Ep. 492 Everything You Know About Aging Is Wrong – The Shocking Science That Reverses Decline with Dr. Vonda Wright
- Team Cynthia
- Aug 15
- 33 min read
Today, I have the honor of reconnecting with Dr. Vonda Wright, a renowned expert in Aging and Longevity with over 20 years of experience in orthopedic surgery and sports medicine. She is also the host of the Hot for Your Health podcast.
In our discussion, we examine how mainstream news relies on sedentary science, highlighting the hallmarks of aging and the value of shifting mindsets around aging. We explore the foundational role of mitochondria in cellular health changes as we navigate the aging process, looking at satellite cells and the communication between muscle, bone, and adipose tissue. We also discuss the musculoskeletal syndrome in menopause, VO2 Max, and the science and lab testing that can help predict longevity and peak performance.
This conversation with Dr. Vonda Wright is truly invaluable, and I highly recommend her book, Unbroken, as a powerful resource for understanding the transition from perimenopause to menopause.
IN THIS EPISODE, YOU WILL LEARN:
Vonda explains how mainstream news is based on sedentary science
How hormonal changes impact muscle quality during the perimenopause to menopause transition
Why exercise is essential for rejuvenating muscle stem cells and maintaining muscle mass as we age
How satellite cells can lose their regenerative capacity through inactivity
Why exercise is necessary for producing Klotho (the longevity protein)
How your muscles, bones, and fat are in constant communication
The benefit of VO2 Max for understanding how your current level of fitness will project into the future
The importance of knowing your longevity goals for creating a balanced fitness plan
Knowing the difference between being lean and being healthy
Why muscle mass is crucial for your health and mobility
The specialty labs Dr. Vonda uses in her practice
“The first thing it takes to change course is a mindset shift.”
– Dr. Vonda Wright
Connect with Cynthia Thurlow
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Submit your questions to support@cynthiathurlow.com
Connect with Dr. Vonda Wright
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today, I had the honor of reconnecting with friend and physician colleague, Dr. Vonda Wright. She's a renowned expert in aging and longevity with more than 20 years of experience in orthopedic surgery and sports medicine, as well as the host of HOT for your Health. Today, we spoke about how mainstream news is based on sedentary science, the value of mindset shifts around aging, the hallmarks of aging, including how mitochondria are at the basis for nearly all cellular health changes as we navigate the aging process, the impact of satellite cells, how muscle, bone and adipose tissue communicate, what the musculoskeletal syndrome of menopause is, VO2 max, longevity science and specific labs that can help predict longevity and peak performance.
[00:01:17] This is truly one of those invaluable conversations with Dr. Wright and her book Unbreakable is one I will recommend for all listeners to purchase and use as part of your longevity protocols and just to better understand our bodies as we are navigating perimenopause into menopause.
[00:01:38] Dr. Wright, such a pleasure to have you back on the podcast. I really enjoyed reading your book.
Dr. Vonda Wright: [00:01:42] Thank you so much for having me. I always love talking to you.
Cynthia Thurlow: [00:01:45] Aw, well, thank you. There's a point that you make early on in the book that mainstream news is based on sedentary science. Share with my community what that means because I could not agree more.
Dr. Vonda Wright: [00:01:58] So, when scientists, particularly epidemiologists, look at cohorts or groups of people, they take all comers, actually. And well, they should, right? They're like anybody that wants in, gets in. And so, a good example of this is the Health ABC. It's a huge NIH funded study, it was taking place at the University of Pittsburgh while I was there and they took a cohort or a group of 70-year-old men and women and they just followed them for 10 years to see what happens to these people as they age. And from that they drew conclusions that said, “Oh, aging people lose their muscle in their thighs. Oh, aging people, this” okay, aging people with the characteristic of being all comers.
[00:02:48] That means that if it's from the United States, 70% of people in the United States do no form of organized mobility or exercise in any day. We get up, we go to a kitchen, we get in our car, we sit at a desk, reverse course, go to bed. So, the conclusions from much population research that come out are based on what happens if you live in a sedentary way, not what happens if you're the Masters Athletes I study from either the senior games or my own patients, I do have a large group of pro-athletes and elite athletes because I'm a sports doctor. But in everyday practice, I've just gotten done with my clinic. They're mere mortals like me. I work out, I compete sometimes, but I'm not a pro.
[00:03:42] Unless you study us or you or people like us who are just invested every day in our mobility, you can't really say what we're capable of as we age, because if you study populations, you study sedentary people.
Cynthia Thurlow: [00:03:57] I think that's a really important distinction. And I find that the older I get when I'm looking at my peers, if I look at people I went to college with or graduate school with, or high school with for that matter, I think that there's this mindset of I'm going to slow down with age, I'm going to have joint pain, I'm going to experience weight loss resistance, I'm going to have poor sleep. I'm not going to be able tolerate eating the foods that I used to eat. And I think that helping to dispel this mentality, to encourage people to think like an outlier and not like the average is a way that is incredibly inspiring because I cannot tell you how often I will hear from just peers, this is normal. And I'm like, but we don't want to be normal.
[00:04:42] We want to live with vitality from now until the end of our lives. I think when I worked in clinical cardiology, I saw so many patients. It was really the outlier patient that was still incredibly active and doing yoga or maybe they weren't running anymore, but they were very physically active. And they were also the patients that were still cognitively so incredibly sharp. And so, I think movement and being mobile and not being frail and dealing with falls is really what we should all be aspiring to as opposed to accepting, like, “Oh, this is something we just have to accept. We're going to get frail, we're going to break our hips, we're going to be in a nursing home,” which is what a lot of my patients believe. They thought that that was their destiny.
Dr. Vonda Wright: [00:05:28] Well, listen, it can be your destiny, it can be if you do nothing to change course. And I think the first thing it takes to change course and something really apparent from what you just said is it takes a mindset shift. I call it mindset mobilization. Because if you believe all those things you just said and that it's inevitable and that nothing you contribute to the equation is going to matter, then what the heck? Why not eat the Bonbon, sit on the chair and I mean, why not? If you believe that or you believe, oh, activity and vibrance is only for people less than 30 or 40, then why try? But that's not destiny, that's giving up.
Cynthia Thurlow: [00:06:15] Yeah.
Dr. Vonda Wright: [00:06:16] Giving up. And I'm encouraged. When I was a little girl, we had this one woman in town, Millie Hartung, who was my only example at the time of an old lady, [Cynthia laughs] vibrant, running down the 5K races, right? Millie Hartung at the time was only 60, [Cynthia laughs] I mean she's just a little older than me. I'm like-- But at that time, she was such anomaly. And then I grew up and there were more of them and more of them and my own dad's 86-year-old Masters Athlete and then I started taking care of Masters athletes and seeing that, “Oh my God.” So, what I'm hoping to see is that these are not just one-off people. It's not so unusual that we all share it on the Internet. You're like, “Oh my God, look at this person.”
[00:07:04] But that we reach some critical mass because enough of us like you and me have pivoted our mindset to look to the future as best of times, right? So, I think it starts with mindset.
Cynthia Thurlow: [00:07:17] No, I couldn't agree more. I think for so many people, as you're navigating that perimenopause to menopause transition, there's so many hormonal changes that are contributing to the multiplicity of symptoms we experience, down to a cellular level. I would love to talk a little bit about how does the perimenopause to menopause transition impact our muscle. I think this is very important for women to understand that it is not just in your head, it is not from lack of effort. Our hormones start to work a little bit against us. And so, helping us understand at a population level, like some of the big level concepts that are happening underneath the surface that are impacting our muscle quality.
Dr. Vonda Wright: [00:08:01] So, I once asked my social media crowd, what have doctors said to you? And I'm so sorry that we've said those things to you, but one of a common theme is that, “Oh my God, you're just getting old.” It's just aging, right? Well, there are 13 hallmarks of aging. There are true biological pathways that change over time. They are well described. First there were six, then we're 12, not 13ish. And in the book, I describe six of them because I think they're the most pertinent. I want to acknowledge, yes, there are things that happen at a cellular level. But here's the deal, let's talk about estrogen, let's take bone and muscle as an example. There is the natural decline that happens with age. Studies show you can lose 3% to 8% of your muscle per decade starting at age 30.
[00:08:53] That's what everybody quotes. I just saw the reference to the study this morning. But when we lose our estrogen, it affects more than hot flashes, night sweats, all the things that people talk about. It affects us, it affects our mitochondria. The mitochondria are the energy powerhouses that live largely in the muscle. Their job is to take the glucose that is given to it out of our blood, and not only glucose, fatty acids and amino acids and glucose, and turn it into the energy coin of our body, the Bitcoin of our body, ATP, which is the energy. So that's mitochondria's job. Mitochondria have alpha and beta receptors to estrogen.
[00:09:37] Estrogen, alpha and beta, little baskets. Estrogen sits in it. And estrogen is critical in antioxidant defense, which is all those free radicals, those waste products of normal metabolism. It's critical for energy defenses. It makes mitochondria more healthy. It helps mitochondria divide so there's more of them to make more energy. All within muscle, dependent on estrogen load. The estrogen is an anabolic steroid, meaning it is a building stimulating steroid. Without it, we have less anabolic stimulus. So, thus, let's do it ourselves. Let's lift harder and give our bodies that strategic stress. So, when people say, “Oh, it's a normal part of aging, there is normal aging and then there's the precipitous change that happens when estrogen walks out the door in muscle, in bone.
[00:10:34] I recently talked about this in front of the FDA. I said to them, “Listen, it's not just aging, right? Because everybody wants to attribute to that and what's the big deal. In fact, some of the naysayers on social media, maybe we shouldn't talk about it. [Cynthia laughs] They're like, “What are you talking about? It's all natural aging.” There is decline, 1% to 2% for bone, 1% to 2%, not the precipitous 20% decline in five to seven years. That happens in bone density. That, my friends, has to do with the hormonal changes associated with midlife and menopause. So, that's how I pull it all together. Yes, aging happens. We can even step in front of that. But it happens differently for men and women based on our hormonal status.
Cynthia Thurlow: [00:11:22] You mentioned the FDA meeting that occurred last week, and you did a beautiful job. I actually finally had time to catch up and listen to you and Dr. Casperson, Dr. Hirsch, and so many other experts. And thank you for the work that you do advocating on behalf of women. And I think it really comes down to understanding that we can say that we want to age naturally, and I respect that. But when you start to understand what is brewing beneath the surface, yes, you can have no symptoms on paper, but there is so much that is changing underneath the surface that I find a lot of women are shocked when they're 55, 60. They're like, “I can't put muscle on. I'm suddenly osteopenic. Does that mean I'm going to be osteoporotic?”
[00:12:06] And so that just continues to unravel as we get older. And so, I always say, like, “Yes, we want to age as appropriately as possible.” I'm not advocating that we reverse age, but I think it's important that we be proactive about the aging process, which, if we're fortunate enough to live long enough, is truly, it's something that we're fortunate to be able to do. Let's talk about satellite cells. I think this is really interesting when we're talking about muscles and how the loss of estrogen is impacting whether or not we can actually trigger muscle protein synthesis. I just think this is an interesting concept, one that I just talked about on a podcast like one of my AMAs, when people were asking, why am I struggling to build muscle at this stage of my life? And this definitely contributes.
Dr. Vonda Wright: [00:12:51] So, satellite cells are muscle derived stem cells that live in the basement membrane of muscle. A stem cell means that the science word is pluripotent, meaning the stem cell can actually become anything when stimulated by its micro environment. So, these stem cells live in the muscle and do their stem cell regenerative thing. But with age, they become exhausted, they lose their stemness, they stop dividing, they lose the morphology of a stem cell, meaning they go from grape and fat to spindly. Literally, they look like tree branches when you look at them under my scrub. “Oh, fat happy stem cells.” And they become all spindly and fibrotic. We know that because some of the lab work I did at University of Pittsburgh was with this type of cells. And in animals, they were animal models and then we repeated it in humans.
[00:13:46] But with age alone, that's what happens. We lose our stemness, we lose our dividing capacity, we stop producing growth factors, and we actually turn on the cell death programming called apoptosis. With something as simple as exercise, we can re-stem stem cells, meaning there is something about exercise. And I had these mice running on a treadmill, people running on a treadmill. [Cynthia laughs] Their stem cells fatten back up and look alive. They start producing growth factors. They turn off the signaling to death. And so, when you rejuvenate the stem cells in the muscle basement layer, they then do what they're designed to do, which is produce new muscle cells, help produce some of the cells to produce the myokines that then talk to its microenvironment.
[00:14:32] So, you just set up in my mind this rejuvenation, a system where you can renew, where with aging alone and sedentary aging, worse, you lose that ability. We think that a decline in estrogen, also, through a mechanism that I don't exactly know, increases how rapidly stem cells age and also decreases their regenerative capacity. So, if you're sedentary without estrogen, it's a double whammy.
Cynthia Thurlow: [00:15:03] Yeah, it makes so much sense because I reflect back on multiple family members who kind of fell outside that WHI time frame. And remembering my grandmother who passed away in her early 90s, and she was a retired nurse. She was sharp as a tack till probably the last few years of her life. But she still went fishing in Colorado. She herself was in her 80s and still volunteering at the senior center. And she said to me, “Cynthia, if you slow down, you die.” That was her mentality. And so, she knew that being active was really important. But she would go to the senior center and she would do her weight training and participate in her classes. And I think that is a mindset that I think for many people, they just forget how important it is to move. They really forget how important it is to move.
Dr. Vonda Wright: [00:15:51] Yeah, I Agree with you. And I love that story of your grandmother, and it's so true. My office, where I'm in my clinic today, is on the third floor of this place called the Lake Nona Performance Club. It is a Taj Mahal gym. [Cynthia laughs] Like, listen, it's all that and more, plus all this biologic metabolic stuff. But listen, there are people in this community. This is their job. They have retired from their day job, and they're here all day. They take this class. They take that class. They have their private lifting sessions. They're in the pool. They're sitting in the hot tub. This is how they've retired. And I got to tell you for sure, I don't think I'm ever going to retire. But when I talk about it, I'm like, I'm going to retire to live-- [crosstalk]
Cynthia Thurlow: [00:16:38] Yeah like that.
[laughter]
I think that sounds like a great idea for sure. There's a longevity protein that you talk about that was new for me called Klotho.
Dr. Vonda Wright: [00:16:48] Yeah.
Cynthia Thurlow: [00:16:49] We talk about Klotho? Because I know that it's involved in protection of skeletal muscle mass, and I'm just curious how it fits in with some of these other things that are changing as we're getting older.
Dr. Vonda Wright: [00:17:00] So, you know what? I was an academic faculty. My entire research area was musculoskeletal aging and longevity. And so, we did these studies in Masters Athletes that found that you can keep your muscle, you can keep your bone, impact exercise is better than no impact. We did this great study that showed you can retain the executive function in your brain. So, we got through all these body systems and we're like, but why? [Cynthia laughs] What is the mechanism? So, we started tooling around, and we discovered this protein, and I pronounce it Klotho. It could probably be both ways, but it was first described in Nature Journal.
[00:17:41] You know more than 30 years ago, Klotho is the goddess who spins the thread of life. So, the scientists who discovered it called it that, and it is called the longevity protein, because every system from brain to heart to muscle to bone, has receptors for Klotho. And what we know is when you engineer mice to not be able to make Klotho, you can do that genetically, take that gene out. Those mice die very old, very young. So, they're little young mice, but they're already old lady mice, right? Because they don't have this protein, which seems to help regenerate. And I don't know that we've worked out the exact mechanism of when Klotho sits on a receptor, this is what downstream. But here's what we do know, we know and maybe somebody's worked it out and I just don't know.
[00:18:35] But it's in our own laboratories, my lab partner Fabrisia Ambrosio found that we can stimulate the transcription which is what we call making proteins, transcription of Klotho by contracting skeletal muscle.
Cynthia Thurlow: [00:18:52] Amazing.
Dr. Vonda Wright: [00:18:53] Not amazing, just skeletal muscle contraction. So, I took my Masters Athletes and I said, “Well it stands to reason if you're doing a lot of muscle contraction, you'll have more Klotho.” So, I had a young group of athletes measure their Klotho. I had a young group of sedentary people mother their Klotho. Had an old whole group of athletes measure their Klotho. I found that not surprisingly, the young athletes had the highest level. Not surprising. Come on, they're young, they're exercising. [Cynthia laughs] But do you know these old people who were exercising had more longevity protein than the sedentary young people.
Cynthia Thurlow: [00:19:34] Wow.
Dr. Vonda Wright: [00:19:35] Isn't that fascinating?
Cynthia Thurlow: [00:19:37] That is fascinating.
Dr. Vonda Wright: [00:19:38] Yes. With something as simple as contracting skeletal muscle. Fascinating.
Cynthia Thurlow: [00:19:42] That is fascinating. And it just goes to show you why it is so important to be physically active.
Dr. Vonda Wright: [00:19:49] Yeah, we're designed-- [crosstalk]
Cynthia Thurlow: [00:19:50] Yeah, people take it for granted. So, when we're thinking about communication and this is what this is all about, the muscles communicating and triggering this protein. How do like muscle and bone and adipose tissue all communicate together? I think this is fascinating. I mean this is part, I'm a physiology nerd. I just enjoy understanding the way the body works but there's constant communication. There's no silos in the body although traditional allopathic medicine might want us to think otherwise.
Dr. Vonda Wright: [00:20:19] Yeah, that's right. So, what you're talking about is the fact that sometimes we think of muscle doing muscle things, just contracting to lift that bone does bone things, just supports the muscle and that fat just hangs off in inconvenient locations giving us grief, right.
[laughter]
[00:20:39] That not only do they do those jobs, some of the most simple parts of their jobs, all three of them are endocrine organs, meaning they produce hormones. Those hormones talk to themselves and those hormones talk to other body parts. Let's take bone for an instance, one of the many hormones that bone produces is called osteocalcin. It produces many. But osteocalcin is produced by bone. It goes to the brain and helps the brain produce bone-derived neurotrophic factor to produce more neurons. The bone does that. We know there is a connection. Although, we're working out the mechanism between Alzheimer's and osteoporosis because of this bone-brain connection. So that's number one.
[00:21:26] Osteocalcin also goes to the pancreas to help with insulin secretion. It goes to the muscle to help with glucose metabolism. If you're a man, it goes to your testicles from the lytic cells, helps you make testosterone. Why wouldn't a brilliant and intentionally designed system. If you need to communicate, why not use a pathway that goes from the top of your head to the bottom of your foot? Why would you make bone throughout the body and only give it one job? Why can't it multitask? And that's just one protein. Muscle makes a lot of proteins, irisin, myosin, galanin. All these proteins that talk to other body parts. Fat makes this protein called leptin, which affects the bones, it affects the muscles.
[00:22:13] So, there's this constant communication going on all the time. The problem is we just don't hear it. It's happening, but we're just deaf to it. So, we don't even listen when our stomach hurts, let alone listen to what's happening at a protein level in our bodies. But isn't it fascinating?
Cynthia Thurlow: [00:22:33] It is fascinating, and it was something that we've never talked about on the podcast before, which is why I wanted to make sure we tied that in. Now, in my new book, which is really focused on the gut microbiome, I do have a whole chapter, courtesy of all that I've learned from you, talking about bone and the gut microbiome. Because there is a gut-bone-microbiome access. But I think it's really helpful to think about this musculoskeletal syndrome of menopause, which, again, this is your research, new terminology for so many of us, I think it's important to understand because it's a constellation of symptoms that all come together that are a byproduct of this menopausal transition. And I think now that there's terminology, hopefully, there will be more research and more emphasis on helping women understand. Like, it is not just we have to worry about our hearts, our bones, and our brain. There's so much more to it than that.
Dr. Vonda Wright: [00:23:31] Well, you know what? I just think it takes a certain curiosity like you've just talked about to keep discovering this paper you mentioned the musculoskeletal syndrome of menopause. I just have to put a timestamp because our group released that about a year ago. And this curiosity has made-- last time I checked earlier this week, 400,000 women, probably women, have downloaded this paper. Now, I am humble enough to know that this is probably not God's gift to papers. God's gift to the medical literature, I think it's a good paper, but what it shows me is that women are dying to know more about the communication in the body, what's going on in the body, and to listen better, I guess, is my point, to listen better by knowing more.
Cynthia Thurlow: [00:24:19] Yeah. And I think it's also, very important for clinicians to understand that this is a process that's ongoing because, again, I think we think of our bodies in these silos like, this is a heart problem, this is a brain problem, this is a bone problem. And yet there's all this interconnection. And one thing that I found really interesting, you do a really amazing job talking about what type of testing can we do to assess our muscle and overall aging? You know, what are the things we can be doing objectively to help us determine what are the areas that we need to focus on? And I would love to talk about VO2 Max and why it's so important.
Dr. Vonda Wright: [00:24:59] Sure. I think there are many tests you can do at many different levels. But if you're looking for the test that has the best research for saying, how fit am I now? And what does that project into my future, I think VO2 max is the one, grip strength is also fine, sit to stand is fine, speed test. But VO2 max, so what it is a measure of how much oxygen you are able to pass from your heart, through your lungs into the blood. And it is a measure of how great the system is working. With no intervention, research shows that you will have a VO2 max decline of about 10% per decade. And like, “Oh, that's nice. What does that even mean?” Well, here's how I apply it clinically.
[00:25:46] There is a line called the frailty line. If your VO2 max is below that line, that is the functional-- the fitness level, when you can no longer get out of a chair by yourself. If you can't get out of a chair, you can't get off the toilet, you can't live alone, you probably can't open your own pickle jars, you just have to live with your family, live with a helper, or go to a nursing home. So, nobody wants to get below the frailty line. So, let's do the math. I think in the book, I talk about what my VO2 Max was when I was 50, which was the last time I did it. And I don't do it all the time because, frankly, it hurts.
Cynthia Thurlow: [00:26:27] It's not fun.
Dr. Vonda Wright: [00:26:29] Not fun. I prefer not to be throwing up on a treadmill, but it's interesting. So, at 50, my VO2 max was around 50. I think it was like 48, but who can do the math? So around 50, if I drop by 10% per decade, at 60, it's going to be 45. At 70, it's going to be 40. At 80, it's going to be 35. No matter how long I live, unless I'm up into 150, am I ever going to pass the frailty line? So that's how I use it functionally. The good news is you can train your VO2 max. I don't train people to do this right out the door. We don't step off the couch and then go train our VO2 max.
[00:27:11] But when you have your aerobics down, whatever you do for your heart down, and it's a habit, then you can add on VO2 max training, which is as hard as you can go for four minutes and then recover for four minutes, as hard as you can go for four-- and you repeat it four times once a week and it's hard. But I layer that on after we have a good baseline to try to stave off this 10% decline.
Cynthia Thurlow: [00:27:35] Well, I would imagine the average person, I think, a sprint for 20 seconds, 30 seconds, maybe moving quickly for a minute, four minutes is quite a bit. I think most people would probably not feel so great in the beginning, but that is purposeful.
Dr. Vonda Wright: [00:27:53] Well, and it's purposeful. [Cynthia laughs]. I don't expect you to feel good during the sprint. But just to delineate what we're talking about, so in Unbreakable, I talk about baseline when I'm prescribing aerobic fitness, I use an 80:20 method. 80% of the time we're in base training at low heart rate, brisk walking, having elevation on the treadmill is working hard, but not that hard. But it's great for your mitochondria, amazing for mitochondrial flexibility, great for general health. 20% of the time, I want you to jack your heart rate up as high as it's safe. I do it sprinting, you can do it on a rowing machine, the VersaClimber, anything you can do, but it's getting your heart rate really, really up. That 30 seconds is about all you can do and then you recover.
[00:28:45] The four minute falls just below that, really, really hard, but probably not full out sprinting. And they work different ways, but both of them are strategic stress, meaning you're working your body hard enough that you know it's alive, you're not dying somewhere. This is strategic stress, which is good for your body.
Cynthia Thurlow: [00:29:08] Well and I think that's an important distinction. It's a purposeful action, it is this hormetic stressor, it's designed to stress the body. Obviously, we're not doing it when we're jet lagged. We're not doing it when you have a poor night of sleep. We're doing it on a day when we've had adequate recovery. We've properly providing nutrition to our bodies and that's probably a whole separate tangential conversation. I'm sure you probably have patients like this. But I think we've gotten into this methodology and social media is both good and bad, right? I think we can have lots of great positive influences on social media and then we can have the opposite of that. And I find a lot of women as they're navigating this middle age point, they sometimes resort to extremes.
[00:29:53] The overexercising, the over restriction of food, over fasting, not enough sleep. They're just not taking care of themselves. And do you find when you're working with your patients that you probably have people that you have to encourage them to back off on the intensity as much as you appreciate intensity, asking them to back off on intensity and be a little kinder to themselves.
Dr. Vonda Wright: [00:30:15] Well, there's phenomenon in sports medicine, overuse syndrome. There is energy deficiency either because you're not eating enough or because you're burning 10,000 calories a day and then you're not eating enough to resupply. So, the body loves homeostasis, it loves eating enough to support your exercise. But I want to introduce a concept. I didn't write about it in the book. I should have. But you have to know what you're working for. And here's what I mean. Tell me how this resonates with you. I work with high-level performing athletes. My husband was a high-level performing athlete. If you are going for performance, if the circle of the Venn diagram is performance, you are going to be doing lots of reps. You're going to be doing it all the time in a very specific way. That may not infer longevity, the other circle.
[00:31:11] Because for longevity science sometimes that's about calorie restriction and moderation because the goal is to live longer. So, performance does not infer longevity. It's a flash in the pan. It's a few years of high performance. Longevity is a long, slow grind and not always that fun because, I mean, look at some of the people who are trying not to die in this country, and wellness is a happy medium, but it's never going to be enough for performers and it's not going to be long enough for longevity people. And so, you have to ask yourself, why because when we go back to your example of, I mean, my office is in a gym. There are people on the indoor football field who burn it out in high intensity classes every single day. And every month they're in my office with overuse injuries, and then they're wondering why they're not losing weight, why they're gutting it out. It's just because of all the things. There's no homeostasis.
[00:32:18] So, how does that sit with you, this Venn diagram? The performance is not longevity. It's not necessarily wellness. What are we working for here?
Cynthia Thurlow: [00:32:26] Yeah, I think it's an important distinction to make. What are your goals? What is realistic? I find that at this stage of life, me personally, there is far more desire to be very clear and intentional about what I'm doing day to day. Whereas before maybe I wasn't getting enough sleep and I was on call and my kids were younger, my husband was traveling, I was over exercising, I was probably over fasting. And now I'm like, “I want to build muscle.” So, building muscle means I need a wider feeding window. It means I need more food, it means I need more sleep and I need more recovery because I'm lifting heavier.
[00:33:02] And so I think for each one of us, we have to ask ourselves, like, what are you willing to, I don't want to use the term give up, but what are you willing to accommodate to make sure you're focused on that goal? For me, I, I think longevity is important, but I also think it's important to build muscle. And I have to deviate from being so rigid about fasting in order to build muscle. And so that was the, I guess the compromise that I made given the goals that I had for myself.
Dr. Vonda Wright: [00:33:29] Right, exactly. Because that’s a dialogue because fasting is a great reset. It's a great anti-inflammatory tactic. But to your point, you may not be feeding enough to not become frail.
Cynthia Thurlow: [00:33:46] And that's where I think body composition and this is something I talk about all the time. Like if you just get on a regular scale that's giving you information, but it does not per se give you the kind of information you'll get if you're measuring fat free mass to muscle mass. And that I think is important. I have shared very transparently with the community that my goal, my functional med doc and I were like, “Okay, we need to put on 5 pounds of muscle and I want you to lose 7 pounds of body fat.” Well, the first time we reassessed things, I gained 3 pounds of muscle and a pound of fat. And so, I said, “I wish it was the reverse, but it is what it is.”
[00:34:20] Meaning I wish I'd lost 3 pounds of body fat along with gaining 3 pounds of muscle. But I think for so many of us, we've grown up in an era where we're so fixated on the number on the scale and I think that, now maybe we're entering an age where we're talking more transparently and openly about why body composition is far more important than just one numerical adage that we get when we step on a regular scale.
Dr. Vonda Wright: [00:34:45] I think most of us or maybe most of us don't. I was thinking about, I was just at a beautiful community event this weekend and I was looking around, even commented to my daughter, wow, these women around here are really lean and fit. It was just the group of people in that community. And then I saw a few women who were underfed and frail looking. I think in their quest to be healthy, it is sometimes, to your point, easy to be unhealthy and overdo it and just get stuck on a rut. I sometimes think most of us can see that though, can see the difference the same way we can see someone who's metabolically unhealthy. We can see someone who's underfed and not see them in judgment. But I'm just seeing our eyes can tell health.
[00:35:34] There's this vibrance of being fedm a vibrance of enough energy, a vibrance of-- I am not the skinniest person in the world. I am not the skinniest I've ever been, but I'm probably as healthy as I've ever been even at my age. And so, I think that's the balance. Does that make sense that I personally am going for?
Cynthia Thurlow: [00:35:55] Yeah, absolutely. And it's interesting and to your point about, it's not judgment, it's observational. I think if we're clinicians, we're constantly just observing patterns and things that we see. And for probably two years I was doing more Pilates than I was lifting. And I finally said to my doctor, I was like, “I'm looking around the room and I love everyone in this community of women. They're amazing.” I said, “But I see more skinny fat people than I see people who look like they have a healthy amount of muscle on their bodies.” And I there's women that are doing three Pilates classes a day. I'm like, “Why is that happening?” And so, it really, forced me on many levels to really rethink.
[00:36:36] Like, okay, I want to be more conscientious about building muscle because you know better than anyone, you see these women, you're on call or you're in the hospital and you see these women who they lose muscle, they become frail, they fall, they break a hip or they hit their head or they fracture a wrist or whatever is going on. And do you feel like there's growing awareness around this that you're seeing less of people that are-- maybe they're more focused on the muscle piece, building piece, being healthier, as opposed to just letting the entire musculoskeletal syndrome of menopause evolve and devolve.
Dr. Vonda Wright: [00:37:14] I see from several viewpoints. If I were looking at the point of view of just my social media feeds and just the people like you, I communicate with, I'm like, “Oh my God, we're doing this great job. Everybody's getting it,” right? Because the algorithm has figured out what [crosstalk] [Cynthia laughs] Or if you read some fitness trends data like I love this company called Fitco, they accumulate all these data. Well, according to Jim's, there's a 258% increase in women demanding weight machines in the gyms. And I love that trend. And I think to myself, “Wow, I hope we are getting to a critical mass.” I think a critical mass for changes between 30 something and 40%. Like that many people are doing it. There's a momentum, the zeitgeist is changing.
[00:38:05] But then I come back into traveling, being in airports, or sometimes my clinic, although my clinic isn't a gym or just the population we were talking about. And I see that even though many, many, many people know that doesn't mean we're taking action. Or maybe there's still a complete knowledge gap on to what will help us or maybe we know what to do, but there's still that emotional burden of whatever carrying around that prohibits us. I had a woman tell me just now when she's stressed, she eats. I think that's pretty common for many of us. So, that's a very long-winded answer to saying I think we're making progress. I don't think we've reached critical mass because I still see populations in need.
Cynthia Thurlow: [00:38:57] Oh, absolutely. And I think it's both give and take. I think that it's going to take a whole tide of change of not just clinicians but patients coming to us and saying, “Hey, I want to make a change.” And I think that there's lots of good options that are out there. But I think for many people it's the growing realization that we cannot not strength train, we cannot not be interested invested in healthy aging and putting ourselves at greater risk for falls and issues related to that. I think about, I have a family member who fell and fractured her hip three years ago and then last year fell and broke her femur, same side. And she has not been mobile since last year because she now needs a knee replaced.
[00:39:43] And she is sharp as a tack. And that is the thing that is most frustrating is she is so smart and so aware of what's going on. And she said, “This is really, really frustrating.” And so, being able to see that from a personal and a professional perspective, that's what we want to try to avoid is getting ever to being at that point where we're no longer able to be mobile.
Dr. Vonda Wright: [00:40:04] Well, and you know what the reality is? It takes one fatal fall. I see it, I see it all the time. I had this woman come and tell me about-- She was an ICU nurse too and she was taking care of an 87-year-old woman who was the community driver. I mean, she's frail, but she could still drive. And she was driving around all her other lady friends even though they were younger than her. So, they were out just doing their thing. She's driving people to doctor’s visits and she's 87. But she fell and in this fall it didn't mean she didn't have bone osteoporosis before, but she had just never fallen. She fell, she broke three ribs, which it makes it really difficult to breathe. And she broke her hip, she broke her shoulder and it was an overwhelming amount of stress. She was 87. Her 70-year-old son didn't know what to do. Because she's so hurt. But the day before she was just fine.
[00:41:03] So, I say all this to say this is the picture of a fatal fall. It's the one thing that totally screws up your brain. But listen, it's not a hopeless message, but we've got to get in front of this. I'm preaching to the choir. It starts in your 30s. Yeah, definitely by the time you're 40. Let's just say we're going to make the decision to take estrogen optimization. Let's say we're going to make that decision in our lives.
[00:41:37] Well, it's fine and dandy to start that at 65, when insurance will finally pay for your DEXA scan. But research shows that to have a long-term outcome on your bone density and to use estrogen as the way to get there, you need to be taking it for 10 years. It's not enough to start it at 65. So, these are decisions we need the millennials to be making so that the minute that their estrogen walks out, they either know whether they're going to or they're not. They're not going to be spending a decade figuring out the answer to this. Because if they are fine, then they're going to add lifting and all the nutrition and all the lifestyle. If they're not fine, they're going to double down on their lifestyle and their lifting. And you just can't wait though, right?
Cynthia Thurlow: [00:42:24] Absolutely. And I hope that subsequent generations, because of the work that you and others are doing in this space, they're, A, more aware of their options and that they can advocate for themselves. I think the DEXA at 65 to me is criminal, that should be done baseline. How many women just lose bone mass while they're breastfeeding? Like, no one talks about that, exactly. No one talks about that. I breastfed two kids for two years and I'm like, “No wonder why I was osteopenic in my 30s.” Having said that I want to make sure that we touch on lab work. You do mention labs and the Unbreakable and some of these are new for me. I wasn't aware that we could test an intracellular NAD that was new. Maybe this is just in specialty clinics.
[00:43:06] Talk a little bit about some of the lab work that you talk about. These are specialty labs. These are probably labs you're going to need to work with someone that's in this space that can order for you. But I thought these were really interesting.
Dr. Vonda Wright: [00:43:18] So, the way I approach people is I have a longevity practice in addition to orthopedic, this is a framework. People will come to me and want to do evidence, influence, longevity, weird stuff that [crosstalk] [Cynthia laughs] rats and mice. Fine. Okay. If you're willing to talk through the risks with me, I'm willing to go down that road. But listen, not until our health is optimized. We are not skipping from average health to longevity stuff. We are going to optimize health. And then if we do that, then we can work into peak performance, such as what we do for our pro athletes, squeezing the performance. And then when we're totally perform like you are at the top of your physiologic game, fine, we'll add some stuff that's only been true proven in rats. [Cynthia laughs]
[laughter]
[00:44:11] It's hard to convince them otherwise. But not in my clinic until we optimize health, we optimize peak performance, then we'll say, “Okay, well let's decide what to do there.” So, what you're talking about are the peak performance labs that I like to get. And so, one that you mentioned is intracellular NAD+. Now, NAD+ is a coenzyme in more than 400 reactions in our body that are involved in body energetics. We know that with age the intracellular level of NAD declines such that in our youth the intracellular level is about 60. But when I first had mine measured when I was 50, I was tired every afternoon, exhausted like I lay my head on the desk, get something from the vending machine, tired. And my NAD+ was 18.
Cynthia Thurlow: [00:45:09] Wow.
Dr. Vonda Wright: [00:45:11] I know. So, what our body can use to make NAD+, this coenzyme is something called NMN or that because in one step NMN is made in your body to NAD+ and your body needs to do it. I am of the school that your body needs to make the NAD+ to and put it in the cells. So, you give it the toolbox NMN. You can also give it NR, which takes two steps to get to NAD+, but that we measure that. So, I use a lab called Jinfiniti. I know the researcher and we can measure that because I want to know if supplementing you is making a difference. So, it's a before, it's a be after with an intervention in between. I also tend to like to measure senescence. You can measure senescence a few ways. One is by drawing blood and through lab methods like PCR, count the actual senescent cells by their cell markers. There's a lab in Vail run by another researcher that I've worked with for 20 years named Johnny Huard, who will measure the cells. [Cynthia laughs]
[00:46:19] For that we can measure something in the blood called beta-gal, which is an indirect reflection of your senescent load. So, what is senescence? Your crowd has probably heard of this, but I'm going to review it. There are four destinations of cells in your body. I always tried to figure out which fingers to use without flipping people off for this. [Cynthia laughs] But there's stem cells. We talked about them. They can become anything. Stemness. They're mature cells. The stem cells make a mature muscle cell, fat cell, cartilage cell.
[00:46:54] And then when these mature cells are done working, they turn on program cell death and they die. That is normal. This is what we want. But there's a population of cells who have done their job, but they're too damaged from their job. The trauma was too great, and they can't die. So, we call them zombie cells. They're called senescent cells, and they circulate around in the body secreting all kinds of noxious inflammatory cytokines that can lead to disease. So, we want a very low senescent cell load. Well, we measure that with either the number of cells measuring beta-gal, and then when we see it's high, which it often is, we do the inflammatory lifestyle with exercise, with nutrition, with a supplement called fisetin or quercetin, which I found out when I was reading my book out loud.
[00:47:47] I've been mispronouncing for years, but I'm just going to say quercetin, and we get that naturally from strawberries. But it's one of those things like resveratrol. You have to drink 7,000 bottles of wine to get the right dose. So, those are two of the specialty labs. I draw measurements of total oxidative load. You can get these at regular labs. I draw IL. Several of the interleukins I draw. Plus things like what's your liver doing? What's your uric acid doing? Some of those things you just don't find in regular chemistries or lipids. Just to do a little deeper dive into performance type labs.
Cynthia Thurlow: [00:48:26] I love learning about new labs. I was like, “These are all new to me. This is fascinating.”
Dr. Vonda Wright: [00:48:31] Good. [laughs]
Cynthia Thurlow: [00:48:32] Yeah. Well, I so loved our conversation. I want to be respectful of your time. Please let listeners know if they've been underneath the rock, how to connect with you. How to purchase your new book, Unbreakable, how to learn more about your work.
Dr. Vonda Wright: [00:48:44] So, I am on Instagram nearly every day. It's my primary teaching platform. But it's only 90 seconds. So, if you want a deeper dive with me, I have a YouTube channel. I do a podcast myself, and a newsletter, all under @drvondawright. I'm trying to be consistent. You can find it all on my website, www.drvondawright.com. Can I show people the cover of my book?
Cynthia Thurlow: [00:49:06] Absolutely.
Dr. Vonda Wright: [00:49:06] So, this is the galley. Here it is. This is out August 26th. And I've just dumped my brain on the way I treat patients. And there is going to be an app released with it on August 26th.
Cynthia Thurlow: [00:49:19] Oh, exciting.
Dr. Vonda Wright: [00:49:22] On the unbreakablebook.com. In here you notice that there's an unbreakable assessment. It contains the ability to use AI to analyze your data for assessment. So, we're really excited about it. Just as tools for learning about your body.
Cynthia Thurlow: [00:49:42] I love it. Thank you for all that you do.
Dr. Vonda Wright: [00:49:44] Thank you. Thanks for having me.
Cynthia Thurlow: [00:49:48] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.
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