime care of the musculoskeletal system.

So what that includes is bones, tendons, ligaments, muscle, out of post tissue.

It's the joints, the from the spine to the shoulders, hips, the knees.

It's everything from cancer care of those organs, through each one of those has a subspecialty hand foot sports.

I'm a sports surgeon, so I'm trained in shoulder hip and knee arthroscopy, meaning I do very big surgeries through very small apertures for athletes and active people.

But this fun orthopedic sports career I've had of taking care of active people and athletes of all ages and skill levels, extends outside of the operating suite.

I take care of the whole person, which is unusual for an orthopedic surgeon.

Usually orthopedic surgeons are very procedurally driven, but I am whole person driven.

And I think that stems from at 23 years old taking care of people in the fight of their lives, knowing that their whole lives are worth taking care of, not just pushing chemo in the middle of the night.

When you say you focus on the whole person, can you help me understand that?

Because I think on one end of that spectrum is doing the surgery, which you do.

And then is the other end of that spectrum thinking about their psychology, their emotions, their how they're feeling, what's...

I'll give you a few examples.

So if you're a... You think of a sports surgeon taking care of young athletes.

So if I have a young athlete come in who...

I'll give you an example of a real person.

He's 19. He has been an athlete his entire life and just been great at it, right?

But never been hurt. Had the great fortune of never being hurt until he stepped wrong.

He got slide-packled on the football field and he blew out his knee.

And his family was moving, so he didn't get immediate care like he could have had he been in his own town.

So weeks later, he shows up to me with a knee that's completely non-functioning.

This child who's a 19-year-old man is panicking in his brain.

He doesn't know why he's in so much pain, why his knee won't work.

Psycho socially, his family is in transition.

They don't have any of the support system and he no longer has his own team.

So that young man is dealing not only with the physical pain of injury.

He's dealing with the psychological anxiety of, oh my god, oh my god, oh my god.

What just happened to my knee will I ever play again.

And they're dealing with the social aspects of here's a family without social support.

So as a whole person doctor, real, really, this family, not only is there sports surgeon, you have an ACL tear, your meniscus tear.

Here's how I'm going to fix it.

Here's what we need to do before then.

Here's the technical aspects of the surgery, but how much protein are you eating?

Because I need your body and tip top shape to heal.

So I talked to my patients about their nutrition as well as their surgical.

But then from the perspective of I, I, to a mother with a lot of children thinking of myself.

How am I going to meet the needs of my child?

Thinking of the mother, she has no resources in this town.

She just moved here, right?

Trying to set them up with the other people they will need to be surrounded with care.

And that approach to this individual family is exactly the surrounding them with care approach.

We take with professional athletes.

There is not one thing that is left unturned for a professional athlete.

We take care of them from the minute they wake up to the minute they go to bed and their family needs.

So this whole person care extends all the way across all types of people.

For a woman, for instance, who comes with a so typical for a midlife woman to come in with an inflamed shoulder, frozen shoulder.

She'll come in because her shoulder no longer moves.

But knowing what I know about the life cycle of a woman and what happens in midlife before I even address the shoulder.

Because sometimes they come insane to me without any prompting, I think I'm falling apart.

And sometimes I think I'm going crazy because I didn't do anything to my shoulder, right?

When they say that to me, we immediately start talking about, well, how are you sleeping?

Are you having any hot flashes, night sweats?

So that I address them as a midlife woman who's lost her estrogen, not just as a shoulder that doesn't work.

Because for me, that's pretty cut and dry.

It's the rest of it that truly is taking care of the whole person.

So that's what it means to me.

It's personal to you, isn't it?

I feel like you have a great deal of empathy.

I can feel it on your, on the surface of your, sitting your face.

What does that come from?

You know, I think that I'm a much better, listen, you make people cry on this podcast and I think you're going to make me cry and I don't mean to.

But that kind of question, I think that this unrelenting need to take care of the whole person has to have come from my time as a cancer nurse.

Because I was only 22, 22 to 28.

I was a cancer nurse and imagine what it's like to be so impressionable, right?

I got all this education, but in the middle, so my job was giving chemotherapy to people who are in the struggle of their life and I'm 23 years old.

And chemo is pushed in the middle of the night.

And at the time in the 90s, we did something called primary nursing, which means every time that person came in, I would have been your nurse every time you're in the hospital every month for six months.

So the kind of therapeutic relationship you develop is meaningful.

And so I was 23 years old, 23 to 28, the formative times of how I built my perspective on the world.

And I'll never forget this is the one story.

There's so many stories like this, but this is the one story that answers that question.

I think why this is personal to me.

So I'm taking care of this woman.

And you know, many, many of the people I took care of won their battles.

You know, they I was with them for six months every night.

Some nights, because people just want to feel normal, I'm giving them their chemo, they're watching TV and buying stuff online on the TV.

And I'm like, why are you buying all this?

Because they just want to feel like themselves, right?

And many, many people successfully walked out and forgot, forgot our names, right?

But not everybody did. And so this one family.

She had been with us for six months.

And I don't know if you've ever been around people who are losing their battle with an illness or are are are living the last days of their lives, but you can tell it's coming.

Just by the way, they breathe, it is true.

People rally right before they die.

And so I knew this woman's time was coming, but she had the most faithful family, Stephen.

Her family came every single day.

And she had a big family.

And we knew they were coming.

They were kind of loud and we loved having them here, but the night that answers this question, I knew it was going to be your last night.

You can always tell it was just she and I in the light in a hospital room.

There's a light over the bed and then the bed.

So there's this light behind her.

And she's breathing in an agonol way.

But I can tell that she's waiting.

She knows her family is going to come the next morning.

And we make it through the night.

It's just she and I and in the morning in this hospital in Chicago, there's a window at the end of the hallway that faces Lake Michigan and the light starts coming in the floor lights up again.

And that's starting to happen.

It's about seven o'clock and I hear the elevator being and it was her family coming.

So I step out into the hallway and this one was different.

I came together every day, but this time her sister was dressed in her wedding gown and the whole family with it was in their tuxedos because her sister was going to get married that day.

And they wanted her to be part of that even though there was no way she was ever going to be part of that.

So I'm 23 years old. I'm standing in the doorway.

My patient is over here.

Her family is coming towards me.

And that indelibly seared in me the balance between life and death, the woman who is not going to continue her journey and her sister who is beginning her journey.

I don't know how it 23 years old for that not to impact what I care about in life.

Steven, if you come to my house, I don't give rats ass about my curtains or buying the shoes with the red souls, even though I can.

So at 23, that kind of life and death made me decide that people were worth working for and worth saving.

And so she had waited for them to come to her that day so she could share in the last family time they were going to have together.

I don't think you come out of a situation like that without your whole life perspective being different.

And so even though you know I'm a sports doctor now, how is that remotely as hard of being a cancer nurse, I am a much better doctor now than I would have ever been had I gone straight into medicine.

So what is that perspective is given you specifically that then translates to being an even better sports doctor.

How does it change how you say that?

It just means that I can't view the procedure as just putting screws in the ACL or what I tried out a new ACL procedure last week.

It was fascinating. But sometimes that is the beginning and the end.

That's not the beginning and the end for me.

How this kid it was this 19 year old kid, how this kid is going to recover in six to nine months and go back to living the life in visions how he's not going to feel abandoned by the sport that he loved or how am I going to help him find a new team because sport is not only an individual thing.

But the whole thing is that the whole thing is not just an entire environment.

It's the society that kid lives in.

So for me, it's not just the cool new technique I did on Wednesday in the OR.

It's taking care of that whole person through the whole journey for the next nine months.

The lady that you're taking care of when you were 23 as old as that impacted how you view.

Yeah, it has. I view death.

We're all going to die, Stephen.

How rapidly we get there can change how we arrive there can change how we feel about our life can change.

But we're all going to get there.

So I don't I don't view it as something to run away from at all.

In fact, in some circumstances in some of my patients circumstances or even as an orthopedic surgeon and some of the traumas I've been involved in, I think death can be kindness and death can be done with extreme dignity.

I don't think it's always the enemy.

One of the things that I think is is also really sort of front of mind in that image of the lady in the in the bed when her sister arrives in the wedding dress is that she had friends and family there.

And a lot of people, you know, there's so much beauty in that moment, regardless of the reality of what's going on there that she's losing her life, but she's losing it surrounded by a group of people that love her.

And I think for many of us, I think I actually had a conversation with a good friend the other day and their biggest fear in life is that they'll actually end up aging and dying alone because they don't have children yet and they don't have children at all.

They made the decision not to have children.

They don't have siblings.

So, you know, I'm not scared of death.

I'd like to extend my health span.

But when I do, I would like to have people around me that love me.

And that's one of the things that I think she clearly had.

Yeah, she did. It's funny to mention that I think about that.

What happens if we live so long in our quest for longevity that everybody we love or raised has already gone before us?

And I don't know what I do.

And I hire the girl next door to.

So with me, take me to my doctor's appointments.

I don't know what to do. I could probably pay a few people to be able to.

I'm in love with planning.

So if we talk about this health span issue and your central mission that you described with the start, usually when I have these conversations, I try and has it a guess where I should begin.

But I actually want to I want you to tell me where we should be beginning.

If we're talking about extending our health span, where does that begin?

Where do we need to start this conversation?

That begins when your parents are raising you and they have the choice of teaching you how to eat teaching you.

I'm old enough that literally I got a cell phone at 38.

So this is not a problem with me growing up.

But there's a problem now where we don't send kids out due to safety and digital to just go play and don't come in until dinner.

That was a real thing when I was growing up.

And so what we know is children's mitochondrial load, meaning how many of our powerhouse mitochondria metabolic.

King pins are really predetermined by how active we are as a child.

So it's really a concern for those of us interested in metabolic health is what are we doing when we raise our children to sit around for the first 10 years of their lives when they're really made to run around right.

It begins with what we teach our children and I think I hear parents a lot of times saying, oh, my kid won't eat this or that or I can't get them to do anything and I'm not scolding them when I respond in the way I'm about to respond to you.

I get it. I'm the mother of a blended family of six children and you can't always make your children do things.

But here's what I know children learn from what they see.

My children were foam rolling with us.

They learned to eat vegetables or they didn't get up from the table or they learn what we teach them.

So the time to begin is when our children are little some would say the time to begin as in utero, which is frightening because I might have done things differently during my pregnancy.

When they're little, but as they're being raised, I certainly think the time to really begin is no later than your mid 30s.

I call between mid 30s to mid 40s with 40 being the center of that the critical decade.

Literally, we're not children anymore.

We've at 30. The literature says we've probably maxed our bone out.

We've probably maxed our muscle out.

What do you mean I'm 30? I know.

What do you think I'm maxing right now?

What do you think I'm maxed my muscle out?

It means that some some scientists, muscle scientists believe that at 30, we've got our peak muscle mass.

And unless we really invest in growing more muscle the rest of our lives.

Like if you choose to be sedentary the rest of your lives, you peak at 30 and you're using it the rest of your life, right?

And so same with bone. And max is out at about 30 unless we continue to invest in it.

Well, what do we know? 70% of our population is sedentary and don't reinvest.

So between 35 and 45. I call it the critical decade.

If you've never thought about your health before, now's the time to hone in.

We need baseline labs. We need your first physical.

We need some of your first screening exams.

I think men is not policy anywhere, but I think as I'm trying to replace testosterone and men in the future, I don't know what I'm raising them up to.

I know I'm putting them when when in within a healthy range.

But I would want to return you to what your testosterone was when you were a young man like you are now and not just guess I think we need first labs, first physicals.

And you need to be more of a quantified self, just like you we were talking earlier, you saw human brain for the first time to notice our bodies so that we can take better care of them early so that we can then do the exercise prescription that I'm sure we'll talk about.

Going forward because it becomes very, very hard with every decade, but I think for men 40 to 50 is an amazing decade for you for a lot of reasons for women, I think between 35 and 45 is critically the time to get our stuff together before our hormones start walking out the door.

So it's much earlier than you would suspect if you if you suspected maybe 50s the age maybe 60 no too late, not too late much harder, right?

Yeah. You know, there's this image that I saw online the other day and I saved it as a bookmark.

I actually wasn't connected to me speaking to you, but I just found it to be fascinating because it's part of this emerging picture in my mind about the importance of muscle.

And one thing you said there is you think we'd reach our peak muscle by.

Around 30, according to some sort of muscle scientists, is does that kind of correlate to what I'm seeing here I'll put this on the screen for anyone that can't see an all in can description below on this graph, which we'll call figure number one graph number one.

Are you saying to me that the peak point there is around 30.

Yeah, and then from it's sort of downhill from there.

So on, you know, on this graph, the peak, if we call it 30, this is a precipitous decline.

It looks very hopeless that what I believe in what our research shows is that you can extend this green line into a more flat curve so that you die quickly maybe in your sleep.

Yeah, like this, zoop done.

Instead of the steady decline over time, but if we do not reinvest in our health and mobility every day, our muscle, weists, our VO2 max or our cardiovascular health declines 10% per decade.

So it's like what happens if you have a formula one car and you get it all maximized, it takes one big race, and then you never reinvest in it.

I mean, our bodies are not unlike a machine.

When you talk about lean muscle mass, what does what is lean muscle mass?

I don't muscles are, but what's lean muscle?

Yeah, you know what I say lean muscle mass and people are like, what do you mean lean versus fatty muscle mass?

What I'm talking about is your skeletal muscle mass.

We have three kinds of muscle.

We have smooth muscle, which is what our guts are.

It's the peristalsis that's happening in our intestines.

Our cardiac muscle, the muscle that will, that is our heart.

That's the cardiac muscle.

And it beats unto itself.

It has its own electrical rhythm.

The rest of the muscle in our body is striated skeletal muscle.

So every time you do this, it's with a type of muscle called skeletal muscle.

We have 650 skeletal muscles.

It is the reason you move.

It is muscle is not only important for local motion, but it's very metabolically active.

It sends off hormones that help control other processes in your body.

It's where most of your mitochondria, which are the powerhouses of your body, take glucose from your blood and turn it into energy.

So it has a lot of roles. Most of us just think about it as what you see in the mirror at the gym, getting bigger and bigger.

But it serves the function of local motion and metabolism.

You did a study. Yes, I did.

And I think that's the pitch right.

I have here, which talks about 2012.

So I'll put this on the screen again.

This is picture number two for anybody that's listening on audio and wants to see the photos.

This is a pretty startling image.

It is. And it scares me. Please can you explain what it is?

It shouldn't scare you because you are healthy.

You are going to be mobile every day when you leave me here.

But so remember that study I introduced the health ABC, which was an NIH funded study of a group of 70 year olds.

They just took a cohort of 70 year olds and watched what happened over a decade.

Well, they did a similar study as this using CAT scans.

I used MRIs. And what they found is that what they described as the inevitable decline of muscle, the inevitable infiltration of your muscle with fat like marbling.

And I said, that cannot be true.

That is what happens if you are sedentary and sit around for the trajectory of your life.

So because I'm a sports doctor, I am surrounded by master's athletes.

So I did a study of master's athletes from 40 to 85.

What this picture is is MRI slices in their mid-die.

So MRIs take pictures of us using a magnet and creates these beautiful pictures.

So the top picture is the MRI slice of a 40 year old and my athletes, where usually runners or triathletes of the five of a 40 year old.

So I'll describe this for you.

It's gorgeous. Yes, we have beautiful muscle architecture of the quadriceps on the top, the hamstrings on the bottom.

The bone has a nice cortex.

There's very little peripheral fat.

And when I looked inside the muscle with a microscope and special software, there was not infiltration of fat or marbling.

So if you want to say it colloquially, this is a flank steak with no marbling.

This is lean muscle. If we sit around for 35 years and have a desk job and we sit at the desk 10 hours a day and we don't go move our muscles, we're not purposeful.

This is what happens. We lose our muscle architecture.

These muscles are almost, you can't even tell what they are.

What's the age of that person?

This is a 74 year old. Now I had a large group.

This is one representative person in each of the groups.

This is the control group.

But the center one, the muscle I'll tell you is grossly fatty infiltrated.

It is well marbled. It is like a colby beef.

And then there's a thick rhyme of peripheral fat.

This is a picture of what we call sarcopycity.

Meaning we have loss of muscle, sarcopenia, and we have obesity excess out of post tissue.

Oh, so the white area is fat and the middle pie is not.

It's the muscle. Yes. And so, you know, you'll see people walking around with these big old thighs.

Well, the truth is sometimes a lot of that is fatty rind.

But look what happens if we invest every day in our mobility.

My athletes in this study were not professional athletes.

They were recreational people like you and me who had just invested in their mobility four to five times a week.

This is the picture. The third picture is a 70 year old triathlete.

If you didn't know better, you would say that I just took another slice of the 40 year old and put it down here.

Very little peripheral fat, very little fatty infiltration and amazing muscle architecture.

And when we looked at the strength of this person, compared to this person, there was virtually no difference.

There's a small difference.

But we know from other people's studies that lifting weights consistently infers a 20 year advantage such that if you're an 80 year old consistently lifting weights, you are functionally as strong as a 60 year old person who doesn't.

And so not only does this study show us that by investing every day in our mobility that we can retain our muscle mass, that has implications for frailty, that has implications for activity.

And what's interesting about that picture, Stephen, once I published it, it has taken on a life of its own.

It is like everywhere on the internet because the reaction is so startling with people thinking, oh my god, I am in control of my health and aging.

And I couldn't be more pleased about that.

No, it is unforgettable in every sense of the word.

I can't believe that. The thing that really shocks me is the 40 year old calf muscle, some a calf for thigh muscle, is quad and hamstrings.

And that's a triathlete is arguably not as good as the 70 year old triathletes.

I would actually say that the 70 year old wins.

And that is that is startling because I thought that aging muscle decline, this sort of sin essence, I think it's called of the body and the muscles is inevitable.

And this is unequivocal evidence that it's not that if I make good decisions now, if I become a triathlete, I can have the flank steak thighs when I'm 70.

What it tells you is that there is no age or time in your life when your body will not respond to the positive stress you put upon it.

And it takes daily investment.

It's not like you can store it all up and then write on it.

It's so important. One of the things that's been a role revelation for me is this idea that muscle is so critical as I get older.

I often think about different exercises that I should be doing as I age.

And sometimes I think about running, but I don't know, I worry about joint pains and stuff.

So I'm a bit of a upper body workout freak.

I just focus on my upper body.

What do you think of my exercise regime?

What should I be adding to it to make sure that I can have the flank steak thighs, but also just a longer health span?

You know, what's critical for long term function is being able to stay upright.

So it's all great that you've making big arms and have upper body strength can do pull ups and lift your case above the in the airplane.

But what you really want to do when you're 97 is walk anywhere you want to go up and down the stairs do, you know, drive any car you want to and that takes lower body strength.

So all your biggest muscles in your body are below your belly button.

So if I were you and had all this trajectory of time, I would work equally as hard on my, my glutes, my quads, my hamstrings, my calves, every muscle below your body.

But not only would I work on my strength to get bigger, but I would focus on power and those are different lifting techniques, right?

The hypertrophy aspect of growing big muscles because they look really great.

You do now and I am not a I am not a trainer, but I've done this quite a while.

So trainers, you're welcome to add in, but you do more reps of lighter weights because that will stimulate hypertrophy.

If we're truly building a growth of muscle bigger biceps, if we're truly interested in power and longevity, which is why I lift I lift for longevity and power because I am not going to be that little lady frail and a bad unless I can help it, right?

I mean, I'm going to help it.

I'm so determined. I want to be able to lift heavy.

So that is fewer reps, but much heavier weight.

So number one, you got to lift with your legs.

Number two, people become frail for a number of reasons, but another reason people lose their independence is they lose their ability to balance and they're falling all the time.

And when you fall, no matter how good your bones are, you are liable to break something.

And so I always train my people not only in muscle building or carrying a load as I like to call it, but in equilibrium and foot speed.

So in the in the place I put my office, it's a performance center.

It's surrounded with all the bells and whistles of the best performance stuff.

And we have a speed and agility coach who usually works with elite division one track athletes.

Well, I had her design foot speed and agility drills for midlife people because I knew this all the time.

I put my my red work bag too close to my desk.

I get up quickly. My bags in the way and I trip, but because I've got the foot speed.

I can hop over it. But if I hadn't retrained that, I might have tripped over it and landed on my hip and broken something.

So it's important as we're going forward.

Yes, I want you to increase your muscle lifting in your lower body, but I want you to work on speed and agility drill.

So you stay nimble, stable, able to balance and don't fall down.

If you trip to your bag, what's the knock on effective back?

Because you just heal, right?

I just heal. Yeah, I just I ran a Spartan race recently and fell off an eight foot ring and didn't break.

So I am working towards being unbreakable in my own life.

That's what I want to happen for you.

But if you're if you're not unbreakable.

What happens when you trip over your bag and fall as you could break your hip and then what happens?

Yeah, well, if you're of any age, but particularly older, when you fall and break your hip.

50% of the time, you do not return to pre fall function, which means you cannot live in the home.

You raised your children.

You cannot drive your car.

The bones are bones and adults take about three months to heal.

Imagine being down for that amount of time.

And unfortunately, in men greater than women, 30% of people die in the first year from the complications of being that sick with a hip fracture.

So, you know, as your orthopedic surgeon, I am desperate to prevent frailty.

I'm desperate to prevent you from falling and succumbing to that sequela.

So we got to lift weights with our rear end, then our legs.

We got to work on our speed and agility.

It was you that use this time, the sitting epidemic.

What is the sitting epidemic?

The sitting epidemic is what we're doing in our country when we in every aspect of our lives, whether we're working, we're working, but we're sitting at a table.

We're playing, we're sitting and we're playing on our phone or watching something.

It is the epidemic where we're spending, I don't know, 10, 14 hours a day sitting in this position.

In fact, I was thinking about it if it was logistically possible for a three hour interview, we should go for a walk.

Not so much. But it's the epidemic of sitting around.

What does sitting around do?

Well, it sends us towards a pathway of something called sedentary death syndrome.

I wish I had made that up, but I didn't.

The professor out of Columbia University in Missouri made up this term that I had been using my whole career to describe what happens to us when we sit our entire lives.

Sedentary deaths syndrome are the 33 chronic diseases that we die of, including the top five cardiovascular disease, stroke, cancer, even, even things like fracture that are completely impacted in a positive way by mobility.

So if we could eliminate sedentary living from our lives, we could probably live better.

And that was the whole supposition of all these studies I did in the beginning of my career at the University of Pittsburgh was to prove that if we took sedentary living out of our vocabulary that we could save our bones, we proved that was two studies.

Our muscles, we proved it with the one that you just saw.

We could save our brains.

We were one of the first to do brain studies looking at the effect of mobility on their brain.

And it's a very hopeful picture.

It's super interesting.

The subject I this week had a friend of mine diagnosed with I think he'd slip like two discs in his back or something.

And he sent a X-ray of his back into the group chat.

I thought, oh, this is so interesting because I've had lots of conversations with people in my podcast about sitting and all of these things.

I spoke to one particular guy called David Rayclin who went and studied the Hads a tribe in Africa, I believe, which is a hunter gatherer tribe.

And what he found is they do sit for about nine or 10 hours a day.

But they squat. I knew that.

Yes. So we sit in chairs.

Yeah. He told me that I think it was him and Daniel Lieberman told me that they brought brought a chair over there.

Yeah. And like these Hads a tribe had like never seen a chair before.

So when they like walked off to go to the toilet, the Hads were all sitting in the chair.

No, they would take the chair and be like, oh my God.

So all the chairs were taken because they just love the chairs because they'd like never had chairs before.

So that the researchers like couldn't find a chair because all the Hads were like chilling in the chairs.

But typically when they sit for 10 hours a day, they're doing this little mini squat thing, which means their muscles are still activated.

But also I think the posture in which they squat is back.

Yes. And they got sent me down this rabbit hole this weekend, literally this weekend, looking at why sort of 80% of Americans will complain about back problems, but the Hads a tribe.

Back problems aren't even like a thing there.

He told me it like almost doesn't exist.

The idea of having a back problem.

But 80% of us are going to have back problems.

And then I think about it.

If we weren't trying, if I weren't trying to be on my best behavior, I'd be sitting in this chair like this, right?

Like a C shape launched over my front core is completely relaxed.

My back core is relaxed and stretched out.

And so over time, they just get weak in atrophy.

It's like laying in a bed.

There's no stimulus for them.

Plus my shoulders get all hunched over in my posture becomes like this.

And so that's why we just sit in chairs and atrophy when you're squatting and I posted recently challenging people to see if they could do a squat like that or get up from a squat like that.

And the response I got was overwhelmingly, oh my God, I can't do that.

I'll work on it because we're so used to sitting in chairs.

It's like a single squat to get down, getting down.

People can do sometimes with falling over getting up is the problem.

What would you recommend in order to avoid the back pains, the sort of sedentary death syndrome or whatever it was called?

What do I do? Because I have to run a business.

I work in an office at a desk.

Well, you know what, even simple things.

For instance, I bought my assistant a standing desk because when I'm in clinic all day for 10 hours, the choice for him was sitting at a desk or standing at his standing desk.

And so that can go a long way.

Number one, number two, taking many blasts of mobility, right?

Getting up, running out the stairs, be a fidgety person, go to the copier, get steps in, just be moving all the time.

The other thing, honestly, nobody knows when you're on a phone, call what you're doing.

You could be wall squatting.

In fact, I have challenged whole groups of people in their next board meeting to wall squat the whole time.

No, I don't know how I'm just thinking would go on, but just adding little things like add that in.

You don't have to sit to take a phone call.

Even in a Zoom meeting, I mean, people have seen worse than you doing a wall squat, you know, in the time of COVID.

I was wondering this morning on my way here, because I was in the bathroom and I dropped something on the floor, covered was maybe in the toothpaste or something.

And I went down to pick it up and my back is just like so tight.

Like my whole, I feel like my whole board, I'm so unflexible.

I went down to pick it up and the way that I go down to pick it up is you think I was, you know, I was going to say an age then, but that's kind of after seeing that.

I know. I'm just like, this guy's better flexibility than me, but I just feel like I'm stiff as hell.

And I don't know what to do about it.

I think there's like, I don't know.

Is it a joint pain joint pains that I have or is it just I don't have strong core?

It could be all those things.

So when I talk to people about to go to tie into the other question, how should you be working out?

How should you be investing in your mobility every day?

There are four components that that we should try to find time for.

Number one is flexibility and dynamic stretching.

So that means is is warming up every single joint in your body every day.

And that can be as simple as seriously a set of jumping jacks doing there's something called an inch worm where it's like a push up position and you walk your feet up and that'll warm up your ankles, your knees, your hips, your shoulders.

But going through a dynamic warm up every day to warm up the joint, putting them through demanding they go through a full range of motion.

And then not forgetting after you work out to static stretch.

We don't static stretch before we work out we static stretch after static stretches what we were taught in in elementary school with you know you stand against a wall.

You hold the stretch for 30 seconds.

That happens in everybody part after you work out before you dynamically warm up.

And so that's when things like yoga and Pilates and whether it's reformer Pilates or floor Pilates or can be great for people to me that is the the salt and pepper of your workout regiment.

It's not just what you do it's what you sprinkle over it.

So that's number one flexibility a because the acronym I use is space.

So people remember F flexibility a is aerobic right when you talk about that see is this weightlifting we talked about see carry a load E is equilibrium and balance.

So when you were reaching over and thinking you were so stiff you could still do it because you're in your 30s you still have the youthful pliability to do it.

Imagine you're 60 now and you haven't done anything about it and nothing's moving.

And you reach over and you don't have the foot speed to cut yourself you fall over it happens all the time from a standing position so the way I teach people to retrain their balance literally is to stand on one foot while you're brushing your teeth every morning because the perturbation of moving your whole body requires core strain through requires proprioception and that's how you'll retrain that particular motion.

So I really need to introduce something like Palatez or yoga to my or just daily stretching OK how long.

Well if you stretch every you dynamically warm up before you do anything including your weightlifting and then the static stretching afterwards of every major muscle group whether it's your triceps or whether it's your hamstrings which are critical for low back pain or your calves you hold the stretch without bouncing for 30 seconds and what you'll feel is at the end of the 30 seconds you'll kind of relax into it and you'll get more of a stretch.

And you only do four reps you are going to get most of the benefit of that stretching after four reps.

But I don't want you to only do that I find many people asking me I do Pilates and yoga is that enough for me and I say that's great but it's never going to be enough.

One of the other things which is related to this that people see as being inevitable is this idea of joint pain we think we can't just get joint pain as we age is joint pain inevitable you've actually brought a big bone with you today which absolutely nobody else you to bring but I guess this is what you can't do.

Stephen this is a femur a femur yeah this is a human femur and I guess a femur is the is the bone that connects your pelvis to your knee.

Oh okay so it's that big bone is the longest bone in your body this bone you brought with you and a lot of people talk about joint pain yes is joint pain and ever to give it to you because you probably know more about this stuff tonight.

So what is a joint yeah joint is the space that is occupied by two bones so the femur the top of it that's in your hip is a ball and it sits in a cup in your in your pelvis so two different bones the pelvis is connected to the femur through the hip joint.

It goes like this right so and then on this end this end of the femur is connected to your tibia and it makes your knee right yeah so is joint pain inevitable it is not do we get it with aging often so that you would think it's inevitable but it is not inevitable why do we get joint pain well every bone.

At the end is covered in an end cap of a structure called cartilage cartilage is a smoother than ice matrix that cushions the bone so that you don't feel your joints one reason people have pain is because they've.

Traumatically disrupted that cartilage and there's potholes in it like if you're a football player and you get hit hard in a piece it impacts so hard it pops off that's a traumatic cartilage injury you will have joint pain from that another reason we can have joint pain is not traumatic cartilage loss but because you've just done so many reps over a lifetime that you've worn it down that's called osteoarthritis and so it's not a pothole per say it's like the whole thing.

It's like the whole surface has been worn down the sandpaper for instance and there's just not enough of it well the reason we get osteoarthritis some of its genetic but much of it is how much we weigh sometimes it's related especially in women to whether or not we have estrogen.

We only get one set of cartilage for a lifetime unless I reconstruct your cartilage because you've been injured or something we get one set so we get joint pain because the cartilage is started to wear down we can get joint pain because.

We've worked really hard in a workout and we've just seen a lot of impact and it inflames your joint but that's usually temporary the permanent is when you really do osteoarthritis so how do I if I want to work out I want to make sure.

I want to make sure that I protect my joints so that I don't have this permanent sort of naturally irreversible joint pain is there certain workouts that I should be avoiding.

Are there certain workouts that are more likely to give me to erode my cartilage and give me joint pain.

Well I think principles that should be used are the principles of weight lifting with progressive overload so if you started out cold and decided you know I'm young and healthy I'm just going to lift my maximum all the time you're probably going to inflame your joint your joint is not used to seeing that kinds of load joints bear to five to ten times body weight so if you've gone from zero to five hundred pounds squat that is five thousand pounds.

That's a lot versus if you start from zero and progressively up your body will get used to the low your bones will build your your cartilage won't grow but it will become more used to the pressure so the principle is to not have aching joints is progressively go up and not just let your ego take over.

So you're saying that muscle helps to kind of as a suspension mechanism for the cartilage.

Well what things project to protect the joints of being of a healthy body composition which includes weight and muscle mass right so the way muscle helps protect the joints is exactly of you said instead of pounding together like this yeah muscle acts as a shock absorber so the bones come together more softly.

So we're for people with osteoarthritis one of the remedies for that is building muscle.

You mentioned a second ago that staying at a decent weight also helps to stave off joint pains and that's sort of a russian of cartilage and I was reading in your work about this pretty shocking.

My breaking my rock is pretty shocking stat yeah that god this is heavy you can take that okay yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah 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yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah 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yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah yeah I've had that over in this book all this podcast before but for some reason I just can't do it.

I can't get myself to do it.

Maybe I'll do it for one day but then the year goes back to the bottom and...

There's this concept in banking called Temporal Disconnect.

It's a banking term. I came upon it as I was writing these books initially and the concept is that bankers, financial people, want us to put a little bit away every day, not for today.

There's no satisfaction in that for today.

In fact, it's deprivation for today.

But it's for the future.

The concept of Temporal Disconnect is that you don't know who you're gonna be in 30 years, or 40 years, a 70-year-old Stephen.

You don't know that guy.

You don't care about that guy.

You don't even know what he's like, what he's gonna become.

So, but you do know today is Stephen.

And so, you're gonna take care of this guy, not that guy.

And so, that's why bankers can't get us to invest our money in the general population.

Most people don't have much savings.

The same is true when we apply it to our health.

What do we want now? What's gonna make me feel good now?

What can I bargain with myself that I'll do it tomorrow?

Or this little bite's not gonna hurt me.

Right? Because the temporal disconnect of at 63, if I don't do something now, I'm gonna have chronic disease rare at ugly head.

That is a hard argument.

Some people are disciplined enough to think like that.

That's a hard one. So, some of the ways to help people now is to help them identify how amazing they're gonna feel now.

Instead of feeling sluggish, sitting in a chair all day with back pain, if we invest every day in walking in sprint intervals, which is gonna make us lose fat.

Or lifting heavy, which is gonna put on the muscle of spanks and make us look good.

And plus, when you get done lifting heavy, you feel like a badass, right?

If you can make that the reward, that is an easier thing to do.

Because you are right. We know what to do.

We just don't do it. And we know what to do when we don't do it.

Because the battle is in the five and a half inches between our ears.

It's not actually picking up the barbell, right?

And so it's identifying how this is gonna make me feel today, not for 20 years.

And here's the other thing.

I honestly think sometimes it comes down to self-worth.

Do I believe that I am worth the daily investment in my health?

Or do I believe that everything else is more important than me?

And that's hard. And I have come to understand that until you believe that you are worth the daily investment in your health, nothing else matters.

Yeah, it's so interesting in that I think one of the things that again that has been cured, that used to be a mind virus of mine was, I think part of me did think when I get to 50, when I get to 60, I'll address it then.

If I've got certain health issues when I'm 60, well, I'll just go to the gym then and I'll just fix it then.

I'll just start becoming active when I'm 50 or 60.

But that's not how any part of my life works.

It's not how my business or my investing works.

Everything is compounding now.

So the decisions I make at 20 or 25 or 30 or your daughter's upstairs, she's 16.

The choices I start making then are so-and-seeds that will flourish for better or for worse when I'm 60, 70.

And you know what's easier than doing a little bit every day?

That's easy. You know, my daughter upstairs, she poor thing can't get away from knowing what the right choices are.

It doesn't mean that she always does them.

But if she maintains this healthy lifestyle she has because she lives in our house, it'll be easy every day.

It's a lifestyle, right?

It's not a monumental pivot.

It's just the way she lives.

And you know, the same if you do all the things that you know to do now, it will become just the way you live.

It's not a high energy expenditure versus waiting until you're 50, when you're 50 pounds overweight, when you have to totally rebuild all your lean muscle mass, you know, you're feeling like a whatever you're going to feel like.

That's a big pivot versus I'm just living another day doing the things I've always done.

This is who I am. I am, yeah, that's one of the things that's been really helped me, I think, from doing this podcast.

Obviously I'm inundated with lots of information about health.

So the the framework I use to decide what to take in and what to implement is just I hear some things like my guests say and they might say, oh, by the way, Steven, Apple juice or orange juices full of sugar.

And in my head, I was going, oh, my God, I thought I was healthy.

And then I don't really, I could take it or leave it anyway.

So these small sort of modifications taking these sort of very sugary drinks out of my life is something that happened.

Being consistent with my workouts focusing on muscle gain, thinking a lot about how I sit, but also making sure I'm as active as I can be.

And then the other thing actually has been supplements.

Yes. Because I sit in this diorecyle studio a lot and I sit in drag and stands, little dungeon a lot.

I spend a lot of time sat at my desk inside without any sort of natural light.

So I've started taking vitamin D supplements frequently because actually I went to the doctors, did my my tests.

How low was it? How low was it?

It was very low. They said, everything's fine, Steve, you're all good here and here.

I did like the full body.

I did my testicles, do my toes, do everything, my blood, everything, my moles, whatever it might be.

And the one thing he did say to me is your vitamin D levels are low.

So I've started supplementing is how crucial is vitamin D for healthy?

You know what? It's a it's a hormone that affects so many organ systems.

It's important for your bones.

It's important for your immune system.

It's important for your brain.

So it's something that everyone should supplement.

They should get their level checked.

We're all low. And then we should supplement up and then have it recheck so that you can have a maintenance dose.

You usually take it with potassium to help absorption magnesium is a is another key player with vitamin D.

What if I want really strong bones?

What should I be taking?

Vitamin D potassium magnesium.

You should be eating one gram of protein per every lean for every ideal body pound you have.

So you build muscle to help your bones.

You know, there's some remote data on boron and zinc, but I'd rather you have the three that we know work to build strong bones.

You not only need muscle, you need proper nutrition.

You need to I should find another term, but you need to bash your bones.

You need to impact your bones.

The mechanical stress of impacting bones, whether it's jumping up and down, running, going up and down the stairs for people with poor bone density.

You can use a reformer, which is a, which is a trampoline.

Is all important for standing the biomechanical signals to your bone that you're doing work.

You need stronger bones.

That is transformed into a biochemical signal that makes your bones, that your bone cells lay down new bone.

That's how you keep healthy bones across a lifespan.

Can you grow new bone? You can, yes, you can actually you can increase your T score.

It's a multifactorial T score is a score that we measure using a test called the Dexascan.

A Dexascan will tell us not only our absolute bone density, but compare us to healthy people.

And this Dexascans are usually used for women or older men who have fallen in fracture.

But a T score tells us what our bone density is compared to a healthy 30 year old, right?

Assuming a 30 year old has laid down optimal amounts of bone.

And we can talk about how that's becoming not true.

But so once we know our T score, it tells us the health of our bones.

Just to give us a gauge of can we rebuild?

So yes, all the things we can lift weights, we can impact our bones, we can have proper nutrition.

If we are a woman and have lost our estrogen, which starts in our 40s, not our 50s, it starts in our 40s, we can make our estrogen decision, as I know you've talked about before.

Because estrogen and testosterone are critical in bone health.

And then if you show up with a T score that shows that you have frank osteoporosis, even two million men in the United States have osteoporosis, it's huge.

Osteoporosis is critical bone density weakness, meaning a T score of minus 2.5.

So if you, this is how it goes.

So remember in the, in the tests in lower school where they would grade you on this bell curve straight up the middle is bone density at 30 and a healthy woman, for instance, zero.

Any positive number for your T score, your bone density is more than zero.

Perfect. You're all good.

Bone density, one standard deviation or minus one below a 30 year old healthy woman is called osteopenia, meaning your bone density is getting low, we really got to step up our efforts.

Bone density number a T score minus 2.5 is the definition of frank osteoporosis, which is bones dangerously brittle.

That score plus there's this index called a frax index of R a X index, which takes all your lifestyle risk, meaning is your mother shrinking.

Do you have a family history of osteoporosis?

Did you already fracture fractures the number one predictor a future fracture?

Did you smoke your whole life?

Did you have an illness where you had to take a lot of steroids that predispose that break down bones?

Are you of genetic makeup where you're predisposed to bone density?

The frax index takes all those and calculates your risk for having a fracture in the next 10 years.

So a T score of minus 2.5 and a frax index of 3.6 or 3, meaning I have a 3% chance of a fracture in the next 10 years.

Those are indications for employing some of the pharmacologic drugs to either maintain bones or to build bones.

And there's a few categories of those that usually send people to an endocrinologist to weed out is kind of a complex decision.

If I was getting to that stage, what kind of things would you tell me that I needed to do?

So if I was getting to the stage where I was minus 2, in that scale.

If you were already a minus 2.5, we would have a long hard discussion about all the lifestyle interventions, nutrition, lifting.

You can still lift how we're going to add mobility impact.

How we're going to get some impact in without breaking a bone.

But we're also going to have a conversation about our hormone status.

And we're also going to, if you're already that low, have a conversation about whether we use a pharmacologic augment like bisphosphonate or forteo or some of the drugs that are available to support bone density.

And each person, man or woman, has to have their individual risks assessed to know which road to go down.

But what we cannot do is we cannot ignore it and hope that it goes away.

You've done so many studies.

And I find studies really fascinating because they're their first party in that regard.

So it's really finding things out for the first time.

What are some of those studies that we haven't discussed that relate to our conversation today that you find most interesting?

Yeah. So let's talk about, we'll start with bone because we're just talking about in master's athletes, we did two studies looking at, could we preserve bone density across a lifespan?

And if we took the variable of sedentary living out of the equation.

So in the first studies that we, my group did, we formed a group called Prima, the performance and research initiative for master's athletes.

We looked at 3000 master's athletes, you had be 50 years old.

And they were competing in the national senior games, which is like Olympics for people over 50.

And these weren't just, these weren't just everybody that could go.

These were the people who had qualified in their state games to go to the national games.

So we looked at 3000 of them.

We did two bone studies.

We found the first question asked, could we maintain bone density across upper age limits because we were active?

And what we found was that yes, a very high percentage of people up even up into 85 had normal T scores.

But then we did a second study that we wanted to ask, okay, so of all the activities you could do, what would make the biggest response from your bone?

And not surprisingly, we found that impact exercise, the running sports, the volleyball, the basketball sports versus the swimming, the biking, the bowling, for instance, there's bowling and senior Olympics.

Those with sports where you impacted your bone.

That impact exercise was as predictive of bone density as things you can't control, like your age, your sex, your genetics.

And so it just shows how important putting mechanical stimulus against your bone is.

So that was really important.

So even bones can be preserved.

We've already talked about the muscle preservation study, which was fascinating.

The very first question I ask was to answer the question, this is this virus in your brain.

When do we really slow down?

When can we say, oh, I'm just getting old.

I'm going to slow down. I based on the athletes I saw, I knew that it wasn't 50.

So I studied 3,000 of these athletes again.

I looked at all the track and field athletes.

I looked at athletes in the 100 meter all the way up to the 10,000 meter.

So all distances sprints versus long distance.

I looked at finished times of the top eight finishers in every age category.

And here's what I found to answer the question, when do we significantly slow down?

It's not 50. It's not 60.

It is not until our mid 70s when we significantly slow down.

If we use athletic performance as a biomarker of aging, so what does that mean?

The example is this, if you put a bunch of men in a one mile race, the 50 year old man in the year I did the study finished that one mile race in five minutes and 34 seconds to put that in perspective, the boy that won the Pennsylvania state high school games when his mile in five 17.

I know 20 seconds in 30, 40 years, right?

How old was he? 17. Let's say he was 17.

But the 50 year old winner didn't 434.

The 70 year old winner of that mile race did it in seven minutes.

So nobody was getting lapt.

So I used those times to see how much we slow down before age 70, we slow down less than 1.2% a year.

So after 70, there is a rapid decline in times or you get slower and slower and slower.

And I call that biology taking over either you don't have the mindset to work that hard anymore or you've got enough injuries that you can't work that hard anymore or you've lost enough enough muscle mass or bone flexibility.

But what it tells us is that we have no excuse until our mid 70s for slowing down if we invest every day in our mobility.

So it really set the stage that was my first study really set the stage for wanting to find out, okay, what's our muscle doing?

What is our bone doing the third study we did which took us five years because we matched for everything.

And now it's common knowledge, but at the time it wasn't we asked the question well if we take sedentary living away from our brain what happens.

And so we had the athlete group and we had a control group that was matched for every variable except their activity level.

And what we found was that people who were chronically active maintained their mental agility and their speed of decision making and their physical aspects of something called the SF 12 which is your perception of your physical prowess.

We're all higher if you invested in your mobility every day.

So even our brains are responsive and we know that now there's lots of studies.

It's something that's talked about a lot.

The final interesting group of studies that we did before I left university Pittsburgh was to start asking the questions of why what's going on here why.

Well, there's this protein called clotheau.

Clotheau was one of the Greek gods who spun the threat of life.

So this protein when it was discovered was thought to play a role in longevity every organ has receptors for clotheau.

We know that mice that are genetically engineered to not be able to make clotheau die old very young they're chronologically very very young mice but they're physiologically very old because they lack this protein.

So I decided to measure clotheau in my athletes and compare them to sedentary people.

So we drew their blood. We ran the alliance the study and and not surprisingly young gish 35 to 50 year old master's athletes had the highest level of circulating clotheau longevity protein.

The second highest level of clotheau in our study were people over 75 who were still athletes.

Do you know the who the lowest clotheau level was sedentary 30 year olds.

So if clotheau is the longevity protein and exercising people have the highest levels the next question was, okay, so what's going on how does exercise give us more longevity protein.

Well, one of my one of my colleagues, Dr.

Fabrice Ambrosio did the study that showed that contraction of skeletal muscle stimulates the transcription or the making of the clotheau's protein.

So it's our bodies response to the stimulus of activity that makes us make more longevity protein because our bodies believe that we are reinvesting in ourselves and not just sitting in a chair waiting to die.

But that's fascinating right.

Interesting. I read about study did as well with rats and stem cells, which is seems somewhat linked this idea of muscular.

Yes, I'm glad you brought it up.

So it's the so remember that picture we talked about that at a tissue level that we can maintain our muscle mass.

So that's at a tissue level the whole flank steak we can maintain.

We wanted to see what's happening at a cellular level what's happening at a stem cell level.

And so we we had a bunch of old lady mice they were mice mice when you're old you're two years old that is a long lifespan for mouse.

These little lady mice were sitting back in the back of their cages just hanging out waiting for their next food and we sampled a little bit of their muscle because the lab that I was a part of looked at a kind of muscle derived stem cell.

Meaning all of our tissues have stem cells in them, including muscle and and we now know those cells as satellite cells at the time in the in the early 2000s we called the muscle drive stem cells when we took them and what do we find these little old stem cells.

Healthy stem cells are around these stem cells had started to become all spindly like tree branches.

They were no longer pumping out growth factor meaning they were not reproductively healthy they were not doing what they were supposed to do and do these stem cells make muscle.

These are stem cells that are found in muscle and when stimulated produce muscle and so they were not dividing.

Because they were all spindly they were not producing growth factor and death in cells is an active process they had turned on the genes that were leading to sell death.

So we took those little old lady mice and believe it or not you can buy treadmills for mice.

Do you know how much a mouse treadmill costs?

No. $30,000. Are you joking?

I'm not. It was like a big part of my whole grant so we bought this treadmill.

We put the little old lady mice on here's what we found in two weeks twice a day many workouts.

Their stem cells were fat and replicating again.

They were churning out growth factor and they had turned off the pro programming for program cell death.

So what that told us is that even at the stem cell level that we can rejuvenate stem cells by something as simple as skeletal muscle contraction.

And so to me that is a fountain of youth type intervention at the cellular level.

Someone said to me on this podcast one down I'm probably going to butcher it but they said aging is the rapid pursuit of comfort.

And I and as you're saying that I was thinking that that's that kind of fits that much of our aging is just to do with our increased pursuit of comfort for whatever reason.

I was thinking about that this morning when we're thinking about I was thinking about you know what is the what is the minimum amount of time we have to work out to what is the min max and I thought well honestly you can probably accomplish what.

Min max isn't about 45 minutes a day so what are we doing with our other more than 90 percent of the time and it goes kind of goes to this what are we doing are we pursuing pleasure all day well we're working but.

Once we're not working what's the rest of that we're just sitting around being pleasureful all day and so that's an interesting question but another way to motivate people is to start associating taking care of ourselves as pleasure.

And not or comfort and not just in the senses I'm going to get a massage or a facial which is what often we think of self care but that's temporary right it just lasts an hour until you I often think that I get off a massage but I'm like okay that was good but what I have to do this every day yeah.

So you start thinking of taking care of yourself as pleasure putting yourself in discomfort temporary discomfort because I'm not really kidding you and you're probably the same when you churn out an upper body workout and your muscles are full of blood and you're looking in the mirror because I know you do we all do you know that is a good result today that's pleasureful and if we if we stop for a moment and notice how good we feel afterwards it's a motivation for how much we don't want to get there because I don't want to get there as much as the next person doesn't want to get there to the gym.

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You have written a paper about a subject we haven't spoke about much you mentioned it briefly from your own experience you talked about going into Perry menopause and thinking you're going to die yeah there's been a lot of research that's come out and you've done a lot of work on how menopause impacts are muscular skeletal yes physiologic physiology I guess is the word what what do women that are and men that are have a partner or a friend or a mother or whatever it might be need to know about how menopause impacts on muscular skeletal functioning yes so I think it is very common for people to know about hot flashes brain fog night sweats what is less commonly known is that 80% of all women going through the same area menopause will experience what the term we've coined the muscular skeletal syndrome of menopause we coined that after the guy in a co urinary syndrome of menopause which is five or six different things put into one category so we can talk about it more easily.

And the muscular skeletal syndrome of menopause we know that 80% of women will experience it 25% of women will be devastated by it and 40% of the time when you go to the doctor and they do do diligence and they work up they send you for imaging nothing will be found structurally so that's why women sometimes think oh my god I'm just old I'm falling apart and am I going crazy because my doctor is telling me there's nothing structurally wrong but that's why we created this no enclai and we're so that women would realize that ubiquitous on every muscular skeletal tissue are receptors for estrogen just like in the brain just like in you know every other body part the muscular skeletal system muscle tendon bone at a post the inflammatory aspects are responsive to estrogen sitting these receptors so what are the things in the muscular skeletal syndrome of menopause well number one is inflammation in estrogen is a huge anti inflammatory prevents the release of a cytokine inflammatory cytokine called tumor necrosis factor and menopause is to be clear is the part part part of the symptoms is the loss of estrogen.

So if we if we just clarify the timeline so a woman's hormones are unlike men's men once you're through purity your testosterone will stay pretty steady women every month as we go through a menstrual cycle cycle estrogen goes up and down when we in around these are average times around 45 it can start early like 35 but around 45 we have used up enough eggs from our week our monthly cycle that we start to become low in our estrogen and our bodies trying to adjust to that our brain without estrogen gets brain fog it has a lot of receptors and nothing to go in them right once we have used up all of our eggs and we are one year from our last menstrual cycle 366 days that is the one day definition of menopause and we live the rest of our 40 40 more years we live post menopause without estrogen unless we supplement so in then Perry menopause in our 40s that's why I say at 47 I thought it was going to die as estrogen is going away all these receptors that used to be filled with estrogen which would then cause all these marvelous downstream effects all the muscle protein synthesis the bone lane down the inflammation would be kept at bay suddenly have have no stimulus so when we're talking about inflammation estrogen is an anti inflammatory effect it prevents the release of Tumnicrosis factor which is a inflammatory cytokine I think of it like a fire or you know nuclear war something that chemicals in our body so that gets out of control and then estrogen is also really important interacting with a part of our immune system called the inflammatory zone so without estrogen controlling inflammation we can get something called arthralgia which is your total body hurts for no reason and this was one of my primary symptoms when I was 47 I went from being an athlete active all the time surgeon I do hauling people's bodies around that I could barely get out of bed it took me a lot to like crank out and get out of bed my whole body hurt there's nothing structurally wrong it's do the inflammation of loss of estrogen another very very very common inflammatory symptom of the muscular skeletal syndrome menopause is frozen shoulder it's all over social media right now it's where it is an inflammatory state men can get it usually diemetic men it just means that you're you're inflamed so you'll present to my office with the story of doc I did nothing I didn't have an accident I didn't hit my shoulder on the closet middle the night when it was dark but I woke up my shoulder is killing me and I can't move it it's literally like this and that's because for some reason the shoulder is very sensitive the capsule the inside skin of the shoulder very sensitive inflammation and so people show up like that frozen shoulder can take two years to get rid of its miserable so that's inflammation the whole book your broadcast yes yes I made this thing up you can't hook your bra right most women do this yeah the first motion you lose in frozen shoulder is internal rotation which is what this is can you bring your brother you can't because what happens is the first thing that goes you can't do this your arms kind of stuck at your side and then you can't lift it up and you can't do your hair so you're trying you know you're doing all this trying imagine not being able to move your arm and when you did move your arm it's excruciating always painful as well excruciating pain like women say to me I'd rather give birth again than have this shoulder so what's going on now like what's going on in the shoulder yeah there's there was a study done by Joe Hanuffin who is a mentor of mine at hospital for special surgery who looked at the stages of frozen shoulder and first it's just big inflammation all the inflammatory side of kinds go and inhabit the I keep doing this the shoulder has an inside skin that surrounds the bones called the capsule is like a thin sheet of paper like cellophane that gets inflamed hot and red that's painful over time the inflammatory cells of the immune system that crawl into the capsule the pain will go away but it will cause a capsule or shrinkage like this that it will actually contract so your pay your shoulder might not be as painful but it still won't move so that's why it's really critical that people come to doctors like me and we get it moving quickly we do not want it to become sucked in because it literally can take two years to defrost all due to this inflammatory into we don't know why the capsule is so sensitive but we know it is so that's the inflammatory aspect of this we know that without estrogen we can lose a two to three percent of our muscle mass and rapidly during this period we have estrogen is an anabolic steroid it's made for muscle building through the amtore system and so without that and we build less muscle and our muscles stem cells are satellite cells become decrease by 30 to 60 percent is profound in a very short amount of time we know our bone about bone density we talked about that estrogen's role in the bone is to control one of the cells called the osteoclast if we talk about bone biology briefly if we have that femur imagine on one side of the cell when you impact your bone the biomechanical stimulus is converted to biomechanical stimulus and it says hey we need to build more bone so the osteoclast crawls up the cell and starts digging out minerals to release to the body to do its function what happens when you have estrogen is the osteoblast comes back up behind it and fills in that hole and builds bone estrogen helps control osteoclasts the more I learn about bone biology after all these years it seems to me that the osteoclast is a little bit of a rogue entity it's going to go on control that needs a lot of a lot of control with estrogen testosterone without those controls what happens in osteoporosis is you can still lay down bone your osteoblasts are still working but it's out of control you're breaking down more bone than you're building yeah so you know inflammation you have muscle you have bone here's one we talked about arthritis earlier there are estrogen receptors on the cartilage cartilage estrogen sitting on the cartilage helps maintain this spundry spongy matrix of cartilage that then protects your bones without estrogen the cartilage matrix breaks down so before 50 men have more traumatic arthritis than women after 50 women can have a rapid progression of their arthritis pile on top of that the weight gain that happens to many women with the load we talked about and it's a disaster and so many women rapidly progress and need total joints which as an orthopedic surgeon is not the endol but we'd like to avoid it right so that's due to estrogen being missing from the cartilage and then finally on that point you talked about weight gain in menopause I read that you you gained weight when you went through menopause I gained 30 pounds 30 pounds so that's equivalent to four roughly for these bricks of each brick weighs seven and a half pounds which is a lot of weight to send me again and when we think about the impact that they'll have on your joints based on what you said earlier yeah yeah my pain was more in our thrallgic pain meaning total body pain although when I had that weight on I had knee I had pain underneath my kneecaps going up and downstairs because of the extra pressure of the my kneecaps on my femurs so does that make sense yes it does yeah so yeah something that we don't I don't think I'd never really consider I never considered how the impact on our joints of weight gain period but then also when you go through menopause weight gain is something that I've heard about over and over and over and over again because of the loss of estrogen and how that will then have a skeletal impact on a variety of different areas of your body but then imagine this perfect storm right you you don't feel like yourself you're tired you your joints hurt maybe your whole body hurts you're losing your muscle so that causes more impact there's no shock absorption you're losing your bone and without even realizing what's happening because it creeps up on you right and you're so busy I mean all the excuses are so busy women very rapidly find themselves at 60 and they have you know there's a syndrome called OSO osteoporotic meaning bad bones you talked about that sarco B-City loss of bone loss of muscle gain of fat you've got all three things and the morbidity and mortality of being osteosarco B-City is three times what it would be if you had one alone so it creeps up on you and you can see how none of these tissues are separate from each other it just becomes this horrible storm and women are like what happened to me what's the remedy for that?

well the remedy is understanding that you can feel like yourself again and here are the steps I ask every woman going through this to do number one you must make your estrogen replacement decision I believe that that decision to replace your estrogen must be based on science and not the fear or the myths that are circulating though and I know you've had these conversations but the women's health initiative study has been largely overturned and so every woman is a sentient being with agency ability to make their own decision and they should make that decision and not just go on here say so that's number one let's make our decision if you make your decision to do that which I have done I replaced my estrogen not for my hot flashes night spets and brain fog those go away frankly I do it to preserve my bone my muscle my brain and my heart that's decision number one number two you are never ever going to feel better until you decide to invest every day in your mobility and so what is mobility it is lifting heavy women have to put down the man be pampy pink weights that we do 20 sets of because we don't want to bulk up you're never going to bulk up unless you do it purposely we must lift as heavy as our bones will let us so for my people I've simplified it into once you have started enough that you feel comfortable moving your body we must lift four rep four sets of our major muscle groups and compound motion so push pull with your upper body bench press pull some kind of pull down and then for the lower body it squats and deadlifts four reps four sets in a progressive manner you can start with two pounds but I want you to progress up and then for the accessory lifts that support the big compound lifts like for instance for my for my bench press I support that with biceps triceps lats delts eight reps four sets okay that is the basis of lifting heavy the other thing we need to do is do or do our cardiovascular training with eighty percent based training which is lower heart rate I mean everybody's talking about zone two I happen to in the place where my office is we have a metabolic lab that was built by a nico san martino who is the guru of zone two and so we use his protocol and that means that I need that I need people to do 60% effort three hours a week but that's not all twice a week we're going to sprint as hard as we can and that freaks people out because we're in the Olympic trial we're in the Olympics right now and everybody thinks it's supposed to look like that like the track and field trials what sprinting means is you just work at maximum heart your maximum hundred percent effort for short bursts so thirty seconds short burst hard as you can go and then you recover for two to three minutes so I'll give you a concrete example in my life my base training heart rate because I have the luxury of measuring it with a lactate threshold is 130 beats per minute I achieve that with an incline of four to five and a speed of about four point two and it's a brisk walk it's almost on the verge of having to jog for 45 minutes when I'm done with that because that's good for my cardiovascular base I punch it up to 11 and I go as hard as I can because I'm not very tall and I don't want to fly off the back of the treadmill but my heart rate goes up to about 186 and I keep it there for 30 seconds what that does that will burn 40% more fat than just even high intensity interval training which is done at about 80% that amount of effort burns 40% more fat it is stressful enough it offsets our normal homeostasis enough that it helps stimulate the formation of more muscle stem cells the muscle perceives that effort and so that is the the working out portion of what we need to do and then the smart anti inflammatory torary nutrition we need to get rid of simple sugar we need one gram of protein per ideal pound high quality protein what does that mean we need a very high concentration of one of the branch chain amino acids called loose scene loose scene is the most powerful amino acid stimulus of the m-tor muscle building pathway loose scene is found in highest percentages in way protein so you can get it from plant protein but just in much lower percentages way has about 10% loose scene and we know that's important in nature because mothers milk is mostly way which means it has the highest amount of loose scene as we're trying to grow muscle in our babies right so loose scene is high in way protein about 10% in animal protein any kind of meat is about 8% and then beans and legumes and plants are about 6.5 so can you get enough protein from plant sure you can you just got to eat a lot of it like a bull does about fiber yeah crazy for fiber the main thing is 30 grams of fiber so that just means complex carbs your microbiome needs fiber it is a slower digestion so that we're not causing carbs spikes I'm not wearing it today it's first time about a year I haven't I am not diabetic but I have worn a continuous glucose monitor because I am just a data geek I love my data I know exactly at this point what foods will spike my glucose and how to keep my glucose steady all day what's been the most surprise because I literally have just taken my continuous glucose monitor off the war if the last two weeks while I was filming TV show called dragons down yeah I gave one to all of the dragons with me and we've been talking about it every what was the most surprising food for you that caused a glucose spike the surprising food well it wasn't surprising I mean I am to the degree to which my glucose spikes shot up is I am so sensitive to simple carbs I can't even look at a simple car and it goes up to 165 which our body is meant to respond to spikes I'm not saying that you have to live like this because I have also found that when I only ate protein or most very low low low carbs that I was so low energy I would be slogging through my clinics and I just need I could feel I needed energy so now I've added sourdough to my breakfast knowing that I'll get a small spike so that was very interesting to me how extremely sensitive it's a simple car a simple car is a sugar ice cream white bread white potatoes white pasta and I'm not only what is the most important thing that we haven't discussed in your work or the most important idea that I know has changed your life maybe people don't understand it or think about it enough that's foundational to having a great health span living long being healthy all of those things that maybe we haven't discussed yeah I want to address that question in a couple ways number one you have to we talked about temporal disconnect and doing the things today that feel good today but for the future and so the way I have really changed since I've been through this is I have thought ahead about what I want to be when I'm 97 and how did I choose 97 well I'm 57 now my daughter my youngest daughter was born when I was 40 if I want to be around the bug the heck out of her until she is my age I need to live till 97 what do I need to do to do what I want when I want when I want it like you can imagine I don't want to be told what to do I'm a surgeon I'm usually in control my environment and I think people just want to be in control I want to do what I want well what it's going to take if I just wait until 63 when when my health span is over to pay attention I'm never going to get there so that is really pivoted my mindset that you I have to do it every day now I don't love doing it I mean I'm not going to lie to you I don't love going and working out most days but with this perspective I will but the other the other tenant that I think is so important we talked about lifting heavy we talked about zone two and sprinting something I've layered on this year is the concept of our VO to max and the fragility line fragility means you get older slower weaker you lose your functional capacity 25% of all people are frail and unable to live independently by the time they're 85 not on my watch and so the frailty line is the cardiovascular health that you need a cardiovascular capacity that you need to be independent in your own home you may not be running marathons so for men it's 18 a milliliters of oxygen per kilogram per minute for women at 16 so how do we figure this out I would go have my have you had your VO to max tested I haven't yet it's torture but you should do it I think what I had a cardio vascular examination and they made me sprint on a treadmill yeah and they were looking but they were looking at my how well my heart coped and if they're measuring my view they put up they didn't yeah you should do it while you're young so you know your base I didn't have a mask on yeah so what it tells is your vascular capacity for for exchanging oxygen from your blood to your lungs elite athletes like the tour to France have have VO to max is in the above 75 sometimes 200 they're just genetic specimens the 50th percentile for a man your age is 55 the 50th percentile for a woman my age is 31 that's the average right that's the average 50 percentile when I was 50 I'm going to give you an example every decade we lose 10% of our VO to max if we don't do anything about it that's just the way we age 10% I can get it back though right you can work at it people who are out of shape can make bigger delta's getting it back people are an extreme shape in the delta smaller because they start out well so for me I'm going to give you an example so people see how this works at 50 when I was 50 I did it my time was 45 so at 60 if I lose 10% let's just do big numbers I'll be down to 40 VO to max at 70 I'll be down to 35 at 80 I'll be down to 25 I'm still above the frailty line at 90 I'll be 20 still above the frailty line not what I was at 50 but not frail I can still live on my own so what I've done now sense the things that I've talked to you about our lifestyle they don't take much energy because it's just how I live I've layered on VO to max training which is a different way to do cardio training it's four minutes as hard as you can go torture and then you recover for four minutes only once and then four minutes as hard as you can go the good news is you only have to do that three times or so once a week and it will work you hard enough to maintain or improve your frail your VO to max frailty line that's something special that you can add on once you've optimized your health once you've done the peak performance things we've talked about then you can add those things on okay well I better get better get on with it then don't feel guilty and I need to go to the gym today but it's certainly changed my perspective on what I'll be doing in a gym and and also while I'll be doing it I think I think the why piece is so critical I think a lot about discipline and incentives and why and behaviors occur and I wrote in my my book that I'm I was trying to sort of sort of simplify why sun habits in my life of stuck and others haven't and then why sun habits where I was a bit of a yo-yo suddenly start and I held them for five years and still to this day and and others haven't and I kind of simplified it down to this idea that the discipline equation starts with the strength of your why I just so you've given yourself a really strong why by having this sort of 97 year old goal like who I'm going to be when I'm 97 and then linking that to a door to which is a pretty strong why plus the enjoyment I get from the goal and then minus the friction or the like lack of engagement from the hard like if the gym is really far away if it takes too long if it if it's embarrassing as friction so if I'm going to a gym and I'm a guy and there's lots of beautiful people there and I'm overweight so you know all of that all of that's friction so how do you like influence that equation to increase your why make it more enjoyable or psychologically reinforcing the act of the discipline and then kill all the friction I possibly can and for me that's where the habits we're talking about today have really stuck yeah interestingly I said to share this before but I'll share it again I was a a yo yo gym goa my gym routine and my health strength routines were all very inconsistent until the pandemic and it was for me just seeing that health is the foundation of all of our lives seeing that on a screen and lockdown that the real sort of variance between outcomes for people that got COVID came down to your sort of pre existing health and so at that point I thought my god like it's not my business it's not my dog it's not my girlfriend it's not my my family that matter the most actually number one the foundation in which all those things it is my health so that became my first foundation my nonnegotiable and hopefully as you say that I mean that my kids when they arrive whenever that whenever I become a father will have a dad until I'm 170 so that's the girl I hope so that's the girl we have a closing traditional this podcast where the last guest leaves a question for the next not knowing who they're leaving it for and the question left for you is what was the last time you took an uncomfortable risk the last time I took an uncomfortable risk and what happened when I did was I am an academic orthopedic surgeon which means I create big business and care and practice within big hospital system so there's a big safety net in that but I have always been what I've called an intra pernure meaning I'm using somebody else's money somebody else's time and but I'm building them a big business three years ago I left that comfort in a late stage of my career I left that comfort and decided I know what I'm doing I believe in myself I'm going to spend my own money and I'm going to go out on my own private practice and I'm going to build these side businesses my keynote speaking my precision longevity practices which are purely entrepreneurial ventures and at 57 to go out and create my own business when all I have ever known is a W2 tax form is a huge risk for me and my family but but I love that I am confident enough in my own capacity Stephen and my own work ethic that even if I had to go work at Starbucks to bridge the gap that I'm going to make this work and it's a it's a very freeing and beautiful mindset to to take what I've learned this whole career and do it for myself well it certainly is working I think you'd agree right it's great it is great I mean you've galvanized a community online of many millions of people you've written some absolutely incredible books all of which I'll link below and you're still doing incredibly important work through YouTube and through Instagram and through all of your channels which I'll link below as well and it's very necessary work because you are you're confronting a mind virus that I think can hold us back from living long happy healthy lives and sometimes it's just an idea right sometimes it's just an idea that can change your life and it's also conversely sometimes just an idea that can ruin your life and I think the work you're doing is replacing those potentially inhibiting ideas with much more constructive health the positive optimistic hopeful ones and for that I thank you thank you you you