Dr. Vonda Wright: La pérdida ósea en la menopausia eleva riesgos de alzheimer y fracturas

Dr. Vonda Wright：更年期骨质流失增加阿尔茨海默病与骨折风险 雌激素的急剧下降会加速骨骼退化，并大幅增加患阿尔茨海默病和致残性骨折的风险，因此需要从35岁开始进行大重量力量训练并评估激素指标。 Dr. Vonda Wright 阐述了肌肉和骨骼健康如何构成各个生命阶段长寿、行动力以及思维敏锐度的基石。通过冲击性运动、大重量力量训练与合理营养的科学依据，她表明预防骨质退化、肌少症以及应对衰老退行性改变是完全可行的。此外，她还澄清了更年期雌激素与激素替代疗法的作用，揭示了肌肉骨骼系统、代谢健康与阿尔茨海默病预防之间的深层联系。 在美国，至少有50%的女性和200万男性患有骨质疏松症，而在髋部骨折的患者中，有30%在一年内死于因行动受限引发的并发症。 (0:00) 精准长寿依赖于对生物标志物的检测，例如通过乳酸阈值测试测定“FatMax”，以确保80%的心血管耐力训练都处于线粒体最高效的燃脂区间。 (7:14) 女性的骨量峰值出现在28岁左右，男性在30岁左右；随着更年期雌激素水平下降，女性的骨密度损失可高达20%。 (9:24) 高冲击力、弹跳类的运动能够引发骨骼的机械重塑，从而在年老时保持骨密度，而游泳或骑自行车等低冲击运动则无法达到此效果。 (12:08) 骨骼与肌肉构成了相互连接的生态系统：骨骼肌收缩会释放鸢尾素（irisin）以发出骨重塑信号，而成骨细胞则分泌骨钙素（osteocalcin），后者能穿过血脑屏障促进神经发生。 (13:51)

Dr. Vonda Wright argues that physical fragility and cognitive decline in later life are largely driven by preventable musculoskeletal and metabolic decay rather than inevitable chronological aging. She contends that preserving long-term independence requires aggressive, early interventions—including heavy resistance training, impact loading, hormonal management, and targeted nutrition—initiated decades before typical diagnostic thresholds. Skeletal Health, Endocrine Signaling, and Fracture Risks (0:00) In the United States, at least 50% of women and 2 million men will develop osteoporosis, a condition marked by severe bone density loss. Wright emphasizes that the clinical consequences of bone fragility are catastrophic: half of all adults who suffer a hip fracture never regain their pre-injury level of mobility, and 30% die within one year due to immobility-related complications such as pneumonia, bedsores, and systemic infections. Low bone mineral density is also clinically correlated with accelerated cognitive decline and Alzheimer's disease. Wright reframes bone not as passive structural scaffolding, but as an active endocrine organ that communicates continuously across physiological systems. Arising from shared mesenchymal stem cell precursors alongside muscle, cartilage, and fat, bone engages in biochemical cross-talk. When skeletal muscle contracts, it releases the signaling protein irisin, stimulating bone remodeling. In turn, bone osteoblasts secrete osteocalcin, an endocrine messenger that travels across the blood-brain barrier to reduce neuroinflammation, stimulate hippocampal neurogenesis, enhance pancreatic insulin sensitivity, and support male testosterone synthesis. Hormonal Decline and Musculoskeletal Menopause Syndrome (82:40) Bone density builds until peaking around age 28 in women and age 30 in men. While higher testosterone levels and thicker cortical bone protect male bone mineral density until roughly age 70, women experience pronounced biological vulnerabilities earlier. Breastfeeding can deplete up to 20% of a woman's bone density within the first six months, which may fail to recover without sufficient caloric and micronutrient support. During perimenopause and menopause, declining estrogen removes the primary regulatory brake on osteoclasts—the cells responsible for bone resorption—causing bone breakdown to outpace reconstruction and triggering up to a 15% to 20% loss in overall density. Wright details her research group's formal classification of the 'Musculoskeletal Syndrome of Menopause.' Because all musculoskeletal tissues contain functional estrogen receptors, estrogen depletion leaves these sites unmanaged, sparking systemic inflammation in approximately 80% of midlife women. Clinical manifestations include generalized joint pain (arthralgia), adhesive capsulitis ('frozen shoulder'), tendinopathies, and accelerated sarcopenia marked by roughly a 20% drop in muscle mass. Wright sharply criticizes conventional medical guidelines that delay insurance coverage for diagnostic DEXA scans until age 65, urging women and men to establish baseline biomarker panels, body composition scans, and hormone evaluations during the critical transition window between ages 35 and 45. Mechanical Loading, Strength Training, and Joint Biomechanics (12:08) Analyzing track-and-field participants at the National Senior Games, Wright’s research demonstrated that high-level athletic performance does not biological decline sharply until after age 70. She argues that earlier physical regression is predominantly behavioral and psychological rather than physiologically predetermined. However, maintaining structural integrity into older decades requires specific mechanical inputs. Bone preservation necessitates 'bounding,' high-impact activities such as running or jumping that exert mechanical deformation to spur bone remodeling, whereas non-impact sports like swimming or cycling fail to stimulate density retention. To preserve functional strength and explosive power, Wright prescribes total-body heavy resistance training at least twice weekly using 4 to 8 repetitions per set, rather than remaining confined to light weights with high repetitions. For midlife women, she recommends 4 sets of 4 repetitions to substitute for the lost anabolic signaling of estrogen. She cautions, however, that impact must be balanced against joint preservation. Cartilage possesses a lower coefficient of friction than ice but lacks active regeneration and is easily damaged when multiplied joint forces (up to 7 to 9 times body weight) collide with excess adipose mass. Furthermore, runners must correct single-leg kinetic imbalances: weakness in the gluteus medius destabilizes the pelvis, triggering inward knee collapse (valgus) and chronic joint wear. Metabolic Sinks, Cognitive Health, and Muscle Nutrition (56:46) Skeletal muscle acts as the body's primary metabolic reservoir and glucose sink, safeguarding against insulin resistance. With approximately 96 million American adults exhibiting pre-diabetes, Wright warns that metabolic dysfunction directly accelerates neurodegenerative conditions, supporting the classification of Alzheimer's disease as 'Type 3 diabetes.' Muscular contraction releases vital protective myokines, notably the longevity protein Klotho, which acts across organ systems to facilitate cellular repair and maintain biological resilience. To prevent age-related muscle wasting (sarcopenia), Wright outlines clear nutritional targets centered on consuming approximately 1 gram of protein per ideal pound of body weight daily. This intake should prioritize leucine-rich sources such as dairy whey to trigger muscle protein synthesis. She debunks the misconception that creatine monohydrate is exclusively for male bodybuilders, recommending a continuous daily maintenance dose of 5 grams for both men and women to support both muscular energy reserves and cognitive function. Bone remodeling protocols further require adequate micronutrient support, specifically vitamin D and magnesium, complemented by restorative sleep. Wright concludes that midlife physical decay is an avoidable trajectory rather than an inevitable consequence of human aging. However, mitigating these risks requires addressing institutional gaps in healthcare—such as insurance policies that delay bone screening until advanced age—and shifting individual focus toward objective metabolic data, progressive mechanical loading, and proactive hormonal management starting by age 35.

骨科运动医学专家Vonda Wright博士指出，骨骼与肌肉并非人体被动的机械支架，而是通过分泌骨钙素与肌因子调控大脑认知、胰岛素敏感性及全身代谢的核心内分泌器官。通过在35至45岁关键窗口期实施大重量抗阻训练、机械冲击刺激、精准蛋白质与肌酸补充，并在围绝经期科学管理激素，个体可以有效预防骨量断崖式下跌与继发性机能衰退。 骨骼内分泌功能与骨-脑轴信号互通 (18:15) 骨骼、肌肉、肌腱、韧带与脂肪组织均起源于间充质干细胞，构成高度协同的代谢生态。当骨骼形成细胞（成骨细胞）分泌骨钙素（osteocalcin）时，该蛋白能穿透血脑屏障，下调中枢神经炎症，上调脑源性神经营养因子（BDNF）并刺激海马体神经发生；临床数据显示约30%的认知障碍或阿尔茨海默病患者合并患有严重骨质疏松症。此外，骨钙素还能增强胰腺胰岛素敏感性、促使骨骼肌清除血糖，并在男性体内协同刺激睾酮生成。 骨骼肌在收缩过程中同样会释放关键肌因子与信号蛋白，例如鸢尾素（irisin）直接指导骨细胞重建与强化，并促进白色脂肪向线粒体密集的棕色脂肪转化。肌肉收缩刺激分泌的长寿蛋白Klotho则作用于全身器官促进组织修复。Wright博士主张，缺乏肌肉与骨骼交互刺激的久坐状态会加速神经通路与代谢系统衰退，维持肌肉质量是保护大脑免受代谢性痴呆（即“3型糖尿病”）侵袭的核心防线。 生命周期骨量断崖与筛查诊断滞后 (34:04) 人体骨量在成熟期后呈现不可逆的自然流失趋势。女性骨量通常在28岁达到峰值，男性则在30岁左右达峰。男性得益于较厚的皮质骨和睾酮保护，骨密度通常维持稳定直至70岁；女性骨量则在40岁左右即开始下降。特别是在孕期哺乳阶段，前6个月母体可流失多达20%的骨密度；而在围绝经期，随着雌激素失去对破骨细胞（骨吸收细胞）活性的抑制刹车，骨流失速度急剧加快，女性在绝经前后可能失去高达15%至20%的全身骨量。 骨骼脆性引发的公共卫生后果十分严峻。在美国，50%的女性及200万男性面临骨质疏松症，50岁以上女性有二分之一会发生骨质疏松性骨折。发生髋部骨折的患者中，半数无法恢复到摔倒前的行动能力，30%在一年内因长期卧床引发的褥疮、肺炎或严重感染而死亡。然而，现有医疗保险体系通常将双能X射线吸收仪（DEXA）常规筛查延迟至65岁，此时骨微结构常已严重受损。Wright博士建议，凡经历低能量跌倒或骨折史的高危个体，应在35岁之后主动自费进行DEXA基线评估，根据T值（T-score低于-2.5即确诊骨质疏松，增加40%以上骨折风险）及时干预。 绝经期肌肉骨骼综合征与代谢风险叠加 (82:40) 针对围绝经期女性群体的普遍慢性疼痛，Wright博士团队正式确立并发表了“绝经期肌肉骨骼综合征”（Musculoskeletal Syndrome of Menopause）这一医学命名。由于所有肌肉骨骼组织均表达雌激素受体，当雌激素水平断崖式下跌，受体失去配体结合，约80%的女性会出现全身性炎症级联反应，具体表现为全身关节痛（arthralgia）、“五十肩”冻结肩、肌腱病变以及肌肉量在短期内骤降约20%的少肌症（sarcopenia）。 Wright博士主张公众应破除对激素替代疗法（HRT）的恐惧，认识到口服避孕药的激素剂量是常规HRT的近10倍；在围绝经期早期于临床指导下使用HRT可有效保护骨密度、维持肌肉组织并降低全身软组织炎症。同时，雌激素匮乏引发的血脂改变、内脏脂肪重新分布与胰岛素抵抗，会使女性代谢轨迹与糖尿病前期高度重叠。若空腹血糖达到110 mg/dL（健康理想值约为85 mg/dL），十年内发展为全面糖尿病的概率高达70%至100%。在35至45岁这一关键十年建立基线指标并扭转胰岛素抵抗，是切断中年代谢向阿尔茨海默病恶化的关键屏障。 冲击负荷、大重量抗阻与营养干预方案 (50:28) 骨骼与肌肉的结构重塑高度依赖特异性的物理刺激。Wright团队对全美老年运动会（National Senior Games）及高水平中老年运动员的研究证明，高水平身体机能直到70岁后才出现显著的生物学滑坡，此前的大多数机能衰退主要归咎于久坐与心理退让。在运动方式上，跑步、跳跃等具有地面冲击力的弹跳类运动（bounding sports）能产生机械应变刺激骨骼重塑，而游泳、骑行等非冲击运动则无法增加骨密度。针对无器械基础的人群，力量训练应从抗阻带过渡至大重量训练：中老年男性推荐每周至少进行两次4组8次（4x8）的渐进超负荷训练；绝经期女性则适宜采取4组4次（4x4）的大重量训练，以神经肌肉强刺激弥补同化激素流失。 在生化与营养支持方面，维持肌肉与骨骼合成需严格执行每日每磅理想体重摄入1克优质蛋白质，重点保证亮氨酸（乳清蛋白为最佳来源）以激活肌肉蛋白合成。Wright博士纠正了女性不应摄入肌酸的误区，指出无需经历充填期，每日持续补充5克一水肌酸（Creatine Monohydrate）不仅促进肌肉维持，更对脑细胞能量代谢具有明确保护作用。对于跑步人群，若不单独加强臀中肌力量以稳定骨盆，单腿支撑落地时极易发生膝关节内翻（valgus）及软骨退化；补充维生素D、镁、锶、锌、硼等微量元素及维持充足睡眠，是完成骨基质矿化的基础保障。 Wright博士系统重构了骨骼作为全身内分泌调控中枢的长寿医学意义，打破了衰老必然伴随骨骼与运动机能崩塌的传统观念。然而，由于骨质疏松的常规临床筛查在现行医疗保险体系中严重滞后至65岁，且激素替代疗法在临床实践中仍受既往偏见制约，个体能否在35至45岁窗口期主动获取生物标志物基线并承担早期监测成本，仍是该精准预防模型转化为普惠健康实践的关键障碍。

## Background 本期内容由知名播客频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2025 年 3 月 6 日在 YouTube 平台发布。节目特邀骨科运动医学外科专家、长寿抗衰学者 Dr. Vonda Wright 担任嘉宾，深入探讨骨骼与肌肉健康对全身系统的重要影响。访谈围绕骨质疏松的致命风险、肌酸的真实益处、围绝经期综合征以及骨脑轴机制展开，旨在打破大众认知盲区，帮助人们构筑更强韧的身体与大脑。 ## TL;DR Dr. Vonda Wright 指出，骨骼不仅是支撑躯体的静态架构，更是一个分泌骨钙素、调控大脑认知与全身代谢的关键内分泌器官；然而骨质流失常被严重忽视，髋部骨折后极高的致残率和致死率构成了晚年脆弱性的核心威胁。她强调 35 至 45 岁是构筑肌肉量与骨密度的“关键十年”，大众应尽早通过大重量力量训练、高冲击运动、充足蛋白质和肌酸摄入来建立生理储备。访谈重点剖析了绝经期雌激素暴跌对女性肌肉骨骼系统的剧烈冲击，提倡通过早期 DEXA 骨密度检测、激素替代疗法（HRT）和精准生活方式干预来阻断代谢崩溃，并推翻了“年过半百体能必衰”的心理宿命论，呼吁大众在任何年龄都应主动掌握健康主导权。 ## Atmosphere & style 整场对谈充满紧迫感与行动力，Dr. Vonda Wright 既有资深外科医生的严谨犀利，又带着布道者般的激昂与感染力。现场穿插的单腿站立与深蹲平衡测试打破了常规访谈的沉闷，让两人的互动生动而富有趣味；而谈及阿姨罹患阿尔茨海默病的经历以及长辈因衰弱失去自理能力时，对话又迅速下沉至令人动容的深情与敬畏。收听体验既像是一场颠覆常识的硬核临床医学公开课，又如同一记唤醒中年健康危机意识的强效警钟，令人在危机感中重获改变生活方式的掌控感与力量。 ## Bulletin - [00:00](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=0s) 骨质疏松的致残与致死率极高：在美国至少有 50% 的女性会患病，且髋部骨折后有 50% 的患者永久丧失自理能力，30% 会在一年内死亡。 - [16:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1008s) 骨骼不仅是物理支架，更是内分泌调控中心，其分泌的骨钙素可穿透血脑屏障促进海马体神经元新生并降低神经炎症，骨质退化与阿尔茨海默病显著相关。 - [01:34:21](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5661s) 大龄老将运动员研究显示，人类在 70 岁之前生理上不会出现显著的速度与耐力断崖式衰退，体能大幅滑坡更多源于心理放弃与缺乏锻炼。 - [01:22:40](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4960s) 绝经期雌激素断崖式下跌会使受体空置，诱发系统性炎症与“绝经期肌肉骨骼综合征”，包括冻结肩、弥漫性关节痛和骨量急剧丢失，亟需早期评估与科学干预。 ## Key takeaways - [16:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1008s) 骨骼是动态内分泌器官，成骨细胞分泌的骨钙素跨越血脑屏障滋养大脑海马体，骨健康与阿尔茨海默病风险紧密相连。 - [13:51](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=831s) 骨骼变脆与骨折是致命危机：女性在哺乳前 6 个月可流失高达 20% 的骨密度，遭遇髋部骨折后 30% 患者在一年内死亡。 - [01:05:25](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3925s) 跑步是单腿运动且不能替代下肢抗阻力量训练，臀肌薄弱会导致膝关节内扣代偿及动力链慢性伤病。 - [07:14](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=434s) 精准长寿干预拒绝“千人一面”，主张通过乳酸阈值测试锁定 FatMax（最大脂肪氧化区间），并将 80% 的有氧训练维持在该心率区间以优化线粒体健康。 - [29:20](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1760s) 35 至 45 岁是构筑后半生健康防线的“关键十年”，应在此时期建立基线血液指标、最大化骨肌储备并监控心肺最大摄氧量（VO2 Max）。 - [40:57](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2457s) 阿尔茨海默病本质上具有“3 型糖尿病”的局部胰岛素抵抗特征，40 岁左右出现的糖尿病前期若不积极逆转，会显著推高晚年神经退行性疾病风险。 - [53:28](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3208s) 肌肉重建任何年龄开始都不晚，绝经期女性尤其需要大重量抗阻训练（如 4 组 × 4 次）以高机械张力替代雌激素的促合成信号。 - [56:46](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3406s) 骨骼肌强烈收缩能转录并释放长寿蛋白 Klotho 与鸢尾素（Irisin），肌肉本质上是驱动机体延缓衰老的生化反应堆。 - [59:50](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3590s) 肌酸并非健美运动员专利，每日稳定补充 5 克肌酸对于两性的骨骼、肌肉与大脑认知代谢均有重要益处。 - [01:13:46](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4426s) 关节软骨极度脆弱且承重可达体重的 7 至 9 倍，健康管理的核心在于优化身体成分（减脂增肌），打破“隐性肥胖 / 泡芙人”的自欺欺人。 - [01:24:40](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5080s) 雌激素枯竭会导致破骨细胞活性失控并诱发“绝经期肌肉骨骼综合征”，女性应在 40 岁出头提早做 DEXA 筛查并基于科学事实评估激素替代疗法（HRT）。 - [01:30:18](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5418s) 下腰痛成为全球第一大致残病因，主要由久坐导致核心肌群失活及缺乏负重所致，应区分机械性疼痛与触电样神经放射痛并推广动态办公。 - [01:34:21](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5661s) 老龄精英运动员的数据证实，人类体能在 70 岁前并不存在生理必然的断崖式衰退，绝大多数机能退化源于心理预期的自我设限与久坐妥协。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=0s) 让骨骼再次“性感”：骨质疏松的致命危机与认知防线 访谈在一段生动的现场动作测试中拉开序幕。Dr. Vonda Wright 指出，那些“只跑步、不做其他交叉训练”的跑者极易受伤，究其根源往往是动作模式与肌肉力量的不平衡。为了直观展示这一点，她在现场让主持人 Steven 尝试单腿动作，以检验臀部肌肉是否有足够力量稳定骨盆，以及膝盖是否会在发力时发生内扣代偿。Steven 摇摇晃晃地尝试，忍不住自嘲道：“我看起来像喝醉了一样”，随即惊讶地反问脚踩高跟鞋却稳如磐石的 Vonda：“你是怎么踩着高跟鞋做到这个动作的？” 随后的开场剪辑直击现代人长期忽视的健康盲区。Dr. Vonda 情绪激昂地宣布，她正掀起一场“让骨骼再次性感起来（make bones sexy again）”的行动。在公众认知中，骨骼往往被视为一副静止的白骨支架，但现实数据令人触目惊心：在美国，至少有 50% 的女性会患上骨质疏松症，同时还有 200 万男性深受其害。骨质疏松绝不仅仅意味着骨骼脆弱，大量研究证实，低骨密度与大脑认知能力的加速衰退直接相关。更致命的是跌倒骨折的后果——一旦发生髋部骨折，无论男女，有高达 50% 的人将永远无法恢复到跌倒前的生活自理水平，而 30% 的人会在一年内直接走向死亡。 骨骼变脆的原因错综复杂，既源自自然衰老和年轻时未能积累足够的骨储备，也源于久坐不动的生活方式，以及社会文化中对女性“必须纤瘦娇小”的畸形审美偏见。甚至连母乳喂养这样自然的过程，都会让女性在最初的 6 个月内损失高达 20% 的骨密度。但这一切绝非不可逆转的宿命，Dr. Vonda 提出了一套名为“坚不可摧（Unbreakable）”的生活方式体系，涵盖肌肉、骨骼、营养，而其中最核心的支柱是心理认知与心智模式（Mindset）。当 Steven 问及绝经与大脑密度之间是否存在关联时，Dr. Vonda 给出了斩钉截铁的肯定回答：这背后正是雌激素的断崖式暴跌，而雌激素是对肌肉、骨骼、肌腱、韧带和脂肪代谢至关重要的核心荷尔蒙。 ```mermaid flowchart TD accTitle: 骨骼脆弱性与健康危机演变链路 accDescr: 展示从年轻储备不足、激素下降到骨质疏松及后续死亡和失能风险的因果链条。 subgraph Causes["脆弱诱因与生理消耗"] C1["年轻时期骨储备不足 / 久坐生活"] C2["哺乳期骨量流失（前6个月达20%）"] C3["绝经期雌激素断崖式暴跌"] end subgraph Pathology["核心病理演变"] P1["骨量流失与骨质疏松"] P2["认知功能加速衰退"] end subgraph Consequences["严重预后风险"] R1["髋部骨折发生"] R2["50% 患者永久失去自理能力"] R3["30% 患者在一年内死亡"] end Causes --> P1 P1 --> P2 P1 --> R1 R1 --> R2 R1 --> R3 ``` - 疾病流行度：美国至少 50% 女性患有骨质疏松症，受影响男性达 200 万人。 - 致命预后：发生髋部骨折后，50% 患者无法恢复跌倒前机能，30% 会在一年内死亡。 - 特殊生理损耗：女性在产后前 6 个月的哺乳期内，骨密度可流失达 20%。 --- ### [02:03](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=123s) 从职业球星到普通人：将精英运动科学运用于长寿与康复 当 Steven 请 Dr. Vonda 阐释她的核心工作与服务人群时，她回顾了自己 30 年运动医学外科生涯的演进路径。运动医学最初的核心任务是如何让顶尖运动员在最高对抗下不断突破极限、屡屡夺冠。在职业生涯早期，医学界主要关注的是训练的动作设计与“周期化训练（Periodization）”；而随着学科飞速发展，顶尖竞技体育早已演变为精密的系统工程。 以她在匹兹堡大学担任 UPMC Lemieux 体育运动中心（NHL 匹兹堡企鹅队训练基地）医疗总监的经历为例，那里的科学保障已经武装到牙齿：球队配备了全职行政主厨，从早餐、午餐、晚餐到球队专机上的所有加餐，全部根据赛程与代谢指标严格定制，因为在毫秒必争的冰球赛场上，瞬时敏捷度与高负荷下的大脑决断依赖于每一个细微指标的极限制衡。 Dr. Vonda 见证了运动表现科学在过去 30 年中跨越的三大阶段：从最开始钻研“如何高强度苦练”，到精研“如何精准供能与进食”，再到如今将核心重心放在“如何深度恢复”。她以美国传奇游泳名将 Dara Torres 为例说明：Dara Torres 在 40 多岁产后重返奥运赛场时，训练策略与她 24 岁时整天泡在泳池里的超长工时截然不同，后期的重点几乎全部转移到了机能修复与神经系统恢复上。如今，Dr. Vonda 将这套淬炼自职业赛场的科学理念系统性平移，既服务于整日处在重压与高认知负荷下的职场精英，也服务于包括她自己在内的每一个渴望健康抗衰的“普通凡人运动员”。 - 医疗总监履历：曾任匹兹堡大学 UPMC Lemieux 体育中心医疗总监，负责 NHL 匹兹堡企鹅队医疗保障。 - 理念迭代：运动医学核心历经三代转变——从单纯的“训练周期化”到“精准营养”，再到以“神经与身体深度恢复”为首要原则。 - 典型范例：奥运游泳选手 Dara Torres 在 40 岁复出时大幅削减水下训练量，转而依靠高级恢复技术实现卓越竞技表现。 --- ### [03:59](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=239s) 大脑优先与作息节律：为什么睡眠是第一位，以及把大脑当作肌肉训练 Steven 提到自己的日常工作极其依赖大脑的敏锐度，并询问运动医学如何在认知健康层面发挥作用。Dr. Vonda 坦言自己并非脑神经科学家，但长期与顶尖神经专家共事，让她对大脑健康的底层逻辑有了颠覆性的认识。在她早年出版的著作中，她曾信奉“活动度为王（Mobility was King）”；后来随着对代谢谢的深入探索，她将“精准营养”推至第一位，活动度退居第二；但随着现代睡眠科学的突破，她现在的绝对原则是：睡眠与机能恢复凌驾于一切之上。如果大脑没有得到充分的代谢废物清除与神经营养修复，任何训练与营养摄入都会大打折扣。 关于训练时间，当下健身界流行“清晨起床立刻晨练”的风潮，Dr. Vonda 对此坚决反对盲从。她指出每个人都必须清楚自己的大脑认知峰值节律。以她自己为例，每天清晨 5:00 到下午 2:00 是她深度思考、学术创作与灵感爆发的黄金时间；过了下午 2:00，她的大脑认知能量开始回落，此时她可以去工地搭房子、连续站台手术，但如果让她写书，必须放在清晨。因此，她绝不会在早晨去健身房流汗，绝不在体力活动上“挥霍宝贵的大脑深度工作能量”。 在认知重塑领域，Dr. Vonda 分享了前沿脑科学带来的突破：大脑的神经回路完全可以像肌肉一样被主动重塑与训练。她与一家名为 Nestree（脑电图神经训练机构）合作，为她的精准长寿客户佩戴 EEG 脑电波头盔进行全脑图谱扫描。扫描能够清晰暴露现代人的认知缺陷：许多高度习惯化、下意识重复的行为几乎不消耗能量，而大脑甚至会主动切断向这些回路的能量倾斜；相反，面对压力事件与新知学习时，过度活跃的回路会造成极度能量内耗。通过针对性的脑电生物反馈训练，个体能够学会让主动认知的大脑“暂时让道”，让潜意识神经回路重新分配能量，激活被长期荒废的关键神经通路，实现大脑运转效率的跃升。 - 理念金字塔演进：Dr. Vonda 的健康优先级排序经历了从“骨骼肌肉活动度”到“营养”，最终确立为“睡眠与恢复第一”。 - 认知节律策略：Dr. Vonda 个人认知顶峰为 5:00 AM - 2:00 PM，保留给最高强度的深度创造性工作，拒绝将早晨黄金脑力浪费在体力锻炼上。 - 大脑肌肉假说：借助高分辨率 EEG 脑电图谱分析压力回路与习惯回路，通过神经反馈实现类似增肌的神经可塑性再训练。 --- ### [07:14](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=434s) 告别“一刀切”：精准长寿医学与乳酸阈值测试（FatMax） 当话题切入核心概念“精准长寿（Precision Longevity）”时，Dr. Vonda 批判了传统临床长寿医学在过去 150 年里的局限性——即被动的“临床观察”与“千人一面、实则无人适用的均码方案（one size fits nobody）”。人类基因组测序的完成，让人类医学历史上第一次能够跳过泛泛而谈的统计学平均值，为个体定制量体裁衣的生理干预方案。 在她的临床实践中，长寿评估绝非盲目堆砌成百上千项无效指标，而是精选大约 23 项超出常规体检范围的关键深度生物标志物。例如，若检测显示 Steven 拥有较高的“衰老细胞负荷（senescent cells）”，方案就会针对性部署清除衰老细胞的特异性补剂与营养支持；而若受试者的全身系统性慢性炎症指标极佳，则无需盲目追加抗炎成分。这种精准填补代谢营养缺口的策略，彻底颠覆了过去全员补充复合配方粉的粗放做法。 在运动干预上，Dr. Vonda 同样强烈反对“每周进行 150 分钟中等强度运动”这类空洞建议。她采用运动生理学黄金标准——乳酸阈值递增负荷测试（Lactate Threshold Testing）： 1. 客户在跑步机或功率自行车上以固定坡度/阻力开始运动； 2. 每隔 4 分钟采集一次指尖末梢血，实时监测血液乳酸浓度与气体代谢； 3. 精准定位线粒体（细胞的能量发电厂）从“纯脂肪氧化供能”转变为“糖原/碳水化合物供能”的临界拐点——即“最大脂肪氧化率区间（FatMax）”。 Dr. Vonda 强调，FatMax 是机体线粒体产能效率最高、代谢弹性最好的甜点区，个体的每周有氧训练应该有 80% 的时间精确锚定在这一心率区间内。这种基于代谢生物学底层的方案，取代了粗糙的心率猜测与公式估算。 - 评估指标体系：避开成千上万无效筛查，聚焦约 23 项超出常规生化范围的长寿特异性标志物（如衰老细胞负荷）。 - 运动处方革命：拒绝宽泛的 150 分钟中等运动推荐，依靠每 4 分钟一次的指尖采血乳酸测试锁定 FatMax 区间。 - 80/20 代谢法则：主张将 80% 的心肺训练时间稳定维持在最大脂肪氧化（FatMax）所对应的心率范围内，以极致优化线粒体健康。 --- ### [09:24](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=564s) 人生的不同季节：男女骨骼峰值与骨量流失的时间轨迹 Steven 提出一个极具穿透力的问题：个性化考量是否应当延伸到人生不同的“季节（Seasons of life）”？我们在 20 岁、30 岁、40 岁以至五六十岁时，身体所关注的核心矛盾是否完全不同？Dr. Vonda 给予了高度赞同：“每一个生理季节都截然不同”，并以骨骼系统的发育与退行全周期作为最具代表性的例证。 人类骨骼并非一成不变，而是在整个前半生处于高强度的合成构筑期。骨量积累在年轻时期一路攀升，女性通常在 28 岁左右达到人生骨量峰值（Peak Bone Mass），男性则在 30 岁左右达到顶峰。在峰值到来之后，身体会进入一段相对平稳的平台期；但随后，男女两性的骨骼命运走向了截然不同的分水岭。 女性的平台期非常短暂，一旦迈入围绝经期，随着卵巢功能衰退、保护性雌激素急剧下跌，骨密度会瞬间进入断崖式暴跌轨道。相比之下，男性具有天生的生理红利，其骨密度通常能稳定维持到 70 岁左右才出现显著下滑——除非该男性患有严重的代谢性疾病、自身免疫性疾病，或者因严重病症长期大剂量使用糖皮质激素（皮质类固醇），这些病理破坏会将男性的骨量断崖期提前整整二十年，直接拉低至 50 岁。理解不同生命周期的骨骼动力学，是制定全生命周期主动抗衰策略的首要认知基石。 - 骨量峰值窗口期：女性平均在 28 岁达到骨量峰值，男性平均在 30 岁达到顶峰。 - 女性流失悬崖：峰值短暂平台期后，女性随着绝经期雌激素断崖式下降，骨量进入急剧丢失通道。 - 男性衰老拐点：健康男性骨密度通常可稳固保持至 70 岁；但若存在代谢异常、自免疾病或长期激素用药史，骨流失拐点将大幅提前至 50 岁。 ### [10:33](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=633s) 衰老的不同阶段与骨密度的性别差异 人体的生理机能随着衰老在不同阶段发生着深刻变化。尽管我们在一生中的任何时期都能增长肌肉，但在30岁之前增肌是最容易的。与此同时，肠道功能也会随年龄改变，肠道微绒毛吸收营养的能力逐渐下滑。例如，步入中年的女性往往需要补充经过“甲基化”（methylated）处理的维生素——即被预先分解、更易吸收的形式，以应对变得低效的肠道吸收功能。 在谈到男女骨骼的差异时，男性的骨密度往往能比女性保持更长时间。这一方面源于睾丸酮的生理刺激以及XY染色体的遗传影响，使男性在年轻时就能构筑更多的初始骨量、拥有更厚的骨皮质和更沉重的骨骼绝对重量；另一方面，当女性步入40岁以后的平台期，体内对骨骼健康至关重要的雌激素开始断崖式下跌，导致女性骨质流失的速度远快于男性。到绝经期时，女性甚至可能已经流失了高达20%的骨密度，从而带来极为严峻的健康隐患。 --- ### [12:08](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=728s) 骨量流失不可避免吗？冲击性运动的力量 面对女性骨量流失是否不可逆的疑问，答案是否定的。2004年，研究团队对参加美国全国老年运动会（National Senior Games）的大批40岁以上资深运动员（Masters athletes）展开了长期追踪。这些参赛者必须在各州比赛中夺冠才有资格晋级，属于高水平的业余运动健将。研究得出的第一个结论是：通过坚持长期的体育锻炼，人们完全有能力将极高比例的骨密度一直维持到80多岁。 进一步的研究探索了何种运动形式对维持骨骼最有效。研究团队将运动分为两类：一类是像篮球、跑步、排球这样具有强冲击力、跳跃蹬地（bounding）的“撞击骨骼”类运动；另一类则是游泳、保龄球、骑自行车等低冲击运动。结果令人震惊：对骨骼产生机械冲击的重要性，竟完全不亚于年龄、染色体性别或家族遗传史等不可控的先天因素。“雌激素的流失是不可避免的，但骨密度的流失绝不必然走向骨质疏松、骨折与衰弱。” ```mermaid flowchart TD accTitle: 运动冲击力对维持骨密度的机制 accDescr: 对比高冲击运动与低冲击运动对骨骼重塑的不同效果 subgraph HighImpact["高冲击运动（冲击/跳跃）"] A["跑步 / 篮球 / 排球"] --> B["地面反作用力重击骨骼"] B --> C["刺激成骨细胞活性"] C --> D["骨密度持久维持至80岁以上"] end subgraph LowImpact["低冲击运动（平缓承重）"] E["游泳 / 骑行 / 保龄球"] --> F["缺乏足够机械应变力"] F --> G["骨质维持效果相对有限"] end ``` - **资深运动员研究证据**：长期保持运动习惯的运动员，其骨量可在80多岁时依然保持强健。 - **冲击的重要性**：撞击与震荡是激活骨骼重建的关键生物力学信号，其效应堪比遗传与激素对骨密度的基线决定力。 --- ### [13:51](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=831s) 骨骼危机：骨折背后残酷的致残与致死率 大众普遍存在一个误区，认为骨骼就像一具静态的枯架，不像肌肉那样可以通过健身房锻炼直观变大变强。为了扭转这种偏见，医生下定决心要“让骨骼再次性感起来”（make bones sexy again）。日常生活中，人们极少关注骨骼，往往只有在称赞别人“骨相优越”、或者考古学家通过骸骨辨识古代族群的生活与死因时，才会意识到骨骼的存在——在人死之后，肌肉与皮肤都会化为乌有，唯独骨骼承载着一生的印记长久留存。 然而，现实中人们真正感知到骨骼的时候，往往是它发生断裂的悲剧时刻。骨骼平日里像个“少言寡语的硬汉”默默支撑身体，一旦断裂便会发出凄厉的警报。骨折带来的不仅是疼痛，更是晚年衰弱与生命危险的序幕： - **女性的高发比例**：每两位女性中就有一人会在一生中经历一次骨质疏松性骨折。 - **髋部骨折的性别分布**：全球70%的髋部骨折都发生在女性身上，而髋部骨折是导致老人失去自理能力、最终不得不入住养老院的核心诱因之一。 - **功能的永久丧失**：无论是男性还是女性，遭遇髋部骨折后有50%的概率再也无法恢复到跌倒前的身体机能，再也无法独立居住或自如驾驶。 - **骇人的死亡风险**：高达30%的患者会在髋部骨折后的一年内离世，死因往往并非骨折创伤本身，而是由长期卧床引发的坠积性肺炎、泌尿系统感染以及极度静坐少动带来的一系列致命并发症。 --- ### [16:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1008s) 骨骼是“超级沟通者”：骨钙素对全身的调控 传统观念常把骨骼、肌肉和脂肪视作各司其职、互不相干的独立器官，但从胚胎发育来看，骨骼、肌腱、韧带、肌肉、脂肪、软骨甚至肌肉干细胞，全都是由同一种源头细胞——间充质干细胞（mesenchymal stem cells）分化而来的。“它们不是远亲邻居，而是亲堂表兄妹，说着同一种语言。”就像英国各地虽然口音千差万别，但本质上都是英语一样，肌骨组织构成了一个紧密联动的生态系统。 当肌肉收缩时，它会释放一种名为鸢尾素（irisin）的蛋白向骨骼对话；反过来，骨骼在受到机械刺激时，成骨细胞会分泌骨钙素（osteocalcin）。骨钙素绝不仅局限于骨骼本身，而是一个穿透全身的超级信号分子： - **大脑保护与神经生成**：骨钙素穿过血脑屏障进入大脑，通过降低神经炎症发挥神经保护作用，并刺激海马体合成新的神经元。 - **胰岛与代谢调节**：它能够作用于胰腺以改善胰岛素敏感性，同时帮助骨骼肌高效抓取血液中的葡萄糖。 - **生殖系统支持**：在男性体内，骨钙素能长途奔袭至睾丸，直接刺激睾丸间质细胞（Leydig cells）合成睾酮。 “骨骼构架看似是它的第一功能，但实际上支撑结构可能只是它的副业，骨骼本质上是一个掌控全身的超级信息调度中心。” ```mermaid flowchart TD accTitle: 骨钙素对全身器官的调控网络 accDescr: 骨骼释放的骨钙素作用于大脑、胰腺、肌肉和睾丸等全身器官 Bone["成骨细胞（Osteoblasts）"] -->|释放| OC["骨钙素（Osteocalcin）"] subgraph TargetOrgans["靶向全身各器官系统"] OC --> Brain["大脑（海马体）\n· 减轻神经炎症\n· 促进神经元新生"] OC --> Pancreas["胰腺\n· 提升胰岛素敏感性"] OC --> Muscle["骨骼肌\n· 增强摄取血液葡萄糖能力"] OC --> Testes["睾丸（间质细胞）\n· 刺激睾酮合成"] end ``` --- ### [19:47](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1187s) 矿物质储备库：钙的微调天平与骨脆性危机 除了机械支撑与内分泌信号交流，骨骼的第三大核心职责是作为全身矿物质的“战略储备仓库”。钙是维持机体运转必不可少的元素，肌肉的收缩、细胞膜两侧分子的转运均依赖钙离子的参与。当人体摄入食物时，肠道负责将钙质吸收入血，并储存在骨骼这一巨大仓库中。 人体内部有一套极为精密的动态平衡系统。一旦机体感知到血液中的钙或磷浓度不足，信号就会传导给骨骼，激活破骨细胞（osteoclasts）。破骨细胞通过分解吸收少量骨组织，将钙释放到血液循环中供全身应急使用。反之，血液中钙质过剩也极为危险，高钙血症会直接诱发心律失常甚至危及生命。因此，当血钙饱和时，骨骼便停止释钙，多余的钙质则通过肾脏由尿液排出体外。 在骨骼建设、骨库矿物质释放与尿液排泄之间，存在着如履薄冰般的精密平衡。如果一个人在年轻生长发育期未能打下坚实的基底、储备充足的骨矿物质，随着年龄增长与微量元素匮乏，骨骼就会在不断的“透支借贷”中走向骨质减少（osteopenia）与骨脆性增加。 ### [22:11](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1331s) 骨骼脆弱的危机根源：年轻女性、哺乳与围绝经期 在临床实践中，文达·赖特医生（Dr. Vonda Wright）经常接诊到年仅25岁至28岁的年轻女性，当为她们进行骨密度扫描时，令人震惊的是，这些正值青春的女性已经出现了骨骼脆弱与骨量流失的症状。造成年轻群体骨骼不达标的核心原因首先在于“骨量储备不足”。社会上长期存在一种扭曲的审美神话，要求女性必须“娇小玲珑”、过度节食，这导致许多女孩体内雌激素分泌中断、月经不规律，而雌激素恰恰是刺激骨骼沉降和矿化的关键激素。此外，随着保障大学女性平等参与体育权利的《教育法修正案第九条》（Title IX）施行53年以来，大量年轻女性参与到高强度竞技体育中，但有些运动员每天消耗高达10,000卡路里，却未能通过科学饮食补充亏空，长期处于“能量负平衡”（energy deficit）状态；再加上当代很多儿童久坐于地下室玩电子游戏，“只练大脑、不练肉体”，严重缺乏承重刺激。威斯康星大学（University of Wisconsin）的骨科研究清晰地证实：在所有女子运动项目中，体操（gymnastics）对骨骼的构建效果最好，正是因为跳跃落地时的地面冲击力与充足营养的结合，铸就了最强健的骨骼。 骨骼面临危险的第二个生命阶段是哺乳期。赖特医生特别强调自己绝非反对母乳喂养——她自己在40岁生子后也坚持母乳喂养了一整年，母乳对婴儿极具益处。然而，科学事实表明，女性在哺乳的前6个月内，体内多达20%的骨密度会流失。如果母亲无法通过饮食或补充剂保证每日至少额外摄入500毫克的钙质，流失的骨量就极难再生。尤其是很多现代女性推迟至30岁以后才生育第一胎，随后又在短时间内紧接着生二胎、三胎，中间没有足够的营养窗口来重建骨骼，骨质便遭受了永久性的隐形侵蚀。 第三个断崖式阶段则是45岁左右的围绝经期（perimenopause）。此时女性体内的雌激素水平经历剧烈的过山车式震荡，最终归零。在骨骼代谢中，雌激素扮演着“刹车片”的角色，严格调控骨吸收（bone resorption）的过程；一旦失去雌激素的约束，破骨细胞分解骨骼的速度就会彻底压垮成骨细胞（osteoblasts）的合成能力，骨代谢平衡崩溃，引发骨密度的断崖式滑坡。 - **年轻群体骨量亏空成因**：极端节食致闭经及雌激素不足、高强度运动下的能量匮乏、久坐不动缺乏重力刺激。 - **哺乳期流失数据**：母乳喂养前6个月骨密度最高可下降20%，必须维持每日500毫克的钙质补充。 - **围绝经期机制**：雌激素断崖式下跌打破破骨细胞与成骨细胞的平衡，骨吸收远超骨重建。 --- ### [25:39](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1539s) 终生骨骼冲击与哺乳期的科学补钙策略 针对斯蒂芬提出的疑问——年轻时做跑步、跳跃等冲击性运动（Impact Sports）是否会引发关节受伤或头部撞击的风险——赖特医生坚定地指出，人体在青年时期必须通过冲击性运动来建立全身的健康基石。年轻时期是细胞能量工厂线粒体（mitochondria）大量生成的黄金窗口，缺乏运动刺激就无法启动充足的合成代谢信号。如果孩子在成长过程中不进行持续的跳跃和撞击，其成年后的骨量峰值将大打折扣。不仅年轻时需要冲击，即便到了60岁，也应该继续通过打篮球等运动给骨骼施加抗阻负荷。赖特医生在全美常青运动会（National Senior Games）精英运动员身上开展的临床研究证实：贯穿整个生命周期的骨骼冲击运动，能切实延缓甚至改善骨密度的退化。 谈及哺乳期间的骨质养护，赖特医生给出了明确且实操性强的补救指南。由于母体每天分泌母乳需要直接输出约500毫克的钙，这部分缺口必须精准填补： ```mermaid flowchart TD accTitle: 哺乳期骨质维护流程 accDescr: 展示哺乳期母体每日500毫克钙质流失的成因及全食物补充路径 subgraph Drain["钙质消耗"] A["母乳分泌"] --> B["每日流失约 500mg 钙"] B --> C["母体骨骼释放骨钙"] end subgraph Replenish["营养干预"] D["全食物补钙来源"] --> E["西梅（Prunes）与椰枣（Dates）"] D --> F["高钙乳制品与酸奶"] D --> G["高品质钙咀嚼片/补充剂"] E & F & G --> H["弥补每日 500mg 钙质缺口"] end H --> I["阻断骨量过度流失并启动产后骨重建"] ``` 赖特医生坦言，自己在40岁当母亲时深知育儿的极度疲惫，但在给婴儿哺乳的同时，必须建立起清晰的补钙意识——哪怕是在喂奶时随手吃一杯酸奶或高品质钙咀嚼片，坚决不能陷入为了迅速消除产后脂肪而盲目节食的误区。研究证实，只要营养供给跟上，母体完全有能力将流失的骨密度全部恢复。 --- ### [27:47](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1667s) 骨脑轴（Bone-Brain Axis）：骨骼与大脑的对话 骨骼绝非人体内一副沉默的支架，而是一个动态的内分泌器官，它与大脑之间构成了复杂的“骨脑轴”（Bone-Brain Axis）。骨骼分泌的骨钙素（Osteocalcin）等功能蛋白释放入血后，能够穿透血脑屏障进入脑组织，发挥关键的神经保护作用： ```mermaid flowchart LR accTitle: 骨脑轴作用机制 accDescr: 骨骼分泌骨钙素跨越血脑屏障并保护海马体记忆功能的过程 subgraph Bone["骨骼内分泌"] B1["负重与冲击刺激骨骼"] --> B2["骨骼分泌骨钙素\n(Osteocalcin)"] end subgraph Brain["中枢神经系统保护"] B2 --> BB["跨越血脑屏障"] BB --> BR1["对抗代谢氧化应激\n(清除自由基/修复细胞)"] BB --> BR2["诱导脑源性神经营养因子\n(BDNF) 释放"] BR2 --> BR3["促进海马体神经元新生\n(强化学习与记忆能力)"] end ``` 在日常人体代谢中，细胞活动不可避免地会产生自由基与氧化应激（oxidative stress），骨钙素能够直接减轻大脑神经元的氧化损伤，协助受损细胞修复。更重要的是，骨钙素能刺激大脑释放脑源性神经营养因子（BDNF），进而促使与记忆核心密切相关的海马体（hippocampus）生长出全新的神经元。流行病学数据高度印证了这一双向机制：临床上低骨密度的患者往往伴随更严重的老年认知障碍，而骨质疏松症与阿尔茨海默病等认知退化之间存在着极其显著的相关性。 --- ### [29:20](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1760s) 35至45岁的“关键十年”与守住衰老脆弱线 在谈到健康维护的核心时间点时，赖特医生提出了“关键十年”（Critical Decade）的概念——即35岁至45岁之间。无论男女，这都是夯实后半生健康防线的最后黄金窗口。此时女性雌激素开始步入波动下滑期，所有人必须在这个阶段建立起终身受益的健康习惯：建立医患关系、进行全面的防癌与慢病筛查，并留存详尽的基础血液指标（baseline labs）。特别对于男性，务必在35岁左右检测自己的基础游离睾酮（testosterone）水平。因为到了50岁时，如果化验单显示睾酮水平为600 ng/dL，从群体统计学上看依然在“正常范围”内，但如果这名男性年轻时的基础水平原本是800或1000 ng/dL，他此时就会饱受疲惫乏力、肌腱与韧带频繁损伤的折磨；拥有年轻时的基线数据，未来的精准替代治疗才能有的放矢。 赖特医生回顾自己40岁时的经历，感慨道："Had I known then what I know now..."（如果我当年懂得现在的知识……）。那时她作为耐力运动员全力备战铁人三项，每天跑步、骑车，进行了海量的有氧训练；但若能重新选择，她会在激素水平尚处顶峰的40岁全力进行大重量抗阻力量训练，最大化堆积肌肉储备。因为衰老过程中虽然随时可以增肌，但起始的储备基线越高，生命后期的抗风险冗余度就越大。 除了肌肉与骨骼，心肺储备更决定了晚年生活的尊严。衡量心肺机能的终极指标是最大摄氧量（VO2 Max），即人体从空气中摄取氧气并扩散到血液中的极限能力： | 人群分类 | VO2 Max 参考值 (mL/kg/min) | 生活状态与生理意义 | |:--- |:--- |:--- | | **世界顶尖运动员**（如帕克城美国奥运中心运动员） | 75 - 90 | 极限心肺耐力，卓越的能量代谢储备 | | **健康年轻普通女性优秀水平** | ~ 50 | 充沛的心肺储备，远离代谢病风险 | | **步入中年后的自然衰退速度** | 每10年自然下降约 10% | 50岁(50) → 60岁(45) → 70岁(40) → 80岁(35) | | **生命脆弱线（Fragility Line）** | 男性 ≤ 18 / 女性 ≤ 16 | 无法独立从椅子上站立、无法自行穿过房间 | 一旦最大摄氧量滑落至男性18或女性16以下，即跌破了残酷的“脆弱线”（Fragility Line），此时个体的基本日常活动都会因心肺功能耗竭而无法自理。斯蒂芬在此深有感触地分享了自己家庭成员的真实经历：一位长辈如今连上楼梯都会气喘吁吁，当小孙子孙女兴奋地跑来喊着“我们一起去玩吧”并欢快地跑远时，这位长辈只能无奈地坐在原地，完全无法迈步追赶。赖特医生强调，年轻时拼尽全力将VO2 Max和骨肌储备推向更高峰值，就是在为晚年换取更宽阔的生活跑道，避免让自己过早被困在失去自理能力的躯壳中。 ### [33:44](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2024s) 骨质疏松症与骨密度检测标准（DEXA 扫描与 T 值） 史蒂文（Steven Bartlett）感叹道，看到许多老人因为身体虚弱，只能坐在花园边眼睁睁看着孙辈玩耍而无法参与其中，这让人感到极其心酸；而他自己保持健康的最大动力之一，就是尽可能延长自己的“健康寿命”（Healthspan），希望直到离世的那一天都能保持健康有活力。在转向跑步与最大摄氧量（$VO_2\text{ Max}$）等话题之前，史蒂文希望先彻底厘清骨骼健康领域的两个核心概念，首先便是“骨质疏松症”（Osteoporosis）到底是什么。 沃达·莱特医生（Dr. Vonda Wright）解释，骨质疏松症本质上就是用来形容“骨密度低下”的医学术语。临床上评估骨密度的金标准是一种名为 DEXA（双能 X 射线吸收测定法）的扫描。它将受检者的骨密度与 30 岁健康年轻人的骨密度峰值进行对比，并得出一个称为“T 值”（T-score）的评分。这就像学校里按正态分布曲线（Bell curve）打分一样，曲线的中心点是 30 岁年轻人的平均值： * **正分（> 0）**：绝佳状态，代表你的骨骼和 30 岁年轻人一样致密强壮。 * **0 至 -1.0**：处于正常至尚可范围。 * **-1.0 至 -2.5（骨质减少，Osteopenia）**：这是一个关键警示信号，意味着骨骼正在变脆弱，“当心，骨量正在流失”。 * **$\le$ -2.5（骨质疏松症，Osteoporosis）**：此时骨折风险会猛增 40% 甚至更高，所有与跌倒、髋部骨折及死亡率相关的负面临床统计数据，都与这一阶段紧密挂钩。 ```mermaid flowchart LR accTitle: 骨密度 T 值评级范围 accDescr: DEXA扫描中T值代表的骨健康状态区间 A["T值 > 0<br/>理想骨量（30岁基准）"] --> B["0 至 -1.0<br/>正常范围"] B --> C["-1.0 至 -2.5<br/>骨质减少 (Osteopenia)"] C --> D["≤ -2.5<br/>骨质疏松症 (Osteoporosis)<br/>骨折风险激增40%+"] ``` --- ### [35:31](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2131s) 骨质流失的高发人群与过迟的医疗筛查痛点 针对美国 50 岁以上人群的患病情况，莱特医生列出了一组令人震惊的数据：大约有 200 万男性患有骨质疏松症——许多人误以为骨质疏松是女性专利，完全忽略了男性的患病风险；而在女性群体中，每两个人中就有一人（至少 50%）一生中会发生一次骨质疏松性骨折。莱特医生强调，骨量断崖式下跌并非不可避免，关键在于抓住 40 岁前后的“关键十年”（Critical Decade）及早介入，“但如果我们不去主动干预，骨折就真的会成为宿命”。 更令人担忧的是现有医疗体系的滞后。在美国及许多其他国家，常规医疗保险直到患者 65 岁才会报销 DEXA 骨密度扫描。莱特医生愤怒地反问：“为什么我们要等到 65 岁？到那个时候，不可逆的骨破坏早就已经发生了！”更严重的是，许多发生过骨折的患者在后续随访中甚至从未做过 DEXA 检测，而医学上预测未来再次骨折最核心的指标恰恰是“既往骨折史”。莱特医生借此发出公共健康呼吁：只要你曾发生过骨折——哪怕是车祸等严重外伤，特别是日常轻微跌倒、甚至只是被家里的宠物狗拉扯导致摔倒的低创伤骨折，都必须自费或要求进行一次 DEXA 扫描，只有明确自己的骨质基准，才能制定逆转和重建骨量的方案。 --- ### [36:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2208s) 骨质疏松的早期隐蔽信号与吸烟的毒害 骨质疏松被称为“寂静的杀手”，往往在骨折前毫无征兆，但日常生活中有迹可循。莱特医生指出，直系亲属的身高变化是最直接的警示信号：如果父母随着年龄增长“缩水变矮”了（例如母亲以前和自己一样高约 1 米 62，如今却矮了一大截），这通常是脊柱椎骨发生微小压缩性骨折的迹象。此外，如果母亲曾发生过髋部骨折，或者自身因哮喘、自身免疫性疾病等长期服用大剂量类固醇皮质激素，骨骼质量往往非常糟糕。 当被问及吸烟对骨骼的影响时，莱特医生斩钉截铁地表示，吸烟对骨骼愈合而言就是“纯粹的毒药”（a poison to bone healing）： * 骨科临床数据显示，吸烟者在骨折固定手术后，发生骨不连（Non-union，即手术修补后骨头仍无法愈合）的概率明显飙升。 * 在脊柱外科手术的大量文献中，吸烟不仅导致植骨融合率暴跌，术后感染率也显著上升。 * 烟草中的有毒有害化学物质会严重破坏微血管灌注与成骨细胞功能。史蒂文庆幸自己从不吸烟并追问电子烟（Vaping）是否同样有害，莱特医生指出电子烟同样充满危害甚至可能更危险，只是目前医学界对电子烟的长期追踪研究仍在累积中。 --- ### [38:28](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2308s) 骨脑轴连接：阿尔茨海默病与骨健康的关联 史蒂文询问骨骼健康与阿尔茨海默病（Alzheimer's Disease）之间是否存在关联。莱特医生确认两者之间存在明显的流行病学相关性：临床上阿尔茨海默病患者与严重骨质疏松症患者往往高度重叠，约 30% 患有大脑神经退行性疾病的人同时患有骨质疏松症。这背后正是骨骼与大脑之间双向生化信号网络（即“骨脑轴”）退化的直接体现。 随后两人聊到了莱特医生的亲身经历。她的阿姨艾达（Aunt Ida）曾是一位聪明绝顶的优秀教师，最终却因阿尔茨海默病离世。看着艾达阿姨逐渐遗忘一切——遗忘了自己是谁，遗忘了抚养所有人长大的家庭农场——是一件极度痛苦的事。阿尔茨海默病患者在去抑制化后往往会表现出暴怒、恐惧或攻击性，艾达阿姨虽然没有这些过激表现，但亲眼见证亲人智力衰退依然让人心碎。这场经历深刻重塑了莱特医生对衰老的认知，为她注入了巨大的紧迫感。她坦言，即便自己深谙所有科学理论、每天规律硬拉举铁，保持这样的自律也是一场日复一日的艰苦战役；每次刚刚完成繁重的写书工作出现运动间隙时，驱使她迅速重返健身房的核心动力，就是对自己失去大脑认知能力的极度恐惧。 --- ### [40:57](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2457s) 健全体魄与清醒大脑的抉择，及阿尔茨海默病的代谢本质 史蒂文抛出一个尖锐的思想实验：“如果在衰老时只能二选一，你会选择一副健康的躯体（Able body），还是一颗健全的大脑（Able brain）？”两人异口同声地选择了“健全的大脑”。他们一致认为，与周遭世界的认知连接与情感纽带，才是构成生命丰饶度的根本所在。但史蒂文也指出，这两者在生理底层其实是紧密捆绑的——如果一个人骨骼脆弱卧床不起，运动量的断崖式下跌必然会拖垮大脑。莱特医生表示赞同：肌肉分泌的肌肉因子（Myokines）能直接滋养大脑神经元，保持运动不仅是在保全躯干，更是为了保全大脑。 更具颠覆性的是，现代医学越来越多地将阿尔茨海默病视作“3 型糖尿病”（Type 3 diabetes）——其本质是大脑局部对葡萄糖利用障碍及胰岛素抵抗所导致的代谢灾难。 ```mermaid flowchart TD accTitle: 代谢综合征向阿尔茨海默病演变链条 accDescr: 胰岛素抵抗发展为糖尿病并最终导致认知障碍的过程 subgraph S1["代谢失控前期"] A["空腹血糖异常<br/>（持续 110 mg/dL 左右）"] B["糖化血红蛋白 HbA1c 接近 6%"] end subgraph S2["系统性糖尿病"] C["胰岛素抵抗恶化<br/>胰腺功能耗竭"] D["10 年内进展为<br/>2 型糖尿病 (70-100% 概率)"] end subgraph S3["神经退行性病变"] E["脑局部胰岛素抵抗<br/>（3 型糖尿病）"] F["神经元代谢衰竭<br/>发展为阿尔茨海默病"] end A & B --> C --> D --> E --> F ``` 莱特医生在门诊中见到了太多触目惊心的案例：大量步入 40 岁“关键十年”的患者拿着体检报告来找她，其空腹血糖（禁食 12 小时后血液中的葡萄糖残留）已经高达 110 mg/dL（正常健康水平应在 85 mg/dL 左右），糖化血红蛋白（HbA1c）逼近 6%。在医学文献中，持续处于 110 mg/dL 血糖水平的人，在接下来的 10 年内有 70% 至 100% 的极高概率发展为完全性糖尿病。 令人愤怒的是大众甚至常规医疗界对“糖尿病前期”（Prediabetes）的麻木态度。当莱特医生询问病人是否知道自己处于糖尿病前期时，患者要么毫不知情，要么轻描淡写地表示：“医生随口提过一句，就让我平时稍微注意锻炼、少吃点碳水。”莱特医生直言，面对糖尿病前期的确诊，正确的态度绝不是轻描淡写，而是应该“尖叫着冲出去拼命自救”（running and screaming to get healthy）。 * **9600 万人处于危险边缘**：根据美国糖尿病协会（ADA）的官方数据，全美有高达 9600 万人患有糖尿病前期，其中绝大多数人根本没有意识到危险。 * **时间线的倒计时效应**：如果一个人 40 岁时对轻度升高的血糖置之不理，10 年后（50 岁）就会确诊 2 型糖尿病，再过 10 年（60 岁）就会面临阿尔茨海默病的高风险。 * **精准抗衰的拦截机制**：在“精准长寿医学”（Precision Longevity）视角下，只要在 40 岁左右通过高强度力量抗阻训练（肌肉是人体最大的葡萄糖存储库）、心肺有氧训练以及严格的抗炎饮食干预，这种走向退行性痴呆的恶性链条是完全可以被提前阻断的。 ### [44:36](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2676s) 连续血糖监测、中年女性代谢与预防糖尿病 谈及糖尿病前期，冯达·莱特医生（Dr. Vonda Wright）语气变得严肃而急迫。她指出，糖尿病前期完全是一个可逆、可预防的状态，本应作为阻止患者发展为完全型糖尿病乃至阿尔茨海默病的黄金窗口期，但在现实医疗中，它往往被医生和患者轻描淡写地一带而过。史蒂文·巴特利特（Steven Bartlett）打趣道，既然人群患病率接近三分之一，那录音棚里总共三个人，“这岂不是意味着摄影师杰克（Jack）很可能已经迈入糖尿病前期了？” 玩笑之余，冯达医生分享了自己的亲身经历。作为一名前耐力运动员，她对连续血糖监测仪（CGM）非常着迷，已经连续佩戴了大约18个月。她坦言，最近因为刚写完新书，生活节奏被打乱，训练强度有所下降，血糖波动立刻如实反映了出来： - **常态化日常方案**：每周4次大重量抗阻训练（Heavy Lifting），其余时间安排约4天二区心率有氧基础训练（Zone 2），其中2天穿插高强度冲刺跑（Sprint），同时坚持高蛋白饮食。在此状态下，她的空腹血糖始终维持在理想的 85 mg/dL 左右。 - **作息被打乱后的变化**：写书期间，抗阻训练降至每周2次，冲刺跑暂停，即便饮食依然克制，血糖指标还是开始悄悄往上爬。 冯达强调，作为一名步入中年的女性，体内的代谢环境发生了剧烈变化，哪怕只是稍微松懈训练，血糖调节能力就会立刻滑坡。这证明代谢健康绝非一劳永逸，而是一种必须每日践行、融入习惯的生活方式。正因如此，当看到临床上很多患者被轻率地告知患有这种足以致命的代谢隐患却未获足够警示时，她感到极为痛心。 --- ### [46:12](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2772s) 饮食对认知敏锐度的影响与精英运动员的食谱 面对高强度的公开演讲、董事会博弈、商务谈判、图书写作以及数小时无间断的播客访谈，史蒂文迫切想知道什么样的饮食能带来哪怕 5% 的脑力与认知表现优势。冯达指出，从她多年担任职业运动员队医的经验来看，顶级厨师和营养师绝不会让顶尖运动员走极端（例如纯肉生酮饮食），而是提供极其均衡的膳食配比：大量新鲜蔬菜、极高密度的优质蛋白质，并在需要时通过氨基酸补剂（如亮氨酸 Leucine）来精准补足短板。 史蒂文分享了自己主持节目的切身体会。有时候连续录制长达4个小时，某些日子大脑反应如行云流水，“boom boom”脱口而出，词句完全不假思索地顺畅涌现；但在另一些日子里，大脑和嘴巴却像彻底断了连接，思维迟钝不堪。他发现影响这一状态的最大变量除了睡眠，就是录制前数小时内摄入的碳水化合物： - 只要吃了面包或大量精制糖，嘴巴和大脑的连接便瞬间宕掉； - 如果保持低碳或生酮状态，思维则极其敏锐清晰。 冯达对此表示认同，但也补充了精细化调整的必要性。她通过佩戴 CGM 发现，如果早晨只吃纯蛋白质（如纯蛋白煎蛋卷），到了上午10点左右接诊患者时，高强度脑力运转就会出现能量瓶颈。因此，她目前会在早餐中加入大约 50 克复合碳水化合物，既不至于引起剧烈血糖飙升，又能为上午的高负荷临床工作提供稳定的脑力燃料。 --- ### [48:11](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2891s) 每日130克蛋白质与“水果是自然界的甜点” 冯达详细拆解了她个人的日常饮食配比。为了有效维持并构建肌肉，她坚持按照每磅体重对应1克蛋白质的黄金标准，每天摄入高达 130 克的优质蛋白质。虽然人体单次进食所能合成蛋白质的上限在学术界已不再设限，但她强调每次进食存在最低触发门槛——单餐至少需要达到 30 克蛋白质才能有效激活肌肉合成信号。 为了在每天三餐加两顿加餐中完成如此庞大的蛋白质摄入量，她摸索出了一套专挑高密度食物的进食公式： - **希腊酸奶**：一杯可提供约 18 克蛋白质； - **高纯度牛肉棒（Beef Stick）**：单根可提供约 16 克蛋白质； - **蔬菜**：大量摄入各类新鲜蔬菜以补充微量营养素与纤维； - **严控水果**：她几乎完全不吃普通水果，唯一的例外是在酸奶中加入蓝莓。她直言：“水果其实是自然界的甜品，如果真要吃，就把它当成甜点对待”； - **碳水化合物**：即便摄入，也严格局限于低升糖指数的复合碳水化合物。 大量的临床研究证实，即便在没有达到理想力量训练频次的情况下，仅靠充足的高蛋白摄入，也能在相当程度上减缓肌肉流失的进程。 --- ### [49:22](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2962s) 赞助插播：企业安全合规平台 Vanta 史蒂文在此处插播了节目赞助商 Vanta 的介绍。他强调，不论是初次面临安全审计的初创公司创始人，还是经验丰富的资深企业管理者，网络安全合规（如 SOC 2、ISO 27001 等 35 类以上合规框架）正变得越来越关键且繁琐。Vanta 能够通过自动化流程减轻安全合规负担，集中工作流，使回答安全问卷的速度提升最高达5倍。根据 IDC 白皮书调研，使用 Vanta 的企业平均每年可节省超过 535,000 美元，并在短短3个月内收回成本。 --- ### [50:28](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3028s) 逆转衰弱：任何年龄开始力量训练都为时不晚 话题转回长寿的关键支柱。史蒂文询问，冯达经常将肌肉视为健康长寿的最核心要素，这背后的逻辑究竟是什么？冯达纠正道，她会将**肌肉与骨骼**并列在同一高度：哪怕浑身练满肌肉，一旦发生髋部骨折，随之而来的卧床、感染和全身衰竭同样致命；当然，强大的肌肉护甲本身就是防止摔倒和骨折的最佳屏障。 面对无数人的顾虑——如果已经六七十岁、过去十几年从未做过负重训练、肌肉早已深度萎缩，现在开始还来得及吗？冯达斩钉截铁地回答：“绝不，永远都不晚（It is never too late）！你的身体永远都会对你施加的战略性压力（Strategic Stress）做出适应性响应。”网络上曾经被视作特例的六七十岁甚至八十多岁的老人，如今越来越多地走进健身房练习力量举、甚至参加健美比赛。即便一个人当下虚弱到连从椅子上站起来都困难，只要方法得当，在短短6个月到1年内，衰弱（Frailty）的轨迹完全可以被彻底逆转。 史蒂文联想到自己即将年满70岁的父亲，过去15年几乎从未碰过杠铃哑铃，身体机能每况愈下，陷入了“缺乏训练导致体能变差、体能变差导致更加不敢动”的恶性循环。冯达解释，大龄初学者绝不需要一上来就去挑战杠铃深蹲或硬拉，力量重建有一个循序渐进的科学路径： ```mermaid flowchart LR accTitle: 大龄与虚弱人群力量阶梯进阶路径 accDescr: 展示从最基础的关节全范围自重活动，逐步过渡到自由重量与抗阻负重的进阶过程。 subgraph 阶段一["基础适应"] A["关节全范围活动<br/>(Full ROM)"] --> B["自重训练<br/>(Body Weight)"] end subgraph 阶段二["渐进负重"] B --> C["弹力带与壶铃<br/>(Bands & Kettlebells)"] --> D["自由重量抗阻<br/>(Free Weights)"] end ``` 冯达回顾了她过去主导的“START”健康干预项目： - **招募对象**：长期久坐不动的极度衰弱人群，部分人体脂率高达 51%，起初甚至无法坚持完成热身动作，做一个俯卧平板支撑都撑不住； - **训练方案**：为期3个月，采用自重与基础壶铃循环训练结合步行耐力； - **惊人成果**：仅用3个月，这些原本无法自理的受试者就能连续平板支撑整整 2 分钟、不间断走完 3 英里（约 4.8 公里），并一气呵成完成原本中途必须放弃的 10 分钟循环训练，最终全部顺利完成了 5 公里（5K）健康跑。 面对身体惊人的可塑性，冯达鼓励史蒂文立刻给父亲请一位专业教练，史蒂文随即笑着答应：“录完节目我就给他打电话。” --- ### [53:28](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3208s) 肌肉记忆、训练频率与绝经期女性的重磅力量训练 针对繁忙现代人因出差、久坐开会而无法系统训练的焦虑，史蒂文提出疑问：维持肌肉到底需要多大的训练频率？中断训练后多久会彻底前功尽弃？ 冯达援引最新的运动科学文献给出了定心丸：对于已有规律训练习惯的人，哪怕完全停训长达 10 周（10-week Hiatus），神经系统与肌纤维内的“肌肉记忆”（Muscle Memory）依然会完整保留，不会发生灾难性的断崖式衰退；一旦重新恢复训练，身体能以极快的速度找回之前的力量与围度水平。 若要实现肌肉生长与强化，每周的最低有效负荷与训练配置如下： - **基础频次**：每周至少进行 2 次渐进负荷力量训练； - **中年男性黄金组数**：推荐采用经典的中高容量方案，即每组约 8 次重复、共 4 组（4 sets x 8 reps）； - **绝经期中年女性的特殊突破**：在具备一定力量基础后，必须进阶至大重量抗阻训练，推荐每组 4 次力竭极限、共 4 组（4 sets x 4 reps）。 针对女性练习大重量容易受伤的质疑，冯达明确指出，这需要长期的动作模式打底与科学过渡，绝非盲目蛮干。女性在中年绝经后面临断崖式的雌激素暴跌，而雌激素原本在女性体内扮演着核心的促合成（Anabolic）刺激作用。为了对抗激素退潮带来的断崖式肌肉流失与骨质变脆，“我们必须通过大重量外力训练带来的高机械张力，向身体强行释放生长信号，以此替代雌激素曾经扮演的促合成角色”。 - 长期停训缓冲期：长达 10 周的停训仍可依靠肌肉记忆快速恢复，短期出差久坐不必产生心理内耗。 - 中年男性抗阻推荐：4 组 × 8 次（渐进负荷）。 - 中年女性抗阻推荐：打好基础后进阶至 4 组 × 4 次大重量（以机械张力替代衰退的雌激素促合成信号）。 ### [55:06](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3306s) 大重量还是高次数：力量、肌肥大与长寿举重策略 Dr. Vonda Wright 强调，即使是从沙发上刚起步的运动新手，也可以先从弹力带、轻重量，甚至被她戏称为“毫无意义的娘娘腔粉色小哑铃”（mamby-pamby pink weights）开始练起，但绝不能止步于此。关键在于循序渐进地实行渐进式超负荷，逐步过渡到大重量抗阻训练，每周至少进行两次全身力量训练以维持机能。Steven 随即提出许多健身房常客共有的困惑：如果用较轻的哑铃多做几次重复（更高次数），难道就不能增肌了吗？ Dr. Wright 解释道，这完全取决于训练目标：轻重量、高次数（例如每组 12 至 15 次）确实能够促成“肌肥大”（hypertrophy），让肌肉围度看起来更大，但这并不等同于真正能输出爆发力与绝对力量（power and strength）。迈入中年及往后的人生阶段，她的训练目标已经彻底转向“长寿与爆发力”：“我现在已经不像年轻时那样在乎肌肉块头有多大了，我在乎的是它能否在漫长时间里强劲有力地运动——我能不能轻松从地板上站起来？能不能把笨重的行李箱一把举过头顶放进行李架？” 追求力量与爆发力，讲究的是“大重量、低次数”。当 Steven 以为针对力量大概做 6 到 8 次时，Dr. Wright 透露了自己的极限方案：她每次只做 4 次重复（4 组，每组 4 次，极限大重量）。Steven 听后十分惊讶，坦言自己此前完全不知道追求长寿的力量训练可以如此精简而强悍。 - **肌肥大模式（Hypertrophy）**：偏低重量、较高次数（通常为 12–15 次/组），侧重增加肌肉截面积与体积。 - **长寿爆发力模式（Power & Strength）**：大重量、极低次数（Dr. Wright 采用 4 组 × 4 次），侧重神经肌肉招募效率与日常生活功能性输出。 --- ### [56:46](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3406s) 肌肉不仅是好看：长寿蛋白 Klotho 与内分泌代谢器官 Steven 提到，许多人仍未意识到肌肉与长寿之间的深层纽带，而大家最常听说的机制通常是肌肉作为葡萄糖的“水槽”（glucose sink）来预防胰岛素抵抗，以及提供物理支撑防止摔倒骨折。Dr. Wright 进一步指出，骨骼肌在现代医学中被视为人体极其关键的**代谢与内分泌器官**。当骨骼肌在抗阻训练（例如二头弯举）中收缩时，它会转录并向全身释放多种强效的生物活性因子： ```mermaid flowchart TD accTitle: 骨骼肌收缩释放的内分泌长寿因子 accDescr: 骨骼肌收缩通过内分泌途径激活 Klotho、Galanin 和 Irisin，分别作用于全身器官修复、大脑压力韧性及白色脂肪棕色化。 subgraph Muscle["骨骼肌主动收缩"] M["骨骼肌力量训练"] end subgraph Factors["释放的关键分子"] K["长寿蛋白 Klotho"] G["神经调控肽 Galanin"] I["运动激素 Irisin (鸢尾素)"] end subgraph Targets["生理长寿效益"] K_Eff["全身器官衰老延缓与细胞修复"] G_Eff["作用于脑部蓝斑核，提升认知韧性与解决问题能力"] I_Eff["激活骨骼重塑，促进白色脂肪转为产热棕色脂肪"] end M --> K M --> G M --> I K --> K_Eff G --> G_Eff I --> I_Eff ``` 其中最震撼的当属“长寿蛋白”Klotho。大约 30 年前《自然》（*Nature*）杂志首次阐明了它的功能。小鼠实验证实，天生缺乏制造 Klotho 能力的小鼠，从生理日历上看虽然极为年轻，却会过早呈现出极度衰老并死亡；而骨骼肌的强力收缩正是体内转录合成 Klotho 的开关。Dr. Wright 多年前曾主导过一项关于血液中循环 Klotho 水平的研究，测试对象涵盖年轻运动员（40岁左右）、高龄老将运动员（60、70甚至80岁大师级选手）以及久坐不动的年轻人。结果显示： 1. 血液 Klotho 水平最高的是年轻运动员； 2. 排名第二的竟是七八十岁的老将运动员； 3. 最低的反而是身体健康的年轻久坐族。 这意味着即使年逾古稀，只要坚持力量运动，血液中奔涌的长寿蛋白依然能远远碾压荒废肌肉的年轻人。 此外，肌肉收缩还会转录一种名为甘丙肽（Galanin）的物质，它穿过循环作用于大脑的蓝斑核（locus coeruleus），这是掌管个体心理韧性与应对压力、解决复杂问题的关键神经区域；另一广为人知的分子则是鸢尾素（Irisin，即运动激素），它能直接滋养骨骼，并将惰性的白色脂肪转化为线粒体密集、产热能力极高的棕色脂肪。因此，肌肉绝不是用来在健身房镜子前摆姿势自恋的装饰品，而是实打实驱动长寿的生化反应堆。 --- ### [59:50](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3590s) 维持肌肉的营养干预：蛋白质、亮氨酸与被误解的肌酸 面对 Steven 关于“市面上有没有卖 Klotho 补充剂”的半开玩笑提问，Dr. Wright 直言没有任何捷径，人体无法外源补充 Klotho，必须靠自己收缩肌肉来合成。要留住肌肉，最基础的前提是给肌肉提供原料。作为一线临床医生，她深知给公众的营养指导必须极度直观且易于执行：“科学界对于蛋白质的需求范围确实有各种精细区间，但普通人需要的是一句能刻在脑子里的话——**每磅理想体重摄入 1 克高品质蛋白质**（1 gram per ideal pound，约合 2.2g/kg）。” 在蛋白质品质方面，肌肉合成最核心的限制性支链氨基酸是亮氨酸（Leucine）。人体无法自身合成亮氨酸，全宇宙亮氨酸与乳清蛋白浓度最高的全天然来源其实是母乳，而成年人主要通过乳清蛋白与乳制品获取；植物蛋白虽然也含有亮氨酸，但浓度要低得多，素食者需要摄入大得多的总量才能达到相同的代谢阈值。 除了蛋白质，Dr. Wright 强烈推荐被严重误读的**肌酸（Creatine）**。她回忆自己最早接触肌酸是在 1992 年奥运会期间与摔跤运动员合作，当时流行超大剂量冲击与周期性停服（cycling）；而现代科研已充分证实，男女皆宜的最佳用法是每日持续摄入 5 克。肌酸不仅帮助合成肌肉，还能直接提升大脑认知能量代谢。 Steven 分享了身边的真实故事：几个月前他在公司办公室问谁在吃肌酸，举手的只有几位男性员工，女同事全部摇头，因为她们误以为“肌酸是健美先生专用的大块头补剂，吃了会发胖长水肿”。去年圣诞节，Steven 和女友也因此发生过激烈争辩，直到女友亲自查阅文献，发现肌酸对认知、皮肤、毛发、骨骼以及肌肉全面有益后，现在也每天坚持服用 5 克。Dr. Wright 对此深表赞同，感叹公众对肌酸的认知仍停留在几十年前“类固醇”式的恐惧中，亟待彻底的再教育。 --- ### [01:02:24](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3744s) 健康行为的动机鸿沟：摆脱“20年后”的延迟承诺与骨骼营养素 尽管播客节目铺天盖地，Dr. Wright 也“在每一座山顶上拼命呐喊”，但她沮丧地发现公众在健康认知与真正采取行动之间存在着令人绝望的鸿沟。人们明明清楚该怎么做，却依然选择躺平，哪怕眼睁睁看着身边长辈遭受糖尿病或阿尔茨海默病的折磨，也无法形成长久改变的动力。 在 Dr. Wright 看来，指望用“吓唬”或“时间跨度上的延迟承诺”来激励普通人是注定失败的。如果你告诉一个三四十岁的人“你今天做深蹲，二十年后到了七十岁身体会很好”，大脑存在天然的“时间断联”（temporal disconnect），没人能对几十年后抽象的自己产生切实共鸣。 > “我面对患者的方式是：我能不能让你明天就感觉好起来？我能不能让你因为今天举起了沉重的铁块，走出健身房时就觉得自己像个了不起的硬汉（badass）？” 唯有建立即时的体感正反馈，让人在当下每天都能体会到精力充沛与掌控感，健康习惯才能真正持续。 谈及深藏体内、看不见摸不着的骨骼健康，这种激励困难尤为明显。人们常常觉得骨质疏松遥不可及，直到某天发生严重骨折才追悔莫及。除了抗阻刺激，Dr. Wright 列举了骨骼健康的几大关键基石： - **核心常量元素**：维生素 D 与镁（Magnesium）。 - **微量营养素**：锶（Strontium）、锌（Zinc）、硼（Boron）。 - **生活方式**：充足且高质量的睡眠（修复骨代谢的关键窗口）。 --- ### [01:04:28](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3868s) 从纯举铁到开跑：提升最大摄氧量与规避“跑者膝”误区 话题转向了心肺耐力。Dr. Wright 称赞 Steven 最近终于走出了器械区开始跑步，甚至发起了号召全球 100 万人一起跑步的健康倡议，赞许他“这项举动将会拯救成千上万条生命”。Steven 笑着坦言，自己过去两三年全部沉浸在力量举铁中，完全把骨骼抗冲击和最大摄氧量（VO2 Max）抛到了脑后；虽然他以前极其讨厌跑步，现在即便仍有抵触，但也逐渐转变成了一种“痛并快乐着”（hate and love it）的复杂情绪。 随着跑量增加，Steven 表达了对运动损伤的普遍担忧，尤其是常听人提起的“跑者膝”（Runner's Knee），他极力想避免自己受伤。Dr. Wright 随即点出了跑圈中极为常见的一个致命误区：许多跑步爱好者天真地以为“我既然一直在跑步，腿部力量肯定足够了，所以进健身房力量训练时我只需要练练手臂和上半身就行了”。这种割裂的错误认知，正是引发下肢关节代偿与严重损伤的根源。 ### [01:05:25](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3925s) 为什么纯跑者容易频繁受伤：单腿运动与臀肌力量的核心作用 很多人以为跑步能让双腿变粗壮，但凭借 30 年的临床运动医学经验，Dr. Vonda Wright 指出事实恰恰相反：“只跑步而不做力量训练的跑者，受伤频率极高。”跑步能锻造出一个强大的心血管系统，如同装上一台大马力引擎，但除非你总是在跑上坡路来刺激臀大肌，否则它通常无法在腰腹以下构建起足够的肌肉量。 关键原因在于跑步在生物力学上是一项“纯粹的单腿运动”。步态分析显示，走路时人体会有双脚同时着地的支撑相，但跑步时你永远只有一只脚着地，身体是在一条腿和另一条腿之间来回腾空切换。如果把双手放在跑者的骨盆两侧观察，理想状态下骨盆必须保持完全水平稳定，而不是每迈出一步就像在时装周 T 台走秀那样剧烈左右摇摆。要实现这种绝对的水平推进，需要极强的臀部力量（尤其是臀中肌等稳定肌群），因为骨盆的平衡完全由臀肌来维系。在诊所里，如果有跑者因下肢疼痛前来就诊，Dr. Vonda Wright 的第一件事就是让其在受控环境下单腿站立并尝试单腿深蹲，观察其骨盆能否保持稳定、膝盖是否会不受控制地向内塌陷；如果做不到，就意味着下肢、臀部和核心力量存在极大的亏欠。 --- ### [01:06:50](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4010s) 身体失衡的连锁反应：从大脚趾关节炎到跟腱炎的真实案例 听到这里，Steven 分享了自己的切身困扰：他目前正在英国备战一场足球比赛，但几乎每次踢球都会遭遇臀部拉伤。这种拉伤甚至具有 100% 的可预测性——即便赛前做了一些拉伸，只要没有完全拉开，踏上球场不到五分钟，臀部就会出现类似轻微撕裂的刺痛感。Dr. Vonda Wright 建议他去专业机构做动作步态分析（Motion Analysis），通过单腿站立对比两侧肢体的动作模式差异。当某种伤病以固定规律反复出现时，身体内部必然存在严重的肌力失衡或代偿机制，而这种失衡完全可以通过针对性训练得到纠正。 为了阐明运动链代偿的连锁破坏力，Dr. Vonda Wright 拿自己作为生动的解剖案例：每当她提高配速或增加跑步距离时，都会百分之百按规律出现左侧跟腱炎（Achilles tendinitis）以及右侧髋屈肌针扎般的剧烈刺痛。追溯根源，竟是因为她年轻时常穿高跟鞋导致左脚大拇趾患上了退行性关节炎。跑步时，由于大脚趾疼痛，她的着力点被迫从足弓中心向外侧的小脚趾偏移；足部翻滚方式的改变对左侧跟腱施加了异常的剪切力，进而导致整个左侧动力链异常紧绷，最终迫使身体对侧的右侧髋屈肌承受了巨大的代偿负荷。她总结道，长期的定点伤病往往源于“一侧太紧，另一侧太弱”，只要精准定位病因，就能彻底摆脱代偿性损伤。 --- ### [01:08:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4128s) 现场测试 Trendelenburg 征：单腿深蹲与纠正性训练方案 为了直观展示肌力失衡如何摧毁运动稳定性，Dr. Vonda Wright 在录影棚里邀请 Steven 离席起身，现场进行临床经典的“特伦德伦伯格征”（Trendelenburg sign）测试。该测试用于评估臀肌是否足够强壮以维持骨盆水平，同时检测膝关节是否会发生力线崩溃内扣（即膝外翻，Valgus）。她指导 Steven 单腿站立在左膝上，保持身体中轴稳定，然后尝试缓慢下蹲： ```mermaid flowchart TD accTitle: 单腿支撑动作模式与代偿机制 accDescr: 展示强健臀肌与虚弱臀肌在单腿着地时的力学差异及后果 subgraph 异常力链模式 ["臀肌力量薄弱（代偿状态）"] A["单腿着地承重"] --> B["对侧骨盆下垂（Trendelenburg 征阳性）"] B --> C["支撑腿膝关节内扣（Valgus 膝外翻）"] C --> D["髌骨轨迹偏移 / 跟腱与髋部承受剪切力"] D --> E["每英里上千次冲击累积导致慢性伤病"] end subgraph 纠正性力量训练 ["功能性重建方案"] F["单腿上台阶（Step-ups）"] G["单腿下台阶（Step-downs）"] H["站姿提髋练习（Hip Hitches）"] end 异常力链模式 -.->|针对性强化修复| 纠正性力量训练 ``` Steven 刚在左腿上弯曲膝盖，身体便剧烈晃动，骨盆向下歪斜，膝盖不由自主地向内侧塌陷，动作变形得让他自嘲“看起来像喝醉了一样”。Dr. Vonda Wright 严肃地指出：“每跑一英里大约有一千步，想象一下，如果你的膝盖在这一千次着地中每一步都发生这种塌陷，你的髌骨正被不断向外拉扯，平衡系统也在被反复折磨。”随后 Steven 换成右腿测试，动作明显更加平稳可控，这立刻印证了他的左侧臀肌力量明显弱于右侧，而左侧正是他每次踢球必然受伤的重灾区。 为了纠正这种双腿力量不均，Dr. Vonda Wright 开出了具体的处方动作： - **放弃双腿对称深蹲的单一迷信**：普通的双腿深蹲虽然有益，但无法解决左右侧肌力不对称的问题。 - **单腿负重上台阶（Single leg step-ups）**：可先从无负重的低矮木箱或台阶开始，逐渐过渡到 18 英寸高度。双手握持哑铃或肩扛杠铃，核心收紧，迈上一条腿平稳站起并下落，重点在于全过程控制骨盆不发生颠簸或晃动。 - **单腿下台阶控制（Single leg step-downs）**：侧向或向前单腿缓慢下放，锻炼离心控制能力。 - **站姿提髋练习（Hip hitches）**：单脚站立在台阶边缘，悬空侧骨盆做孤立的上下提拉下沉，专注刺激支撑腿的臀中肌，防止躯干倾斜代偿。 --- ### [01:11:44](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4304s) 中场赞助：ZOE 肠道健康检测与 Perfect Ted 抹茶 录制中场插入了节目的两则商业赞助： - **ZOE 居家全方位代谢与肠道菌群检测**：Steven 介绍了由其投资的健康科技公司 ZOE。该品牌拥有庞大的微生物组数据库，检测套装包括附着在手臂上监测食物升糖反应的连续血糖传感器（CGM）、便捷的居家血脂血液采样、用于测定代谢清除能力的标志性“ZOE 蓝饼干”，以及用于深入分析肠道微生物构成的粪便样本收集工具。用户寄回样本后，系统会依据专属数据生成高度个性化的日常营养膳食方案。 - **Perfect Ted 纯正抹茶饮品**：Steven 分享了自己将日常能量来源彻底切换为抹茶的经历，并透露自己已向 Perfect Ted 投资超过 100 万英镑。该品牌坚持从日本直采仪式级（ceremonial grade）抹茶，口感顺滑、自然回甘，避免了低端抹茶常见的苦涩杂草味，能为他高强度的长时间播客录制提供稳定持久的专注力。 --- ### [01:13:52](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4432s) 肥胖对关节的巨大负担：软骨的极度脆弱与承重机制 回到正题后，Steven 提起两人此前交流过的一个令人震惊的医学事实：身体每增加一点多余的体重，对骨骼和关节造成的损伤都是呈不成比例的放大效应，他希望 Dr. Vonda Wright 进一步剖析并阐明随着年龄增长必须控制体脂的深层原因。 Dr. Vonda Wright 从关节软骨的精微结构切入解释。以膝关节股骨远端为例，每一根骨头的末端都包裹着一层致密的软骨保护层（cartilage bumper）。软骨本质上是由胶原纤维网架和嵌入其中的软骨细胞组成的基质结构，其核心天职就是吸收冲击力，避免坚硬而脆弱的骨骼直接发生刚性碰撞磨损。健康软骨的表面极其平滑，“在物理学中，软骨的摩擦系数（coefficient of friction）甚至低于冰面”，它能让关节在无痛状态下滑动自如。 然而，软骨对机械外力的耐受度却非常脆弱。Dr. Vonda Wright 透露，当他们在实验室进行软骨损伤机制研究时，甚至不需要动用重型机械压榨，“我们想要破坏一块软骨标本，所需要做的仅仅是从上方朝它扔下一颗小弹珠而已”。这直观证明了软骨在遭受垂直点状撞击或持续过载时有多么容易受损。如果在日常生活中长期背负沉重的过量脂肪，软骨每时每刻都在超负荷承受放大数倍的物理压力。 - **极低摩擦系数**：天然健康的关节软骨在润滑液配合下，摩擦系数比两块相互摩擦的冰块还要顺滑。 - **软骨损伤阈值低**：实验室重力模拟证明，仅弹珠大小的质量坠落冲击即可诱发软骨胶原网架的微结构撕裂与不可逆破坏。 ### [01:15:06](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4506s) 关节负荷与身体成分的真相：打破“泡芙人”的幻觉 健康的肌肉不仅负责身体运动，更是保护关节软骨的核心减震器。当肌肉不足时，关节软骨承受的冲击和撞击就会成倍增加；虽然冲击力对刺激骨骼密度有益，但对缺乏血供的软骨却极具破坏性。在日常活动中，膝盖和髋关节所承受的压力高达体重的7到9倍，如果身体承载过多的脂肪而缺乏支撑性肌肉，软骨的磨损速度将极其惊人。因此，健康管理的核心指标绝不是体重秤上的绝对重量，而是身体成分（Body Composition）——必须通过增加肌肉量并压缩脂肪组织（Adipose Tissue）的比例，来建立真正有保护力的肉体构架。 许多人在面对生活方式改变时往往陷入拖延，直到遭遇确诊或跌入人生低谷才被迫改变。为了打破这种惯性，客观、冰冷的数据往往是唤醒意识的第一道催化剂。在临床评估中，全面细致的身体成分分析能够揭示外表无法反映的真相：许多人在镜子前看起来体型匀称，甚至自满于“不胖”，但检测却显示其体脂率高达32%，精瘦肌肉量严重匮乏，处于典型的“隐性肥胖 / 泡芙人”（Skinny Fat）状态。镜子中的视像容易让人自欺欺人，腰腹上的赘肉或许还不足以引发警惕，但毫无道德评判的检测数据绝不撒谎。当患者看到自己干瘪的肌肉量和超标的脂肪比例时，这种清醒的认知结合3至6个月的定期复查机制，便能转化为持久的内生驱动力。 工具层面的辅助同样至关重要，包括记录身体感受的健康日志以及连续动态血糖监测仪（CGM）。动态血糖仪不仅能让人看清食物对身体的实际影响，更能揭示隐藏的生理机制：即便在不进食的状态下，高强度的精神压力也会促使皮质醇激增，进而迫使肝脏释放大量糖原造成血糖骤升。通过数据彻底“点亮”体内的生化运作，能让人获得前所未有的掌控感。然而，所有仪器与追踪方式的背后，最不可或缺的基石依然是内在的自我价值认同。“归根结底，你必须足够珍爱自己；任何外部压力或医生的苦口婆心，都无法强迫一个人珍视自己并愿意每天为自己的健康进行投资。” ```mermaid flowchart TD accTitle: 身体成分评估与行为改变驱动机制 accDescr: 展示从身体成分数据暴露隐性肥胖到工具追踪与内在认同驱动生活方式改变的路径 subgraph DataExposure ["客观数据觉醒"] A["身体成分分析 (DEXA / 体成分仪)"] --> B["揭示『泡芙人』真相<br/>(高体脂 32% + 严重缺乏精瘦肌肉)"] B --> C["数据不撒谎、不带道德审判<br/>破除照镜子的自欺欺人"] end subgraph TrackingTools ["反馈与追踪机制"] C --> D["持续追踪 (每 3-6 个月复测)"] D --> E["日志记录每日身体感受"] D --> F["动态血糖监测 (CGM)<br/>洞察压力皮质醇与肝糖波动"] end subgraph CoreMotivation ["底层行为闭环"] E & F --> G["深层自我珍视与认同<br/>『每天对自己进行健康投资』"] G --> H["实现肌肉重建与抗炎生活方式转变"] end ``` ### [01:18:32](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4712s) 击碎绝经期神话：绝经前期认知与激素替代疗法决策 绝经期（Menopause）长期以来被笼罩在无知与误解之中，公众乃至许多医护人员的“绝经期认知素养”（Menopause Literacy）普遍处于极低水平。绝大多数女性甚至从未听说过“围绝经期 / 绝经前期”（Perimenopause）——这一阶段通常持续长达十年，是正式进入绝经日之前漫长且剧烈波动的激素动荡期。在医学定义上，只有在最后一次月经结束整整365天后，那一天才被称为“绝经日”（在美国女性中平均发生在51岁左右）。许多女性不仅对围绝经期和激素替代疗法（HRT）一无所知，更因为上一代母亲的沉默寡言和社会的忽视而羞于启齿，甚至误以为“默默忍受衰老折磨是女性必经的宿命”。 “女性必须承受痛苦”是一个彻底过时的错误神话。现代医学拥有比以往任何时候都多的科学手段和生活方式干预来消除这些痛苦。女性必须基于科学事实而非恐惧心理来尽早制定激素替代策略。理想的状态是在40岁出头就主动阅读相关专著、收听专业播客、寻找匹配的临床医生，在危机全面爆发前做好充分布局。医学上完全可以在仍有月经来潮时启动低剂量激素支持，这本身毫无禁忌；作为对比，现代女性常规服用的口服避孕药，其激素剂量往往是激素替代疗法（HRT）的整整十倍以上。 要平稳度过中年危机，女性必须构建自己“坚不可摧的生活方式（Unbreakable Lifestyle）”。这种生活方式包括三大支柱：提早建立重抗阻力量训练习惯、结合低心率有氧基底训练与冲刺间歇训练（HIIT），以及践行抗炎饮食。这些日常习惯必须在身体陷入极度不适之前就内化为本能生活方式，否则一旦深陷绝经期的严重失衡中，患者往往心力交瘁，根本无法在绝望与不适中从头学习并适应繁杂的新健康规则。 - **围绝经期关键跨度**：正式绝经日前的整个十年，激素剧烈波动，症状通常在40岁左右悄然显现。 - **绝经日严格定义**：最后一次自然月经周期之后整整持续365天无月经的那一天（美国平均中位年龄为51岁）。 - **避孕药 vs HRT 剂量差异**：普通口服避孕药所含的人工合成激素剂量是常规绝经期激素替代疗法（HRT）生理剂量的近10倍。 ### [01:21:22](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4882s) 骨密度断崖式下跌：破骨细胞与早期 DEXA 筛查 绝经与骨质流失之间存在直接且致命的生理联系，这主要源于雌激素和睾酮等关键激素的急剧断崖。在骨骼的代谢平衡中，存在两种分工明确的细胞：一种是负责分解吸收陈旧骨质的“破骨细胞”（Osteoclast），另一种是负责合成沉积新骨的“成骨细胞”（Osteoblast）。在生理状态下，雌激素的核心功能之一就是强力制约和抑制破骨细胞的活性。当围绝经期及绝经期雌激素枯竭后，尽管成骨细胞仍在工作，但失去了刹车的破骨细胞活性全面暴走，导致骨骼分解速率远远凌驾于重建速率之上。 在这种激素真空期内，女性可能会迅速丢失高达15%的骨密度。骨质流失的过程静默无声，但常规医疗体系的筛查指南却存在严重的系统性滞后。在现行的医疗保险体系下，DEXA（双能X射线吸收仪）骨密度扫描往往要到女性65岁时才被纳入报销范围。在临床医生看来，65岁才做人生第一次骨密度检测无异于亡羊补牢，此时患者的骨小梁早已千疮百孔，陷入了完全被动的劣势（behind the eight ball）。女性一旦迈入围绝经期，就应该主动自费进行常规 DEXA 筛查，哪怕省下喝咖啡的零花钱，也必须尽早掌握自己真实的骨骼储备状况，为干预争取宝贵的时间窗口。 | 生理机制 / 临床指标 | 雌激素充足期（青年及育龄期） | 绝经前期与绝经后（雌激素匮乏） | 临床干预对策与建议 | |:--- |:--- |:--- |:--- | | **骨代谢平衡** | 破骨细胞被雌激素有效抑制，与成骨细胞维持动态平衡 | 破骨细胞失去抑制，骨吸收远超骨重建 | 尽早评估激素替代疗法（HRT），重塑骨代谢稳态 | | **骨量变化幅度** | 骨量处于平台期或缓慢生理流失 | 短时间内可发生高达 **15%** 的骨密度急性断崖式丢失 | 结合抗阻重训与抗炎营养，减缓骨流失斜率 | | **检测筛查现状** | 常规体检极少覆盖骨密度 | 医保通常拖延至 **65岁** 才报销 DEXA 检查 | 建议女性在进入**围绝经期（40多岁）**即自费进行基础 DEXA 扫描 | ### [01:22:40](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=4960s) 绝经期肌肉骨骼综合征：雌激素匮乏引发的全身炎症 为了正视绝经对女性运动系统的广泛破坏，Vonda 医生与其学术团队正式确立并发表了一个全新的临床诊断命名——“绝经期肌肉骨骼综合征”（Musculoskeletal Syndrome of Menopause）。长期以来，成千上万的中年女性走进骨科诊室，在没有任何预先诱导的情况下脱口而出同样绝望的心声：“医生，我觉得我的身体正在彻底散架，我觉得自己快疯了，可之前的每个医生都坚称我的检查指标完全正常。”当医生真正愿意坐下来耐心倾听，就会发现这些所谓“没病”的女性正在承受着极其剧烈的器质性病痛。 过去30年的流行病学数据早已证实，50岁以上女性发生炎性关节炎的概率远高于同龄男性，其根本原因深植于人体发生发育学生物学：包括骨骼、肌肉、肌腱、韧带以及脂肪在内的所有肌肉骨骼组织，均由相同的起源细胞——间充质干细胞（Mesenchymal Stem Cells）分化而来。这意味着人体所有的运动结缔组织表面，均密集分布着雌激素受体。作为体内最强大的天然内源性抗炎剂之一，一旦雌激素水平暴跌，整个肌肉骨骼系统就会瞬间陷入失控的炎症风暴。 这种系统性炎症在临床上表现为一系列极具特征性的重度体征： 1. **全身性关节与肌肉钝痛（Arthralgia）**：全身上下爆发无休止的弥漫性剧痛，许多患者晨起时僵痛难忍，严重者甚至无法凭借自己的力量翻身下床（Vonda 医生坦言自己作为常年训练的运动员，在缺乏雌激素时也曾痛到难以起床）。 2. **冻结肩（Frozen Shoulder / 五十肩）**：肩关节囊发生严重的无菌性炎性挛缩。大量女性患者走进诊室时手臂已经完全丧失活动度，甚至由于无法反手扣上内衣后扣而陷入生活崩溃。由于高度集中爆发于50岁上下，东亚传统医学将其精准地命名为“五十肩”，其底层推手正是雌激素骤降诱发的组织纤维化与炎症反应。 3. **肌少症（Sarcopenia）急速恶化**：雌激素受体失去信号输入，导致精瘦肌肉合成受阻、分解加速，短期内肌纤维可流失达20%。 4. **肌腱与韧带病变高频爆发**：跟腱炎、网球肘（肱骨外上髁炎）、髌腱炎等无诱因地大面积涌现。这是因为肌腱与韧带中的胶原纤维高度依赖雌激素受体维持其柔韧度、弹性和微细损伤修复，受体信号的中断直接导致整个结缔组织架构急剧退化并丧失机械承载能力。 ### [01:25:27](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5127s) 绝经期肌肉骨骼综合征：从命名到被近30万人下载的突破性论文 在缺乏雌激素的环境下，女性身体会发生剧烈的系统性变化。Dr. Vonda Wright 回忆，在临床中目睹了大量患者饱受全身性疼痛折磨后，她整合了全球现有的有限医学数据，决定赋予这种普遍却被长期忽视的病症一个正式的医学名称——“绝经期肌肉骨骼综合征”（The Musculoskeletal Syndrome of Menopause），并将成果公开发表。她向 Steven Bartlett 解释，这个命名具有极高的临床实用价值：现代门诊留给医患交流的时间极其严苛，如果一位女性在短短 15 分钟内向医生抛出六七种互不相干的痛苦症状，医生往往要在 600 多种鉴别诊断中疲于奔命；但如果患者能直接说明“我认为自己患有绝经期肌肉骨骼综合征，我的手臂抬不起来、关节疼痛”，临床医生就能瞬间抓住核心病因，省去漫长而低效的排查。 这篇论文的传播力堪称医学界罕见的现象级事件。在学术界，顶级医学期刊的最佳论文平均下载量通常在 10,000 次左右，而 Dr. Vonda Wright 关于绝经期肌肉骨骼综合征的论文下载量已逼近 300,000 次，Steven 惊呼这简直是学术界的《纽约时报》畅销书。Vonda 强调，这项研究之所以引发如此巨大的震动，并非仅仅因为论文本身写得扎实，更因为全球女性与临床医生对该领域知识的渴求极其迫切。为了消除知识获取的门槛，她特意将这篇论文设为开放获取（Open Access），任何人无需付费即可直接查阅与打印。她强烈呼吁大众去搜索并打印这篇文章带给自己的主治医生，让医生清楚认识到：患者的全身游走性剧痛源于系统性慢性炎症，肩关节动弹不得是绝经期冻结肩的炎症发作，膝盖酸痛则是绝经期骨关节炎的典型表现。 ```mermaid flowchart TD accTitle: 绝经期肌肉骨骼综合征的发生机制与干预路径 accDescr: 流程图展示了雌激素受体空置如何引发肌肉骨骼炎症及针对性的科学应对措施。 subgraph Causes["核心病理机制"] A["绝经期雌激素断崖式下跌"] --> B["肌肉骨骼组织α与β受体空置"] B --> C["系统性全身高炎症反应"] end subgraph Symptoms["临床综合征表现"] C --> D1["冻结肩与关节痛 (Arthralgia)"] C --> D2["骨质流失与骨质疏松"] C --> D3["肌肉萎缩与退行性关节炎"] end subgraph Solutions["基于科学的应对"] D1 & D2 & D3 --> E["正式命名与开放获取论文"] E --> F["医患高效沟通与精准诊断"] E --> G["激素替代疗法 (HRT) 激活受体"] end ``` ### [01:27:49](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5269s) 关节炎的双重面貌：类风湿与骨关节炎 当对话谈及关节酸痛时，Steven 敏锐地抓住了 Vonda 先前提到的大脚趾关节炎问题，并急切地询问关节炎的根本成因。Vonda 指出，公众常说的关节炎主要分为两大类：其一是自身免疫性疾病——类风湿性关节炎（Rheumatoid Arthritis），此时免疫系统发生紊乱，将自身组织误判为外来抗原并发起自我攻击；其二则是日常生活中最普遍的骨关节炎（Osteoarthritis），本质上是一种“磨损性关节炎”（wear and tear arthritis）。 骨关节炎的核心病理是骨骼末端起保护缓冲作用的软骨层逐渐退化磨损。这种磨损通常源自关节经历的数以万计的机械重复负荷（例如长跑每英里需迈出约 1,000 步的撞击），或是重大物理创伤所致。Vonda 分享了自己早年担任匹兹堡大学美式橄榄球队队医的经历：在球场上，防守锋线与进攻锋线的球员频繁发生极其剧烈的正面身体对撞，导致许多年仅 20 岁的小伙子就已经过早磨光了关节软骨，饱受膝关节骨关节炎的折磨。软骨层一旦剥蚀退化，便会引发骨骼受力异常，诱发持续的酸痛、关节肿胀与僵硬。在临床干预上，轻中度骨关节炎可通过保守手段积极管理，而当软骨完全损耗殆尽时，关节置换手术则是终末期的最终解决途径。 ### [01:29:09](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5349s) 激素替代疗法（HRT）与骨骼肌肉受体：基于科学而非恐惧的选择 针对绝经期伴随的骨关节炎和肌肉骨骼退化，Steven 提出了许多人心中的核心疑问：这是否意味着为了避免绝经期肌肉骨骼综合征，女性都应该接受激素替代疗法（HRT）？ Vonda 给出了斩钉截铁的生理学解释：人体的每一块肌肉、骨骼与关节软组织中，都密集分布着雌激素的 α 受体与 β 受体。科学研究已明确证实，当体内的雌激素水平归零、受体长期处于“空置”状态时，高达 80% 的女性都会不可避免地表现出绝经期肌肉骨骼综合征的各种症状。相反，如果通过外源性补充让雌激素重新充盈这些受体，就能够切实遏制骨量流失、防止骨骼肌萎缩，并显著降低由冻结肩与关节痛带来的炎症风暴。Vonda 强调，每个人都是具有独立思辨能力的行动主体（"People are thinking beings, they have agency"），她从不强制替患者做主，但坚决主张每一位女性都应该拥有知情权，摆脱陈旧观念与恐惧的束缚，依据扎实的生理学证据来决定是否通过 HRT 摆脱慢性疼痛、阻断机能退化。 ### [01:30:18](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5418s) 全球第一大致残原因：久坐生活方式与腰背痛的隐形危机 两人的讨论随后转向现代人极为普遍的下腰痛（Lower back pain）。Steven 引用世界卫生组织（WHO）2020 年的数据指出，全球有多达 6.19 亿人正承受腰背痛的困扰，它已成为全球致残的单一最大病因。更耐人寻味的是，这类疼痛似乎是西方现代文明的“特产”——曾有学者深入非洲哈扎（Hadza）原始部落进行田野调查，发现那里的人们终生完全没有下腰痛的困扰，原因在于他们日常习惯深蹲，生活中根本没有椅子这种人造结构。 Vonda 深入剖析了现代人腰痛呈地方性风土病式爆发的三大主因： 1. **久坐导致的肌肉完全失活**：现代人每天至少在椅子上坐 10 个小时，坐姿往往含胸驼背；在这一姿态下，腹部核心与下背部肌群处于完全松弛状态，没有任何维持力量的生理刺激。 2. **全民缺乏有效抗阻锻炼**：统计显示，70% 的现代人在全周任何时刻都几乎不进行任何有意义的运动，萎缩脆弱的肌肉再也无法为脊柱提供稳固支撑。 3. **骨骼退化与微骨折**：绝经后女性以及极高龄男性常因骨质疏松发生椎体压缩性骨折，这种隐性骨折初期往往单纯表现为严重的下背部剧痛。 在临床诊断上，Vonda 特别提醒大众区分两种截然不同的背痛： - **普通机械性下腰痛**：表现为腰部的酸痛与晨起僵硬感。这属于生活方式病，正规的医嘱应指导患者增强核心力量、接受物理治疗，并严格戒烟——因为吸烟会直接毒害骨细胞、加速脊柱退变。 - **神经受压（需要外科评估）**：疼痛从腰部起步，像触电或闪电般一路沿着大腿后侧向下放射（"literally think about how lightning would feel"）。这代表神经根自脊髓穿出处遭受了机械性压迫，必须立刻接受专科影像检查与医疗干预。 ### [01:32:55](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5575s) 动态工作与学习：站立办公桌、靠墙深蹲与动觉认知 鉴于西方人群中约 80% 的人一生中都会经历下腰痛，Steven 询问站立式办公桌与步行走步机是否是有效的日常解法。Vonda 给予了高度肯定，并建议重新审视工作时间的分配：在白天的日常工作中，诸如回复邮件、处理常规电话、事务性沟通等轻脑力劳动完全可以在站立或慢速走步机上完成。她甚至指导合作团队在开会时开展“靠墙深蹲会议”（Wall squat meetings）——放弃围坐在会议桌旁，全员靠墙半蹲开会，这种方式不仅能直接强化腿部与核心肌群，还能倒逼大家提升会议效率。Vonda 幽默地指出，人类真正需要坐下来的时刻，“只有在我们需要坐下来解决世界和平那种层级的大问题时”，其余大部分时间身体都完全适合保持直立与动态。 此外，运动对认知学习能力的提升已被大量神经科学研究所证实。动觉学习（Kinetic learning）产生的动能对大脑回路大有裨益。Vonda 分享了自己的时间管理技巧：在听 3 小时以上的长音频播客时，她根本无法在椅子上干坐几小时，但如果一边在走步机上散步一边收听，不仅毫无疲惫感，大脑对信息的记忆与留存率反而大幅跃升。 ### [01:34:21](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5661s) 老龄精英运动员研究：人类究竟在几岁才会真正衰退？ 谈及过往发表的研究，Steven 好奇地询问 Vonda 个人最引以为傲的科学发现是什么。Vonda 毫不犹豫地提到了她针对老龄精英运动员（Master's athletes）开展的开创性研究，旨在从科学角度回答一个核心命题：人类到底从几岁开始，体能才会真正不可逆转地断崖式下跌？ 在当今大众文化中，贺卡公司 Hallmark 的宣传或是步入 40、50 岁生日时常见的搞怪“安息吧”（Rest in Peace）黑色气球，无一不在灌输“人过中年便注定迅速衰老软弱”的消极暗示。然而，Vonda 调取并分析了全美田径赛场上从 100 米短跑至 10,000 米长跑所有项目的各个年龄组前八名成绩，得出了惊人的结论：**在跨过 70 岁门槛之前，人类在生理层面上根本不会出现显著的速度与耐力衰退**。 研究揭示了令人震撼的对比数据： - **50 至 70 岁组 1 英里（约 1,609 米）冠军成绩**：4 分 34 秒。 - **同年度全美高中生 1 英里顶尖冠军成绩**：4 分 17 秒（年过半百的老者仅比处在体能巅峰的高中精英慢了十几秒）。 - **70 岁组 1 英里冠军成绩**：跑进 7 分钟以内。 这组严谨的赛道数据表明，如果一个人在 70 岁之前体能急剧下滑，这绝非单纯的生物学衰老造成的，而是心理学层面的自我设限与放弃——人们因为偶发的关节酸痛便误以为自己“已经老了”，从而主动降低训练强度甚至彻底瘫坐不动，最终任由肌肉萎缩吞噬健康。正如 Vonda 所言，人类体能的滑坡“不是因为生理衰竭，而是源于心理放弃”（"it's not because of biology, because of psychology"）。 ### [01:35:56](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5756s) 衰老心态与新书《Unbreakable》 许多人误以为年老后的体能下滑是必然规律，因而轻易向衰老屈服。这种心理预期催生了自证预言式的恶性循环：人们因为认定衰老不可避免而停止付出努力与玩耍，最终身体真的陷入了衰退。然而，衰老本身是自然法则，但“如何衰老”却完全取决于个人。Vonda Wright 医生刚刚交稿了她的全新著作《Unbreakable: Strong Bones, Muscle, and Mind to Age with Power》。该书将她长年倡导的健康长寿理念深化拓展，重点聚焦于女性的衰老与长寿问题。 ```mermaid flowchart TD accTitle: 《Unbreakable》书籍结构与核心框架 accDescr: 图表展示了Vonda Wright新书的三大板块：打破衰老定时炸弹、践行不可阻挡生活方式、追求巅峰表现与前沿科技。 subgraph Part1["第一部分：拆解衰老支柱（定时炸弹）"] A["代谢失调定时炸弹"] B["基因宿命论误区<br/>（DNA非最终宿命）"] C["明确科学机制：衰老绝非必然虚弱"] end subgraph Part2["第二部分：坚不可摧的生活方式"] D["骨骼、肌肉与营养管理"] E["价值观导向的目标设立"] F["构筑大脑与骨骼双重韧性"] end subgraph Part3["第三部分：迈向下一阶段"] G["拒绝做时间的受害者"] H["极限发挥巅峰表现"] I["借助前沿健康科技赋能"] end Part1 --> Part2 --> Part3 ``` 书中将传统的衰老支柱形容为体内的“定时炸弹”，其中包括严重的代谢机能障碍，以及误以为“DNA 决定命运”的消极认知。Wright 医生强调，基因并非不可更改的宿命，人体可以通过后天行为进行表观遗传修饰。全书进一步提出了一套名为“坚不可摧（Unbreakable）”的生活方式体系： - 身体层面不仅涵盖骨骼密度、肌肉储备与精准营养，更把心态与认知置于核心位置。 - 目标的设定必须与深层价值观绑定；单纯空喊“80岁跑马拉松”毫无意义，唯有将其与对晚年独立自主、保留清醒大脑等价值观紧密相连，才能转化为持续的行动力。 - 大脑韧性（Brain resilience）与骨骼韧性（Skeletal resilience）同样需要长期抗阻与训练，二者相辅相成，才能实现“充满力量地老去”。 - 书籍最终篇章探讨如何优化身体机能、榨取巅峰表现，并引入尖端科技来主导未来，拒绝沦为时间的受害者。目前该书已在 Wright 医生的官方网站开启预订候补名单。 --- ### [01:38:42](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5922s) 围绝经期、糖尿病与阿尔茨海默病的致命重叠 Wright 医生分享了她前一周在“美国糖尿病协会”（American Diabetes Association）发表演讲的核心洞察。她指出了中年期、绝经期与代谢疾病之间令人震惊的交集：当雌激素骤降离场时，身体经历的代谢重塑、血脂异常、内脏脂肪重新分布以及胰岛素敏感性丧失，其病理机制与糖尿病前期（Prediabetes）几乎如出一辙。 如果个体在关键的 35 至 45 岁这十年间忽视了代谢健康，带着胰岛素抵抗的病理状态步入围绝经期，缺乏雌激素保护后，这两股破坏力会产生灾难性的复合效应。这直接导致绝经后女性的糖尿病发病率激增，进而呈几何倍数拉高患阿尔茨海默病的风险。Wright 医生强烈呼吁，健康预防的警钟必须前移至 35 岁，及早干预代谢健康是拯救女性大脑与生命的关键举措。 --- ### [01:39:50](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5990s) 男性参与围绝经期认知的意义与伴侣共情 Steven 坦言，自己深入探讨绝经期话题的一个重要原因，是为了身边的女性以及年仅 32 岁的伴侣做好知识储备，以便在她们进入人生关键十年时充当坚实的支持力量。Wright 医生对此给予高度评价，并指出若有更多男性主动展现出这种求知欲，理解中年女性在生理、心理、情绪以及性生活层面的巨变，社会上许多走向破裂的婚姻其实完全可以被挽救。 现实中，绝大多数男性对女性激素变化的认知极度匮乏，甚至许多女性自身也缺乏相应常识。伴侣之间若能打破信息壁垒，建立起深厚共情： - 面对女性情绪波动、疲惫或身体不适时，男性不会盲目指责，也不会像某些缺乏经验的医生那样武断地归咎于“心理失常”或“性格突变”。 - 认知转化为同理心后，双方能够以科学的视角共同应对身体机能重塑，共同寻找医疗、营养和运动上的支持方案。 --- ### [01:41:36](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=6096s) 终极之问与节目结语 按照《CEO日记》（The Diary Of A CEO）的传统，前一位神秘嘉宾留下了一个未知受众的问题：“你如何知道何时该适可而止（How do you know when is enough）？” Wright 医生沉思后作答：在工作或追逐事业目标的道路上，当一份事业变成纯粹的机械折磨（grind）、当你不再对它保有热爱、它不再能够滋养你的灵魂时，那就是该停下并放手的时候了。 对谈尾声，Steven 对 Wright 医生的卓越贡献表达了诚挚感谢。他特别提及 Wright 医生在 Instagram 上打造的高互动性科普社群，赞扬她无偿公开大量宝贵临床知识，并分享了大量读者与患者家属因她的内容而彻底改变生活的反馈。Steven 随后向观众发起订阅倡议，透露频道仍有约 53% 的常客尚未订阅，承诺将根据观众反馈持续带来顶尖嘉宾；最后，他介绍了基于往期嘉宾深度问题制作的“对话卡牌”（Conversation Cards），该产品旨在把直击灵魂的高质量交流从演播室带入大众的日常生活。 ## Notable quotes > [00:00](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=0s) make bones sexy again — Dr. Vonda Wright > [07:14](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=434s) one size fits nobody — Dr. Vonda Wright > [12:08](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=728s) 雌激素的流失是不可避免的，但骨密度的流失绝不必然走向骨质疏松、骨折与衰弱。 — Dr. Vonda Wright > [16:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1008s) 骨骼构架看似是它的第一功能，但实际上支撑结构可能只是它的副业，骨骼本质上是一个掌控全身的超级信息调度中心。 — Dr. Vonda Wright > [29:20](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=1760s) Had I known then what I know now... — Dr. Vonda Wright > [36:48](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2208s) a poison to bone healing — Dr. Vonda Wright > [40:57](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2457s) running and screaming to get healthy — Dr. Vonda Wright > [48:11](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=2891s) 水果其实是自然界的甜品，如果真要吃，就把它当成甜点对待 — Dr. Vonda Wright > [50:28](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3028s) It is never too late — Dr. Vonda Wright > [55:06](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3306s) 我现在已经不像年轻时那样在乎肌肉块头有多大了，我在乎的是它能否在漫长时间里强劲有力地运动——我能不能轻松从地板上站起来？能不能把笨重的行李箱一把举过头顶放进行李架？ — Dr. Vonda Wright > [01:02:24](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3744s) 我面对患者的方式是：我能不能让你明天就感觉好起来？我能不能让你因为今天举起了沉重的铁块，走出健身房时就觉得自己像个了不起的硬汉？ — Dr. Vonda Wright > [01:05:25](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=3925s) 只跑步而不做力量训练的跑者，受伤频率极高。 — Dr. Vonda Wright > [01:29:09](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5349s) People are thinking beings, they have agency — Dr. Vonda Wright > [01:34:21](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5661s) 在跨过 70 岁门槛之前，人类在生理层面上根本不会出现显著的速度与耐力衰退 — Dr. Vonda Wright > [01:34:21](https://www.youtube.com/watch?v=ffgpqk5hZBE&t=5661s) it's not because of biology, because of psychology — Dr. Vonda Wright ## Mentioned Dr. Vonda Wright, Steven Bartlett, Dara Torres, 匹兹堡企鹅队 (Pittsburgh Penguins), 匹兹堡大学 (University of Pittsburgh), UPMC Lemieux 体育运动中心, Nestree, 全美常青运动会 (National Senior Games), 威斯康星大学 (University of Wisconsin), Vanta, ZOE, Perfect Ted, 世界卫生组织 (WHO), 美国糖尿病协会 (American Diabetes Association), Unbreakable: Strong Bones, Muscle, and Mind to Age with Power, Fitness After 40: Your Strong Body at 40, 50, 60, and Beyond, The Diary Of A CEO, The 33 Laws Of Business & Life, DEXA 扫描, Klotho 蛋白, 骨钙素 (Osteocalcin), 鸢尾素 (Irisin), 甘丙肽 (Galanin), 肌酸 (Creatine), 激素替代疗法 (HRT) ## Video description Could you be losing bone strength without realising it? Dr Vonda Wright breaks down the importance of bone health and its impact on osteoporosis, Alzheimer’s, and longevity Dr Vonda Wright is an orthopaedic sports medicine surgeon and expert on active aging and mobility. She is the author of 44 research publications and of books such as, ‘Fitness After 40: Your Strong Body at 40, 50, 60, and Beyond’. In this conversation, Dr Vonda and Steven discuss topics such as, the truth about creatine for women, the early signs of arthritis, how running doesn’t build muscle, and the secret cause of Alzheimer's. 00:00 Intro 02:03 Vonda's Mission to Help People Live a Longer, Stronger Life 03:59 How Much of Vonda's Work Crosses Into the Cognitive Realm? 06:03 Training the Brain Like a Muscle 07:14 What Is Precision Longevity? 09:24 How Does the Body Change in Different Seasons of Life? 11:17 Why Do Men's Bones Maintain Their Density Longer Than Women's? 12:08 Is Loss of Bone Density Inevitable for Women? 13:51 Why Bone Health Is Crucial for Overall Health 19:47 How Do Bones Release Substances Into the Body? 21:52 What's Making Your Bones Fragile? 25:39 Importance of Impact Sports for Bone Health 26:42 How to Care for Bone Health During Pregnancy and Breastfeeding 27:47 What Is the Bone-Brain Axis? 29:20 What Is the Critical Decade for Bone Health? 34:04 What Is Osteoporosis? 35:31 How Many Americans Over 50 Have Osteopenia? 36:48 Early Warning Signs of Osteoporosis 37:44 Smoking vs. Bone Health 38:28 Is There a Link Between Alzheimer's and Bone Health? 39:09 Alzheimer's Disease in Vonda's Family 40:57 Would Vonda Choose an Able Body or an Able Brain? 41:52 Prediabetes 46:12 Diet for Good Cognitive Performance 48:11 The Perfect Diet for Vonda 49:22 Ads 50:28 Strong Muscles and Bones as Keys to Longevity 50:48 You're Never Too Old to Build Strength 53:28 Workout Strategies for Building Muscle 55:26 Higher or Lower Weights: What's Best for Building Muscle? 56:46 Why Is Muscle Critical for Longevity? 59:50 Nutrients for Muscle Preservation 01:03:06 How to Find Motivation to Take Responsibility for Your Health 01:03:57 Vitamin D: Crucial for Bone Health 01:04:28 How to Prevent Injury While Running 01:11:45 Ads 01:13:52 Why Should People Avoid Obesity as They Age? 01:15:44 Strategies to Promote Motivation 01:18:32 Myths About Menopause 01:21:22 Link Between Menopause and Bone Density 01:22:40 The Musculoskeletal Syndrome of Menopause 01:27:49 What Causes Arthritis? 01:29:09 Is HRT a Remedy for Musculoskeletal Symptoms of Menopause? 01:30:18 Why Is Back Pain on the Rise? 01:32:55 Back Pain Prevention 01:34:21 Study: Age-Related Decline in Performance Among Elite Senior Athletes 01:36:16 New Book: *Unbreakable* 01:38:42 Link Between Menopause, Diabetes, and Alzheimer's 01:39:50 The Importance of Men Knowing About Menopause 01:41:36 How Do You Know When To Stop? Follow Dr Vonda: Instagram - https://g2ul0.app.link/PgWdlIghuRb Website - https://g2ul0.app.link/fUepAxlhuRb Podcast - https://g2ul0.app.link/0MRGecrhuRb You can purchase Dr Vonda’s book, ‘Fitness After 40: Your Strong Body at 40, 50, 60, and Beyond’, here: https://g2ul0.app.link/pldFkf4guRb Research Document: https://stevenbartlett.com/wp-content/uploads/2025/03/DOAC-Vonda-Wright-Independent-research-further-reading.pdf My new book! 'The 33 Laws Of Business & Life' is out now - https://g2ul0.app.link/DOACBook You can purchase the The Diary Of A CEO Conversation Cards: Second Edition, here: https://g2ul0.app.link/f31dsUttKKb Get your hands on the Diary Of A CEO Conversation Cards here: https://bit.ly/conversationcards-youtube Follow me: https://g2ul0.app.link/gnGqL4IsKKb Sponsors: Vanta - https://vanta.com/steven ZOE - https://zoe.com PerfectTed - https://www.perfectted.com with code STEVEN40 for 40% off" [Source](https://www.youtube.com/watch?v=ffgpqk5hZBE)

[0:00] Dr. Vonda Wright: make bones sexy again [7:14] Dr. Vonda Wright: one size fits nobody [12:08] Dr. Vonda Wright: 雌激素的流失是不可避免的，但骨密度的流失绝不必然走向骨质疏松、骨折与衰弱。 [16:48] Dr. Vonda Wright: 骨骼构架看似是它的第一功能，但实际上支撑结构可能只是它的副业，骨骼本质上是一个掌控全身的超级信息调度中心。 [29:20] Dr. Vonda Wright: Had I known then what I know now... [36:48] Dr. Vonda Wright: a poison to bone healing [40:57] Dr. Vonda Wright: running and screaming to get healthy [48:11] Dr. Vonda Wright: 水果其实是自然界的甜品，如果真要吃，就把它当成甜点对待 [50:28] Dr. Vonda Wright: It is never too late [55:06] Dr. Vonda Wright: 我现在已经不像年轻时那样在乎肌肉块头有多大了，我在乎的是它能否在漫长时间里强劲有力地运动——我能不能轻松从地板上站起来？能不能把笨重的行李箱一把举过头顶放进行李架？ [62:24] Dr. Vonda Wright: 我面对患者的方式是：我能不能让你明天就感觉好起来？我能不能让你因为今天举起了沉重的铁块，走出健身房时就觉得自己像个了不起的硬汉？ [65:25] Dr. Vonda Wright: 只跑步而不做力量训练的跑者，受伤频率极高。 [89:09] Dr. Vonda Wright: People are thinking beings, they have agency [94:21] Dr. Vonda Wright: 在跨过 70 岁门槛之前，人类在生理层面上根本不会出现显著的速度与耐力衰退 [94:21] Dr. Vonda Wright: it's not because of biology, because of psychology

[13:51] Dr. Vonda Wright: Bones are master communicators... Muscle and bone are not separate; they are one ecosystem. [38:28] Dr. Vonda Wright: My choice was super clear for me. I'd rather have the able brain. [38:28] Steven Bartlett: Me too. Me too... human relationships, that is the fullness of life. [50:28] Dr. Vonda Wright: It is never too late. Your body will always rise to the strategic stress you place on it. [63:06] Dr. Vonda Wright: I think we have to make you feel good every single day... Can I make you feel better tomorrow? Can I make you feel like a badass because you lifted heavy weights today? [73:52] Dr. Vonda Wright: Cartilage has a in physics a coefficient of friction that is less than ice... in our laboratories when we were doing cartilage research and wanted to damage cartilage, all we had to do is drop a marble on it. [78:32] Dr. Vonda Wright: I always encourage women to make their hormone replacement decision based on science and not fear and to make it early... birth control is 10 times the dose of hormone replacement therapy. [82:40] Dr. Vonda Wright: Every musculoskeletal tissue is derived out of the same type of stem cell, the mesenchymal stem cell... all of those tissues—muscle, bone, tendon, ligament, fat—are sensitive to estrogen, and without it, several things happen. [99:50] Dr. Vonda Wright: If I could get more men to take the attitude that you've just expressed... to learn about the changes in midlife women... I think we could save a lot of marriages.

[0:00] Runners who only run are hurt a lot and [0:02] it's usually due to emotion imbalance so [0:05] I always do this test to show them [0:06] whether your butt muscles are strong [0:08] enough to keep your pelvis straight and [0:10] whether you're strong enough to keep [0:11] your knee from falling into this [0:13] position I look like I'm drunk or [0:14] something how are you doing this with [0:16] your heels on Dr vond Wright is a [0:18] leading orthopedic surgeon and Longevity [0:20] expert leveraging her expertise with [0:22] Elite athletes to revolutionize the way [0:23] we move eat and train to live longer [0:26] stronger and better I'm on a rampage to [0:28] make bones sexy again because in the [0:31] United States at least 50% of women will [0:34] get osteoporosis along with 2 million [0:35] men now osteoporosis is low bone density [0:38] and studies show that people with low [0:40] bone density have higher cognitive [0:42] decline it increases your risk of [0:44] fracture if you break your hip 50% of [0:46] the time whether you're a man or a woman [0:48] you will not return to preall function [0:50] and 30% of the time you will die and [0:52] there's a lot that causes bone fragility [0:54] such as aging not building enough bone [0:56] in our youth it's our sedentary [0:57] Lifestyles the myth that women have to [0:59] be teeny tiny and it's even things like [1:01] a woman breastfeeding will lose 20% of [1:03] her bone density in the first 6 months [1:05] but it's not inevitable and I will lay [1:06] out a lifestyle that I call unbreakable [1:08] it's about muscle bone nutrition but the [1:10] most important part is mindset I'm very [1:13] very excited uh just to pause that is [1:16] there a link between menopause and brain [1:18] density yes and it's because of the [1:20] plummeting of estrogen which is critical [1:22] for muscle bone tendon ligament fat and [1:25] without it it can have dire effects so [1:27] you need to know the following [1:32] this has always blown my mind a little [1:33] bit 53% of you that listen to the show [1:36] regularly haven't yet subscribed to the [1:38] show so could I ask you for a favor [1:40] before we start if you like the show and [1:41] you like what we do here and you want to [1:42] support us the free simple way that you [1:44] can do just that is by hitting the [1:45] Subscribe button and my commitment to [1:47] you is if you do that then I'll do [1:49] everything in my power me and my team to [1:51] make sure that this show is better for [1:52] you every single week we'll listen to [1:54] your feedback we'll find the guest that [1:56] you want me to speak to and we'll [1:58] continue to do what we do thank you so [1:59] much [2:00] [Music] [2:03] Dr vonder Wright yes for anyone that's [2:08] unaware of what you do and who you do it [2:10] for what do you do and who do you do it [2:12] for so you know in as a sports doctor [2:15] over the years we've learned how to take [2:17] really high- performing athletes you [2:19] know those are who are winning all the [2:22] time who need to continually get better [2:24] and better and better at their craft and [2:26] over the 30 years of my career we've [2:29] gone from really focusing on how they [2:32] train the periodization of their [2:34] training to the last time I uh was at [2:39] the University of Pittsburgh I was the [2:40] medical director of the UPMC Lemieux [2:43] sports complex which is where the [2:45] Pittsburgh Penguins are housed and it [2:47] had gotten so uh scientific they had a [2:50] full-time Chef every meal from breakfast [2:53] lunch dinner every meal on the planes [2:55] were prepared because when it comes down [2:58] to split-second agility [3:00] top of brain thinking every little bit [3:03] counts and so in the 30 years of my of [3:06] my medical career it's gone from just [3:08] learning more about performance science [3:10] of how to train to how to feed people to [3:15] how to recover people so instead of [3:18] doing for instance I think Dara Torres [3:21] was talking about her uh Olympic runs in [3:24] her 40s right she trained much [3:25] differently when she was 24 and in her [3:28] 40s after she had had a child it was [3:31] much more about recovery not as much [3:32] hours in a pool so I take all those [3:36] things that we've learned over this [3:37] course of my career and now apply them [3:40] not only to athletes but to people like [3:42] you and me who were in high performance [3:44] jobs I need to be tip toop in every [3:46] sphere of my life as you do and how do [3:49] we eat better recover better take the [3:51] principles of performance that we've [3:53] learned from athletes into high [3:56] performers and even mere mortal athletes [3:58] like me I love of my work involves like [4:00] cognitive performance making sure my [4:02] brain is sharp when it needs to be yes [4:04] how much of your work crosses over into [4:06] the cognitive realm you know I am not a [4:09] brain scientist myself but I am [4:11] fortunate to be surrounded by people who [4:14] are expert in that so from my own [4:17] perspective I've come to appreciate at a [4:20] much deeper level personally um as well [4:23] as professionally the role of sleep in [4:26] fact we've talked about my previous [4:28] books from the early 2000s before and [4:31] when I wrote those books Mobility was [4:33] King I wrote only about mobility and [4:36] then as I progressed in my career I got [4:38] deeper deeper deeper into nutrition and [4:41] then I would say okay nutrition is [4:42] number one and Mobility is second but at [4:44] this phase of evolution of sleep science [4:48] and knowing how restoring the brain and [4:50] providing adequate time and nutrients I [4:54] put sleep first sleep and Recovery first [4:56] because you can't do any of these other [4:58] things without a r well recovered brain [5:01] in fact somebody asked me the other day [5:04] about timing of working out and is it [5:06] always necessary to do it in the morning [5:08] like that's the Mantra get up go do your [5:10] workout and my answer to that was you [5:14] have to know how your brain works for [5:16] instance my brain is best between 5:00 [5:19] a.m. and 2: p.m. that is when I'm going [5:21] to get all my deep work done I'm going [5:23] to be creative I'm going to think after [5:26] 2 p.m. I could build you a house I can [5:28] continue operating but if I'm going to [5:30] write a book it's going to be early so I [5:33] do not work out in the morning because [5:35] I'm not going to waste that brain [5:37] energy on physical activity when I need [5:41] it for this deep work so that's the way [5:44] I apply brain science but I I'm so lucky [5:47] to be surrounded in in the place I am [5:49] now with people who put eegs on your [5:52] head and map your brain and tell you [5:54] which brain Pathways you're too [5:56] stressful on and and which brain [5:58] Pathways we can train and you can train [6:00] the physical brain like a muscle you can [6:03] train the physical brain like a muscle [6:05] yeah so there's this company called [6:07] nestry that I just happen to have access [6:09] to and they put EEG helmets on my [6:12] Precision longevity clients and we map [6:15] their brains and look at for instance [6:18] here's an example things that are [6:20] habitual take very little brain injury [6:23] uh energy even if we need a lot of brain [6:25] energy they become so habitual our brain [6:28] turns away uh energy from them versus [6:31] things we're learning or things we're [6:33] stressed about we devote so much energy [6:35] to that so once they this company Maps [6:39] our brains then they have this training [6:43] program where it's almost like getting [6:46] your your cognitive brain out of the way [6:49] and let your subconscious brain reapply [6:52] energy to the pathways that you actually [6:54] need that you you've begun to to ignore [6:57] and it makes you more efficient and I'm [6:59] being an adequate in explaining it but [7:02] brain scientists believe that you can [7:04] retrain the brain like a muscle and [7:06] devote energy to neurop Pathways so I [7:10] know we do this to athletes to try to [7:12] squeeze performance out of them when you [7:14] use that term Precision longevity what [7:17] does that mean so you know after the [7:20] understanding of human DNA knowing what [7:23] we're truly made [7:25] of it pushed us out of a time in [7:28] medicine [7:30] where we've been for the last 150 years [7:33] which is [7:34] Observe and one size fits nobody now [7:39] that we've sequenced the human genome we [7:41] can develop Health Plans your health [7:45] plan my health plan it's not generic [7:48] here's an example when I have people who [7:51] want to talk to me about living [7:53] healthier longer and we and we draw a [7:56] set of biomarkers it's not 6,000 [7:58] biomarkers it's just a set of about 23 [8:00] that are Beyond regular labs and I see [8:03] that for instance maybe stevenh you have [8:05] a high load of senescent cells well I'm [8:08] going to specifically design your Gap [8:10] nutrition according to what you need you [8:12] might not need anything for inflammation [8:15] because maybe your inflammation labs are [8:17] good but historically what we would have [8:19] done is say okay let's just give [8:21] everybody the same formula but now we [8:23] are able to devise what your body needs [8:26] at your time I do the same thing with [8:27] exercise I never say let's have you do [8:30] 150 minutes of moderate exercise because [8:34] I have access to lactate threshold [8:37] testing where you're walking on a [8:39] treadmill running on a treadmill or on a [8:41] bike every four minutes we're pricking [8:43] your finger and I can tell exactly what [8:46] when your mitochondria the little energy [8:49] storehouses in your cells go from [8:51] burning fat to burning Caro [8:54] carbohydrates and that place is called [8:57] the fat Max and that is when your [8:59] mitochondria your energy organel are [9:03] most efficient and that's where we want [9:05] to work out 80% of the time so that's [9:09] just an example of how I'm going to tell [9:12] you what heart rate you need to work out [9:14] in I'm going to tell you how to get fill [9:16] the gaps in your nutrition instead of [9:18] just doing broad guidelines because [9:21] that's the state-of-the-art right [9:23] now when you think about personalization [9:26] I was thinking also not just about the [9:28] individual but different phases of life [9:30] and how maybe in my my 20s there's a [9:33] certain set of things I need to be [9:34] thinking about more so than in my 30s my [9:36] 40s and my 50s and my 60s is that a [9:38] useful way to think about it are there [9:40] different things we need to be thinking [9:41] about in different seasons of our life [9:43] or is it the same things in every [9:46] season well I love that question and the [9:50] one one word answer is yes every season [9:54] of our life is different let's take [9:56] bones for [9:57] instance we build build build build [10:00] bones yeah until in women we're about 28 [10:03] and uh men 30 we reach Peak bone mass we [10:08] then reach a plateau where we keep our [10:09] bone density and then in women it begins [10:12] to plummet due to hormonal influences [10:15] for men men usually maintain their bone [10:19] density until their 70s when they [10:21] plummet unless they have a metabolic [10:23] problem an autoimmune disease or having [10:26] had the need to take a lot of steroids [10:27] and then you see a big difference at 50 [10:30] so in Bones that's a good example how [10:33] every few decades our bones are reacting [10:36] differently muscle is the same way we [10:39] know that we can gain muscle at any time [10:42] in our lives but we do it most easily [10:46] until we're about 30 [10:48] right we also know of uh changes in the [10:53] way our gut functions as we age having [10:56] to do with absorption and the uh the [10:58] ability of the microvilli in our gut to [11:01] absorb nutrients and different kinds of [11:03] nutrients women in midlife for instance [11:06] need vitamins that are something called [11:08] methylated which means broken down a [11:09] little more because our gut function is [11:12] less efficient so every phase of our [11:14] aging were different well on that point [11:17] of bones that that sounded like you were [11:19] saying men's bones maintain their [11:21] density longer and women don't why why [11:24] is that and is that linked to menopause [11:26] well men uh because of the influence of [11:29] testosterone and the genetics of having [11:32] um XY chromosomes build more bone [11:35] initially thicker cortices more more [11:38] absolute poundage of Bones and so um and [11:41] then because of the plummeting of [11:43] estrogen which is critical for bone [11:45] health women lose bone faster than men [11:48] such that after about age of 40 when we [11:51] get to that Plateau women start to lose [11:54] bone density about 20% by the time they [11:58] get to their menop pause and um that can [12:01] have dire effects for women but that is [12:03] all due to the role of estrogen on [12:06] controlling bone density so is this [12:09] inevitable is the loss of bone density [12:11] inevitable for women it is not in um in [12:15] 2004 we studied a very large group of [12:18] Masters athletes meaning athletes uh 40 [12:21] and older in the National senior games [12:24] which is Olympics for uh people of that [12:27] age demographic and the National games [12:30] you have to have won your State Games to [12:32] qualify so these were pretty highlevel [12:34] recreational athletes so we did a study [12:37] looking at their bone density across [12:39] time and the first thing the first study [12:41] we found was that with chronic exercise [12:45] such as these people did you can [12:47] maintain your bone density at a very [12:49] high proportion into your 80s the second [12:51] question we asked was okay if we know we [12:55] can do that what exercise is really [12:57] important for that and so we divided [12:59] Sports up into uh bounding Sports where [13:02] the bones were being impacted like like [13:05] basketball running um volleyball [13:08] anything when you come down hard on your [13:10] bones versus swimming bowling the less [13:13] biking and we found that bashing your [13:17] bones impact was as important in [13:20] maintaining bone density as things you [13:22] can't control like your age whether [13:25] you're born with XX chromosomes or XY [13:28] chromosomes family history so impacting [13:32] bones causing them to build up over time [13:35] is critically important for maintaining [13:37] bone density so to answer your question [13:40] is loss of bone density inevitable loss [13:42] of estrogen is inevitable loss of bone [13:45] density doesn't have to result in [13:48] osteoporosis fracture and [13:50] Frailty so I want to get into why that's [13:52] happening but just to pause there [13:54] because a lot of people don't think [13:55] bones are that important oh like I think [13:57] a lot of people see our bones as just [13:58] some thing that yeah we can't influence [14:01] you don't think of them like muscles [14:02] muscles I go to the gym I can expand my [14:03] muscles I can get strong but with bones [14:06] it feels like they're static you know so [14:09] how how would you refute that so that I [14:12] start caring about my bones and what is [14:14] the cost if I don't care about my bones [14:17] well you know what I'm on a rampage for [14:19] this year that to bring to make bones [14:22] sexy again CU here from a very [14:24] superficial level is why we should care [14:26] and then I'll tell you from a more [14:27] scientific level [14:29] you know we only think of our bones [14:31] usually in a couple times like you look [14:34] in the mirror and somebody tells you oh [14:36] your bone structure is magnificent look [14:38] at this model's bones and or uh and [14:41] we're all touching our cheekbones or we [14:43] think about them when we hear about a [14:45] great archaeologist who's just [14:48] discovered a new people group and we can [14:50] tell from our bones how they lived how [14:53] they died how healthy they were in fact [14:56] in that setting bone is the last remnant [14:59] of your whole life it endures the [15:01] longest I mean the hisory the history [15:04] you talk about in your bones outlives [15:07] anything muscle goes away skin goes away [15:10] everything except your bones which [15:12] remain that's fascinating right [15:17] but the other reason we even think about [15:19] our bones is when they break right when [15:22] they bones people think bones are silent [15:25] like a strong silent type just hanging [15:27] back [15:29] until they break and then they're [15:31] screaming at you right and and causing [15:34] Frailty and here's some bone stats [15:36] because the real answer to the question [15:38] is coming one in two women will have an [15:41] osteoporotic fracture in her lifetime so [15:43] it's either me or your partner or me or [15:46] your assistant right one in two will [15:49] have an osteoporotic fracture women have [15:52] 70% of all hip fractures hip fractures [15:55] are one of the main contributors to [15:57] ending up in a nursing home because you [15:59] can no long walk and take care of [16:00] yourself right 70% are women if you [16:04] break your hip 50% of the time whether [16:07] you're a man or a woman you will not [16:09] return to preall function you cannot go [16:11] live in that house where you raised your [16:13] children you may not be able to drive [16:16] and go be totally independent right and [16:17] 30% of the time it's a huge number 30% [16:21] of the time you will die either from the [16:25] complications of the fracture from the [16:27] bed rest from the in infections you get [16:29] the bladder infections just the sequele [16:32] of being that sedentary so those are [16:36] those are not meant to scare people that [16:38] is the reality that I see every day as [16:40] an orthopedic surgeon on [16:42] call but there are other reasons to [16:44] carry about the bones because fracture [16:46] is a big one [16:48] bones and it makes sense nature is so [16:50] conservative bones are in our body from [16:54] the top of our head to our pinky toe [16:56] right bones are master [16:59] communicators we think of muscle which [17:02] we're all talking about now and Bone and [17:06] adapost and everything as as siloed [17:10] organs that don't have much to do with [17:12] each other except they live next to each [17:14] other the fact of the matter is for [17:17] instance when we're talking about the [17:19] musculoskeletal system bone tendon [17:23] ligament muscle fat cartilage muscle [17:26] stem cells there are all all derived [17:29] from the same stem cell the mesenchimal [17:31] stem cell so they're not distant [17:35] neighbors they're [17:37] cousins and they all speak in the same [17:39] language they may have different [17:41] dialects I was thinking about an example [17:43] of of this you know how in the UK [17:46] English is the language but depending on [17:48] what parish you live in or which country [17:50] within the UK English sounds very [17:53] different but it's the same language So [17:56] within musculoskeletal tissue isue [17:59] muscle and bone are not separate they [18:02] are one ecosystem such [18:05] that when muscle releases a protein [18:10] called irisin it talks to the Bone when [18:13] bone releases a protein called [18:15] osteocalcin it talks to the muscle but [18:18] in the case of [18:19] bone osteocal if we just stick with that [18:23] protein it talks to the whole body when [18:27] your osteoblast s the bone building [18:30] cells in your bones released osteocalcin [18:33] it goes to your brain and has a [18:35] neuroprotective effect by decreasing [18:37] inflammation it goes to your brain and [18:40] causes the synthesis of neurons in the [18:44] hippocampus it goes to the pancreas and [18:47] helps with insulin insensitivity it goes [18:50] to the muscle and helps the muscles [18:53] scoop up glucose out of the blood right [18:56] if you're a man osteocal can travel to [18:59] the testes and that organ the litig [19:02] cells under stimulation of osteocalcin [19:05] will produce testosterone so it's like a [19:08] miracle and a wonder that we just think [19:11] of Bones as the strong silent type that [19:14] hold up our [19:16] muscle because actually bone and and the [19:19] proteins that it produces are Master [19:22] communicators and it makes so much sense [19:25] because we have bone everywhere in our [19:27] bodies why wouldn't our body bodies use [19:29] it like that I thought it was just a [19:30] frame well and it is a frame right [19:33] what's Muscle without bone just a heap a [19:35] metabolic tissue right it makes us gives [19:38] us our statue but it's a master [19:41] Communicator the framework is almost a [19:44] secondary job in my opinion the bone is [19:47] releasing stuff I got this [19:50] um [19:52] this little analogy I'm going to put on [19:54] the table in one of the one of the tubs [19:57] I've got some mineral some and then this [20:00] is the body yeah so could you explain to [20:02] me how the the bone is releasing [20:06] something into the body so we've talked [20:08] about the bone being structural right it [20:10] holds you up it gives you your stature [20:13] we've talked about bone being a master [20:15] Communicator another job of the bone is [20:19] as your body's [20:20] Storehouse to really really important [20:23] maybe if we just talk about one of them [20:25] calcium calcium is is a critical mineral [20:28] in our body we need it for muscle [20:31] contraction for pushing um molecules [20:34] across cell [20:35] membranes but we've got to store it [20:37] somewhere so when we eat food our body [20:41] pull our intestines pull it out of the [20:43] food we eat and stores it in our bones [20:48] and so our body is always sensing how [20:50] much calcium how much phosphorus do we [20:52] have what do we need when our body [20:53] senses that we need more it goes to the [20:56] Bone it tickles the osteoclastic and say [20:59] osteoclast we need some more calcium the [21:02] osteoclast breaks down some bone [21:04] releases calcium and it goes into the [21:07] body for [21:09] use and then the body has enough to use [21:12] the body does not just keep piling it in [21:14] because [21:15] hypercalcemia causes heart arhythmia [21:17] it's bad right the body is perfectly in [21:20] homeostasis in Balance so when the bone [21:23] has released enough it sits back and [21:26] keeps storing it right [21:29] the calcium your body doesn't need if [21:31] the bone is [21:33] full it's excreted through the kidneys [21:36] and this is a really fine balance [21:38] between building bone releasing the [21:41] storehouse of minerals into the [21:44] bloodstream or saying oh we've got [21:46] enough let's send it out in our urine [21:49] the body is such a miracle like that so [21:52] if I don't have enough calcium or some [21:54] of these other minerals does that mean [21:56] that my bones are going to become [21:58] fragile [21:59] so you know there are lots of things [22:01] that go into bone fragility or [22:03] osteopenia and one of them is not laying [22:07] down enough bone in our youth if we T [22:09] you asked me earlier about changes [22:11] across a lifespan when it comes to Bone [22:15] what's interesting is that I get very [22:17] very young women in my clinic for 25 28 [22:22] whom for various reasons I do a bone [22:24] density test on and they are already [22:27] have brittle bone [22:29] I know it's it's it's shocking well I [22:32] think that happens for a number of [22:33] reasons number one we didn't build [22:35] enough bone there is still a myth in [22:37] this country that women have to be teeny [22:39] tiny that we have to starve ourselves [22:41] and when that happens many women do not [22:43] have consistent menstrual cycles and [22:47] estrogen which then helps us lay down [22:49] bone so that's number one we don't [22:52] estrogen plays a role in laying down but [22:54] yes it does critical role so we're not [22:55] laying down enough or maybe [22:58] we're athletes we're in we Title 9 which [23:02] is the law that um equalize sport for [23:05] women in college is 53 years old so [23:09] maybe young women are not laying down [23:11] enough bone because they're expending so [23:13] much energy 10,000 calories a day and [23:16] then they're not refeeding in the way so [23:18] they're always living in a state of [23:20] energy [23:21] deficit and not laying down enough bone [23:24] or maybe young women are coming to my [23:26] office with not enough bone because we [23:29] are raising an entire generation of [23:30] sedentary children who are sitting [23:33] around in their basements on playing [23:35] games building brains but not building [23:40] bodies that is borne out by looking out [23:44] of the University of Wisconsin [23:46] Orthopedic researchers there studied [23:48] which women's [23:50] sports build the best bone and it's [23:53] gymnastics it is the pounding and the [23:56] feeding of those athletes that builds [23:58] the best best bone so we have trouble [24:00] with not enough brittle bones in [24:03] adolescence because we're not building [24:05] it the second place in the lifespan that [24:08] we may become low in bone density and [24:11] hear me people I am not saying not to [24:15] breastfeed I mean I in my children I my [24:18] child I breastfed for a year it's really [24:20] great for [24:21] babies [24:23] but a woman breastfeeding will lose 20% [24:26] of her bone density in the first 6 [24:28] months of breastfeeding and if she's not [24:29] really careful to get 500 milligrams of [24:32] calcium a day in her food or through [24:37] supplementation she will not build it [24:39] back and then if you have children in [24:42] ear in succession because many women are [24:44] waiting until 30s to have their first [24:46] child and then have less time we may [24:48] never build backbone so that's another [24:51] key point that people don't realize [24:53] could be dangerous to the bones and then [24:56] finally yes is this period about around [24:59] per menopause starting around 45 when [25:03] estrogen levels become very chaotic and [25:06] then ultimately zero that can cause the [25:09] rapid decline in bone density and Bone [25:13] weakness that you're actually asking me [25:16] about and that's because estrogen is [25:18] critical for controlling the absorption [25:22] this part the [25:24] absorption of bone and without estrogen [25:27] controlling the absorption it just keeps [25:29] breaking down bone faster than the [25:32] osteoblast the building cells can build [25:35] it so there's an an unbalance a [25:38] disregulation so I want to go into all [25:40] of that starting with the point you made [25:41] about um having doing Impact Sports when [25:44] we're younger yeah because like people [25:46] often say if you do Impact Sports when [25:47] you're younger especially some of them [25:49] there's other consequences like injury [25:51] or hitting your head so you're saying [25:53] that we should be running or jumping [25:56] when we're younger to build our our bone [25:58] strength absolutely to build everything [26:01] oh it's you know we we uh make [26:04] mitochondria most the energy of [26:06] ourselves we make a lot of mitochondria [26:08] in our youth if we're not active in our [26:10] youth we don't have the anabolic [26:12] stimulus as much to make as much [26:14] mitochondria if we are sedentary [26:17] children we will make bone but we will [26:19] not build bone to the extent we do if [26:21] we're bashing it every day and I and I [26:24] think the data out of Wisconsin is a [26:26] good illustration of that and is in all [26:28] seasons of life if I'm 60 years old [26:30] should I still be bashing that bone [26:32] playing basketball abs and that's what [26:34] my study from the national senior game [26:36] shows that by impacting your bones [26:38] across your lifespan you can change your [26:41] bone density so on that point of [26:42] pregnancy which was your second point [26:45] there during my pregnancy after my [26:47] pregnancy what do I need to be doing is [26:49] it drinking milk yeah so if and this is [26:52] the data I gave you was specifically for [26:54] breastfeeding okay so for breastfeeding [26:56] mothers uh you will lose about 500 [26:59] milligrams of calcium a day as you're [27:02] making milk for your child you must [27:04] replace that I like people to replace [27:07] their calcium with whole food right with [27:10] prunes and dates and and high calcium um [27:14] Dairy if you will if you simply cannot [27:16] do that okay take a supplement but if [27:19] you forget to do that I mean I get it I [27:21] was a young mother I'm exhausted I [27:22] wasn't a young mother I was a [27:23] 40-year-old mother [27:25] exhausted you have to be so mindful as [27:28] your the baby's latching on to eat some [27:30] calcium eat your yogurt eat your calcium [27:33] chew from Whole Foods if you will so [27:36] that you rebuild your bone which you're [27:38] completely capable of doing studies show [27:40] you will rebuild your bone but not if [27:42] you're not aware not if you're in the [27:45] I've got to lose the baby fat starving [27:46] phase let's not do that you talked to [27:50] about how bone has an impact on various [27:52] parts of the body and I've had you talk [27:54] about this phrase the bone brain axis [27:56] yeah what is the bone brain AIS well if [27:59] we just talk about um just choose one of [28:04] the the proteins that bone makes [28:07] osteocalcin so as that's released into [28:10] the bloodstream one of the places it [28:12] goes is into it through into the brain [28:15] and it can cause it can Aid in the [28:19] neuroprotective effects so what is that [28:22] mean under normal metabolism we um [28:27] develop free radical [28:29] through du due to normal metabolism cell [28:32] work um we develop oxidative stress and [28:37] osteocalcin works to decrease that [28:40] oxidative damage to repair cells in the [28:42] brain so that's number one number two it [28:46] stimulates the release of something [28:48] called brain derived neurotropic protein [28:51] bdnf factor which stimulates the growth [28:55] of neurons in a part of the brain called [28:57] the hippocampus which is involved in [28:59] memory and here's here's the opposite [29:02] side of it we know in people that have [29:05] low bone density they also have higher [29:09] brain cognitive dysfunction with age and [29:12] vice versa there's an association in the [29:14] literature with osteoprosis and [29:17] cognitive decline and vice versa I heard [29:20] you in the The Business Insider [29:22] interview do describe there being a [29:23] critical decade yes for bone health mhm [29:28] what is the critical decade I think the [29:30] critical decade for most of our health [29:31] Stephen is no later than 35 to 45 for [29:34] men and women that's because um we know [29:39] for [29:40] women that's when estrogen starts to [29:43] decline or become chaotic so when we're [29:46] in our 30s to 40s that is the time to [29:49] get all of our health habits together [29:51] it's time to get a physical to see what [29:53] your Baseline labs are I think it would [29:55] be critical for men and women [29:57] particularly men to get a baseline [29:59] testosterone so that in the future when [30:01] we're thinking about supplementing [30:03] testosterone we're supplementing back to [30:05] your particular level because in the [30:08] future let's say when you're 50 a man's [30:10] testosterone could be 600 which Falls [30:13] within the normal range but if he's [30:15] still feeling low energy not himself a [30:18] lot of tendon and ligus injuries well [30:21] his young testosterone might have been [30:23] 800 or a th000 so I like people to get [30:27] baseline lab if they've never been to [30:29] the doctor before uh around 35 all [30:32] things so that we know what we're [30:34] returning you to number one number two [30:38] if you have been so busy with your [30:40] career and stepped away from any [30:42] semblance of mobility and resistance [30:44] training now is the time because had I [30:48] known then what I know now when I was 40 [30:52] I was training for triathlons I was an [30:54] aerobic athlete right I ran I biked but [30:58] what I would have done then if with what [31:00] I know now is I would have been lifting [31:02] a lot of weight to build maximum muscle [31:06] while I still had the most hormones to [31:08] start at a better place because you can [31:10] build muscle but it's better to start [31:12] from a higher average so get some Labs [31:15] make a relationship with the [31:17] doctor get all your preventive screening [31:20] do not uh blow that off um develop the [31:24] habits that are going to carry you [31:25] through a lifetime whether it's smart [31:27] anti- inflammatory nutrition whether [31:30] it's getting into a resistance training [31:32] program building up your cardiac [31:35] machine I saw that you were running a [31:37] lot now and we want the highest possible [31:40] V2 Max that we can as we enter into [31:44] midlife because we never want as we age [31:48] to cross something called the fragility [31:50] line so V2 [31:53] Max is the measure of it's the ultimate [31:57] measure of fit [31:58] how much oxygen you are capable of [32:01] pulling out of the air and diffusing [32:03] across your lungs into your [32:04] blood world class athletes I was just at [32:07] the US uh Olympic Center in Park City [32:10] Utah those athletes have a V2 Max of 75 [32:13] 80 sometimes 90 right mere mortals are [32:18] considered excellent when they have a V2 [32:20] Max uh of around 50 for women around [32:24] 50 so you can build V2 to Max and should [32:29] in the critical decade because once we [32:31] hit midlife we will decline 10% a decade [32:37] if we don't consistently build it up so [32:39] what does that look like so if I started [32:42] at 50 50 years old my last V2 Max was [32:45] when I was at when I was 50 and it was [32:48] 50 it was pretty good because I was an [32:50] endurance person right just in whole [32:53] numbers by the time I turn 60 it's going [32:55] to be 45 70 40 80 35 I never ever ever [33:02] want to hit 18 if I'm a man or 16 if I'm [33:07] a woman because that is the level of V2 [33:11] Max when we can't get up from a chair by [33:13] ourselves we when we can't walk across [33:15] the room because that takes cardiac [33:17] function and so the higher we get our V2 [33:21] Max in our youth the more Runway we have [33:23] even if we don't continue to build it up [33:26] yeah I've got a family member that can't [33:27] walk upstairs without being out of [33:29] breath and it's so debilitating because [33:31] when you have grandkids and the [33:33] grandkids start running around and you [33:34] want to play with them it's so sad [33:36] watching this particular family [33:38] member see the grandkids come the [33:40] grandkids say let's play the grandkids [33:42] run off and this person can't go after [33:44] them so they just have to watch they [33:46] literally watch the the grandkids [33:48] playing in the garden because they can't [33:49] play with them and I think it's s such a [33:51] sad thing it's one of my big motivators [33:53] to try try and stay healthy is just to [33:55] be able to extend my health span that's [33:58] right so that I can be healthier [34:00] hopefully until the day that I die thatd [34:01] be great but would I want to talk about [34:04] running I want to talk about V2 Max to [34:06] close off on the subject of Bones [34:08] there's two terms that I that I want to [34:10] hear one is this term osteoporosis yes [34:13] now I have no idea what osteoporosis is [34:15] I've heard it a couple of times in my [34:16] life but I don't know if it's something [34:18] I should be thinking about worried about [34:20] um or what it means yes osteoporosis is [34:23] the word we use to describe low bone [34:25] density Okay so so the way we measure [34:29] osteoporosis is uh using an x-ray called [34:32] a DEA scan a dual X-ray and it just [34:35] measures it Compares your bone density [34:39] to that of a 30-year-old healthy person [34:42] and it gives us something called a [34:43] t-core so it's it's like when you're in [34:46] school and you're graded on a bell curve [34:48] and the center of the curve is average [34:50] and that's the average for a [34:53] 30-year-old when you get a dexa scan [34:55] score and it's positive fan fantastic [34:58] you have bones of a [35:00] 30-year-old if you get a t-core on a [35:03] dexas scan that's from 0 to [35:05] minus1 it's okay minus one is the [35:09] definition of osteopenia meaning watch [35:12] out your bones are getting weak the [35:15] definition of osteoporosis is minus a [35:18] t-core of minus [35:20] 2.5 increases your risk of fracture by [35:23] 40% or more all the bad statistics that [35:26] I talked to you about come with [35:30] osteoporosis and how many people have [35:32] osteopenia osteoporosis in over the age [35:35] of 50 in America well two million men [35:37] have osteoporosis interestingly isn't [35:39] that interesting you don't think about [35:40] it as a men's disease and uh one in two [35:44] women will have an osteoporotic fracture [35:46] so at least 50% of women but it's not [35:48] inevitable that's why I'm so interested [35:51] in in Catching people early in the [35:54] critical decade it's not inevitable but [35:56] it will be inevitable if we don't catch [35:58] it but here's the thing that's [36:01] bothersome in the United States and in [36:03] many other countries uh with people I [36:06] deal with you cannot get a dexa scan [36:08] paid for until you're [36:09] 65 by 65 the damage is done why are we [36:13] waiting even with people who have had a [36:16] fracture there's a gap in followup such [36:19] that they should all have a dexa scan [36:22] because the number one thing that [36:24] predicts future fracture is past [36:26] fracture [36:28] so Public Service Announcement if you've [36:30] had a fracture get a dexa scan even if [36:33] it was a traumatic one like you had b a [36:34] car accident but definitely if you have [36:37] fallen if your dog pulled you down if it [36:39] was a low trauma fracture get a dexa [36:43] scan because then at least you'll know [36:44] where you are and can then plan a course [36:47] for building your bone are there any [36:49] early warning signs that I might be [36:51] suffering from osteoporosis or on my way [36:53] to [36:54] osteoporosis you know I think you can [36:56] get Clues from your own family okay if [36:59] your mother [37:00] shrank if you if you used to be able to [37:03] look your mother in the eye like me my [37:04] mother looked me in the i54 and now [37:07] she's way down here we lose height in [37:10] both men and women due to uh compression [37:12] of her spine vertebrae we lose height so [37:16] if your dad shrank if your mother shrank [37:18] that's a good indication that you have a [37:20] family history where osteoporosis can [37:23] exist or if your mother had a hip [37:26] fracture or or if for some reason maybe [37:30] asthma you've had to be on uh high dose [37:33] steroids your whole life or an [37:35] autoimmune that's very bad for bones so [37:38] from a medical standpoint from a family [37:40] history standpoint from a personal [37:42] standpoint usually fracture what about [37:44] if I'm a smoker does that have an impact [37:46] on my bone health and chances yeah I'm [37:49] really glad you asked that smoking is a [37:50] poison to Bone healing whether it is [37:53] fracture will heal more slowly in fact [37:56] we have a very a much higher rate of [37:58] non-union which is where we fix a [37:59] fracture and it still doesn't heal in [38:02] smokers we know that uh there is a big [38:05] body of data within the orthopedic [38:06] literature for people who have spine [38:08] surgery who are smokers they are not [38:11] only less healing but they're more [38:12] infected so the the noxious chemicals in [38:15] smoking are very bad for [38:18] bone good thing I don't smoke is that [38:21] smoking vaping or is it it's all vaping [38:24] might be more dangerous we just don't [38:25] have as much literature [38:28] okay and the the last thing before we [38:29] talk about running in fe2 Max and [38:31] endurance and sports and all those [38:33] things is the link between Alzheimer's [38:36] in bone health is there a link that goes [38:40] back to what we were talking about [38:41] before and there's a [38:44] correlation we I don't believe we worked [38:46] out the causation but there's a [38:48] correlation we see people with [38:52] Alzheimer and people with uh dangerous [38:55] osteoporosis are sometimes the same same [38:57] group 30% of the time people with brain [39:00] disease also of osteoporosis and it may [39:03] do be due to this uh connection that [39:05] we've talked about uh between the two [39:07] organ systems you had an aunt that [39:10] passed away from Alzheimer's I do my [39:12] aunt Ida she was brilliant she was a [39:14] teacher and she stopped remembering she [39:16] didn't remember herself she didn't [39:18] remember the farm that we were all [39:20] raised on that's a really hard thing to [39:23] witness um sometimes people with [39:26] Alzheimer's [39:28] lose the inhibition and they become [39:30] angry and enraged and afraid she never [39:32] did that but um but that's a hard thing [39:35] to witness how how did that experience [39:39] change you or change your focus or add [39:41] to the sort of what reservoir of [39:45] thoughts concerns reference points in [39:47] your life well you know what it has done [39:49] it has put an urgency and even it still [39:52] is a day-to-day battle I don't want I [39:55] think sometimes think people think for [39:57] me personally that because I talk about [39:59] these things all the time and I do lift [40:01] heavy and I do the thing I live the life [40:03] I prescribe for people that it's easy [40:05] and it's not easy you know I just I told [40:07] you IID finished this book I was writing [40:09] and there was a big gap in the [40:11] consistency of this lifestyle but what [40:14] motivates me to get back is the question [40:18] of what would it be like to live without [40:21] a brain that's [40:23] preserved I mean I don't know sometimes [40:25] I think about if I was aging and I had [40:28] to choose one would I choose an able [40:31] body or an able brain isn't that hard I [40:34] don't know that you do have to choose [40:36] but I can't fathom what life would be [40:39] like without an able brain and so for me [40:41] that motivates me to lift to make my [40:44] skeletal muscle secrete the uh proteins [40:47] that go to the brain and build better [40:49] brain to eat the foods that are not [40:51] going to clog my arteries it's just as a [40:53] motivator because I want to be this way [40:56] until I die [40:57] mhm what would you choose if you had to [41:00] an able body or an able brain my it was [41:03] super clear for me I'd rather have the [41:04] able brain me too me too relationships [41:08] that is that is the fullness of [41:11] Life protect but these things are also [41:14] fundamentally interconnected aren't they [41:15] that's why when I look at the alimer [41:16] stats around bone health I think well if [41:18] you were had osteoporosis or something [41:20] and you weren't moving as much maybe [41:22] yeah maybe you know what a huge [41:24] motivator for my patience is now that [41:26] you've brought this up [41:29] is Alzheimer's disease is thought of as [41:32] the third phase of diabetes right and so [41:35] everybody is aware of diabetes and it [41:37] means you don't process sugar and you [41:40] have glucose intolerance and your [41:41] pancreas is no longer functioning and [41:44] and the bad sequella that can come with [41:46] that what people are not aware of as [41:48] much at least as a people who come to my [41:51] clinic is pre-diabetes and if you don't [41:54] mind me diverging a little bit because [41:56] it's so important to disc question you [41:57] just asked me and can we prevent it and [42:00] and if we got to choose what would we [42:02] choose but I have people coming into my [42:04] office all the time and I look at their [42:06] labs and they have a fasting glucose [42:09] they've had their Labs drawn they've [42:10] done what we've said get in front of [42:11] your critical decade they've had their [42:14] fasting glucose drawn and it's [42:16] 110 which is I'm going to tell you and [42:19] and their hemoglobin A1c is nearing six [42:23] so fasting glucose is the glucose that [42:26] remains in your blood after you haven't [42:27] eaten for 12 hours in a normally [42:30] functioning pancreas metabolic system we [42:34] want our fasting glucose to be around [42:37] 85 right that's normal means we eat [42:41] something insulin comes out of our [42:43] pancreas the sugar is put into our [42:45] muscle and then the blood sugar is [42:47] around 85 if it's staying up 110 [42:52] consistantly we know from the [42:55] literature that you have a 70 to 100% [42:58] chance of developing full-blown diabetes [43:00] within 10 years but what I see in people [43:04] coming into my office is I'll say did [43:06] anybody ever tell you you were [43:08] pre-diabetic and either the answer is no [43:11] or the answer is oh yeah somebody told [43:13] me they said just make a few you know [43:16] focus more on your exercise and and what [43:19] I think the reaction to pre the [43:22] diagnosis of pre-diabetes should be is [43:25] running and screaming to get healthy [43:27] because if we know that with a [43:29] consistent blood sugar in the [43:31] pre-diabetic range and we're casually [43:33] told by our healthare provider oh just [43:36] go try to exercise more you know just [43:39] casually approach this don't eat so many [43:41] carbs that is not serious enough because [43:44] we know from a preventative standpoint [43:46] from a Precision longevity standpoint [43:49] which is all about prevention we can [43:51] prevent you from getting to diabetes in [43:53] the next 10 years if we're really really [43:55] serious about lifting weights about [43:59] cardio Health about anti-inflammatory [44:01] nutrition following so I don't view [44:04] pre-diabetes as a casual thing at all [44:08] because if in a 10 years you're going to [44:10] get diabetes and in 10 more years you're [44:12] going to have Alzheimer's disease and I [44:15] could have prevented that by paying [44:16] attention when I was [44:18] 40 it's almost inexcusable that we're [44:20] not paying more attention to it 96 [44:23] million people in the United States have [44:26] pre-diabetes [44:27] 96 million 96 million according to the [44:29] American Diabetes Association I just [44:31] gave a talk at their annual [44:33] convention 96 million have a [44:36] preventable [44:38] characteristic that we can prevent them [44:40] from becoming diabetic and getting [44:42] Alzheimer disease and yet it is too [44:44] casually spoken [44:46] of that's like almost one in three that [44:48] means that there's three of us in this [44:50] room so Jack's [44:51] got pre pre-diabetes perhaps potentially [44:55] you're an you an an urance athlete [44:57] wouldn't you say I was an endurance [44:59] athlete and I'm I've been I don't have [45:00] it today it ran out but I'm a little [45:02] obsessed with continuous glucose [45:04] monitoring so I've been wearing it for [45:06] about 18 months and and uh it's so [45:10] interesting I told you that you know I [45:12] just finished this book and I've gotten [45:14] a little bit off my regular intensity [45:16] and it changes my blood sugar so I run a [45:20] little I because I haven't been lifting [45:22] four times a week only twice a week [45:24] because I haven't been sprinting twice a [45:27] week like I Norm my normal regimen is I [45:29] lift heavy four times a week I on the [45:32] other days I do about four days of Bas [45:35] training Zone too two of those days I [45:37] Sprint I always eat a lot of protein [45:39] that is my [45:41] lifestyle and my blood sugar is 85 when [45:44] I do that and I'm a midlife woman and [45:47] you know the metabolic things that [45:48] happen to midlife women even backing off [45:51] a little bit starts to creep up my blood [45:53] sugar so this is a constant daily [45:55] habitual lifestyle that we all need to [45:58] lead and so when I see that and someone [46:01] as healthy as me when my patients show [46:03] up and they casually been told that they [46:07] have something that's going to kill them [46:09] I don't think that's enough attention [46:12] that's what I've been thinking a lot [46:13] about recently is what diet is going to [46:15] lead me to better cognitive performance [46:17] to someone that spends a lot of my time [46:18] talking yes but then also I'm on stage [46:20] I'm in boardrooms and in meetings and in [46:22] negotiations I'm reading emails and [46:23] writing books Etc so I'm always thinking [46:26] if I can just get 5% Edge well I can [46:28] tell you for instance the the dietitians [46:31] and chefs that make the food for the pro [46:33] athletes that I've taken care of across [46:35] my life they're not only eating meat [46:39] they have a very well-balanced diet that [46:41] includes lots of vegetables lots of high [46:44] protein they they take amino acid [46:46] supplements if they need to fill in the [46:49] gaps right if they're not getting enough [46:50] Lucine or something but they just don't [46:52] go down one one pathway I haven't seen [46:56] that in the Pros that I take care of he [46:59] to has given me a very sharp mind has it [47:01] an extremely sharp mind it's so [47:03] interesting as a podcast when you sit [47:04] here and you have all these [47:05] conversations because some days you show [47:07] up and sometimes these conversations [47:09] last for four hours and your brain and [47:11] mouth just don't feel like they're [47:12] connected yeah and then on other days I [47:14] come here like boom boom and it's [47:16] automatic yeah it's like I don't have to [47:18] think and it's just flowing off off my [47:20] mouth and the variance the big I said so [47:22] the causal factors are obviously sleep [47:24] is one of them the other one is how many [47:27] carbohydrates I've had in recent yes [47:30] hours so if I've had a lot of carboh [47:33] hydrates something you know like if I've [47:35] had bread my mouth and my brain have no [47:38] connection if I've had lots of sugar my [47:40] mouth in my brain are completely done [47:42] agreed agreed you know because of this [47:44] CGM thing I found that if I only eat [47:47] protein for breakfast which uh egg white [47:50] omelette or you know whatever just [47:52] protein that I needed a little complex [47:56] carbs in order [47:57] for about 10:00 in the morning to be [47:59] able to function at a high level with my [48:01] patients so now I've added 50 gr of [48:03] carbs in the morning but that's not a [48:05] lot of carbs not very much I just needed [48:07] that little complex but uh interesting [48:10] right and what do you eat I eat 130 [48:14] grams of protein a day there's no upper [48:16] limit on how much protein you can eat in [48:18] a single setting I try to get at least [48:20] 30 because there is a lower thresholds [48:22] for 30 and so if I do that uh it takes [48:25] three meals and a couple SN a day I [48:28] that's a lot of volume of food so I try [48:30] to eat really dense so uh a cup of Greek [48:34] yogurt is like 18 grams and a really [48:37] pure beef stick is another 16 so at this [48:40] time I at this point I've [48:42] memorized the most dense foods that I [48:44] can to get that much protein it's a lot [48:46] of protein it's a gram per pound it's a [48:50] gram per pound and that's what I need to [48:52] build muscle Studies have shown that uh [48:55] eating high protein Al without lifting [48:57] as much as I want myself and others to [48:59] do will help maintain muscle and then I [49:02] eat a lot of vegetables I don't now I [49:06] hope people are not going to throw them [49:07] at me but I don't eat fruit except [49:09] blueberries fruit is Nature's dessert so [49:12] if we're going to eat fruit eat it as [49:13] dessert I eat I eat blueberries with my [49:16] yogurt but um and then carbs I only eat [49:19] complex carbs if I eat them at [49:22] all quick one I want to talk about [49:24] something we all need to take seriously [49:26] which is cyber security whether you're a [49:28] first-time founder facing your very [49:30] first audit or a seasoned professional [49:32] who's been through it all staying [49:33] compliant is getting more critical than [49:35] ever and more complicated I have to say [49:37] and that is where vant comes in who is a [49:39] sponsor of this podcast vant takes the [49:41] pain out of security compliance [49:43] automating the tedious but essential [49:45] process of proving your business is [49:46] secure across over 35 Frameworks like [49:49] sock 2 ISO [49:52] 271 centralize your workflows answer [49:54] security questions up to 5 times faster [49:57] and protect your business without losing [49:59] focus on growth and this is really a [50:01] critical part of this a new IDC white [50:04] paper found that companies using van [50:06] save over [50:08] $535,000 a year and it pays for itself [50:11] in just 3 months for a limited time my [50:13] community gets $1,000 off vter at [50:16] v.com that's [50:18] van.com for $1,000 [50:22] off you're um a very big advocate of [50:26] muscle you know when we talk about [50:27] longevity something that you continually [50:29] come back to as the most important thing [50:31] for people's longevity I think I would [50:34] put muscle and bone near the same [50:37] category because you can have all the [50:38] muscle you want but if you break your [50:40] hip you still have the downstream [50:42] effects now you're much Les less likely [50:43] to break your hip if you're strong but I [50:46] think muscle or bone are really [50:47] important what if [50:50] you 65 years old 70 years old and you [50:53] haven't got MH strong muscles right now [50:56] now your muscles have um declined let's [51:00] say over the last couple of decades is [51:02] it too late never it's never too late it [51:05] is never too late your body will always [51:07] rise to the Strategic stress you place [51:10] on it so there are a lot of and growing [51:13] number of what used to be anomalies all [51:16] over the Internet of people in their 60s [51:18] 7s 80s and Beyond in a gym powerlifting [51:22] becoming uh competitive bodybuilders so [51:25] even if you're starting [51:27] not being able to get up out of a chair [51:29] over a very short amount of time 6 [51:31] months a year you can reverse the [51:34] trajectory of your Frailty but it takes [51:37] consistency right I do wonder that I [51:39] think about think about my father and [51:41] he's approaching his 70s now and I don't [51:45] think he's done weight training for the [51:46] last 15 15 years yeah and there is a [51:49] part of me that did wonder is it too [51:51] late now to to start doing weight [51:53] training because it's almost like a a [51:56] two-sided problem in the fact that you [51:58] haven't done it yes so you find it [52:00] harder so you don't do it so you find it [52:02] harder and then you sort of spiral down [52:04] to this sedentary State well and you [52:07] know what you do for that is nobody [52:09] expects you to start with powerlifting [52:13] squats deadlifts nobody expects that [52:16] moving our body through a range of [52:18] motion doing body weight progressing to [52:21] free weights progressing to like kettle [52:23] bells progressing to bands when once you [52:26] see that your body is capable of [52:28] adapting and [52:30] progressing you will get there pretty [52:33] rapidly I used to do this program called [52:35] a start where I would take people fresh [52:39] off the couch and over three months we [52:41] would get them to a 5K race because 5K [52:44] is a meaningful distance for people who [52:46] are sedentary and over that course of 3 [52:49] months we did a series of um body weight [52:53] and kettle bell type exercises in a Circ [52:57] followed by walking and people started [53:00] with 51% body fat not being able to get [53:03] through the warmup not be able to hold [53:05] himself up in a plank and in three [53:07] months they could plank for 2 minutes [53:10] they could walk for three miles they [53:11] could keep going for the entire [53:14] 10-minute circuit without having to stop [53:17] so there is never an age or skill level [53:19] when our body will not respond to the [53:22] Strategic stress you put on it so uh get [53:25] a trainer for your dad if he'd accept it [53:29] if he would accept it I'll call him [53:30] after this if I am trying to build [53:32] muscle are there a certain amount [53:35] of days of the week or repetitions I [53:37] need to do to build the muscle I think [53:39] about this a lot when I'm out here in La [53:41] I'm I'm I'm trying to make sure that I [53:43] don't lose my muscle but I spend a lot [53:44] of time sat down in here recording [53:46] podcasts so is there a certain amount of [53:49] times I need to work out that muscle [53:50] before I lose it you know I was just [53:52] reading this morning actually that um [53:55] even with a 10 week Hiatus from let's [53:57] say you're lifting consistently even [53:59] with a 10we Hiatus uh you will retain [54:02] muscle memory so that you don't make [54:04] serious declines which is little relief [54:06] to me because it's been a little while [54:08] with this book so you retain muscle [54:10] memory and you can quickly once you get [54:13] started again get back up to the place [54:15] you were um so all is not lost if you [54:19] take a few days off [54:22] but the minimum if we're really working [54:25] at it is a couple days a week [54:27] progressively lifting harder for men in [54:29] midlife it's about eight reps four sets [54:32] for women once we've trained to the [54:35] place we can lifting heavy four reps [54:37] four sets and when I say that out loud I [54:40] get a lot of comments about somebody's [54:42] going to get hurt well it's true but you [54:44] have to work your way up to that like [54:46] any sport you have to work your way [54:48] towards that level because what we're [54:50] trying to do by lifting heavier [54:52] especially for women is replace the [54:54] anabolic stimulus that estrogen [54:57] was you must work hard enough estrogen [55:00] creates growth we must signal our body [55:03] by the intensity of our work to build [55:06] muscle and lifting heavy does that so if [55:09] you're starting on the [55:10] couch uh start with bands start with [55:15] light weights start with the Mambi pami [55:16] pink weights that I rail against but [55:18] don't stay there continue to work your [55:20] way up in a progressive way to heavy [55:23] lifting total body at least twice a week [55:25] to maintain [55:26] do I need to increase the weight load to [55:29] build muscle because I wonder when I go [55:31] to the gym sometimes you know I might be [55:34] using smaller dumbbells but I'm doing [55:35] more repetitions yeah is that still [55:37] going to build muscle well it depends [55:39] what you want so so lighter weights [55:41] higher reps is uh [55:44] will will uh function for hypertrophy [55:47] for big bigger total muscle but not [55:50] necessarily power and strength in Lo in [55:53] midlife and Beyond I am Lifting for [55:55] longevity EMP power so I'm not as [55:58] interested as I once was in the bigness [56:00] of my muscle I'm interested in can it [56:04] move powerfully over times can I get up [56:08] off the floor can I lift my suitcase [56:09] above my head so Lifting for power is [56:13] lower reps higher weights so it just [56:15] depends what our goal is you may be [56:16] focused on hypertrophy right now which [56:18] is fine because you've not reach the [56:20] critical decade so if I'm looking for [56:22] hypertrophy yeah higher reps lower [56:24] weights so 12 12 15 reps low weight and [56:30] then if I was looking for power then [56:31] maybe 6 eight 6 eight that's right how [56:33] many do you do I do four you do four mhm [56:36] so big weight four big weights four reps [56:39] four sets interesting I didn't know that [56:42] M interesting [56:45] and just to give some sort of [56:47] foundational knowledge as to why muscle [56:49] is so important because some people [56:50] still might not um be aware of the link [56:52] between longevity and muscle a lot of [56:55] this is to do with from what I [56:58] understand glucose so it has to do with [57:02] muscle as the snc for [57:04] glucose uh it is a key factor in [57:08] preventing insulin resistance not to [57:10] mention strength staying upright not [57:13] falling down causing a fracture right so [57:16] muscle is a metabolic endrocrine organ [57:18] it releases when it [57:21] releases um you know one of the things [57:23] that releases is skeletal muscle [57:25] contraction by curls causes the [57:27] transcription of a protein called clo [57:29] which is the longevity protein about 30 [57:31] years ago it was described in nature it [57:34] is the protein when muscle contracts [57:37] that's transcribed it works on every [57:39] organ we know that it's critical for the [57:42] longevity and repair of organs because [57:44] mice who are born without the ability to [57:47] make [57:48] clo die [57:51] old very young chronologically they're [57:53] very young mice but they die very old [57:56] mice because they have not enjoyed this [57:58] protein clo we make clo by the [58:02] contraction of skeletal muscle here's a [58:04] study I did uh years ago that showed [58:08] that I measured clo level circulating in [58:10] the blood of older Masters athletes [58:14] people 60 70 80 younger Master's [58:17] athletes 40 and sedentary people and [58:20] what I found that the highest levels of [58:22] circulating cloo the longevity pro [58:25] protein [58:26] we're in young athletes not surprising [58:31] the second highest level of longevity [58:34] protein clo were in Old Masters athletes [58:39] 70 80 the lowest level of longevity [58:42] protein were in young sedentary people [58:45] so even old athletes had more [58:48] circulating [58:49] cloo than young sedentary people so just [58:52] the contraction of skeletal muscle can [58:54] add to your longevity through this [58:56] protein another Protein that's released [58:59] with skeletal muscle contraction called [59:02] ginin it is transcribed goes to the [59:06] brain works at a place called the [59:08] nucleus culus which is critical for [59:11] resilience it makes you more resilient [59:14] it helps you able to problem solve and [59:17] then you know a very popular uh protein [59:20] that is transcribed with skeletal muscle [59:22] contraction is called irisin it's the [59:24] exercise protein which you know it works [59:27] on bone it works on fat to Brown fat [59:30] from white fat to Brown fat which is has [59:34] higher thermogenesis it has higher [59:36] mitochondrial load it so muscle just in [59:40] doing its thing not just looking pretty [59:42] in a gym mirror does all these metabolic [59:44] functions and so that's why we think it [59:47] has such a key role in longevity so if [59:51] I'm trying to protect my muscle as I age [59:53] are there any supplements that I should [59:55] be taking [59:56] I mean do they sell cloo supplements [59:59] they don't you have to make it oh F [60:02] contract your own muscles well uh you [60:05] need to feed your [60:07] muscles I always quote people one gram [60:09] per ideal pound because listen I I I'm [60:12] an actual practicing person doctor and [60:16] here's what I know people need really [60:18] Specific Instructions and they can't be [60:20] confusing [60:21] so is there a range of protein people [60:24] need yes there is but people can [60:26] remember one gram per ideal pound so you [60:28] got to feed your muscle with protein [60:30] high quality protein the highest quality [60:33] protein has the greatest percentage of [60:36] an an essential amino acid called Lucine [60:39] Lucine is not made by the body it has to [60:41] be taken in from the outside it's a [60:43] branch train amino acid and you get it [60:45] from whey protein the best source in the [60:49] universe of Lucine and whey protein is [60:51] mother's milk but most of us don't drink [60:53] that as adults so we get it from dairy [60:55] products [60:56] you can get it from plants for everybody [60:58] that is a plant lover you just have a [61:00] much lower percentage you have to eat a [61:01] lot more of it so high quality protein [61:04] number one number two there's a lot of [61:06] research uh for uh creatine [61:09] supplementation for both men and women [61:12] when I first started being aware of [61:14] creatine in 1992 it was during the [61:17] Olympics I was working with a bunch of [61:18] wrestlers at that time um we would give [61:21] very very high doses we would cycle the [61:23] creatine we would come on and off now [61:26] steadily five uh grams a day will help [61:29] build muscle it will help build brain [61:31] it's really interesting a couple of uh [61:33] months ago I asked the people in my [61:36] office if they used creatine yeah and a [61:39] couple of the guys put their hands up [61:41] none of the women put their hands up huh [61:43] and I asked them why I said why didn't [61:44] use creatine they said that they thought [61:46] it was for [61:47] bodybuilders well it started out for [61:50] bodybuilders but it's for everyone [61:52] actually it's very well studied so I [61:55] actually had this um debate with my [61:56] girlfriend last year at Christmas time [61:58] um because I was taking creatine and [62:00] asked if she wanted some and she made [62:01] the same comment to me that it was for [62:02] bodybuilders and I she put on weight if [62:04] she had it and then I said no that's not [62:06] true so she Googled it and she saw that [62:07] it's good for like cognitive performance [62:09] skin hair muscle bone etc etc and now [62:13] she takes it every day perfect I think [62:15] there's a big um re-education piece to [62:17] be done there because we us we almost [62:18] used to think of it like uh a steroid or [62:22] something and it's not at [62:24] all you know what despite podcasts like [62:27] this and despite me screaming from every [62:31] Mountaintop I find that there still is a [62:34] an incredible knowledge deficit in the [62:36] general public about the principles of [62:38] how to be the healthiest we can be and [62:41] an even bigger Gap in the ability to [62:45] take action for ourselves I mean and [62:47] it's not a judgment it's simply an [62:49] observation that we know what to do but [62:51] we don't do it and we know what to do [62:53] and we don't do it even if we see in our [62:56] family someone who's going through the [62:58] throws of diabetes or even on the [63:00] Alzheimer's it's still not enough [63:03] motivation and I think that's the real [63:05] problem to solve motivation how'd you [63:07] solve [63:09] that sometimes sometimes we solve it by [63:11] scarce right you know someone has a [63:13] tremendous health problem but sometimes [63:15] that's not even [63:17] enough I have found that it is never [63:20] going to be motivating enough to try to [63:22] say okay if you do this today in 20 [63:24] years you're going to be much better [63:26] there's this temporal disconnect people [63:28] just don't get it what they're going to [63:29] be like at 70 I think we have to make [63:31] you feel good every single day it's like [63:34] when we were talking about your brain [63:36] when you're doing heavy work and [63:38] cognitive work if you can feel better [63:41] every single day you'll continue the [63:42] behavior not for a promise so I think [63:45] that is the that is the [63:47] way to talk to anybody way I talked to [63:50] my patients can I make you feel better [63:51] tomorrow can I make you feel like a [63:54] badass cuz you lifted heavy weights [63:56] today um it's hard though with things [63:58] like bone you're telling someone that [64:00] they need to be getting I don't know [64:02] their calcium and stuff like that they [64:03] think well I can't see my bones and [64:05] osteoporosis is so far away that yeah [64:07] it's hard until you see someone fracture [64:09] or you fracture yourself I agree with [64:11] you vitamin D as well as crucial isn't [64:13] it for bone health I was reading that [64:14] there it is it is magnesium vitamin D [64:19] magnesium uh lesser known things [64:21] strontium zinc Boron and micronutrients [64:24] but big thing [64:26] vitamin D magnesium sleep sleep talked [64:30] about that a little bit as well how [64:32] important that was um you mentioned that [64:33] I'm running now yes you are thank you [64:36] for noticing you'd never mention it and [64:38] a million others are supposed to join [64:40] you I noticed yes we're going to try and [64:41] get a million people running that's [64:43] great you're going to save a lot of [64:44] lives oh thank you um but much of it [64:46] because of the work that people like you [64:47] do and that come on my show and inspire [64:49] me to think about things like my va2 Max [64:52] and I'd definitely been just weight [64:53] training for the last couple of years [64:54] not really thinking about my bones or my [64:57] V2 Max so this has been quite a big [64:59] shift for me yeah but when I think about [65:02] running I definitely hated it I still [65:04] hate it a little bit but I I hate and [65:06] love it now which is [65:08] progress what are the things I should be [65:11] thinking about CU people talk to me [65:13] about Runners knees and stuff like that [65:15] and I don't want to get injured right [65:17] but I'm running quite a lot so I hear uh [65:19] from a lot of [65:21] Runners that oh okay I'm going to lift [65:23] with my arms because I'm running so that [65:25] means my legs are going to get stronger [65:29] well what I know from 30 years in [65:32] practice is that Runners who only run [65:34] are hurt a [65:36] lot and here's why running builds a big [65:40] cardiovascular [65:42] engine but it does not build muscle mass [65:45] below your belly generally unless you're [65:47] running uphill all the time and you're [65:49] building glutes [65:51] but so what happens running is a single [65:54] leg sport if you if you look at a gate [65:56] analysis you're on one [65:59] leg at a time you're never on two legs [66:02] and walking you're in two legs on [66:03] running you're in one leg so if this is [66:07] if my hands are on someone's pelvis when [66:09] we're running we can't be going like [66:12] this every single stride sort of [66:14] oscillating oscillating like we're [66:16] walking on a catwalk in Fashion Week we [66:18] want to be running like this straight [66:22] well that takes tremendous glute [66:25] strength butt string because it's the [66:27] glutes that balance the pelvis if we [66:29] were in my office and you came in with [66:32] pain as a runner I would stand you on [66:34] one leg to see even if in a controlled [66:37] POS uh environment you could do a single [66:40] leg Squat and keep your pelvis stable [66:43] without your knee falling in and if you [66:45] can't it just tells me that we have a [66:46] lot of butt core and hip strength to do [66:50] and my lower back something I think [66:52] about because when I train especially [66:55] I'm training for a football match at the [66:57] moment oh um in the UK and I always seem [67:01] to get a glute injury so I and it's all [67:05] it's almost like 100% predictable that [67:07] if I don't stretch properly even even if [67:10] I stretch a little bit but don't stretch [67:11] fully yeah when I run on that football [67:13] pitch within five minutes I feel like a [67:15] little it's almost like a little tear in [67:17] my glute yeah almost yeah what am I [67:19] doing what do you think is happening it [67:21] might be useful to you as you're [67:22] training to have a motion analysis to [67:24] have someone stand you on one leg and [67:27] look at the way that that one motion [67:29] pattern is different from the other [67:31] because if it's predictable like that M [67:33] there's an imbalance in you and so it [67:36] can likely be trained I mean I can give [67:39] you an example in my life if you want to [67:41] see how that works so when I run and [67:44] when I increase my my speed and [67:47] distances I predictably predictably get [67:51] left Achilles [67:53] tendinitis and I get right hip flexor [67:55] sharp stabbing [67:57] pain predictably that is [68:00] because my left big toe from wearing [68:04] high heels all my life has arthritis so [68:08] when I run I don't run through the [68:09] center of my foot I run through the side [68:12] of my foot where your pinky is where my [68:13] pinky is so instead of running through [68:15] like this I run through like this puts [68:18] extra stress on my achilles tendon [68:20] changes my gate enough that it's tight [68:23] all up through the left side of my body [68:26] and my right um hip flexor is taking the [68:29] brunt of that that is a motion pattern [68:32] deficit that I know I have so if you [68:34] were predictably getting the same injury [68:36] all the single time it's probably due to [68:39] Something's too tight on one side [68:41] something's too weak on the other side [68:43] and if you get it evaluated you could [68:45] probably train it out of you you have [68:48] athletes and people that come you stand [68:50] on one leg to test something yeah what [68:52] is that do you want to see it yes yeah [68:54] let's do it [68:56] so to test whether we have muscle [68:58] imbalances that could cause injuries [69:00] when we run because I had said Runners [69:02] are very hurt athletes that I take care [69:04] of this is called the Trendelenburg sign [69:07] and it tells us whether your glute your [69:09] butt muscles are strong enough to keep [69:11] your pelvis straight and whether you're [69:13] strong enough to keep your knee from [69:15] falling into this position okay which is [69:17] called vagus so collect yourself we're [69:20] going to stand all stacked up on our [69:23] left knee my left knee yeah oh gosh yep [69:27] and then we're going to do some single [69:28] leg squats without falling [69:30] over so what happens is people drop [69:33] their hip and their knee Falls like this [69:37] it goes blop yeah a thousand steps a [69:41] mile so you can imagine if your knee's [69:43] like this a thousand steps a mile your [69:45] little kneecaps getting pulled off and [69:47] we can't balance we're getting our [69:49] balance a thousand steps of Mile so we [69:51] can train this let's do the other leg [69:54] engage sit single leg squat you look [69:56] like I'm drunk or something yep there [69:59] you go now you're [70:01] compensating but the goal in the mirror [70:03] is not to have the hip drop and not to [70:05] have the knee fall in I feel like this [70:07] one's way stronger and that's why it was [70:08] easier it it looks that way so that [70:10] means this glute this rear end glute is [70:13] stronger than that one that's the one [70:15] that always gets injured my left one yep [70:17] because it's not functioning as well and [70:19] it leaves this side unprotected so what [70:21] have I got to do so uh double leg squats [70:25] are good but single leg step UPS single [70:27] leg lunges as in like so if we had a [70:31] step we would be holding a we could [70:33] start with no weights like [70:37] this and you're tall you could start low [70:40] you could go up here I usually usually [70:41] use an 18 and then when you feel [70:44] comfortable and your hips not bouncing [70:47] up and down take your your we weight [70:49] your barbell and step up and step down [70:54] okay yep y right cuz it's Single Leg so [70:57] I'd have my weight and I'd be going like [71:00] this MH and then I step down step down [71:03] with the same [71:04] foot and what am I what am I doing here [71:06] I'm I I'm just you're strengthening one [71:09] side at a time okay because if you step [71:11] up if it and you're wobbly M then that's [71:14] what's happening when you're running [71:16] okay and so you can do step Downs too I [71:18] mean you can come this way and then come [71:22] like this okay yeah and then we do uh [71:26] there are lots of things like this a [71:28] good physio but if we're up here we can [71:30] do things like um hip hitches where you [71:33] put your leg down I am in heels today [71:36] but we go down like [71:37] this without going down like this yep [71:42] okay thank you so much let's get the [71:43] table back [71:44] in your gut and my gut is the home of [71:47] our digestion and it's also a gateway to [71:49] Better Health but it can be hard to know [71:51] what's going on in there Zoe who [71:53] sponsors this podcast has one of the [71:55] largest microbiome databases on the [71:57] planet and one of the world's most [71:58] advanced at home gut health tests their [72:00] blood sugar sensor which I have in this [72:02] box in front of me goes on your arm so [72:04] you can see how different foods impact [72:05] your blood sugar then there's the at [72:07] home blood sample which is really easy [72:09] and analyzes your body's blood fat and [72:11] of course the [72:14] famous blue Zoey cookie which tests your [72:18] metabolism oh and I can't forget there's [72:20] also a poo sample which is a critical [72:22] step in understanding the health of your [72:23] microbiome and you post it to Zoe and [72:25] you get your results back which will [72:27] help you to understand your body's [72:28] response to different foods using your [72:30] results Zoe's app will also create a [72:32] personalized nutrition plan for you and [72:34] this is exactly why I invested in the [72:36] business so my question to you is how [72:38] healthy is your gut head to zoe.com to [72:40] audio your kit and find out and because [72:42] you're one of our listeners use code [72:44] Steven 10 for 10% off your membership [72:46] head to zoe.com [72:48] now I've invested more than a million [72:51] pounds into this company Perfect Ted and [72:53] they're also a sponsor of this podcast I [72:54] switch over to using matcha as my [72:56] dominant energy source and that's where [72:58] perfect headed comes in they have the [72:59] matcha powders they have the matcha [73:01] drinks they have the pods and all of [73:03] this keeps me focused throughout a very [73:05] very long recording day no matter what's [73:07] going on and their team is obsessed with [73:09] quality which is why they Source their [73:11] ceremonial grade matcha from Japan so [73:14] when people say to me that they don't [73:15] like the taste of matcha I'm guessing [73:16] that they haven't tried perfect head [73:18] unlike low quality matcha that has a [73:20] bitter grassy taste perfect Ted is [73:22] smooth and naturally sweet and without [73:24] knowing it you you're probably a perfect [73:25] head customer already if you're getting [73:27] your match at places like blank Street [73:29] or Joe and the juice but now you can [73:31] make it yourself at home so give it a [73:33] try and we'll see if you still don't [73:35] like matcher so here's what I'm going to [73:37] do I'm going to give you 40% off our [73:39] matcher if you try it today head to [73:41] perfect ted.com and use code [73:43] steven4 or if you're in a supermarket [73:45] you can get it at tesos or Holland and [73:47] Barett or in the Netherlands at Albert [73:49] Hine and those of you in the US you can [73:51] get it on [73:52] Amazon on the subject of OB it and [73:55] weight we talked last time really [73:57] fascinating thing that you said to me [73:58] which stayed with me is that the more [74:00] weight we're carrying the more harm it's [74:02] doing to our bones in a really [74:04] disproportionate way could you clarify [74:06] that again but also talk to me about [74:08] give me the case for keeping my body fat [74:11] down as I age so what we were talking [74:14] about is uh joint health yeah and the [74:18] fact that every bone if in your knee for [74:20] instance if your Fe if this is your [74:22] femur the end of every bone has a bumper [74:25] of cartilage cartilage is a matrix of [74:27] collagen fibers that has cells in it and [74:30] its entire job is to shock absorb so the [74:33] bones don't do so much of this bones are [74:35] pretty fragile but they Glide cartilage [74:39] has a in physics a coefficient of [74:42] friction that is less than ice so it's [74:44] smoother than ice it Glides right if [74:47] it's [74:48] perfect cartilage is very subject to the [74:52] forces of weight such that in our [74:54] Laboratories when we were doing [74:55] cartilage research and wanted to damage [74:57] cartilage all we had to do is drop a [74:59] marble on it so it doesn't take much so [75:02] if we're carrying around a lot of heavy [75:04] extra weight and we don't have the [75:06] muscles to support that instead of [75:08] muscles actually like a shock absorber [75:10] and protecting our cartilage we're [75:12] banging more now remember banging is [75:14] good for bones it's not good for [75:16] cartilage so we want to make sure that [75:19] we have a healthy weight so that we're [75:21] not exerting so much load because it's 7 [75:24] to n we talked about last time 7 to n [75:27] times uh body weight pressure across the [75:30] joints and so that's why we want to [75:33] compose our body and have a body [75:36] composition not a weight a body [75:38] composition of of more muscle than at [75:42] aost tissue yeah this kind of goes back [75:44] to what we were saying earlier because [75:46] you can say these things but still [75:48] changes still far away from many many [75:50] people and I was just wondering in the [75:52] people that you've seen make radical [75:53] changes that you've worked with are [75:57] there key things that happen we talked a [75:58] little bit about someone hits Rock [76:00] Bottom they get a bad diagnosis they're [76:02] forced but is there is there anything [76:04] else that one can do to will themselves [76:07] to change to keeping a journal some kind [76:10] of exercise I think it's really helpful [76:12] to know as much about yourself as [76:14] possible so if I'm intaking someone into [76:17] a program we're going to build I don't I [76:20] weigh them but what's most important is [76:23] I do a body composition so that we can [76:25] go through step by step and say in your [76:27] current body you have I'm making these [76:30] numbers up 32% body fat you have very [76:34] little lean muscle so even though you [76:35] may be okay with the way you look in a [76:37] mirror you're skinny fat meaning you [76:40] have two little muscle and too much [76:42] adapost tissue and and we just and we [76:44] talk about all the things we've talked [76:46] about about why we need to build more [76:48] muscle but when you see those numbers [76:50] numbers don't lie nor are they judgments [76:53] but if you're just looking in the mirror [76:55] you may say oh that's okay or you may [76:57] hate the little belly roll but it's not [76:59] you don't hate it enough but when you [77:01] see that you have very little muscle [77:02] mass and a very high percentage of fat [77:06] those data alone are sometimes a [77:08] motivation and then if we know that [77:12] we're going to redo that test in three [77:15] months or six months and track changes [77:17] over time that can be an added motivator [77:20] besides tragedy data can be a motivator [77:24] wanting to feel like yourself again in [77:27] in women in midlife someone sometimes [77:29] just say I just want to feel like myself [77:31] again well we're different people after [77:34] our estrogen goes away and so it takes a [77:36] different kind of work to feel like [77:37] ourselves again but at the end of the [77:40] day so tools wise I think journals are [77:42] are helpful tracking uh keeping a record [77:45] of how you felt on a day what you did [77:47] that day cgms and stuff as well anything [77:50] that turns the lights on has been really [77:52] that's right data cgms are you you know [77:55] I learned what I was going to learn at 3 [77:56] months but I've had it on for 18 months [77:58] just cuz that data Spurs me on like oh I [78:02] that was a really stressful o day my [78:04] sugar spiked up even though I wasn't [78:05] eating I must have been very high [78:07] cortisol I'm releasing so much from my [78:09] liver it's just informs me about the [78:11] inner workings of my body but also at [78:14] the end of the day you have to love [78:16] yourself enough Stephen and I can't make [78:19] you love yourself and I can't a number [78:21] of harassments in my office cannot make [78:24] make you value yourself enough to invest [78:27] in yourself daily and at the end of the [78:29] day that's what it's going to [78:31] take I've talked quite extensively on [78:33] this podcast about menopause it's really [78:36] fascinating to me I think in part [78:37] because I didn't even know what it was [78:39] yes even it a couple of years ago [78:41] probably a year and a half ago I had no [78:42] idea what it was what are some of the [78:45] pervasive myths about menopause that [78:47] people still need to sort of get [78:50] past despite everyone talking about it [78:52] despite you having lots of ation about [78:55] it I still find a lot of people who have [78:58] never heard of Perry [79:00] menopause which is the decade leading up [79:03] to the day of menopause which is 365 [79:07] days after your last men menstrual cycle [79:09] on average in this country it's about [79:13] 51 people have not heard of per [79:15] menopause they've never heard of hormone [79:18] replacement therapy and they don't know [79:20] what to do about it and they're ashamed [79:23] to talk about it because [79:25] somehow needing things in this country [79:28] if you're a [79:30] woman have gone unnoticed for instance [79:33] like oh I'm just going to suffer through [79:35] my mom never talked about it so I think [79:38] the myth that you have to suffer is a [79:40] myth there is more known now than [79:43] there's ever been about how using [79:45] lifestyle to feel better I always [79:48] encourage women to make their hormone [79:50] replacement decision based on science [79:51] and not fear and to make it early [79:55] how I I encourage my patients even in [79:58] the mid 40s to read the books watch the [80:02] podcasts identify a clinician so when [80:05] it's time for them to make their [80:07] decision they've got [80:08] everything um lined [80:11] up and you can take hormones while [80:13] you're still menstruating and there's no [80:15] reason not to in fact that's what birth [80:17] control is birth control is is 10 times [80:21] the dose of hormone replacement therapy [80:24] so [80:25] under careful supervision you can make [80:27] your decision very early what I want [80:30] people to do uh is educate themselves I [80:34] call it menopause literacy because we [80:36] have a very low level of menopause [80:38] literacy in this [80:40] country I want them to make their [80:42] hormone replacement decision [80:45] meaning am I going to go on them where [80:47] am I going to get them can I find a [80:50] clinician to help me number three I [80:52] would like them to as we talk talked [80:54] about [80:55] earlier build their unbreakable [80:58] lifestyle develop the habits early not [81:00] when they're in the throws of menopause [81:02] and feeling desperate but early of [81:04] lifting weights of cardio that includes [81:08] base training and Sprint intervals [81:11] anti-inflammatory nutrition early so [81:13] that it's just the way you live so that [81:17] when you're feeling so bad you're not [81:19] trying to learn all these things at [81:21] once and there is a significant link [81:23] between menopause and bone density [81:27] because you lose some of those critical [81:30] hormones like testosterone like estrogen [81:32] and testosterone so estrogen on [81:35] Bones acts to control the cell that [81:38] breaks down bones we talked about in [81:40] bone health there's a cell that breaks [81:42] down Bones called the osteoclast with a [81:44] c and a cell that builds bones with [81:47] called an [81:48] osteoblast estrogen helps control the [81:50] osteoclast so even in menopause when [81:55] there is no estrogen we're still [81:56] building bone but breaking down bone out [81:59] strips building bone so replacing [82:02] hormones helps rebalance bone breakdown [82:06] and Bone [82:09] rebuilding and if we lose our estrogen [82:13] around the time of this per menopause [82:16] menopause we can lose [82:17] 15% of our bone density and if we don't [82:20] catch it because insurance only pays for [82:23] dexas scans when we're 6 5 Which is far [82:25] too late in my opinion we're behind the [82:27] eightball so I encourage everyone once [82:30] they start going through par menopause [82:31] to get a dexa scan whether they have to [82:33] pay for it at their gym save up their [82:35] coffee money it's worth knowing your [82:38] bone status what are some of the most um [82:42] obvious but pertinent muscular skeletal [82:46] syndromes of menopause I'm glad you [82:48] asked that in July my group and I [82:50] created a [82:51] nomenclature called the muscular [82:53] skeletal syndrome of menopause because [82:56] women were showing up in my [82:58] office saying things without prompting [83:02] because I I'm a doctor who listens I sit [83:04] down on a stool we have a conversation I [83:06] do not chart in front of you so [83:09] people talk to me and out of nowhere [83:12] women would say to me Doc I feel like [83:15] I'm falling [83:17] apart and I don't know what's going on [83:19] but I feel like I'm going crazy because [83:21] I've been told nothing's wrong with me [83:24] and I started noticing that more and [83:26] more as women started coming [83:28] in with their shoulders not moving which [83:31] is an entity called frozen shoulder and [83:34] so as I [83:35] started looking at this pattern and [83:38] reading the very few studies that were [83:40] done we've known for 30 years that the [83:43] incidence of arthritis inflammatory [83:46] arthritis in women after 50 is much [83:49] higher than inflammatory arthritis in [83:50] men we've known it for 30 years and as I [83:54] started researching remember how I said [83:56] earlier that every muscular skeletal [83:58] tissue is derived out of the same type [84:00] of stem cell the mesenchimal stem [84:03] cell all of those tissues muscle bone [84:07] tendon ligament [84:09] fat muscle Drive stem cells are all [84:13] sensitive to estrogen and without it [84:15] several things happen there's something [84:17] called arthralgia which is total body [84:20] pain meaning your body hurts so much [84:24] that you can't even get out of bed that [84:25] was one of the biggest things I had I'm [84:27] an athlete and I could barely get out of [84:29] bed because I was so [84:31] inflamed due to the lack of estrogen [84:33] estrogen is a huge anti-inflammatory [84:36] agent so I was totally inflamed my body [84:39] hurt that's called arthralgia women come [84:42] in and I'm not kidding they come in they [84:44] say my arm won't move literally it won't [84:47] move or I can't hook my bra that is due [84:50] to the inflammation of losing estrogen [84:53] in Asian cultures it's called the [84:54] 50-year-old woman's shoulder because it [84:56] happens to 50-year old women it is a [84:58] sign of the inflammation of losing [85:01] estrogen we know about sarcopenia the [85:03] loss of lean muscle mass about 20% when [85:06] you lose your estrogen we've talked [85:08] about loss of bone density we have [85:10] increased incidence of tendon and [85:12] ligament problems Achilles tendon tennis [85:15] elbow patellar tendon because the [85:18] collagen fibers of Tenon and ligament [85:21] have estrogen receptors on them and so [85:23] everything starts to work less well [85:27] without the presence of estrogen so I [85:29] saw all of those things and we gathered [85:32] the world's data which isn't a lot a lot [85:35] more research needs to be done and we [85:37] gave it a nomenclature we called it and [85:39] published it as the muscul skeletal [85:42] syndrome of menac cause because I tell [85:44] you for sure Stephen if someone goes [85:46] into their doctor's office which in this [85:48] country is so restricted in the time [85:51] that we can spend and says I have this [85:54] and this and this and this and this six [85:55] things in 15 minutes it is difficult to [85:59] get through that but if someone comes [86:02] with a nomenclature of I think I have [86:05] the musculoskeletal syndrome of [86:07] menopause my arm doesn't move blah blah [86:10] blah immediately you don't have to go [86:13] through a differential diagnosis of 600 [86:15] things you're like oh as a [86:17] doctor this paper on the [86:20] musculoskeletal syndrome of menopause [86:22] has currently been downloaded almost [86:24] 300,000 times and to put that in [86:28] context some of the biggest journals in [86:30] the world medical journals in the world [86:32] documented they did a a survey of how [86:34] many times their best articles had been [86:36] downloaded the best scientific journals [86:40] their articles are downloaded about [86:41] 10,000 times this muscular scal syndrome [86:45] of menopause has been downloaded nearly [86:47] 300,000 and it's not because yes it's a [86:51] good paper the need is so great Stephen [86:54] to communicate what the heck is going on [86:57] with people that I made it open access [87:00] meaning you don't have to pay to get [87:01] this article and I encourage people to [87:05] Google it it'll come up number one to [87:07] print it to read it to give it to your [87:10] doctors so that they can understand that [87:12] you're highly inflamed that's why your [87:14] total body hurts that your shoulder [87:16] doesn't move because you're inflamed [87:19] that your knee hurts because you have [87:21] the arthritis of menopause and just to [87:24] build the understanding of what is [87:26] actually going on with people [87:29] fascinating I didn't mean 300,000 [87:31] downloads I know it's amazing it's like [87:33] a New York Times bestseller bestseller [87:37] research paper 30,000 p over or [87:39] something crazy crazy yeah [87:41] congratulations well you know what [87:43] research is a team effort and and we all [87:46] work together but thank you it's needed [87:48] used a word there arthritis which we've [87:51] not talked about yet but but used it to [87:53] describe your big toe as well yes I did [87:55] what is causing arthritis I don't want [87:57] to get arthritis oh who does there are [87:59] there are two kinds of arthritis there's [88:00] an autoimmune meaning your body is [88:03] identifying yourself as not yourself and [88:06] that's called rheumatoid arthritis that [88:07] is very different than the way I used it [88:10] today which is osteoarthritis which is [88:13] wear and tear arthritis okay so wear and [88:16] te arthritis can happen through [88:18] thousands and thousands of repetition uh [88:21] on a joint uh we were talking earlier [88:23] about running it's a thousand steps a [88:25] mile it can happen due to trauma I have [88:28] a lot of I used to take care of the [88:30] University of Pittsburgh football team [88:32] and I had a lot of 20-year-olds with [88:33] knee arthritis because the impact was so [88:36] great as linemen hit each other that [88:39] they would wear out their cartilage so [88:42] wear in ter arthritis [88:44] osteoarthritis is loss of the cartilage [88:47] layer on the end of bone it causes [88:51] aching pain it causes swelling it causes [88:56] stiffness uh and then to the degree that [88:59] you have it we can treat you [89:02] conservatively through a variety of [89:05] ways or at the end of the road we can [89:07] replace your joints I want to just [89:09] circle back on we were talking there [89:11] about the collection of symptoms that [89:12] are associated with menopause and you [89:14] were talking about how arthritis is a is [89:16] a factor are you telling me that to [89:19] avoid the muscular skeletal symptoms of [89:22] menopause [89:24] I should be taking hormone replacement [89:26] therapy here's what I'm telling you I'm [89:29] telling you that [89:31] every musculoskeletal tissue has Alpha [89:35] and beta estrogen receptors we know that [89:38] when those sit empty you will manifest [89:41] some of the muscular skeletal syndrome [89:42] of menopause 80% of us [89:45] do what I'm telling you is [89:48] that estrogen sitting in those receptors [89:51] can prevent bone loss can prevent muscle [89:54] loss can decrease the inflammation of [89:56] arthralgia and frozen shoulder so [89:58] everyone gets to make their own [90:02] decision people are thinking beings they [90:05] have agency they get to make that [90:07] decision to get out of pain and to [90:10] prevent the musculoskeletal syndrome of [90:12] menopause based on science and not [90:17] fear one of the um one of the things I'm [90:20] a little bit concerned about these days [90:22] is back pain yeah lower back pain in [90:25] particular um I read that lower back [90:26] pain is the single leading cause of [90:28] disability globally significantly [90:29] affecting individual's quality of life [90:31] and productivity which was published on [90:33] the World Health Organization yeah [90:36] article in 2020 lower back pain affected [90:40] 69 million people globally and its [90:44] prevalence is increasing due to a number [90:46] of different factors one being aging but [90:48] also I just think generally how we're [90:50] living more sedentary lives and sitting [90:52] on these chairs and stuff like that mhm [90:54] back pain yeah common thing only seems [90:56] to exist in the Western World I had [90:58] someone come here from the who studied [90:59] the hadza tribe in Africa and they don't [91:02] have back pain there yeah how do they [91:04] live not like this right they squat yes [91:06] they don't have chairs [91:08] yes well back pain is endemic in our [91:12] population due to our lifestyle we're [91:13] sitting here for several hours I'm [91:15] probably sitting like this all hunched [91:17] over at some points our our cores are [91:20] relaxed we're not our our front cores [91:23] are relaxed relaxed our our lower back [91:26] is relaxed there's no stimulus to keep [91:29] our core strong sitting in a chair and [91:31] we do this 10 hours a day at least [91:34] right that's number one number two then [91:38] 70% of people do no meaningful exercise [91:40] any time of the week so we never rebuild [91:43] it so we get low back pain due to muscle [91:47] weakness and another reason we get low [91:50] back pain particularly in women or very [91:53] elderly men is compression of our [91:54] vertebrae compression fractures of our [91:57] spine that can be very painful it [91:59] presents as low back pain I want to [92:02] differentiate for people listening the [92:03] difference between low back pain and and [92:06] nerve impingement that needs surgery low [92:09] back pain is that aching in your low [92:11] back the [92:13] stiffness when you go to a doctor with [92:15] low back pain there should be telling [92:18] you how to get stronger sending you for [92:21] physical therapy to stop smoking if [92:23] you're smoking CU that poisons bones [92:25] right all the lifestyle [92:27] things if you have pain starting in your [92:30] back but shooting down your leg like [92:33] electricity down the back of your leg [92:36] like literally think about how lightning [92:38] would feel that is because a nerve is [92:40] being impinged as it comes out of your [92:42] spinal cord that is something that needs [92:46] to be examined and looked at but I just [92:48] want to differentiate that because a lot [92:50] of people um mistake the tube to and a [92:55] lot I think it was 80% of westerners [92:57] will experience lower back pain and it [92:59] got me thinking about standing desks and [93:02] things like that do you advise people to [93:03] use standing desks I do and walking [93:05] treadmills um because there's so much [93:08] work that we do during the days that [93:09] isn't deep work we're emptying out our [93:11] email we're returning some phone calls [93:13] we're doing the less heavy brain heavy [93:17] parts of our job all can be done [93:19] standing or I've encouraged uh groups of [93:23] people that I work with to hold their [93:24] meetings doing wall squats just don't [93:27] sit at the board table pull up a wall [93:29] everybody's squat better be a pretty [93:31] quick meeting because that that takes a [93:33] lot of strength but to build in that [93:36] kind of Mobility the only time we really [93:38] need to sit is when we're solving World [93:41] Peace yeah the rest of it we can stand [93:44] and in fact Studies have shown that if [93:46] we're trying to learn something it's [93:48] better to be moving as we learn because [93:51] the kinetic energy of learning is better [93:53] for our brain [93:54] for instance I used an [93:56] example uh yesterday actually when I I [93:59] was teaching people how to time manage [94:02] and I said when I'm listening to long [94:04] form podcasts like this I can't sit for [94:07] three hours but I can walk and listen [94:10] and I retain more for instance [94:14] so that that been proven that if we're [94:16] in exercise we retain more in terms of [94:19] studying oh okay you've done a lot of [94:21] studies they're so fascinating H have [94:24] you got a favorite the very first one we [94:27] did on Master's athletes answering the [94:30] question at what age do we really slow [94:33] down because if you believe [94:36] Hallmark and all the uh rest in peace [94:39] balloons that go around on your 40th or [94:41] 50 birthday slowing down is an [94:44] inevitable part of aging but the fact of [94:47] the matter is and our study showed [94:50] that when I looked at track and field [94:53] ath in every race from 100 m to 10,000 M [94:57] and I looked at the top eight finishes [94:59] in every age group in every race that we [95:03] do not significantly slow down until [95:07] we're past [95:08] 70 so between 50 and [95:11] 70 the guy who won the one mile race [95:16] finished it in four minutes and 34 [95:18] seconds the same year of the study the [95:21] kid that won the high school mile race [95:23] did it in four minutes and 17 seconds [95:26] the 70 70-year-old who won the one mile [95:28] race did it in a little less than 7 [95:31] minutes it just shows you that if we're [95:34] slowing down dramatically before our 70s [95:37] we've either decided not to train so [95:39] hard we're just not trying anymore we've [95:41] been terribly injured right and we can't [95:45] but it's not because of biology because [95:47] of psychology exactly no light bulb goes [95:50] off we think though we think that when [95:53] we experience that first twinge that [95:54] first pain we start to get a little bit [95:56] tied we think it's natural so we kind of [95:58] relent to it we just give in and then [96:00] that's that slow spiral downwards into a [96:02] lifestyle which becomes self-fulfilling [96:04] I guess we stop trying hard we stop [96:06] playing hard because we stop trying hard [96:08] because we think it's inevitable we [96:10] think no aging is inevitable how we age [96:13] is is up to us you're working on a book [96:16] aren't you you've just handed in the [96:17] manuscript for we're very very excited [96:19] about this book unbreakable unbreakable [96:22] go strong live long age with power and [96:26] it really picks up the conversation of [96:28] aging and Longevity that I've been [96:30] talking about for a long time but really [96:33] focuses on the longevity of [96:36] women so the book is framed around the [96:40] pillars of Aging which I call time bombs [96:44] the time bomb of metabolic dysfunction [96:47] uh the time bomb that we think means our [96:49] DNA as our destiny which it is not we [96:51] can modify ourselves and several others [96:55] and really explain the science of what's [96:57] going on and that aging is not an [96:58] inevitable decline from Vitality to [97:00] Frailty unless we cop to that attitude [97:03] right and then the second part of the [97:05] book lays out a lifestyle that I call [97:08] unbreakable it's about muscle it's a [97:10] bone it's about nutrition but the most a [97:12] very important part is what you just [97:14] said it's about attitude and mindset and [97:18] so I help [97:20] people set standards and goals for for [97:23] what they want based on their values if [97:25] I didn't Value Independence if I didn't [97:28] value having my brain till the very end [97:31] and all the other things that I [97:34] value then my goals would be uninformed [97:37] I could say oh I want to run a marathon [97:38] at 80 but that's not enough unless it's [97:41] connected to my values and then further [97:44] along we talk about building resilience [97:47] because brain resilience can be built in [97:49] the same way that skeletal resilience [97:51] can and I believe it takes both both of [97:53] those things to progress and to age with [97:57] power and then the final sections of [98:00] this book really take us to the next [98:02] level how do we now that we've optimized [98:04] our health and decided that we are not [98:09] the [98:10] victims of time I don't believe that I [98:13] believe we [98:15] can shape our future how what do we do [98:18] for Peak Performance how do we continue [98:20] to squeeze performance out and what are [98:22] the cool techniqu technologies that can [98:24] help us I'm very very excited yay can we [98:27] pre-order it yet uh not yet but you can [98:29] get on my wait list on my website okay [98:32] I'll link that below for anyone that's [98:33] Keen to get that book I I'll be on that [98:35] list as well I'll give you one is there [98:38] anything else that we should have talked [98:39] about that we haven't Dr [98:41] vunda last week I was uh speaking at the [98:45] American Diabetes Association and [98:48] talking about midlife and menopause [98:50] which you and I have talked about and [98:51] all the metabolic changes that go on [98:53] when estrogen walks out the door and [98:55] we've already talked today about [98:58] pre-diabetes and how we need to put on a [99:00] big alarm because of all the metabolic [99:02] changes that will lead to diabetes and [99:04] Alzheimer's but when I look at those two [99:06] things separately per menopause and all [99:08] the metabolic changes and the lipid [99:10] changes and the fat distribution and the [99:12] insulin insensitivity and pre-diabetes [99:15] they are nearly identical and what we [99:18] know is that this is another alarm to [99:22] sound if we have not paid attention in [99:24] the critical decade of our lives and [99:27] become pre-diabetic and then are a woman [99:29] and lose our estrogen it compounds the [99:32] normal metabolic changes that happen [99:34] with insulin resistance to the loss of [99:37] estrogen and after menopause women have [99:40] more diabetes and therefore more [99:42] Alzheimer's and so if I can back all [99:45] this up and start people thinking about [99:47] it when we're 35 that is work worth [99:49] doing that's exactly what you're doing [99:52] it's exactly what you're doing I think [99:54] you know the reason I'm so compelled by [99:55] menopause as well a secondary reason is [99:57] because I have so many wonderful women [99:58] in my life incl including my partner who [100:00] yeah might not be as fortunate to be [100:01] exposed to all the information that I [100:03] get exposed to by doing this so many of [100:05] the questions I'm asking you almost pre- [100:08] preparing me to be a supporting act in [100:12] her in her life she's what 32 now so you [100:15] know critical critical years you know [100:17] what Stephen if I could get more men to [100:19] take the attitude that you've just [100:21] expressed to have the Curiosity it to [100:23] learn about the changes in midlife women [100:26] and not only bodily changes but but [100:30] attitudinal and the sexuality changes I [100:33] think we could save a lot of marriages [100:34] but I find that there is for the lack of [100:38] knowledge there is amongst the women [100:39] there is even less knowledge among the [100:41] men but if it's a partnership so I think [100:45] your attitude and curiosity is is [100:47] laudable because I think we could save a [100:49] lot of relationships if everyone felt [100:51] that way yeah cuz if for me it has [100:54] created a ton of empathy MH and with [100:56] empathy you approach challenges [100:59] differently with a different perspective [101:00] yeah and there's less blame and there's [101:02] more yeah I think supporting um [101:05] encouragement so that's really why I [101:07] think it's important as well for men to [101:08] understand these things [101:10] because when you start noticing [101:13] differences maybe in someone in way she [101:15] she's feeling or your mother or yeah [101:17] grandmother or even your [101:19] daughters you might not be some of those [101:22] you know naive doctors who think [101:24] someone's losing their mind or that [101:25] they're just being different or it's [101:27] their personality and you might [101:28] understand that there's something deeper [101:29] going on um and also something that's at [101:32] least in part you can do something about [101:35] absolutely which I think is the most [101:37] important conclusive point we have a [101:39] closing tradition on this podcast where [101:40] the last guest leaves a question for the [101:42] next guest with not knowing who they're [101:43] leaving it for and the question left for [101:45] you is how do you know when is [101:48] enough I think how you know when it's [101:51] enough when it becomes if it pertains to [101:54] work or striving for something or is [101:59] when you don't love it anymore when it [102:01] becomes a grind and you don't love [102:04] it that's when it's enough because it's [102:06] not feeding [102:08] you [102:12] amen Dr Vite thank you so much for the [102:15] work that you do um you're such a star [102:18] and I think everybody should go follow [102:19] you on Instagram because you built an [102:21] incredible community over on Instagram [102:22] where you give away so much of this [102:24] knowledge absolutely free of charge but [102:26] I also think everybody should go to your [102:28] website thank you they should buy this [102:30] book I know this book is um maybe they [102:32] should just get on the wait list for the [102:33] upcoming book as well unbreakable [102:35] unbreakable um and they can get on that [102:36] weight list on your website right now [102:38] yes they can join your Instagram [102:39] Community which I think is phenomenal [102:41] it's so wonderful to see yeah um how [102:44] because you know usually people have a [102:45] following but I really feel like you [102:47] have a community yes I see it in the [102:49] comment sections I see that people are [102:50] really really engaged and there as you [102:52] saw from the amount of people that [102:54] downloaded that paper that you published [102:56] there's a real thirst and hunger for [102:59] this information and I get so many [103:01] messages when from the last conversation [103:03] we had yeah but from these conversations [103:05] generally about from women from their [103:09] husbands who are so thankful for you oh [103:12] like so thankful it's you know because I [103:13] have lots of conversations about lots of [103:15] things but this particular conversation [103:18] provokes a certain type of energy that [103:19] is very atypical oh you know what I mean [103:22] you understand it because you feel it [103:23] every day but I really feel it as well [103:25] so thank you for doing the work that you [103:26] do and for turning the lights on for so [103:28] many people that are living in the [103:30] darkness as it relates to information [103:33] and that information is no doubt [103:35] undoubtedly saving many millions of [103:36] people's lives I hope so and that's work [103:39] worth we're doing so thank you so much [103:40] Dr vond thank you this has always blown [103:43] my mind a little bit 53% of you that [103:45] listen to the show regularly haven't yet [103:47] subscribed to the show so could I ask [103:49] you for a favor if you like the show and [103:51] you like what we do here and you want to [103:52] support us the free simple way that you [103:54] can do just that is by hitting the [103:55] Subscribe button and my commitment to [103:57] you is if you do that then I'll do [103:59] everything in my power me and my team to [104:01] make sure that this show is better for [104:02] you every single week we'll listen to [104:04] your feedback we'll find the guests that [104:06] you want me to speak to and we'll [104:07] continue to do what we do thank you so [104:09] much some of the most successful [104:11] fascinating and insightful people in the [104:12] world have sat across from me at this [104:14] table and at the end of every [104:15] conversation I asked them to leave a [104:17] question behind in the famous Diary of a [104:20] CEO and it's a question designed to [104:21] spark the kind of ation that matter most [104:24] the kind of conversations that can [104:25] change your life we then take those [104:27] questions and we put them on these cards [104:30] on every single card you can see the [104:33] person who left the question the [104:36] question they asked and on the other [104:37] side if you scan that barcode you can [104:39] see who answered it next something I [104:41] know a lot of you have wanted to know [104:43] and the only way to find out is by [104:45] getting yourself some conversation cards [104:47] which you can play at home with friends [104:48] and family at work with colleagues and [104:50] also with total strangers on holiday [104:52] I'll put link to the conversation cards [104:54] in the description below and you can get [104:55] yours at the diary.com [104:59] [Music]