Dr. Vonda Wright Links Daily Muscle Load To 20-Year Health Advantage

Vonda Wright 博士：日常肌肉负荷可带来20年健康优势 坚持抗阻训练与高强度活动度训练可预防严重的机能衰退并维持肌肉结构，将健康寿命延长至63岁以后。 Vonda Wright 博士探讨了如何通过针对性的日常抉择、维持肌肉量以及积极的健康寿命策略，来预防常被误认为是必然衰老的身体机能衰退。她强调35岁至45岁是优化骨密度、心血管健康和瘦肌肉量的关键十年，有助于在63岁左右重大疾病显现之前做好防护。本次对话涵盖了诸多可操作的方案，包括抗阻训练、VO2 max 间歇训练、动态运动以及代谢健康管理，以帮助人们在步入晚年后依然保持独立自理能力。 日常生活方式决定了人体70%至90%的衰老轨迹与健康结局，机能衰退多源于缺乏运动而非生物学必然；普通人的健康寿命通常在63岁左右告终，且多数重大致命疾病平均在62.94岁集中显现。 (8:05) 女性在35至45岁、男性在40至50岁迎来优化肌肉、骨骼与心血管健康的“关键十年”；骨骼肌是重要的人体代谢器官，持续的大重量抗阻训练能为晚年赋予长达20年的功能性力量优势。 (24:51) 跌倒导致的髋部骨折在老年群体中后果极为严重：50%的患者在受伤后无法恢复独立生活能力，并有高达30%的患者在伤后第一年内因继发并发症离世。 (41:18) 为系统性预防久坐致死综合征与衰老损伤，赖特医生提出FACE日常运动法则，整合动态柔韧性（F）、有氧耐力（A）、大重量负重抗阻（C）以及平衡敏捷协调训练（E）。 (48:25)

Orthopedic surgeon Dr. Vonda Wright argues that physical decline is largely an artifact of sedentary living rather than biological destiny, asserting that individuals can maintain physical independence into their 70s and beyond. Through progressive heavy resistance training, impact loading, adequate protein intake, and targeted hormonal management, she contends midlife adults can actively prevent frailty and chronic disease. Redefining Aging and the Midlife Intervention Window (8:05) Dr. Wright asserts that conventional assumptions regarding inevitable physical deterioration stem from observational data—such as the NIH-funded Health ABC study—that captured the effects of chronic inactivity rather than intrinsic biological limits. With up to 70% of the population engaging in minimal intentional daily mobility, typical aging cohorts reflect 'Sedentary Death Syndrome,' a clinical profile encompassing 33 chronic conditions including cardiovascular disease, stroke, and metabolic dysfunction. Because muscle mass and bone mineral density peak near age 30, and the statistical onset of major chronic conditions averages 62.94 years of age, Wright identifies the window between ages 40 and 63 as a critical runway. In her view, course-correcting lifestyle behaviors during one's 40s provides essential leverage to preserve healthspan before pathological decline becomes significantly harder to reverse. Joint Mechanics, Muscle Mass, and Metabolic Recomposition (56:53) Joint pain is not an unavoidable consequence of chronological aging, according to Wright, but is heavily driven by skeletal leverage and excess body weight. Biomechanical lever arms dictate that gaining 1 pound of body weight transmits approximately 9 pounds of mechanical pressure across the knee joint, while holding 1 pound in the hand exerts roughly 10 pounds of force at the shoulder. Consequently, she notes that losing 10% of total body weight substantially unloads joint surfaces and alleviates arthritic symptoms. To safeguard joints and metabolic health, Wright cautions against caloric restriction without resistance exercise. Unassisted dieting causes 25% to 50% of weight loss to come directly from skeletal muscle, the body's primary glucose sink and protective shock absorber. When weight is subsequently regained, up to 80% accumulates as fat. Wright therefore advocates prioritizing body recomposition through heavy resistance training—specifically targeting large lower-body muscle groups—to preserve functional capacity and metabolic rate. Impact Loading, Bone Preservation, and Fall Prevention (83:31) Research by Wright’s PRIMA initiative examining 3,000 masters athletes aged 50 and older demonstrated that high-impact activities such as running and volleyball preserved normal bone T-scores into individuals' mid-80s, rivaling age, biological sex, and genetics as predictors of bone density. Across track and field sprint and distance disciplines, competitive performance dropped by less than 1.2% per year prior to age 70, showing that steep athletic decline is delayed until the mid-70s in active populations. Maintaining structural density and equilibrium is vital to preventing catastrophic falls in older adults. Wright notes that hip fractures require roughly three months of bone healing, during which prolonged immobility leads to rapid decline: 50% of older patients never regain independent living, and 30% die within one year. To counteract this risk, she prescribes the daily 'FACE' protocol: dynamic flexibility drills before workouts with 30-second post-exercise static stretching, aerobic conditioning, carrying heavy loads, and daily equilibrium drills. Hormonal Shifts, Protein Needs, and Frailty Thresholds (97:09) During perimenopause, declining estrogen removes vital anti-inflammatory and anabolic protections, causing what Wright co-termed the 'Musculoskeletal Syndrome of Menopause.' Affecting an estimated 80% of perimenopausal women, this state accelerates osteoclast activity, increases muscle loss to 2% to 3% annually, and promotes severe joint inflammation such as frozen shoulder and arthralgia. Wright recommends evaluating hormone replacement therapy alongside heavy compound resistance training and consuming 1 gram of protein per pound of ideal body weight, emphasizing leucine-rich sources to stimulate muscle protein synthesis. To prevent functional frailty, Wright highlights maintaining cardiorespiratory fitness above the 'frailty line'—defined as a VO2 max of 18 mL/kg/min for men and 16 mL/kg/min for women. Because VO2 max naturally decreases by roughly 10% per decade without conditioning, Wright recommends combining Zone 2 aerobic base work with weekly high-intensity interval sessions (such as 4-minute maximum efforts paired with 4 minutes of recovery) to sustain independent living well into advanced age. While Dr. Wright maintains that functional vitality can be extended into late life, her clinical framework relies heavily on rigorous personal adherence to heavy lifting, impact loading, and dietary discipline, alongside access to medical diagnostics such as DEXA scans and individualized hormone therapy assessments.

骨科运动医学专家 Vonda Wright 博士指出，传统认知中老年阶段的体能衰退与虚弱多由长期缺乏运动导致，而非人类生理的必然宿命。她主张通过大重量力量训练、机械冲击负荷、针对性营养摄入以及更年期激素管理，个体在70岁中叶前完全有能力维持高水平行动力并主动规避功能性衰竭。 衰老认知的重塑与关键干预窗口 (8:05) Wright 博士回顾指出，以往诸如美国国立卫生研究院（NIH）资助的 Health ABC 等大规模人口研究，因样本中高达 70% 的人群缺乏日常主动运动，本质上记录的是长期久坐生活方式导致的病理后果，而非自然的衰老潜力。其研究团队对参加美国全国老年运动会的 3,000 名 50 岁以上资深运动员（PRIMA 研究）的追踪显示，70 岁以前运动员成绩年均下降幅度低于 1.2%，显著的体能下滑通常直到 70 岁中叶才会因生物学规律显现。 与此同时，心血管疾病、脑卒中、2型糖尿病、阿尔茨海默病及癌症等致死性慢病的平均确诊年龄为 62.94 岁，恰逢传统退休阶段。人体骨密度与肌肉量通常在 30 岁达到顶峰，因此 35 至 45 岁是建立健康基准的“关键十年”，而 40 至 63 岁则是纠偏生活方式的核心窗口期。Wright 强调，若等到 63 岁发病后才开始被动应对，扭转身体机能的难度将大幅增加。 骨骼肌的代谢调控与关节生物力学 (56:53) 骨骼肌不仅负责运动，更是全身最大的代谢器官与葡萄糖吸收库，承载着体内绝大多数线粒体。Wright 博士团队与匹兹堡大学的研究证实，骨骼肌收缩能直接刺激长寿蛋白 Klotho 的转录与分泌；在针对两岁老年小鼠的实验中，为期两周、每日两次的跑台运动成功使老化萎缩的肌源性干细胞（卫星细胞）重启分裂并恢复活性。但在减重策略上，单纯依赖节食会导致 25% 至 50% 的减重来自于肌肉分解，一旦饮食恢复，反弹体重的 80% 会转化为脂肪，造成基础代谢与身体成分的恶性循环。 在关节力学方面，关节在活动中需承受 5 至 10 倍于自重的载荷，强壮的肌肉是防止软骨撞击磨损的核心减震器。受长骨杠杆效应影响，体重每增加 1 磅，膝关节承受的机械压力便会放大 9 磅；手部持重 1 磅，肩关节负荷相应增加约 10 磅。研究表明减重 10% 即可显著缓解骨关节炎疼痛。针对久坐导致脊柱核心肌群拉长萎缩的现象，Wright 建议通过深蹲与渐进式超负荷抗阻训练来重建关节支撑体系，而非盲目冲刺极端大重量。 FACE 运动框架与规避机能虚弱红线 (48:25) 针对日常行动力与防跌倒需求，Wright 提出了 FACE 运动架构：F（柔韧性与动态热身，静态拉伸须置于训练后，每个目标肌群保持 30 秒、重复 4 次）；A（有氧耐力，支持心血管代谢）；C（负重训练，利用大重量、低次数建立爆发力与骨密度）；E（平衡与本体感觉，如单腿站立刷牙以训练脚踝敏捷度与核心稳定性）。临床数据显示，老年人发生髋部骨折后，50% 无法恢复伤前的独立生活能力，且有 30% 的患者在骨折后一年内死于继发性并发症。 在心肺机能方面，人体最大摄氧量（VO2 Max）随年龄每十年自然衰减约 10%，而维持生活自理能力的“虚弱红线”阈值分别为男性 18 mL/kg/min、女性 16 mL/kg/min（85 岁人群中约 25% 因机能不达标而失去独立生活能力）。Wright 建议采用两极化有氧方案：将 80% 的心肺训练投入到 2 区心率训练中（每周累计约 3 小时），并每周补充一次冲刺间歇训练（竭尽全力 4 分钟结合 4 分钟恢复，重复 3 次），确保步入高龄后心肺指标仍稳居自理红线之上。 更年期肌骨综合征与骨质重建路径 (97:09) 女性围绝经期出现的雌激素骤降会引发系统性炎症，被 Wright 共同定义为“更年期肌骨综合征”。该综合征影响约 80% 的围绝经期女性（其中 25% 症状严重，40% 的常规影像检查无可见结构损伤）。雌激素受体广泛分布于肌骨组织中，当失去对肿瘤坏死因子（TNF）等炎性因子的抑制后，极易引发全身关节痛、冻结肩、每年 2% 至 3% 的肌肉流失，以及肌卫星细胞池锐减 30% 至 60%。同时，破骨细胞过度活跃打破骨骼更新平衡，导致骨质流失急剧加速；全美亦有约 200 万男性面临骨质疏松威胁。 应对这一转变需要多学科干预。Wright 主张在个体风险评估下接纳激素替代疗法（HRT），以保护骨骼、大脑与心血管。对于骨骼密度的维持与重建，高冲击性运动（如跑步、跳跃、蹦床）产生的机械刺激与年龄、性别一样具有决定性影响。在营养层面，她建议按理想体重每磅摄入 1 克高亮氨酸含量的优质蛋白质（优先选择乳清蛋白或动物源蛋白）以激活 mTOR 通路，同时每日摄入 30 克膳食纤维并严格限制精制单糖，以防范血糖尖峰导致的组织糖基化与慢性炎症。 Wright 博士强调，健康管理的最大心理阻碍在于“时间脱节”，即人们难以将眼前的即时享受与数十年后的身体退化建立直接关联。尽管其以资深运动员为样本的研究证实了人体在高龄阶段依然具备极高的机能保留潜力，但对于患有慢性基础疾病或长期缺乏锻炼的普通大众，大负荷力量训练的安全性边界、个体化的激素治疗评估以及高标准饮食方案的长期依从性，仍需在临床实践中审慎权衡。

## Background 本期内容由知名播客频道《The Diary Of A CEO》（主持人史蒂芬·巴特利特，Steven Bartlett）于2024年7月22日发布在YouTube平台。节目邀请了骨科运动医学外科专家冯达·莱特博士（Dr. Vonda Wright），深入探讨人类是否注定走向衰弱与衰老，并分享了打破衰老宿命、重塑下半生身体机能的终极健康策略。 ## TL;DR 莱特博士结合35年的临床与前沿科研经验，彻底击碎了“断崖式衰老与慢性病不可逆”的世俗神话，指出绝大多数晚年虚弱本质上是长期久坐引发的病态退化，而非生物学必然。她提出以35至45岁为关键转折期，通过大重量抗阻力量训练、敏捷度平衡练习、二区有氧与高强度冲刺（80/20法则），搭配高蛋白抗炎饮食来拉高最大摄氧量和骨骼肌储备。同时，她深度解析了围绝经期雌激素断崖对女性肌肉骨骼系统的剧烈冲击及应对方案，呼吁人们将目标从单纯“减重”转向“身体成分重构”，将患病期极限压缩至生命末期以实现独立有尊严的长寿。 ## Atmosphere & style 整场对话充满力量感、专业严谨且兼具深邃的人文关怀，既有顶尖医学专家的循证剖析与生动道具展示，又有肿瘤病房临终守夜的动人温情叙事。主持人与嘉宾的互动默契而热烈，从探讨衰老“思维病毒”的警醒反思，层层递进到对自我价值感认同与自律公式的心力重塑。观看体验宛如经历一场震撼的心智洗礼，不仅彻底消除了对年老失能的潜意识恐惧，更激发起立刻起而行之、主动投资身体资产的充沛掌控感与生命激情。 ## Bulletin - [32:04](https://www.youtube.com/watch?v=D6wTuogebU8&t=1924s) 肌肉衰减并非衰老的必然宿命，MRI 研究显示 70 岁坚持训练者的肌肉质量与 40 岁运动员几乎无异，人体 70% 至 90% 的衰老轨迹由后天生活方式决定。 - [56:45](https://www.youtube.com/watch?v=D6wTuogebU8&t=3405s) 骨骼力学杠杆效应显示身体每增加 1 磅净重，膝关节需承受高达 9 磅的额外冲击负荷，减重与增肌是缓解退行性关节痛的核心力学手段。 - [01:00:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=3637s) 单纯热量限制节食会导致减重总量的 25% 至 50% 为骨骼肌，且反弹体重中 80% 为脂肪，应将重心转向增加瘦肌肉与降低体脂率的“身体成分重构”。 - [01:52:01](https://www.youtube.com/watch?v=D6wTuogebU8&t=6721s) 每周 2 次 30 秒全力冲刺的高强度间歇刺激，相比传统 HIIT 能多燃烧 40% 的脂肪，并能显著激活长寿蛋白 Klotho 与肌肉卫星干细胞再生。 ## Key takeaways - [02:18](https://www.youtube.com/watch?v=D6wTuogebU8&t=138s) 打破“衰老思维病毒”：传统认知将老龄化等同于失能虚弱，本质上是对久坐病态退化的误判，人类在 75 岁之前无需向衰老妥协生活节奏。 - [08:05](https://www.youtube.com/watch?v=D6wTuogebU8&t=485s) 健康寿命与预期寿命存在近 20 年的断层，全球主要慢性致死疾病的综合加权爆发期集中在 62.94 岁左右，40 岁至 63 岁是不可错过的修正窗口期。 - [11:57](https://www.youtube.com/watch?v=D6wTuogebU8&t=717s) 全人医疗理念（Whole Person Care）：骨科不仅是修补机械关节，更要深度统筹患者术后康复、社会归属、营养摄入与内分泌背景。 - [27:10](https://www.youtube.com/watch?v=D6wTuogebU8&t=1630s) 35 至 45 岁是构筑身体资产的“关键十年”，30 岁达到肌肉与骨量峰值后若保持久坐，机体将陷入断崖式透支衰退。 - [30:34](https://www.youtube.com/watch?v=D6wTuogebU8&t=1834s) 骨骼肌是核心内分泌与代谢器官，负责摄取血液葡萄糖；持续抗阻力量训练能让人享有约 20 年的生理机能跨代领先优势。 - [38:08](https://www.youtube.com/watch?v=D6wTuogebU8&t=2288s) 下肢大肌群力量、爆发力与神经敏捷步频是晚年独立自理的生命线，能有效规避高致残、首年死亡率高达 30% 的致命性髋部骨折。 - [42:28](https://www.youtube.com/watch?v=D6wTuogebU8&t=2548s) 久坐致死综合征与现代坐姿摧毁了躯干核心并诱发 33 种慢病，日常应践行“FACE”训练法则：柔韧性（F）、有氧（A）、负重（C）与平衡（E）。 - [01:07:50](https://www.youtube.com/watch?v=D6wTuogebU8&t=4070s) 精制简单糖会引发成瘾性多巴胺渴求、急性血糖飙升与蛋白质糖化（焦糖化变性），进而诱发全身慢性系统性低度炎症与胰岛素抵抗。 - [01:10:14](https://www.youtube.com/watch?v=D6wTuogebU8&t=4214s) 破解“跨期脱节”心理阻碍：将对几十年后防病的虚无恐惧，转化为大重量训练带来的即时充血紧致与自我价值认同。 - [01:16:04](https://www.youtube.com/watch?v=D6wTuogebU8&t=4564s) 骨骼需要受控的物理机械撞击（Bash Your Bones）才能启动成骨细胞新生，结合维生素 D、镁、钾与足量优质蛋白方可切实逆转骨流失。 - [01:30:03](https://www.youtube.com/watch?v=D6wTuogebU8&t=5403s) 骨骼肌的主动机械收缩能直接触发长寿蛋白 Klotho 的基因转录，并能唤醒衰老肌卫星细胞重新丰满、逆转凋亡程序。 - [01:41:18](https://www.youtube.com/watch?v=D6wTuogebU8&t=6078s) 雌激素是全身关键抗炎剂与合成代谢信号，其断崖式撤退会诱发高发的绝经期肌骨综合征、冻结肩以及“骨质疏松-肌少-肥胖症”三重打击。 - [01:50:41](https://www.youtube.com/watch?v=D6wTuogebU8&t=6641s) 女性必须摒弃粉色轻哑铃，转向大重量复合抗阻训练，结合每磅理想体重 1 克高亮氨酸优质蛋白质以高效刺激 mTOR 途径合成肌肉。 - [01:57:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=7057s) 维持最大摄氧量（VO2 Max）是远离生活无法自理“虚弱线”的终极防线，年轻与中年时期的有氧心肺储备决定了晚年生活质量的下限。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=D6wTuogebU8&t=0s) 衰老真相与肌肉骨骼的力量：片头精华 节目开篇抛出了一个颠覆常规认知的震撼结论：仅仅坚持30秒的某种特定运动，其燃烧脂肪的效率甚至能比高强度间歇训练（HIIT）高出40%。作为骨科运动医学外科医生和衰老运动机能领域的先驱研究者，冯达·莱特博士（Dr. Vonda Wright）直言，人类在75岁之前完全没有任何放慢生活节奏、向衰老妥协的借口。节目展示了极具冲击力的核磁共振（MRI）对比切片：一位40岁运动员的肌肉切片展现出致密且优美的肌肉架构；而一个长期久坐办公、35年缺乏运动的人，其肌肉严重萎缩并被厚厚的脂肪浸润；令人惊叹的是，另一张属于一位74岁坚持每周进行4到5次机能训练的老人切片，其肌肉质量和结构几乎与年轻运动员无异。这意味着，一个坚持规律举重训练的80岁老人，在功能性力量上完全可以媲美甚至超越一个不运动的60岁普通人。 针对大众普遍担忧的“年龄越大关节越痛”的宿命论，莱特博士给出了坚决的否定：关节疼痛并非衰老的必然副产物，体重才是诱发疼痛的关键杠杆。微小的体重波动会对关节造成成倍的机械载荷冲击——如果在日常生活中增加1磅的身体重量，由于生物力学杠杆原理的作用，关节实际承受的压力相当于一块沉重砖块的重量。同理，体重看似仅增加了10磅，关节软骨所承受的机械压力激增幅度却相当于100磅。为了打破这种机能退化的恶性循环，莱特博士指出，每个人每天都应该为机能活动投资，并总结了四项不可或缺的核心日常训练法则。 ```mermaid flowchart TD accTitle: 体重增加对关节压力的生物力学放大效应 accDescr: 流程图展示微小体重增加通过身体机械杠杆机制被放大为对关节的巨大压力 subgraph Input["体重变化"] A["身体净增重 1 磅"] B["身体净增重 10 磅"] end subgraph Mechanism["关节力学放大"] C["骨骼与关节机械杠杆效应"] end subgraph Impact["关节实际承压"] D["局部关节承压相当于多块重砖"] E["相当于关节承受 100 磅新增压力"] end A --> C B --> C C --> D C --> E ``` ### [01:27](https://www.youtube.com/watch?v=D6wTuogebU8&t=87s) 主持人致谢与频道订阅承诺 在正式开启深度对话之前，主持人史蒂芬·巴特利特（Steven Bartlett）插播了一段真诚的30秒幕后独白。他首先由衷感谢每周准时收听的全球听众，坦言能够将这档播客推向如今的规模，是团队过去做梦也未曾预料到的成就。但与此同时，他强调团队依然抱着刚起步的心态在全力以赴。 史蒂芬提到，目前常态化收看节目的观众中只有24%点击了订阅按钮，他借此诚恳呼吁更多观众加入订阅行列，并作出承诺：团队将倾尽全力保证内容水准，继续邀请观众最期待的重磅嘉宾，坚守节目的深度与质感，不负大家的信任与陪伴。 ### [02:18](https://www.youtube.com/watch?v=D6wTuogebU8&t=138s) 终身使命：打破“断崖式衰老”的世俗神话 莱特博士投身医学领域、照护病患并从事前沿研究已有近35年之久。当被问及每天清晨从床上爬起、满怀激情奔向手术台与写字台的核心动力时，她毫不犹豫地表示，自己一生的座右铭就是要“彻底改变这个国家乃至整个世界对衰老的认知”。在她的职业生涯初期，社会思潮普遍充斥着一种悲观宿命论：衰老被定义为一条不可逆的下坡路，人们从充满生机的青年期坠落至软弱无力的迟暮之年，甚至被迫在生命最后的20年里频繁奔波于诊所，过着毫无生活质量的苟延残喘日子。 莱特博士从一开始就对这种荒谬的衰老叙事持怀疑态度。这种反叛的信念一方面源于童年记忆——在20世纪70年代，她的父亲经常带她参加长跑比赛，将她安顿在起跑线旁并说“在这等我20分钟”，在那里，她亲眼目睹了五六十岁的人依然在跑道上拼搏竞速并收获全场欢呼；另一方面，她的职业生涯始于一名肿瘤科护士，每天目睹患者为生存奋力抗争，更让她深信人类的生命绝不应沦落于被动衰退的宿命。 随着自身科研的深入，莱特博士揭露了一个被医学界忽视的真相：以往断定人类老去必然虚弱的理论，大多建立在传统的大样本人群研究之上，例如美国国立卫生研究院（NIH）资助的著名“健康ABC研究”（Health ABC Study）。这类研究追踪了大量70岁群体的衰老演变，然而残酷的社会现实是，普通人群中高达70%的人每天连一步额外的机能运动都懒得做。也就是说，传统医学此前记录并归纳的所谓“衰老规律”，本质上不过是“长期久坐生活方式导致的病态退化”。为此，莱特博士与团队展开了针对终身积极运动人群的原创性开创研究，用无可辩驳的数据证实，只要持续投入活动，人类完全可以在高龄阶段继续保有健康、活力与充沛的生命乐趣。 - 传统衰老认知将晚年曲解为漫长滑向衰弱的过程，甚至预设晚年20年要在频繁看病中度过。 - 人群健康追踪研究（如 Health ABC Study）的样本存在巨大偏差，其数据本质上反映了长期久坐不动人群的退化，而非真正的生物学衰老极限。 - 莱特博士历经35年医学实践与20年骨科手术历练，终于迎来大众从被动的“疾病救治”向主动的“机能预防”转变的觉醒时刻。 ### [05:50](https://www.youtube.com/watch?v=D6wTuogebU8&t=350s) 衰老思维病毒：预期寿命与健康寿命的鸿沟 史蒂芬深有感触地指出，许多人精神上都感染了一种“衰老思维病毒”（Mind Virus），先入为主地认为人到了一定年龄就必须向衰退举白旗，而正是这种信念层面的认输，反过来诱发了身体的停滞、放弃运动与最终的衰弱。莱特博士对此高度共鸣，她强调大脑与身体之间存在极强的双向反馈连接，大脑会无条件相信你灌输给它的暗示。如果你坚信63岁是身体机能从巅峰滑向断崖式衰败的节点，生理机能便会顺应这种消极预期加速垮掉。 ```mermaid flowchart LR accTitle: 寿命与健康寿命之间的断层差距 accDescr: 对比人类平均预期寿命与健康寿命之间的鸿沟，突出晚年近二十年的患病期 subgraph UK["英国数据 (UK)"] A1["健康寿命: ~63 岁"] --> B1["漫长患病与机能受损期 (~18年)"] --> C1["平均预期寿命: 81 岁"] end subgraph USA["美国数据 (USA)"] A2["健康寿命: ~63 岁"] --> B2["漫长患病与机能受损期 (~14.6年)"] --> C2["平均预期寿命: 77.6 岁"] end ``` 莱特博士进一步厘清了“预期寿命”（Lifespan）与“健康寿命”（Healthspan）之间令人痛心的割裂现状： - **英国现状**：新生儿平均预期寿命约为81岁。 - **美国现状**：出生预期寿命仅为77.6岁。 - **健康寿命的普遍瓶颈**：无论英美，代表无严重慢性病、生活能够自理的高质量健康寿命，平均仅能维持在63岁左右。 这意味着现代人平均要在疾病缠身与失能痛苦中度过近20年。然而，这一残酷差距恰恰揭示了巨大的可塑空间：人类并非在63岁走向生命的终点，在这长达近20年的跑道上，衰老轨迹完全可以被重塑。莱特博士指出，科学研究证实，人体70%至90%的健康状态与衰老进程取决于后天的生活方式选择，而非先天继承的基因组合。她幽默地调侃道，自己的母亲非常庆幸她不再把身体的小毛病怪罪到遗传头上，每个人都拥有打破基因宿命、活出超预期健康态的掌控权。 ### [08:05](https://www.youtube.com/watch?v=D6wTuogebU8&t=485s) 63岁疾病爆发魔咒与40岁的黄金转折点 史蒂芬分享了他通过大型语言模型ChatGPT进行的一项统计推演：他拉取了全球致死率最高的慢性疾病清单，包括心脏病、肺癌、慢性阻塞性肺疾病（COPD）、中风、下呼吸道感染、阿尔茨海默病、2型糖尿病、结直肠癌、乳腺癌以及前列腺癌，并按照各项疾病的死亡权重与平均发病年龄进行加权运算。最终计算得出的高危疾病爆发综合平均年龄恰恰是 **62.94岁**——一个精确印证了健康寿命断层的数字，也是绝大多数人即将遭遇致命疾病伏击的危险关口。 莱特博士一针见血地指出，63岁并非疾病突然“降临”的节点，而仅仅是隐匿发展数十年的病理发生“显性爆发”的时刻。许多人在就医问诊时信誓旦旦地自称没有任何健康问题，往往仅仅是因为他们长年未做过深度检查；还有许多人虽然已经出现隐匿指标异常，但在恶化到每周必须跑三次医院之前往往选择忽视。最令人扼腕叹息的是，63岁恰恰是社会普遍的法定退休年龄节点——正当人们以为终于卸下工作重担、准备安享憧憬的生活时，却突然发现自己被未曾提前维护的衰败身体彻底套牢。 面对这种严峻现实，莱特博士强调必须将改变思维病毒的行动提前。她指出，**40岁是人生中最具里程碑意义的黄金十年**，也是生理与心理上必须真正“成为成年人”（Adulting）的关键时刻。步入40岁，意味着必须收起侥幸心理，严肃打理自己的身体健康资产；如果此前因疲于奔命而忽略了肉体机能的信号，那么40岁就是人生最后且最宝贵的逆转窗口。 ### [10:09](https://www.youtube.com/watch?v=D6wTuogebU8&t=609s) 把握40至63岁的健康修正黄金窗口期 在人生的健康轨迹中，40岁到63岁之间存在着一个极为关键的“路线修正”（course correct）窗口。Dr. Vonda Wright 指出，许多人在前半生忙于抚养子女或打拼事业，往往无暇顾及自身的细微衰老迹象；然而，若等到63岁身体亮起红灯时才幡然醒悟并开始关注健康，扭转衰退局面的难度将会呈指数级上升。这也是她每天清晨醒来投身这项事业的核心动力——彻底改变这个国家乃至全世界对衰老的认知与应对方式。 她的使命不仅限于关照处于中年时期的同龄群体，更迫切希望向“千禧一代”的孩子、侄子侄女等年轻后辈大声疾呼。她强调，年轻一代其实对自己的长远健康拥有巨大的掌控权，前提是他们必须尽早“抬起头来，多加留意”，在不可逆的慢性损耗发生之前建立起主动维护身体机能的意识。 ### [10:50](https://www.youtube.com/watch?v=D6wTuogebU8&t=650s) 从癌症护士到骨科外科医生的职业蜕变 回顾自身的求学历程与职业转向，Dr. Vonda Wright 走过了一条非同寻常且极为艰辛的道路。她最初在惠顿学院（Wheaton College）取得了生物学学士学位。当时正值全美护士严重短缺，拉什大学（Rush University）向优秀本科毕业生抛出橄榄枝，承诺在三年内为他们提供护理学学士与硕士的双学位培训。她抓住了这一机遇，毕业后投身于肿瘤护理一线，照顾身患绝症的癌症患者，并与当时的领头专家共同管理拉什癌症研究所（Rush Cancer Institute）。 ```mermaid flowchart LR accTitle: 冯达·赖特医生的职业演变历程 accDescr: 展示从生物学学士、癌症专科护士到芝加哥大学医学院及11年骨科外科训练的完整职业轨迹。 subgraph Nursing ["护理与肿瘤医学阶段"] A["惠顿学院<br/>生物学学士"] --> B["拉什大学<br/>护理学本硕连读 (3年)"] B --> C["拉什癌症研究所<br/>肿瘤科护士 / 管理运营"] end subgraph Medical ["骨科外科医生阶段 (28岁转型)"] C --> D["芝加哥大学医学院<br/>医学博士 (4年)"] D --> E["骨科住院医规范化培训<br/>(6年)"] E --> F["运动医学专科研修<br/>(1年 Fellowship)"] F --> G["骨科运动医学外科专家"] end ``` 到了28岁，Dr. Wright 经历了一系列深刻的内心抉择。尽管她渴望开展突破性的医学科研，但内心深处最强烈的召唤依然是亲手照护病患——“那是深植于我灵魂与核心的本能”。于是，她在28岁毅然重新考入芝加哥大学医学院。更具挑战性的是，她选择了外科领域中最漫长的一条荆棘之路——骨科运动医学。在4年医学院毕业后，她又完成了长达6年的骨科住院医师培训以及为期1年的专科进修（Fellowship），总计耗费了11年的高强度训练，才终于蜕变成为一名顶尖的外科专家。 ### [11:57](https://www.youtube.com/watch?v=D6wTuogebU8&t=717s) 何为骨科手术：不仅是修补关节，更是全人照护 面对“如何向一个10岁孩子解释骨科手术”的问题，Dr. Wright 概括道：骨科手术本质上是对人类“肌肉骨骼系统”（musculoskeletal system）的终身照护。这一系统涵盖了骨骼、肌腱、韧带、肌肉、脂肪组织，以及从脊柱贯穿到肩、髋、膝的全身各类关节。骨科涵盖了从骨肿瘤切除到各个精细亚专科的庞大领域，包括手外科、足踝外科以及她所深耕的运动医学。 作为一名运动医学外科专家，Dr. Wright 精通肩关节、髋关节和膝关节的关节镜微创手术（arthroscopy）。她形象地描述道，自己的核心工作就是“通过极其微小的孔隙，在人体内部完成极其复杂的宏大手术”，帮助各年龄段、不同竞技水平的运动员和运动活跃人群重获机能。然而，她认为自己真正独特之处在于将关照延伸到了无影灯之外的手术室外部。与传统以流程和手术刀为绝对核心的操作型骨科医生不同，她坚持践行“全人照护”（whole person care），而这一根植于人性深处的理念，正是源于她23岁时在病床前陪伴癌症患者生死搏斗的深刻烙印。 ### [13:20](https://www.youtube.com/watch?v=D6wTuogebU8&t=800s) 全人诊疗的实践：从重伤运动员到更年期女性 在全人照护的理念下，治疗永远不只是一场纯粹的技术操作，而是对患者生理、心理与社会支持系统的全方位托举。Dr. Wright 列举了临床中的两类典型案例： - **遭遇毁灭性伤病的19岁运动员**：一名终身未受过伤的年轻足球运动员，因遭遇飞铲滑铲导致膝盖重创（前交叉韧带与半月板撕裂）。由于全家恰好搬迁到新城市，他错过了黄金就诊时间，数周后来到诊室时膝盖已完全失去功能。男孩陷入极度恐慌，担心职业生涯就此终结；而初来乍到的家庭在这个城市毫无社交支持系统。 - **技术与营养支持**：Dr. Wright 不仅为他规划关节镜手术与术前康复，还深入追问其日常蛋白质摄入量，确保身体处于最佳愈合状态。 - **心理与社会网络托举**：身为多名孩子的母亲，她深深共情那位无助的母亲，主动为其调动资源、构建支持网络。她指出，这种对待普通少年的方式，正是顶级团队照顾职业运动员的黄金标准——“从清晨醒来到夜晚入睡，绝不遗漏患者及其家庭的任何一项需求”。 - **饱受肩周炎折磨的中年中期女性**：中年女性常因“冻结肩”（frozen shoulder，肩关节发炎僵硬）前来就医，许多人无助地哭诉“我觉得自己正在分崩离析，甚至觉得自己快疯了，因为我根本没撞伤过肩膀”。 - **洞悉更年期根源**：Dr. Wright 绝不会机械地开出消炎药或安排局部治疗，而是直接探问她们的睡眠质量、潮热和夜间盗汗情况。她清楚地意识到，肩部炎症的元凶往往是更年期雌激素骤降所引发的全身性无菌炎症反应。把对方当成一位经历内分泌巨大动荡的中年女性来医治，而非仅仅看作“一只报废的肩膀”，才是全人医学的真谛。 ### [16:53](https://www.youtube.com/watch?v=D6wTuogebU8&t=1013s) 极致同理心的源头：肿瘤病房里的婚礼与守夜 当被问及身上那份直抵人心的强大同理心从何而来时，Dr. Wright 动容地回忆起22至28岁那段做癌症护士的峥嵘岁月。在20世纪90年代，医院实行“责任制原发护理”（primary nursing）模式，同一位患者每次住院化疗，都由同一名专属护士负责全程照料。在那长达半年的周期里，年仅23岁、世界观正处于形成阶段的她，夜复一夜地在漆黑的深夜里为挣扎在生死边缘的患者推注化疗药物。 为了重寻正常生活的尊严，病人们常常在半夜一边打着化疗针，一边守着电视屏幕疯狂电视购物。许多人最终战胜了病魔，康复出院并逐渐淡忘了医护的名字；然而，也有许多生命永远留在了病房里。 Dr. Wright 讲述了一段令她终生难忘的临终陪伴故事： 一位与病魔抗争了整整6个月的女患者生命走向尾声。那是一个由Dr. Wright独自值守的漫长通宵，病房里只有病床上方投下的一束微光。患者呼吸微弱且极度困难（濒死叹息样呼吸，agonal breathing），但Dr. Wright凭经验感知到，这位病人一直在凭借惊人的意志力死死撑着一口气，等待着家人的到来。 破晓时分，晨光穿透芝加哥医院走廊尽头那扇面向密歇根湖的大窗，点亮了整层楼面。早晨7点整，电梯发出了清脆的“叮”声。Dr. Wright 走出病房迎上前去，眼前的场景让她瞬间震撼：平时总是热闹相随的一大家子整整齐齐地走出了电梯，而这一次截然不同——病人的亲妹妹身披洁白圣洁的婚纱，其他所有家庭成员全部身着笔挺的正式礼服与燕尾服。因为妹妹原定于当天举行婚礼，为了让弥留之际的姐姐亲眼见证自己出嫁的模样，全家人在奔赴教堂之前，选择将婚礼的第一站搬到了这间最后的病房…… ### [20:29](https://www.youtube.com/watch?v=D6wTuogebU8&t=1229s) 癌症病房里的顿悟：全人关怀与对死亡的重新审视 23岁那年作为肿瘤科护士的经历，彻底重塑了冯达·赖特医生（Dr. Vonda Wright）对生命与人性的看法。当时她站在病房门口，一侧是生命垂危、自知时日无多的女性患者，另一侧是正快步走向病房的家人——新娘身着洁白的婚纱，专程赶在婚礼前来见姐姐最后一面。两个截然相反的生命时刻在门廊交汇：一个人的生命旅程正走向终点，而另一个人的崭新人生才刚刚起步。那位奄奄一息的姐姐竭尽全力坚持着，只为等待家人赶来，共度彼此之间最后的温情时刻。赖特医生坦言，在23岁的年纪目睹这样的生离死别，生命中最重要的事情被“深深烙印在心底”： > “史蒂文，你要是来我家，我根本不在乎窗帘长什么样，也懒得去买红底高跟鞋——哪怕我完全买得起。因为在23岁时，那种生死考验让我明白，人本身才是唯一值得为之奋斗、值得去拯救的存在。” 这段经历直接铸就了她日后成为骨科与运动医学医生的行医哲学。在她看来，运动医学的技术难度远不及肿瘤护理那般残酷，但也正因如此，她不会把手术单纯当成“机械操作”。以她前一周刚给一位19岁年轻人做的新型前交叉韧带（ACL）重建手术为例，许多医生的工作在手术室拧紧最后一颗螺钉时就宣告结束，但赖特医生认为这只是起点。她关心的不仅是膝盖的生物力学结构，更关注这个年轻人如何在未来6到9个月中康复并重拾生活理想；如何让他不被自己热爱的运动和圈子抛弃；如何帮他找到新的归属——因为运动不仅是个人的竞技，更是一个人赖以生存的社交环境。 面对史蒂文关于“如何看待死亡”的提问，赖特医生给出了极其豁达而坚定的回答： * **死亡不可避免，但抵达的方式可以改写**：所有人终有一死，无法逃避；但衰老恶化的速度、走向终点的姿态以及对自我一生的感受，完全掌握在自己手中。 * **死亡并不总是敌人**：在部分绝症患者或骨科遭遇的极端创伤抢救中，死亡有时反而是一种慈悲与解脱，完全能够以极具尊严的方式进行。 * **长寿悖论与孤独担忧**：史蒂文提到身边一些选择丁克或没有兄弟姐妹的朋友，最恐惧的往往不是死亡本身，而是年老时孤苦伶仃地死去。赖特医生风趣地回应道，追求长寿确实伴随着这样的难题——如果活得太久，身边的挚爱与晚辈都已先走一步，难道到时只能花钱雇邻家女孩推自己去看医生？这不仅关乎医学，也需要及早做出人生规划。 --- ### [24:51](https://www.youtube.com/watch?v=D6wTuogebU8&t=1491s) 健康寿命的起点：从童年线粒体到父母的榜样力量 当话题转向如何延长“健康寿命”（Healthspan）以及这一过程究竟应从何处起步时，赖特医生的答案出人意料：健康寿命的真正起点，其实是父母抚养孩子的方式。 赖特医生指出，自己38岁才拥有第一部手机，而现代儿童由于安全担忧和电子产品的普及，早已失去了“出门玩到吃晚饭才回家”的童年生活方式。从代谢健康的角度来看，这是极其令人担忧的： * **童年活动决定线粒体储备**：儿童早期的运动量直接预先设定了其体内“能量工厂”——线粒体（Mitochondria）的总量与代谢效能。如果孩子在最渴望奔跑的前十年里一直坐着不动，对未来的代谢健康会造成深远损害。 * **身教胜于言传**：面对许多家长抱怨孩子挑食或不爱动，作为抚养了6个孩子的重组家庭母亲，赖特医生强调孩子是通过“眼睛看”来学习的。在她的家庭中，孩子们从小就看着大人用泡沫轴滚压放松，跟着全家人一起吃蔬菜，“他们学会的是我们所展示的生活”。 虽然有人主张健康管理甚至应追溯至宫内孕期，但对于已经成年的个体而言，赖特医生提出了一个极其明确的时间节点：最迟不能晚于30多岁中叶，其中**35岁至45岁之间（以40岁为核心）被称为“关键十年”**（The Critical Decade）。 ```mermaid flowchart TD accTitle: 生命周期健康资产积累路径 accDescr: 展示从童年线粒体储备到关键十年的健康寿命积累路径 subgraph Phase1 ["童年奠基期 (0-10岁)"] A["户外玩耍与规律活动"] --> B["建立充足线粒体储备"] C["家庭饮食与习惯榜样"] --> D["建立基础代谢健康"] end subgraph Phase2 ["身体资产峰值 (约30岁)"] B & D --> E["骨密度达到峰值"] B & D --> F["肌肉质量达到峰值"] end subgraph Phase3 ["关键十年 (35-45岁)"] E & F --> G{"是否持续投资运动与健康？"} G -- "久坐不动" --> H["每年断崖式衰退 (断崖曲线)"] G -- "主动干预与监测" --> I["平缓健康寿命 (压缩患病期)"] end ``` --- ### [27:10](https://www.youtube.com/watch?v=D6wTuogebU8&t=1630s) 35至45岁“关键十年”：30岁生理峰值与身体资产投资 当赖特医生指出“肌肉与骨骼质量通常在30岁左右就达到顶峰”时，刚满30岁的史蒂文感到十分惊讶与不解。赖特医生明确解释，肌肉生理学界普遍认为： > “如果你选择在余生保持久坐不动，那么你在30岁时就已经耗尽了肌肉与骨骼生长的巅峰红利，之后的一生都只是在坐吃山空、持续消耗。” * **久坐人口的危机**：现实中高达70%的人口处于久坐状态，从未对骨骼与肌肉健康进行再投资。 * **建立健康基准线（Quantified Self）**：赖特医生呼吁，无论此前是否关注健康，步入35至45岁这一关键区间都必须开始重视身体数据。这包括获取第一次全面的基准血液检测、首次深度体检和早筛检查。 * **男性激素储备基准**：她特别建议年轻男性尽早测定自身健康状态下的睾酮水平。当未来步入中老年需要进行睾酮替代治疗时，医生才能有据可循地将其恢复到年轻时的健康基准线，而非凭空猜测范围。 * **性别窗口期的差异**：对男性而言，40至50岁是重新掌控身体力量的黄金十年；而对女性来说，35至45岁是至关重要的防御窗口，必须在雌激素等激素断崖式“离场”（走向更年期）之前，筑牢骨骼与肌肉屏障。 --- ### [29:20](https://www.youtube.com/watch?v=D6wTuogebU8&t=1760s) 肌肉曲线与断崖式衰老：压缩发病期的健康法则 史蒂文在屏幕上展示了一张肌肉衰退曲线图（图表1），图表显示人体机能在30岁登顶后，便呈现出一条近乎令人绝望的急速下滑直线。赖特医生对这张图表进行了深度解读与修正。 如果不进行主动的健康投资，人体的衰老轨迹确实如曲线所示这般残酷： * **最大摄氧量（VO2 Max）与心血管机能**：每增长10岁，机能就自然下降约10%。 * **肌肉与骨骼损耗**：随着活动量减少，肌肉萎缩与骨量流失逐年加剧，导致晚年出现漫长而痛苦的失能期。 然而，赖特医生及其团队的研究证实，**人类完全有能力将这条急转直下的衰退曲线“拉平”**。通过每天对运动能力和身体机能的主动投资，我们可以维持极高水平的行动力与健康寿命，将疾病与失能极度压缩至生命的最末端，实现“在熟睡中毫无痛苦、迅速安详地告别世界”（"Zoop, done"），而非经历长达数十年的病痛折磨。要打破这种宿命般的衰退，核心就在于将每一次运动与保养都视作对生命资产的持续重投。 ### [30:34](https://www.youtube.com/watch?v=D6wTuogebU8&t=1834s) 什么是瘦肌肉组织：骨骼肌的代谢与运动机能 谈话从一个生动的比喻切入：如果拥有一辆经过精密调校的一级方程式（F1）赛车，跑完一场大赛后便再也不去维护和投资，它很快就会报废；人体就像一台复杂的机器，同样需要持续的维护与投资。当被问及“瘦肌肉组织”（Lean muscle mass）的真正含义时，沃恩达·赖特医生（Dr. Vonda Wright）澄清说，许多人会困惑瘦肌肉是否对应着“肥肉型肌肉”，而实际上医学上谈论的是人体的骨骼肌。人体内共有三类肌肉：第一类是构成内脏和平滑肌组织的平滑肌，负责推动肠道蠕动；第二类是心脏的心肌，它拥有独立的电生理节律，自主持续跳动；第三类则是附着在骨骼上的横纹骨骼肌。 人类体内拥有整整 650 块骨骼肌，每一次关节的屈曲与伸展都由它们主导。赖特医生强调，骨骼肌的意义绝非仅限于在健身房镜子前展示块头或者负责日常躯体位移，它更是一个高度活跃的内分泌与代谢器官。肌肉能够分泌调控体内多种生理进程的激素，同时也是线粒体最为密集的场所。作为细胞的“动力工厂”，线粒体从血液中摄取葡萄糖并将其转化为能量，因此健康的骨骼肌对于调节血糖和全身新陈代谢具有决定性的保护作用。 - **人体三大肌肉类型**：平滑肌（消化道与内脏蠕动）、心肌（自发节律性泵血）、骨骼肌（650块，负责运动与姿势）。 - **代谢核心**：骨骼肌是人体消耗葡萄糖、维持胰岛素敏感性和产生内分泌信号分子的核心场所。 --- ### [32:04](https://www.youtube.com/watch?v=D6wTuogebU8&t=1924s) 震撼医学界的核磁共振研究：肌肉衰减并非衰老的宿命 赖特医生分享了她一项在互联网上引起巨大轰动的标志性研究。在此之前，美国国家卫生研究院（NIH）资助的“健康 ABC 研究”（Health ABC Study）通过跟踪 70 岁人群长达十年，利用 CT 扫描观察到随着年龄增长，肌肉量不可避免地缩水，脂肪像雪花肉一样侵入肌肉纤维内部。赖特医生作为一名每天接触高龄运动达人的骨科运动医学专家，断然拒绝接受这种“衰老必然导致肌肉萎缩和脂肪化”的宿命论。她认为，传统研究记录的其实是“久坐不动的生活方式在数十年来产生的后果”，而非衰老本身的自然生物学过程。 为了验证这一假设，赖特医生招募了一批 40 岁至 85 岁的资深业余运动员（Masters athletes），利用核磁共振（MRI）对他们的大腿中段进行高精度横截面扫描，并与久坐不动的同龄人进行对比。屏幕上呈现的三幅横切面图像形成了极其强烈的视觉震撼： ```mermaid flowchart TD accTitle: 三组人群大腿横截面MRI对比 accDescr: 对比40岁运动员、74岁久坐老人与70岁铁人三项运动员的大腿肌肉形态与脂肪分布。 subgraph Young["40岁 业余运动员"] A["饱满的股四头肌与腘绳肌<br/>皮下脂肪极薄<br/>无肌内脂肪浸润<br/>（如纯瘦牛排 Flank Steak）"] end subgraph Sedentary["74岁 久坐对照组"] B["肌肉架构严重萎缩模糊<br/>厚厚的环形皮下脂肪外皮<br/>肌束内严重脂肪浸润<br/>（肌少性肥胖 Sarcobesity / 如神户牛肉）"] end subgraph Master["70岁 铁人三项运动员"] C["肌肉形态与40岁近乎一致<br/>肌纤维紧实无网状脂肪<br/>皮下脂肪极少<br/>（功能力量媲美年轻人）"] end Young -. "30余年缺乏运动".-> Sedentary Young -. "每周4至5次规律投入".-> Master ``` 第一幅图是 40 岁业余长跑或铁三选手的横截面，股四头肌和腘绳肌肌肉结构清晰饱满，骨皮质坚硬，外周脂肪极薄，肌纤维内部在显微镜和专业算法下几乎没有脂肪浸润，“就像一块没有任何大理石花纹的上等侧腹牛排（Flank steak）”。第二幅图是一位 74 岁久坐老人的切片，肌肉轮廓模糊辨识不清，内部被大理石花纹般致密的脂肪严重浸润，“就像一块高脂肪的神户牛肉”，外围包裹着厚厚的皮下脂肪层，这是典型的“肌少性肥胖”（Sarcobesity，即肌肉减少症与肥胖症并存）。而令人惊叹的是第三幅图——一位 70 岁的业余铁人三项运动员，其大腿横截面与 40 岁的运动员几乎一模一样，保持着紧密的肌肉组织和极低的脂肪比例。 - **肌肉力量的跨代优势**：研究表明，持续进行抗阻力量训练可以带来约 20 年的生理机能领先优势；一位坚持举重的 80 岁老人，其肌肉功能和力量足以媲美一名 60 岁不运动的成年人。 - **实验人群属性**：入组的运动员并非职业选手，而是像普通大众一样每周自主抽出 4 到 5 天时间进行规律运动的普通业余爱好者。 - **网络反响**：该对比图发表后迅速席卷社交媒体，成为健康老龄化领域最具说服力的图像证明，彻底打破了“衰老即虚弱”的既有认知。 --- ### [36:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=2197s) 身体对良性压力的永恒响应：没有无法逆转的起点 面对这两张近乎重合的 40 岁与 70 岁运动者核磁共振图，主持人史蒂芬（Steven）深感震撼，甚至直言 70 岁老人的肌肉形态在某些细节上比 40 岁的人还要紧实。史蒂芬感慨自己以往一直认为身体和肌肉的机能衰退（衰老细胞积聚与肌少症）是注定的生物学铁律，而这组数据无可辩驳地证明了人体的可塑性。 赖特医生对此做出了极具力量的总结：“在你的整个人生中，无论处于哪个年龄段、哪个节点，你的身体都永远不会停止对你所施加的良性压力（Positive stress）做出适应性回应。”衰老并不意味着机体不可避免地下滑，真正的决定因素在于每天的生活方式投资。机体无法像银行账户一样把年轻时的健康“打包存起来”供晚年挥霍，它依赖于日复一日的实际行动。史蒂芬坦言这一认知彻底颠覆了他的观念，但也引出了现实问题：普通人该如何具体规划自己的运动方案？出于对跑步伤膝盖的担忧，他长期专注于上半身力量训练，他急切地想知道这种健身策略在长寿视角下是否合理。 > “在你的整个人生中，无论处于哪个年龄段、哪个节点，你的身体都永远不会停止对你所施加的良性压力做出响应。” > —— 沃恩达·赖特医生 --- ### [38:08](https://www.youtube.com/watch?v=D6wTuogebU8&t=2288s) 决定晚年独立生活的关键：下肢力量、爆发力与步频敏捷度 赖特医生对史蒂芬专注于上半身力量的训练习惯给出了坦诚而专业的修正建议。她肯定了锻炼出粗壮手臂、能在飞机行李架上轻松托举箱子确实很酷，但如果放眼到 97 岁时的生存状态，真正决定一个人能否独立生活、尊严终老的核心能力是“维持身体直立不倒”。到了晚年，能够随心所欲地上街行走、自如下楼梯、独立驾驶汽车，完全取决于下半身的强健程度。人体最大、最有力的肌群全都位于肚脐以下——臀大肌、股四头肌、腘绳肌和小腿肌群。 赖特医生不仅强调下肢训练的重要性，还进一步剖析了举重模式的差异： | 训练目标 | 动作模式 | 生理机制与长寿意义 | |:--- |:--- |:--- | | **肌肥大（Hypertrophy）** | 较轻重量 + 较多重复次数（High reps, lighter weights） | 专注于增大肌肉横截面积与围度，改善体态外观 | | **力量与爆发力（Power & Strength）** | **大重量 + 较少重复次数（Fewer reps, heavy weights）** | 激活高阈值运动单位，构筑晚年对抗虚弱、维持行动力的核心防线 | 除了下肢抗阻力量，赖特医生指出了老年人丧失独立性的另一大杀手：**平衡能力衰退引发的跌倒**。老年人一旦发生跌倒，哪怕骨质再致密，也极易造成严重骨折甚至致命打击。因此，她在自己的运动表现医学中心引入了极具前瞻性的训练方案——聘请通常指导顶级第一级别（Division 1）大学田径选手的速度与敏捷性教练，专门为中年及以上人群量身打造“步频（Foot speed）与敏捷平衡训练”。 赖特医生风趣地举了自己的例子：在办公室里，她常常把红色的工作包随手放在办公桌旁，起身太急时脚下很容易被包带绊到；正是因为她日常接受了敏捷度与脚步反应速度的专门训练，大脑与神经肌肉能在失衡瞬间迅速做出反应，让她在绊倒前直接轻巧地单脚跳过障碍化险为夷。如果缺少这种神经肌肉协调与步速反应的日常再训练，哪怕一次看似平常的绊脚，都可能演变成改变晚年命运的严重事故。 - **长寿训练法则一**：必须把同等甚至更多的精力倾注在下肢大肌群（臀、大腿、小腿）的负重训练上。 - **长寿训练法则二**：追求真正的大重量爆发力，打破“老年人只能做轻量运动”的偏见，预防卧床虚弱。 - **长寿训练法则三**：将神经平衡系统、步频反应与敏捷度训练纳入日常，从根本上拦截跌倒风险。 ### [41:12](https://www.youtube.com/watch?v=D6wTuogebU8&t=2472s) 髋部骨折的致命威胁与敏捷训练 Dr. Vonda Wright 强调，仅仅增加下肢力量是不够的，必须同步练习速度与敏捷性训练（Speed and Agility Drills），以保持身体灵活、具备平衡能力并防止跌倒。主持人问，如果被背包绊倒摔了一跤，身体难道不能自己愈合吗？Dr. Wright 笑谈自己近期参加斯巴达障碍赛（Spartan Race）时从一个8英尺（约2.4米）高的吊环上摔落，但骨头毫发无损，因为她一直在努力让自己在生理上变得“坚不可摧”（unbreakable）。然而，对于大多数没有建立这种身体储备的人来说，绊倒摔在地上极有可能直接摔断髋骨（Hip Fracture）。 这种骨折带来的连锁反应极其致命。在任何年龄段，尤其是老年人中，髋部骨折后有 50% 的人永远无法恢复到跌倒前的身体机能。这意味着他们再也无法独立生活在自己抚养子女成人的家中，甚至无法再开车。成人的骨骼愈合需要大约 3 个月，长时间的卧床与失能会引发严重的全身衰退。更惊人的是，在发生髋部骨折的第一年内，有 30% 的人会因各种并发症而离世，且男性的死亡率甚至高于女性。作为骨科医生，Dr. Wright 迫切希望预防虚弱综合征（Frailty），防止人们跌倒并陷入这一悲惨结局，因此必须通过下肢与臀部负重训练，结合敏捷与平衡训练来建立防护网。 - **50% 失去独立功能**：髋骨骨折患者中有一半无法恢复到跌倒前的日常活动水平，失去独立居住或驾驶能力。 - **骨骼愈合周期**：成人骨折通常需要约 3 个月才能愈合，导致长期卧床。 - **一年内死亡率达 30%**：髋部骨折引发的严重并发症在首年导致近三分之一的患者死亡，其中男性风险更高。 ### [42:28](https://www.youtube.com/watch?v=D6wTuogebU8&t=2548s) “久坐流行病”与久坐致死综合征 主持人提出“久坐流行病”（Sitting Epidemic）这一概念，询问其具体危害。Dr. Wright 指出，现代社会中无论工作还是娱乐，人们几乎时刻坐在桌前、看手机或看电视，每天处于坐姿的时间往往长达 10 到 14 个小时。她甚至开玩笑表示，如果实际条件允许，这场 3 小时的长篇播客访谈本该一边走路一边进行。 这种长期静坐的生活方式正在把人类推向密苏里大学哥伦比亚分校一位教授所命名的“久坐致死综合征”（Sedentary Death Syndrome）。该病症涵盖了导致现代人死亡的 33 种慢性疾病，包括前五大死因：心血管疾病、中风、癌症等，甚至骨折风险也与之直接相关——而所有这些疾病都能通过恢复身体活动得到积极逆转。Dr. Wright 在匹兹堡大学早期开展的科研工作核心，正是为了证明如果将久坐生活方式从日常中剔除，就能拯救我们的骨骼（已通过两项研究证实）、拯救肌肉，并且是首批通过神经影像学证实运动能改善并拯救大脑的研究之一。 ```mermaid flowchart TD accTitle: Sedentary Death Syndrome Mechanism accDescr: 长期久坐生活方式导致肌体萎缩并最终诱发久坐致死综合征及其并发症的过程。 subgraph Habit["久坐生活习惯"] A["每日静坐 10-14 小时<br/>（工作、刷手机、看电视）"] B["缺乏活动刺激<br/>（肌肉废用与核心萎缩）"] A --> B end subgraph Cascade["身体机能退化"] C["骨密度下降与肌肉萎缩"] D["大脑机能与认知衰退"] B --> C B --> D end subgraph Outcome["久坐致死综合征 (SeDS)"] E["诱发 33 种慢性疾病<br/>（心血管病、中风、癌症等）"] F["虚弱跌倒与骨折致命并发症"] C --> E C --> F D --> E end ``` ### [44:27](https://www.youtube.com/watch?v=D6wTuogebU8&t=2667s) 哈扎部落与现代人的脊柱悲剧：为何 80% 的人有腰背问题 主持人分享了身边的真实案例：本周一位朋友由于第 5、6 节椎间盘突出而将 X 光片发到群聊中；同时他提到此前采访过的学者 David Raichlen 和 Daniel Lieberman 对非洲哈扎部落（Hadza tribe，狩猎采集部落）的研究。研究发现哈扎人每天静止休息的时间其实也长达 9 到 10 个小时，但他们绝大部分时间是在“深蹲”（Squat），而非坐在椅子上。学者们甚至曾带了一把椅子过去，哈扎人从未见过椅子，一旦研究人员离开，哈扎人就会争相坐在椅子上享受这种前所未有的舒适感。然而，哈扎人传统的下蹲姿势能让肌肉始终保持微激活状态，且背部保持挺直，因此在哈扎部落中腰背痛几乎“不存在”；而在现代文明中，80% 的美国人都会遭遇背痛困扰。 Dr. Wright 解释，坐在传统椅子上时，人若不刻意端正就会瘫软成“C形背”（Slouched over），腹部核心彻底放松，背部肌肉被拉长且不发力，日久天长核心肌群就会废用性萎缩，就像长期卧床一样，加上双肩前扣，体态彻底崩塌。为了打破这种萎缩，Dr. Wright 曾在社交媒体发起“能否蹲下去并顺利站起来”的挑战，收到的大量反馈都是惊呼“我根本做不到”。许多人虽然能勉强蹲下（甚至直接摔倒），但完全无法凭借自身力量重新站起。 - **80% 现代人遭受腰痛**：与几乎无腰背痛的哈扎部落形成鲜明对比，椅子导致的无力与失活是罪魁祸首。 - **深蹲与坐椅的区别**：自然深蹲能激活躯干和下肢肌群、维持脊柱中立；坐椅导致前后核心完全松弛并逐渐萎缩。 ### [46:51](https://www.youtube.com/watch?v=D6wTuogebU8&t=2811s) 办公场景中的微运动与 FACE 运动法则 针对现代职场人士如何应对背痛与久坐风险，Dr. Wright 提供了极为具体的日常行动指南。首先是环境改造，例如她为自己的诊所助理配备了升降站立办公桌（Standing Desk），避免一天接诊 10 小时全程处于坐姿；其次是碎片化微运动（Mini Blasts of Mobility），比如频繁站起来快步爬楼梯、做个“坐不住的人”（fidgety person）、起身去打印机走动增加步数；此外，在打商务电话甚至参加 Zoom 会议时，他人根本注意不到你在做什么，完全可以背靠墙做“靠墙静蹲”（Wall Squat）。 主持人随后提到当天早晨在浴室弯腰捡掉落的牙膏时，深感自己背部紧绷、全身僵硬得宛如老人。针对这一痛点，Dr. Wright 详细拆解了每天必须投资的“FACE”四要素训练法则： 1. **F - Flexibility（柔韧性与动态拉伸）**：运动前必须进行动态热身（Dynamic Warm-up），把全身每一个关节活动开、要求关节走完完整的活动度（Full range of motion）。例如一组简单的开合跳（Jumping Jacks），或者“毛毛虫爬”（Inchworm，从俯卧撑姿势向前挪动双脚，全面激活脚踝、膝盖、髋部和肩膀）。而传统的静态拉伸（Static Stretch，如对着墙推腿保持30秒）绝不能放在运动前，必须放在运动结束后进行；瑜伽与普拉提（垫上或器械普拉提）则是非常出色的补充，相当于日常训练的“油盐调料”。 2. **A - Aerobic（有氧运动）**：心肺功能与耐力维持。 3. **C - Carry a load（负重与抗阻训练）**：通过举铁和负重刺激肌肉骨骼生长。 4. **E - Equilibrium and balance（平衡与身体协调）**：强化本体感觉，防跌防衰。 Dr. Wright 指出，主持人能够在僵硬感中捡起牙膏，是因为他正处于 30 多岁，身体仍具有年轻的柔韧代偿能力，但必须立即开始系统性地活动每一个关节，否则身体僵化只会加速恶化。 ### [50:30](https://www.youtube.com/watch?v=D6wTuogebU8&t=3030s) 重训平衡感与正确的拉伸方法 步入 60 岁且长期缺乏身体锻炼的人，关节活动度往往极度受限。当身体发生倾斜或试图伸手够东西时，由于脚下步频与反应跟不上，往往无法及时稳住自己，从而直接从站立姿态跌倒。为了防止这种灾难性的跌倒，Dr. Vonda Wright 分享了一个极其实用的日常平衡训练法：每天早晨刷牙时单腿站立。在刷牙过程中，身体微小的晃动扰动会迫使核心肌群发力，并极大地激活本体感觉（Proprioception），从而重新建立并强化神经肌肉的平衡控制。 针对很多人询问是否必须依靠普拉提（Pilates）或瑜伽来改善身体僵硬，Dr. Wright 指出日常规律拉伸同样有效。她强调在开始任何运动（包括举重力量训练）前，必须先进行动态热身（Dynamic Warm-up），而在训练结束后则应进行静态拉伸（Static Stretching）。静态拉伸需要覆盖全身主要肌群，例如肱三头肌、小腿肌肉以及对缓解下背痛至关重要的腘绳肌（Hamstrings）。拉伸时应保持静止而不弹颤，每个动作保持 30 秒——在第 30 秒临近结束时，肌肉会逐渐放松下沉，从而获得更深层的延展。每个动作重复 4 次即可获取该拉伸的绝大部分收益。Dr. Wright 同时告诫，仅靠瑜伽或普拉提绝不足以维系长久健康，不可本末倒置。 - **刷牙单腿站立训练**：利用刷牙时的身体扰动，训练核心力量与本体感觉。 - **动态热身先行**：运动或举重前必须进行动态热身激活关节与肌肉。 - **静态拉伸原则**：运动后进行，不弹颤保持 30 秒，重复 4 次即能达到最佳拉伸效果。 --- ### [52:06](https://www.youtube.com/watch?v=D6wTuogebU8&t=3126s) 关节结构与关节痛的真相：软骨的磨损机制 随着年龄增长，关节痛似乎成了人人皆有的常态，但 Dr. Wright 明确表示“关节痛绝非不可避免”。现场她展示了一根真实的人类股骨（Femur）——人体内最长、最结实的一根骨头。股骨上方呈球状的股骨头嵌入骨盆的髋臼中构成髋关节，下端则与胫骨（Tibia）相接构成膝关节。关节本质上就是两块骨头之间交汇活动的腔隙。 ```mermaid flowchart TD accTitle: 关节结构与损伤类型 accDescr: 展示两块骨骼间的软骨缓冲层以及外伤性软骨缺损与骨关节炎的区别 subgraph JointStruct["关节解剖结构"] B1["骨骼 A (如股骨)"] C1["关节软骨 (比冰面更光滑的缓冲基质)"] B2["骨骼 B (如胫骨/骨盆)"] B1 --- C1 C1 --- B2 end subgraph DamageType["软骨磨损原因"] T1["急性创伤性缺损: 如剧烈撞击导致软骨碎裂脱落 (形成坑洞)"] T2["骨关节炎 (Osteoarthritis): 长期高负荷磨损 (如砂纸打磨变薄)"] end C1 -.-> DamageType ``` 骨头末端覆盖着一层名为“软骨”（Cartilage）的结构，其表面比光滑的冰面还要细腻平整，作为缓冲垫层让人在活动时感知不到骨头的撞击。关节痛主要源于软骨受损： 1. **急性外伤性损伤**：如美式橄榄球运动员遭遇剧烈撞击，导致软骨局部碎裂脱落，在软骨面上形成如同道路坑洞（Potholes）般的缺损。 2. **骨关节炎（Osteoarthritis）**：一生中经历了过多机械重复与重负荷磨损，整层软骨像被砂纸打磨过一样变薄退化。 骨关节炎的发生除了遗传因素外，很大程度上取决于体重大幼，且女性绝经后雌激素缺乏也会加剧软骨流失。人体一辈子只有这一套天然软骨，除了极少数通过手术重构软骨之外，软骨无法再生。高强度训练带来的暂时性关节发炎通常只是短期不适，而永久性、不可逆的关节疼痛几乎全部源自骨关节炎。 --- ### [54:54](https://www.youtube.com/watch?v=D6wTuogebU8&t=3294s) 渐进超负荷与肌肉减震：预防关节磨损的运动法则 为了在运动中保护软骨免受侵蚀，力量训练必须遵循“渐进性超负荷”（Progressive Overload）原则。很多人仗着年轻健康，不做循序渐进的准备就盲目冲击极限重量，极易引发急性关节炎症。关节承受的负荷常达到体重的 5 到 10 倍，如果一个人直接从零基础挑战 500 磅的深蹲，关节瞬间承受的轴向负荷高达惊人的 5,000 磅。相反，从轻重量起步、循序渐进地提升负荷，骨骼密度会逐渐强化，软骨虽然不会增厚生长，但能逐渐适应这种周期性机械压力。远离关节疼痛的核心原则就是循序渐进，绝不能让虚荣心（Ego）主导训练。 肌肉在关节保护中扮演着关键的“机械悬挂与减震系统”（Suspension / Shock Absorber）角色。缺乏肌肉保护时，骨骼之间是生硬的剧烈撞击；而强壮的肌肉群能有效吸收冲击动能，使骨端接触变得轻柔平缓。因此，对于骨关节炎患者而言，建立并强化肌肉储备是极其核心的治疗手段之一。 --- ### [56:45](https://www.youtube.com/watch?v=D6wTuogebU8&t=3405s) 1磅体重带来9磅关节压力：全人治疗与杠杆原理 在探讨关节健康与体重控制时，Dr. Wright 拿出了事先准备的道具：一块 1 磅重的石头和重达 9 磅的红砖。她揭示了一个惊人的生物力学事实：直立行走或上下楼梯时，根据长骨的力学杠杆原理以及重力地面的反作用力，**身体每增加 1 磅体重，膝关节所承受的额外压力高达 9 磅**。 | 体重变化 | 膝关节压力变化 | 机制与影响 | |:--- |:--- |:--- | | **增重 1 磅 (0.45 kg)** | **增加 9 磅压力** | 骨骼杠杆力臂放大轴向负荷与重力冲击 | | **增重 10 磅 (4.5 kg)** | **增加约 90-100 磅压力** | 关节软骨承受巨大额外挤压，显著加速退化 | | **减重 10% 总体重** | **大幅卸载关节负荷** | 显著缓解关节疼痛，推迟或避免手术介入 | 类似的情况也发生在肩关节等其他部位。手握 1 磅重量平举时，因长力臂的力矩放大效应，肩关节内部实际感受到的负荷是 10 倍。因此，术后康复患者哪怕只是举起 2 磅的哑铃，肩部其实已经在承受 20 磅的载荷。 基于这一力学机制，Dr. Wright 提出了针对关节炎的“全人治疗方案”（Whole Person Approach）。传统的单一外科思路往往是“打封闭针，然后排期做关节置换手术”，而她的整体干预方案优先采用生活方式干预： 1. **抗炎营养体系**：摄入充足的优质蛋白质，严格戒除精制糖（糖是引发体内系统性炎症、加剧关节疼痛的关键诱因）。 2. **力量训练增肌**：构建强壮肌群以充当关节减震器。 3. **针对性减重**：降低绝对体重，利用“1比9”的力学倍数成倍卸载关节承受的压力。 随后，对话转向晚年保持健康的重大心态转变：不再执念于单纯的减重，而是转向全力增肌。针对随着衰老人们往往认为体重增加不可避免、许多男性尤其对减掉腹部脂肪（Abdominal Fat）极度痴迷的现象，话题由此深入展开。 ### [01:00:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=3637s) 从“减重”转向“身体重构”：肌肉是大自然的塑身衣 当被问及人们是否需要转变传统观念时，冯达·赖特医生（Dr. Vonda Wright）进一步指出，大家不应该把目标定为“减重”，而是应当关注“身体成分重构”（Recomposition）。核心问题在于：我们的身体到底是由什么构成的？我们迫切需要的是健康的肌肉，并时刻关注体脂率的高低。脂肪并非毫无用处，它在人体内承担着不可或缺的生理功能，但关键在于肌肉与脂肪的相对比例。 许多人陷入的误区是仅仅依靠极端的热量限制（节食）来降低体重。赖特医生引用多项明确的研究指出，如果只做节食而不进行抗阻力量维持，所减掉的体重中将有 25% 到 50% 是宝贵的肌肉组织。肌肉是人体的“葡萄糖水槽”（Glucose Sink），负责摄取血液中循环的糖分；一旦流失大量肌肉，人体的代谢清除能力就会骤降。更严重的是，当人们忍受不了极端的节食而恢复饮食时，反弹回来的体重中有高达 80% 都是脂肪。这种周而复始的“溜溜球式节食”（Yo-yo Dieting）会让肌肉储备越来越少、代谢每况愈下。因此，她向所有男女呼吁：忘掉体重秤上的数字，把重点放在“如何在降低体脂率的同时增加肌肉量”。 赖特医生坦言，由于自己的体脂率低、肌肉含量高，她实际的体重可能比大家目测的要重得多，但她根本不在乎这个读数。她笑着调侃道：“我也和所有人一样爱美，很在乎衣服穿在身上合不合身，而肌肉就是大自然的‘塑身衣’（Spanx）。即使你的体重更重，但你的身体更加紧实，穿衣服更好看，整个人状态也更出色。决定体态的从来不是体重，而是身体成分。” ```mermaid flowchart TD accTitle: 极端节食的恶性循环对比 accDescr: 展示仅靠节食减重导致代谢下降与脂肪反弹的恶性循环机制 subgraph Restriction["极端节食阶段"] A["单纯热量限制节食"] --> B["体重下降：25%-50% 为肌肉流失"] B --> C["肌肉水槽萎缩，代谢与控糖能力大幅下降"] end subgraph Rebound["饮食反弹阶段"] C --> D["恢复正常或暴饮暴食"] D --> E["反弹体重：高达 80% 为新增脂肪"] E --> F["体脂率恶化、体态松弛，陷入恶性溜溜球循环"] end F -.->|"再次尝试节食"| A ``` - **单纯热量限制的代价**：减掉的体重中有 25% 至 50% 来自骨骼肌流失。 - **体重反弹的成分构成**：溜溜球式节食反弹的重量中，高达 80% 为身体脂肪。 - **肌肉的代谢功能**：肌肉是体内最大的葡萄糖代谢清除终端，是保障代谢健康的基石。 --- ### [01:02:48](https://www.youtube.com/watch?v=D6wTuogebU8&t=3768s) 25岁与45岁的体能差异：C罗与自律的分水岭 针对“我们是否能在 45 岁时保持与 25 岁一样好的身材和体能”这一疑问，赖特医生给出的答案是：“我们可以达到不同的巅峰（Different）。”无论是像汤姆·布雷迪（Tom Brady）还是克里斯蒂亚诺·罗纳尔多（Cristiano Ronaldo, C罗）这样的职业体坛传奇，都在打破年龄的桎梏。即使在普通人当中，也有无数人在中年突然警醒过来——意识到“如果我现在继续坐在沙发上无所作为，今天就是我余生中最强壮的一天”。无数普通人通过科学举铁与高蛋白饮食，在中年迎来了人生最巅峰的身体状态。赖特医生分享了切身体会：她在 40 岁时达到了体能的第一个巅峰，体脂率降到 19%；随后围绝经期的到来让她一度感觉“痛苦得快要死掉”；然而到了 57 岁，她再次迎来了人生的最佳身体状态。 主持人史蒂芬·巴特利特（Steven Bartlett）作为一个狂热的足球迷，分享了他观察到的震撼对比。他提到 C罗 与曼联昔日的一位前队友——两人如今同为 41 岁左右，在 30 多岁并肩作战时，两人的体格几乎毫无二致，都拥有分明的腹肌。然而短短几年过去，那位队友逐渐放纵生活、开始饮酒、放弃严格饮食，如今两人的外貌和精气神看起来相差了整整 15 到 20 岁。 巴特利特感叹，C罗在最近的比赛甚至泳池无上装采访中依然呈现出刀刻般的肌肉线条，这种常年自律与几年松懈带来的轨迹分化令人触目惊心。对此，赖特医生抱持乐观态度，她强调只要那位队友重新投入时间、找回纪律，即便是 40 多岁也完全有能力重塑肌肉线条、“再次被雕刻出来（Become ripped again）”。 - **中年觉醒心态**：“我现在坐在椅子上，除非我立刻行动，否则今天就是我未来生命中最强壮的一刻。” - **年龄与身体的对话**：赖特医生在 40 岁时体脂率为 19%，即便经历围绝经期的严重健康低谷，57 岁时依然在整全健康层面登上了人生最巅峰。 - **生活方式的复利与分化**：35 岁时肉眼难辨差异的两位顶尖运动员，仅因数年间对饮食与酒精的管控差异，41 岁时身体表象年龄可拉开 15 至 20 岁的鸿沟。 --- ### [01:05:43](https://www.youtube.com/watch?v=D6wTuogebU8&t=3943s) 顶尖运动员抗衰老的四大支柱：聪明的训练与科学管理 当被问及高龄顶尖运动员与普通人拉开差距的底层逻辑时，赖特医生结合自己长期为职业运动员提供医疗支持的经验，拆解了高龄保持巅峰的核心要素： 1. **善用年龄的智慧（聪明的训练）**：年长运动员不再像 25 岁时那样一味在球场上死磕 4 个小时。诸如达拉·托雷斯（Dara Torres）或迈克尔·菲尔普斯（Michael Phelps）等老将，训练高度系统化，追求“最大化与最小化（Max-min）”的高效结合。他们只进行约一个半小时极具针对性的专项技能锤炼，同时将大量的时间和精力倾斜到“身体恢复”和肌肉保护上。 2. **严苛精确的营养支持**：赖特医生回忆她在匹兹堡大学担任 UPMC 勒米厄体育综合中心（UPMC Lemieux Sports Complex）医疗总监的经历，该中心是 NHL 匹兹堡企鹅队（Pittsburgh Penguins）的大本营。球队为队员配备全职大厨，从早晨睁眼后的第一顿早餐、午餐、全天所有加餐，甚至是专机飞行中的航空餐，每一口食物都经过严密计算与配比，确保营养不仅能提供爆发力燃料，更能精准加速身体微损伤的修复，“没有任何一口饮食是随意的差错”。 3. **全面的生理数据监测**：顶尖运动员的体能与体能恢复情况完全由科学数据驱动（如 Whoop 等监测穿戴设备）。团队随时追踪其前一晚的深度睡眠质量、自主神经系统恢复状态以及肌肉对大重量举铁训练的生物学应答，把整个身体维保变成一门严谨的实验科学。 4. **先天的基因底子**：赖特医生也坦承，不可否认顶尖巨星生来便拥有优越的细胞质和基因天赋，但这并不妨碍普通人通过前三项原则大幅改写自己的衰老曲线。 --- ### [01:07:50](https://www.youtube.com/watch?v=D6wTuogebU8&t=4070s) 糖分的毁灭性影响：多巴胺成瘾、蛋白质糖化与胰岛素抵抗 谈到“糖分”对身体的破坏，赖特医生毫不留情地指出它在多个层面上都在摧毁健康。她坦言自己其实极度嗜甜，甚至本能里“巴不得早餐全吃饼干”，正因如此，她深刻体验过戒糖（Sugar Detox）的残酷。前三天完全依靠意志力和纪律硬撑，到了第四天，身体甚至会下意识地走向食品储藏柜前发呆——那不是真正的饥饿，而是大脑的奖赏中枢在疯狂渴求糖分带来的“多巴胺冲击”（Dopamine hit）。 赖特医生明确澄清，她绝不反对碳水化合物，人体运转离不开碳水化合物，但人体真正需要的是富含膳食纤维的高纤维复合碳水。现代人最大的灾难在于摄入过多甜菜糖、蔗糖、蜂蜜和龙舌兰蜜等高升糖指数（High Glycemic Index）的游离糖与简单糖。这些糖分被极速消化吸收并涌入血液，引发急剧的血糖飙升（Blood sugar spike）。 面对失控的血糖，胰腺被迫疯狂分泌胰岛素，试图将血液中的过量葡萄糖运入肌肉细胞储存或消耗。然而肌肉的接纳速率是有限的，一旦涌入的糖分超载，身体只能别无选择地将其转化为体内脂肪囤积起来。更可怕的是，高血糖状态会引发体内蛋白质的“糖化反应”（Glycosylation）： > “这本质上就是在将你体内的蛋白质焦糖化（Caramelizing proteins）。就好像你把一块牛排扔在烤架上烤得太久，表面结成焦糖硬壳一样。这种蛋白质变性状态在体内具有高度破坏性，会诱发剧烈的全身性炎症反应，而慢性低度炎症正是各类慢性致命疾病的温床。” 长此以往，疲于奔命的胰腺分泌过量的胰岛素，最终会导致机体产生胰岛素抵抗（Insulin Insensitivity / Resistance），彻底击垮人体的代谢防御系统。 ### [01:10:14](https://www.youtube.com/watch?v=D6wTuogebU8&t=4214s) 戒糖的心理阻力与银行学概念“跨期脱节” Dr. Vonda Wright 明确指出，她并不反对复合碳水化合物和膳食纤维，她所坚决反对的是由现代食品工业体系与个人妥协选择共同催生的“高加工、高糖饮食”。在她接诊的患者中，戒除简单糖（simple sugar）永远是最艰难的一步。许多人愿意顺从地去健身房报到，也能按部就班地完成规定的有氧运动，可一旦医生提出“必须彻底砍掉精制糖”，各种各样的借口便立刻涌现。Steven 随之提出，糖分除了带来强烈的生理与神经化学成瘾外，健康生活方式的落实从根本上取决于人的主观决策与意志力。为什么许多人听了无数播客、读了大量健康书籍，心里明明一清二楚，行动上却往往只能坚持一天就打回原形？ ```mermaid flowchart TD accTitle: 跨期脱节与健康决策机制 accDescr: 展示跨期脱节概念如何导致人们忽视远期健康，以及如何通过即时奖赏重塑行为驱动力 subgraph Problem["跨期脱节 (Temporal Disconnect)"] A["即时自我（当下的享受与便利）"] -->|忽视| B["远期自我（30-40年后的陌生人）"] C["储蓄匮乏 / 饮食放纵 / 拖延运动"] -->|恶果累积| D["60岁以后慢病缠身与肌肉退化"] end subgraph Solution["即时回报重构"] E["认知重塑：自我价值感认同"] --> F["追求即时正向反馈"] F --> G["冲刺间歇：快速燃脂与代谢提升"] F --> H["大重量力量训练：即时塑形与力量感"] end Problem -.->|转变视角| Solution ``` 面对这一困境，Vonda 引入了一个源自银行业的概念——“跨期脱节”（Temporal Disconnect）。银行和理财顾问总是告诫人们每天都要存一点钱，但这在当下毫无快感可言，甚至是一种剥夺；其收益完全属于不可预测的未来。跨期脱节的核心在于：你根本无法想象30或40年后的自己会是什么样子。对一个年轻人来说，70岁时的自己如同一个陌生的路人，你既不认识他，也很难发自内心去在乎他。人们真正熟悉且想要讨好的是“当下的自己”，因此普遍倾向于满足眼前之需，并自我安慰说“就吃这一小口不会怎样”、“明天我再去运动”。由于大多数人缺乏将几十年后慢病风险具象化的超强自律，单凭遥远的恐惧往往难以支撑持久的行为改变。 --- ### [01:13:00](https://www.youtube.com/watch?v=D6wTuogebU8&t=4380s) 改变激励机制与自我价值认同 要击破跨期脱节的心理屏障，必须将健康投资的回报“即时化”。与其要求人们为了20年后的骨骼着想，不如让他们体会到当天就能获得的巨大收益：不再整天坐在椅子上忍受背痛与昏睡迟钝，而是去散步、做冲刺间歇训练以高效燃脂，或者进行大重量力量训练。举起大重量能给身体套上一层天然的“塑身衣肌肉”，不仅体态优美，练完之后更能让人油然而生一种所向披靡的强大力量感（"feel like a badass"）。Vonda 直言，健康管理的关键不在于杠铃有多重，而在于“两耳之间那五英寸半的大脑空间”所进行的博弈。 - **行为的终极阻碍在于“自我价值感”**：许多人无法坚持的深层原因是内心潜意识觉得自己不值得每天为健康付出时间与精力，习惯性地把工作、家庭等外在事务排在自己前面。如果不能打心底确立“我值得这份每日健康投资”的信念，任何养生法则都无法生根。 - **复利效应不可推迟**：Steven 反思了自己过去的一个思维误区（"mind virus"），即以为可以等到50岁或60岁身体出毛病时再去健身房恶补。现实生活、投资与商业一样遵循残酷的复利机制；20岁、25岁乃至16岁时做出的微小抉择，都会在六七十岁时结出相应的果实。 - **生活方式而非痛苦转折**：Vonda 以自己16岁的女儿为例指出，在健康家庭环境中长大的孩子，做出正确抉择只是日常生活的自然状态。每天做一点微小投资毫不费力，而等到50岁时超重50磅、肌肉量严重流失再去破釜沉舟地重建，其需要付出的能量将呈几何倍数增加。 --- ### [01:16:04](https://www.youtube.com/watch?v=D6wTuogebU8&t=4564s) 维生素D、微量元素与骨骼健康的生物力学刺激 谈及日常习惯的微调，Steven 提到自己主持播客以来的收获：他戒掉了曾以为十分健康的浓缩果汁（如苹果汁和橙汁），坚持规律健身并增加肌肉量。然而，由于常年在封闭且缺乏自然光线的录影棚与工作室内录制节目，他近期进行全身精密体检时，唯独被查出维生素D严重匮乏。 Vonda 严肃指出，维生素D本质上是一种深层调控人体多器官系统的激素，对骨骼构建、免疫调节及大脑功能至关重要。由于现代人室内生活方式普及，绝大多数人的维生素D水平都偏低。科学的做法应当是先验血测定基准值，遵医嘱进行高剂量补充拉升数值，随后复查并转入终身低剂量的日常维持。在补充维生素D时，通常建议搭配钾（Potassium）以促进吸收，而镁（Magnesium）则是协同激活的另一核心要素。 ```mermaid flowchart LR accTitle: 骨骼重塑与密度增强机制 accDescr: 展示机械冲击应力如何通过生物力学转化促进新骨生成并提升T值 subgraph Input["力学刺激与营养基石"] A["机械撞击 (跑跳/下楼/蹦床)"] B["营养供给 (蛋白质+VitD+Mg+K)"] end subgraph Mechanism["信号级联反应"] C["骨组织机械应力感受"] --> D["生物力学信号转为生物化学信号"] end subgraph Output["骨骼生理改变"] D --> E["成骨细胞合成新骨基质"] E --> F["DEXA扫描测定T值改善"] end A --> C B --> E ``` 针对想要强化骨骼密度的群体，Vonda 给出了明确的营养与力学干预指南： - **核心营养素组合**：重点补充已被确证有效的维生素D、镁和钾三者，配合每天按理想体重每磅摄入 1 克蛋白质，以促进肌肉对骨骼的附着与牵拉支撑；关于硼（boron）和锌（zinc）的强化数据目前较为边缘，无需舍本逐末。 - **骨骼需要“物理冲击”（Bash Your Bones）**：骨骼依赖机械应力（mechanical stress）的撞击才能生长。上下跳跃、跑步、爬楼梯都是极佳的力学刺激；对于骨密度极低或骨质疏松患者，可以利用小型蹦床（Reformer/trampoline）进行缓冲性冲击。这种物理冲击会被骨组织感应并转化为生物化学级联信号，促使成骨细胞沉积矿物质并生成新骨。 - **骨密度逆转与 T 值（T-score）**：通过持续的力学刺激与系统营养支持，人完全有能力逆转骨流失并长出新骨。临床上通过双能X射线吸收仪（DEXA scan）测定 T 值，不仅能测出绝对骨密度，还能精准评估个体骨质与健康年轻人基准相比的相对健康水准。 ### [01:19:19](https://www.youtube.com/watch?v=D6wTuogebU8&t=4759s) 骨密度检测与骨质疏松的诊断标准 DEXA 扫描（双能 X 射线吸收测定法）在临床上通常用于发生跌倒并骨折的女性或高龄男性。然而，它所提供的 T 值（T-score）具有更普遍的参考意义：它是将个人的骨密度与一名健康的 30 岁人群（理论上骨量积累达到峰值的人群）进行对比。了解自己的 T 值能够为骨骼健康状况提供明确参考，从而评估我们是否需要、以及能否重建骨量。 人体在骨骼维护上面临着多重生理挑战。对于女性而言，雌激素水平的下降并非始于 50 岁，而是在 40 多岁就已经开始；而雌激素和睾酮对维持骨密度起着决定性作用。如果检测显示严重的骨质疏松（仅在美国就有多达 200 万男性患有骨质疏松，这绝非女性专属疾病），就意味着骨骼处于极度脆弱的状态。 诊断骨密度的钟形曲线（正态分布）标准如下： - **峰值基线（T 值 = 0）**：以 30 岁健康成年人的平均骨密度为中心。 - **健康骨骼（T 值 ≥ 0）**：任何正数值均代表骨密度高于平均值，处于极其理想的状态。 - **骨量减少（Osteopenia，-1.0 > T 值 > -2.5）**：低于 30 岁健康基准 1 个标准差，提示骨密度正在降低，必须立刻加强干预手段。 - **确诊骨质疏松（Osteoporosis，T 值 ≤ -2.5）**：骨密度极度低下，骨骼处于极其脆弱、极易断裂的危险边缘。 ```mermaid flowchart LR accTitle: 骨密度诊断区间示意图 accDescr: 展示从正常骨量、骨量减少到确诊骨质疏松的 T 值评定区间 subgraph Normal["正常骨密度"] A["T-score ≥ 0<br/>理想骨量状态"] end subgraph Osteopenia["骨量减少期"] B["-2.5 < T-score < -1.0<br/>需警惕并加强生活干预"] end subgraph Osteoporosis["确诊骨质疏松"] C["T-score ≤ -2.5<br/>骨骼脆性极高，需医疗介入"] end Normal --> Osteopenia --> Osteoporosis ``` --- ### [01:21:24](https://www.youtube.com/watch?v=D6wTuogebU8&t=4884s) 骨折风险评估工具（FRAX）与临床干预策略 除了单一的 T 值之外，临床上还会结合 FRAX 指数（Fracture Risk Assessment Tool，骨折风险评估工具）进行全面筛查。FRAX 综合了患者多维度的生活方式与遗传风险因素，包括母亲身高是否变矮变缩、家族是否有骨质疏松病史、个人是否发生过骨折（既往骨折是预测未来再次骨折的最关键指标）、是否有长期吸烟史、是否长期使用导致骨质流失的类固醇激素药物，以及其他遗传体质倾向。FRAX 模型通过这些指标计算出患者在未来 10 年内发生骨折的绝对概率。 当患者的 T 值达到 -2.5 且 FRAX 显示未来 10 年骨折概率达到 3% 至 3.6% 时，就达到了启动药物干预的指征。医生通常会建议患者转诊至内分泌科，评估使用双膦酸盐（Bisphosphonates）或特立帕肽（Forteo，重组人甲状旁腺素类似物）等药物来维持现有骨量或促进新骨生成。 针对 T 值低至 -2.0 甚至 -2.5 的患者，Dr. Vonda Wright 强调必须采取多管齐下的干预方案： - **生活方式调整**：优化高蛋白与矿物质营养，坚持抗阻力量训练以刺激骨骼重建。 - **安全负荷与冲击训练**：在避免跌倒断裂的前提下，通过针对性动作提供必要的机械冲击。 - **激素水平评估**：系统检查性激素（雌激素或睾酮）水平并制定管理策略。 - **药物联合治疗**：评估骨吸收抑制剂或骨形成促进剂的必要性，决不能抱侥幸心理坐视不管。 --- ### [01:23:31](https://www.youtube.com/watch?v=D6wTuogebU8&t=5011s) 老年运动员研究（PRIMA）：冲击力对骨密度的决定性影响 为了探究如果完全排除“久坐不动”这一变量，人体在整个生命周期中是否能持续维持骨密度，Dr. Vonda Wright 团队成立了老年运动员表现与研究计划（PRIMA, Performance and Research Initiative for Masters Athletes）。研究团队针对 3,000 名参加全美高级运动会（National Senior Games，50 岁以上选拔赛晋级运动员）的老年运动员进行了两项深入的骨骼对比研究。 第一项研究证实，高水平运动活跃的老年人直到 85 岁仍有极高比例保持着完全正常的 T 值。第二项研究则进一步探究了不同运动形式对骨骼健康的刺激差异。结果表明： - **高冲击性项目（跑步、排球、篮球等）**：对骨骼产生强烈的机械应力刺激，其对骨密度的保护与预测效应，与年龄、性别和遗传基因等不可控因素同等重要。 - **低/无冲击性项目（游泳、自行车、保龄球等）**：虽然有益心肺与代谢，但因缺乏骨骼轴向受力，在刺激骨质生成方面的效果明显弱于冲击性运动。 这一发现证明，施加在骨骼上的机械应力负荷是决定骨骼抗衰老能力的核心驱动力。 --- ### [01:25:50](https://www.youtube.com/watch?v=D6wTuogebU8&t=5150s) 人类何时真正变老？基于田径成绩的生物学衰退转折点 社会上普遍存在一种如同“脑部病毒”般的消极心态，人们往往一过 50 岁就习惯性叹气：“我老了，该慢下来了。”为了验证人体究竟在何时才会发生显著的生理退化，Dr. Vonda Wright 分析了 3,000 名 50 岁以上老年田径运动员在 100 米到 10,000 米各个距离赛跑中前八名的完赛成绩，将竞技运动表现作为衡量老化的生物标志物。 数据显示，人体的机能断崖并不是发生在 50 岁，甚至不是 60 岁： - **70 岁之前**：顶尖运动员的成绩每年退步幅度小于 1.2%。在 1 英里（约 1,609 米）比赛中，50 岁组别冠军的成绩可达 4 分 34 秒至 5 分 34 秒（同期宾夕法尼亚州高中冠军成绩为 5 分 17 秒）；甚至 70 岁组别冠军也能在 7 分钟内跑完 1 英里，全程没有任何人被套圈。 - **70 岁之后**：成绩才呈现急剧下滑。Dr. Vonda Wright 将这一现象称为“真正的生物学机制接管”（Biology taking over）——要么是长期积累的伤病阻止了高强度训练，要么是去脂体重大幅流失和柔韧性衰退，或是精神上不再渴望承受极限强度的折磨。 这表明，只要每天持续投入力量与活动度训练，人类在 70 岁中叶之前没有任何借口向衰老妥协。 ```mermaid flowchart TD accTitle: 运动表现与机能衰退年龄轨迹 accDescr: 说明70岁前后人体机能衰退速率的显著差异 subgraph Steady["50 岁至 70 岁中叶：机能稳定期"] S1["每年成绩降幅 < 1.2%"] S2["依赖每日运动负荷与活动度维持生理机能"] end subgraph Decline["70 岁中叶以后：生物学机制接管"] D1["成绩与机能急剧下滑"] D2["肌肉量/灵活性大幅损耗、陈旧损伤累积或意愿降低"] end Steady -->|突破拐点| Decline ``` --- ### [01:28:20](https://www.youtube.com/watch?v=D6wTuogebU8&t=5300s) 长期运动对认知敏捷度与长寿蛋白 Klotho 的启示 在匹兹堡大学进行的第三项历时 5 年的配对研究中，研究团队严格控制了所有其他变量，仅以“长期运动”与“久坐不动”作为对照，对比了老年运动员组与普通对照组。评估结果（包括基于 SF-12 简明健康调查问卷的身体自我效能感知）显示，常年坚持高水平活动的人群，不仅在外在体能上占据优势，在脑力灵活性、反应速度以及决策敏捷度上同样显著优于久坐对照组。 为了进一步解开运动对抗衰老的深层分子生物学机制，研究团队将目光投向了以希腊神话中纺织生命之线的命运女神命名的长寿蛋白——Klotho。人体几乎所有器官都遍布 Klotho 受体。在基因工程小鼠实验中，被敲除 Klotho 基因的小鼠在生物学年龄极年轻的阶段就会提前衰老致死，证明该蛋白是调控生命跨度与抗衰老机制的核心分子之一。 - **SF-12 评估指标**：量化受试者对自身体能、精神敏捷度与生活自理能力的综合认知。 - **Klotho 蛋白特质**：广泛分布于全身主要脏器，是目前抗衰老与代谢再生研究中备受瞩目的核心靶点。 ### [01:30:03](https://www.youtube.com/watch?v=D6wTuogebU8&t=5403s) 长寿蛋白 Klotho 与肌肉收缩的抗衰机制 冯达·莱特医生（Dr. Vonda Wright）分享了她针对长寿蛋白 Klotho 开展的研究。Klotho 是一种与寿命密切相关的关键蛋白，缺乏它会导致生理机能急剧衰老。为了探究运动对该蛋白的影响，她的团队通过酶联免疫吸附测定（ELISA）检测了不同人群体内的 Klotho 水平。结果出人意料却又合乎逻辑：35 岁至 50 岁的老将运动员（Masters athletes）血液中循环的 Klotho 水平最高；紧随其后排在第二位的，是年逾 75 岁但依然坚持运动的老年运动员；而体内 Klotho 浓度最低的群体，竟然是 30 岁上下长期久坐不动的年轻人。这意味着，一个缺乏运动的 30 岁年轻人，在长寿蛋白层面甚至远不如一位 75 岁积极锻炼的长者。 那么运动究竟是如何促使人体合成更多长寿蛋白的？莱特医生的同行法布里齐娅·安布罗西奥博士（Dr. Fabrisia Ambrosio）的研究给出了答案：**骨骼肌的机械收缩会直接刺激 Klotho 蛋白的基因转录与表达**。人体对运动刺激做出的这一生物学响应，本质上是因为身体感知到了你在主动“再投资自己”，而不是“坐在椅子上静静等待死亡”。 ```mermaid flowchart TD accTitle: 肌肉收缩与细胞抗衰机制 accDescr: 展示骨骼肌收缩如何激活Klotho蛋白表达与骨骼肌卫星细胞的年轻化 subgraph ExerciseStimulus ["运动与肌肉刺激"] A["骨骼肌主动收缩"] end subgraph MolecularLevel ["分子层面：Klotho 表达"] B["刺激基因转录"] C["促进长寿蛋白 Klotho 合成"] D["75岁运动者水平远超30岁久坐者"] A --> B --> C --> D end subgraph CellularLevel ["细胞层面：卫星干细胞逆转"] E["激活肌肉卫星干细胞"] F["形态由干瘪树枝状恢复为饱满圆形"] G["大量分泌生长因子 / 抑制细胞凋亡基因"] A --> E --> F --> G end ``` - **各群体 Klotho 水平排序**：35–50 岁老将运动员 > 75 岁以上高龄运动员 > 30 岁左右久坐人群。 - **机制核心**：骨骼肌收缩是启动长寿蛋白基因转录的生物学信号源。 --- ### [01:31:31](https://www.youtube.com/watch?v=D6wTuogebU8&t=5491s) 跑步机上的小鼠：运动逆转干细胞衰老 在证实了组织层面可以保持肌肉量之后，莱特医生的实验室进一步探究了细胞与干细胞层面的微观变化。他们将目光聚焦于肌肉来源的干细胞（即如今所称的“肌卫星细胞”，Satellite Cells）。研究人员观察了多只处于暮年的两岁老年雌性小鼠——对小鼠而言，两岁已是极长寿命的晚年，它们平时只是缩在笼子深处无精打采地等待喂食。活检取样显示，健康干细胞原本应呈现圆润形态，而这些衰老小鼠的干细胞已经退化成干瘪如树枝般的形态，丧失了分裂增殖能力，停止分泌生长因子，并开启了走向细胞程序性死亡（凋亡）的基因通路。 为了改变这一现状，实验室动用科研基金购置了一台价值高达 3 万美元的小鼠专用跑步机，安排这批衰老小鼠接受每天两次的短时微运动训练。仅仅两周之后，检测结果令人震撼：小鼠体内的肌卫星细胞重新变得饱满圆润并恢复分裂，生长因子的分泌源源不断，导致细胞凋亡的基因程序被彻底关闭。这项实验在细胞层面确证：哪怕仅仅是通过最基础的骨骼肌收缩，也能重新激活干细胞的生命力，堪称生理层面的“不老泉”。 - **实验对象**：2 岁高龄雌性小鼠（相当于人类极高龄阶段）。 - **干细胞衰老表现**：形态由圆形变为干瘪枝状、丧失增殖能力、停泌生长因子、启动凋亡程序。 - **干预措施与效果**：每天 2 次短时跑步机训练，仅历时 2 周，干细胞恢复饱满圆润、重启生长因子分泌并关闭凋亡基因。 --- ### [01:34:05](https://www.youtube.com/watch?v=D6wTuogebU8&t=5645s) “衰老是对舒适的迅速追逐”：重塑对自我照护的认知 主持人史蒂芬·巴特利特（Steven Bartlett）引述了播客往期嘉宾的一句名言：“衰老就是对舒适的迅速追逐（Aging is the rapid pursuit of comfort）”，莱特医生对此深表赞同。现代人常常苦苦思索如何用最短的时间达到最大的健身收益（Min-max），实际上每天只需专注锻炼约 45 分钟即可达标，但剩下的 90% 以上的时间，人们却几乎都在追逐安逸、久坐享受或沉溺于短暂的舒适中。 莱特医生指出，人们需要彻底转变对“自我照护（Self-care）”的观念。传统观念常将自我照护等同于做个面部护理或去按摩一小时，但这种舒适极其短暂，离开按摩床后效果便烟消云散。真正的长效自我照护往往始于“暂时的不适”。例如，走进健身房完成一次高强度的上半身抗阻训练，当你练到肌肉充血、站在镜子前审视雕刻般的成果时，那种由内而外的成就感与满足感才是深层次的愉悦。意识到训练后获得的持久良好状态，正是战胜“迈进健身房前的不情愿”的最强动力。 --- ### [01:37:09](https://www.youtube.com/watch?v=D6wTuogebU8&t=5829s) 围绝经期与被忽视的“绝经期肌骨综合征” 谈到女性生理健康，莱特医生深入剖析了绝经期对女性肌肉骨骼系统的剧烈冲击。公众往往熟悉潮热、盗汗和脑雾等绝经期典型表现，却极少有人知道，高达 80% 步入围绝经期（Perimenopause）的女性都会遭遇**绝经期肌骨综合征（Musculoskeletal Syndrome of Menopause）**。这一概念由莱特医生等人提出，参照了“绝经期泌尿生殖综合征”的命名模式，旨在将一系列分散的肌骨衰退症状进行系统化归纳。 现实中，有 25% 的女性因该综合征生活遭受严重打击；更无奈的是，40% 的患者前往医院就诊并接受影像学排查时，结构上并未发现任何破损或器质性病变。这常导致女性陷入恐慌和自责，误以为自己只是“彻底老了”或心理出了问题。莱特医生解释说，这是因为雌激素受体广泛分布在人体的肌肉、肌腱、骨骼和脂肪等各类肌肉骨骼组织中。雌激素是一种强效的天然抗炎剂，能够有效抑制促炎细胞因子——肿瘤坏死因子（TNF）的释放。当绝经期到来、体内雌激素骤然暴跌时，失控的炎症便会席卷全身肌骨系统，诱发剧烈的酸痛、僵硬与功能衰退。 - **高发生率**：80% 的围绝经期女性会出现绝经期肌骨综合征症状。 - **重症比例与诊疗困境**：25% 的患者遭受严重功能损伤；40% 的就医病例在常规影像学检查中找不到结构性破损，导致病因被忽视。 - **生理诱因**：肌肉、肌腱、骨骼等组织富含雌激素受体；雌激素的断崖式下降打破了抗炎平衡，导致肿瘤坏死因子（TNF）等促炎因子大量释放。 ### [01:39:36](https://www.youtube.com/watch?v=D6wTuogebU8&t=5976s) 绝经的生理学定义与雌激素骤降的全身性炎症反应 女性每个月的月经周期中，体内的雌激素水平都会经历规律的起伏波动。通常在45岁左右（有些人早至35岁左右），卵巢中用于月经周期的卵泡已消耗殆尽，体内雌激素水平随之断崖式下跌，身体随之进入剧烈的代偿与调整期。由于大脑密布雌激素受体，一旦缺乏配体结合，女性便会频繁出现严重的脑雾现象。从严格的医学定义来看，“绝经”（menopause）实际上只是一个具有纪念意义的单一时间点——即最后一次月经结束后的整整1年（366天）。然而，绝经之后长达40余年的后半生里，除非进行外源性激素替代治疗，否则女性都必须在彻底缺乏雌激素的环境中生活。正因如此，在40多岁的围绝经期阶段，激素的大幅震荡常常让人感到生命垂危，Dr. Vonda Wright 回忆道，自己在47岁时甚至一度以为自己要死掉了。 雌激素原本充当着强大的抗炎与合成代谢信号，一旦它被抽离，下游原本由它保护的肌肉蛋白合成、骨基质沉积等机制便失去刺激，导致体内的炎症如同脱缰野马。雌激素能有效抑制肿瘤坏死因子（TNF，一种强效促炎细胞因子）的释放，并在免疫系统的炎症小体（inflammasome）调节中发挥关键作用。失去这层防火墙后，炎症因子如野火般肆虐，许多女性因此遭遇全身广泛性疼痛（arthralgia）——这是一种没有任何器质性损伤却让人痛不欲生的状态。Dr. Vonda Wright 亲身经历过这种痛苦：她从一名身手矫健、整日搬抬病人体位的外科医生兼运动员，骤变为早晨甚至难以爬起下床的病患，全身无处不痛，而背后的始作俑者完全是雌激素撤退引发的无菌性系统炎症。 - **绝经的医学定义**：自最后一次月经来潮起算，连续整整1年（366天）无月经的特定时间节点。 - **围绝经期发病年龄**：平均在45岁左右开始出现明显症状，部分女性可在35岁前后提早发生。 - **关键促炎因子**：失去雌激素后，体内肿瘤坏死因子（TNF）等炎症细胞因子失控，引发广泛性关节痛（arthralgia）。 --- ### [01:41:52](https://www.youtube.com/watch?v=D6wTuogebU8&t=6112s) 冻结肩：“扣内衣测试”与炎症导致的关节囊挛缩 更年期肌骨骼综合征（Musculoskeletal Syndrome of Menopause）中最臭名昭著且极其普遍的表现之一就是“冻结肩”（frozen shoulder，即肩周炎）。虽然男性（尤其是糖尿病患者）也会偶发，但绝经期女性的发生率极高。患者常常没有任何外伤史或碰撞史，往往只是某天清晨醒来，便发现整条手臂剧痛难忍且无法动弹。肩关节的关节囊（包绕在骨骼外部如玻璃纸一般菲薄的滑膜内层）对体内的炎症状态异常敏感。 冻结肩最早丧失的运动维度是肩关节内旋。Dr. Vonda Wright 形象地将其命名为“扣内衣测试”（hook your bra test）——患者完全无法将双手反向伸到后背去扣上内衣，接着便连梳头、抬手都无法做到。这种病程伴随着撕心裂肺的剧痛，许多经历过的女性向她坦言，这种疼痛“比生孩子还要痛苦”。特种外科医院（Hospital for Special Surgery）的专家 Jo Hannafin 曾对冻结肩的病程阶段做过深入研究：初期是由于大量促炎因子涌入引发急性充血红肿，极其剧痛；随着免疫细胞进一步浸润，急性炎症退去，但会导致肩关节囊纤维化收缩与重度挛缩。此时即便痛感有所减轻，肩部却已彻底卡死，往往需要长达2年才能自然“解冻”。因此，及时的医疗干预至关重要，必须在关节囊严重挛缩粘连前恢复其活动度。 ```mermaid flowchart TD accTitle: 绝经期冻结肩的病理进展阶段 accDescr: 展示从雌激素匮乏到急性发炎，再到关节囊挛缩冻结的病理发展链条 subgraph Phase1["第一阶段：急性炎症期"] A["雌激素急剧撤退"] --> B["全身促炎细胞因子失控"] B --> C["高敏感度肩关节囊发炎充血"] C --> D["极度剧痛 & 首失内旋功能<br/>（扣内衣、梳头困难）"] end subgraph Phase2["第二阶段：纤维挛缩期"] D --> E["免疫细胞浸润与胶原重塑"] E --> F["关节囊物理性收缩硬化"] F --> G["关节彻底卡死（冻结）<br/>解冻恢复通常历时漫长（长达2年）"] end ``` --- ### [01:44:32](https://www.youtube.com/watch?v=D6wTuogebU8&t=6272s) 肌肉蛋白合成受阻与失控的破骨细胞 雌激素在本质上是一种强效的合成代谢激素（anabolic steroid），它能直接激活人体的 mTOR 通路驱动肌肉合成。在更年期雌激素流失的过程中，女性肌肉量会以每年2%到3%的速度急剧缩水，其肌肉干细胞（卫星细胞，satellite cells）数量更是会在短时间内暴跌30%到60%，这极大地削弱了肌肉自我修复和对抗老化的资本。 在骨骼代谢系统方面，骨骼每天都在经历骨吸收与骨形成的动态平衡： 1. 骨骼在受到生物力学撞击刺激后，将力学信号转化为生化信号，启动骨骼重建。 2. 破骨细胞（osteoclasts）率先爬上骨小梁，挖掘并溶解矿物质释放入血供全身使用。 3. 成骨细胞（osteoblasts）紧随其后，在破骨细胞掘出的小坑中填补胶原与钙盐，重新生成新鲜坚硬的骨质。 雌激素的核心功能正是充当抑制破骨细胞的“刹车系统”。破骨细胞本质上是一个极其凶猛且容易脱缰的“流氓细胞”，在缺乏雌激素与雄激素双重约束的情况下，成骨细胞虽然仍在勉强工作，但破骨细胞的骨质破坏速度已远远超越了生成速度，最终演变成严重的骨质疏松症。 - **肌肉干细胞损失**：肌肉卫星细胞数量在短期内剧减30%至60%，严重制约肌肉再生。 - **骨代谢失衡机制**：成骨细胞的填充速率赶不上失去雌激素制约的破骨细胞的破坏速率，导致净骨量持续亏损。 --- ### [01:46:27](https://www.youtube.com/watch?v=D6wTuogebU8&t=6387s) 软骨退化、体重增加与“骨质疏松-肌少-肥胖症”三重风暴 除了肌肉与骨骼，关节软骨表面同样密布着雌激素受体。雌激素能维系软骨基质内部如海绵般的弹性多孔结构，起到吸收冲击、缓冲压力的作用。失去雌激素的滋养后，软骨基质迅速降解脆化。在50岁之前，由于运动损伤，男性的创伤性关节炎患病率普遍高于女性；然而到了50岁以后，女性软骨由于激素断供开始加速剥脱，退行性关节炎的病程呈爆发式恶化。 雪上加霜的是绝经期代谢下降伴随的体重暴增。Dr. Vonda Wright 透露自己在经历更年期时体重足足飙升了30磅（约13.6千克），相当于在身上硬生生挂了4块7.5磅重的沉重砖块。这不仅引发了全身广泛性的弥漫痛，更直接导致了严重的髌股关节应力升高——由于体重激增，膝盖骨紧紧挤压在股骨滑车表面，连上下楼梯都伴随着剧烈研磨般的膝下痛。 肌肉萎缩导致冲击吸收力归零，软骨脆化使得承压能力骤降，骨质疏松削弱了骨架支撑，而体重骤增又大幅放大了机械载荷。这种恶性循环在60岁左右的女性身上常汇聚成一种可怕的临床合力——“骨质疏松-肌少-肥胖症”（Osteosarcobesity），即同时具备严重骨质疏松、肌少症与中心性肥胖。患有这种复合综合征的女性，其全因发病率与死亡率是单独患有其中任何一种疾病的三倍以上。这并非单一器官的问题，而是一场由雌激素匮乏引爆、悄无声息侵蚀全身的系统性灾难。 ### [01:49:39](https://www.youtube.com/watch?v=D6wTuogebU8&t=6579s) 雌激素替代疗法的科学抉择 面对更年期带来的身心冲击，首要对策是重建掌控感，坚信自己能够恢复往昔的活力与状态。Dr. Vonda Wright 强调，每位女性必须跨出的第一步，就是依据现代科学而非坊间流言与恐惧，对雌激素替代做出明智决策。长期以来引发大众恐慌的美国“妇女健康倡议”（Women's Health Initiative, WHI）研究结论，如今在医学界已被大幅推翻与修正。女性是拥有自主权与判断力的独立个体，绝不应仅凭道听途说的谣言做出健康选择。 谈及自身经验，Dr. Wright 坦言自己毫不犹豫地选择了补充雌激素。然而，她的核心考量并非为了缓解潮热、盗汗或脑雾——在她看来，这些症状随着时间推移终究会消退。促使她补充雌激素的深层生理动机，是为了长期保全骨骼、肌肉、大脑认知以及心血管系统的健康。 - **科学决策优于恐慌**：WHI 研究中关于激素替代疗法危害的旧认知已基本被推翻，治疗决策需立足于最新循证医学。 - **保护核心器官**：补充雌激素不仅是应对更年期表面症状，更是保护骨密度、肌量、脑神经和心脏功能的长期健康投资。 --- ### [01:50:41](https://www.youtube.com/watch?v=D6wTuogebU8&t=6641s) 拒绝粉色轻哑铃：大重量复合抗阻训练法则 Dr. Wright 指出，想要切实改善身体状态，第二项不可妥协的基石是每日对自身“机动性”（Mobility）进行投资，而其核心就是进行大重量抗阻训练。女性必须彻底丢掉那些“软绵绵的粉色轻哑铃”——很多人误以为做 20 次小重量动作能塑形且不粗腿，但事实上，除非经过极其严苛的定向增肌训练，女性绝不可能随随便便练得过于粗壮。骨骼与关节在安全承受范围内，能抗多重就应该扛多重。 针对日常训练体系，她将其简化为一套循序渐进的动作方案。基础建立在大肌群的复合动作为主： - **上半身核心推拉**：卧推（Bench Press）与下拉动作（Pull-down）。 - **下半身核心力量**：深蹲（Squats）与硬拉（Deadlifts）。 - **大重量核心组规范**：大复合动作用大重量进行 4 组、每组 4 次（4 reps × 4 sets），从能够胜任的轻重量开始，持续进阶负荷。 - **辅助孤立训练**：为支持大型复合动作，搭配二头肌、三头肌、背阔肌及三角肌的辅助训练，采用 4 组、每组 8 次（8 reps × 4 sets）的强度标准。 --- ### [01:52:01](https://www.youtube.com/watch?v=D6wTuogebU8&t=6721s) 80/20 心肺法则：二区有氧与 30 秒极限冲刺 在心肺耐力维度，Dr. Wright 推崇基于代谢科学的训练组合，遵循 80% 基础训练与 20% 高强度冲刺的比例。她诊所所在的代谢实验室由“二区心率训练”（Zone 2）教父伊尼戈·圣米兰（Iñigo San Millán）设计，团队完全遵循其训练方案：每周保持约 3 小时、强度在 60% 最大努力程度的有氧基础训练。 除了稳态基础训练，每周必须安排两次全力以赴的高强度冲刺。这里的“冲刺”并非要像奥运田径选手那样在跑道上狂奔，而是指在短时间内将心率拉至 100% 极限努力程度。具体执行方式为：全力冲刺 30 秒，随后休息恢复 2 到 3 分钟。Dr. Wright 以自身跑步机训练为例：日常通过 4 至 5 度的坡度配合 4.2 迈的时速进行快走，心率维持在乳酸阈值决定的 130 次/分，持续 45 分钟；完成基础训练后，她会将速度直接打到极限档位全速狂奔 30 秒，心率飙升至 186 次/分。 ```mermaid flowchart TD accTitle: 80/20 心肺与代谢训练模型 accDescr: 展现二区基础耐力训练与全速冲刺的高低搭配结构及生理收益。 subgraph Base["80% 基础心肺训练 (Zone 2)"] A["每周累计 3 小时<br/>约 60% 努力程度"] --> B["巩固线粒体功能<br/>打下心血管基础"] end subgraph Sprint["20% 极限冲刺刺激 (Sprint Interval)"] C["每周 2 次<br/>30 秒全力爆发 (100% 负荷)"] --> D["心率拉至峰值<br/>休息间歇 2-3 分钟"] D --> E["多燃烧 40% 脂肪<br/>打破体内稳态"] E --> F["刺激肌肉干细胞生成"] end ``` - **超额燃脂效应**：这种短时全力冲刺相比普通强度约 80% 的高强度间歇训练（HIIT），能多消耗 40% 的脂肪。 - **打破体内稳态**：极限心率爆发给予肌肉强烈的代谢刺激，迫使机体突破既有稳态，进而促进肌肉干细胞的激活与生成。 --- ### [01:54:15](https://www.youtube.com/watch?v=D6wTuogebU8&t=6855s) 促肌合成营养：亮氨酸、优质蛋白与膳食纤维 科学运动必须配合抗炎饮食。Dr. Wright 明确提出每日蛋白质摄入基准：按理想体重每磅摄入 1 克高品质蛋白质。衡量蛋白质质量的关键指标，在于支链氨基酸中亮氨酸（Leucine）的浓度。亮氨酸是激活哺乳动物雷帕霉素靶蛋白（mTOR）信号通路、启动肌肉蛋白质合成的最强力开关。自然界的生存逻辑印证了这一点——母乳中的蛋白质绝大部分是乳清蛋白，其目的正是利用超高浓度的亮氨酸驱动婴儿肌肉迅速发育。 | 蛋白质来源 | 亮氨酸平均占比 | 摄入建议与吸收特性 | |:--- |:--- |:--- | | **乳清蛋白 (Whey Protein)** | ~10% | 亮氨酸浓度最高，吸收极其迅速，最有效激活 mTOR | | **动物性蛋白 (肉类/鱼/蛋)** | ~8% | 氨基酸配比完整，肌合成效率优异 | | **植物性蛋白 (豆类/坚果)** | ~6.5% | 浓度相对较低，纯素饮食者需大幅提升进食总量方能达标 | 除蛋白质外，肠道微生态每日需要 30 克膳食纤维（复杂碳水化合物）。纤维素能够有效延缓胃排空与消化速度，阻断血糖骤然飙升。身为狂热的生理数据控，Dr. Wright 过去一年持续佩戴连续血糖监测仪（CGM），借此洞察不同食物对自身血糖波动的实时影响，精准掌握全天平稳控糖的节律。 --- ### [01:56:08](https://www.youtube.com/watch?v=D6wTuogebU8&t=6968s) 警惕简单碳水：连续血糖监测的饮食洞察 主持人 Steven Bartlett 分享了他录制英国商业投资真人秀《龙穴》（Dragon's Den）期间佩戴 CGM 的经历，并曾为现场所有投资人佩戴仪器以探讨血糖波动。谈及最令人震惊的控糖发现，Dr. Wright 坦言自己对“简单碳水化合物”（Simple Carbs）极其敏感，几乎“只要看一眼简单碳水”，血糖就会瞬间飙升至 165 mg/dL。 然而，极端低碳并不等同于健康。Dr. Wright 曾尝试几乎仅摄入蛋白质与极低碳水化合物的饮食，结果导致白天门诊查房时极度疲劳、步履维艰，机体显然缺乏必要动能。为了在控糖与供能之间取得平衡，她如今在早餐中引入天然酸酵母面包（Sourdough），接纳适度且可控的小幅血糖波动。所谓应当严格限制的简单碳水，涵盖精制糖、冰淇淋、白面包、精制白土豆和白意面等各种深加工精粮。 --- ### [01:57:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=7057s) 97岁独立生活蓝图与最大摄氧量“脆弱线” 在构建长期健康跨度（Health Span）时，最常被忽视的是“时间脱节”（Temporal Disconnect）的概念——人们往往不愿为了几十年后的长远收益而在当下付出汗水。Dr. Wright 以极其生动的个人动机阐述了自己的心态转变：她在 40 岁时生下小女儿，如今自己 57 岁，如果想要活到女儿也达到 57 岁、能够继续“在女儿身边烦她”，自己就必须健康活到 97 岁。身为掌控欲极强的外科医生，她绝不接受在晚年丧失自主能力、任人摆布。 人如果在 63 岁健康跨度终结、慢性病缠身时才开始着手挽救，往往为时已晚。除了大重量力量训练与二区心肺，她今年特别强调了最大摄氧量（VO2 Max）与“身体脆弱线”（Frailty Line）的概念。衰老伴随着速度与力量的衰减，导致功能性生活能力不可逆地丢失；到 85 岁时，有 25% 的老年人会陷入重度衰弱，无法在日常生活中独立自理，而这是她行医理念中绝不容许发生的情形。 - **脆弱线阈值**：维持在家庭中独立生活的最低有氧代偿门槛，男性约为 18 ml/(kg·min)，女性约为 16 ml/(kg·min)。 - **年轻时的储备**：人体 VO2 Max 随年龄逐年退化，唯有在年轻和中年时期通过科学测试与高强度训练将摄氧峰值拉得足够高，晚年跌落至脆弱线之下的风险才会被彻底杜绝。 ### [02:00:07](https://www.youtube.com/watch?v=D6wTuogebU8&t=7207s) 最大摄氧量（VO2 Max）与远离“虚弱线”的抗衰法则 最大摄氧量（VO2 Max）衡量的是心血管系统将氧气从血液有效交换至肺部并输送给肌肉组织的综合能力。冯达·赖特（Dr. Vonda Wright）指出，顶尖精英耐力运动员（如环法自行车赛选手）的 VO2 Max 通常远超 75，是生理基因层面的极致标杆。对普通人而言，同年龄段处于第 50 百分位数的健康基准因性别与年龄而异：30 多岁的男性约为 55，而步入中老年的女性基准约在 31 左右。如果放任不管，人体每经历一个十年，VO2 Max 就会自然流失约 10%，这是衰老的客观规律。 赖特医生以自身经历阐明了为什么早期的心肺储备是防范老年失能的“终极护城河”。如果平时严重缺乏锻炼，重新开始训练时摄氧量的提升幅度（Delta）反而更加显著；而长期保持巅峰状态的人，因起点本就处于高位，提升的边际空间会相对收窄。赖特在 50 岁时测得的 VO2 Max 为 45，即便任由其按每十年递减 10% 的自然速度衰退，她在 60 岁时仍有 40，70 岁有 35，80 岁有 25，到了 90 岁依然维持在 20 左右。这个数值始终稳稳高过导致生活无法自理的“虚弱线”（Frailty line），这意味着她在 90 岁高龄时依然可以独立生活。 ```mermaid flowchart LR accTitle: VO2 Max衰退轨迹与虚弱线对比 accDescr: 展示从50岁高储备出发，即便每十年下降10%，至90岁依然高于无法自理的虚弱线。 subgraph AgingReserve["心肺储备十年递减模型（每10年降10%）"] A["50岁储备<br/>VO2 Max: 45"] --> B["60岁储备<br/>VO2 Max: 40"] B --> C["70岁储备<br/>VO2 Max: 35"] C --> D["80岁储备<br/>VO2 Max: 25"] D --> E["90岁储备<br/>VO2 Max: 20"] end subgraph FrailtyThreshold["自理门槛"] F["失能与虚弱警戒线<br/>(Frailty Line)"] end E -.->|"显著高于门槛"| F ``` 为了不仅守住底线，更能主动拓宽安全冗余，赖特医生在日常既有的健康生活方式之上，额外叠加了高强度的 VO2 Max 间歇训练。这种心肺强化手段被称为“近乎折磨的 4x4 间歇法”： - **极限冲刺**：竭尽全力维持 4 分钟高强度输出，让心率逼近极限； - **主动恢复**：严格控制在 4 分钟的主动休息或慢速恢复； - **训练频次**：每周仅需重复该循环 3 至 4 次（单次总耗时不到半小时），就足以给心肺产生强烈的超量代偿刺激； - **分层策略**：此类高强度间歇属于健康金字塔顶层的“强化补丁”，应建立在先期完成基础体态、力量和营养优化的基石之上。 --- ### [02:02:22](https://www.youtube.com/watch?v=D6wTuogebU8&t=7342s) 自律公式：找到无法动摇的“Why”与消除行为阻力 面对严苛的训练要求，史蒂文·巴特利特（Steven Bartlett）坦言这彻底颠覆了他对走进健身房的认知——关键不在于动作本身，而在于“为什么要做”（The Why）。史蒂文回顾了自己在《极简商业进化论》（The Diary of a CEO 著作）中总结的“自律方程”（Discipline Equation）。人们总在某些习惯上陷入反复放弃的“溜溜球效应”，却能将另一些习惯牢固保持数年，其底层逻辑完全取决于三大核心变量的博弈：目标意愿的强度（Why）、在追求过程中的即时心理愉悦感（Enjoyment），以及执行该行为时所承受的摩擦阻力（Friction）。 当目标变得具体而充满情感羁绊时，行动的内在推力将被成倍放大。例如赖特医生设定了“97 岁时依然体魄强健”的愿景，并将这一目标直接与陪伴女儿深度绑定；而外在阻力则往往表现为距离过远、训练耗时过长，或是身材欠佳者走进充斥着俊男靓女的健身房时所面临的社交尴尬与容貌焦虑。要让健康习惯真正扎根，最有效的方式便是无限压缩一切可能诱发逃避的现实阻力，同时不断强化心理层面的认同感。 史蒂文分享了自己人生转折的亲身经历：在 2020 年疫情暴发之前，他在力量训练和健身房打卡上是一个极其不稳定的“溜溜球式”健身者。然而在疫情封控期间，屏幕上不断更新的数据让他猛然惊醒——面对病毒冲击，个体预后结局的真正分水岭正是其“原发基础健康状况”。那一刻他深刻意识到，健康并非悬挂在生活边角的选修课，而是承载事业、爱犬、伴侣以及家庭所有意义的底层地基；健康一旦坍塌，其他一切追求皆无从谈起。这一顿悟让锻炼彻底变成了他生活中不可妥协（Non-negotiable）的绝对优先级。 --- ### [02:04:30](https://www.youtube.com/watch?v=D6wTuogebU8&t=7470s) 终极拷问：57岁跳出体制温床的巨大冒险 在节目的闭幕传统环节中，史蒂文拿出了上一位匿名嘉宾留下的手写问题：“你上一次冒着巨大的不适去冒险是什么时候？最终带来了什么结果？” 赖特医生坦诚地分享了自己人生下半场最惊心动魄的一次跃迁。在此之前，她的身份始终是一名顶尖的学术型骨科外科医生（Academic Orthopedic Surgeon）。在大型医疗联合体与公立医院系统中工作，宛如生活在一张巨大的安全网内，她将自己当时的身份定义为“体制内创业者”（Intrapreneur）——运用医院系统的资金、品牌与平台去拓展巨大的诊疗业务。然而在三年前，当时已经 57 岁的赖特做出了一个在常人看来不可思议的决定：彻底告别深耕数十年的体制舒适圈，由自负盈亏的创业心态主导，全额自掏腰包开创属于自己的独立私人诊所，并全力打造关于精准长寿医疗（Precision Longevity）与主题演讲的个人商业版图。 对于一个一生职业履历中只见过 W-2 雇员纳税单的传统外科医生来说，在接近六十岁的高龄押上个人与家庭的积蓄自主创业，是一场承受极高心理压力的巨大冒险。但支撑她跨出这一步的，是对自身专业素养与工作伦理的绝对自信：“即便创业初期需要我去星巴克端咖啡来填补收入缺口，我也坚信自己一定能把这件事做成。”这种摆脱体制庇护、将毕生所学全权交由自己支配的转变，赋予了她前所未有的自由感与生命力。 史蒂文在结语中对此表达了极高的敬意。他指出，赖特医生的独立探索不仅取得了商业与学术上的巨大成功，更重要的是，她在线上线下凝聚了数以百万计的追随者。衰老过程中最致命的阻碍往往不是身体机能的滑坡，而是一种认为“衰老必然伴随衰弱和病痛”的**思想病毒（Mind Virus）**。赖特医生的实践与科普正在以充满建设性、乐观与希望的全新认知，系统性地替换掉那些让大众自我设限的陈旧观念，真正重塑了人们对待生命后半程的姿态。 ## Notable quotes > [02:18](https://www.youtube.com/watch?v=D6wTuogebU8&t=138s) 彻底改变这个国家乃至整个世界对衰老的认知 — 冯达·赖特医生 > [20:29](https://www.youtube.com/watch?v=D6wTuogebU8&t=1229s) 史蒂文，你要是来我家，我根本不在乎窗帘长什么样，也懒得去买红底高跟鞋——哪怕我完全买得起。因为在23岁时，那种生死考验让我明白，人本身才是唯一值得为之奋斗、值得去拯救的存在。 — 冯达·赖特医生 > [27:10](https://www.youtube.com/watch?v=D6wTuogebU8&t=1630s) 如果你选择在余生保持久坐不动，那么你在30岁时就已经耗尽了肌肉与骨骼生长的巅峰红利，之后的一生都只是在坐吃山空、持续消耗。 — 冯达·赖特医生 > [36:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=2197s) 在你的整个人生中，无论处于哪个年龄段、哪个节点，你的身体都永远不会停止对你所施加的良性压力做出响应。 — 冯达·赖特医生 > [01:00:37](https://www.youtube.com/watch?v=D6wTuogebU8&t=3637s) 我也和所有人一样爱美，很在乎衣服穿在身上合不合身，而肌肉就是大自然的‘塑身衣’。即使你的体重更重，但你的身体更加紧实，穿衣服更好看，整个人状态也更出色。决定体态的从来不是体重，而是身体成分。 — 冯达·赖特医生 > [01:02:48](https://www.youtube.com/watch?v=D6wTuogebU8&t=3768s) 如果我现在继续坐在沙发上无所作为，今天就是我余生中最强壮的一天。 — 冯达·赖特医生 > [01:07:50](https://www.youtube.com/watch?v=D6wTuogebU8&t=4070s) 这本质上就是在将你体内的蛋白质焦糖化。就好像你把一块牛排扔在烤架上烤得太久，表面结成焦糖硬壳一样。这种蛋白质变性状态在体内具有高度破坏性，会诱发剧烈的全身性炎症反应，而慢性低度炎症正是各类慢性致命疾病的温床。 — 冯达·赖特医生 > [01:34:05](https://www.youtube.com/watch?v=D6wTuogebU8&t=5645s) 衰老就是对舒适的迅速追逐 — 史蒂芬·巴特利特 > [02:04:30](https://www.youtube.com/watch?v=D6wTuogebU8&t=7470s) 即便创业初期需要我去星巴克端咖啡来填补收入缺口，我也坚信自己一定能把这件事做成。 — 冯达·赖特医生 ## Mentioned 冯达·赖特 (Dr. Vonda Wright), 史蒂芬·巴特利特 (Steven Bartlett), 《CEO日记》 (The Diary Of A CEO), 《40岁后的体能》 (Fitness After 40), 《极简商业进化论》, 惠顿学院 (Wheaton College), 拉什大学 (Rush University), 拉什癌症研究所 (Rush Cancer Institute), 芝加哥大学医学院 (University of Chicago Pritzker School of Medicine), 美国国家卫生研究院 (NIH), 健康 ABC 研究 (Health ABC Study), 克里斯蒂亚诺·罗纳尔多 (Cristiano Ronaldo), 汤姆·布雷迪 (Tom Brady), 达拉·托雷斯 (Dara Torres), 迈克尔·菲尔普斯 (Michael Phelps), 匹兹堡企鹅队 (Pittsburgh Penguins), UPMC 勒米厄体育综合中心 (UPMC Lemieux Sports Complex), Whoop, 密苏里大学哥伦比亚分校, 哈扎部落 (Hadza tribe), 特种外科医院 (Hospital for Special Surgery), 妇女健康倡议 (Women's Health Initiative, WHI), 伊尼戈·圣米兰 (Iñigo San Millán), 法布里齐娅·安布罗西奥博士 (Dr. Fabrisia Ambrosio), 全美高级运动会 (National Senior Games), 《龙穴》 (Dragon's Den), Klotho 蛋白, DEXA 骨密度扫描, FRAX 骨折风险评估工具 ## Video description Are humans destined to grow old and frail? With these ultimate ageing hacks you gain turn back the clock and transform your life Dr Vonda Wright is an orthopaedic sports medicine surgeon and host of the health and fitness podcast, ‘HOT for Your Health’. She is also the author of books such as, ‘Dr. Wright’s Guide to THRIVE’, ‘Fitness After 40’, and ‘Younger in 8 Weeks’. 0:00 Intro 02:18 I Want Everyone To Have A Healthy Ageing Process 05:50 Your Ageing Mindset Is The Cause Of Your Health Decline 08:05 This Is When You’ll Start Having Life-Threatening Diseases 10:50 What's Your Academic Background 11:57 What's Orthopedic Surgery? 13:20 The Importance Of Healthy Mind During An Injury Recovery 16:53 Taking Care Of The Whole Person Not Just Their Disease 22:47 How I Changed My View On Death 24:51 Extending Your Health Span 27:10 Why You Need To Look After Your Bones & Muscles At 30-40s 30:47 What's Lean Muscle Mass? 36:44 What's The Best Exercise Regime To Stay Young 41:12 The Importance Of Strong Muscles When Old 42:28 The Sedentary Death Syndrome 44:27 80% Of The Population Will Have Back Problems 46:51 How To Avoid Future Body Aches 47:57 What To Do About Body Stiffness 49:33 What's Static Stretching? 52:31 Can We Revert Joint Pain? 54:54 Don't Do This When You Exercise! 01:00:07 Losing Abdominal Fat 01:02:48 Can We Get As In Shape As When We Were 25? 01:05:43 How Cristiano Ronaldo Stays That Fit & Healthy 01:07:50 Sugar Impact On Our Body 01:10:57 How To Apply All These Knowledge To One's Self 01:16:04 Vitamin D Supplements 01:18:58 Strengthening Our Bone Structure 01:22:33 What To Do If You Have Weak Bones? 01:23:32 Our Biology Is Ticking Over 01:31:29 Findings About Muscles 01:34:05 Comfort Is Making Us Age 01:37:09 How Does Menopause Affect Our Musculoskeletal Functioning 01:39:18 What Is Menopause? 01:49:32 How To Keep Healthy And Strong 01:56:08 What Makes Your Glucose Spike? 01:57:09 What's A Simple Carb? 01:59:50 The Importance Of A Good VO2 Max 02:02:22 Last Guest Question Follow Dr Vonda: Instagram - https://g2ul0.app.link/VlYN04wVkLb Twitter - https://g2ul0.app.link/dm1pZ5yVkLb You can purchase Dr Vonda’s book, ‘Fitness After 40: Your Strong Body at 40, 50, 60, and Beyond’, here: https://amzn.to/3S9xbCk Learn more about the studies mentioned, here: https://g2ul0.app.link/F7QqG7WDhLb You can purchase the The Diary Of A CEO Conversation Cards: Second Edition, here: https://g2ul0.app.link/f31dsUttKKb Follow me: https://g2ul0.app.link/gnGqL4IsKKb Sponsors: Linkedin Ads: https://www.linkedin.com/doac24 [Source](https://www.youtube.com/watch?v=D6wTuogebU8)

[2:18] 冯达·赖特医生: 彻底改变这个国家乃至整个世界对衰老的认知 [20:29] 冯达·赖特医生: 史蒂文，你要是来我家，我根本不在乎窗帘长什么样，也懒得去买红底高跟鞋——哪怕我完全买得起。因为在23岁时，那种生死考验让我明白，人本身才是唯一值得为之奋斗、值得去拯救的存在。 [27:10] 冯达·赖特医生: 如果你选择在余生保持久坐不动，那么你在30岁时就已经耗尽了肌肉与骨骼生长的巅峰红利，之后的一生都只是在坐吃山空、持续消耗。 [36:37] 冯达·赖特医生: 在你的整个人生中，无论处于哪个年龄段、哪个节点，你的身体都永远不会停止对你所施加的良性压力做出响应。 [60:37] 冯达·赖特医生: 我也和所有人一样爱美，很在乎衣服穿在身上合不合身，而肌肉就是大自然的‘塑身衣’。即使你的体重更重，但你的身体更加紧实，穿衣服更好看，整个人状态也更出色。决定体态的从来不是体重，而是身体成分。 [62:48] 冯达·赖特医生: 如果我现在继续坐在沙发上无所作为，今天就是我余生中最强壮的一天。 [67:50] 冯达·赖特医生: 这本质上就是在将你体内的蛋白质焦糖化。就好像你把一块牛排扔在烤架上烤得太久，表面结成焦糖硬壳一样。这种蛋白质变性状态在体内具有高度破坏性，会诱发剧烈的全身性炎症反应，而慢性低度炎症正是各类慢性致命疾病的温床。 [94:05] 史蒂芬·巴特利特: 衰老就是对舒适的迅速追逐 [124:30] 冯达·赖特医生: 即便创业初期需要我去星巴克端咖啡来填补收入缺口，我也坚信自己一定能把这件事做成。

[8:05] Dr. Vonda Wright: Between 40 and 63, you have time to course correct. But if you decide at 63 to pay attention, it is much, much, much harder. [17:01] Dr. Vonda Wright: I think that this unrelenting need to take care of the whole person has to have come from my time as a cancer nurse. [17:01] Dr. Vonda Wright: I don't know how at 23 years old for that not to impact what I care about in life... that kind of life and death made me decide that people were worth working for and worth saving. [17:01] Dr. Vonda Wright: For me, it's not just the cool new technique I did on Wednesday in the OR. It's taking care of that whole person through the whole journey for the next 9 months. [22:47] Dr. Vonda Wright: We're all going to die, Steven. How rapidly we get there can change. How we arrive there can change... I don't view it as something to run away from at all. [22:47] Dr. Vonda Wright: In some of my patients' circumstances, or even as an orthopedic surgeon in some of the traumas I've been involved in, I think death can be kindness. And death can be done with extreme dignity. [22:47] Dr. Vonda Wright: What happens if we live so long in our quest for longevity that everybody we love or raised has already gone before us? [24:51] Dr. Vonda Wright: I call between mid 30s to mid 40s with 40 being the center of that: the critical decade. [24:51] Dr. Vonda Wright: At 30, the literature says we've probably maxed our bone out. We've probably maxed our muscle out... unless we really invest in growing more muscle the rest of our lives... you're using it the rest of your life. [30:47] Dr. Vonda Wright: We have 650 skeletal muscles. It is the reason you move... Muscle is not only important for locomotion, but it's very metabolically active. [50:32] Dr. Vonda Wright: I find many people asking me, 'I do Pilates and yoga. Is that enough for me?' And I say, 'That's great, but it's never going to be enough.' [51:59] Dr. Vonda Wright: We only get one set of cartilage for a lifetime [118:54] Dr. Vonda Wright: 25% of all people are frail and unable to live independently by the time they're 85. Not on my watch. [124:30] Dr. Vonda Wright: At 57, to go out and create my own business when all I have ever known is a W-2 tax form, is a huge risk for me and my family. But... I am confident enough in my own capacity... that even if I had to go work at Starbucks to bridge the gap, that I'm going to make this work.

[0:00] Do you only have to do that for 30 [0:01] seconds? That will burn 40% more fat [0:04] than even high-intensity interval [0:06] training. [0:07] Really? [0:07] So, it begins with [0:09] Dr. Vonda Wright is a renowned [0:11] orthopedic surgeon and a pioneering [0:12] researcher in mobility and aging. [0:14] Through simple methods, she enables [0:16] people to maintain their strength all [0:17] the way through till their later life. [0:19] We have no excuse until our mid-70s for [0:22] slowing down. These are MRI slices of a [0:25] 40-year-old athlete. We have beautiful [0:28] muscle architecture, but if we sit [0:30] around for 35 years and have a desk job [0:33] and we don't go move our muscles, this [0:34] is what happens. [0:36] Jesus. My god. [0:37] But, this is a 74-year-old who had just [0:39] invested in their mobility four to five [0:41] times a week. So, if you're an [0:43] 80-year-old consistently lifting [0:45] weights, you are functionally as strong [0:47] as a 60-year-old person who doesn't. [0:49] But, I worry about joint pain. Is joint [0:51] pain inevitable? [0:51] It is not, but one reason people have [0:54] pain is because of how much we weigh. [0:56] Small changes in our total body weight [0:59] can have profound effects on the joint [1:01] pain we feel. Let's say this rock is 1 [1:03] lb. If you gain 1 lb, you would think [1:06] that this is all the amount of pressure [1:08] you're going to feel, but because of the [1:09] mechanics, what you actually feel is the [1:12] weight of these bricks. [1:14] So, you think gaining 10 lb doesn't mean [1:16] much, but imagine gaining 100 lb of [1:18] pressure. So, how should you be [1:20] investing in your mobility every day? [1:22] There are four components that we should [1:23] try to find time for. Number one is [1:27] Quick one before we get back to this [1:28] episode. Just give me 30 seconds of your [1:30] time. [1:31] Two things I wanted to say. The first [1:32] thing is a huge thank you for listening [1:34] and tuning into the show week after [1:36] week. Means the world to all of us, and [1:37] this really is a dream that we [1:39] absolutely never had and couldn't have [1:41] imagined getting to this place. [1:43] But, secondly, it's a dream where we [1:44] feel like we're only just getting [1:45] started. And if you enjoy what we do [1:47] here, please join the 24% of people who [1:50] watch this channel regularly and have [1:52] hit the subscribe button. Means more [1:55] than I can say. And if you hit that [1:56] subscribe button, here's a promise I'm [1:58] going to make to you. I'm going to do [2:00] everything in my power to make this show [2:02] as good as I can now and into the [2:04] future. We're going to deliver the [2:05] guests that you want me to speak to, and [2:07] we're going to continue to keep doing [2:09] all of the things you love about this [2:10] show. [2:11] Thank you. Thank you so much. Back to [2:13] the episode. [2:17] Dr. Vonda Wright, you've been [2:20] treating patients, learning about [2:22] medicine, taking care of people, and [2:24] working in the industry you've worked in [2:26] for [2:27] almost 35 years now. [2:31] To do that, [2:32] Yes. [2:33] you must have a great deal of passion. [2:35] You must be on a bit of a mission. So, [2:37] my my first question to you is as you [2:39] sit here today, what is what is [2:41] occupying your your focus, your mind, [2:43] your passion? What is that when you wake [2:45] up in the morning and you think about [2:46] the work you're doing and why you're [2:47] doing it? What is the answer to that? [2:51] The answer to the question of why I wake [2:53] up every day and and rush into my work, [2:55] whether it's into the surgery or whether [2:58] it's into taking care of individuals or [3:00] writing, is because [3:03] I have been working under the mantra of [3:06] um I'm going to change the way we age in [3:09] this country or in this world. Because [3:11] when I started, there was this steadfast [3:15] belief. Doesn't The national zeitgeist [3:17] has changed now, but when I started, [3:18] there was this belief that aging was an [3:21] inevitable decline from the vitality of [3:24] youth down a slippery slope to frailty [3:26] where we would spend 20 years of our [3:28] lives dying, going to the doctor's [3:30] office every 3 years. And I never ever [3:34] believed that. I never believed it. And [3:36] maybe it was because [3:38] when I was a child, I lived at in the [3:40] '70s where you could just take your kid [3:42] with you to a race, and my dad would do [3:44] that. I mean, [3:45] he'd take me to a 5K and say, "Wait [3:47] here. I'll be back in 20 minutes." And I [3:49] would see people in their 50s and 60s [3:52] racing and they would be celebrated or [3:56] or maybe it's because I started as a [3:58] cancer nurse and I saw people [4:01] fighting every day for their lives and I [4:03] believed that that was not the destiny [4:06] that we were [4:08] that we were doomed to. So, [4:10] as I progressed through my career and I [4:12] started doing the research myself, I [4:15] realized that this myth we had in our [4:17] country that or all over the world that [4:20] aging had to be this inevitable decline [4:23] was based on population studies. And [4:26] what does that mean? Well, population [4:28] studies just look at a cohort of people [4:31] and see what happens over time. There's [4:33] a huge study [4:34] uh funded by the NIH in the United [4:37] States called the Health ABC for [4:39] instance and they looked at a population [4:41] of 70-year-olds and just followed them [4:43] over time. Well, what do we know about [4:45] populations of people? Well, what we [4:47] know is that up to 70% of them do not do [4:50] one extra step of mobility a day. So, [4:53] what we know about aging has been what [4:56] we know about sedentary living. [4:59] And so, I did not believe that we truly [5:02] understood how the trajectory of our [5:04] aging could be [5:06] for people who remained active across [5:09] the course of their lives. So, [5:12] my team and I did that original research [5:14] and we proved that you can be healthy, [5:17] vital, active, joyful long into the [5:19] foreseeable future much more than we [5:21] gave ourselves credit for. [5:24] And it drives me because even over all [5:26] these years, 35 years, 20 years of it as [5:28] an orthopedic surgeon, [5:30] it is only now [5:32] that people are beginning to pick up the [5:34] mantle of prevention and not only [5:37] disease care. [5:38] And so, sometimes I sit back and I [5:40] think, "Oh my god, you know, I've been [5:42] preparing for this time in the history [5:44] of people my whole career." So, I am [5:48] made for such a time as now. [5:50] So interesting cuz it's only in recent [5:52] times, I think from doing this podcast, [5:53] that I started to question the idea, the [5:55] sort of mind virus that even I had, that [5:57] once I get to a certain age, I just have [5:59] to kind of concede to the inevitable [6:01] decline. And it's only recently that I [6:03] thought, "Actually, there's a been a [6:04] couple of people that have came here and [6:05] told me about how to have that that [6:08] that's not the case. And actually, it is [6:09] a bit of a mind virus. [6:10] Mhm. [6:11] Like the virus of that belief, the [6:13] impact of that belief, is what causes [6:16] you to give up. [6:17] Yes. [6:18] uh [6:19] become frail and to stop moving and [6:21] those kinds of things. [6:22] Well, because with that, our brain tells [6:24] us, we know this, I've been you've had [6:26] many discussions about the connection [6:27] between our brain and our body. [6:30] Our brain will believe whatever we tell [6:31] it. And if our brain thinks that, oh, [6:34] sometime 63, a light bulb goes off and [6:38] we go from youthful vigor to aging and [6:40] decline, [6:42] well, then we start believing that about [6:44] ourselves. And [6:47] you know, there's a concept now that I [6:49] work with all the time [6:51] that really examines the difference [6:53] between life expectancy. In the UK, life [6:55] expectancy right now is 81. [6:58] Unfortunately, in the United States, [7:00] it's 77.6. From the from birth, babies [7:03] born now have a life expectancy of that [7:05] much. Our health expectancy, our health [7:08] span, [7:09] the amount of healthiness we have, [7:12] is only about 63. [7:14] So, that gives us a huge runway to [7:18] change the trajectory. And it also [7:22] tells us that we're not dying at 63. [7:26] We're dying on average at 81. So, we can [7:29] do everything we possibly can in those [7:31] 20 years. And we also know that 70 to 80 [7:35] to 90%, depending on who you believe, of [7:38] our health and aging is predetermined by [7:40] our lifestyle choices, not the genes we [7:43] inherit. So, my mother is very thankful [7:46] that I stopped blaming her for all the [7:49] health things that go on, but but each [7:51] and every person has the ability to live [7:54] outside of their genetic predisposition. [7:58] And that is a very hopeful message that [8:01] can pivot your mindset virus. [8:04] I I took the top sort of illnesses and [8:08] diseases, things like heart disease, [8:10] lung cancer, um I can't even pronounce [8:12] this one, chronic obstructive pulmonary [8:14] disease. [8:15] Yeah, COPD. [8:16] Strokes, lower lower respiratory [8:18] infections, Alzheimer's disease, type 2 [8:20] diabetes. [8:21] I can't pronounce this one either, [8:22] colorectal [8:24] cancers. [8:25] Colorectal cancers. [8:26] I nailed that. Breast cancer and [8:28] prostate cancer. And I got the average [8:30] ages that typical people typically get [8:32] them. Then I weighted it by the amount [8:35] of people that die [8:36] um from each of those diseases with [8:38] heart disease being the most popular. [8:39] Yeah, it did actually come up. I used [8:40] ChatGPT. I'm pretending I did this math [8:42] for myself. Uh it came up that 62.94 [8:45] years old chk is the exact age where [8:49] on average I'm going to get one of these [8:52] and I'm going to potentially die from [8:53] one of these. [8:54] Those are when they manifest. You may [8:56] have them before then. [8:58] to [8:58] Maybe you never knew it because I have [9:00] people who say to me when I ask them [9:02] their health history, "What medical [9:04] problems do you have?" And they're like, [9:05] "I don't have any." Only because they've [9:06] never been to a doctor. [9:08] Mhm. [9:08] Or maybe they've been diagnosed, but [9:10] they haven't gotten so bad that they're [9:12] not spending 3 days a week in the [9:14] doctor's office. Or maybe they are they [9:16] are sick. Those three categories, right? [9:18] But your ChatGPT data is correct that [9:22] that is when it shows up. And [9:25] what does that correspond to? That [9:27] corresponds to when the average person [9:29] retires. [9:31] So, just when you start thinking you [9:33] have time to live the life that you [9:36] envision, [9:37] you're saddled with health problems that [9:39] you have not taken care of. But [9:41] but think about it this way. Talking [9:43] about this mind virus and how we need to [9:45] change it, [9:47] um we can talk about this, but I think [9:49] that 40 is the most remarkable decade of [9:52] a person's life and it's also [9:55] the time to adult or get your proverbial [9:58] expletive together. It's time to get it [10:00] together from a health perspective. [10:03] Well, [10:04] between 40 if you're just noticing your [10:06] health at that time because maybe you've [10:07] been working so hard and you never [10:09] noticed it before you're raising other [10:11] people or whatever the circumstances [10:13] are. [10:14] Between 40 and 63, you have time to [10:17] course correct. [10:19] But if you decide at 63 [10:23] to pay attention, [10:25] it is much much much harder. And so, you [10:28] know, part of my mission, you asked me [10:30] why I wake up every morning to change [10:32] the way we age in this country, is to [10:35] not only take care of people in my [10:37] demographic, my middle-aged demographic, [10:39] but to really get to my millennial [10:41] children and my millennial nieces and [10:43] nephews to say, you have such control of [10:46] your health if you just look up and pay [10:48] attention. [10:50] What's your academic education? Can you [10:52] run me through your sort of [10:53] qualifications and how that pivoted and [10:54] turned uh throughout your career? [10:56] Sure. [10:57] I have a degree in biology [10:59] uh from Wheaton College and then [11:01] immediately after that uh there was such [11:04] a shortage of nurses that they the Rush [11:07] University said, [11:09] "If you have a good bachelor's degree, [11:11] come. We'll give We'll train you in [11:13] another bachelor's degree in nursing and [11:15] a master's degree in 3 years." So, I [11:16] did. And with that, I went and took care [11:20] of people with cancer and ran the Rush [11:22] Cancer Institute with the physician that [11:25] was there at the time. And then at 28, I [11:27] decided to that [11:30] through a series of decisions, we can [11:31] talk about that [11:33] um I wanted to do great research, but I [11:35] still needed to take care of people [11:37] because it is in my heart and soul to do [11:38] that. And so I went back to medical [11:40] school at the University of Chicago at [11:42] 28 only to choose the longest possible [11:46] road, which is orthopedic surgery, which [11:48] is an additional 11 years because it's 4 [11:51] years of medical school, 6 years of [11:53] residency, a year of fellowship and then [11:56] I finally emerged. [11:57] What is orthopedic surgery? [11:59] Oh. [12:00] Explain like I'm a 10-year-old. [12:01] so [12:02] orthopedic surgery is the lifetime care [12:05] of the musculoskeletal system. So, what [12:08] that includes is bones tendons, [12:10] ligaments muscle, adipose tissue. It's [12:15] the joints the from the spine to the [12:18] shoulders, hips, the knees. It's [12:20] everything from cancer care of those [12:22] organs through [12:25] each one of those has a subspecialty, [12:27] hand, uh foot. [12:30] Sports. I'm a sports surgeon, so I'm [12:31] trained in shoulder, hip, and knee [12:33] arthroscopy. [12:35] Meaning I do very big surgery through [12:37] very small apertures uh for athletes and [12:40] active people. Um but this fun [12:43] orthopedic sports career I've had of [12:46] taking care of active people and [12:48] athletes of all ages and skill levels [12:51] extends outside of the operating suite, [12:54] right? I have [12:56] I take care of the whole person, which [12:58] is unusual for an orthopedic surgeon. [13:00] Usually [13:01] orthopedic surgeons are very [13:02] procedurally driven, but I am whole [13:04] person driven. And I think that stems [13:07] from [13:08] at 23 years old taking care of people's [13:11] in the fight of their lives [13:13] knowing that their whole lives are worth [13:14] taking care of not just pushing chemo in [13:17] the middle of the night. [13:19] When you say you focus on the whole [13:21] person, can you help me understand that? [13:23] Cuz I think on one end of that spectrum [13:25] is doing the surgery [13:27] Yes. [13:27] which you do. [13:28] Mhm. [13:28] And then is the other end of that [13:29] spectrum thinking about their I guess [13:32] their psychology, their emotions, their [13:34] how they're feeling, what's [13:35] give you a few examples. So, if you're a [13:37] uh you think of a sports surgeon taking [13:39] care of young athletes. So, [13:41] if I have a young athlete come in who I [13:43] have I'll give you an example of a real [13:45] person. He's 19. He has been an athlete [13:48] his entire life and just and been great [13:50] at it, right? But never been hurt. Had [13:51] the great fortune of never being hurt [13:53] until he stepped wrong. He got slide [13:56] tackled on the football field and he [13:58] blew out his knee. And his family was [14:00] moving, so he didn't get immediate care [14:02] like he could have had he been in his [14:03] own town. So, weeks later he shows up to [14:06] me with a knee that's completely [14:07] non-functioning. This child, who's a [14:09] 19-year-old man, is panicking in his [14:12] brain. He doesn't know why he's in so [14:14] much pain, why his knee won't work. Um [14:17] psychosocially, his family is in [14:19] transition. They don't have any of the [14:21] support system and he no longer has his [14:23] own team. So, that young man is dealing [14:26] not only with the physical pain of [14:28] injury. [14:30] He's dealing with the psychological [14:32] anxiety of oh my god, oh my god, oh my [14:34] god, what just happened to my knee? Will [14:35] I ever play again? And they're dealing [14:37] with the social aspects of here's a [14:39] family without social support. So, as a [14:42] whole person doctor, [14:45] realize severely in this family not no [14:47] not only is there sports surgeon, you [14:50] have an ACL tear, your meniscus torn. [14:52] Here's how I'm going to fix it. Here's [14:54] what we need to do before then. Here's [14:56] the technical aspects of the surgery, [14:58] but how much protein are you eating [15:00] because I need your body in tip-top [15:02] shape to heal. So, I talk to my patients [15:04] about their nutrition as well as their [15:07] surgical. But then from the perspective [15:10] of [15:12] I too am a mother with a lot of children [15:14] thinking of myself, how am I going to [15:15] meet the needs of my child? Thinking of [15:18] the mother, she has no resources in this [15:19] town. She just moved here, right? Trying [15:22] to set them up with the [15:24] the other people they will need [15:27] to be surrounded with care. [15:29] And that approach to this individual [15:31] family is exactly [15:34] the surrounding them with care approach [15:36] we take with professional athletes. [15:38] There is not one thing that is left [15:40] unturned for a professional athlete. We [15:42] take care of them from the minute they [15:44] wake up to the minute they go to bed and [15:46] their family needs. So, this whole [15:49] person care extends all the way across [15:53] all types of people. [15:55] For a woman, for instance, who comes [15:56] with a which is so typical for midlife [15:59] women to come in with an inflamed [16:01] shoulder, a frozen shoulder, she'll come [16:03] in because her shoulder no longer moves. [16:06] But, knowing what I know about the life [16:08] cycle of a woman and what happens in [16:11] midlife, [16:12] before I even address the shoulder, [16:17] because [16:20] sometimes they come in saying to me [16:21] without any prompting, "I think I'm [16:24] falling apart and [16:26] sometimes I think I'm going crazy cuz I [16:28] didn't do anything to my shoulder, [16:29] right?" When they say that to me, [16:32] we immediately start talking about, [16:33] "Well, how are you sleeping? [16:35] Are you having any hot flashes, night [16:37] sweats?" So so that I address them as a [16:39] midlife woman who's lost her estrogen, [16:41] not just as a shoulder that doesn't work [16:43] because for me that's pretty cut and [16:44] dry. It's the rest of it that truly is [16:48] taking care of the whole person. [16:50] So, that's what it means to me. [16:51] Mhm. [16:53] It's um it's personal to you, isn't it? [16:55] I I feel like you have a great deal of [16:57] empathy. I can feel it on your on the [16:59] surface of you. I can see it in your [17:00] face. [17:00] Yeah. [17:01] Where does that come from? [17:02] Mhm. [17:04] You know, I think I think that I'm a [17:07] much better Listen, you make people cry [17:09] on this podcast and I think you're going [17:10] to make me cry and I don't mean to, but [17:13] that kind of question, [17:15] I think [17:16] that this [17:19] unrelenting need to take care of the [17:22] whole person has to have come [17:25] from my time as a cancer nurse. [17:27] Because I was only I was only 22 22 to [17:31] 28. I was a cancer nurse and imagine [17:34] what it's like to be so impressionable, [17:36] right? You I got all this education but [17:38] in the middle so my job was [17:41] giving chemotherapy to people [17:43] who were in the struggle of their life [17:45] and I'm 23 years old. And chemo is [17:47] pushed in the middle of the night. And [17:49] at the time in the 90s we did something [17:52] called primary nursing which means every [17:55] time that person came in if you would [17:57] have come in I would have been your [17:58] nurse every time you're in the hospital [18:01] every month for 6 months. So the kind of [18:04] therapeutic relationship you develop [18:07] is meaningful. And so I was 23 years old [18:10] 23 to 28 the formative times of how I [18:13] built my perspective on the world and [18:15] I'll never forget. [18:17] This is the one story there's so many [18:19] stories like this but this is the one [18:20] story that answers that question I think [18:22] why is this is personal to me. [18:25] So I'm taking care of this woman and you [18:28] know many many of the people I took care [18:31] of won their battles. You know they I [18:33] was with them for 6 months every night [18:36] so some nights [18:38] because people just want to feel normal [18:40] I'm giving them their chemo they're [18:41] watching TV and buying stuff online on [18:43] the TV and I'm like why are you doing [18:45] all this because they just want to feel [18:46] like themselves, right? [18:48] And many many people successfully walked [18:50] out and forgot forgot our names, right? [18:52] But not everybody did and so this one [18:54] family [18:57] she had been with us for 6 months and [19:00] I don't know if you've ever been around [19:01] people who are losing [19:03] their battle with an illness or are are [19:06] are living the last days of their lives [19:08] but you can tell it's coming just [19:11] by the way they breathe. It is true [19:13] people rally right before they die and [19:15] so I knew this woman's time [19:18] was coming, but she had the most [19:19] faithful family, Steven. Her family came [19:22] every single day and she had a big [19:24] family and we knew they were coming, [19:27] they were kind of loud and and we loved [19:30] having them here, but the night that [19:33] answers this question, I knew it was [19:35] going to be her last night. You can [19:37] always tell and it was just she and I [19:39] and the [19:40] the light in a hospital room, there's a [19:42] light over the bed and then the bed, so [19:44] there's this light behind her [19:46] and she's breathing in an agonal way, [19:48] but I can tell that she's waiting. She [19:50] knows her family's going to come the [19:51] next morning. [19:54] So we make it through the night. It's [19:55] just she and I and and in the morning in [19:58] this hospital in Chicago, there's a a [20:01] window at the end of the hallway that [20:03] faces Lake Michigan and the light starts [20:05] coming in. The floor lights up again [20:07] and that's starting to happen. It's [20:09] about 7:00 and I hear the elevator bing [20:13] and it was her family coming, so I step [20:15] out into the hallway and this one was [20:17] different. [20:18] They always came together every day, but [20:20] this time [20:22] her sister was dressed in her wedding [20:23] gown and the whole family with it was in [20:25] their tuxedos cuz her sister was going [20:27] to get married that day and they wanted [20:29] her to be part of that, even though [20:31] there was no way she was ever going to [20:33] be part of that. So I I'm 23 years old. [20:36] I'm standing in the doorway. My patient [20:38] is over here. Her family is coming [20:40] towards me [20:41] and [20:43] that indelibly [20:45] seared in me [20:46] the the balance between life and death, [20:49] the woman [20:50] who is not going to continue her journey [20:52] and her sister who's beginning her [20:54] journey and I don't know how at 23 years [20:57] old for that not to impact what I care [20:59] about in life. Steven, if you come to my [21:01] house, I don't give a rat's ass about my [21:04] curtains or buying the shoes with the [21:07] red soles, even though I can, [21:10] but [21:10] at 23, that kind of life and death made [21:13] me decide that people were worth [21:16] working for [21:17] and worth saving. [21:20] And so, [21:21] she had waited for them [21:23] to come to her that day so she could [21:25] share [21:26] in the last family time they were going [21:28] to have together. [21:29] And I don't think you come out of a [21:31] situation like that without your whole [21:32] life perspective being different. [21:35] And so, even though, you know, I'm a I'm [21:36] a sports doctor now, how is that [21:39] remotely as hard as being a cancer [21:42] nurse? I'm a much better doctor now than [21:44] I would have ever been had I gone [21:46] straight into medicine. [21:49] What is the the perspective it's given [21:50] you, specifically that then translates [21:53] to being an even better sports doctor? [21:54] How does it change how you view death? [21:56] that I can't view the procedure as just [21:58] putting screws in the ACL. Or what? I [22:01] tried out a new ACL procedure last week. [22:03] It was fascinating. But, sometimes that [22:07] is the beginning and the end. [22:09] That's not the beginning and the end for [22:10] me. [22:12] How this kid, it was this 19-year-old [22:13] kid, how this kid is going to recover in [22:16] 6 to 9 months and go back to living the [22:18] life he envisions, how he's not going to [22:20] feel abandoned by the sport that he [22:23] loved, or [22:25] how am I going to help him find a new [22:26] team because sport is not only an [22:29] individual thing, it's an entire [22:31] environment. It's the It's the the [22:33] society the kid lives in. So, for me, [22:35] it's not just the cool new technique I [22:38] did on Wednesday in the OR. It's taking [22:41] care of that whole person through the [22:43] whole journey for the next 9 months. [22:47] The lady that you were taking care of [22:48] when you were 23 years old, has that [22:50] impacted what how you view [22:53] death? [22:54] Yeah. [22:56] It has. [22:57] I view death. [23:01] We're all going to die, Steven. [23:04] How rapidly we get there can change. How [23:06] we arrive there can change. [23:09] How we feel about our life can change. [23:12] But we're all going to get there. [23:14] So, I don't [23:16] I don't view it as something to run away [23:19] from at all. In fact, in some [23:21] circumstances, in some of my patients' [23:24] circumstances, or even as an orthopedic [23:26] surgeon in some of the traumas I've been [23:27] involved in, I think death can be [23:29] kindness. [23:31] And death can be done with extreme [23:33] dignity. [23:35] I don't think it's always the enemy. [23:39] Mhm. [23:39] One of the things that I think is is [23:41] also [23:42] um really sort of front of mind in that [23:44] image of the lady in the in the bed when [23:46] her sister arrives in the wedding dress [23:47] is that she had friends and family [23:49] there. [23:50] Oh my goodness. [23:50] And a lot of people, you know, [23:52] Right. [23:52] there's so much beauty in that moment [23:54] regardless of the the um the reality of [23:56] what's going on there, that she's losing [23:57] her life, but she's losing it surrounded [23:59] by [23:59] Yeah. [24:00] a group of people that love her, and I [24:01] think for many of us, I think I actually [24:03] had a conversation with a good friend [24:04] the other day, and their their biggest [24:05] fear in life is that they'll actually [24:07] end up aging and dying alone because [24:09] they don't have children yet, and they [24:11] don't have children at all. They made [24:12] the decision not to have children. Um [24:14] they don't have siblings, so [24:16] you know, if [24:17] I'm not scared of death. I'd like to [24:19] extend my health span, but um when I do [24:21] die, I'd like to have people around me [24:23] that uh love me, and that's one of the [24:25] things that I think she she clearly had. [24:27] Yeah, she she did. [24:29] It's funny you mention that. I think [24:30] about that. What happens if we live so [24:32] long in our quest for longevity that [24:35] everybody we love or raised has already [24:37] gone before us, and I don't know. What [24:38] do I do? Do I hire the girl next door to [24:41] sit with me, take me to my doctor's [24:43] appointments? Yeah, I don't know what to [24:44] do. [24:45] probably pay a few people to [24:46] bit of planning. [24:47] It takes a little bit of planning. [24:50] So, if we if we talk then about this [24:52] health span issue and your central [24:53] mission that you described at the start, [24:55] usually when I have these conversations, [24:56] I try and hazard a guess where I should [24:58] begin, but actually I want you to tell [25:00] me where we should be beginning. If [25:02] we're talking about extending our health [25:04] span, where where does that begin? Where [25:06] do we need to start this conversation? [25:08] That begins when your parents are [25:09] raising you and they have the choice of [25:12] teaching you how to eat, teaching you [25:15] I'm old enough that literally I got a [25:18] cell phone at 38. So this is not a [25:20] problem with me growing up, but there's [25:21] a problem now where we don't send kids [25:23] out due to safety and digital to just go [25:26] play and don't come in until dinner. [25:27] That was a real thing when I was growing [25:29] up. And so what we know is [25:32] children's [25:34] mitochondrial load, meaning how many of [25:36] our powerhouse mitochondria metabolic [25:40] kingpins [25:42] are really predetermined by how active [25:44] we are as a child. So it's really a [25:47] concern for those of us interested in [25:49] metabolic health is what are we doing [25:52] when we raise our children to sit around [25:54] for the first 10 years of our of their [25:55] lives when they're really made to run [25:57] around, right? So it begins with what we [26:00] teach our children and I think I hear [26:03] parents a lot of times saying, oh my kid [26:06] won't eat this or that or I can't get [26:08] them to do anything and I'm not scolding [26:10] them when I respond in the way I'm about [26:12] to respond to you. I get it. I'm the [26:14] mother of a blended family of six [26:15] children and you can't always make your [26:18] children do things, but here's what I [26:19] know. Children learn from what they see. [26:23] My children were foam rolling with us. [26:25] They learned to eat vegetables or they [26:27] didn't get up from the table or they [26:29] learn what we teach them. So the time to [26:31] begin is when [26:34] our children are little. Some would say [26:36] the time to begin is in utero, which is [26:38] frightening cuz I might have done things [26:40] differently during my pregnancy, but [26:43] when they're little. But as they're [26:44] being raised, I certainly think the time [26:48] to really begin [26:50] is no later than your mid 30s. I call [26:53] between mid 30s to mid 40s with 40 being [26:57] the center of that the critical decade. [26:59] Literally, we're not children anymore. [27:01] We've at 30 [27:03] the literature says we've probably maxed [27:07] our bone out. We've probably maxed our [27:09] muscle out. [27:10] do you mean? I'm 30 with [27:11] I know. I'm thinking about you right [27:13] now. [27:13] What do you think I've maxed my muscle [27:15] out and my bone out? [27:16] that some some scientists, muscle [27:18] scientists, believe that at 30 we've got [27:21] our peak muscle mass. [27:23] And unless we really invest in growing [27:25] more muscle the rest of our lives, like [27:27] if you choose to be sedentary the rest [27:29] of your lives, you peaked at 30 and [27:30] you're using it the rest of your life, [27:32] right? And so [27:35] same with bone. Bone maxes out at about [27:37] 30 unless we continue to invest in it. [27:40] Well, what do we know? 70% of our [27:42] population is is sedentary and don't [27:44] reinvest. So, between 30 5 and 45, I [27:49] call it the critical decade. If you've [27:50] never thought about your health before, [27:52] now's the time to hone in. We need [27:54] baseline labs. We need your first [27:56] physical. We need some of your first [27:58] screening exams. I think men, this is [28:01] not policy anywhere, but I think as I'm [28:04] trying to replace [28:06] testosterone in men in the future, [28:08] I don't know what I'm raising them up [28:10] to. I know I'm putting them with within [28:12] a within a healthy range, but I would [28:15] want to return you to what your [28:17] testosterone was when you were a young [28:19] man like you are now and not just guess. [28:21] I think we need first labs, first [28:23] physicals, um to be more of a quantified [28:27] self just like you we were talking [28:29] earlier, you saw a human brain for the [28:31] first time, to notice our bodies so that [28:35] we can take better care of them [28:37] early so that we can then [28:40] do the exercise prescription that I'm [28:43] sure we'll talk about [28:45] um [28:46] going forward because it becomes very [28:49] very hard with every decade. But I think [28:52] for men 40 to 50 is a an amazing decade [28:57] for you for a lot of reasons. For women, [28:59] I think between 35 and 45 is critically [29:02] the time to get our stuff together [29:05] before our hormones start walking out [29:07] the door. So, it it's much earlier than [29:10] you would suspect. If you If you [29:11] suspected maybe 50 is the age, maybe 60, [29:15] no. Too late. Not too late. Much harder, [29:18] right? [29:19] Mhm. [29:19] Yeah. [29:20] You know what I There's this image that [29:22] I saw online the other day and I saved [29:24] it as a bookmark. I I actually wasn't [29:26] connected to me speaking cheap, but I [29:27] just found it to be fascinating cuz it's [29:29] part of this emerging picture in my mind [29:30] about the importance of muscle. And one [29:33] of the things you said there is you [29:34] think we'd reach our peak muscle by [29:37] Around 30. [29:38] According to some sort of muscle [29:39] scientists. Is Does that kind of [29:41] correlate to what I'm seeing here? I'll [29:43] put this on the screen for anyone that [29:44] can't see and I'll link it in the [29:45] description below. But on this graph, [29:46] which we'll call figure number one, [29:48] graph number one, [29:49] are you saying to me that the peak point [29:51] there is [29:52] Around 30. [29:53] Yeah. And then from it's sort of [29:55] downhill from there. [29:56] So, you know, on this graph, the peak, [29:58] if we call it 30, this is a precipitous [30:00] decline. It looks very hopeless. But [30:03] what I believe and what our research [30:05] shows is that you can extend this green [30:07] line into a more flat curve so that you [30:10] die [30:12] quickly. Maybe in your sleep. Yeah, like [30:14] this. [30:15] Zoop, done. [30:16] Okay. [30:17] Instead of this steady decline over [30:18] time. But if we do not reinvest in our [30:21] health and mobility every day, [30:24] our muscle wastes, our VO2 max, or our [30:28] cardiovascular health declines 10% per [30:31] decade. So, it's like what happens if [30:34] you have a Formula 1 car [30:36] and you get it all maximized, it takes [30:38] one big race, [30:40] and then you never reinvest in it. [30:43] I mean [30:44] our bodies are not unlike a machine. [30:46] When you talk about lean muscle mass, [30:48] what does What is lean muscle mass? I [30:50] know what muscles are, but what's lean [30:52] muscle [30:52] Yeah, you know what? I say lean muscle [30:54] mass and people are like, "What do you [30:55] mean? Lean versus fatty muscle mass?" [30:58] What I'm talking about is your skeletal [30:59] muscle mass. We have three kinds of [31:01] muscle. We have smooth muscle, which is [31:04] what our guts are. It's the peristalsis [31:06] that's happening in our intestines. [31:08] Our cardiac muscle, the muscle that will [31:11] that is our heart. That's the cardiac [31:13] muscle. Um and it beats onto itself. It [31:16] has its own electrical rhythm. [31:19] The rest of the muscle in our body is [31:22] striated skeletal muscle. So every time [31:24] you do this [31:26] it's with a type of muscle called [31:28] skeletal muscle. We have 650 skeletal [31:30] muscles. It is the reason you move. [31:33] Uh it is Muscle is not only important [31:36] for locomotion, but it's very [31:38] metabolically active. It sends off [31:41] hormones that help control other [31:43] processes in your body. It's where most [31:46] of your mitochondria, which are the [31:47] powerhouses of your body, take glucose [31:50] from your blood and turn it into energy. [31:52] So it has a lot of roles. Most of us [31:55] just think about it as what you see in [31:56] the mirror at the gym getting bigger and [31:58] bigger, but it serves a function of [32:01] locomotion and metabolism. [32:04] You did a a study. [32:06] Yes, I did. [32:06] Um and I think that's the picture I have [32:08] here which talks about [32:10] So what I'll put this on the screen [32:11] again. This is picture number two for [32:12] anybody that's listening on audio and [32:13] wants to see the photos. Um this is a [32:16] pretty startling image. [32:17] It is. [32:18] Um and it scares me. [32:20] Please can you explain what it is? [32:21] It shouldn't scare you because you are [32:22] healthy [32:23] You are going to be mobile every day [32:25] when you leave me here, but So remember [32:27] that study I introduced the Health ABC, [32:30] which was an NIH-funded study [32:32] of a group of 70-year-olds. They just [32:34] took a cohort of 70-year-olds and [32:36] watched what happened over a decade. [32:38] Yeah. [32:38] Well, they did a similar study as this [32:41] uh using cat scans. I used MRIs. And [32:43] what they found is that uh [32:47] that what they described as the [32:48] inevitable decline of muscle, [32:50] the inevitable infiltration of your [32:52] muscle with fat, like marbling. And I [32:54] said, "That cannot be true. That is what [32:57] happens if you are sedentary and sit [32:59] around for the trajectory of your life." [33:02] So, [33:04] because I'm a sports doctor, I am [33:05] surrounded by masters athletes. So, I [33:07] did a study of masters athletes from 40 [33:09] to 85. What this picture is is MRI [33:13] slices in their mid thighs. So, MRIs [33:16] take pictures of us using a magnet and [33:19] creates these beautiful pictures. So, [33:20] the top picture is the MRI slice of a [33:24] 40-year-old and my athletes were usually [33:27] runners or triathletes of the thigh of a [33:29] 40-year-old. So, I'll describe this for [33:31] you. [33:32] It's gorgeous. [33:34] Yeah, it's beautiful. [33:34] Yes, we have beautiful muscle [33:36] architecture of the quadriceps on the [33:38] top, the hamstrings on the bottom. [33:40] The bone has a nice cortex. There's very [33:43] little peripheral fat. And when I looked [33:44] inside the muscle uh with a microscope [33:47] and special software, there was not [33:50] infiltration of fat or marbling. So, if [33:53] you want to say it [33:54] colloquially, this is a flank steak [33:57] Yeah. [33:57] with no marbling. This is lean muscle. [34:00] If we sit around for 35 years and have a [34:02] desk job and we and we sit at the desk [34:05] uh 10 hours a day and we don't go move [34:08] our muscles, we're not purposeful, this [34:10] is what happens. We lose our muscle [34:12] architecture. [34:14] These muscles are are almost you can't [34:16] even tell what they are. [34:18] Uh they are [34:19] of that person? [34:20] This is a 74-year-old. Now, I had a [34:22] large group. This is one representative [34:24] person in each of the groups. This is [34:25] the control group. [34:28] But, the center one, the muscle I'll [34:30] tell you is grossly fatty infiltrated. [34:33] It is well marbled. It is like a Kobe [34:35] beef. And then there's a thick rind of [34:38] peripheral fat. This is a picture [34:41] of what we called sarcobesity. [34:43] Meaning we have loss of muscle, [34:44] sarcopenia, and we have obesity. [34:48] Excess adipose tissue. [34:49] Oh, so the white area is the fat and the [34:52] middle part is the muscle. [34:54] Yes. And so, you know, you'll see people [34:57] walking around with these big old [34:58] thighs. Well, the truth is um [35:02] sometimes a lot of that is fatty rind. [35:05] But look what happens if we invest every [35:07] day in our mobility. My athletes in this [35:10] study were not professional athletes. [35:12] They were recreational people like you [35:14] and me who just invested in their [35:16] mobility four to five times a week. [35:19] This is the picture the third picture is [35:21] a 70-year-old triathlete. [35:23] Really? [35:23] If you didn't know better, you would say [35:25] that I just took another slice of the [35:26] 40-year-old and put it down here. [35:29] Very little peripheral fat, very little [35:31] fatty infiltration, and amazing muscle [35:33] architecture. And when we [35:36] looked at the strength [35:38] of this person compared to this person, [35:41] there was virtually no difference. [35:42] There's a small difference, but we know [35:44] from other people's studies that um [35:48] lifting weights consistently infers a [35:51] 20-year advantage such that if you're an [35:53] 80-year-old consistently lifting [35:54] weights, you are functionally as strong [35:57] as a 60-year-old person who doesn't. And [35:59] so not only does this study show us that [36:02] by investing every day in our mobility [36:06] that we can retain our muscle mass [36:09] that has implications for frailty. That [36:11] has implications for activity. And [36:13] what's interesting about that picture, [36:15] Steven [36:17] once I published it, it has taken on a [36:19] life of its own. It is like everywhere [36:21] on the internet because the reaction is [36:24] so startling with people [36:26] thinking, "Oh my god, I am in control of [36:28] my health and aging." And I couldn't be [36:31] more pleased about that. [36:32] No, it is it is unforgettable [36:35] Yeah. [36:35] in every sense of the word. I can't [36:37] believe that. The thing that really [36:39] obviously shocks me is the 40-year-old's [36:42] um calf muscles or the calf or [36:44] thigh [36:44] thigh thigh muscle [36:45] Yeah. [36:46] is arguably [36:48] And that's a triathlete is arguably not [36:50] as good as the 70-year-old triathlete's. [36:53] Oh, well, actually say that they're two [36:55] different people, so [36:56] the 70-year-old wins. [36:58] And that is that is startling because I [37:00] I thought that aging muscle decline, the [37:03] sort of senescence, I think it's called, [37:05] of the of the body and the muscles is [37:07] inevitable. And this is unequivocal [37:10] evidence that it's not. That if I make [37:11] good decisions now, I become a [37:13] triathlete, [37:15] I can have the flank steak [37:17] thighs when I'm 70. [37:19] What it tells you is that there is no [37:22] age or time in your life when your body [37:24] will not respond to the positive stress [37:26] you put upon it. [37:28] And it takes daily investment. It's not [37:30] like you can store it all up and then [37:33] ride on it. [37:33] Mhm. [37:35] It Yeah, it's so it's so important. [37:37] That's one of the things that's been a [37:38] real revelation for me is this idea that [37:39] muscle is so critical as I get older. [37:41] Yeah. [37:42] Um [37:43] I often think about different exercises [37:46] that I should be doing as I age and you [37:48] know, sometimes I think about um [37:49] running, but I but it's quite I don't [37:51] know, I worry about joint pains and [37:53] stuff. [37:54] Yeah. [37:54] So, I'm a bit of an upper body workout [37:57] freak. I just focus on my upper body. Um [38:00] What do you think of my exercise regime? [38:02] What should I be adding to it to make [38:03] sure that I can have the flank steak [38:05] thighs, but also just a longer health [38:07] span? [38:08] You know, what's critical [38:10] for long-term function is being able to [38:12] stay upright. [38:13] So, it's all great that you've making [38:16] big arms and have upper body strength [38:18] and do pull-ups and lift your suitcase [38:20] above the in the airplane. [38:22] Thanks. [38:22] But what you really want to do when [38:23] you're 97 [38:25] is walk anywhere you want to, go up and [38:28] down the stairs, do, you know, drive any [38:30] car you want to, and that takes lower [38:31] body strength. [38:33] So all your biggest muscles in your body [38:35] are below your belly button. [38:37] So if I were you [38:38] and had all this trajectory of time, [38:42] I would work equally as hard on my [38:45] my [38:46] glutes, my quads, my hamstrings, my [38:49] calves, every muscle below your body. [38:52] But not only would I work on my [38:54] strength [38:56] to get bigger, but I would [38:59] focus on power, and those are different [39:01] lifting techniques, right? The [39:02] hypertrophy aspect of growing big [39:05] muscles cuz they look really great. Uh [39:07] you do [39:09] Now, and I am not a I am not a uh [39:11] trainer, but I've done this quite a [39:13] while, so trainers, you're welcome to [39:15] add in, but uh you do more reps of [39:18] lighter weights [39:20] because that will stimulate hypertrophy. [39:22] Okay. Hypertrophy. [39:24] a growth of muscle, bigger biceps. If [39:26] we're truly interested in power and [39:28] longevity, which is why I lift, I lift [39:31] for longevity and power because I am not [39:35] going to be that little old lady frail [39:37] in a bed unless I can help it, right? I [39:39] mean, I'm going to help it. I'm so [39:40] determined. [39:41] Um [39:42] I want to be able to [39:44] lift heavy. So [39:46] that is fewer reps, but much heavier [39:49] weight. So number one, you got to lift [39:51] with your legs. Number two, [39:55] people become frail for a number of [39:57] reasons, but another reason people lose [39:59] their independence is [40:01] they lose their ability to balance, and [40:03] they're falling all the time. And when [40:05] you fall, no matter how good your bones [40:07] are, [40:09] you're liable to break something. And so [40:11] I always train my people not only in [40:14] muscle building or carrying a load, as I [40:16] like to call it. [40:18] But in equilibrium and foot speed. So in [40:21] the in the [40:22] place I put my office, it's a [40:24] performance center. It's surrounded with [40:26] all the bells and whistles of the best [40:28] performance stuff. And we have a speed [40:30] and agility coach who usually works with [40:33] elite division one track athletes. [40:35] Well, I had her design foot speed and [40:38] agility drills for midlife people [40:41] because I do this all the time. I put my [40:43] my red work bag too close to my desk. I [40:45] get up quickly. My bag's in the way and [40:48] I trip. But because I've got the foot [40:50] speed, I can hop over it. But if I [40:52] hadn't retrained that, I might have [40:55] tripped over it and landed on my hip and [40:57] broken something. So, it's important as [41:00] we're going forward, yes, I want you to [41:02] increase your muscle lifting in your [41:04] lower body, but I want you to work on [41:06] speed and agility drills so you stay [41:08] nimble, stay [41:10] able to balance and don't fall down. [41:12] If you fall down, if you trip over your [41:13] bag, what's the not kind of effective [41:15] that cuz you just heal, right? [41:17] I just heal. [41:18] Yeah. [41:18] Yeah, I just I ran a Spartan race [41:20] recently and fell off an 8-ft ring and [41:22] didn't break. So, I am working towards [41:24] being unbreakable in my own life. [41:27] That's what I want to happen for you. [41:28] But if you're if you're not unbreakable, [41:32] what happens when you trip over your bag [41:33] and fall is you could break your hip. [41:35] And then what happens? [41:36] Yeah. Well, if you're [41:39] of any age, but particularly older, when [41:42] you fall and break your hip, [41:44] 50% of the time, you do not return to [41:47] pre-fall function, which means you [41:49] cannot live in the home you raised your [41:51] children. You cannot drive your car. It [41:53] bones are bones in adults take about 3 [41:56] months to heal. Imagine being down for [41:58] that amount of time. And unfortunately, [42:01] in men greater than women, [42:03] 30% of people die in the first year from [42:06] the complications of being that sick [42:09] with a hip fracture. So, you know, as [42:11] your orthopedic surgeon, I am desperate [42:15] to prevent frailty. I'm desperate to [42:17] prevent you from falling and [42:20] succumbing to that sequela. So, we got [42:22] to lift weights with our rear end and [42:24] our legs. We got to work on our speed [42:26] and agility. [42:27] It was you that used this term, the [42:29] sitting epidemic. [42:31] Mhm. [42:32] What is the sitting epidemic? [42:35] The sitting at epidemic is what we're [42:37] doing in our country [42:39] uh when we [42:41] in every aspect of our lives, whether [42:43] we're working or working, but we're [42:46] sitting at a table. [42:47] We're uh playing, we're sitting and [42:50] we're [42:51] playing on our phone or watching [42:52] something. It is the epidemic where [42:55] we're spending [42:56] I don't know, 10, 14 hours a day sitting [42:59] in this position. In fact, I was [43:01] thinking about it, if it was logist- [43:03] logistically possible [43:06] for a 3-hour interview, we should go for [43:07] a walk. [43:10] Not so much. But, but it's the epidemic [43:13] of sitting around. What does sitting [43:15] around do? Well, it [43:17] sends us towards a pathway of something [43:19] called sedentary death syndrome. I wish [43:22] I had made that up, but I didn't. A [43:24] professor out of Columbia University in [43:25] Missouri made up this term that I had [43:28] been using my whole career to describe [43:30] what happens to us when we sit our [43:32] entire lives. [43:34] Sedentary death syndrome are the 33 [43:37] chronic diseases that we die of, [43:39] including the top five, cardiovascular [43:41] disease, stroke, cancer, [43:45] um [43:46] even even things like fracture [43:49] that are completely impacted in a [43:52] positive way by mobility. [43:54] So, if we could eliminate sedentary [43:56] living from our lives [43:59] we could probably live better. And that [44:00] was the whole supposition of all these [44:03] studies I did in the beginning of my [44:04] career at the University of Pittsburgh [44:06] was to prove that if we took sedentary [44:09] living out of our vocabulary, that we [44:11] could save our bones. We proved that [44:13] with two studies. Our muscles, we proved [44:15] it with the one that you just saw. [44:17] We could save our brains. We were one of [44:19] the first to do brain studies looking at [44:21] the effect of mobility on the brain. [44:23] And it's a very hopeful picture. [44:26] It's super interesting this subject. I [44:28] this week had a friend of mine [44:31] diagnosed with I think he'd slipped like [44:33] two discs in his back or something. I [44:35] think like I think disc five and six or [44:37] something and he sent a x-ray of his [44:40] back into the group chat. [44:42] I thought oh, this is so interesting cuz [44:43] I've had lots of conversations with [44:44] people on my podcast about sitting and [44:46] all of these things. I spoke to one [44:47] particular guy called David Raichlen who [44:50] went and studied the Hadza tribe in [44:53] Africa I believe, which is a [44:54] hunter-gatherer tribe. And what he found [44:56] is they do sit for about nine or 10 [44:58] hours a day, [45:00] but they [45:01] They squat. [45:03] I knew that. Yes. [45:04] So we sit in the chairs. [45:05] sitting. They're squatting. [45:06] He told me that I think it was him and [45:08] Daniel Lieberman told me that. They'd [45:09] brought brought a chair over there. [45:11] Yeah. [45:11] And like these Hadza tribe had like [45:13] never seen a chair before. So when they [45:14] like walked off to go to the toilet, the [45:15] Hadza were all sitting in the chair. No, [45:17] but they would they would take the chair [45:18] and be like, "Oh my god." So like all [45:19] the chairs were taken cuz they just [45:20] loved the chairs. [45:22] Cuz they'd like never had chairs before. [45:24] So that the researchers like couldn't [45:25] find a chair cuz all the Hadza were like [45:26] chilling in the chairs. But typically [45:29] when they they sit for 10 hours a day, [45:30] they're doing this little sit mini squat [45:32] thing, which means their muscles are [45:33] still activated. [45:35] But also I think the the posture in [45:36] which they they squat is [45:37] Their backs are straight. [45:38] Yes. And it got sent me down this rabbit [45:39] hole this weekend, literally this [45:41] weekend, looking at [45:43] why sort of 80% of Americans will [45:45] complain about back problems, but the [45:47] Hadza tribe, back problems aren't even [45:49] like a thing there. He told me it like [45:50] almost doesn't exist, the idea of having [45:52] a back problem. But 80% of us are going [45:55] to have back problems. [45:56] It's endemic. Well, think about it. If [45:57] we weren't trying If I weren't trying to [45:59] be on my best behavior, I'd be sitting [46:01] in this chair like this, right? [46:02] Like a C-shaped back. [46:03] Slouched over. [46:05] My [46:06] front core is completely relaxed. My [46:09] back core is relaxed and stretched out. [46:12] And so, over time, they just get weak [46:15] and atrophy. It's like laying in bed. [46:16] There's no stimulus for them. Plus, my [46:18] shoulders get all hunched over and my [46:20] posture becomes like this. And so, [46:24] that's why we just sit in chairs and [46:26] atrophy. When you're squatting, and I [46:28] posted recently challenging people to [46:30] see if they could do a squat like that [46:32] or get up from a squat like that. And [46:34] the response I got was overwhelmingly, [46:36] "Oh my god, I can't do that. I'll work [46:38] on it." [46:40] Because we're so used to sitting in [46:41] chairs. [46:42] do like a single squat, these people are [46:43] saying. [46:43] To get down, getting down people can do. [46:46] Sometimes it's falling over. Getting up [46:48] is the problem. [46:51] What would you recommend [46:52] Yeah. [46:52] in order to avoid the back pains, the [46:55] sort of sedentary death syndrome, or [46:57] whatever it was called. What do I do? [46:59] Because I I I I feel I run a business. I [47:00] work in an office at a desk. [47:01] Yes. Well, you know what? Even simple [47:03] things. Uh [47:05] for instance, I bought my assistant a [47:06] standing desk because when I'm in [47:08] clinical all day, [47:09] uh for 10 hours, the choice for him was [47:11] sitting at a desk or standing at his [47:14] standing desk. And so, that can go a [47:17] long way. Number one. Number two, taking [47:19] mini blasts of mobility, right? Getting [47:23] up, running out the stairs, be a fidgety [47:25] person, go to the copier, get steps in, [47:28] just be moving all the time. [47:30] The other thing, honestly, nobody knows [47:33] when you're on a phone call what you're [47:34] doing. You could be wall squatting. In [47:37] fact, I have challenged whole groups of [47:38] people in their next board meeting to [47:40] wall squat the whole time. [47:42] No I [47:43] don't know how much thinking would go [47:44] on, but just adding little things like [47:46] add that in, you don't have to sit to [47:49] take a phone call. Um even in a Zoom [47:51] meeting. I mean, people have seen worse [47:53] than you doing a wall squat, you know, [47:55] in the time of COVID. [47:56] I I was wondering this morning um on my [47:59] way here cuz I was in the bathroom and I [48:01] dropped something on the floor. [48:03] I can't remember what it was. Might have [48:04] been the toothpaste or something. And I [48:06] went down to pick it up and my my back [48:08] is just like so tight. [48:09] Is it? [48:10] Like my whole I feel like my whole body [48:11] I'm so unflexible. I like went down to [48:13] pick it up and the way that I go down to [48:15] pick it up is you'd think I was [48:16] you know, I was going to say an age [48:18] then, but that's kind of after seeing [48:19] that flying knee I'm like this guy's got [48:22] better flexibility than me. But I just [48:24] feel like [48:25] You're stiff. [48:26] I'm stiff as hell. [48:27] Uh-huh. [48:28] And I don't know what to do about it. [48:29] Cuz I I think there's like a I don't [48:31] know. Is it a joint pain joint pains [48:33] that I have or is it just I don't I [48:34] don't have strong core? [48:36] It could be all those things. So, when I [48:39] talk to people about to get to tie into [48:41] the other question, how should you be [48:43] working out? How should you be investing [48:44] in your mobility every day? Uh there are [48:47] four components that that [48:50] we should try to find time for. [48:52] Number one is flexibility and dynamic [48:54] stretching. What so that means is [48:56] is warming up every single joint in your [48:59] body every day. And that can be as as [49:02] simple as seriously a set of jumping [49:06] jacks, doing uh there's something called [49:08] an inchworm where it's like a push-up [49:10] position and you walk your feet up and [49:12] that'll warm up your ankles, your knees, [49:14] your hips, your shoulders. But going [49:17] through a dynamic warm-up every day to [49:19] warm up the joint, putting them through [49:21] demanding they go through a full range [49:22] of motion. And then not forgetting after [49:25] you work out to static stretch. We don't [49:28] static stretch before we work out, we [49:31] static stretch after. [49:32] It's done. [49:33] Uh static stretch is what we were taught [49:34] in in elementary school with, you know, [49:37] you stand against a wall, you hold the [49:38] stretch for 30 seconds. That happens in [49:42] every body part after you work out [49:45] before you dynamically warm up. And so [49:47] that's when things like yoga and Pilates [49:50] and whether it's reformer Pilates or [49:53] uh floor Pilates or can be great for [49:56] people. [49:57] To me that is the the salt and pepper of [50:00] your workout regimen. It's not just what [50:02] you do. It's what you sprinkle over it. [50:04] So that's number one, flexibility. A, [50:06] oh, because the acronym I use is face. [50:09] Just so people remember. F, flexibility. [50:11] A is aerobic, right? We can talk about [50:14] that. C is this weight lifting we talked [50:16] about. C, carry a load. E is equilibrium [50:20] and balance. So when you were reaching [50:23] over and [50:25] thinking you were so stiff, you could [50:27] still do it because you're in your 30s. [50:28] You still have the youthful pliability [50:30] to do it. Imagine [50:32] you're 60 now and you haven't done [50:34] anything about it and nothing's moving [50:37] and you reach over and you don't have [50:39] the foot speed to catch yourself. You [50:40] fall over. It happens all the time from [50:43] a standing position. So the way I teach [50:45] people to retrain their balance [50:47] literally [50:48] is to stand on one foot while you're [50:50] brushing your teeth every morning [50:52] because the perturbation of moving your [50:54] whole body requires core strength, it [50:56] requires proprioception [50:58] and that's how you'll retrain that [51:00] particular motion. [51:02] So I really need to introduce something [51:03] like Pilates or yoga to my [51:06] Or just daily stretching. [51:07] Okay. For how long? [51:09] Um well, if you stretch every you [51:12] dynamically warm up before you do [51:14] anything including your weight lifting [51:17] and then [51:18] um the static stretching afterwards of [51:21] every major muscle group whether it's [51:23] your triceps or whether it's your [51:25] hamstrings which are critical for low [51:27] back pain or your calves. You hold the [51:29] stretch without bouncing for 30 seconds. [51:33] And what you'll feel is at the end of [51:35] the 30 seconds, you'll kind of relax [51:38] into it and you'll get more of a stretch [51:40] and you only do four reps. [51:42] You are going to get most of the benefit [51:44] of that stretching after four reps. [51:47] But I don't want to only do that. I find [51:49] many people asking me, [51:51] "I do Pilates and yoga. Is that enough [51:53] for me?" And I say, "That's great, but [51:55] it's never going to be enough." [51:57] One of the other things which is related [51:58] to this that people see as being [51:59] inevitable is this idea of joint pain. [52:01] We think we kind of just get joint pain [52:03] as we age. Is joint pain inevitable? [52:06] You've actually brought a big bone with [52:08] you today which absolutely nobody asked [52:09] you to bring, but I guess this is what [52:10] you carry around with you. [52:15] Steven, this is a femur. [52:17] A femur? [52:18] A femur. Yeah. [52:20] This is a human femur. [52:21] Um and I guess a femur is the [52:24] It's the bone that connects your pelvis [52:26] Yeah. [52:26] to your knee. [52:27] Oh, okay. So, it's that big bone in your [52:28] leg. [52:28] bone. It's the longest bone in your [52:30] body. [52:31] This bone you brought with you. Um a lot [52:33] of people talk about joint pain. [52:34] Yes. [52:35] Is joint pain inevitable? I'll give it [52:37] to you because you probably know more [52:38] about this stuff than I do. [52:39] So, what is a joint? A joint is the is [52:42] the space that is occupied by two bones. [52:45] So, the femur, the top of it, that's in [52:47] your hip, [52:49] is a ball [52:50] and it sits in a cup in your in your [52:52] pelvis. [52:54] So, two different bones, the pelvis is [52:56] connected to the femur through the hip [52:58] joint. [52:59] It goes like this, right? [53:01] So, [53:02] and then on this end, this end of the [53:05] femur is connected to your tibia and it [53:07] makes your knee. [53:08] Okay. [53:09] Yeah. [53:10] So, uh is joint pain inevitable? It is [53:13] not. Do we get it with aging? Often, so [53:16] that you would think it's inevitable, [53:18] but it is not inevitable. Why do we get [53:20] joint pain? Well, every bone [53:22] at the end is covered in an end cap of a [53:26] structure called cartilage. Cartilage is [53:29] a [53:30] smoother than ice matrix [53:35] that cushions the bone so that you don't [53:37] feel your joints. One reason people have [53:40] pain is because they've traumatically [53:43] disrupted that cartilage and there's [53:45] potholes in it. Like if you're a [53:46] football player and you get hit hard and [53:48] a piece it impacts so hard it pops off. [53:51] That's a traumatic cartilage injury. You [53:54] will have joint pain from that. Another [53:56] reason we can have joint pain is not [53:58] traumatic cartilage loss but because [54:01] you've just done so many reps over a [54:03] lifetime that you've worn it down. [54:06] That's called osteoarthritis. [54:08] And so it's not a pothole per se, it's [54:11] like the whole surface has been [54:14] worn down with sandpaper for instance [54:16] and there's just not enough of it. [54:19] Well, the reason we get osteoarthritis, [54:21] some of it's genetic but much of it is [54:24] how much we weigh. [54:25] Sometimes it's related especially in [54:27] women to whether or not we have [54:29] estrogen. [54:30] Um we only get one set of cartilage for [54:32] a lifetime unless I reconstruct your [54:34] cartilage cuz you've [54:36] been injured or something. Uh we get one [54:38] set. So we get joint pain because the [54:41] cartilage has started to wear down. We [54:44] can get joint pain because [54:46] we've worked really hard in a workout [54:49] and we've just seen a lot of impact and [54:50] it inflames your joint but that's [54:52] usually temporary. [54:54] The permanent [54:55] The permanent is usually due to [54:57] osteoarthritis. [54:58] So so how do I if I want to work out and [55:00] I want to make sure that I protect my [55:01] joints so that I don't have this um [55:03] permanent sort of [55:05] naturally irreversible joint pain? [55:07] Yeah. [55:08] Is there certain workouts that I should [55:09] be avoiding? [55:11] Are there certain workouts that are more [55:12] likely to give me to erode my cartilage [55:15] and give me joint pain? [55:16] Well, I think principles that should be [55:19] used are the principles of weight [55:20] lifting with progressive overload. So if [55:22] you started out cold and decided you [55:26] know, I'm young, I'm healthy, I'm just [55:28] going to uh lift to my maximum all the [55:31] time, you're probably going to inflame [55:33] your joint. Your joint is not used to [55:34] seeing that kinds of load. Joints bear [55:37] five to 10 times body weight. So, if [55:39] you've gone from zero to 500 lb squat, [55:44] that is 5,000 lb. [55:46] Yeah. [55:47] That's a lot. Versus, if you start from [55:49] zero and progressively up, your body [55:51] will get used to the load, your bones [55:53] will build, your uh [55:56] your cartilage won't grow, but it will [55:58] become more used to the pressure. So, [56:00] the principle is um to not have aching [56:04] joints is progressively go up and not [56:06] just let your ego take over. [56:08] So, you're saying that muscle helps to [56:11] kind of as a suspension mechanism for [56:13] the cartilage? [56:14] Well, what things project protect the [56:16] joints? Uh being of a healthy [56:20] body composition, which includes weight [56:22] and muscle mass, right? So, the way [56:24] muscle helps protect the joints is [56:27] exactly as you said, instead of pounding [56:29] together like this, [56:31] Yeah. [56:31] muscle acts as a shock absorber. So, the [56:34] the bones come together more softly. [56:36] Ah, okay. [56:37] So, where for people with [56:38] osteoarthritis, one of the remedies for [56:40] that is building muscle. [56:42] Um I've got um you mentioned a second [56:45] ago that staying [56:48] at a decent weight also helps to stave [56:50] off joint pains and that's sort of [56:51] erosion of cartilage. [56:52] Mhm. [56:53] And I was I was reading in your work [56:54] about this pretty shocking um [56:57] Grab my my brick and my rock. [57:00] This pretty shocking stat. [57:02] Yeah. [57:02] That [57:03] God, this is heavy. You can take that. [57:05] Okay, [57:06] I'm going to put it down for you. Yeah. [57:08] Um [57:10] in your work you describe how putting on [57:12] even a small amount of weight increases [57:14] the pressure on our joints by a huge [57:17] amount. So, can you explain that using [57:18] this? [57:19] Yeah. [57:20] So, when we think about pressure across [57:21] our joint, we're we're thinking about [57:23] whether we gain weight [57:25] or lose weight. The joint, which in this [57:28] bone is the femur, the femur, the end of [57:30] the femur is sitting against the tibia, [57:32] and that's what makes your knee joint. [57:34] When you go up and down the stairs and [57:35] have pain in your knee, [57:37] what's happening there? Well, [57:39] if you gain 1 lb, this rock is 1 lb, you [57:43] would think that this is all the amount [57:45] of pressure you're going to feel, but [57:46] because of the mechanics, the physics of [57:48] the long bones, the pressure of gravity [57:50] pushing up on you, what you actually [57:53] feel is the weight of these bricks, [57:55] which is 9 lb. [57:57] So, gaining 1 lb in weight [57:59] 1 lb in weight [58:01] exerts nine times the pressure [58:04] on your joint. [58:06] So, you think gaining 10 lb doesn't mean [58:08] much, but imagine gaining 100 lb of [58:10] pressure. [58:11] Or the reverse of that is even small [58:15] changes in our total body weight, 1 lb, [58:18] 10 lb, can have profound effects on the [58:21] joint pain we feel. [58:22] So, if I lose 1 lb, I'm taking 9 lb [58:24] this away. [58:25] Mhm. [58:26] Uh what some research shows that if you [58:28] lose 10% of your body weight, you can [58:30] make a profound difference [58:32] in [58:33] uh the pressure your joint experiences [58:35] and decrease your pain. [58:37] So, when I prescribe treatment for [58:39] arthritis, here's the whole person, [58:41] whole person approach. If I just wanted [58:44] to say, "Okay, you've got arthritis, I'm [58:45] going to give you an injection and [58:48] sign you up for surgery." [58:50] That might be a typical surgical [58:51] approach, but my approach is we look at [58:53] your nutrition, we talk about [58:55] anti-inflammatory nutrition, enough [58:57] protein, uh not eating sugar. Sugar is a [59:00] huge inflammatory, which increases your [59:02] arthritis pain. We talk about building [59:05] muscle [59:06] so that we have more shock absorption. [59:08] We talk about losing absolute amount of [59:11] body weight so that we unload the joint [59:14] in another way. [59:16] Even before we get to any medical type [59:19] treatment, it's the lifestyle approaches [59:21] that you can use. [59:23] I would have thought that if I put on 1 [59:24] lb of weight, I would put 1 lb of [59:28] pressure on my joints, but what you're [59:30] saying is if I put on 1 lb of weight, [59:31] I'm actually putting 9 lb of pressure on [59:34] my joints. [59:34] Yes. You know, it has to do with the [59:37] across the joint, the physics of the [59:39] lever arms of our bones. So, for [59:41] instance, in our shoulder, if you put 1 [59:43] lb in your hand, the pressure felt in [59:45] your arm because of this long lever arm [59:48] to lift it is is 10 times. So, I always [59:51] tell my patients who are recovering, [59:53] "Don't feel discouraged when you lift up [59:55] 2 lb weight, it's 20 lb on your [59:57] shoulder." It has to do with the the [59:59] physics of pulling the weight up in the [60:01] axial load. It has to do with the [60:03] gravity and the impact of bones one on [60:05] another. [60:06] You talk about these three major mindset [60:08] changes that we need to kind of [60:11] um experience in order to make sure that [60:13] we can be fit and healthy in our late [60:15] years. Things like not focusing on [60:16] weight loss, but instead focusing on [60:18] building muscle. [60:19] Mhm. [60:19] That for me is again, it's a bit of a a [60:21] narrative violation because [60:24] um I think as we age, one of the things [60:26] that we see as being an inevitable is [60:27] that we are going to gain weight. So, [60:29] most people go to war with just trying [60:31] to lose specifically abdominal fat. [60:33] Mhm. [60:33] a lot of men are really quite obsessed [60:35] with their abdominal fat. Why why do we [60:37] need to make that mindset shift? [60:39] You know what? And I'll take that shift [60:41] even further, and it's I like to frame [60:43] it as we don't want to lose weight. We [60:45] want to [60:46] uh recompose. What are we made of, [60:49] right? We want to be made of [60:52] healthy muscle. We We want to care about [60:55] how much body What percentage of our [60:57] body is fat? We need fat. Fat has a [60:59] purpose in our body, or we wouldn't have [61:00] it. But what percentage are muscles? So, [61:03] what happens when we just focus on [61:04] losing weight and our primary method is [61:08] calorie restriction? What we know, it is [61:11] clear from from many papers that if we [61:14] just calorie restrict with nothing else, [61:16] we will lose 25 to 50% of our weight as [61:21] muscle. [61:22] And then that makes us metabolically [61:24] less healthy because muscle is a glucose [61:27] sink. [61:28] Mhm. [61:29] You know, when we feed ourselves and [61:30] there's sugar circulating, it is taken [61:32] up by our muscle. With if we lose 25 to [61:35] 50% as we lose weight, [61:38] we have less metabolic availability to [61:40] get rid of all that. And then when we [61:42] come off our crazy calorie restricted [61:44] diet, the weight we gain back is 80% [61:48] fat. So if we are if we're troubled with [61:51] yo-yo diets, which so many people [61:54] struggle with that, they'll lose weight, [61:56] they'll gain weight, they'll lose [61:57] weight, it becomes this circle as we're [61:59] continuously losing more muscle. So when [62:02] I frame it [62:03] for men and women, I want them to [62:06] to think of recomposing. [62:09] How as I'm losing fat percentage can I [62:12] gain muscle? [62:14] And so that puts it in a different [62:16] perspective. I don't care what you [62:18] weigh. You know, I'm a muscular woman. I [62:20] weigh more probably than people would [62:22] think I would because I have lower body [62:25] fat. I have higher muscle content. And [62:26] that's what we care about. And for [62:28] people I always chuckle when I say this [62:31] that are really interested in the way [62:33] clothes fit, which I am. I'm as vain as [62:35] they come. Well, muscle is nature's [62:37] Spanx. You may weigh more, but you're [62:40] tighter and everything fits and looks [62:42] better. So it's not weight, it's [62:45] composition. [62:47] Can we be [62:50] as [62:51] in shape as we were when we were 25 when [62:54] we're [62:55] 45? [62:55] We can be different. [62:57] Different, okay. [62:57] There are lots and lots of examples all [63:00] over [63:01] of uh either people staying healthy. I [63:04] mean, look at Tom Brady. He's a great [63:05] example, right? [63:07] Cristiano Ronaldo is a great example of [63:08] a classical athlete. [63:08] I just saw him the other day uh playing [63:11] actually in this Europe tournament. I [63:13] just saw him playing. Um there are lots [63:16] of examples of that from pro sports now, [63:18] but even in mere mortal athletes, [63:20] they're posting all over the internet [63:22] how they have maintained or [63:25] many people a light bulb turns off and [63:27] they say I'm a [63:28] I'm sitting on my rear end. I'm as [63:30] strong today as I've ever going to be [63:32] unless I do something. And we have [63:34] pictures of people investing in [63:36] weightlifting and high protein meals and [63:39] and getting in better shape than they [63:42] ever were. I was in the best shape of my [63:44] life when I was 40. [63:46] And then I went through perimenopause [63:47] and thought I was going to die. And now [63:51] I'm 57. I'm in some of the best shape of [63:54] my life. [63:55] I am in not [63:57] I'm not 19% body fat like I was when I [64:00] was 40, but as a whole person, this is [64:03] the best it's ever been. [64:05] It's really interesting as a football [64:06] fan, a soccer fan. Um [64:08] No, it is called football. As a football [64:10] fan [64:11] seeing how two different players at the [64:13] same age. I'm thinking about I won't [64:14] name names cuz it's makes it personal, [64:16] but someone like Cristiano Ronaldo and I [64:19] compare him to another player from my [64:22] club Manchester United who Cristiano [64:24] played there at one point who is also 41 [64:27] years old or whatever Cristiano is now. [64:29] And they look [64:32] 15 to 20 years apart. [64:34] Really? [64:34] And Cristiano Ronaldo carried on [64:36] playing. He [64:37] By all accounts from things that I hear [64:39] at Manchester United has the most [64:40] discipline with his routine, his [64:41] nutrition. And then another player who [64:44] at the time when they both played [64:45] together in their 30s, they kind of [64:46] looked the same physically. [64:48] Yes. [64:48] But just because for some reason they [64:50] let go, it almost appears that they let [64:52] go. They got on the alcohol a little [64:53] bit. Their diet shifted. They now look [64:55] like they're 15 years older than [64:57] Cristiano. [64:58] But at 35 they kind of look the same. [65:00] They both had abs. And it's so crazy how [65:02] just a couple of years [65:04] of just kind of [65:06] forgetting about these simple [65:08] disciplines can send your perceived [65:10] trajectory of your health so widely [65:12] apart. [65:13] Mhm. [65:13] Whereas Cristiano, he literally looks [65:15] like [65:15] I saw him. He did a He did a penalty [65:17] kick. [65:18] Yeah, I'll put a photo of of him the [65:20] physique he he's in up on the screen cuz [65:22] Whoop, who are a sponsor of mine my [65:24] sponsor of this podcast, they went out [65:25] there recently to Saudi Arabia, I [65:27] believe, where he's playing, and they [65:28] did a topless poolside interview with [65:30] him, and I was like, "Jesus my god." [65:32] Look at that. [65:32] And I compare him to the his colleagues [65:34] and [65:34] I contend to you though that that [65:35] colleague [65:36] Yeah. [65:36] because he's still in his 40s [65:38] if they put the time back in [65:40] Yeah. [65:41] could become ripped again. [65:42] Um the the basic stats that I need to [65:45] think about in order to be a Cristiano [65:48] Ronaldo as opposed to another one of his [65:50] colleagues that didn't manage to stay in [65:51] shape. What are those fundamentals that [65:53] you think Cristiano is hitting? [65:55] Or from your work with athletes? [65:57] Yeah. I think that [65:59] um [66:01] I think we harness the power of our age, [66:03] the wisdom of our age. So, he probably [66:05] works out now differently than he did [66:08] when he was 25. He He probably, and I [66:11] don't know his routine, but people like [66:13] Dara Torres or [66:15] Michael Phelps, they spend more time on [66:17] recovery, more time on muscle work. [66:20] They're very systematic about their [66:22] workouts. They do max-min. They they get [66:26] the maximum workout in their skill set [66:28] their skill workouts. They're not out on [66:29] the field for 4 hours anymore. They get [66:32] an hour and a half in. They work on the [66:33] skills they need to do. So, they're [66:34] smarter, right? Number two, nutrition is [66:38] monitored from literally When [66:41] uh one of my jobs at the University of [66:42] Pittsburgh was as the medical director [66:44] of the UPMC Lemieux Sports Complex. We [66:47] housed the Penguins, the Pittsburgh [66:48] Penguins, which is the professional [66:50] hockey team. [66:52] They had a full-time chef from the [66:53] minute they woke up. They came in for [66:55] breakfast. [66:56] Lunch was cooked. All snacks were [66:58] provided. Even the food on the airplanes [67:00] was provided so that they had this very [67:03] regimented diet full of the nutrition [67:06] they needed not only to fuel them, but [67:08] to recover them. So, that's nutrition. [67:10] Nothing is a mistake. [67:11] Uh number three, [67:14] they are their workouts are not only the [67:17] skilled workouts, but the conditioning [67:19] workouts are completely monitored. I [67:21] mean, you're sponsored by Whoop. Whoop [67:23] takes care of a lot of athletes. We know [67:25] their recovery state. We know how well [67:27] they slept the night before. We know [67:29] their response to the heavy lifting. [67:33] So, I think that athletes at that level [67:36] are able to [67:38] maintain the way they are because it's a [67:40] science. [67:41] Also, frankly, [67:44] they're genetically specimens. They got [67:46] this great cytoplasm they were born [67:48] with. [67:49] Sugar. [67:51] You don't speak very fondly of it. You [67:52] I've read it quite where you say it will [67:54] destroy your body on so many levels. [67:56] It does. So, you know what? I love [67:58] sugar. I'll you know, I love sugar. I [68:02] would rather eat cookies for breakfast, [68:04] but I don't. [68:06] And and the first time I sugar detoxed, [68:09] after the first 3 days it was rough [68:11] because, you know, sugar is addictive. [68:13] There's an addictive center in our [68:14] brain, you know. And so, after 3 days [68:17] you can gut it out and use your [68:20] willpower discipline. But after 3 days, [68:22] the fourth day you're going to your [68:23] cupboard and you're standing there [68:26] and you're like, "I don't know why I'm [68:27] here." Well, it's your brain looking for [68:29] a dopamine hit of sugar. So, what does [68:31] sugar do? [68:33] I am not opposed to carbs. [68:36] Our body needs carbs. It doesn't need as [68:37] much as we get, but we need fiber-filled [68:40] carbs. Fiber is critical in our bodies. [68:42] What we don't need is [68:45] beet and sugarcane and honey and agave, [68:50] all the simple sugars that have a [68:53] a steep glycemic index, meaning you eat [68:56] it. [68:58] It's easily digested, rapidly digested, [69:01] goes immediately to your blood, your [69:03] blood sugar will spike. Give you some [69:05] examples. [69:06] And then [69:08] what happens is our pancreas will [69:10] release insulin, [69:11] which will [69:13] frantically try to carry it into our [69:15] muscles to be used. Well, [69:17] that happens at a finite rate. And when [69:20] you have too much sugar circulating, [69:22] that overcomes the rate that it can be [69:24] removed, our body stores it in fat, [69:27] right? [69:28] With a high blood glucose, our body goes [69:31] through a circumstance called uh [69:34] glycosylation, which is essentially [69:37] caramelizing proteins in your body. It's [69:40] like [69:41] you have a steak and you leave it on the [69:42] grill extra long and it gets that [69:44] caramelized. Well, [69:45] that state of our proteins in our body [69:48] is highly inflammatory. Well, we know [69:50] high inflammation [69:52] is something that contributes to chronic [69:54] disease. It This excess of blood sugar [69:58] contributes to insulin insensitivity, [70:01] meaning our poor pancreas is trying to [70:04] pop out enough insulin to get rid of the [70:07] sugar [70:08] that it pops out so much that it we [70:09] become insensitive to it. There's just [70:11] an overabundance. So, [70:14] all of those reasons are why [70:16] I am not opposed to com- [70:18] complex carbs and fiber. I am opposed to [70:20] the highly processed, sugar-filled diet [70:24] that [70:26] is produced for us by our current food [70:28] system and by the choices we make. I [70:29] don't blame society. I don't blame our [70:32] food system. [70:33] I blame them and the choices we make. Um [70:38] So, I That's one of the first things I [70:39] recommend to my patients. Do you know [70:41] it's the hardest thing for them to give [70:43] up? [70:44] And they'll do everything else. They'll [70:45] get to a gym. They'll [70:47] they'll do aerobics the way I want them [70:49] to. But then when I say, [70:51] "And we need to eliminate simple sugar." [70:54] That's when the excuses come out. [70:57] It's interesting cuz yeah, I mean it's [70:58] difficult. There's obviously a [70:59] physiological sort of chemical hold that [71:02] sugar has over over us. But on this [71:04] point of psychology and willpower or [71:07] whatever we want to call it, [71:09] everything that we've discussed so far [71:11] today is kind of contingent on you [71:14] making a decision. [71:16] Yes. [71:16] Now, how when you talk about the whole [71:17] human, how can you influence someone who [71:20] might have got this far in the [71:21] conversation today and they they [71:23] understand everything you said? They go, [71:24] "Yeah, I know some of that stuff. I know [71:25] this thing here and you know, I've heard [71:27] that over in this book or this podcast [71:29] before, but for some reason [71:32] I just can't [71:32] Can't do it. [71:33] Can't do it. Can't get myself to do it. [71:35] Maybe I'll do it for 1 day, but then the [71:37] yo-yo goes back to the bottom and [71:39] There's this concept in banking called [71:42] temporal disconnect. It's a banking [71:44] term. I came upon it as I was writing [71:47] these books initially and the concept is [71:49] that bankers, financial people, want us [71:52] to put a little bit away every day. Not [71:54] for today. There's no satisfaction in [71:56] that for today. In fact, it's [71:57] deprivation for today. [72:00] But it's for the future. [72:02] The concept of temporal disconnect is [72:04] that you don't know who you're going to [72:06] be in 30 years. You're or 40 years, a [72:09] 70-year-old Steven. You don't know that [72:10] guy. You don't care about that guy. You [72:12] don't even know what he's like, what [72:14] he's going to become. So, but you do [72:16] know today's Steven and so you're going [72:18] to take care of this guy, not that guy. [72:21] And so, that's why bankers can't get us [72:23] to invest our money in the general [72:24] population, right? Most people don't [72:26] have much savings, right? The same is [72:28] true when we apply it to our health. [72:30] What do we want now? What's going to [72:32] make me feel good now? What, you know, [72:34] can I bargain with myself that I'll do [72:36] it tomorrow or this little bite's not [72:39] going to hurt me, right? [72:41] Because the temporal disconnect of at 63 [72:44] if I don't do something now, [72:48] I'm going to [72:49] have chronic disease rear its ugly head. [72:52] That is a hard argument. Some people are [72:54] disciplined enough [72:57] to think like that. That's a hard one. [73:00] So, some of the ways [73:02] to help people now is to help them [73:05] identify how amazing they're going to [73:07] feel now. In- instead of feeling [73:08] sluggish, sitting in a chair all day [73:11] with back pain, if we invest every day [73:14] in [73:15] walking, in sprint intervals, which is [73:18] going to make us lose fat, or lifting [73:20] heavy, which is going to put on the [73:21] muscle of spanks and make us look good. [73:24] And plus, when you get done lifting [73:25] heavy, you feel like a badass, right? If [73:28] you can make that the reward, that is an [73:31] easier thing to do. Because you are [73:33] right. We know what to do. We just don't [73:35] do it. And we know what to do, and we [73:37] don't do it because the battle is in the [73:40] 5 and 1/2 inches between our ears. [73:43] It's not [73:45] actually picking up the barbell. [73:47] Right? And so, it's identifying how this [73:50] is going to make me feel today, not for [73:53] 20 years. [73:54] And here's the other thing. [73:57] I honestly think sometimes it comes down [73:59] to self-worth. [74:00] Do I believe that I am worth the daily [74:04] investment in my health? Or do I believe [74:07] that everything else is more important [74:09] than me? [74:10] And that's hard. [74:12] And I have come to understand that until [74:14] you believe that you are worth the daily [74:16] investment in your health, nothing else [74:18] matters. [74:19] Yeah, it's so interesting and I think [74:21] one of the things again that has [74:23] been um cured, that used to be a mind [74:25] virus of mine, was I think part of me [74:27] did think when I get to 50, when I get [74:29] to 60, I'll address it then. [74:31] Yeah. [74:31] I if I've got um certain um [74:35] health issues when I'm 60, well, I'll [74:37] just go to the gym then, and I'll just [74:39] uh [74:39] Yeah. [74:39] I'll just fix it then. I'll just start [74:41] becoming uh active when I'm 50 or 60. [74:44] But I But that's not how any part of my [74:47] life works. That's not how my business [74:48] or my investing works. Everything is [74:50] compounding now. [74:51] Yeah. [74:51] So the decisions I make at 20 or 25 or [74:54] 40 or your daughter's upstairs. She's [74:56] what she's young [74:57] 16 [74:57] 16. The choices I start making then [75:00] Yeah. [75:00] are sowing seeds that will [75:02] flourish for better or for worse when [75:03] I'm [75:04] 60, 70. [75:05] And you know what's easier than doing a [75:07] little bit every day? That's easy. You [75:10] know, my daughter upstairs, she [75:13] poor thing can't get away from knowing [75:15] what the right choices are. It doesn't [75:16] mean that she does always does them, but [75:18] if she maintains this healthy lifestyle [75:20] she has because she lives in our house, [75:23] it'll be easy every day. It's a [75:24] lifestyle, right? It's not a monumental [75:28] pivot. It's just the way she lives. And [75:31] you know, the same if if you do all the [75:33] things that you know to do now, it will [75:36] become just the way you live. It's not a [75:38] high energy expenditure versus waiting [75:42] until you're 50 when you're 50 lb [75:44] overweight when you have to totally [75:47] rebuild all your lean muscle mass, you [75:49] know, you're feeling like a [75:51] whatever you're going to feel like. [75:53] That's a big pivot versus I'm just [75:56] living another day [75:58] Mhm. [75:58] doing the things I've always done. This [76:00] is who I am. [76:03] I am Yeah, that's one of the things [76:04] that's been really helped me I think [76:06] from doing this podcast is obviously I'm [76:07] inundated with lots of information about [76:09] health. [76:09] Mhm. [76:10] So that the the framework I use to [76:12] decide what to take in and what to [76:13] implement is just I I hear some things [76:16] that my guest say and they might say, [76:17] "Oh by the way Stephen, um [76:20] apple juice or orange juice is full of [76:22] sugar." [76:23] Mhm. [76:23] And in my head I was going, "Oh my god, [76:24] I thought that was healthy." And then [76:26] and I don't really I could take it or [76:27] leave it anyway. So these small sort of [76:29] modifications, taking these sort of very [76:31] sugary drinks out of my life is [76:32] something that happened. Um [76:35] being consistent with my workouts, [76:36] focusing on muscle gain [76:38] thinking a lot about how I sit, but also [76:40] making sure I'm as active as I can be. [76:42] Mhm. [76:42] Um and then the other thing actually has [76:43] been supplements. [76:45] Yes. [76:45] Because I sit in this Diary of a CEO [76:47] studio a lot and I sit in Dragon's Den's [76:49] little dungeon a lot. [76:50] Mhm. [76:51] I spend a lot of time sat at my desk [76:52] inside without any sort of natural [76:54] light. So, [76:55] I've started taking vitamin D [76:56] supplements frequently because actually [76:58] I went to the doctors, did my my tests [77:00] and it [77:00] How low was it? [77:01] How low was it? It was very low. They [77:03] said everything's fine, Steve. You've [77:04] all good here, here, and here. I did [77:05] like the full body. I did my testicles [77:07] to my toes to everything, my blood, [77:08] everything, my moles, whatever it might [77:10] be. And the the one thing he did say to [77:12] me is your vitamin D levels are low. [77:14] Mhm. [77:15] So, I've started supplementing. Is is [77:17] how crucial is vitamin D for healthy? I [77:19] mean, [77:19] You know what? It's a it's a hormone [77:21] that affects so many organ systems. It's [77:23] important for your bones. It's important [77:25] for your immune system. It's important [77:26] for your brain. So, it's something that [77:29] everyone should supplement. They should [77:31] get their level checked. We're all low. [77:33] And then we should supplement up and [77:35] then have it rechecked so that you can [77:37] have a maintenance low dose. You usually [77:40] take it with potassium to help [77:42] absorption. Magnesium is a is another [77:45] key player with vitamin D. [77:47] What if I want really strong bones? What [77:49] should I be taking? [77:50] Uh, [77:51] vitamin D, potassium, magnesium. [77:54] Yeah. [77:54] You should be eating uh 1 g of protein [77:56] for every lean for every ideal body [77:58] pound you have. So, you build muscle [78:01] to [78:02] um [78:03] to help your bones. You know, there's [78:04] some remote data on boron and zinc, but [78:08] I'd rather you have the three that we [78:09] know work. [78:11] To build strong bones, you not only need [78:13] muscle, you need proper nutrition, you [78:16] need to [78:18] I should find another term, but you need [78:20] to bash your bones. You need to impact [78:22] your bones. The mechanical stress of [78:24] impacting bones, whether it's jumping up [78:27] and down, running, going up and down the [78:29] stairs. For people with poor bone [78:31] density, you can use a reformer, which [78:33] is a which is a a trampoline. [78:36] Um, is all important for sending the [78:40] biomechanical signals to your bone that [78:42] you're doing work, you need stronger [78:44] bones. That is transformed into a [78:47] biochemical signal [78:49] that makes your bones [78:51] uh, that your bone cells lay down new [78:53] bone. That's how you keep healthy bones [78:56] across a lifespan. [78:57] Can you grow new bone? [78:59] Um, you can [79:01] Yes, you can actually. You can can [79:03] increase your T-score. It's a [79:05] multifactorial. [79:07] T-score is a score that we measure using [79:10] a test called a DEXA scan. [79:12] Uh, a DEXA scan will tell us uh, not [79:15] only our absolute bone density, but it [79:17] but compare us to healthy people. And [79:19] this DEXA scans are usually used for [79:21] women or older men who have fallen and [79:24] fractured. [79:25] But a T-score tells us what [79:28] our bone density is compared to [79:31] a healthy 30-year-old, right? Assuming a [79:34] 30-year-old has laid down optimal [79:36] amounts of bone. And we can talk about [79:38] how that's becoming not true. But [79:41] so once we know our T-score [79:44] it tells us the health of our bones. [79:46] Um [79:49] just to give us a gauge of can we [79:50] rebuild? So yes, all the things we can [79:54] lift weights, we can impact our bones, [79:56] we can have proper nutrition. [79:58] If we [79:59] are a woman and uh, have lost our [80:03] estrogen, which starts in our 40s, not [80:06] our 50s. It starts in our 40s. We can [80:08] make our estrogen decision, as I know [80:10] you've talked about before. [80:12] Uh [80:14] because estrogen and testosterone are [80:16] critical in bone health. [80:19] And then [80:21] if you show up with a T-score that shows [80:23] that you have frank osteoporosis [80:27] even 2 million men in the United States [80:29] have osteoporosis. It's it's huge. [80:31] Osteoporosis is [80:33] uh, critical bone density [80:35] weakness, meaning a T-score of minus [80:37] 2.5. So, if you This is how it goes. So, [80:40] remember in the in the tests in lower [80:43] school where they would grade you on [80:44] this bell curve? [80:45] Mhm. [80:46] Straight up the middle is bone density [80:49] at 30 in a healthy woman, for instance, [80:51] zero. [80:53] Any positive number for your T-score, [80:55] your bone density is more than zero, [80:57] perfect. You're all good. Bone density [81:00] one standard deviation or minus one [81:03] below a 30-year-old healthy woman [81:05] is called osteopenia, meaning your bone [81:08] density is getting low, we really got to [81:10] step up our efforts. A bone density [81:13] number, a T-score minus 2.5 is the [81:17] definition of frank osteoporosis, which [81:20] is bones dangerously brittle. [81:24] That score, plus there's this index [81:27] called a FRAX index of FRAX index, which [81:31] which takes all your lifestyle risk, [81:33] meaning [81:35] is your mother shrinking? Do you have a [81:36] family history of osteoporosis? Did you [81:39] already fracture? Fracture is the number [81:41] one [81:42] predictor of future fracture. Did you [81:45] smoke your whole life? Did you have an [81:47] illness where you had to take a lot of [81:49] steroids that predisposes that break [81:51] down bones? Are you of genetic makeup [81:54] where you're predisposed to bone [81:56] density? The FRAX index takes all those [81:59] and calculates your [82:01] risk [82:02] for having a fracture in the next 10 [82:04] years. [82:05] So, a T-score of minus 2.5 and a FRAX [82:10] index of 3.6 or three, meaning I have a [82:12] 3% chance of a fracture in the next 10 [82:16] years, those are indications for [82:18] employing some of the pharmacological [82:21] drugs to either maintain bones or to [82:24] build bones. And there's a few [82:25] categories of those that I usually send [82:28] people to an endocrinologist to weed [82:30] out. It's kind of a complex [82:32] decision. [82:33] If I was If I was getting to that stage, [82:34] what kind of things would you tell me [82:35] that I needed to do? So, if I was [82:37] getting to the stage where I was minus [82:38] two on that scale. [82:40] If you were already a minus 2.5, we [82:42] would have a long, hard discussion about [82:45] all the lifestyle interventions, [82:47] nutrition, lifting. You can still lift. [82:50] Uh how we're going to add mobility, [82:53] uh impact. How we're going to get some [82:56] impact in without breaking a bone. But, [82:59] we're also going to have a conversation [83:00] about our hormone status. [83:02] Um and we're also going to if you're [83:05] already that low, have a conversation [83:07] about whether we use a pharmacologic [83:09] augment like bisphosphonate or Forteo or [83:13] some of the drugs that are available to [83:15] support bone density. And each person, [83:19] man or woman, has to have their [83:21] individual risks assessed to know which [83:23] road to go down. But, what we cannot do [83:26] is we cannot ignore it and hope that it [83:28] goes away. [83:31] You've You've done um so many studies, [83:34] and I find studies really fascinating [83:36] cuz they're they're first first party in [83:39] that regard. So, it's really finding [83:40] things out for the first time. What is [83:41] your What are some of those studies that [83:43] we haven't discussed that relate to our [83:44] conversation today that you find most [83:46] interesting? [83:46] Yeah. So, let's talk about We'll start [83:48] with bone because we're just talking [83:50] about in masters athletes, we did two [83:52] studies looking at could we preserve [83:54] bone density across a lifespan if we [83:57] took the variable of sedentary living [83:59] out of the equation. [84:00] So, in the first studies that we my [84:02] group did, uh I we formed a group called [84:05] PRIMA, the Performance and Research [84:07] Initiative for Masters Athletes. [84:10] We looked at 3,000 masters athletes. You [84:13] had be 50 years old uh [84:15] and uh they were competing in the [84:18] National Senior Games, which is [84:21] uh like Olympics for people over 50. [84:24] And these weren't just these weren't [84:27] just everybody that could go. These were [84:28] the [84:29] people who had qualified in their state [84:31] games to go to the national games. [84:33] So we looked at 3,000 of them. We did [84:35] two bone studies. We found the first [84:37] question [84:38] asked, could we maintain bone density [84:41] across upper age limits because we were [84:44] active? And what we found was that yes, [84:46] a very high percentage of people up even [84:48] up into 85 had normal T scores. But then [84:52] we did a second study that we wanted to [84:55] ask, okay, [84:57] so of all the activities you could do, [85:00] what would make [85:02] the biggest response from your bone? [85:05] And not surprisingly, we found that [85:08] impact exercise, the running sports, the [85:10] volleyball, the the basketball sports, [85:15] versus the swimming, the biking, the [85:18] bowling, for instance, there's bowling [85:20] in senior Olympics. Um those with sports [85:23] where you impacted your bone, [85:27] that impact exercise was as predictive [85:30] of bone density as things you can't [85:33] control, like your age, your sex, your [85:35] genetics. And so it just shows how [85:38] important putting mechanical stimulus [85:40] against your bone is. So that was really [85:42] important. So even bones can be [85:44] preserved. We've already talked about [85:46] the muscle preservation study, which was [85:48] fascinating. [85:50] The very first question I asked was to [85:52] answer the question, [85:55] this is this virus in your brain. [85:58] When do we really slow down? [86:00] When can we say, oh, I'm just getting [86:03] old. [86:04] I'm going to slow down. [86:06] I based on the athletes I saw, I knew [86:09] that it wasn't 50. [86:12] So I studied 3,000 of these athletes [86:14] again. I looked at all the track and [86:16] field athletes. [86:18] I looked at athletes [86:21] in the 100 m all the way up to the [86:23] 10,000 m. So, all distances, sprints [86:25] versus long distance. [86:27] I looked at [86:29] finish times of the top eight finishers [86:32] in every age category, and here's what I [86:34] found. [86:35] To answer the question, when do we [86:37] significantly slow down? [86:39] It's not 50, it's not 60, it is not [86:42] until our mid-70s [86:45] when we significantly slow down [86:47] if we use athletic performance as a [86:50] biomarker of aging. So, what does that [86:51] mean? The example is this. If you put a [86:54] bunch of men in a 1-mile race, [86:57] the 50-year-old man [87:00] in the year I did the study finished [87:02] that 1-mile race in 5 minutes and 34 [87:05] seconds. [87:06] To put that in perspective, the boy that [87:08] won the Pennsylvania State High School [87:10] Games [87:11] won his mile in 5:17. [87:14] Oh, wow. [87:15] I know. [87:16] 20 seconds in in in 30, 40 years, right? [87:20] How old was he? [87:21] 17. Let's say he was 17. [87:23] Uh but, the 50-year-old winner did it in [87:25] 4:34. The 70-year-old winner of that [87:28] mile race [87:30] did it in 7 minutes. So, nobody was [87:32] getting lapped. Right? So, I used those [87:36] times to see how much we slow down. [87:39] Before age 70, we slow down less than [87:43] 1.2% a year [87:46] timing-wise. So, [87:48] after 70, there is a rapid decline in [87:51] times, or you get slower and slower and [87:53] slower. And I call that biology taking [87:56] over. Either [87:57] you don't have the mindset to work that [87:59] hard anymore, or you've got enough [88:01] injuries that you can't work that hard [88:03] anymore, or you've lost enough enough [88:05] lean muscle mass or or bone flexibility. [88:08] But, what it tells us is that we have no [88:11] excuse until our mid-70s [88:14] for slowing down if we invest every day [88:16] in our mobility. So, it really set the [88:18] stage. That was my first study. [88:20] Really set the stage for wanting to find [88:22] out, okay, what's our muscle doing? What [88:24] is our bone doing? The third study we [88:27] did, which took us 5 years because we [88:30] matched for everything. [88:32] And now it's common knowledge, but at [88:34] the time it wasn't, we asked the [88:36] question, well, if we take sedentary [88:37] living away from our brain, what [88:39] happens? And so we [88:42] had the athlete group, and we had a [88:44] control group that was matched for every [88:47] variable except their activity level. [88:50] And [88:51] what we found was that people who were [88:54] chronically active maintained their [88:57] mental agility and their speed of [88:59] decision-making, and their [89:03] physical aspects of something called the [89:05] SF-12, which is your perception of your [89:07] physical prowess, were all higher if you [89:11] invested in your mobility every day. So, [89:14] even our brains are responsive. And And [89:17] we know that now. There's lots of [89:19] studies. It's a It's something that's [89:20] talked about a lot. [89:22] The final interesting group of studies [89:25] that we did before I left University of [89:27] Pittsburgh was to start asking the [89:29] questions of why. What's going on here? [89:31] Why? [89:32] Well, there's this protein [89:35] called Klotho. [89:36] Klotho was [89:38] uh one of the Greek gods who spun the [89:40] thread of life. So, this protein, when [89:42] it was discovered, was thought to play a [89:45] role in longevity. Every organ has [89:48] receptors for Klotho. [89:50] We know that mice [89:52] that are genetically engineered to not [89:54] be able to make Klotho [89:57] die old [89:59] very young. They're chronologically [90:01] very, very young mice, but they're [90:03] physiologically very old because they [90:05] lack this protein. [90:07] So, I decided to measure Klotho in my [90:10] athletes and compare them to sedentary [90:13] people. [90:14] So, we drew their blood, we ran the [90:15] ELISA study, and and not surprisingly, [90:19] youngish [90:21] 35 to 50-year-old masters athletes had [90:24] the highest level of circulating Klotho [90:26] longevity protein. [90:29] The second highest level of Klotho in [90:31] our study were people over 75 who were [90:34] still athletes. Do you know the who the [90:36] lowest Klotho level was? Sedentary [90:39] 30-year-olds. [90:40] So, if Klotho is the longevity protein, [90:46] and exercising people have the highest [90:48] levels, the next question was, "Okay, so [90:51] what's going on? How does exercise give [90:53] us more longevity protein?" [90:56] Well, one of my one of my colleagues, [90:58] Dr. Fabrizio Ambrosio, did the study [91:00] that showed that contraction of skeletal [91:03] muscle [91:05] stimulates the transcription or the [91:08] making of the Klotho protein. [91:11] So, it's our body's response to the [91:14] stimulus of activity that makes us make [91:18] more longevity protein cuz our bodies [91:20] believe that we are reinvesting in [91:22] ourselves and not just sitting in a [91:24] chair waiting to die. [91:26] Mhm. [91:26] But, that's fascinating, right? [91:28] Right. [91:29] Interesting. You [91:31] I read I read about study you did as [91:32] well with rats and stem cells, which is [91:34] seems somewhat linked to this idea of [91:35] muscular [91:36] Yes, I'm glad you brought it up. So, [91:38] it's the So, remember that picture we [91:40] talked about that at a tissue level [91:42] that we can maintain our muscle mass. [91:45] So, that's at a tissue level, the whole [91:47] flank steak we can maintain. [91:49] We wanted to see, well, what's happening [91:51] at a cellular level? What's happening at [91:53] a stem cell level? [91:54] And so, we we had a bunch of old lady [91:58] mice. They were mice. [91:59] Mice, when you're old, you're 2 years [92:02] old. That is a long lifespan for a [92:04] mouse. These little old lady mice were [92:06] sitting back in the back of their cages, [92:08] just hanging out, waiting for their next [92:10] food. And we sampled a little bit of [92:12] their muscle. Because the lab that I was [92:15] a part of looked at a kind of muscle [92:18] derived stem cell. [92:20] Meaning all of our tissues have stem [92:22] cells in them, including muscle. And And [92:24] we now know those cells as satellite [92:27] cells. At the time, in the in the early [92:29] 2000s, we called them muscle derived [92:31] stem cells. Well, we took them, and what [92:32] did we find? These little old stem cells [92:36] Healthy stem cells are round. These stem [92:38] cells had started to become all spindly, [92:41] like tree branches. [92:43] They were no longer pumping out growth [92:45] factor, meaning they were not [92:47] reproductively healthy. They were not [92:49] doing what they were supposed to do. [92:50] And do these stem cells make muscle? [92:53] These are stem cells that are found in [92:54] muscle, and when stimulated, produce [92:57] muscle. [92:57] Okay. [92:59] And so, they were not dividing [93:02] because they were all spindly. They were [93:04] not producing growth factor, and death [93:07] in cells is an active process. They had [93:09] turned on the genes that were leading to [93:12] cell death. [93:13] So, we took those little old lady mice, [93:15] and believe it or not, you can buy [93:16] treadmills for mice. [93:18] Do you know how much a mouse treadmill [93:19] costs? [93:20] No. [93:20] $30,000. [93:22] I'm not. It was like a big part of my [93:24] whole grant. So, we bought this [93:26] treadmill. [93:27] We put the little old lady mice on. [93:29] Here's what we found. In 2 weeks, [93:32] twice a day, many workouts, [93:35] their stem cells were fat and [93:36] replicating again. [93:38] They were churning out growth factor, [93:41] and they had turned off the pro [93:44] programming for program cell death. So, [93:47] what that told us is that even at the [93:49] stem cell level, that we can rejuvenate [93:52] stem cells by something as simple as [93:55] skeletal muscle contraction. And so, to [93:57] me, that is a fountain of youth type [94:00] intervention. [94:01] Mhm. [94:02] At the cellular level. [94:05] Someone said to me on this podcast one [94:06] day, I'm I'm probably going to butcher [94:07] it, but they said [94:09] aging is the rapid pursuit of comfort. [94:14] And I And as you were saying that, I was [94:16] thinking, oh, that's now that kind of [94:17] fits. [94:18] That much of our aging [94:21] is just to do with our increased pursuit [94:23] of comfort for whatever reason. [94:25] Mhm. [94:26] Um [94:27] I was thinking about that this morning [94:29] when we're thinking about I was thinking [94:30] about, [94:31] you know, what is the [94:33] what is the minimum amount of time we [94:35] have to work out to What is the min-max? [94:38] And I thought, well, honestly, you can [94:40] probably accomplish what [94:42] min-max is in about 45 minutes a day. [94:45] So, what are we doing with our other [94:47] more than 90% [94:49] of the time? And it goes kind of goes to [94:51] this. What are we doing? Are we pursuing [94:53] pleasure all day? Or we're working, but [94:58] once we're not working, what's the rest [94:59] of that? We're just sitting around being [95:01] pleasurable all day? And so, [95:04] that's an interesting question, but [95:05] another way to motivate people [95:08] uh [95:09] is to start associating taking care of [95:12] ourselves as pleasure. [95:14] And not [95:15] or comfort, and not just in the senses [95:18] I'm going to get a massage or a facial, [95:19] which is what often we think of [95:21] self-care, but that's temporary, right? [95:23] It just lasts an hour until you get I [95:25] often think that. I get off a massage [95:27] bed, I'm like, okay, that was good, but [95:29] do I have to do this every day? [95:31] Mhm. [95:31] Yeah. [95:32] So, you stop thinking of taking care of [95:34] yourself as [95:35] pleasure. [95:36] Putting yourself in discomfort. [95:38] Temporary discomfort, because I'm not [95:40] really kidding you, and you're probably [95:42] the same. When you churn out an upper [95:44] body workout, and your muscles are full [95:47] of blood, and you're looking in the [95:48] mirror, cuz I know you do, we all do, [95:50] and you're like, that is a good result [95:52] today." [95:54] That's pleasurable. And if we if we stop [95:56] for a moment and notice how good we feel [95:58] afterwards, [96:00] uh it's a motivation for how much we [96:02] don't want to get there, cuz I don't [96:03] want to get there as much as the next [96:05] person doesn't want to get there. [96:06] To the gym. [96:08] If you are a B2B marketer, then you want [96:10] to stick around for the next 30 seconds [96:12] or so. As a business-to-business [96:14] marketer, you'll know how tough it is to [96:16] explain what you do. I've been there, [96:18] too. But there's a platform that gets [96:20] us, and that's LinkedIn, where I'm happy [96:21] to say sponsor this podcast. Imagine a [96:24] place where you can connect with [96:25] professionals who truly understand your [96:27] world. That is LinkedIn Ads. LinkedIn [96:29] Ads helps you to build a meaningful [96:31] relationships and drive results in a [96:32] respectful environment. With over a [96:34] billion members, including 130 million [96:37] senior-level executives and 10 million [96:40] C-level executives, you can target your [96:42] audience precisely by job title, [96:44] industry, and much more. LinkedIn [96:47] members are always updating their [96:48] profiles, so your targeting stays fresh [96:51] and relevant. It's no surprise that [96:52] LinkedIn is the highest returning paid [96:54] social platform. And LinkedIn Ads have [96:56] kindly offered all of you a $100 credit [96:59] to launch your first campaign and start [97:00] reaching the right people. Go to [97:02] linkedin.com/doac24 [97:06] to claim your credit. Terms and [97:08] conditions apply. [97:09] You have written a paper about a subject [97:12] we haven't spoke about much yet. You [97:13] mentioned it briefly from your own [97:14] experience. You talked about going into [97:16] perimenopause and thinking you were [97:17] going to die. [97:18] Yeah. [97:19] There's been a lot of research that's [97:20] come out, and you've done a lot of work [97:21] on how menopause impacts our [97:24] musculoskeletal [97:25] Yes. [97:26] physiologic physiology, I guess is the [97:28] word. [97:28] Mhm. [97:29] What what do women that are and men that [97:31] are have a partner or a friend or a a [97:33] mother or whatever it might be [97:35] need to know about how menopause impacts [97:37] our musculoskeletal functioning? [97:39] Yes. [97:40] So, I think um it is very common for [97:43] people to know about hot flashes, brain [97:46] fog, night sweats. What is less commonly [97:49] known is that 80% of all women going [97:53] through perimenopause [97:56] will experience what the term we've [97:58] coined the musculoskeletal syndrome of [98:00] menopause. We coined that after the [98:02] genitourinary syndrome of menopause, [98:04] which is five or six different things [98:07] put into one category so we can talk [98:09] about it more easily. So, in the [98:11] musculoskeletal syndrome of menopause, [98:13] we know that 80% of women will [98:14] experience it. [98:16] 25% of women will be devastated by it, [98:20] and 40% of the time when you go to the [98:22] doctor [98:23] and they do due diligence and they work [98:25] up, they send you for imaging, nothing [98:27] will be found structurally. So, that's [98:29] why women sometimes think, "Oh my god, [98:32] I'm just old. I'm falling apart, and am [98:34] I going crazy because my doctor's [98:36] telling me there's nothing structurally [98:37] wrong." But, that's why we created this [98:40] nomenclature so that women would realize [98:43] that ubiquitous on every musculoskeletal [98:45] tissue are receptors for estrogen, just [98:49] like in the brain, just like in, you [98:51] know, every other body part, the [98:53] musculoskeletal system, muscle, tendon, [98:56] bone, adipose, the inflammatory aspects [98:59] are responsive to estrogen sitting these [99:02] receptors. So, what are the things in [99:04] the musculoskeletal syndrome of [99:05] menopause? Well, [99:07] number one is inflammation. In estrogen [99:10] is a huge anti-inflammatory. It prevents [99:13] the release of a cytokine, a [99:15] inflammatory cytokine called tumor [99:17] necrosis factor. [99:18] And menopause, just to be clear, is the [99:20] part part part of the symptoms is the [99:23] loss of estrogen? [99:24] So, if we if we just clarify the [99:27] timelines, so [99:29] uh a woman's hormones are unlike men's. [99:31] Men, once you're through puberty, your [99:33] testosterone will stay pretty steady. [99:36] Women, every month, as we go through a [99:38] menstrual cycle, cycle, estrogen goes up [99:40] and down. [99:41] When we [99:43] in around These are average times. [99:45] Around 45, it can start early like 35, [99:49] but around 45, we have used up enough [99:52] eggs from our week our monthly cycle [99:55] that we start to become low in our [99:58] estrogen and our body is trying to [100:01] adjust to that. Our brain without [100:03] estrogen gets brain fog. It has a lot of [100:05] receptors and nothing to go in them, [100:06] right? [100:08] Once we have used up all of our eggs [100:12] and [100:13] we are 1 year from our last menstrual [100:16] cycle, 366 days, that is the one day [100:19] definition of menopause. [100:22] And we live the rest of our 40 40 more [100:24] years we live post menopause without [100:26] estrogen unless we supplement. So, [100:29] in perimenopause in our 40s, that's why [100:32] I say at 47 I thought I was going to [100:34] die. [100:35] As estrogen is going away, all these [100:38] receptors that used to be filled with [100:40] estrogen, which would then cause all [100:41] these marvelous downstream effects, all [100:44] the muscle protein synthesis, the bone [100:46] laying down, the inflammation would be [100:48] kept at bay, [100:50] suddenly have have no stimulus. So, when [100:53] we're talking about inflammation, [100:56] estrogen is an anti-inflammatory effect. [100:58] It prevents the release of tumor [101:00] necrosis factor, which is a inflammatory [101:02] cytokine. I think of it like a fire or, [101:06] you know, nuclear war or something that [101:08] chemicals in our body. [101:10] Um [101:11] so that gets out of control and then uh [101:14] estrogen is also really important [101:17] interacting with a part of our immune [101:18] system called the inflammasome. So, [101:20] without estrogen controlling [101:22] inflammation, we can get something [101:24] called arthralgia, which [101:26] is your total body hurts for no reason. [101:29] And this was one of my primary symptoms [101:31] when I was 47. I went from being an [101:33] athlete, active all the time, surgeon, I [101:36] do hauling people's bodies around to I [101:39] could barely get out of bed. It took me [101:41] a lot to like crank out and get out of [101:43] bed. My whole body hurt. [101:45] There's nothing structurally wrong. It's [101:47] due the inflame inflammation of loss of [101:49] estrogen. Another very very very common [101:52] inflammatory symptom of the [101:54] musculoskeletal syndrome of menopause is [101:56] frozen shoulder. It's all over social [101:58] media right now. It's where [102:00] it is an inflammatory state. Men can get [102:03] it, usually diabetic men. It just means [102:05] that you're you're inflamed. So you'll [102:07] present to my office with the story of [102:11] Doc, I did nothing. I didn't have an [102:13] accident. I didn't hit my shoulder on [102:15] the closet in the middle of the night [102:17] when it was dark, but I woke up and my [102:19] shoulder is killing me and I can't move [102:21] it. [102:23] It's It's It's literally like this. And [102:26] that's because for some reason the [102:28] shoulder is very sensitive, the capsule, [102:30] the inside skin of the shoulder, very [102:33] sensitive to inflammation. And so people [102:36] show up like that. Frozen shoulder can [102:37] take 2 years to get rid of. It's [102:39] miserable. So [102:40] that's inflammation. [102:42] Is that the the whole hook your bra [102:43] test? [102:44] Yes. Yes. I made this thing up. You [102:46] can't hook your bra, right? Most women [102:48] do this. [102:49] Yeah. [102:50] The first motion you lose in frozen [102:53] shoulder is internal rotation, which is [102:55] what this is. [102:56] Hooking your bra on. [102:57] Hooking your bra. You can't. [102:59] Cuz what happens is the first thing that [103:00] goes, you can't do this. Your arms kind [103:03] of stuck at your side. [103:05] And then you can't lift it up. And you [103:07] can't do your hair. So you're trying you [103:08] know, you're doing all this trying [103:11] Imagine not being able to move your arm [103:12] and when you did move your arm, it's [103:13] excruciating. [103:14] Oh, it's painful as well. [103:15] Excruciating pain. Like women say to me, [103:18] I'd rather give birth again than have [103:20] this shoulder. So [103:22] What's going on there? Like what's going [103:23] on in the shoulder? [103:24] Yeah, there's [103:25] there was a study done by Jo Hannafin, [103:27] who was a mentor of mine at at Hospital [103:29] for Special Surgery, who looked at the [103:31] stages of [103:32] a frozen shoulder. And first, it's just [103:35] big inflammation. All the inflammatory [103:37] cytokines go and inhibit the I keep [103:40] doing this. The shoulder has an inside [103:42] skin that surrounds the bones called the [103:43] capsule. It's like a a thin sheet of [103:45] paper, like cellophane. [103:47] That gets inflamed, hot and red. That's [103:50] painful. [103:52] Over time, [103:53] the inflammatory cells of the immune [103:56] system that crawl into the capsule, [103:59] the pain will go away, but it will cause [104:01] a a capsular shrinkage like this. The It [104:04] will actually contract. So, your pain [104:06] your shoulder might not be as painful, [104:08] but it still won't move. So, that's why [104:10] it's really critical that people come to [104:12] doctors like me and we get it moving [104:14] quickly. We do not want it to become [104:16] stuck in cuz it literally can take 2 [104:18] years to defrost. [104:21] All due to this inflammatory into We [104:24] don't know why the capsule is so [104:25] sensitive, but we know it is. [104:28] So, that's the inflammatory aspect of [104:30] this. [104:32] We know that without estrogen, uh we can [104:37] lose uh 2 to 3% of our [104:39] um muscle mass. [104:41] And rapidly during this period, we have [104:45] estrogen is an anabolic steroid. It It's [104:48] made for muscle building through the [104:50] mTOR system. And so, without that, and [104:53] we build less muscle and our muscle stem [104:57] cells or satellite cells become [105:00] decreased by 30 to 60%. It's profound in [105:03] a very short amount of time. [105:05] We know our bone about bone density. We [105:07] talked about that. Estrogen's role in [105:09] the bone is to control one of the cells [105:12] called the osteoclast. If we talk about [105:15] bone biology briefly, if we have that [105:17] femur, imagine on one side of the cell, [105:20] when uh you impact your bone, the [105:22] biomechanical stimulus [105:24] is converted to biomechan- biochemical [105:27] stimulus and it says, "Hey, [105:29] uh we need to build more bone." So, the [105:31] osteoclast [105:33] crawls up the cell [105:35] and starts digging out minerals to [105:38] release to the body to do its function. [105:41] What happens when you have estrogen [105:43] is the osteoblast comes back up behind [105:46] it and fills in that hole [105:48] and builds bone. [105:51] Estrogen [105:52] helps control osteoclasts. The more I [105:55] learn about bone biology after all these [105:57] years, it seems to me that the [105:59] osteoclast is a little bit of a rogue [106:01] entity. It's going to go uncontrolled. [106:03] It needs a lot of a lot of control with [106:06] estrogen, testosterone. Without those [106:08] controls, what happens in osteoporosis [106:12] is you you can still lay down bone. Your [106:13] osteoblasts are still working, but it's [106:16] out of control. You're breaking down [106:19] more bone than you're building. [106:20] Okay. [106:21] Yep. [106:22] So, [106:23] you know, inflammation, then you have [106:25] muscle, you have bone. [106:27] Here's one. We talked about arthritis [106:30] earlier. [106:32] There are estrogen receptors on the [106:34] cartilage. Cartilage estrogen sitting on [106:36] the cartilage helps maintain this spongy [106:39] mate- spongy matrix of cartilage that [106:43] then protects your bones. Without [106:45] estrogen, the cartilage matrix breaks [106:47] down. So, before 50, men have more [106:50] traumatic arthritis than women. [106:52] After 50, women can have a rapid [106:57] progression of their arthritis. Pile on [106:59] top of that the weight gain that happens [107:01] to many women with the load we talked [107:03] about and it's a disaster. And so many [107:06] women rapidly progress and need total [107:08] joints, which as an orthopedic surgeon [107:11] is not the end-all, but we'd like to [107:14] avoid it, right? So, that's due to [107:17] estrogen being missing from the [107:18] cartilage. And And finally, [107:21] On that point, [107:22] you talked about weight gain there in [107:23] menopause. I read that you you gained [107:26] weight when you went through menopause. [107:27] I gained 30 lb. [107:29] 30 lb. So, that's equivalent to four [107:31] roughly four of these bricks if each [107:32] brick weighs [107:34] um [107:34] 7 and 1/2 lb. Which is a lot of weight [107:38] to suddenly gain. And when we think [107:39] about the impact that that will have on [107:40] your joints based on what you said [107:42] earlier. [107:42] Yeah. [107:43] Yeah. [107:45] My pain was more an arthralgic pain [107:48] meaning total body pain. Although [107:51] when I had that weight on [107:53] I had um [107:55] knee I had pain underneath my kneecaps [107:57] going up and down stairs [107:59] because of the extra pressure [108:01] of the my kneecaps on my femurs. [108:04] So [108:06] does that make sense? [108:06] Yes, it does. Yeah. That's That's uh [108:09] yeah, something that we don't I don't [108:10] think I'd never really considered. I [108:11] never considered how the impact on our [108:13] joints of weight gain period, but then [108:15] also when you go through menopause [108:17] weight gain is something that I've heard [108:19] about over and over and over and over [108:20] again because of the loss of [108:22] estrogen [108:23] and how that will then have a skeletal [108:24] impact on [108:26] a variety of different areas of your [108:27] body. [108:29] But then imagine this perfect storm, [108:31] right? You [108:32] you don't feel like yourself. You're [108:34] tired. You [108:36] your joints hurt. Maybe your whole body [108:38] hurts. You're losing your muscle. So, [108:40] that causes more impact. There's no [108:42] shock absorption. You're losing your [108:44] bone and without even realizing what's [108:46] happening cuz it creeps up on you, [108:48] right? And you're so busy I mean all the [108:51] excuses are so busy. [108:54] Women very rapidly find themselves at 60 [108:58] and they have you know, there's a [108:59] syndrome [109:01] called OSO [109:03] osteoporotic [109:06] meaning bad bones. We talked about that. [109:08] Sarco [109:10] bicity [109:11] loss of bone, loss of muscle, gain of [109:15] fat. You've got all three things. [109:17] And the morbidity and mortality of being [109:19] osteosarcobesity [109:23] is three times what it would be if you [109:25] had one alone. [109:26] So, it creeps up on you and you can see [109:28] how none of these tissues are separate [109:31] from each other. [109:32] It just becomes this horrible storm and [109:35] women are like, "What happened to me?" [109:38] What's the What's the remedy for that? [109:39] What's the remedy for that? [109:41] Well, the remedy is understanding that [109:45] you can feel like yourself again and [109:47] here are the steps I ask every woman [109:49] going through this to do. Number one, [109:51] you must make your estrogen replacement [109:53] decision. I believe that that decision [109:56] to replace your estrogen [109:58] must be based on science and not the [110:00] fear or the myths that are circulating. [110:03] Though, and I know you've had these [110:05] conversations, but the Women's Health [110:07] Initiative study has been largely [110:09] overturned. Um [110:12] And so, every woman [110:15] is a sentient being with agency, ability [110:19] to make their own decision and they [110:20] should make that decision and not just [110:22] go on hearsay. So, that's number one. [110:24] Let's make our decision. [110:25] If you make your decision to do that, [110:28] which I have done, I replaced my [110:31] estrogen not for my hot flashes, night [110:33] sweats, and brain fog. Those go away, [110:35] frankly. [110:37] I do it to preserve my bone, my muscle, [110:39] my brain, and my heart. [110:41] That's decision number one. Number two, [110:44] you are never ever going to feel better [110:47] until you decide to invest every day in [110:50] your mobility. And so, what is mobility? [110:52] It is [110:54] lifting heavy. [110:56] Women have to put down the manby pamby [110:58] pink weights [111:00] that we do 20 sets of because we don't [111:02] want to bulk up. You're never going to [111:03] bulk up unless you do it purposefully. [111:06] We must lift as heavy as our bones will [111:08] let us. So, for my people, [111:10] I've simplified it into once you have [111:13] started enough that you feel comfortable [111:16] moving your body, [111:18] we must lift four rep [111:21] or sets [111:23] of our major muscle groups in compound [111:25] motions. So, push pull with your upper [111:27] body, bench press, pull, some kind of [111:29] pull down. [111:31] And then for the lower body, it's squats [111:34] and deadlifts. Four reps, four sets [111:38] in a progressive manner. You can start [111:40] with 2 lb, but I want you to progress [111:42] up. [111:43] And then for the accessory lifts that [111:46] support the big compound lifts, like for [111:48] instance, for my for my bench press, I [111:51] support that with biceps, triceps, lats, [111:54] delts, eight reps, four sets. Okay, that [111:57] is the basis of lifting heavy. [112:01] The other thing we need to do is [112:05] uh [112:06] do a do our cardiovascular training with [112:09] 80% base training, which is lower heart [112:13] rate. I mean, everybody's talking about [112:15] zone two. I happen to in in the place [112:17] where my office is, we have a metabolic [112:19] lab um that was built by Iñigo San [112:23] Martín [112:24] San Martino, who's the guru of zone two. [112:26] And so, we use his protocol, and that [112:28] means that I need that I need people to [112:31] do uh 60% effort 3 hours a week, but [112:36] that's not all. [112:37] Twice a week, [112:39] we're going to sprint as hard as we can, [112:41] and that freaks people out cuz we're in [112:43] the Olympic trial. We're in the Olympics [112:44] right now, and everybody thinks it's [112:46] supposed to look like that, like the [112:48] like track and field trials. What [112:50] sprinting means is you just work at [112:53] maximum heart your maximum 100% effort [112:57] for short bursts. So, [113:00] 30 seconds, [113:02] short burst, hard as you can go, and [113:04] then you recover for 2 to 3 minutes. So, [113:07] I'll give you a concrete example. In my [113:09] life, my base training heart rate, [113:12] because I have the luxury of measuring [113:14] it with a lactate threshold, is 130 [113:16] beats per minute. [113:18] I achieve that with an incline of 4 to 5 [113:21] and a speed of about 4.2 and it's a [113:24] brisk walk. It's almost on the verge of [113:25] having to jog. [113:27] For 45 minutes. When I'm done with that, [113:30] cuz that's good for my cardiovascular [113:32] base, [113:33] I punch it up to 11 and I go as hard as [113:36] I can cuz I'm not very tall and I don't [113:38] want to fly off the back of the [113:39] treadmill. [113:40] But my heart rate goes up to about 186 [113:42] and I keep it there for 30 seconds. What [113:44] that does, that will burn 40% more fat [113:48] than [113:49] just uh even high-intensity interval [113:51] training, which is done at about 80%. [113:54] That amount of effort [113:56] burns 40% more fat. It is stressful [113:59] enough, it offsets our normal [114:01] homeostasis enough that it [114:04] um helps stimulate the formation of more [114:06] muscle stem cells. The the muscle [114:08] perceives that effort. And so, that is [114:12] the the working out portion of what we [114:14] need to do and then the smart [114:15] anti-inflammatory nutrition, we need to [114:18] get rid of simple sugar. [114:20] We need 1 g of protein per ideal pound. [114:23] High-quality protein, what does that [114:25] mean? [114:26] We need [114:28] a very high concentration of one of the [114:30] branch-chain amino acids called leucine. [114:32] Leucine is the most powerful amino acid [114:36] stimulus of the mTOR [114:39] muscle-building pathway. [114:42] Leucine is found [114:45] in highest percentages [114:47] in whey protein. [114:49] So, [114:51] you can get it from plant protein, but [114:53] just in much lower percentages. Whey has [114:56] about 10% leucine. [114:58] And we know that's important to nature [115:01] because mother's milk [115:04] is mostly whey. [115:06] Which means it has the highest amount of [115:08] leucine as we're trying to grow muscle [115:09] in our babies, right? [115:11] So, leucine is high in whey protein, [115:14] about 10% [115:16] in animal protein, any kind of meat is [115:19] is about 8%, and then beans and legumes [115:23] and plants are about 6.5. So, can you [115:27] get enough protein from plants? Sure, [115:29] you can. You just got to eat a lot of it [115:31] like a bull does. [115:33] What about fiber? [115:35] People are going crazy for fiber at the [115:36] moment, it seems. [115:37] 30 g of fiber. So, that just means [115:39] complex carbs. Your microbiome needs [115:41] fiber. [115:45] It it it is a slower digestion so that [115:48] we're not causing carb spikes. I'm not [115:50] wearing it today. It's the first time in [115:51] about a year I haven't. I I'm not [115:54] diabetic, but I have worn a continuous [115:56] glucose monitor because I am just a data [115:58] geek. I love my data. I know exactly at [116:01] this point what foods will spike my [116:04] glucose and how to keep my glucose [116:06] steady all day. [116:08] What's been the most surprising cuz I I [116:09] literally have just taken my continuous [116:10] glucose monitor off. I wore it for the [116:12] last 2 weeks while I was filming a TV [116:15] show called Dragon's Den. And I gave one [116:16] to all of the dragons with me and we've [116:18] been talking about it every day. What [116:19] was the most surprising food for you [116:20] that caused a glucose spike? [116:22] The surprising food, um [116:26] well, it wasn't surprising. I mean, I am [116:30] to the degree my glucose spikes shot up [116:34] is I am so sensitive to simple carbs. I [116:37] can't even look at a simple carb and it [116:39] goes up to 165, which [116:42] our body is meant to respond to spikes. [116:44] I'm not saying that you have to live [116:46] like this because I have also found that [116:48] when I only ate protein or most very low [116:52] low low carbs, that I was so low energy, [116:55] I would be [116:56] slogging through my clinics and I just [116:58] need I could feel I needed energy. So [117:00] now I've added sourdough to my breakfast [117:03] knowing that I'll get a small spike. [117:05] So that was very interesting to me how [117:07] extremely sensitive [117:09] It's a simple carb. [117:11] A simple carb is a sugar, ice cream, [117:14] white bread, white potatoes, white [117:17] pasta. [117:18] All the good stuff, [117:20] annoyingly. What is the What's the most [117:21] important thing that we haven't [117:23] discussed in your work or the most [117:25] important idea that I don't know has [117:27] changed your life, maybe people don't [117:29] understand or think about it enough [117:30] that's foundational to having a great [117:32] health span, living long, being healthy, [117:34] all of those things that maybe we [117:35] haven't discussed. [117:37] Yeah. [117:38] I want to address that question in a [117:39] couple ways. Number one, [117:41] um [117:44] you have to We talked about temporal [117:46] disconnect. And doing the things today [117:49] that feel good today, but for the [117:50] future. And so the way I have really [117:52] changed [117:53] since I've been through this is [117:56] I have thought ahead about what I want [117:58] to be when I'm 97. And how did I choose [118:01] 97? Well, I'm 57 now. [118:04] My daughter, my youngest daughter was [118:06] born when I was 40. If I want to be [118:09] around to bug the heck out of her until [118:11] she is my age, I need to live till 97. [118:14] What do I need to do [118:16] to do what I want, when I want, when I [118:18] want it? Like you can imagine, I don't [118:21] want to be told what to do. I'm a [118:22] surgeon, I'm usually in control of my [118:24] environment. And I think people just [118:26] want to be in control. I want to do what [118:28] I want. Well, what's it going to take? [118:29] If I just wait [118:31] until 63 [118:34] when when my health span is over to pay [118:37] attention, I'm never going to get there. [118:40] So that has really pivoted my mindset [118:43] that I have to do it every day now. [118:46] I don't love doing it. I mean, I'm not [118:47] going to lie to you. I don't love [118:50] going and working out most days. [118:52] but with this perspective I will. [118:54] But the other the other tenant that I [118:57] think is so important, we talked about [118:59] lifting heavy, we talked about zone two [119:01] and sprinting, something I've layered on [119:03] this year [119:05] uh is the concept of our VO2 max and the [119:08] fragility line. Fragility means you get [119:11] older, slower, weaker. [119:14] Uh [119:15] you lose your functional capacity. 25% [119:18] of all people are frail and unable to [119:20] live independently by the time they're [119:22] 85. Not on my watch. And so [119:26] um the frailty line is the [119:29] cardiovascular health that you need the [119:32] cardiovascular capacity that you need to [119:35] be independent [119:36] in your own home. You may not be running [119:38] marathons. So for men it's 18 [119:41] ml of oxygen per kilogram per minute. [119:44] For women it's 16. So how do we figure [119:46] this out? I would go have my Have you [119:48] had your VO2 max tested? [119:50] Uh [119:51] I haven't. [119:52] It's torture but you should do it. [119:54] I think well I had a cardiovascular [119:56] examination and they made me sprint on a [119:58] treadmill. [119:58] Yeah. [119:59] Um and they were look but they were [120:00] looking at my how well my heart coped. I [120:02] don't know if they're measuring my VO2 [120:03] max. They didn't. [120:05] Yeah. [120:06] You should do it while you're young so [120:07] you know your base. [120:08] I didn't have a mask on, you know. [120:09] Yeah. So what it tells is your [120:11] cardiovascular capacity for for [120:13] exchanging oxygen from your blood to [120:15] your lungs. Elite athletes like the Tour [120:18] de France have have VO2 maxes in the [120:22] above 75, sometimes 200. They're just [120:25] genetic specimens. [120:27] Um the 50th percentile for a man your [120:30] age is 55. The 50th percentile for a [120:33] woman my age is 31. [120:35] That's the average, right? [120:36] That's the average, 50th percentile. [120:37] When I was 50 I'm going to give you an [120:39] example. [120:40] Every decade we lose 10% of our VO2 max [120:43] if we don't do anything about it. That's [120:45] just [120:47] the way we age. 10% [120:49] I can get it back though, right? [120:50] You can work at it. [120:53] People who are out of shape can make [120:55] bigger deltas getting it back. People [120:57] are in extreme shape and the delta [120:59] smaller cuz they start out well. So for [121:01] me, I'm going to give you an example so [121:03] people see how this works. At 50, when I [121:05] was 50, I did it. [121:07] My VO2 max at that time was 45. So at [121:10] 60, if I lose 10%, let's just do big [121:13] numbers, I'll be down to 40 VO2 max. At [121:16] 70, I'll be down to 35. At 80, I'll be [121:20] down to 25. I'm still above the frailty [121:23] line. At 90, I'll be 20. Still above the [121:26] frailty line. Not what I was at 50, but [121:30] not frail. I can still live on my own. [121:32] So what I've done now, since the things [121:34] that I've talked to you about are a [121:36] lifestyle, they don't take much energy [121:39] cuz it's just how I live. [121:41] I've layered on VO2 max training, which [121:44] is a different way to do cardio [121:45] training. It's 4 minutes as hard as you [121:48] can go. [121:50] Torture. [121:51] And then you recover for 4 minutes. Only [121:53] 4 minutes. [121:55] And then 4 minutes as hard as you can [121:56] go. The good news is you only have to do [121:58] that three times or so once a week. [122:02] And it will work you hard enough [122:05] to maintain or improve your frail your [122:07] VO2 max frailty line. That's something [122:10] special that you can add on [122:12] once you've optimized your health, once [122:14] you've done the peak performance things [122:16] we've talked about, then you can add [122:18] those things on. [122:21] Okay, well I better get I better get on [122:23] with it then. [122:23] Don't feel guilty. [122:24] I need to go to the gym today, but it's [122:26] certainly changed my perspective on what [122:27] I'll be doing in the gym and and also [122:29] why I'll be doing it. I think. I think [122:31] the why piece is so critical. I think a [122:32] lot about discipline and incentives and [122:35] why certain behaviors occur. And I wrote [122:37] in my my book that um I was trying to [122:38] sort of sort of simplify why some habits [122:41] in my life have stuck and others [122:42] haven't. And then why some habits where [122:44] I was a bit of a yo-yo suddenly stuck [122:45] and I held them for 5 years and still to [122:47] this day and and others haven't and um I [122:50] kind of [122:51] simplified it down to this idea that [122:54] the discipline equation starts with the [122:56] strength of your why. Like this So [122:58] you've given yourself a really strong [122:59] why by having this sort of 97-year-old [123:02] uh goal, like who I'm I'm going to be [123:03] when I'm 97 and then linking that to [123:05] your daughter, which is a pretty strong [123:06] why. [123:06] Yeah. [123:07] Plus the the enjoyment I get from the [123:08] pursuit of the goal. [123:09] Mhm. [123:10] And then minus the friction or the like [123:12] lack of engagement from Yeah, the hard [123:15] like if the gym is really far away, if [123:16] it takes too long, if it if it's [123:18] embarrassing is friction. So if I'm [123:19] going to a gym and I'm a guy and there's [123:22] lots of beautiful people there and I'm [123:23] overweight, it's Yeah, all of that all [123:25] of that's friction. So how do you like [123:26] influence that equation to increase your [123:28] why, make it more enjoyable or [123:30] psychologically reinforcing the act of [123:32] the discipline, and then kill all the [123:34] friction I possibly can. [123:36] And for me, that's where the habits [123:38] we're talking about today have really [123:39] stuck. [123:39] Yeah. [123:40] Interestingly, I've said share this [123:42] before, but I'll share it again. I was a [123:44] um a yo-yo gym goer. My [123:47] gym routine and my health strength [123:50] routines were all very inconsistent [123:51] until the pandemic. And it was for me [123:54] just seeing that health is the [123:55] foundation of all of our lives, seeing [123:57] that on a screen in lockdown, that the [123:59] real sort of variance between outcomes [124:01] for people that got COVID came down to [124:03] your sort of pre-existing health. [124:05] Yeah. [124:05] And so at that point I thought, "Oh my [124:06] god, like it's not my business, it's not [124:08] my dog, it's not my girlfriend, it's not [124:09] my my family that matter the most. [124:11] Actually, number one, the foundation in [124:13] which all those things sit is my [124:15] health." So [124:16] that became my first foundation, my [124:18] non-negotiable. Um and hopefully, as you [124:20] say, that'll mean that my kids, when [124:21] they arrive, whenever whenever I become [124:23] a father, [124:24] um will have a dad until I'm 170. [124:28] So that's the goal. [124:30] That's the goal. We have a closing [124:32] tradition on this podcast where the last [124:33] guest leaves a question for the next, [124:35] not knowing who they're leaving it for. [124:36] And the question left for you [124:39] is what was the last time you took an [124:41] uncomfortable risk? [124:42] The last time [124:44] I took an uncomfortable risk and what [124:46] happened when I did was [124:48] uh I am an academic orthopedic surgeon. [124:51] Which means [124:53] I create big business and [124:56] care and practice within big hospital [124:58] systems. So, there's a big safety net in [125:00] that. But, I have always been what I've [125:03] called an intrapreneur. [125:05] Meaning I'm using somebody else's money, [125:07] somebody else's time, and but I'm [125:09] building them a big business. [125:12] Three years ago, I left that comfort. In [125:15] a late stage of my career, I left that [125:17] comfort and decided I know what I'm [125:19] doing. I believe in myself. I'm going to [125:22] spend my own money and I'm going to go [125:23] out on my own in private practice. And [125:26] I'm going to [125:27] uh build these [125:30] side businesses, my keynote speaking, my [125:33] precision longevity practices, which are [125:35] purely entrepreneurial ventures. [125:38] And and at 57, to go out and create my [125:41] own business when all I have ever known [125:43] is a W-2 tax form, is a huge risk for me [125:47] and my family. But, [125:49] but I love that [125:51] um [125:52] I am confident enough in my own [125:54] capacity, Steven, and my own work ethic [125:57] that even if I had to go work at [125:59] Starbucks to bridge the gap, that I'm [126:01] going to make this work. And it's a it's [126:03] a very freeing and and beautiful mindset [126:06] to to take what I've learned this whole [126:09] career and do it for myself. [126:11] Well, it certainly is working. [126:13] I think you'd agree, right? [126:15] It's great. [126:16] It is great. I mean, you've galvanized a [126:18] community online of many millions of [126:19] people. You've written some absolutely [126:21] incredible books, all of which I'll link [126:22] below. And you're still doing um [126:25] incredibly important work through uh [126:27] YouTube and through Instagram and [126:29] through all of your channels, which I'll [126:30] link below as well. And it's very [126:31] necessary work, because you are you're [126:33] confronting a mind virus that I think [126:34] can hold us back from living long, [126:36] happy, healthy lives. And sometimes it's [126:39] just an idea, right? Sometimes it's just [126:41] an idea that can change your life. And [126:42] it's also, conversely, sometimes just an [126:44] idea that can ruin your life. And I [126:47] think the work you're doing is replacing [126:49] those potentially inhibiting ideas with [126:51] much more constructive, healthy, [126:52] positive, optimistic, hopeful ones. And [126:55] for that, I thank you. [126:57] Thank you.