Live Like a Girl with Dr. Mindy Pelz - Strong Is Ageless: How to Age with Power, Strength & Science with Dr. Vonda Wright

Episode Date: August 11, 2025

Understanding menopause is key to thriving through it! Dr. Vonda Wright shares insights on musculoskeletal health, strength training, and maintaining vitality. She explores the critical 'mental-essence' period, the importance of strength training, vital nutritional changes, and how these components come together to help women lead vibrant, empowered lives into their 80s and beyond. Discover the essential strategies to prevent osteoporosis, maintain muscle mass, and achieve overall health and wellness through every stage of life. To view full show notes, more information on our guests, resources mentioned in the episode, discount codes, transcripts, and more, visithttps://drmindypelz.com/ep300 Dr. Vonda Wright is a double-board-certified orthopedic surgeon and internationally recognized authority on human performance, longevity, and women's health. The founding director of the Performance and Research Initiative for Masters Athletes (PRIMA), she has served as a physician for athletes at the University of Pittsburgh, Georgia State, the Pittsburgh and Atlanta Ballet, World Rugby, and the PGA. A highly sought-after media expert, she has been featured on the Diary of a CEO, Jay Shetty, and Mel Robbins podcasts as well as the Today show, the Dr. Oz show, and in top publications including The New York Times, USA Today, and the Observer. She has authored five books, including Fitness After 40 and Guide to THRIVE. She lives with her husband, a retired two-time Stanley Cup champion, near Orlando, Florida. Check out our fasting membership at https://esetacademy.drmindypelz.com. Please note our medical disclaimer.

on this episode of the Resetter podcast. I bring you Dr. Vonda Wright. And we're going to talk about menopause and the musculoskeletal system. And it's a really cool conversation for a variety of reasons. But one of them is you're going to want to get a pen and a pad of paper because has she got some incredible ways that we can keep our musculoskeletal system strong, healthy and functioning well into our hundreds. So let's talk about who Dr. Wright is. So she is an orthopedic surgeon. She has worked with a lot of elite sports teams.

This isn't her first book. She actually has a book coming out. She's done several books. And she has literally been in the trenches with athletes, non-athletes, women, men for years. I love about Dr. Wright and why I wanted to bring her to you is she now has mastered a formula for musculoskeletal health and menopause. So what you're going to learn in this conversation is you're going to learn that when estrogen goes down, this is the beginning of things like injuries from our activities, joint replacement, osteoporosis. And there are some really simple ways that we can start to prevent this. And it doesn't matter if you're 70 and hearing this or you're 30 in hearing it. She has some really smart strategies for making sure that we prevent

osteoporosis, we prevent hip replacement, and that we stop injuring ourselves. So we go through that. We also spent a lot of time talking about nutrition. And what do we need to know about the way we eat for our musculoskeletal system, we broke down every single exercise you could think of. I, we went from Pilates to yoga, to rucking, to weightlifting, to how often should you be weightlifting, to what kind of muscles are you trying to activate when you weightlift? So it, you know, a lot of times when I bring you all podcasts, there's a lot of theories and philosophies and mindset, this one is application. And I'm really excited to bring it to you. She has a new book coming out called Unbreakable. We will leave links for it. I highly recommend that you grab a copy

and sit back and enjoy her humor, her straightforwardness. I absolutely loved. And it's just a really profound and fun discussion that I know is going to help you move your health forward and give you a new vision of what fitness can look like as we age. So Dr. Vonda Wright and Unbreakable. Enjoy. Welcome to the Resetter podcast. This podcast is all about empowering you to believe in yourself again. If you have a passion for learning, if you're looking,

to be in control of your health and take your power back. This is the podcast for you. I am just so excited to have this conversation with you. So welcome. Thank you. And you know what I have to tell you? Like so many of the digital world, I feel like I've known you for years. So I'm finally so happy to sit across a desk from you. Yeah. Thank you. I have to tell you that I think the menopausal conversation has been really interesting to watch how it has transpired. and I always say we went from a cultural hush to cultural chaos. And then somewhere along this like emergence, I saw your work. And I was like, yes, let's talk about the musculoskeletal system and how it changed.

Because not only did I have major injuries as an athlete going through my menopausal experience, but I had a practice full of menopausal women that I didn't really understand what was going on until people like you really emerged and taught us. So thank you. I'm so happy you wrote this book. My pleasure. My pleasure. Yeah.

Okay. So here's the first heart space. What I want to know is what is it like to be a female orthopedic surgeon? Let's just start off with that. Oh, my God. So, you know, we're the fun people in medicine, right? Everybody going to, all the guys going to orthopedic surgery, 94% are guys. Now, when I trained so, so long ago, there were 3%.

So between, you know, then and now we've doubled, which means it's going to take us 150 years. God, I better take some insurgents. We're fast a little more. We're trying really hard. But so 94% guys, and we're the fun guys, right? Because we're all the old athletes. They're the engineers, but they're fun engineers.

And we get to do fun things by and large, except for those musculoskeletal oncologists and some of the pediatric stuff, most of what we do is fun and aspirational. Imagine I have spent my life making people walk again. Yes, right. Or making their shoulders again. Yes. You know, every time one of my golfers that I fix his shoulder does a hole in one, I'm like, you know, that's mine. I did that.

So it's really aspirational. It's beautiful. But what an honor. You know, I mean, for for doctors, it's such an honor. People trust us with a lot of important things, sometimes the first time they meet us. And that's an honor. That's sacred. And so, yeah.

So we're the fun people, but we take what we do so seriously. Like, you can imagine academic meetings. There are these big debates on where the two millimeters. we put the ACL screw. I'm like, from an outside of you're like, it's two millimeters. Right. But it's really, wow. Wow.

So were you in practice and doing surgeries on both men and women and then seeing like a trend in menopausal women? Is it like I would think, you know, my husband just had hip replacement surgery. And I was like, I was like, did anybody take a picture of his hip? I want to see. Like, exactly. would have been in there watching if they would have let me watch because I wanted to like see how where it had degenerated and all that. So I would think if you had the opportunity to open up a lot of

menopausal women's hips and shoulders that you saw something most of us didn't see. So my practice, just to answer the first question and then tell you how I got into where I am now is, you know, I'm a fellowship trained sports doctor. So my job is not only the sports surgery, but I'm a team doctor. So meaning that I'm the guy on the field and all the football, I was the head football doctor for University of Pittsburgh and all their Olympic sports teams. And so there's the team doctor's side of that. And the reality is most of the teams I took care of were men's athletics. I had a few female teams.

I had female rugby teams. But just the way it worked out. But in 2012, Mindy, I read a statistic that women make 80% of all the health care decisions in this country for themselves and everyone we touch. And it just a light bulb went off because we're 51% of the population and therefore 50% of all my patients, athlete or not, were women. And so when I went through my own menopause more than a decade ago, it hit me. I tell the story, 40 best shape of my life. I had a baby. I'm training for all kinds of things. I've got, God knows I'll never get back to it. 19% body fat. And then 40.

about killed me, right? Very metaphylisting. And I became a scholar not only of women, but of menopause. And really did such a deep dive. I considered myself an expert, especially within the lane of musculoskeletal. Because here's what women would say to me, once I started listening with menopal ears. I'm sure you heard this in your own practice. I don't know what happened.

Yep. I think I'm falling apart. Yep. Yep. Do you know what else? I might be going crazy because I taught my other doctor about it. And they said, nothing's wrong with you. You're just getting old.

Yep. Here's the part that killed me. And this is what really keeps me so focused. They say to me without prompting. But you know what? I didn't want to come in today because I have a very high pain tolerance. Like it's a button, right? Yeah.

High pain tolerance. But, Doc, I just can't take it anymore. And in a very defeated way, and I'm a musculoskeletal doctor, but people are weeping because it's so hard. So I decided once I started listening with those ears, the ears that come with experiencing it, I love that. It's more than reading it in a stress study. I lived it. And musculoskeletal syndrome of menopause was one of my biggest symptoms, right?

I couldn't get out of bed. It's so painful. And we can talk about all those things. That is when I really became committed to exposing what affects 80% of all women at almost the same rate as hot flashes, night sweats and brain fog, is the musculoskeletal syndrome of menopause. Yep, yep. Yeah. And so let's launch from there.

If as women are listening to this, I feel like there's some like golden rules we need to follow when we go into our perimenopausal years. Like, are there things that we should, we should start doing differently? I can tell you for me, I was an ex-teness player in college, and I turned me into a runner, and all of a sudden at 43, I was injury upon injury upon injury. And it took me several years to figure out, oh, wait, something has shifted as my hormones have shifted. And so I had to change the way I worked out. So what are some of those ground rules that we need to know when you're going into menopause as far as your musculoskeletal system goes? Well, I think it's helpful to know that muscle, tendon, ligament, bone, fat, satellite stem cells,

cartilage, disc, anulus in the back, you know, they are all from the same stem cell. So they're all going to respond in a cousin-like way to estrogen. Every one of those tissues has estrogen, alpha, and beta receptors on them that keep them healthy. Cartilage, for instance, the matrix is like a mesh, if you will, with estrogen receptors and without estrogen sitting there, the matrix starts to fall apart. Such that, here's men before 50 have more arthritis. women after 50 without estrogen have rapid increase in arthritis in the hips, the knees, the hands. So the first thing women have to know going through what I call, I call this thing, I like to make up words.

So I call this transition the mental essence to be reminiscent of the chaos of adolescence. Like people get that, right? Oh, that's good. Yeah, mental essence is awesome. We're exiting our hormones the way we came into them in total chaos. Number one thing to go into is to recognize this is different, right? The same things are not going to work now that work then. This is a different life stage to embrace.

And every tissue in the musculoskeletal system. So it follows that, for instance, if your tendons and ligaments naturally with age, increase, these are, these are supposed to be collagen fibers, increase your covalent bonding and get tighter, and then they don't have estrogen to help repair the micro tears. We're going to have more tendinitis. On top of the fact that estrogen is a huge anti-inflammatory, it works directly on the immune system,

it modulates immune cytokines, we're more inflamed, so the microenvironment's hot, bothered. We have less regenerative capacity and just the natural aging. We're getting tighter. So we're more prone to things like tennelbo, Achilles, and then latest. And so just recognizing, oh my God, it's not the same. I can't just rest for two days. I have to have a mobility practice to stretch out my tenets out. To keep my joints moving. So the synovial fluid continues to be produced and we don't dry up like a raisin in the sun, right?

Yep. So recognition. What age do you think that starts at? Yeah, you know what? Perimenopause on average in this country is about 45. However, it can be much earlier. It can be 35, right? And it all comes down to, and your listeners know this, to the fact that by about age 40,

we have one to three percent of our eggs left, right? So we're not producing enough estrogen. And by the time it catches up or people recognize that they're about 45 with complete cessation of our menstruation on average in this country, about 52. Right. But I call the decade between 35 and 45, the critical decade to get your shit together. Here's why. Here's why, because I wish I had done it.

Yeah, me too. Me too. Because I don't know about you. You were an athlete. I was an athlete. If I saw I was gaining a little weight or I was sore, it was a really quick fix for me. Yep. And I'm, you know what, this is so ironic.

I am a musculoskeletal aging researcher. I don't think I thought it would ever happen to me. Oh, yeah. That's interesting. But if you're listening, please recognize that between 35 and 45, 35, you still have all your hormones by and large, you've got this youthful vigor, 45, you're going to start to be chaotically perimenopause when things change. Let's make sure we have learned what's coming. Let's make sure we establish a standard of our nutrition, right? Because when we get to 45 or even later,

or 52 when menopause happens, if we're suddenly having to create six or seven new lifestyle things, it is so weird. People are like, what should I do now, Vonda? And if they're 55, I'm like, this and listen. Right. Right. But at 35, if we layer in, how are we going to have an anti-inflammatory diet? How are we going to eat enough protein?

And what does that even mean? If we think about, okay, at 35, how do I start lifting in a way that's going to help me stimulate muscle protein synthesis and not just hold endurance? Right. I think starting early and layering on the lifestyles, by the time we get to be perimenopausal, when hormones may or may not be helping us at all, our endogenous hormones, it's not such. a shock. It's not so hard. Yeah. So that was a lot. Yeah. No, it's, I really like a getting ahead of it. I think that is a really important point. And it was interesting as you was talking. I was thinking, yeah, that when I was 43, that's how I found fasting because I, like you, anytime I needed to drop a few pounds, I would just put a couple more hours in each week on the, you know, running. And it would make you go, yeah.

run a little more, but then the injury kept piling upon injury upon injury. And I was like, what is going on? And so that's when I learned about fasting. I was like, oh, wait, I can actually get my weight to drop doing it that way. What's interesting about what you're saying is that you're using nutrition like most people would use supplements or they would use medication. Like I love this idea of like bringing it in in the beginning so that you can keep that a good foundation of inflammation. down. And then my question is collagen is, would it be worth it to eat collagen rich foods, especially in those early perimenopausal years? Well, I think the best date on collagen,

and I'm not an expert, but I think the best date on collagen happens to be surrounding bones and muscle, actually. Oh, okay. Yeah. And so, you know, there's some data that you can increase bone density one to two percent a year by supplementing with the right kind of collagen. Imagine entering the critical decade maxed out on everything with the best bone density, right? Before you start losing your estrogen with the best muscle. And so pulling in all the tools, I don't think it's one thing. I think if I look at the, and I mean, we're both deep into the longevity community.

We both appear at these same things. And I think what happens sometimes is we think one gadget's going to do it for us. Right. Right. Right. Shoney tool. And that's not my experience as a clinician. It is this constant, it's this ecosystem, as we like to say. It's not one little thing you turn on with the switch. Well, that's why I talk about it like this. Yeah. You know, I was doing at all the biohacking everything for so many years. And one day it hit me, I don't think you can hack a woman's body. You can't like hack into it. You have to harmonize it. It's not a body that's hackable.

And it's a body that needs love and nourishment and needs a rhythm to it. And so I really... You work in a rhythmic manner. When you think about every month, there's a rhythm of our complexity, hormones up, hormones down. We exchange different verses, you know, men get their testosterone in it slowly declines. And so you may be more inclined to hack that. Right.

That's another topic. I've made several comments. I really do love men. I'm married men. I have fours scenes. Yeah, right. There you go. Let's be. Yeah. Well, it's our moment, too. We're having our moment. We're finally, finally getting to stand on our soapbox and scream from the rooftop. So, okay, so we've got nutrition. You're going to make some nutrition changes. Okay, what else could I do as I'm going through this transition? So in the critical decade, please, please, please. please use Pilates and yoga as your movement icing but your meat and potatoes has to be building muscle mass while you still have your estrogen I say do it while you have estrogen do it while you can do it later you sure can and I'm working my butt off to try and I know you are too yeah your endogenous estrogen is easier to make muscle with as a stimulus. So learn to lift. You don't have to

lift heavy when you're 30. It depends what you want. If we want to go into prescription of lifting, people criticize me a lot because I mostly talk about heavy lifting. I don't care how you lift, but it depends why you're lifting. So if you're younger and you want to build endurance, then lift for endurance, do tons of reps with the lightest weight possible to 25 to failure. I would never do that. How boring is that? But anyway, that's a lot of joint motion. That's a lot of joint motion. If you want hypertrophy, which is what people in their 30s or generally want, well, that's a mid-range rep set. As a solidly post-menopausal woman like me, I am lifting for strength, and power, which requires heavier lifts.

So in the younger years, which is what you've asked me about, let's build a foundation. So our body knows how to lift. Let's move for hypertrophy. So you know the form so that as you progress and need that strategic stress of lifting heavier, you don't have to start at zero off the couch because that's a long. Yes, yes. Yeah, I would definitely say I fell in the camp in the 40s. because I love to run.

I fell into, and I love yoga. So I fell in that camp. And when I went to go lift weights, when I lifted weights in my 20s in college, because we had to, it was like I could look at a barbell and poof, I got like muscle. Now I'm like, I'm like two years ago, I'm 55. Two years ago, I went into the, I hired a trainer. I was like, I need to build muscle. Oh my God.

We were working so hard for so many months. and then I would look in the mirror and I'm like, it feels like I'm doing nothing. So yeah, so I think you're really on to something. If you don't, if you, if you, you would say 40s, late 30s, like switch away from your cardio and really look at weightlifting. Is that what you're saying is like the critical time period? I think cardio is important. They do two separate things, right?

We want a big, we want a strong cardiovascular engine. Listen, what disease kills is the number one killer? of men and women. I'm not seeing abandoned cardio. What I am saying, though, is it cannot be the only thing you do. I'll tell you from a orthopedic doctor standpoint, and I'm sorry runners when I say this, and I was a runner. I've run multiple. Yep, yep. I get it. If I hear one more runner telling me they don't lift with their legs because they run, oh God. That is a surefire way to end up in my clinic with some kind of butt pain because your glutes don't fire or because you've got pelvic instability and instead of running in a straight line, you're running like a weble, right?

Running as a single leg sport, you have to be able to balance in a in a in a mini squat without falling over to run well. Otherwise you're adjusting all the time. So when I so when I say cardio is important, but if we're looking at it from a health span and longevity, I want you to, this is just how I prescribe it, there's many ways to do it, unless you're training for a big race, unless you're a training athlete again, running a marathon, 80% of the time spend in base training. So we build mitochondrial flexibility. We're burning fat. We're at our lactate threshold. 20% of the time, and I'll tell you, this is not based on my research, It's based on, there's a researcher here in my building that trains tour to France.

Oh, wow. So 80% of the time-based training, 20% of the time, we are gunning it as fast as it's safe for our heart. So that we give our bodies that positive stress working in that high zone to stimulate all the muscle protein synthesis and cardiac function. But we don't do that all the time. And that's what I see. the injured people coming into my office spend a lot of time at the highest, highest zones. Yeah. Yeah. And they're injured every three weeks and then they have to recover and then their brain's angry. No dopamine. So I'm not saying cardiac's not important. It's not the only thing anymore. But and what I hear you saying is, and if you're going to do it, do some sprints, get the, get the max cardiovascular and then get your butt to the gym and start lifting weights. Yeah. Yeah. So.

With lifting weights, are you a fan of like max amount of weight for eight reps? Or is there like a formula you follow? So when we're lifting for strength and power, the strength. And again, I'm about to, I'm framing what I'm saying because now I'm- You can say, no, let it go. Let it out. Let it out. There's a little here of all the bros hopping out of the woodwork and telling me that,

that I don't know what I'm talking. talking about because but listen I've been I've been in the locker rooms of the best athletes training with their trainers yeah writing my own things reading I know what I'm talking so yeah I'm just I'm just responding in my own head this internal time of course I love it I'm watching what you're doing I think it's beautiful so listen I prescribe power lifting upper body push upper body pull lower body push and pull for the four power lifts so bench press some kind of pull deadlift and and squat, those are the lifts that I want you to lift to failure, but to get to failure in a lift range of three to six. Now, I've been taking care of people so long that I know for sure.

They want to be, they want a specific instruction. So I have chosen four. It's what I do. It's what my strength conditioning coach taught me to do. Four reps to failure. So what does that mean? I can pound out four reps. I can, if I'm bench pressing, I can do five like this. But if I try six, one arms coming down and I'm dumping the weights off, right? Four reps, four sets for each of the power lifts. Now, that's not the whole story, but power lifts are complex. They do multiple joints.

They involve your core, everything, right? To support that lift, I then, on bench day, will do. Do the supportive lifts, biceps, triceps, lats, delts, eight to ten reps. I'm not trying to. I love that. Yeah. So that is the framework that I use for midlife women plus the core. So that basic framework builds strength.

Okay. How many days a week are we talking? Because you're doing the main muscles. Minimum of two. I'd love people to carve out four days, but minimum two. And would it look like two days of the power lifting and two days of the supportive lifting? No, so it's one power lift a day. If you're doing four days per week, one power lift day and the supportive lifts to go. And there's some overlap. For instance, on a deadlift supports might be some pliometrics, might be some step ups with a weight, might be some goblet squats, might be some hamstrings.

And her muscles love varieties. So it's usually not the same thing. for six weeks or. So, but, but it's, so that's how I do strength. Now when you, that may take six months to build up through from nothing. It may take nine months to get this form down. I'd expect nobody to go from couch to heavy lifting. It's a progression. But once we're solid in that, once we've been doing it for a while,

if we want power, which is strength over time, then we add in some temperate, pole lifting, meaning I hate this when my strength guy makes me do it. One, two, three down. Oh, yeah, I hate that. Closuring up. I'm like, this is torture. But that's going to get me off the floor when I'm on the floor. That power is going to keep me sane, right? Because we lose our type two muscle fibers with age. And so building power, the pliometric type things, that's what that's all for, not to torture us. you also bring up a really good point and something that my athletic brain had to think about in my 40s is that the purpose of working out became very different and right like I like you

mentioned dopamine earlier like the the pushing myself out of breath gave me the dopamine high and I started not running as much because I kept getting injured and so then all of a sudden I had to call it forward movement exercise because I thought if I called it if I called it walking I was criticizing myself. I was like, are you seriously walking? The other part of my brain was like, no, I'm moving forward. It's a forward movement exercise. But then I realized that right, left, right left movement was really calming to the nervous system.

So all of a sudden, forward movement became my, like, you know, Xanax. And so I really repadtered everything. But strength training, what's interesting about strength training for most, not maybe in your 40s, but if you start, if you're listening to this and you're in your 50s, you're 55, it's not like you're going to do all this heavy lifting and look in the mirror and have bulging muscles. You're going to have security as you continue. Maybe you will, but it does, for me, I've noticed it doesn't have the same visual effect, but where I notice it is when I'm standing in line and all of a sudden my posture feels better. Or you brought up the point. I reach

down to pick something off the ground and I'm like, oh, wow. can pop back up. So can you talk a little bit about what we could expect if we follow a strength training protocol that might be as satisfying as looking in the mirror and seeing a muscle? Well, so here's what happens. The only people who pop out muscles like you're thinking are, I mean, some people are genetically that way. You may work out forever.

And it's just part of your cytoplasm. people with very low body fat will expose their muscles, right? You may have, look at discus throwers or shot put throwers. Those are really muscular people, but they also have a lot of body fat. So you don't see the definition. But what you will feel if you're a midlife woman is your clothes will fit better. You won't have a leaner profile because, you know, you'll burn some of the visceral fat. I wrongly say, but just for ease, I say we're exchanging fat for muscle.

But it makes this leaner. When we get on a body composition, we're leaner, makes our clothes fit better because I say muscle is nature spanks. That's beautiful. It really goes away a little bit. And so those are still satisfying, right? Yes, agreed. If I want to be really cut and lean, that is hard bodybuilder work. You've got to build by eating more calories to build the muscle.

And then you don't look like you're lean at all. And then you got to suck all that off. And unless you're trying to do that, what's the goal? I always return to what are we working for? Right. I am working for strength and power. Along the way, my clothes fit better. I'm leaner.

I'm not quite as jiggly. I don't have to wear spanks, right? So not that I don't like Sarah Blakely. I sure do. I was going to say, you know, hopefully Sarah's not listening. I'm a big thing with you, Sarah. I'm just trying to build some muscle. Yeah. Yeah. So you bring up a really important point because when I was in my 20, I think most of us when we were in our 20s and 30s, use cardio to get the same effect. You're saying, hey, when you go into menopause, use weightlifting to get the same effect you were trying to get in cardio in your 20s and 30s. Is that accurate?

And the fact of the matter is that you can have a big cardio engine and still not be strong in old age. Still can't open the pickle jar. Right. Maybe a lifelong runner and still become frail because you can't get up out of a chair because running doesn't build the same kind of muscle that lifting does in the lower. No. No.

And what about grip strength? You know, we have all these studies. on how grip strength is a predictor of longevity. And what I've noticed in the weightlifting was that you have to hold the bar, you have to pull yourself up. Like there's a natural increase in your hand strength. And that has to be beneficial. What do we know about grip strength and its purpose through menopause?

Yeah, you know what? And those studies are population studies. They're not done in health. it's not particularly in women per se. But what it showed is people who have better grip strength. I think the number in women is over 30 pounds of grip strength, men over 50, I believe, if I'm remembering my numbers well. It just infers better overall strength.

It's not saying that you can bench a certain amount of pounds. It just means in general you have upper body strength, which is always less than lower body strength. Remember, those are in populations. Those are population studies. what do we know about our population in the United States at least? 70% of people do no form of organized exercise at any time. So I think it's a predictor of longevity and frailty.

Kind of a party trick, if you ask me. I wouldn't be satisfied. I have a grip strength of whatever, over 35. That's not the end all and be all. It doesn't mean I can stop working. Right. So I shouldn't buy one of those grip strength. or like, you can.

And I show people, I'm like, let's see what you can do. It's right. It's an awareness. Mm-hmm. Of course. Because if you've got a group strength of 20 and you think you're okay, you're not. Yeah. Yeah.

Okay. So we've got nutrition. We've got strength training. Mm-hmm. And we, I think we've said it. But, you know, I'm curious if you strongly feel we should stop the long distance running, the Spartan racing, the cross. fitting, like, is all of that off the table as we go through this?

No, I don't think, I am not the orthopedic surgeon that is ever going to tell you to stop running because it's going to give you arthritis. Number one, there's no data, no data at all. I am never going to stop you from wanting to achieve a goal. I do Spartan races. I mean, I still, I mean, one of my, my first Spartan race was several years ago at that time as 56. And someone actually said that.

I was giving a speech. And as I walked on, the introducers, like, and she ran her first Spartan race at 56. And I started thinking, what does that have to do with it? Right. I am capable. I believe that I'm going to try it and not die. So no, I am not saying.

But what I'm saying is you need to train differently. And you need to harness the wisdom of your age, not to be a jackass out there and just think that because you were 20 and could do it, you can do it now, right? Right. Unless you've been training for that, keeping your tendons and ligaments springy, building muscle mass, feeding your body, don't expect it to respond like it did the morning you woke up from parting the night before and you ran a race. That doesn't happen at our age. No. Right. So. Yeah. And what about rucking? Rucking is making quite, I'm sure you're getting asked this all the time. And I'll tell you my behind the scenes. I will. I, I watched all the rucking and I watched all the women that were rucking. And the first thing I thought is, are you fucking kidding me? I can't just go for a run.

I can't just go for a hike. Now I kind of put a goddamn weighted vest on. Yeah. I was like, I'm rebelling against this. You are. And then I put one on. Oh, you loved it. I loved it.

What did you love about it? Well, so at the time I was living in L.A. and our neighborhood had a really like a steep hill. And so if I put it on and I walked up the hill, I had the same cardiovascular impact that I did as if I was running a sprint on a track. Yes. So, but I didn't have the joint jamming. And I got the high and I got all of it.

So then I was addicted. So I am so glad you said that because the data are, you know, come on, the data on whether it builds bone density or kind of close. minus, really small study. It's big in the, it's really big in the menopause circles. And I'm never going to encourage women not to do it if it makes them feel like they're achieving something. But if it's the end of all and cure all weighted vest, maybe they increase your bone density 1 to 3 percent consistently. But you know why I like it? Yeah, tell me. So I have a 20 pound weighted vest. Exactly what you found. I can.

can get the same work out at less intensity. My heart rate goes, it's about 10 extra beats per minute with this, I wear a full vest, 10 extra beats per minute. I'm feeling all like badassery because I'm wearing this vest. But you know what? The vest I have, I wear a rucksack vest. It has these little ties on the side. It does something to my nervous system. Oh, oh. It's like a hug. It's like a hug. It's like a, it's like, you know, you're upset. Okay, hug from behind. Yes. Calming my nervous.

I don't know if that's real. Yes. What I feel. It's a calming of my nervous system now. I'm so happy you said that because I thought the same thing. I came back and I was like, I am so happy and so calm and I don't know what's going on. And I thought it reminded me when my kids were in kindergarten, I remember there was a kid. that would act up in class all the time.

Well, actually what the mom did is she brought in a bunch of weighted frogs, like those like frogs like stuffy frogs, but they were heavy like a beanbag. And it was a parent participation class and she said, if Joey acts up, put a frog on his shoulder. And I remember at the time thinking, really, like that's really going to help Joey in his tantrum. And then one day I was in class and Joey acted up and I pulled a frog out and I put it on his back. And sure enough, he quieted. And then I started putting frogs on my, these weighted frogs on my kids and on the other. I'm like, let's calm everybody down. And so when I put the rucking vest on, I thought the same thing. It's like a weighted blanket. It's like a caught. And at a time when our nervous system is so frazzled. Yes. It gives you that added sense of security. Yes. And you know what? One day, day I was just wearing it around the house, cleaning the house. My daughter's like, oh, you're wearing your vest. I'm like, it just does something to calm me.

That is amazing. Somebody needs to come up with like a funny meme where like a menopausal woman is like highly agitated. Then she puts a rocking vest on. It's like, yeah. I don't think it gets enough credit for that. And I went back to go look at the evolutionary explanation for why rucking might be helpful to menopausal women. And if you go and you look at like, you know,

people like Kristen Hawks, who's the champion of the grandmother hypothesis and has studied the hads of tribe, what they grand, the postmenopausal women do in the hads of tribe is they go for a walk every day to go forage for food. But they take the kids like the toddlers, like the four and five-year-olds that couldn't go out and hunt and aren't really staying at home with the women who are nursing and pregnant, and they would put them on their back. And they would walk with them. Yeah, they're talking. I mean, when you study the grandmother hypothesis, you realize that we are fitness-wise, not meant to perish. We're actually meant to be even better than ever. Yeah. And then she would get a bunch of tubers. She would put them on her head. So she was constantly

waiting herself, which is an evolutionary design. Interesting. It makes sense. You know, it really makes sense. And it makes, I just, he made me think, I have this gorgeous 40-pound grandson. Put him on your back. Put him on my back. I lift him up to the swing sets. So it makes so much sense, doesn't it? Yeah.

Yeah. He can go, he can be your strength training. And then you're getting oxytocin with him. Like the whole thing is amazing. It's all going. Okay. Anything else we need to know about. Yes.

Yeah. Okay, please tell me. So when I prescribe exercise to midlife people, We talked about, the acronym I use is face. Again, I find people like, yeah, it's great. F is flexibility and joint mobility. I know this will ring with you because we have to keep our tendons and ligaments long, and we have to keep our joints moving through a full range of motion.

Otherwise, they get dried out, all rusted out, and we become the hunched over, shuffling people. So that's F, A is aerobics, he is carrying a load. We talked about, but E, We've got to spend time on equilibrium and foot speed. I physically teach the women that come here to be with me physically. Footspeed. I have this Olympic track and field at speed coach here in this place where I work.

We teach our women the same methods that we teach Olympic athletes to move our feet fast. And why do we need to do that? So when we're trying to trip, we don't fall down. We have enough foot speed to get over the bag that I trip on nearly every day by my desk or not to fall off the curve so that we do not have the fatal fall. We're alive and well. We trip over something. We break our hip and we have a 30% chance of dying at one year.

It's foot speed. It's balance. So what is that? But that just happened to my 85-year-old mom. She fell over on a box and osteoporotic fractured her shoulder, had to have reverse shoulder surgery. And, you know, your parents can be really good models of what you don't want to age like. And I thought about that.

Her balance can be really off. So what does foot speed look like? Like, is it like, do I need to take up like salsa dancing or can I? Tulsa is a very good to work on all of this, including your brain. Salts up, but foot speed looks like, imagine, imagine sitting on a box, sitting on a a plio box, and just on the ground going like this real fast. Oh, just like, we call it, you know, I used to do P90X forever. And he called it football sprints where you're like.

Exactly. Agility. Or sometimes we use hexagons and we just go foot out, foot in, foot in. Oh, yeah. You know what I'm going to introduce back? I just made a real about this. I am going to introduce hopscotch back to this. Oh, hopscotch is so fun.

It's jumping. It's lateral motion. Yes. Play. Play is so good for us. Yes. When I post that, I want to see you hopscotching. I will.

I will. And then you get to act like a kid, which is going to now bring in like dopamine and serotonin. So wait, but you could do. even more, like you could do everything on the play yard was great. So we had hopscotch and then we had monkey bars. Have you ever tried doing the monkey bars as an adult? Yes, because it's a Martin race and it's very hard. Okay. It's very hard. But that's grip strength. That's upper body strength. Yeah. I'm not good at doing a rope, but I can do the rings. Yeah. And what about jump rope? Would jump rope be good? Good for footspeed and jumping because for those of your listeners that don't know bone builds.

When we translate biomechanical impact, literally bashing your bones to biochemical signals that, oh, we need to build some bone osteoblasts, jump roping, jumping up and down, plio boxes. A mini tramp can work. NASA uses mini tramps. If your knees are killing you, get in a pool and jump in a pool, right? I'll take anything to build your bones. But four times body weight jumping is what the papers say. Interesting. Yeah.

What about vibration plates? Yeah. Like power plates have some research that shows that the small vibrations, I forget the hurts, 50 hertz, can that going up your bones can stimulate osteo. the osteoblast to build bone. And so if we, I love your acronym of face. So if we follow the face strategy that we, if we, is that one we, if we, I was going to say face ourselves.

Yeah. Is that a recipe not just for keeping your posture strong and your mood's good, but is it a recipe for preventing osteoporosis? Impact in the form of cardio can prevent osteoproasis. lifting definitely. We can increase our bone density up to 13% a year by a consistent heavy lifting program because of the, again, the mechanical pull on bones. And then the way equilibrium and foot speed works is to prevent the fatal fall. So the face is how I encompass all the types of mobility that we need in midlife. Because listen, when I was 20, I got away with cardio and

I didn't live that much. But like you did, my balance was good. My flexibility was good. But now we need to pay attention to those four things. Yeah, I think that's so beautiful. Okay, I want to come back to collagen and creatine because I do know the connection that as estrogen goes down, those two go down as well. You had mentioned my sense in what you said before is you're not a huge supplement fan. Did I misread you? I have a short stack. I don't have 62 things. Excellent. Tell me. We must have enough calcium, but I prefer calcium be taken in food. I prefer such as. Such as, believe it or not, salmon poached with the bones, like in a can, like fresh, canned salmon or sardines, mushrooms, prunes and figs, all dairy.

I mean, when you add those up, you can get 1,800 milligrams of calcium pretty well. If you're eating. Amazing. Yeah. Supplement, vitamin D3, obviously. Magnesium 500 milligrams in the form of L3anate or glycinate, not citrate people, unless you want diarrhea, because that's what we give in the hospital to relieve. Listen, yeah. Magnesium citrate, a little green bottle does the trick.

creatine. I take 10 grams of creatine a day. Five is what we started with. And then that paper recently came out with Alzheimer's cognitive function with 20. So I'm like, okay, I'll just up it to 10. Yeah. So 10 of creatine, really good, really good research with muscle and brain. What else? Lots of protein. I take a few longevity type supplements. I don't take the whole stack that people can. I take a form of NMN so that my body will build NAD plus. Okay. Measure my intracellular NAD plus with a, there's a lab called Gin Phinety, owned by a scientist, a friend of mine.

So that, I also take Phycetin because I am really interested in senescent cells, increasing the load of senescent cells, which for your listeners are those cells, which are neither living nor dying, they're just too damaged to die. So they're spewing out all kinds of cytokines. So fysotin comes from berries, strawberries. You can't get enough by eating strawberries. But a lab out of veil led by Johnny Huard has done tons of research showing we can deansen cell load with these.

Beautiful. Yeah, these simple supplements. Thinking what else I tell? I'm visualizing my... Are you... Yeah. Are you a big fan? of, oh, count, you're like, do I need to get 30 grams at every single meal? Or are you just like,

hey, just eat protein? Well, eat protein. I'm a big fan of a gram per pound. Here's why. Here's why. I can support with research up to 0.73 to 0.86 grams per pound. But I'm a clinician. And I'm telling you, nobody's doing that math. Right. Yes. Thank you. Yeah, nobody's doing it. And number two, we don't absorb it all. Yes. So, but I think we need enough protein. I find most women are under-proteined. They eat a salad with nothing dressing soup.

I call it dressing soup. Do you, the box and the lettuce is all. I love that. Would you, would you, what would you say to a vegetarian? You know what? Here's what I say to you. Think about bulls. Bulls are, bovine are completely,

made of muscle. It is possible to build muscle, eating only vegetables. You just have to eat all the freaking time. Right. Oh, yeah. So many calories. Three and a half cups of northern white beans to get the same protein and a little cup of yogurt. It can be done. Number one. That being said, you have to be mindful of your essential amino acids. You're probably not going to get the branch chains, the other six amino, there's nine essential amino acids, but you know, you know this. You got to be very careful if you're only eating plants. Yeah. Yeah. You have to be really intentional. That is, I mean, I was a vegetarian in my 20s. Yeah. How did you do? Oh, horrible. I was injured all the time. I was a competitive athlete. I gained a bunch of weight because I was just doing carbs all

the time. And it took me a long time because I had read a Diet for New America by John Robbins. And I was like, oh my God, we're hurting the animals. And so then I decided, and then I just became sicker and sicker until about 25. I was like, I'm done. I need to go back to eating meat. And things got a lot better. So, but I have a lot of empathy for people who are like, well, I don't want to eat animals. And I, and we do need plants. We need to eat plants. But at the end of the day, I think if you're looking at muscle in general, it needs a lot of protein and it's hard to get. Yeah. So, and do you think osteoporosis is preventable? So here's my take on it. The short answer is yes, but it doesn't start in midlife. We lay down maximum bone density between about 15 and 25.

Some will extend it to 30. I do bone densities on everybody, either by dexascans or REMs, which is ultrasound. And I have 22-year-olds and 30-year-olds with terrible bone density. So number one, we can prevent it if we lay down enough bone initially and get a high-peak bone mass. But many people don't because we are taught to be small and not eat. Or maybe we are athletes and we're not re-feeding enough. So we're not having periods for nine months. I used to not have periods for months because I was a ballet dancer.

Oh, wow. Oh, yeah, that's the worst. Yeah, that's the worst. And then, so we need to lay down bone to prevent. Then what happens when we're making babies? We take 500 milligrams of calcium from our bones a day to make a baby. And now we're a program to rebuild that, but only if we're eating well enough, only if we have time to rebuild and don't have a baby every year first. So that's the, that's the motherhood loss of calcium. And then at 45, we start losing our estrogen. There is a normal aging decline in bone density that happens in men and women. But for women, without the stimulation of estrogen, which balances bone breakdown and bone bone, we precipitously will lose 15 to 20 percent. So that's why, Mindy, I want people to start in the critical decade.

It's so smart. Because to prevent osteoporosis in women who have always lost 20%, rolling a boulder up a hill, it's much harder than knowing it's going to happen, getting in front of it, putting all the things in place, and never losing it in the first place. Now, if you have lost it, like if you're osteopenic, your T score is down to below minus one, but not yet osteoprotic. You can rebuild that. We jump.

We eat protein. Yeah. We lift weights heavy. We do all the things. You can reverse osteopenia. And then osteoporce. Yeah, you have to think about whether you want to use medications. Yeah.

It's interesting because my 85-year-old mom has had two hip replacements, a shoulder replacement. And she's awesome. Yeah, she's bionic. and she's osteoprotic. And so my sister, my sister's in like 58, we spend a lot of time like talking about how do we not end up like mom. And so it is interesting. I love this idea of doing it early, even though I'm out of that critical period. I just am curious. I mean, for me, the rucking, one of the things that inspired me was what I had seen in the research on rucking and osteoporosis. I don't want to give your people the thought that it's too late ever.

It's not too late. Your body will always respond, always. You know, my mother's 86 and she's building muscle, you know? That's amazing. That's amazing. You need to reel with her. Oh, she's amazing. Yeah. What about hip replacements? Do you think, I mean, that's a pretty in vogue surgery right now. Is it preventable? So, listen, I think, I think, I think, I think I've already said that arthritis rapidly progresses in women over 50 because of the loss of estrogen. It's preventable if we get in front of the estrogen problem. It's preventable if we don't develop the arthritis that comes by carrying around an extra 50 or 100 pounds.

Interesting. Because cartilage is very sensitive to load. In fact, in our cartilage lab, I was at the University of Pittsburgh, we used to kill cartilage by just dropping a weight on it, right? it's very sensitive. In that sense, it's preventable. But in my career lifetime, the attitude on total joints has changed completely. Oh, yeah.

We used to wait until the last minute, get it at the last very minute, suffer for 20 years, lose all your muscle mass because you only get one set. Now we know that by sentencing people to sitting around for 20 years until they're old enough, we're sentencing them to sedentary death syndrome. So I am much more apt to send a 50-year-old who have destroyed their knees due to trauma or sports or something like football to get knee replacements, knowing that we might have to revise them in 20 years. I've given him or her 20 years of active life.

Does that make sense? Yeah. Oh, yeah. Yeah. I've totally changed my opinion on joint replacement after just having so many people in my life go through it and watching them and going, wait, that really looks like it kind of worked. So, yeah, so you're right, the technology has changed. Where do you think HRT fits into the musculoskeletal profile of a menopausal woman? Like, would you sit with every 40-year-old and just say, yes, you have to get on HRT?

like is it a must in order from a musculoskeletal lens? So my statement is every woman is a sentient being with agency to decide. Yes, I insist, yes, I insist, however, your decision be made based on facts, not fear, not fear of the WHA, but the facts of what we know from reanalysis of data. That's where I stand on that. That being said, every musculoskeletal tissue, has estrogen receptors. So if I want to maintain muscle and bone and tendon and ligament and cartilage, I want enough of it around. And I'm going to tell you for sure, Mindy, in my patients and in my own life,

the minute or the month that I started with hormone optimization, my arthralgia went away. My body didn't hurt anymore and I could get out of bed. And for the women out there that suffer from frozen shoulder, which is like just everybody. Inflammation of the shoulder capsule, as a critical part of decreasing that inflammation that just takes over your shoulder joint. So is it mandatory? Hormons are never mandatory. Do I demand people make the decision based on facts and make an intelligent decision?

Yeah. And if you decide that you just want no part of it, like 90% of women do, well, that's your decision. There are consequences to every decision that you make with agency. Yeah, that's really well said. One of the ways I always explain it is that it's definitely a personal, personal choice, but it doesn't give you a free pass from lifestyle changes. And yeah, I think a lot of women were like, oh, okay, well, I can just stop suffering and eating my Big Mac and skimping on sleep and not working out and I'll rub some cream on me and I'll be fine. And I think, I think hopefully as a collective world, we're starting to see that different.

Yeah, it's not one thing. Right. Exactly. It takes an ecosystem. Yeah. Yeah. So dream with me, as we finish this up, dream with me for a moment. If people hear conversations like this, they read your book, they start to approach

menopause from such a different angle than our mothers did and our grandmothers did. the piece that I haven't visually been able to master in my mind is where do you think we'll be at 80? What do you think 80 will look like aging if we follow your formula? 80 will be we get to do what we want to do when we want to do it without having to ask somebody to help us unless we want to. That's my 80-97 whatever I live to goal. I may choose to ask for help, but I don't want to have to. Beautiful. That's beautiful.

How long do you think I just have to add this extra thing? How long do you think the musculoscal skeletal system can thrive? Like the human body, they say, is you can live to 120. Do you think you can, if you follow regiments like what you're teaching, do you think you can physically thrive well into your hundreds? I think so as long as you haven't traumatized. joints as a young person. I was a football doctor. I had very young men with very old knees from the trauma. Yeah. So if we do constant maintenance, we're reinvesting, we're feeding this vessel. I think our bodies are meant to last. Yeah. I love that. And I think that, I mean,

that is the message that needs to get out because we need to re-pattern in our brains how we've see aging and the only model visual model we have right now is our mothers and then we of course have our grandmothers but there's this whole new wave of aging that's coming and I think we need more to point out that more and more about just how the body was built to thrive even into our hundreds so you know I'm going to tell you for sure that has been the guiding light of my career to change the way we age in this country I just love that well I'm excited for your book how do people get it Where do they go buy it? It's available everywhere now for sale.

There's a website, The Unbreakable Book.com. So it is all the goodies on it, The Unbreakable Book. I hope everybody loves it. Yeah, it is a great name. When I first saw it come through my socials, I was like, ooh, that's a good name for a book. So well done on that. And we'll leave links for everybody. and I have to ask you, what's your favorite chapter?

Do you have a favorite chapter or section of the book? I like the stories I tell throughout. But you know what? I love, I just got done recording it on audiobook. I really love. There's one chapter that's all about this conversation. It pulls everything about aging into the menopause conversation. Amazing.

I love that chapter. Well, I can't wait to read it. And I'm just so happy that you're like, bringing your information out. I think it's so easy as doctors for us to just get stuck in our little clinics. And the benefit of social media in books is that you get your knowledge, but they aren't necessarily in your clinic. So, yeah. Yeah, thank you. I've really enjoyed this. And good luck, good luck with the book. And everybody go get it. We should all be, we should have like one bookcase that just has all the menopausal books. Yeah, because you can,

can't have too many. So yeah, so thank you. Chearing you on, Vonda. Thank you for this conversation. My pleasure. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.