The Ultimate Human with Gary Brecka - 215. Dr. Vonda Wright: On Menopause, Women’s Hormone Therapy, and Perimenopause Symptoms

Starting point is 00:00:00 You can decrease the odds by 60% of the following diseases by starting hormones earlier in perimenopause. Stroke, cardiovascular disease, heart attack, brain death, and osteoporosis. There is a temporal disconnect here that I will worry about that when I need to worry about it. Starting earlier is really prevention is the best medicine. Listen, I can help anybody 50, 60, 70 year olds, but if you truly want to get in front of prevention, The critical decade people, 35 to 45, need to wake up. It is time to get your health standards together. Not something weird that we do for six weeks.

Starting point is 00:00:36 It's just how we live. But I think this is just such a powerful message that you don't have to suffer to be natural. As a woman, you should be in a position to thrive all the way through your 50s, 60s, 70s. Listen to me, Gary, how passionate I get. It is a war cry, a mantra to me that I am going to save the health of women coming after me. Having had such an intimate experience with it in how it revolutionized my wife in such a short period of time, how soon can a woman reasonably start hormone therapy, estrogen, pregnant alone, supplementation? If we're truly interested, Gary, in preventive health for women. Hey, guys, welcome back to the Ultimate Human Podcast.

Starting point is 00:01:28 I'm your host, human biologist, Gary Brecker, where we go down the road of everything, anti-aging, biohacking, longevity, and everything in between. And today's a really special session because we're coming to you live from Riyadh, Saudi Arabia with my guest that I am so excited to have on. I don't say this very often. You can go back and look at all my podcasts.

Starting point is 00:01:50 I am a big fan of your work, and so is my wife. She was super excited about this podcast. She's starving, so she's eating right now, and then she's going to come sit in with us. But welcome to the podcast, Dr. Vonda Wright. Thank you so much for having me. And I'm going to take it easy on you today because it's 3.30 in the morning, our time. That's right. You're from Orlando.

Starting point is 00:02:09 I came from Miami, so we're on the same time zone. And I just checked the time. I'm like, okay, it's 3.30 in the morning. I don't think I've ever done a podcast, a 3.30 in the morning. But you're holding up pretty well. I'm doing great. And how ironic that we're practically neighbors in the United States. And we've flown 5,000 miles to sit.

Starting point is 00:02:25 across from each other. I was talking to the team about that this morning. I'm like, why is it that we're landing so many of these guests and we're halfway around the world? But I'm glad that we got a chance to do this. You know, what I love about your work, I mean, you're a board-certified orthopedic surgeon, clearly qualified. But what I love about your work is you're a, you have this very back-to-the-basics approach. And you're not afraid to talk about weightlifting for women, diet, sleep, you know, exercise, mobility, those things that we have big data on that we really just can't overlook. Yes.

Starting point is 00:03:00 You know, I think in this space that you and I are both in, you know, the biohacking longevity space, what do you want to call it? So often people are looking for that magic pill. Yes. Like, is it NED? Is it NMN? Is it this special type of resveratrol? You know, what is the secret to life extension?

Starting point is 00:03:17 And the truth is there's some of the basics that you just can't get around. Well, you know, what's interesting as a practicing surgeon, people come to me and what they're asking me for are all the gadgets, the longevity things, the evidence influenced things, but they come to me in what I call fine. Their health is, how are you today? I'm fine. I'm just tired and fine. And so I think having taken care of nearly 100,000 people in my career, I've come to understand that. If I take you from fine to doing all the things that we know work and have known work, the things you've just mentioned, and we optimize your health, then I can apply the same things I apply to pro athletes and executives because I'm a sports surgeon, right? So my whole career has been optimizing performance in the performers. Then I can apply to you those principles. And then when you're at peak performance, of course.

Starting point is 00:04:20 then I'm going to reach into the longevity world and do all the secret sauce things that we're just discovering. But I tend not to want to jump to this until we're optimized because I feel like we're skipping steps. I agree with that. And in your experience, where are the vast majority of people getting it wrong? When they say that they're fine, usually what they'll do is they'll just chalk it up to a consequence of aging or a consequence of their environment that they're dressed or their spouse or their kids or their career. But I've found that it's usually not any of those things. You know, it's usually the absence of a lot of the basics.

Starting point is 00:04:58 But where do you find that the vast majority men and women that are coming to you that say they're fine? What do they get in wrong? I think they feel good enough today, right? They're able to get up and just go through their daily routine with their health and their future as an afterthought. Somehow we've prioritized the carpool or the next meeting or the next deal as from a temporal perspective like today more important. But there's this concept in banking. I learned from the bankers. It's called temporal disconnect. And in the banking and finance world, it means that on average, they can't get anybody to save $10 for their future, right? Well, from a health perspective,

Starting point is 00:05:46 if we're feeling fine today, it's good enough today, we can't bank the health for the future. So what I try to do is help people identify what it's going to take to feel amazing today. Not just fine. I want you to feel vibrant today because that, my friend, is addictive. That is what people will come back to, not some remote promise of 150 years, which we're we'll probably get to based on science and all the things we're learning. But if I can make you feel optimized today, that is why you'll come back. That's amazing. And where do you start with them? I mean, do you do, because I think this whole term lifestyle medicine is a term that I've really

Starting point is 00:06:36 fallen in love with because rarely, if you've ever gone to see a physician, do they ask you anything about your lifestyle? I mean, you have hypertension, you have poor sleep, you have weight gain, what a retention, brain fog. You have all these consequences going on. And no one ever says, well, are you sleeping? Yeah. How are you sleeping? Or what are you eating on a daily day? You know, walk me through your day. Are you moving other than to just get in the car and take the kids to school? Or to get between your home and your office. And so where do you start with them? How does that assessment look for you? In my own practice, whether honestly it's, I have separated out my time, whether it's my orthopedic practice, and I'll give you an example, or whether it's my

Starting point is 00:07:19 midlife menopause or my precision longevity practice, we always assess where you are now. So I'll give you an orthopedic example of taking care of the whole person. And we can go into why many doctors can't do the whole person approach if you want to. And it doesn't have to be due with our desire. It frankly has to do with time. Time and compensation. Time and compensation, if we're on. about it. So if a woman comes to me and she has the dreaded frozen shoulder, which means

Starting point is 00:07:50 out of nowhere. My wife had that. So I want to go down this rabbit hole. Awful. So what happens in frozen shoulder? It's an inflammatory response to midlife or inflammation, obviously, because it also happens in people with diabetes. But how it presents is, out of nowhere, Gary, nothing happened. You did not bang your shoulder into the door. You did not work out hard. you have quick onset of excruciating pain. Unbelinual. Unrelenting and you cannot sleep. And then with very short amount of time, you can't move your arm, right?

Starting point is 00:08:25 It's this motion people come in with. It's exactly what happened to my wife. Exactly. I mean, exactly what happened to sage. In a quick amount of time. So when a person comes into my orthopedic clinic and I know I read a 46-year-old woman shoulder pain, almost without paws. I know what's going on.

Starting point is 00:08:44 So I'll go in the room and I'll say, how can I help you today? But I do not focus on the shoulder first. We talk about the fact that she's 47 or 46 and how are you sleeping and what else are you feeling? And because I am interested in helping her identify that she's in this critical time period of her life when her ovaries are stopping their production of estrogen and things. are changing. If I were to do the typical thing, which is just say, oh, your shoulder's not moving. You've obviously got a frozen shoulder. Let me give you an injection, send you to therapy, blah, blah, blah. I missed the whole picture, and I'm not taking care of the whole person. And so for me,

Starting point is 00:09:29 my style of orthopedic surgery is taking care of the whole person. So we're talking about how the fact they're not sleeping. They're anxious. They've never been anxious. But all of a sudden, they feel different. And within five minutes, Gary, of starting a whole person approach to the frozen shoulder, these women are crying in my office. And it's not because I'm the meanest doctor they've ever seen. It's because finally, finally, they feel heard and seen. And it's so hard. And almost to a woman, Gary, and men say this to me too, because I take care of both men. and women. But people will say to me, but you know what, I have a very high pain tolerance. Because there seems to be some badge of honor that, or is handed out on the, oh, I've got to, they say, I have a very

Starting point is 00:10:26 high pain tolerance and I thought I could do this. I didn't want to come. But the reality is people wait and wait and wait and suffer when we could have intervened really early. And so I think that's why, coming in with a frozen shoulder, treating someone like a whole person and not a body part, they are quickly telling me about how they really feel and crying sometimes. Yeah. No, that was my wife. I feel like that is the way people deserve to be treated as not a sum of body parts, whether it's your liver, your pancreas, or your heart or your shoulder. Does that make size? You know, it was interesting because I was not, I was unaware of the relationship between menopause and frozen shoulder.

Starting point is 00:11:10 And so we sent her for an MRI and she had adhesive capsulitis. Of course. And of course, the first thing that that orthopedic did was say, well, we can do manipulation under anesthesia. I can break up all these. Yeah, but you don't need to do that. I know. Thank God we didn't.

Starting point is 00:11:23 Okay. And I, you know, we decided to go down the road of taking a deep dive into the hormones. We did a Dutch test. And which I'm sure you're familiar with, but what was fascinating about this test was it just showed it can complete collapse of not just the hormones, but also some of their precursors, pregnant alone was zeroed out. Her cortisol was completely floored out, so it wasn't rising in the morning at all. In fact, her melatonin was off the charts in the morning. So she was waking up with a high amount of melatonin and virtually no cortisol response. She had no

Starting point is 00:12:02 pregnant alone, so aldosterone, cortisol were all off because of that. And And so we began to go down the hormone road, which I will tell you, was life-changing for her. Within weeks, her shoulders started to thawed. And it's completely thawed now. Yes. I mean, should we talk about that? I definitely want to talk about that. If nothing else, I'll just keep this podcast for my wife because she'll appreciate it.

Starting point is 00:12:31 I'll get brownie points with sage. But yeah, and you and I talked about it beforehand. I want to go down this road for sure because there's so many women listening to this. And I think there's a paucity of understanding of that time frame. I want people to understand the biology of what's going on. And also, maybe we can talk a little bit about dispelling some of the myths of the link between estrogen and breast cancer. Oh, let's do that. There's a lot of fear around that.

Starting point is 00:12:55 One of the things that we discussed before the camera started rolling was I found those studies too and actually followed the very same study that, linked breast estrogen at the time to breast cancer, decoupled it, and fell in the polar opposite camp that there was actually a reduction. And I think there's a lot of women listening to this and a lot of the husbands that are curious about this too for their wives. Is the hormone therapy a viable option? If you know me, you know I'm a huge believer in the benefits of hydrogen water. H2 tab delivers cost-effective portable tablets that generate ultra-clean molecular hydrogen at 12 parts per million, one of the highest concentrations on the market, with over 1,300

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Starting point is 00:14:12 and upgrade your hydration today. Now let's get back to the Ultimate Human podcast. Well, let's, do you mind if we start back at, why this even happens? Why does this even happen? So I think the fascinating, almost legendary thing that happens when you birth a female baby, a baby with XX chromosomes is housed within her eggs,

Starting point is 00:14:36 her ovary, her ovaries are all the eggs she will ever have more than two million. Isn't that fascinating? That is still fascinating. So the legacy of your entire family exists within the ovaries of these baby girls that we have, right? So it's the natural history of ovarian life that, you know, and to contrast it, The analogous structure and an X, Y person, a male, is testicles, but you build 1,500 sperm a day or a minute. It's rapid, right? A female child is born with all the eggs.

Starting point is 00:15:14 The natural history is that by puberty, we've lost a large percent of those. And then what we are designed to do, which we don't always do, is every month cyclically, as hormones predictably rise. and fall, we use and exhaust a percentage. But here is why midlife is so profound for women and so different between men and women, because it is wrong to say that the physiology of men or women are the same. My own data show down to the stem cell level that they're different. So by the time a woman reaches 35 to 40, you start to not feel like you've always felt because we have less than 1% of our eggs left. Estrogen, by and large, a very tiny percent is made in the adrenals, but most of a woman's

Starting point is 00:16:05 estrogen is made in the follicle or the egg shell of an egg. So when you have so few, you're just not producing the same level, healthy levels you've always produced. And the reason that's important, and there's one of several things I want your audience to walk away with is estrogen, progesterone, and testosterone. are not sex hormones. They are hormones, just like thyroid hormone or any hormones our body makes. They're not specifically sex hormones.

Starting point is 00:16:38 There are estrogen receptors, alpha and beta, on every tissue of the body. So imagine every tissue in the body becomes rapidly starved of one of its key ligands, of one of its key signaling pathways for all the good things, such that we know from the work of Lisa Moscone and Robbie Brenton, that without estrogen, your brain not only stars, but changes its chemistry. The heart without the influence of estrogen has 30 to 40 percent more microvascular disease. I'm an orthopedic surgeon. Let's talk about bone. We will lose 20 percent of our bone density in the time between perimenopause and menopause. Wow. These are profound, profound biologic changes.

Starting point is 00:17:30 So we started this conversation talking about frozen shoulder. Why do people walk in so inflamed? Why are women so inflamed in midlife? It's because estrogen is a profound anti-inflammatory. So when women walk into my office bringing it back and we take the time to listen, how are you sleeping, what's your brain doing? How do you feel in general? and they say, I don't feel like myself anymore, from a human biology standpoint, it makes so much

Starting point is 00:18:00 sense. If every tissue in your body is affected, it makes sense that we should be having longer conversations about the restoration of the most natural way of living, which is with estrogen. It's not a byproduct. It's not something we should suffer through. If we're truly interested, Gary, In preventive health for women, we must talk about estrogen and we must talk about it earlier because my generation of women, I'm a generation Xer, you know, baby boomers have lost out because of this study. Xers are not sitting down. We are going to change the future so that millennials and my 17-year-old daughter, my 18-year-old

Starting point is 00:18:49 daughter, will never starve our brains. We'll never have 60% more microvascular disease in our hearts. We'll not lose our bone density so that we end up frail. It's almost, listen to me, Gary, how passionate I get. It is a war cry, a mantra to me that I am going to save the health of this, the women coming after me. And it's so astounding because I think it starts a lot earlier than, you know, now that I've, I'm, I went through it with my wife. So I'm way more familiar now than I was before. And what seemed like this rapid collapse, I mean, the frozen shoulder was the peak where we're like, okay, we're going to come to a full stop and we're going to fix this. But when we started backing things up,

Starting point is 00:19:36 just like what you're talking about, the brain fog, mood numbness, loss of libido, short term, I don't want to say short term memory issues because that sounds too, but. No, I don't. lost my nouns. Yes, exactly. That's what I mean. Yes, I lost my nouns. It's not like dementia Alzheimer's. It's. It's just like fumbling a little bit, like the words that, you know, she would say, it's just right on the top. It's right here. It's right here and I can't get it out. You know, I, you know, childhood best friends that I haven't talked to in a while and I would be talking about a story with them and then their name would escape me. And she, you know, so she was like, and my wife is on her game. I mean, we built a business together. She's very detailed oriented.

Starting point is 00:20:18 She's a list taker. She's very structural about the way that she goes about her day. Extremely organized. And then all at one time just unraveled. And it was astounding to me how fast the genie went back in the bottle once we addressed it. Like, I mean, I've got to say, you know, women, if you're listening and you're suffering from this, you know, get a really good hormone test. Go see a practitioner that understands this because it was life-changing. And I want women to be literate themselves.

Starting point is 00:20:49 I think gone are the days, long gone are the days. Maybe when I started practicing medicine, we were still in it. But gone are the days when a person can just blindly take advice. I encourage all people, men and women, to become experts in their own health, to become literate, to read. That's right, to understand so that they can make the best choices for themselves and to do it early, right? to your point, we think perimenopause can, which is the time when we're, when we have so few eggs

Starting point is 00:21:21 can start in their 35. Who would suspect while we're still having children? But many women we understand now, including myself, I had my last child when I was 40, go right from postpartum to perimenopause. Wow. But I don't, I'm going to say this now because we're going to unpack it, But I want women listening to understand that, it's, you can feel better again. I mean, I, in a silly way, say, I went from menopause misery to midlife mastery. I have mastered this. Yeah. I am back in a way that.

Starting point is 00:21:58 I like that. Yeah. I am back in a way that I always was. I get 15% of it because you said it on my podcast. That's, listen to you. Metapause misery to midlife mastery. I love it. Yeah.

Starting point is 00:22:10 Yeah. And so these women. they're listening now, 35, 37, 40, because I think we have mistakenly put menopause much further into our future, and we think, I'll start worrying about that in my late 40s, maybe even my early 50s, and I'll just address it then. And these subtle changes that are sort of stacking on top of each other, you know, I liken it to tearing pages out of a phone book, right? They're not, it's not like you all of a sudden go off a cliff. It's just, you know, I can't find my keys and my wallet.

Starting point is 00:22:44 I don't feel like myself. I don't feel like myself. And kind of, you know, libido sort of starts to leave the building. And I noticed, too, like a little bit of flattening of the mood, not like a flat affect, but I mean, mood numbness, right? Of course. And the peaks and valleys, wasn't like a little apathetic, just always upset. But like the elation, the passion, the arousal, the joy, you know, that's sort of flattened out too. And I think the sad thing is that a lot of these.

Starting point is 00:23:13 are consequences or scenarios that women can push through. They can live with. It doesn't drive them to the ER, right? It's not taking you to the urgent care. And so these pages keep coming out of the phone book, right? And pretty soon, you're an inch through, I'm dating both of us, by the way, because we both know what a phone book is. Yes, the yellow page. The millennials are like, yeah, we don't know what yellow pages are. But, and then all of a sudden, it's, it's to the point where it can be disrupting relationships. It could be. be disrupting their career. Completely. Well, you've brought that up a couple times and I think it's so critical and I love that we're recruiting male experts into this conversation because

Starting point is 00:23:56 several studies have been done that show that up to 70% of all midlife marriages that end divorce at least partly can be attributed to a lack of understanding about these changes because if a man doesn't understand that it's not that his spouse doesn't care for him anymore. it's all these biological things going on and she doesn't want to talk about it and he just assumes that it's a caring issue i mean so if we could save marriages that have gone on for 20 30 45 years for sure that are ending in midlife uh that's work worth doing even as an aside totally agree with you you know and i think very often we we attach um love and attraction to arousal and libido and they're very different things. You can be deeply in love with your spouse. You can be very attracted to your spouse,

Starting point is 00:24:47 but you don't have arousal or libido because of these changes going on. And it doesn't mean that you're now disinterested in your spouse or you're any less attracted to them or love them any less. But I think because we lump all of those together, we think very often if libido and arousal leave the marriage or they are less frequent, that that all of a sudden means my spouse doesn't love me anymore. They're not attracted to me anymore, you know. But when you think about it biologically, you know, people at the forefront of sexual health like Kelly Casperson and Rachel Rubin talk about estrogen progesterone and testosterone, not as systemic hormones, which they are, obviously, but almost as neurotrophic hormones, right? I mean, libido comes from the brain.

Starting point is 00:25:35 I mean, I'm not an expert at this, right? It's a, it's, it happens in the brain, then it happens physiologically. But it's an interesting point you make that these relationship-type changes that happen because of physiology are actually attitudinal, their psychological, their brain functions. And so to call these hormones, to recognize that they're neurotrophic hormones working in the brain makes so much sense. If you want protein to build lean muscle, but without the caloric impact or need

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Starting point is 00:26:54 that physiology is where the answer lies. And very often when you just deprive the body of certain raw material. Right. This is a raw material, a primary messenger. You get the expression of that disease. You know, you're an orthopedic. I mean, we, I spoke recently at a conference for osteostestrong, which is a, you know, bone density machines that actually, you know, load the bones for bone density. It was fascinating to me how many folks that were there, you know, still were onto the auspice that bones were made of calcium.

Starting point is 00:27:31 And bones are calcium combined with phosphorus and which makes hydroxyapotite. But in order for these to combine, you need these 12. minerals. And so deficiencies in these nutrients have consequences in brittle bones. And it's not just the absence of the load. It's also the absence of the mineral requirements to assemble the bone. And for women, when you think of emotion, it's like, well, how do you assemble a motion? Well, I mean, just like you said, your hormones are signaling molecules. And so when your emotions are off and your mood is off. You're not developing a mental disorder, a mood disorder, a emotional illness, you know, you're missing raw material. You're missing raw materials. That's

Starting point is 00:28:14 right. Yeah. It's very analogous to bone. Yeah. And so putting them back can be just phenomenal. So when you do this assessment with a woman, even in perimenopause, which I'm really glad you pointed out could happen in the 30s because I don't think most women in their 30s are even thinking about this. I love the fact that you talk about bone density in the 30s, too. You're like, hey, you better get busy now so you don't have osteopenia. Yeah. Osteoprocess is not, it is a disease that manifests in old age, but it begins in your teen years. Yeah. You know, I had two grandmothers that had fractured hips.

Starting point is 00:28:48 I was lucky enough to be alive and have a great grandmother for a while, but also my grandmother. What was fascinating to me, and people should really listen to this, is that in both cases of their hip fractures, we found out that their hip fractured, and then they fell. Yes. They didn't fall and break their hip. That's right. My grandmother was actually at a sink washing dishes. So common.

Starting point is 00:29:18 And her femoral neck broke. Yes. And she fell, and they said, oh, grandma fell and broke her hip. And then we found out from the ortho. No, actually. It broke and then she fell. It broke and then she fell. I remember when I was in the mortality space.

Starting point is 00:29:32 Now, we didn't. With insurance. You know this with insurance. that, you know, this hip fracture, we called it a triad of death because it was a very quick acceleration to the grave. And I think I realized now that it wasn't the actual fracture that accelerated it to a grave. It was just the representation, the skeletal system cannot even support its own weight. Yes. Right?

Starting point is 00:29:53 I understand if you fall down to flight steps and you get... Traumatic is very different than a traumatic. Yeah. So I'd love to unpack that too. Let's talk about bones. Because, you know, there's got to be connection between this hormonal depletion, you know, perimenopause and loss of a bone density because men don't suffer the same consequences until much later. Much later. I mean, two million men in the United States have osteoprocess, but to your point, we'll just do men first. Yeah, let's get us out of the way.

Starting point is 00:30:23 Yeah, let's get the men out of the way testosterone interacts with the bone. I mean, men will see osteoprocess at 50 if you have a metabolic disease and after 70. almost 80 from true osteoporosis, and then men have a 30, and women have a 30% chance of dying in the first year, and we'll talk about the cause of the triad that you're talking about. And then if you do survive it, 50% of the time, you'll never be independent again. But the reality is bone health, as I've alluded to, begins in our teenage years. And so as I talk about this globally, I want people to understand that it's almost a harbinger of total health, meaning because bones are a primary organ. We think of them, if we think of them at all, Gary, often we don't, unless we're at Fashion Week and we're thinking about our cheek bones

Starting point is 00:31:16 and our collar bones. Most of those are covered in filler by the time you're 50s. There you go. The reality is bone is structural. Without bone muscle, which we're all, we're all love muscle these days is just a heaping pile of metabolic tissue without bone that gives us human form, right? But bone, not just structural, you alluded to the fact it's a storehouse of many minerals in our body that the body just takes out of like a cupboard. That's the point. We buffer the pH of the blood from that. That's right. Every day we withdraw minerals from the bone. That's its job. In the long bones and the pelvis, we make all the hematopoetic cells our body needs, red blood cells, a whiplet cells, the platelets, with the stem cells, with the spleen.

Starting point is 00:32:06 So it's an incubator. It is a storehouse. It is structural. But here's what I love to tell people. It is an endocrine organ, producing multiple hormones that travel to different parts. It is the master communicator of your body. So I'll give you a couple examples. The bone creates a hormone called or a,

Starting point is 00:32:29 a substance called osteocalcin. OsteoCalcine will go to the brain and help your brain make neuroderived, brain-derived neurotrophic factor to build a better brain. It coordinates with your pancreas and muscle for glucose and insulin regulation. If you're a man, osteocalcin from your bone, goes to the testes to help make testosterone and there are mind, there are bone gut axis. there's a bone brain access. So it puts a whole new light on bone

Starting point is 00:33:02 and why it's important because it is the body's master communicator. And why wouldn't it be, if I were designing a human, we have bone from the top of our heads to the bottom of our pinky toe. Why don't I make that the highway of communication? So that sets the stage for why

Starting point is 00:33:22 it's so important to build a lot of bone. We build peak bone mass. by the between 15 and about 25 so because I'm a bone doctor I get bone densities or REM scans on every person and Gary I find very very young women with low bone density and it's because several things I think women are still dying under the thought that we have to be this big right we can't take up space we can't eat and we can't right and so as a result many women do not have regular cyclical periods, which is critical for building better bone. Or maybe, you know, we've 54 years into Title IX, which equalized sports in the United States. And maybe we're just

Starting point is 00:34:11 working out and burning 10,000 calories a day. And like so many teams I've taken care of, replenish with gummy worms. Right. Never going to be enough. Right. Or maybe the third reason young women are not building enough bone is they're too sedentary. It's an epidemic around the world, sedentary living. So we have this young population of women not peaking out their bone density. And then we move into, there's this term running around social media called the matriessence, the time when we're fertile and deciding to have children, right? Well, it's very unknown that during pregnancy, it takes about 500 milligrams of calcium a day to build a baby. And if we're not eating enough calcium, we're going to take it from our bones.

Starting point is 00:34:57 The body will prioritize the baby. It's a paracetic relationship, yeah. Yes. And so there is an entity called the osteoprocess of pregnancy that results in vertebral fractures. Wow. Isn't that amazing? Wow. Our body is designed after we give birth to replenish our bones, but only if we eat.

Starting point is 00:35:16 Only if we're not trying to lose the 40 pounds we get right in starving ourselves. And then if we choose to breastfeed, and I'm a big fan of breastfeeding, I don't want any of your audience. I don't want any of your audience to think I'm not. It takes calcium to build milk for your baby. No question. So there's this time in middle-eye, in early, you know, young womanhood when we're still taking from our bones. If we then replete our bones, great. Many women do not, because then this is what happens, Gary.

Starting point is 00:35:47 In perimenopause, when estrogen is walking out the door and she's not saying goodbye, she's just leaving. She didn't say goodbye in our case here. Yeah, right. She's gone. That happened to me, like gone. Estrogen is critical for controlling the homeostasis of bone. So bone biology, I know I'm not teaching you, but to your audience, the osteoclast, the cell that resorbs bone is controlled by estrogen. Because I like to think of it as a wild child.

Starting point is 00:36:16 It's going to eat bone. That's all it does. It's going to take what the body needs. Coming behind it is the osteoblast, which rebuilds the potholds of bone. When we have estrogen, our body loves homeostasis. It's going to keep these two cell types working in harmony. But without our estrogen, the osteoclast gets ahead. And we have more bone breakdown than we have bone building to the tune of 20% in the perimenopausal years.

Starting point is 00:36:47 We triple our bone loss. Both men and women will lose bone over time. But without estrogen, women triple. it. This is why I hear you preaching to women in their 30s so often. Oh my gosh. It's the critical decade. If we're truly interested in prevention, Gary, listen, I can help anybody 50, 60, 70-year-olds, but if you truly want to get in front of prevention, the critical decade people, 35 to 45, need to wake up. Yeah. It is time to get your health standards together. Make this lifestyle that you and I talk about the standard. Not something weird that we do for six weeks. Right. How we live. It's

Starting point is 00:37:29 just how we live. What does a healthy bone lifestyle look like? For men and women. Yeah, for men and women. We have to eat enough protein. Bones are 50% protein. We have to be concerned with calcium and minerals from our diet. I think it's hard to get enough. You talk about this all the time. A micronutrients because our soil is depleted. But I still would rather you, you get most of your calcium from your food. And it's not that hard. I mean, a cup of yogurt has about 300 milligrams. You just have to be conscientious about it.

Starting point is 00:38:03 So calcium and protein from our food, micronutrient supplementation, most of us need that because of the depletion of our soil, number one. Number two, we must get in a habit of lifting weights. Loading. Our bones must be loaded. Bones take the biomechanical impact of loading, I like to pound my hand, the biomechanical of loading, turn it into biochemical signals to build better bone. Because think, I don't know if you've ever had a cast, but if I put someone in a cast,

Starting point is 00:38:40 not only do their muscles atrophy, right, you physically get a stronger, a little or limb, But if you look on an extra x-ray, you'll have the osteopenia of disuse. Bones actually stop investing in that bone. It is amazing how efficient the body is. Like when you ignore it, it just forgets about it. That must not be important. Yeah. So it takes, it takes great nutrition.

Starting point is 00:39:06 It takes impact exercise not only from lifting weights to build muscle, which pull on the bone. but I'm trying to introduce the world back to jumping. Yeah, I've heard you talk about an eight-inch. Eight-inch box jump. It doesn't, because walking gives you about 1.5 times body weight of impact. Running only about 2.5, we need three to four times body weight to stimulate our bones for impact. You'll get that from really short jumps. People get a little intimidated.

Starting point is 00:39:41 I box jump with a 24-inch box. It's because I do it all the time. You don't have to. But most adults don't do two things anymore. We don't sprint. Very true. And we don't jump. But we're capable of it.

Starting point is 00:39:54 It's just we stop playing. Yeah. Our foundational motion patterns are playing. Think of our children. They've got it right. Jumping and playing. So food, lifting weights, jumping. Here's one that people don't talk about, but I talk about all the time is balance and

Starting point is 00:40:15 foot speed because you may have strong bones. You may jump around, but unless you can balance, I know. You're going to fall over. It's so frustrating that you say that because I was actually watching one of your videos one time and you were talking about balancing on one foot while you're brushing your teeth. So then I started. You tried it? I tried it and I was like, damn, this is harder than I thought. And you made it look so easy. And then you did like a candlestick pose or something. But it's so true. I read a statistic. It wasn't a clinical study, so don't quote me on this, but it said that after the age of 30, less than 5% of adults will ever sprint again. Yes, I've read that somewhere. So for the rest of your life, you don't break out into a

Starting point is 00:41:05 dead sprint. I found that fascinating. And it's not because we're incapable. It's just because we stop doing it, right? Yeah. You're totally, you're completely capable of sprinting. Yeah. I mean, yeah. Yeah. So, so these kinds of things are so good for us. I mean, are the auxiliary muscles of respiration, you know, exercising our diaphragm, getting air down into the lobes of our lungs. Oh, absolutely. So I actually, I read that and I immediately started sprinting again. But I hadn't gone my whole lifetime without sprinting. But I think it is so important too, because, you know, I have a saying that aging is the aggressive pursuit of comfort. And the reason why I coined that term is because most of us are aggressively just seeking comfort.

Starting point is 00:41:49 You know, Grandma, you shouldn't go outside. It's too hot. You shouldn't go outside. It's too cold. Just lay down. Relax. Just eat at the first pang of hunger, right? And it sort of destroys our natural defense mechanisms. You know, if we don't load our bones, they really don't strengthen. They do not. If you don't tear your muscles, they don't grow. If you don't challenge the immune system at So for women that are listening to this, especially women in their 30s or at any age, adding into their regiment things like jumping, maybe they're not in condition or don't like sprinting for whatever reason. But, you know, jumping impact. I also read a study that the bone density was the highest in gymnasts. They are. That's worked out of the University of

Starting point is 00:42:37 Wisconsin-Madison. Okay. I forgot where I read it. And how does it have to do with the... The impact. Of all collegiate athletes, the gymnasts have the best bones. And it makes sense, right? Yeah.

Starting point is 00:42:48 It makes sense once you understand that. Yeah. We did a study years ago in master's age athletes, those that are 15 above, competing in the national senior games. And the first study we did just observed who had the boats, but can you, the question was, can you preserve bone density over the lifespan? And even those athletes in their 80s had good bone density, which was remarkable. So we dug deeper and asked the question, well, which athletes?

Starting point is 00:43:14 And of course, we knew the answer would be the impact athletes. But we documented that the jumping, the volleyball, the basketball, the jumping type sports because of the impact, had much better bone density than, say, bowling or the walking. Which is a sport in the national senior games. Yeah, but the swimmers. So is cornhole. Yeah. The swimmers had less good bonuses. So, I mean, we know the answers, but it likens so many things in life. We know what to do, Gary. We just don't do it. We just don't do it. We're not willing to invest in ourselves. And then suddenly a light bulb goes off. But that's why I think you and I agree, and I say this all the time, aging is not an inevitable decline from vitality to frailty. We stop being able to work hard because we simply have stopped working hard. Yeah. You know, Peter Attia talks about the 100-year decathlon, you know, about how you need to prepare today for what you want to be able to do when you're age 100.

Starting point is 00:44:16 And I think that theory, would you call temporal disconnect. Yes. I'm going to steal that one from you, by the way. You're going to see it start appearing on my podcast. I stole it from the bankers. It came from me, people. You know, because you're right. There is a temporal disconnect here that I will worry about that when I need to worry about it.

Starting point is 00:44:35 And when people are getting more woke to their wellness and they're becoming citizen scientists, like you said. And so starting earlier is really prevention is the best medicine. I definitely want to close the loop on female hormone therapy, though, because having had such an intimate experience with it in how it revolutionized my wife in such a short period of time. And knowing the number of friends that she has that are her age, that are either still suffering or just haven't figured it out and my female audience. You're a fan of hormone replacement therapy. Yes. And testing for the hormones.

Starting point is 00:45:17 And how soon can a woman reasonably start hormone therapy, estrogen, pregnant alone, supplementation? I want to promise this entire conversation with the thought that women are sentient beings with agency to choose. so I demand not that every woman go on hormones although if I were the queen of the world every woman would go on hormones and go on them early but every woman is sentient and has agency to choose but you must choose out of facts not fear you can't glom on to some cultural mantra and go with that you must be more curious and must be wiser in the decisions because it's your body so that's my disclaimer number one some women come to me and say, well, I want to do it naturally.

Starting point is 00:46:09 I don't want to put artificial things in my body, to which I say, what? Let's unpack that statement because I hear it dozens of times a day. I've got to be miserable and natural, you know? Miserable. Well, what's more natural than giving your body the building blocks it always has had? you have always had estrogen, progesterine, and testosterone. That is the natural state.

Starting point is 00:46:37 What's not natural is not having them. So then the next thing people say to me is, yeah, but you know, I'm not a pill person. I don't want to take pills. I'm going to eat some soybeans and some yams. There you go. Okay, we'll do that. But do you know where body identical estradiol comes from? It is a plant-based...

Starting point is 00:46:57 Yeah. Harvesting of the hormone your body makes. You cannot. So what's more natural than taking the hormone your body makes? That's natural. Not eating yams and soybeans to try to get at what your body makes anyway. Oh, and by the way, we harvest estradiol, the molecule, which is the body identical hormone. It's the same molecule.

Starting point is 00:47:26 There's only, you know, body, bioidentical is a marketing term. But when we say body identical, estradiol is a chemical structure. We're not making this stuff up. Nature made this stuff, right? Right. Creation made this stuff up. I was fascinated when I found out that came from yams too. Yeah, right. So, okay, estradiol, your bodies, there are three or four kinds of estrogen,

Starting point is 00:47:50 but this is the main one to restore to your body. If you have a uterus, you must protect the endometrium with micronized progesterone, not artificial progesterone, micronized progesterone. And then testosterone is a female hormone. Yeah. It's a hormone. Men and women have it. And let me tell you something.

Starting point is 00:48:13 Everything came back with her. Oh, this regimen. Not to get too personal, but things got a lot better around our eyes. I always talk about my own hormone journey. These three systemic hormones is where we start. But that's not where we end. To prevent the genitoneary syndrome of menopause, which is vaginal atrophy, the loss of sensation in our perineum, the loss of tissue. Our labia will absorb.

Starting point is 00:48:44 And yes, I'm so glad you said that. 80% of all women suffer from incontinence. Nobody talks about it. Nobody talks about it. Vaginal estrogen, which is safe for every person, including. people who have breast cancer, that's the fourth component. That is the fourth component. And then, you know, frankly, I'm as vain as they come. We lose 30% of the collagen in our face as estrogen walks out the door. Yes. Microdoses of estrogen on the face can restore the collagen build

Starting point is 00:49:17 to an extent. Yeah. So much better than superficial things we pat on, you know. So facial estrogen, vaginal estrogen, estradiol, progesterone, testosterone, is the complement that gives our body back the building blocks that it needs. And how early can we start? You can start in perimenopause, which can, in some women, can start at 35. The average age of perimenopause is 45, but we do not have to start, we do not have to wait until menopause at 51 or 52, we can start much earlier. And the opposition to that that I hear all the time is,

Starting point is 00:50:01 why are you going to start a young woman on hormones, blah, blah, blah? Of course she needs to, yeah. But let's think about that. There are generations of women who have been put on birth control pills, which I'm not opposed to. However, it's synthetic. It is not natural. Those are artificial types of estrogen.

Starting point is 00:50:22 At 10 times the dose of menopause hormone therapy. So in menopause hormone therapy, we're giving you... At 14 years old, too. Oh, right? For decades, right? Right. So we're taking body identical hormones in very low doses. It is not an argument when people bring up to me.

Starting point is 00:50:46 Yeah, but why are you giving hormones to young women? Well, you're giving birth control to young women, which is 10 times the dose. we do it for decades and decades, starting at teenagers. Much lower ages. Right. And I don't want people to think from this conversation. I'm opposed to birth control. I am not.

Starting point is 00:51:01 But I want people to be more curious and just don't slam on a mantra. They hear somewhere that, oh, hormones, well, you're taking them anyway. Yeah. So let's think this through a little bit. Yeah. Because if I can, Gary, there's new data that I'm going to present at this conference that is presented at Zenos. That was Saudi Arabia.

Starting point is 00:51:21 In Saudi Arabia. Well, it's being currently, as we speak, presented at the menopause meeting in Orlando that's going on this week. New data in 120 million women, it's a retrospective analysis of a vast database. 120 million. This is a vast study that shows that you can decrease the odds by 60% of the following diseases by starting hormones. earlier in perimenopause, stroke, cardiovascular disease, heart attack, brain death, and osteoporosis, going back to the astonishing ability of early hormone decision-making and truly being preventive disease modalities.

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Starting point is 00:53:04 Now, let's get back to the Ultimate Human Podcast. Wow, that is astounding. You know, there was a very similar mantra with men, and I think with men, it's a little bit different, you know, starting testosterone too early can be... It suppresses sperm. Yeah, suppresses in you. And you also have a few other arrows in the quiver to try to raise testicular production of testosterone more naturopathically. But in 2018, the American Journal of Urology updated their clinical guidelines on testosterone therapy.

Starting point is 00:53:41 I found it fascinating. In fact, if you go to that study, American Journal of Urology and you put in an American Journal of Urology testosterone, you scroll down to section 13. you'll start to read there on guidelines that clinicians should use to inform testosterone-deficient patients. Now, it also talks about women in this too. And dispelling the myth that it was linked to prostate cancer, dispelling the myth that it was increasing the risk of cardiovascular disease, dispelling the miss that if you had prostate cancer, that it increased the incidence of prostate cancer. But yet so many, now that was 2018, so I realized why that one's holding on a little bit. But I think there is a fear around hormone replacement therapy because of some of these

Starting point is 00:54:27 studies that came out early on. It's like we talked about the war on saturated fat. That was in the 90s. And people still think that rib-eyes are deadly. And so we just need to be eating highly processed foods. And sugar is not the enemy. Saturated fat is the enemy. We know that to not be true.

Starting point is 00:54:45 Now, thankfully, we're about to update our nutritional guidelines, you know, health and human services is. But I think this is just such a powerful message and such a great message that you don't have to suffer to be natural. You know, you should be, as a woman, you should be in a position to thrive all the way through your 50s, 60s, 70s. We have the technology now. The science is there. These are safe. These are effective. There are physicians that understand what they're doing. I think it's becoming a lot mainstream. I hope so. You know, we, we were really blessed to have a, an OB-GYN as our clinic director. Her name's Dr. Carrie Sarda. She delivered 9,000 babies. She's an absolute phenom of a woman, especially when it comes to

Starting point is 00:55:33 female hormone therapy. And she was preaching the same thing years ago and getting a lot of flack from her colleagues that she wanted to start women on these hormones. And to your point, estrogen is like, you know, if you've had to pick something sinister to really mess with a woman, it would be estrogen because it's like skinny elasticity, mood, memory, emotion, sleep, energy, and libido, you know, all of these things. It's everything. Just like that one thing. If I just wanted to have one dial to mess up as much stuff as I could, it would be that estrogen dial. and, you know, especially the E2 dial. But so I'm so glad that you clarified that for that for us and came full circle because so many people have become citizen scientists now.

Starting point is 00:56:27 Thankfully, there's great thought leaders out there like you that are teaching women and men for that matter. Yes. That you need to take your health care choices into your own hands right now. And there are lifestyle changes. We used to we used to call modifiable risk factors. in the insurance space. And modifiable risk factors were, okay, this person has, their BMI is too high, they're morbidly obese,

Starting point is 00:56:54 they're heavily sedentary, they're smoking, modifiable risk factors were, what if they change these? But the sad truth is the vast majority of people don't. Well, and that continues today. I mean, I think that as a population, it would seem, you know, if I believe my social media, because I tend to click on the healthy things, I would believe that people are really making big steps. And I think that there are a lot of big steps.

Starting point is 00:57:23 But I don't have to tell you with your history in the insurance business that 70% of people in the U.S., many people across the world are fine. They're living and fine. They're good today until we know the research shows that health span ends about 63. life expectancy for men in the United States is about 76 for women's 79 in Australia. We were talking about Australia. It's 85. They're doing something better. I love the Australian Sue Bach. We were actually just talking about how much we both love Australia. I just had a tour there and people are amazing. Food is really good. Food is great. They're outside. I love Australia,

Starting point is 00:58:03 but their life expectancy is 85. But we're in the Middle East right now. And on average, the life expectancy is like the United States, 79. The question becomes, I believe we are moving the needle. I believe people are becoming the CMOs of their own health. But at a population level, I think it takes the kind of effort that you've described to me in Dubai and what they're doing here in the kingdom because still 70% of people do not invest every day in their health and mobility. They're just living fine, doing whatever it takes to carpool, get home.

Starting point is 00:58:39 And it's going to take... one by one, countrywide change. Yeah, I agree. Well, it's happening. You know, I chair the Maha action, which is, you know, supporting Bobby Kennedy's agenda to make some changes at Health and Human Services and CDC, the FDA. And there's a lot of flack and a lot of pushback on that, too. And it is not a political agenda by any means.

Starting point is 00:59:06 It's an agenda about recapturing the health of America because no parent, is excited to hear that for the first time in modern history, our children have a shorter life expectancy than we do. That, to me, is mind-numbing with all that we have access to and that we spend $5 trillion a year on health care. Our children should all be living a lot longer than we are. And yet, I think the primary driver of children's health is parent health. I agree with that. And then the parent influence. So this is fascinating. So my audience loves you.

Starting point is 00:59:49 Thanks, guys. But for those that are new to you, where can my audience find you? I love that you've asked. And please talk about your new book. Yes, every day I educate on Instagram. I want you to go and follow me in. But 90 seconds is never going to be enough. Well, that's where I started doing the candlestick and the brushing my teeth home on like.

Starting point is 01:00:08 So it impacted you. I'll be honest with you. Try brush you. your teeth on one leg. She does it on her video. That's it. But I've written a new book. It's called Unbreakable. And it's, you know, the title Unbreakable is a nod to the fact that I'm a bone doctor. But what it really is is... I like to reading it right now. Oh, that's wonderful. It's on our nice, Sam. It is a mindset approach to aging with power. It is a physical approach to aging with power. And I do end the book by examining where are we going? What are the peak performance

Starting point is 01:00:38 things we can do. And what are the emerging longevity technology that after we've optimized our health implemented the peak performance I do for athletes? Where can we go into the future? Because longevity science is changing. So it's called Unbreakable. It's a thankfully, I'm so thankful it's in New York Times and London Times bestseller. Thank you. Awesome. Great job. Yeah. And it deserves to be. And they can find you on Instagram too. And I wind down all of my podcasts by asking my guests, same question. So there's no right or wrong answer to this question. But what does it mean to you to be an ultimate human? To be ultimately human to me means to not only, I've got so many answers, ultimately human to me means that I get to do what I want to do, when I want to do it,

Starting point is 01:01:34 uninhibited by mental and physical constraints to be ultimately human takes a daily investment in myself and an anonymous selfish mantra but this vessel is worth caring for it is yeah and i think you were so spot on to point out that so many people are living in fine you know they're walking around at a six, they're like, I can deal with this because it's not a two, when they could be walking around at a nine or a ten. That's right. So Dr. Wright, thank you so much for your time today. We're going to go into my VIP room because the VIPs are a community that I'm building

Starting point is 01:02:19 of like-minded people. And they're the only ones that I let know who's coming on the podcast first. Oh. So they have some questions for you. I let them ask that guess. questions directly. So they have some great questions for you. But for the rest of you guys, please check out Dr. Vonda Wright. She is an absolute pioneer, not just in women's health, bone health, men's health, I think gives very practical advice, unencumbered advice with real

Starting point is 01:02:47 statistics and science to back it up. Please read her book, especially if you're a woman. My wife is partially part of the way through the book now. So we're big fans. And until next time, that's just science. Thank you.

The Ultimate Human with Gary Brecka - 215. Dr. Vonda Wright: On Menopause, Women’s Hormone Therapy, and Perimenopause Symptoms

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