I am thrilled today to have the opportunity to speak with Dr. Vonda Wright, a practicing double-boarded orthopedic sports surgeon who has positioned herself at the intersection of longevity, women's health, and performance.
Dr. Wright is a great advocate for women's health, well-known and highly regarded for her frequent media appearances and thought leadership. In our discussion, we cover the importance of menopausal literacy and the impact of musculoskeletal syndrome in menopause, focusing on the critical decade, bone health, risk factors, and how to assess muscle strength. Dr. Wright shares her formula for strength training, and we explore the benefits of Zone 2 sprint training, examining the importance of V02-Max testing, particularly for frail individuals. We also address common musculoskeletal issues and essential lifestyle practices for maintaining orthopedic health.
This insightful conversation with Dr. Vonda Wright is one of my top picks on the podcast. I know you will love it!
IN THIS EPISODE YOU WILL LEARN:
What menopausal literacy means
The symptoms of musculoskeletal syndrome during menopause
The roles estrogen and testosterone play in the musculoskeletal system
Why it is essential to focus on your health and notice any hormonal changes in the critical decade between the ages of 35 and 45
How the loss of loss of muscle mass and strength can lead to frailty and a risk of falling in middle-aged patients
Why women must base their decisions regarding estrogen on facts
The benefits of making smart nutrition, exercise, and sleep your priorities
The exercise Dr. Wright recommends for improving cardiovascular fitness
How weightlifting and trampoline rebounding in midlife supports bone health
How to use how to use V02 Max data to track your fitness level
Some essential nutritional factors for supporting midlife health
Bio:
Dr. Wright is a practicing double-boarded Orthopaedic Sports Surgeon, Author, Speaker, Researcher, and Innovator whose work stands at the intersection of Longevity / Women’s Health / Performance. Widely recognized for her thought leadership, Dr Wright is a frequent media and conference expert. Her innovative science-based approach is changing the lives of millions in mid-life.
Dr Wright practices in Lake Nona, Florida, and is the founder and CEO of Precision Longevity.
“High-quality protein contains leucine- an amino acid you cannot make and
must get from food, which is critical for muscle building.”
-Dr. Vonda Wright
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Vonda Wright
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of connecting with Dr. Vonda Wright. She's a practicing, double-boarded orthopedic sports surgeon, author, speaker, researcher, and innovator who works stands in the intersection of longevity, women's health and performance. She's widely recognized for her thought leadership and is a frequent media and conference expert. This is undoubtedly one of my favorite recent conversations on the podcast and is a must listen for all Everyday Wellness listeners.
[00:00:57] Today, we spoke about the role of menopausal literacy, the impact of musculoskeletal syndrome of menopause, the impact of the critical decade, bone health and risk factors, how we assess muscle strength, her formula for strength training, the role of Zone 2 sprint training, and more. Why we should test her VO2 max, especially for the frailty line, common musculoskeletal issues she sees in clinical practice, and key lifestyle measures for everyone to focus in on to help support overall orthopedic health. I know you will love this conversation as much as I did recording it. Dr. Wright is an incredible women's health advocate.
[00:01:44] Well, Dr. Wright, such a pleasure to connect with you. I'm a huge admirer of your work. Welcome to Everyday Wellness.
Dr. Vonda Wright: [00:01:49] Thank you so much for having me. I appreciate it, Cynthia.
Cynthia Thurlow: [00:01:53] Absolutely. I would love to really start our conversation today around menopausal literacy. I think that this is certainly something that most of us did not learn during our training. And I feel like in many ways, this generation of women are really changing the narrative about building awareness for women prior to going into perimenopause, and certainly perimenopause into menopause. But how do you define menopausal literacy as a clinician?
Dr. Vonda Wright: [00:02:23] No one has ever asked me that question before. I really love that. [Cynthia laughs] And I think the answer to that is generational. My 84-year-old mother never talked to me about it, but she was put on hormone replacement therapy and that she was one of the ones that she was put on it. It was taken away. And then I sent her, when she was maybe 68 or something, I sent her to a doctor where we were living at the time in Pittsburgh who was a hormone specialist, and she put her right back on. And thank God, because my 85-year-old mother has a normal bone density, which is unheard of. And so, there's that generation who’d had it. It was snatched away, but then, oh, my gosh, the baby booming generation.
[00:03:10] If I were 63 or older, I would be so angry, because that is the generation that never got it and maybe never will. So, they are now coming to the place of frailty, saying, what happened to us? How come nobody ever told us? And then my generation, I'm 57, so I am a Xer, and I am the generation that was raised to believe, and at least this is what my parents told me, that I could be anything I wanted if I worked hard enough. What I didn't realize is that I could have anything I wanted, but I could not have it equally. So, now my vision is to not lie to my daughters. I have a 29-year-old daughter and I have a 17-year-old daughter.
[00:03:57] I am working hard so they can be not only what they want to be, but equally. And that means in their healthcare, they deserve to have equal access to research dollars. They deserve to have equal access to research dollars. They deserve to before they go into perimenopause, when helter-skelter breaks out, to know it's coming. And so, when we talk about menopause literacy, which I love that you've even named it, I think it's generational, but I think that when I get millennials in my office, I give them the resources. Here's how you're going to make your estrogen decision. These are the three books I recommend. So, it's the generation x of us.
[00:04:47] I don't know how old you are. You may be much younger than me, but millennials and Z people, I hope, as they're coming up, they will not have to explore in the way Xers are currently exploring. They're going like, “Oh, yeah. Because I used this language yesterday, and I am a 41-year-old.” I said, “Listen, this is coming. You cannot avoid it. You need to know it, and you need to get in front of it.” And I think she was like, “What?” I'm like, “This is coming. You may not be feeling it now, but give yourself five to ten years.” So, in terms of--, that's such a long answer. You'll find that, Cynthia, I tend to just drone on and on, but I think it's generational. I think those of us hot in the middle of it right now have an obligation to our daughters.
[00:05:31] But I'm going to tell you for sure, the majority of the women that I encounter in public, even at a birthday party the other day, have no idea, no idea, and are still whispering about it. And sometimes I feel like everybody knows because you and I know, and because we're talking about it all the time, and everybody in the menopause is talking about it all the time. It feels like the world knows. But the truth is, only 7% of women are prescribed hormone replacement, which means that even less of them have probably been told about it or even know what menopause is. Gosh. There is no direct answer, but I think that is how I think about it right now.
Cynthia Thurlow: [00:06:13] Yeah, I love your answer. I'm 52, so I am part of your generation. But when I think about my mom, who's 78, and when the Women's Health Initiative came out, she went from being on hormone replacement therapy to being taken off of it. And I've watched my mom and her sisters navigate menopause. Now, 25 years in, depending on the individual and the net impact on their bones, their brain, their cardiovascular risk, their mood. And they have given me permission to talk openly about this. So, I'm not sharing anything that they're uncomfortable with the community knowing. But I do think that, that generation lost out on so much protection from HRT.
[00:07:00] And my hope is that our generation is actively talking much more proactively than any other generation has had the opportunity to do so. So, things will be different for your children's generation, my children's generation, and certainly helping to build awareness so that conversations are started. My mother never spoke to me, even though my mom was a nurse, never ever had a conversation with me about perimenopause, menopause. There was so much shame around that loss of fertility, and yet there shouldn't be. I mean, you live long enough, this is what's going to happen. [Wright laughs] And so there's no shame, --[crosstalk]
Dr. Vonda Wright: [00:07:38] And they have done. Who wants to be fertile till you're 70? I mean.
Cynthia Thurlow: [00:07:42] No, thank you.
Dr. Vonda Wright: [00:07:44] No, thank you.
Cynthia Thurlow: [00:07:45] [laughs] No, thank you. Absolutely, no, thank you. But one of the things that I love about your work, number one, the advocacy, but also bringing awareness to some of the changes that will occur in women's bodies if they're not proactively working against it. And you're an orthopedic surgeon, and so you've coined this phrase of musculoskeletal syndrome of menopause, really pivot a little bit and talk about this, because it is relevant to everyone that is listening.
Dr. Vonda Wright: You know, when I was going through my own menopause, I had what people have like brain fog, such that I would ask for an instrument in the OR, and I would say, I need this thing. I need the thing that I could describe it. Adjectives never went away. Nouns went away. So, I had the brain fog, I had the night sweats, and I have a story for each one of these symptoms. But the thing that devastated me was, I am an athlete. I've always been active, whether I was truly an athlete or just running around, because being an orthopedic surgeon is a physical job. I can lift all the 300 pounders I need. But the musculoskeletal syndrome of menopause, primarily the symptom of arthralgia, which is total body pain, I could not get out of bed. I would swing both legs over and slowly push myself out and then shuffle until I warmed up enough.
[00:09:10] And that was new to me. And then as I became more of a self-advocate and a student of this, because you believe me, nobody taught me this in medical school or orthopedics, where 96% of all my peers were born with the disfortune of not having ovaries. So, how would they even know. So, anyway, as I self-educated, I learned that it was not only total body aches, but the frozen shoulder and the rapid progression of arthritis in women after 50 and things like loss of lean muscle mass. I truly began to understand osteoporosis. And I'm a bone doctor, this is my responsibility. And then I experienced the redistribution of fat from periphery to visceral.
[00:10:03] Those are all the tissue specific results of estrogen walking out the door and never looking back when it comes to the musculoskeletal system. And it's all because of the same reason we have symptoms other places. Estrogen is ubiquitous in our body. Every organ system has receptors. This is my little basket illustration. An estrogen receptor is like a basket, and estrogen fills it, and when it fills it, it causes a shape change that allows all the downstream amazingness that estrogen does for the musculoskeletal system, whether it's inflammation, cartilage, muscle, bone, fat. So, I decided if somebody came to me, I'm sure it's to you too. When you see patients came to me and said, “I have these six different things, gosh, that is hard to do in 15 minutes,” and I would probably glaze over.
[00:10:59] So, I wanted to give women a nomenclature such as, “Okay, clinician. I have the musculoskeletal syndrome of menopause. Because my estrogen has gone and I am primarily-- having and choose a symptom.” I'm primarily having arthralgia. I'm primarily having shoulder frozenness so that we could advocate and communicate better. But part of that is advocating women, consumer women, patients. Part of that is educating our own disciplines, because only one very, very brilliant orthopedic chairman has invited me to come do grand rounds on the musculoskeletal syndrome of menopause. She's a woman. She heard me talk about it in a little sports medicine group, and she's like, “Oh, my God, I've got to get all the departments together to talk.” And it's not because the others are reluctant. They just don't know.
[00:11:58] So, as I advocate, as I produce papers on this part, my job is to educate my own field so that they treat women better and don't just dismiss them and say stupid things like, “Oh, it's just part of getting old.” I mean, so is erectile dysfunction, but nobody tells the men that, do they?
Cynthia Thurlow: [00:12:17] [laughs] No, absolutely not. It's interesting. I think it was Avrum Bluming when I interviewed him that said, “Cynthia, if men had a catastrophic hormonal change like women do when they go into menopause, I mean, men go through andropause, but I don't think it's nearly as dramatic,-
Dr. Vonda Wright: [00:12:34] I don't think so.
Cynthia Thurlow: [00:12:34] -Men would never stand for it”. And he's like, “Women are having a moment. People are paying attention. Women are talking about these things. Healthcare practitioners are being forced to have these conversations and/or refer out to appropriate people. So, I love that you are coming at this as a clinician, as a woman who's navigated the transition into menopause.” And, one of the things that I find really interesting about the changes that are starting to really occur around age 40, this loss of muscle mass and loss of strength. And for you, as a clinician, I would imagine that you are seeing many, many patients, male and female, that are frail. And maybe this is where we pivot and talk about why frailty is a concern and the concern about falls and fall risk.
[00:13:23] And so I think, unfortunately, we as a country don't properly educate patients. That process really starts in our 40s and 50s, and maybe it doesn't show up until later stage of the 60s into 70s, but this is why-- I was an ER nurse before I was an NP and the amount of falls that I saw, sometimes just breaking a hip or a bone, but more often than not, blunt force trauma to the head, head bleeds, things that sometimes can have really unfortunate consequences. So, for you as a clinician, that loss of strength and muscle mass oftentimes precedes the frailty piece. What are some of the things that you talk to your patients about to help educate them? Obviously, lifestyle piece is important, but I know that you're probably starting earlier than the average clinician having those conversations.
Dr. Vonda Wright: [00:14:14] You're so right. Because what we don't realize, unless we're thinking about it, is perimenopause is the start of our estrogen decline. I mean, we have estrogen dominance for a while, but it's because our ovaries are retiring. What we don't also realize is that around in our 40s, women lose 50% of their total testosterone, which is critical in the musculoskeletal system. And even though we haven't worked out the exact dose response pathways like we have for men, because what we have to do for testosterone in women, we have to infer from the male data, because there's just not enough research. But my point being, it starts happening in our 40s, and so that's when I want people to start thinking about it.
[00:15:01] Here's another terminology that I throw out there all the time, is there's a decade that I call 40-ish, 35 to 45. You have enough hormones to make a difference. I say that it is 40-ish is the critical decade to get our health shit together. Sorry to have sworn at your audience, but listen people, it is the adulting time. We have been out of college long enough. Maybe we've settled into our careers. Maybe we have littles that we're frantically trying to raise. But it is time to turn some light back on ourselves, because it is the critical time that our bodies are going to enter into midlife, and we can stop worshiping our youth, because, frankly, it may not have been that amazing anyway. We just think it was and pivot, like, literally pivot to face the future of midlife and beyond.
[00:15:57] So, that begins in 40-ish, 35 to 45. Then what we have to realize is, as our hormones plummet, both estrogen and testosterone levels change, everything changes that our health span, on average, lasts until 62, that time in our lives when the ravages of chronic disease are kind of quiet. At 62, the diseases that kill us are demanding attention. And many people tell me because I see them a lot. And as the more general practitioners will tell you, that's when people start going to three doctors’ visits a week health span, 40ish, 35 to 45, 62, health span becomes really apparent that it's ending.
[00:16:43] And here's what happens Cynthia, because I still, even at this age in my career take trauma call. I am called to the emergency room or to the hospital room. And lying before me is the future of women if they do not pay attention. I see the future of women today, every call day. And what is it? Typically, the woman is laying there 75, 85, 93 a couple months ago, she has broken her hip doing nothing. She's not out in a spartan race. She's going around her house. She trips over the rug. My office is next to the airport. She trips over her own bag, and she breaks her hip, and she's lying there in the hospital bed. Bones are silent until you break one, particularly here's my femur. I always pull this out. Here's the femur. You break your femoral neck. It is excruciating. So, they're lying there not moving because it doesn't hurt when you don't move. She is incontinent because she has not had estrogen since she was 50.
[00:17:49] And she has the gyneco-urinary syndrome of menopause with the fragile mucosa. She has recurrent bladder infections. Her uterus is prolapsing. She's incontinent. She's lying there in bed with one of those weird devices probably developed by men. It looks like a hot dog to catch the incontinence. Incontinence is one of the number one reasons women are moved to nursing homes. Broken hip, incontinent, when I asked the medical people to clear her so I can take her and fix her hip, she has so much cardiac disease that they have trouble clearing her, or they have to do an entire cardiac workup and optimization to give me 45 minutes-- that's your job, to give me 45 minutes to put metal in her hips so she can walk again. Broken hip, incontinent, cardiovascular disease so serious that it takes an entire cardiac workup.
[00:18:47] And then you know what's next? She either has a touch of dementia or she has frank Alzheimer's. And there she lays in front of me with four things that could have been prevented by the use of estradiol. Could we please prevent the future of frailty that I see every day as an orthopedic surgeon by starting to pay attention when we're 40. I am getting chills, even when I talk about this a lot, because I see the future of women every day. And we could be healthy, vital, active, joyful. If we get in front of this and realize that it is not just inevitable decline. Because when you break your hip, when you break your femur, which one in two women will break a bone across their lifespan due to frailty, 50% of the time, you do not return to pre-fall function.
[00:19:39] You can't live in the house where you've raised your children, where you're surrounded by your own memories, with the stairs going up to the second floor like this. You can't live there anymore. And a third of the time, you will die within one year from the complications of the chronic diseases that we've been talking about. And I don't mean to be histrionic or doom and gloom. I am describing the reality of being an orthopedic surgeon who takes trauma call. It happens every time I'm on call, so it's very frequent. So, I want women at 40 to make their estrogen decision. You don't have to supplement. You don't have to replace. We are all sentient beings with choice to control that part of our health.
[00:20:27] But you must make the decision based on facts not fear, not based on the wives’ tales or the tabloids you read as you're checking out in the grocery. Women need to talk to people like you and me so we can direct them to the place where they can make an intelligent decision. And if you choose not to, here's what you have to do. If you sit around and wait for time to pass, I predict for you, you will be like that patient.
[00:20:57] But if you invest every day in smart nutrition with enough protein, if you take the supplements that we believe you need for bone health and muscle health, if you walk every single day and if you're capable, sprint every single day so that we make more muscle stem cells and build a better heart. If you engage in lifting weights, even if you never in your life have thought about it, there is never an age or skill level when your body will not respond to the stress you put on it. So, we must learn to lift. And then finally, for the first time in our lives, maybe people have been better at it than I have. You have to pay attention to your sleep and restoration, because when I was training all those years, I was a nurse first.
I don't know if you know that I was a nurse.
Cynthia Thurlow: [00:21:47] I did.
Dr. Vonda Wright: [00:21:48] I didn't sleep when I was in training. I'll tell you the horrible stories about sleeping in the library and then working the night shift, and then I went back to medical school. And then I chose a very long path. And then I had a child, so I probably didn't sleep for 20 years. I used to say stupid things like, “Oh, you know, I'll sleep when I die.” Only now to know that I will die [Cynthia laughs] if I don't sleep. You must make your estrogen decision, and you must pay attention to the lifestyle ways that you control your health, because I see the future of women's health today, every time I'm on trauma call.
Cynthia Thurlow: [00:22:25] Yeah. Thank you so much for sharing that. And listeners probably know, I have two family members that in the past six weeks, one fell and broke her femur.
Dr. Vonda Wright: [00:22:34] Oh, no.
Cynthia Thurlow: [00:22:35] 80-year-old with long-term corticosteroid use, chronic immunosuppressive, renal transplant, which means a kidney transplant. And then my father fell and got two subdural hematomas.
Dr. Vonda Wright: [00:22:47] Wow.
Cynthia Thurlow: [00:22:48] And so I share this as a cautionary tale that I saw hundreds, if not thousands of patients in the ER and then as a cardiology NP doing preop clearances. And you're absolutely correct. A lot of these patients, we would talk to the families and we would say, “We know grandma has a bad heart, has a leaky valve. If we don't intervene, she's never going to walk again. But if we do intervene, there's a high likelihood she could have an infarct or have a heart attack postoperatively, congestive heart failure, etc.” And so, it is a real concern. And for me now, both as a clinician but also as a family member, seeing these two family members fall.
Dr. Vonda Wright: [00:23:26] Mm-hmm.
Cynthia Thurlow: [00:23:27] It just magnifies why it’s so important. Now when we were talking about bone health, obviously, there are things we can do now, but I’m thinking about our younger women, many of whom are appropriately put on oral contraceptives so that they have choices about when they choose to become pregnant. What are some of the risk factors that you’re aware of that impact bone health before we go into perimenopause and menopause? Because I think these are important to talk about, because these are reasons that may impact many of the listeners.
Dr. Vonda Wright: [00:23:58] I love that you asked me that. Because of late, we're in Olympic trial time now, so we're parading out all our young champions who have worked their whole lives to get to where they are. It's a really timely question, but what happens along the way for young women? And also, because honestly, in the United States, we've had Title IX for about 52 years, so women have been equalized in sport trying to get there in terms of access for 52 years.
[00:24:32] Well, female athletes very commonly live in a state of relative calorie deficiency, meaning either they're working so hard all the time and they're underfeeding, they just can't get enough calories in, or they are purposely under calorie because they want to be little, like our pinkies, we’re told to be little, especially if you take care of gymnasts and dancers and runners. So, what we're having now, and I also have these patients in my clinic, are young women in their 30s coming in with osteoporosis because they never lay down enough bone when they had the opportunity due to relative calorie restriction, overuse or not athletic calorie restriction, but they just want to be skinny. So, it's a real problem.
[00:25:24] So, my poor 17-year-old and my 29-year-old and all of her friends hear me constantly talking about the fact that, “Are you out there bashing your bones? Are we jumping up and down? Are we doing impact exercise? Are you feeding yourself enough? How much protein have you had?” Such that my 17-year-old is very conscious about getting enough protein in which I'm so glad because she was a ballet dancer most of her life. And she is teeny tiny. So, the osteoporosis is not a disease of old women, it is a disease of people. Because 2 million men in this country have osteoporosis. Now, theirs is a little bit characteristically different than women’s, but when men fall and break a femur, it is devastating because they're usually older.
[00:26:10] To get back on track, bone health is a concern of all women. It should start when they're teenagers. Are you getting off the couch? Are you exercising? Are you eating enough to build the muscle and bone you need for a lifetime?
Cynthia Thurlow: [00:26:28] I think it's such an important message, and certainly I think about many women that go without menstrual cycles for years and years and years. And don't think of it as being a cautionary tale. I remind women that our menstrual cycle is really another vital sign. And if you're not getting your menstrual cycle, the question is why? And it's interesting, even with the rise of social media. I'm seeing 27, 28-year-olds that are premature ovarian insufficiencies, so they're literally positioning themselves to have the magnification of every potential side effect of going into early menopause x100, because it's not as if they're 57 or 47 or 50. But being that young and that long without those sex hormones is a huge concern.
Dr. Vonda Wright: [00:27:15] Yeah.
Cynthia Thurlow: [00:27:16] You're talking to your patients about bone health and talking about how we build bone, how we break down bone and the interrelationship of estrogen, or estradiol and progesterone. Can we just speak to osteoclasts and osteoblasts? Because I do think this is interesting how the bone breakdown accelerates and within that setting of that loss of estrogen.
Dr. Vonda Wright: [00:27:39] Yeah. So, I mean, bone biology is a multistep process with multiple cellular processes and stimulates. But if we break it down to basics, we have multiple kinds of bone cells. The two that I want to talk about today is the osteoclast. And I always do this as if I've got my bone cells on my femur here. [Cynthia laughs] We have the osteoclast whose job is to go along the bone, and when it receives stimulation from the body that, “Oh, we need some minerals. Oh, I've seen some deficits everywhere in our body. I need some of the things in the storehouse of the bone.” The osteoclast comes along, digs out the minerals, leaves a little hole so that those things can go off and work. Coming closely behind is the osteoblast, B for build.
[00:28:30] It's like, “Oh, my God, there's a hole in the bone. Let's fill it in.” And so, these two cells work in tandem. They crawl along the bones. And so, throughout our lives, there's a relative balance of breakdown for supplies and rebuilding, because our bones replace themselves every 10 years. What happens in menopause as estrogen walks out the door? Estrogen is an osteoclast regulator. It keeps the osteoclasts in control. The osteoclast is a crazy. If you want to personalize these cells, a little crazy cell, it's going to go out and go roughshod unless things control it like estrogen. So, when estrogen leaves, it's not that the osteoblast stops working, it continues to work and build. It's just that the breakdown outpaces the osteoblast. So, instead of working like this, they're working like this.
[00:29:26] Now, this is a gross oversimplification, and sometimes I think bone biologists are going to write me hate mail. But for those of [Cynthia laughs] us who deal with the general public, it's a very visual way to see what's dampening the osteoclast. So, to answer the question can you build bone? You continue to build bone, but you break it down more. So, we know this, we know that we can build better bone in the presence of estrogen. We know that we can prevent osteoporosis with the presence of estrogen. It's the one reason the FDA has approved estrogen easily. If you say this person has osteoporosis, it's easy to prescribe. But there are other ways to get around bone density problems in midlife. So, estrogen is one of them. Lifting weights is another. Everybody always asks me, “But what if you already have osteoporosis? Can you lift?”
[00:30:22] And the answer is “Yes.” And you can lift heavy if you're careful. There's a study that has shown, it's called the LIFTMOR study, that under supervision in a careful way, you can lift heavy even in the presence of bone deficit. So, we need to lift weights. We need to impact our bones. I prefer jumping with a jump rope, running up your stairs. You can also rebound on a trampoline. That's what astronauts do when they come back with bone deficit. NASA has done great work that you can rebound on a trampoline. Weighted vests are all the rage right now. Then I get the question. But wait, “If I've got osteoporosis in my spine, should I be overloading my thoracic spine with a weighted vest?”
[00:31:09] Well, my suggestion to that is, “Well, let's put the weighted belt around our waist, because it's our lumbar spine and our hips that need to see the extra load. Our shoulders don't need the load. Our hips and our spine need the load. [laughs] So, let's put it there as a weighted belt, for instance. So, there are still lots of ways that we can address our bone health even before we get on to the dreaded pharma alendronate. And there's a whole list of different drugs that I usually send my patients to an endocrinologist who's really an expert at that, before we have to do that. So, we're not without hope as estrogen leaves our bone regulation a little bit pell-mell.
Cynthia Thurlow: [00:31:51] Yeah, it's so interesting because I joke. Well, I don't joke. I'm honest when I say I didn't realize that my peak bone and muscle mass was in my 20s and 30s. Had I known that, there's so much more that I would have done. And perhaps it's the time to pivot and at least touch on muscle health, because this podcast community definitely knows the value of why muscle is this endocrine organ. It is metabolic currency. It is so important. How can we measure other than objectively, if we're at the gym, we're lifting weights and, we're going up on weights. And I definitely want to get to your methodology about how many reps, for how long, how many sets. What is the current proxy for determining muscle strength?
[00:32:38] I've read that things like grip strength are a proxy of overall strength. Is that something that you employ? Do you believe that fervently? Is that something that you recommend? I laugh because my dad used to walk around with one of those little hand grips, and we thought it was more of a, one of these things where he was just showing us how strong he was. But when you're working with patients and helping them understand the role of sarcopenia, I always say it's not a matter of if but when, unless you're actively working against it.
Dr. Vonda Wright: [00:33:06] Well, I do have a grip strength goniometer, or whatever it's called, and I do bring it out at my midlife mastery retreats, at big conferences when I'm speaking to groups, because it is a really tangible way, and then it becomes a competition, so I can't get it out of people's hands because they're all [Cynthia laughs] gone around, like, “Let me see what this. Oh, and then let me compare If they're within 10% of each other.” It is a validated measure for judging overall strength, because the truth of the matter is, when we lift weights, our biggest muscle groups are below our legs. So, I'm not going to make people, do a broad jump or do weighted squats, although wall squats are also a good way to tell. But we have validated data on grip strength, people.
[00:33:55] It turns a light bulb on, it turns on a little bit of competition, and everybody wants to see the needle move. So, I could use it as a clinical value. It could be another vital sign. There is some data that walking speed, getting up from a chair speed, and grip strength predicts surgical outcomes. So, I think if I were a general surgeon who did massive. I'm an arthroscopist, so my surgeries are generally sports related. But if I were doing Whipple’s, for instance, or big cardiac surgery, it might be something I measured to see the physical competency of people coming into the OR frankly. But how do we measure muscle strength or prowess as it relates to this? Well, we can do proxies like that what I would rather do is people chart their own progress. Everybody's going to start from somewhere.
[00:34:49] And many times people assign a judgment to that. I mean, sometimes I do. I say, put down those namby-pamby pink weights, [Cynthia laughs] partially to be funny, but partially to help people understand that our body responds to stress. Not all stress is bad. Our body doesn't know that it needs to be stronger, faster, smarter unless we put the stress on it, that it wakes up and says, “Oh, my God, I need to be stronger, faster, smarter.” And so, when it comes to building muscle, that's why 30 reps of a tiny weight is not going to do anything for us, versus fewer reps of heavier weights that we both psychologically, neuromuscularly, and within the muscle itself are fatigued, exhausted for instance. And that's what's going to stimulate building of muscle. It's going to stimulate replication of muscle stem cells, the satellite cells.
[00:35:44] So, that is an indirect way to say, we just have to know where we're starting and then monitor every month. A month is about a good-- every day is too frequently, but every month you can see real change.
Cynthia Thurlow: [00:35:57] Yeah. And so, one of the questions that I had was, how do we know that we are lifting heavy enough?
Dr. Vonda Wright: [00:36:04] Yeah, well. And the question I get is, “Well, what's heavy? What number should I start with?” Everybody’s heavy is different. Here's an example from my biceps’ curls. We want to be lifting heavy enough that we can only do for our big compound lifts, meaning our push and pull with our upper extremities. Push and pull with the lower extremities. So, for the arms, push is something like a bench press. I'm doing this because I do it with a bar, a bench press or a pole, like a pull up for the lower legs, push, pull is squats and deadlifts. Those are the giant compound lifts. They involve multiple body parts four reps, four sets. Now, it's an actual range, three to six. But to make it easy for my people, I chose four, four reps, four sets.
[00:36:58] But it means that the four reps need to be near failure. You can't do eight reps of the weight that you do the four reps, you need to be able to do four, knowing that maybe you could get five, but definitely not eight. Those compound lifts, at that weight that heavy, are then augmented by the accessory lifts. So, I'll give you an example for my bench press, four times four, I accessorize with biceps, triceps, lats, delts, rows, eight reps, four sets. So, still eight is more. But it's not three sets of 15. And so, for heavy, my biceps, I can biceps curl 15 pounds until tomorrow morning. We could just be doing this all day. That is not going to build more bicep for me, strength for me. But I can only do 25 pounds three times.
[00:37:56] The fourth, I'm trying to engage my back, which is bad technique. So that is heavy, and that's how everyone should gauge their heavy. And it takes a little bit of experimentation. If you've never, ever, ever lifted before or you didn't lift since high school, maybe we have to go back and do functional lifting, body weightlifting, small kettlebells and free weights, which is fine, because we're just trying to reeducate our bodies again, to even know itself, to get our neuromuscular pathways and to trust ourselves to build the confidence. And, there are studies that show with adequate protein, body weight, exercise, you can still make good gains. But once you feel comfortable with yourself again, then I direct everyone to lift in the way I've just described. And maybe it demands taking lessons. I mean, who's born knowing how to power lift? Not me.
[00:38:53] So, I took lessons. I hired a trainer for a short amount of time. Actually, not short. I hired a guy just because I liked to work out with him for about six months. But I totally learned how to do this such that I can do it by myself now. And maybe that's what it takes.
Cynthia Thurlow: [00:39:10] Yeah. And I love that you-- It's very, very clear that most, if not all of us are probably not lifting heavy enough because we're going to 10 reps, we are going to 12 reps. Maybe we're going to 20, which is great for endurance, but is not going to activate those satellite cells, which are so important. Now, along with strength training, I know that it's also important to incorporate some degree of sprinting, or I think sprinting is what you like to do. How do we differentiate about how frequently to do sprint training and or Zone 2, which I know has become very popular and something I actually enjoy doing. I was doing it this morning on a 4% incline with a 12-pound weighted vest on the treadmill, just because it's hot and humid where I am.
[00:39:57] But what are your thoughts about frequency of sprint work, Zone 2, if you are an advocate of that, and then also flexibility work, which I feel like-- Thankfully, I'm not super stiff, but I know plenty of my friends will say, “Oh, my gosh, I have to do more yoga, I'm so stiff.”
Dr. Vonda Wright: [00:40:11] So, Zone 2, your listeners may know, but what we're talking about when we're doing zoned training is using our heart rate as a guide for effort. So, Zone 5 is your VO2 max, where practically, you can't do it very long, almost zero amount of time, and you're throwing up. Nobody likes to do VO2 max testing. I've done it twice. Nobody loves it. I don't love it. So, there's that. Zone 1 is like, I'm Zone 1 right now. I'm hanging out. Zone 2 is the heart rate where we can be burning fat. So, in our cells, we have organelles called mitochondria, which are the powerhouses. We all learned this in high school biology and beyond. The powerhouses in the cells, it's where your ATP is produced by whatever substrate we're feeding into our mitochondria at that time.
[00:41:04] And whatever we're using, the fuel, is really based on the demand. So, we start out when we're doing lowish demand things at a lower heart rate. We can metabolize fat, but that is not a fast enough process. If we need lots and lots of energy, lots and lots of ATP. So that's when we start metabolizing carbs. That then throws off lactic acid, which causes the burn and decreases our performance. So, when we do Zone 2, we're working in a heart rate around our fat max, meaning the heart rate where we're burning fat maximally before we shift over to burning carbs. And so, you can either learn what that is by coming to me, and I'll do--
[00:41:52] We have a lab where I am, and we'll stick you and we'll prick your finger and will tell you, “Oh, this is the heart rate where you're starting to produce lactic acid. So, this is your range.” An easy estimate is 181 minus your age, unless you are highly metabolically dysfunctional because there are some people are already at upper zone sitting in a chair, and they're very metabolically unhealthy. But for the average person, 181 minus your age can tell you approximately 120, 130 is your Zone 2. So, the scientists that I follow for this recommend three hours a week, no less than 45 minutes at a time. So, that's what I do. My Zone 2 heart rate is much like yours. It's an incline of four. It's a speed of 4.2.
[00:42:41] I find that when I wear my weighted vest, I do, do that. I do it mostly because I do spartan races, and they put a 40-pound flap jacket on you. So, I use a 20-pound weighted vest just to practice for that. That increases my heart rate about 10 beats per minute, interestingly. But so, 181 minus your age, 3 hours a week, broken up into 45 minutes sessions twice a week. We want to work harder. We want to sprint. Again, it is not what it looks like on the track, it's what your heart rate is doing. Sprinting is speeding up on any modality, treadmill, rowing, anyway, you're getting your heart rate up to about 85 or 90% of your maximum. So, I do that. So, remember, I'm usually at 4.2. I do that by punching 11. I'm going as hard as I can.
[00:43:33] I'm not very tall. I'm just trying not to fly off the treadmill. [Cynthia laughs] But I only do it for 30 seconds. You can do anything for 30 seconds. Then I spin it back down to three and I completely recover. It takes me two to three minutes to recover, and then my heart rate's back down. I do it again and I do it four times. And that is where we really build our cardiovascular fitness. We're stimulating satellite cell replication. And I'm going to tell you for sure, because I've done it myself and on other of my patients. The combination of sprinting in Zone 2 and lifting weights is what recomposes your body. You will become lean and muscular and lose the body fat that will poison your body with this combination.
Cynthia Thurlow: [00:44:21] I love that. And for anyone listening, these are very accessible things to do. You mentioned VO2 max, and that no one likes testing VO2 max. Is that something that you routinely recommend to middle-aged women, or is that more for your sports medicine patients?
Dr. Vonda Wright: [00:44:40] Well, it's usually applied to high level endurance athletes who want to measure their performance. But listen, let's talk about it like this. There is a line in the sand called the frailty line, and it is the measure of VO2 max, below which you cannot be independent. You cannot walk in your house. You cannot do anything but sit in a chair. For women, it is 16. VO2 max is measured as oxygen per kilogram per time. So, it's a complicated unit, but for women it’s 16, for men, it's 18. Here's how you use VO2 max data for mere mortals like me. We generally lose 10% per decade. You can retrain it. Now, I have added VO2 max training on to my sprint training, and I love it even less.
[00:45:28] But you only have to do it once a week because I am interested in maintaining or building VO2 max. But let's use this. So, my last VO2 max that I tested when I was 50. I'm due for another one, but I don't love that idea. [Cynthia laughs] What's 45? So, if I lose 10% of 45 per decade, let's just do round numbers 45 to 40. I will be down to 40 by the time I'm 60. I will be down to 35 by the time I'm 70. I will be down to 30 by the time I'm 80. I will be down to-- I'll make this up 28. That's five more, 28 by the time I'm 90. I am still above the frailty line. If I have never been in cardiovascular shape, if I chose to sit around my entire youth. This is the problem with gaming. I am not opposed to gaming.
[00:46:23] In fact, I was one of the first sports medicine doctors in the country to design sports medicine programs for gamers. But here's why it bothers me. We replicate mitochondria when we're little, when we're active. We build muscle. We build cardiovascular fitness that we use as a baseline across our lives. If we arrive at midlife, if at 50, my VO2 max was 25. Do the math. I am going to get frail long before I'm old. That's how I'm interested in VO2 max for my people. Not because I'm training Tour de France athletes on a daily basis, because I take care a lot of mere mortal athletes like me who continue to be really active a thousand days from 60.
Cynthia Thurlow: [00:47:13] Oh, it's so interesting, I think for everyone listening, even for myself, I'm like, “Mm, I think I want to know what my number is.”
Dr. Vonda Wright: [00:47:20] Yeah.
Cynthia Thurlow: [00:47:20] Because I want to stay way above that frailty line. Now, I would love to pivot and talk a little bit about some of the more common issues that you see in your middle-aged women. I know you touched on frozen shoulder, which I know can also be worse in those that are chronically inflamed or diabetic.
Dr. Vonda Wright: [00:47:40] Yes, that's right.
Cynthia Thurlow: [00:47:41] And it can come on suddenly. Thankfully, I've never actually experienced that. But what are some of the common, let's just say common musculoskeletal injuries in nonathletes.
Dr. Vonda Wright: [00:47:51] Yeah. So, the most common things we see you named frozen shoulder, the other shoulder injury is rotator cuff tendinitis, which means inflamed rotator cuff. Now, when you look in the mirror and you see these muscles, these are not your rotator cuff. I call these your cosmetic muscles, your biceps, [Cynthia laughs] your triceps, your delts, your traps, they do nothing for the health of the shoulder in general. The four little muscles that are a layer deep underneath here, that raise your arm, that do this, do that. Most of us never work those out a day in our lives, and yet they're critical. So, they are connected to the bone. The rotator cuff is connected to the bone, as all muscles are, by tendons that develop tiny micro tears that never, never heal.
[00:48:37] So, by the time we're midlife, they can become inflamed, and that is augmented by the loss of our hormones, whether you're a man or a woman, or they can become, frankly torn. So, rotator cuff tendonitis and rotator cuff tear. So, that's the most common shoulder things. I'm seeing a lot now. I live in Florida that we are all active all times of year. Lots of tennis elbow right now. People are out playing pickle and tennis. And it's another tendon problem that the micro tears never heal. We don't have hormones to heal them. So that's shoulder and elbow. Then I see a lot of lateral hip pain because it's bursitis, lots of people get bursitis. They go to their orthopod or whoever's going to inject them, they get an injection but many times the root cause is never addressed.
[00:49:28] The root cause of trochanteric bursitis or IT band syndrome is a weak butt and core. Our butts are not just for sitting on people. Our butts, our glutes, are the most powerful muscle in our body, and they need to be constantly maintained. So, when they're weak, when our glute meat is weak, it causes us to shift our hips like this when we're walking. That is not how we want to walk. We want to walk with solid, stable hips, not like, bless their hearts, the supermodels who actively pivot their hips. I don't know how they don't have bursitis. [Cynthia laughs] That is why you get bursitis. So, you should never get a hip injection without also going to therapy or going back to the gym to work on your butt core and hip strength.
[00:50:16] And then for the knees, we can get creaky knees. Knees that make sounds without pain. I'm not that worried about. We can get meniscus tears, which presents a sharp, stabbing pain intermittently or all of these joints, shoulders, elbows, hips, knees can have arthritis, which is the loss of the smoother than ice coating on the ends of the bone. So, my femur I do this. People don't know what I'm doing. This is my femur. This is the coating. So, on this end of our femur, we have a bumper of smoother than ice tissue that is supported by estrogen. It's a matrix. It's kind of spongy. It's delicate, and without that support, we lose it rapidly. Thus, these pain, the swelling, it's an aching pain. It's a stiffness. So those are very, very common things that I see in midlife people.
Cynthia Thurlow: [00:51:11] Yeah, it makes so much sense. And for a lot of people, I think pickleball seems to be this new phenomenon. I mean, everyone in my neighborhood is playing, and I was actually saying to my husband, I think we need to-- I think it's a good thing. I think more so for thinking about brain health, learning something new, that hand eye coordination, for sure. I'd love to round out the conversation today, touching on some nutritional pieces. You mentioned protein being very important, but I think the standard American diet is so pro inflammatory, it is hugely problematic for metabolic health. What are some of the nutritional pieces, other than protein, that you think are really important for patients to zero in on? And I would love your take on alcohol as well.
Dr. Vonda Wright: [00:51:55] Okay, I'll give you those things. So, protein, 1 g of high quality protein per ideal pound. High quality means it has sufficient leucine content. Leucine is one of the amino acids you can't make. So, you got to get it from food. And it's critical for muscle building. So, you get a lot of it from animal proteins, from whey protein, less so from plant proteins, although, for those people who choose to only eat plants. Look at a bull. Look how muscular a bull is. Clearly, you can build muscle from plant protein. You just have to eat a lot of it. They spend all day eating plants. So, protein. Number two, and people hate this, people hate this when I tell them to stop eating simple sugar. No white sugar, no added sugar, o white bread, white carbs, simple carbs, those things with high glycemic indexes.
[00:52:51] I'm sorry, including fruits. Fruits should be treated as dessert. You can have fruits, but you should never eat fruit juice, although it's healthy. I don't know why we're giving our children apple juice or it's just 500 calories of sugar. It's cultural because it causes a huge spike. It makes us so inflamed all over. So, when you make the very hard decision to stop eating added sugar and you have to read the back of packages, because even healthy things like Greek yogurt sometimes have 9 g of added sugar. When I did this for the first time, a couple things happened. I did this, I remember distinctly leading up to Christmas when I was 47.
[00:53:33] Stupid time of year to stop eating sugar, but I did. Within a month, a few things happened. Within a few days, I was no longer inflamed. I could feel the difference. It's that rapid. Within about a week, my taste buds stopped craving it. I stopped going to my pantry, opening the door, and wondering why I was there. Well, that is my brain sending me to get my dopamine hit from sugar. That stops after about seven days, if you can withstand it. But what happened? And I didn't even try. I lost 12 pounds because Americans eat 16 pounds of added sugar a month without even knowing it, because it's in everything. So, you just have to be aware, read the packages, eat whole foods, even the whole foods are frozen like frozen vegetables.
[00:54:18] Because sugar is added to everything in our culture, every processed food, it's hard to get away from. So, protein, get rid of simple sugar and simple carbs. I'm not anti-carb. I want you to eat complex carbs and lots of fiber. You just have to be more aware of what you're eating. And then alcohol falls into the nutritional thing. I've never loved it. I was drunk for the first time when I was 38, lying at home on Christmas Eve on my own couch with my friends. But, so I'm not a typical drinker. So, I've never loved it. But I have completely stopped now. And here's why, it's because we know that alcohol is a category 1 carcinogen.
[00:55:05] And as an orthopedic woman, I have five times the breast cancer risk of a normal, a non-orthopedic woman because of the x-rays that I'm exposed to, even with lead that's made for men. So, my upper tail of my breasts are almost never covered. So, this is where orthopedic women get their breast cancer. I don't need any more risk for breast cancer because I'm already at high risk because of my profession, number one. And number two, it's noxious to our brains. We think it helps us relax and fall asleep. Well, if you talk to somebody like Kristen Holmes from WHOOP, you are passed out. But you are not in deep rem sleep. You are not in restorative sleep. You're just passed out. So, for those reasons, I've made the personal decision not to drink. Now it is everybody's decision.
[00:55:54] I get a lot of interesting comments. I posted on it the other day, my decision not to drink. And I haven't drunk for anything for about a year. I have no less fun. My daughter just got married. We had lots and lots of fun without it. I get lots and lots of comments about everybody needs their little vice. I'm not saying don't have fun. I'm just saying consider what it's doing to you and if it's worth it.
Cynthia Thurlow: [00:56:18] That's such an important message and one that's very much in alignment with things that we talk about on the podcast. This has been so enjoyable. I hope you will come back.
Dr. Vonda Wright: [00:56:27] Thank you.
Cynthia Thurlow: [00:56:28] Please let listeners know how to connect with you on social media, how to work with you if they're interested in having an evaluation.
Dr. Vonda Wright: [00:56:34] So, every single day, I am committed. I'm on Instagram. I educate on Instagram. You are welcome to DM me. I still, even though I have almost a million women, I still try to make a point and get there and do as much as I can there. If you want to see me about longevity, about menopause mentoring is what I call it. I make a lot of referrals. I do roadmaps for people, so it's not so confusing. You could DM me about that or I have this special VIP phone number, 407-232-2334 and leave me a message and we'll connect you. And then if you are one of the people who have an orthopedic problem and you need that expertise from me, I am so happy to see you in Orlando, Florida. People do fly in from all over the world and you can just google me and that will come up.
Cynthia Thurlow: [00:57:25] Awesome. Thank you so much for your time.
Dr. Vonda Wright: [00:57:27] Thank you.
Cynthia Thurlow: [00:57:30] If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.
Комментарии