The Midlife Muscle Loss Lie: How to Stay Strong at Any Age | Dr. Vonda Wright

0:00Jonathan Fields: Ever been told physical decline in muscle loss is just a natural part of aging? Turns out it's a complete lie. Research tells us you can reverse it once you know how. In today's episode, you'll discover how the science on muscle loss and aging got it so wrong. The relationship between menopause, muscle loss, and joint pain all over the body. We'll talk about the critical decade in midlife, when building muscle is most important, and why you're still never too old to begin, and how well-intended advice to avoid weights can be devastating and destructive, even coming from well-intended professionals.

0:37Jonathan Fields: And finally, what to immediately focus on to start rebuilding muscle, bone, mobility, and health. Our guide is renowned orthopedic surgeon, researcher, and author of Unbreakable, Dr. Vonda Wright. I'm Jonathan Fields, and this is Good Life Project, and we'll jump right in after this short break.

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4:31Jonathan Fields: And there's often so much mythology that gets built around that. So much great information, often coupled with misinformation. And it's so hard for folks who are just out in the public to figure out what is what. You make a really bold invitation. Invite us to reconsider what we call normal aging and say like, this isn't actually biology, it's behavior. You call it sedentary science. Take me into this concept. What do we mean by that? And how did you come to this? So, you know, what we know about aging is done from, by and large, now I've done some work, other people have subsequently done work in active people, but by and large, what we know about aging is from population studies.

5:21And I'll give you an example. There's a giant NIH-funded study, multi-center study called the Health ABC that was going on, when was that? In the late 90s or early? It was in the 90s and early 2000s. And what it did is it followed a cohort of 70-year-olds across a decade of their lives and just observed. And there were some active intervention studies. But what do we know about, so it's population. And so everything they observed took into account or was secondary to the fact that 70 % of people in the United States live sedentary lives. So when I say things like we die of sedentary death or the science is all a sedentary science, it's because do we truly know the trajectory of aging in people who remain chronically active?

6:20And so I'm not talking about pro athletes who may remain active or medal winners. I'm talking about mere mortal athletes like me who just invest every day in their mobility. What are we capable of if we take away the variable of sedentary living? And so what we find is starkly different than what we find in sedentary populations who just wait for time to happen as if longevity is a timeline instead of longevity being built by design.

6:57Jonathan Fields: yeah so then is it fair to say that most of what we've been told about this is what happens as we get older like this is the process of decline that you should expect to meet your body to meet your muscular schedule you know your all of your different systems that most of that information it sounds like is based largely on large-scale studies that measure populations that don't distinguish between people who are actually staying intensely or moderately active well into the midlife and later life. And those who, as you described, 70 % or so of people are largely sedentary. So we're sort of taking the assumptions about sedentary life as we age and applying them to everybody.

7:43Jonathan Fields: Is that right? That's true. Now, if you find yourself in the sedentary bucket, then we know a lot about what we can predict about your aging and ultimate frailty and the things that happen when we don't use this body that we've been given. Now, there are hallmarks of aging, things I call in my book time bombs of aging, that are real. biologic processes like senescence, which is, and we can go into this, but senescence essentially means cells are so damaged after their normal lifespan that they don't go into normal apoptosis and therefore accumulate and do bad things in our body. Or let's say telomere length shortening or inflamaging.

8:30There are 13 hallmarks of aging that we know are normal biologic processes, But the way that sedentary living fits into that is, number one, nothing's wrong with aging. It's the way we live. Number two, there are hallmarks of aging. But if we choose to not act upon our body's own capacity to modulate how we age, then we know how that's going to turn out. But what do we know? We know that between 70 and 90 % of our health and aging is due to the lifestyle factors that we do today. We can change senescent load. We can change telomere length. We can change inflammatory status. The list goes on, right?

9:21So you know what it does, Jonathan? It puts hope and power in our hands. Aging with frailty is not inevitable. We can change it if we choose to.

9:36Jonathan Fields: So let's tease out in a little bit more detail what aging and frailty versus, what would you describe as the opposite of aging and frailty? Aging with power. Aging with power. And what does that mean? You know what, when I think about that, what does aging with power mean to me? I want at every age to do what I want to do, when I want to do it, to the highest capacity that I can do it. You know, if I choose to sit in a wheelchair, it's because I want to be first in line at the airport, not because I have to, right? Not because my mobility has drained away from me. If I choose to travel alone when I'm in my 80s and 90s, I want to have built my health to be able to do that.

10:26So when I talk about aging with power, it's physically, but it's also a mindset shift that it's possible, right? And so what I see as an orthopedic surgeon is that many times men and women get caught up in our busy lives. We're building our careers. We're building our families. We're just feeling fine. So we don't invest in the capacity of this body until we reach an age when we're like, oh, my goodness, I can't get up from a chair anymore or I can't hop over this thing or I'm going to fall down. Right. That is not an inevitability. That is the consequence most of the time of not reinvesting every day in our mobility.

11:14I mean, it's interesting, right?

11:16Jonathan Fields: Because we've all heard the variations of ideas like once you hit your mid-30s, maybe 40s, every year there is inevitable shrinking of your muscle tissue in your body. And that maybe you can do something to slow it down, maybe even stop it, but it's really hard to do anything about that. That's sort of like this common thing that has been out there for a long time. And that, you know, by the time you're in your 70s, if you're fortunate to live in your 80s or 90s, that the muscle mass on your body, which is so important in letting you move through the world and also helping all different systems function, is just going to be a lot less than it was 10, 20, 30, 40 years ago.

12:02Jonathan Fields: Take me to the counter argument. it. So do we reach peak bone density, muscle mass, brain function, heart capacity by the time we're 30? Well, there's science to bear that out, that we reach a peak. Is it necessary to give in to the slow, steady decline that men go through? Men decline at about 1 % per year due to the loss of their testosterone and other things. Well, I would contend that although the numbers thrown out are you'll lose 3 % to 8 % of your muscle mass per decade after 30, right? Can you lose that much? Yes, you can. Can you build muscle at any age? And there's plenty of examples of this.

12:47Yes, you can. Or is it inevitable that you're going to lose so much bone density over time? It can be that way, but can you maintain and build bone? Plenty of examples. Yes, you can, but not without reinvesting every day in a lifestyle that maintains that. But here's the question. What if you wait too long? I get lots of emails and stuff from people like, oh my God, oh my God, I'm 60 and I finally got the message. Is it too late for me? Absolutely not. There are plenty of examples with proper lifting, proper feeding that we can rebuild the body. Will we rebuild it to 20? Maybe not. But can we rebuild it to healthy, vital, active, joyful, doing anything we want to do?

13:40I've seen it. I take care a lot of – I had a 63-year-old who came to train with us because he wanted to hike to base camp again. The last time he did it was 23. He wanted to go again. He's 63. He knows he's probably not going to do it at 97. What's the point? But, I mean, his muscle mass was tremendous. I just think that people give in too soon, right? They're like, ah, it's going to happen anyway. There was a study that came out last year that did show that there are two distinct inflection points for aging, 44 and about 60. Interesting. It's interesting to me. Do I read that? as a study that shows the inevitability of time and, oh my God, there's nothing you can do?

14:28No. I use that as if I don't do anything about it, I'm about to have a giant new inflection point. And that I use as a hopeful motivation, knowing that at my age, I have more muscle now than I did when I was 40. And if I believe the inevitability of decline, how could that be possible?

14:49Jonathan Fields: Talk to me about, because I think a lot of people are probably joining us saying like, This sounds really interesting. Talk to me about the three MRI images that you'll often explore, because I think it just really illustrates this idea that it is never too late. I love that you bring that up. And so in 2011, at the University of Pittsburgh, where I spent my academic career in orthopedics, I was fortunate to be surrounded by an entire menu of great scientists. And so we put together a working group called PRIMA, the Performance and Research Initiative for Masters Athletes, which means I only studied people over 40, right?

15:31If you weren't 40, you weren't cool enough and you weren't old enough. So one of the studies we did tried to answer the question, if we invest every day in our mobility, can we retain our muscle mass? And so now, again, the people I studied were not professional athletes. They were runners, triathletes. They were just people who invested every day. So we used MRI. We did MRIs of the thighs of people from 40. I can't remember the oldest. I'd have to look it up, 87 or something. And we did what are called axial slices, which for in layman's terms, looks like you cut a ham, right? The Christmas ham.

16:12And so in the middle of these images, which probably as I'm describing it, some of your listeners are going to say, hey, I've seen that picture. Because it's taken on a life of its own, Jonathan. It's everywhere on the Internet. But I love that it's so illustrative. The first picture of the 40-year-old thigh shows a giant femur bone in the middle. It's got a thick cortex. Around that, on the top, are beautiful quadriceps. Around the back are beautiful hamstrings. And there's a very thin layer of peripheral fat, which shows up white in MRIs. When we looked inside that muscle with special NIH software, where we found that there was not much intramuscular adipose tissue or marbling.

17:00These were not Wagyu beef. These were lean, flank steak people. And so we did that at every age group and compared it to sedentary people. What happened? So at 40, we have this gorgeous example of bone, muscle, and fat ratio. The second picture in the lineup is my control group, A group of sedentary people sat around at their desks for 35 years, hoping the time would be their friend. And what we found was that the cortex of the bone in the middle was very thin, which represents osteopenia or osteoporosis. The muscle itself had lost its distinct architecture. You could no longer tell the sheets of gorgeous muscle.

17:46and you can see with your naked eye the fatty infiltration, the intramuscular adipose tissue. And there was a thick rind, an intramor of fat. Now, fat is not just an innocuous tissue hanging around in bad places. It is a noxious metabolic organ. And so that's what you see in the middle. But what do you see on the other side? You see the same type of axial slice, meaning the ham-like slice of a 70-year-old triathlete, not a pro athlete, but someone who is just investing every day. And what you see is the same thick rind bone, muscle architecture that you can recognize, very thin fat layer. And when we looked inside, again, not much marbling.

18:34Now, we tested the strength of these people. And it wasn't until the mid-60s that their strength was statistically different. Functionally, not that different, but enough to be statistically different. So these three photos of the 40-year-old and the 70-year-old who look almost identical has become a beacon of hope for people like, does this even matter? Can I retain my muscle mass? Am I in control of my skeletal longevity? the answer is much more than you think you are. So let's get at it.

19:13Jonathan Fields: Yeah. I mean, which is, it's so compelling because it really does bump up against this idea that so many of us have been told for so many years that there is all you can hope to do on your best day is slow the process. But, you know, like their decline is inevitable. It's going to come. And you're showing visually, you know, and in data that we can do a lot of things. Like we are not powerless against this process, that it is much less about inevitability or even DNA and much more about what we say yes and no to on a daily basis. Does that land? Completely, Jonathan. We have the power to choose.

19:54We can choose to let time sweep us away and become frail, or we can get in front of it, as I like to say. Am I going to lose muscle? oh, well, the hallmarks of aging says I will. Well, what am I going to do about that? Right. How do I still be able to carry something of a mountain if I choose to? You know, I mean, I happened to choose to last summer. I can still do it. Right. Because I don't you like the thought of having that choice, Jonathan?

20:23Jonathan Fields: Well, of course. I mean, I think everybody loves that choice. You know, I'm somebody who turned 60 last year. And, um, I'm in that season where I'm like, I would love to hang on to what I have, or maybe even expand on it. Or, you know, I, I'm very fortunate. I spent my whole adult life in New York city. We were in Boulder, Colorado now. So I, I hike in gorgeous mountains four or five days a week year round. And I want to keep doing that. And I want to go up challenging steep faces and I want to do all these things for as long as I can. So, um, no, it's very inspiring. And we'll be right back after a word from our sponsors.

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25:05So about five years ago when a small group of us, which is now grown to be nationally, started talking about the transitions women go through in midlife out loud, shouting it instead of saying, oh, they're getting old or they're going through menopause. So I started thinking about how to communicate it in a way that people would understand. And so I thought, you know, my husband and I were a blended family. We have six children. We have gone through adolescence and puberty six times, right? Everybody knows the chaos in a person's life when they get their hormones. It's hormonal, psychological, physiological, social.

25:49Well, I started thinking about what happens in menopause when estrogen walks out the door. Our ovaries lose, they retire, they essentially senesce, they're unable to produce estrogen. It is the same physiologic chaos. It is hormonal, psychological, physiological, and social. It affects everybody surrounding the woman in the center of the family. So I made up the word menolescence because people instantly get it. They're like, oh, it's not just the cessation of your menses. It's this whole environmental and physiologic change. But I think words matter, Jonathan. And so I tend to make up a lot of words.

26:37Menolescence. Maybe we'll talk about the musculoskeletal syndrome of menopause. Skeletal longevity. And I just made up another one, the skeletonization of women, because I think when we can say something like menalescence and people immediately understand that it's this cataclysmic ecosystem of change, it helps people explain themselves better. Or maybe not feel quite so gaslit when they go to the doctor or they tell their spouse something, I don't feel like myself. And maybe they're told, well, of course not. You're just getting old. Well, of course you're getting old. We're all getting old. But this is different.

27:21Jonathan Fields: You just brought up musculoskeletal syndrome of menopause, which – so take me into this also, right? Because part of what you're describing are changes, systemic changes, physiological changes, behavioral changes, relational changes. is. But there's a basket of, quote, symptoms or feelings that tend to land in the body during this season that so often have been looked at just disparate. And you're like, no, no, no, no. There's something more connected happening here. So take me into this concept. You know, the first thing people have to realize is that there are estrogen receptors on every tissue in the body, the brain, the heart, the pink, everything.

28:08I can't name one that doesn't have estrogen receptors. The musculoskeletal tissues are the same. Bone, tendon, ligament, muscle, fat is a musculoskeletal tissue, cartilage, muscle stem cells, the disc, the annulus of the spine, all have estrogen receptors. So that's fact number one, right? Every tissue. So I've been an orthopedic surgeon since 1999. And over all those years, women have always come into me with their frozen shoulders or saying my body totally hurts and I don't know why. But it wasn't until I went through my own mental lessons. You know, I was in, I always like to say I was in the best shape of my life at 40.

28:50I really was until maybe now. And at 47, I thought I was going to die when estrogen walked out, right? At that point, I started listening to people differently because I understood what it meant when they came in and told me that their entire body hurt. It made a difference to me to know that frozen shoulder was an inflammatory process and without estrogen, we are highly inflamed. And then I started digging deep because I'm a curious person. I have to know everything. And do you know what I found, Jonathan? I found that for 100 years, 100 years, we have known about something called the arthritis of menopause.

29:401925, the paper was written. Do you think anyone's picked up the mantle? Not so much. In fact, I just presented last year to the International Society of Cartilage Research because they're like, you're talking about something. I think it has to do with us. And so my entire hope was to spark a new generation of researchers to solve this 100-year-old problem. Do you know how long we've known the association between estrogen and bone density? 86 years the first papers put it together. And yet we have millions of women with osteoporosis that we haven't solved, and one in two women having an osteoporotic fracture.

30:24And, you know, name a tissue in the skeletal system. So as I started reading, I'm like, there's estrogen receptors on every tissue. We've known these associations. I'm like, we need a language. Because Jonathan, when a woman goes into a doctor and says, my shoulder won't move, my total body hurts, I don't know why my knees hurt, my back. In a 15-minute insurance-based doctor's visit, it is understandable that the eyes glaze over because we're like, how are we going to solve six problems at once? But when someone comes in and says, or the doctor has read this paper that we wrote and says, I'm 46 and my total body hurts and I think I have the musculoskeletal syndrome of a menopause, it creates a common language and an ability to frame what's going on.

31:19Well, what's the root cause of that? Many times the root cause is decline in estrogen and nothing structural at all.

31:27Jonathan Fields: How much exposure has this concept and this language had in the profession? Like, because I would imagine that a lot of people are going to walk into their local or longtime doctor's office and say, like, all the things you just said, my knee hurts, my shoulder hurts, this hurts, all these different things. And as you just described, oftentimes, no shame or blame on the practitioner. They are operating very often in a system which gives them seven to 15 minutes to do everything. So often just on a practical basis. You know, it's like, well, we can address one of these, maybe two at the most, then come back maybe another time or four or five more times.

32:10Jonathan Fields: How do you get a concept like this to be mainstream language and to just be on the tip of the tongue when somebody, when a woman goes into a practitioner and says, this is what's going on. And the practitioner can just kind of be like, maybe we need to actually take a broader look. Maybe there's something bigger going on. You know, I think there's a couple things to unwrap there. Number one, I couldn't be more pleased with the exposure this particular paper has gotten. You know, we published it in the International Menopause Society Journal, Climacterics. I always say that word wrong. Climacteric.

32:46And, you know, it's been downloaded almost 550 ,000 times, which has got to be a world record for a paper. And I don't say that because, oh, my God, it's a Nobel laureate paper. Jonathan, it shows that the need is so great. right? People are starving. Women are starving for information. So number one, it's had a life of its own. But number two, the second thing to unpack is that every one of the women I ever talk to, whether it's individually in my clinic like today or from a giant stage, one of the main points that I try to translate is that they have to become completely literate in midlife and what's happening to them.

33:29They need to be able to converse in the language of perimenopause and menopause because gone are the days when the paternalistic era of doctor knows everything. Gone are those days. It was over when I was training, right? So I think people need to be as educated as they possibly can. But the reality is only about 7 % of all medical schools cover menopause at all. And only 30 % of all OB-GYN residencies cover menopause at all. And I can tell you as an orthopedic surgeon, it was never brought up. Even these associations with musculoskeletal tissue and estrogen. So that's why I think women have to be completely literate.

34:15So how is this information being disseminated? Well, people are reading the papers. They're downloading it. There's a group of us shouting from every mountaintop trying to educate people. We're doing big CME events to try to educate thousands of doctors because they certainly don't get it in their own medical school. And I'm thankful for podcasts and the popular press that are picking up the mantle of talking about 40 years of a woman's life that were never talked about before. I think it's going to take all of this, plus it's going to take a tremendous, almost insurmountable amount of catching up with the research because women's health research is vastly behind.

35:05Jonathan Fields: Let's spend a little bit more time on things that you brought up a number of times now, this idea of preserving bone and preserving muscle. And we want to do this because it allows us to do all the things we want to do in the world. You know, and that doesn't necessarily mean hike mountains or run triathlons, but it means doing a lot of everyday stuff that can just slowly sneak away from us. You talk about a critical decade for women, roughly 35 to 45 years old, as the highest leverage window for building the body that you will have for the rest of your life. Why that window specifically? And I'll tag this on also.

35:47Jonathan Fields: I think you've kind of answered it partially, because there will be a lot of people joining us who are older than 45 and saying, did I miss my window? So let's start out with why that window? Why 35 to 45? What happens in there that's so critical? I call the critical decade 35 to 45 because think about where we are in life. If we believe that our tissues by and large peak around 30. Now, every tissue has its own aging process, but that's a good line. What else is going on when you're between 35 and 45? Well, if we know that the average onset, the median onset of perimenopause, when we have so few eggs left that we're just sputtering along and it becomes hormonal chaos, that means that in the decade before, our ovaries continue to produce enough estrogen, which means that all the tissues are covered, the receptors are covered, and we have the biggest potential to maintain our peak or grow.

36:51So I call it, let's get our health standards in order. Let's figure out our mindset about aging. Good research has shown that how you age is deeply impacted by your mindset around aging, right? So let's pivot our mindsets. Let's read and become completely literate about what's to come. You should arrive in perimenopause as an expert in perimenopause. You should arrive in perimenopause knowing which direction you're going to go with your hormone optimization. You shouldn't wait until you feel terrible. Let's figure out ahead of time and figure out where to get them. Because it's a little hard right now to find a clinician who there's not enough clinicians to go around.

37:36Number three, if you have not started building the best physical body you can, let's go, people. Let's learn to lift weights. Let's learn not only how to build bigger muscles, but stronger muscles. Because why would we want that? It is about now. It's about feeling amazing now. I never feel more amazing than when I am at my strongest. But the reality is, why do women end up in nursing homes? Well, number one, 70 % of all nursing home residents are women. They get there for many, many, many, many reasons. But one, they can't get up from a chair by themselves, meaning they can't go to the bathroom by themselves.

38:17Or number two, their brains are not functioning anymore. They need memory care. They need assistance. Or number three, they're so incontinent that they can't be taken care of in their own homes. Well, what is the time to do all the preventive work in muscle building, in pelvic floor? It's when we have our estrogen in our 30s and early 40s. So mindset, become completely proficient in what's going to happen. Number three, we have got to start building muscle and lifting weights. So it's just a part of how we live, not some new habit. Number four, we must invest in our cardio. the number one killer of women in this country, is heart disease?

39:05It's not cancer. It's heart disease. When are we going to build our biggest cardio reserve? Well, let's start in our 30s, right? Can we please... I always hesitate. I say things like, can we please stop treating our bodies like a garbage disposal and putting whatever in there, the food, the garbage? Could we establish nutrition standards so that we eat enough protein, we get enough fiber, that it becomes our lifestyle and not just another six-week diet that leaves us frustrated, that it's so natural it takes no effort, right? It's just how I eat. It's what I do, right? So it's those lifestyle things in the 30s, in the critical decade, that if we build the big in us bank, that when we start losing our estrogen in a rapid way, it's not a slow decline, it's a precipitous decline.

40:07That we're not left socially, psychologically, physically, and hormonally devastated. That's why I think it's so critical.

40:19Jonathan Fields: And we'll be right back after a word from our sponsors.

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41:25Jonathan Fields: Go to wildalaskan.com slash goodlife for$35 off your first order of premium wild caught seafood. That's wildalaskan.com slash goodlife for$35 off your first order. Thanks to Wild Alaskan Company for sponsoring this episode. Good Life Project is sponsored by Orkin. Now, before we get back, we have a message from Ashley, the mosquito about Orkin. Hey, besties, hope all of you are high key so excited for summer. It's literally giving all of us mosquitoes life. So we thought we'd help everybody make the most of it before Orkin pros try to ruin our fun. Remember, if you have standing water on your lawn from the pool or the sprinkler, let it sit there.

42:04Jonathan Fields: the more the merrier and when they're standing water there'll be plenty more mosquitoes next up is a bit of a hot take we're so hype on it let mosquitoes inside what could go wrong just let us inside please thanks love you finally the number one rule this summer is do not under any circumstances speak to anybody from orkin that's literally so cringe and will ruin the vibe of any get-together we might be having take it from mosquito orkin pros know literally everything about us, period. Don't visit Oregon.com for a free estimate today.

43:01Jonathan Fields: white-knuckling my way past the foods that I actually really wanted. Then I found Hero Bread, and that whole mental model just kind of fell apart. Here's what got me. It actually tastes great. The texture is soft and fluffy the way bread is supposed to be, and the numbers are genuinely surprising. We're talking zero grams of sugar, zero grams of net carbs in the sliced bread, and up to 32 grams of fiber. My go-to is still the Everything Bagel, 19 grams of protein, and it holds up beautifully toasted with eggs. And I've also been all over the Hero noodles lately. 12 grams of protein, 80 calories per serving, and pasta night is fully back in rotation.

43:36Jonathan Fields: No compromises, just the meals that actually make you happy, working with your goals instead of against them. So go to hero.co, that's h-e-r-o dot c-o, and use that code goodlife at checkout for 10 % off your order. So let's circle to the second half of that question that I asked them because somebody is joining us and they've just heard you say this and they're in their fifties or sixties and they did not pay attention in 35, 40. And again, we're like, there's no shame, no blame here. Like we've all had very different access to information and we're told very different things earlier in life.

44:14Jonathan Fields: Right. Um, but I want to make sure that that person who's joining us is not feeling really defeated by what you just said. Well, I love that you've taken the time to step back for this because here's what I know. Here's what I know from observing people in my ecosystem. Here's what I know from doing the actual science. There is never an age or skill level when your body will not respond to the good stress you put upon it. For instance, when I was starting down the road of researching aging and musculoskeletal longevity, and you do all the background reading and you learn what's out there. Some of the very first studies that I read were done in the early 1990s by Maria Fiataron, who her research group took 90-year-old men in nursing homes and did chair exercises with them.

45:09And by retraining their neuromuscular pathways over six weeks, they increased their function by more than 100%. 90-year-old guys sitting in chairs in a nursing home in six weeks, right? So there is never an age to when you can't reclaim the potential your body has. Your body can rebuild muscle. Your body can stabilize and rebuild bone. I mean, you can sharpen your brain. And there are myriad examples all over the internet now. I mean, they're everywhere of people showing their transformations from in their 50s being unrecognizable to now in their 60s being stronger and feeling more healthy and vital and having higher capacity than they've had in decades.

46:02So will it take longer the later you start? Sure, Well, it'll take longer. But can you? Yes. Are you worth it? Yes. What is the outcome if you don't? Well, I see the future of frail women every single day as an orthopedic surgeon. It is not a future that we would aspire to, but we can step in front of it.

46:28Jonathan Fields: So I want to make sure I have my head wrapped around it. There is this optimal window somewhere between 35 and 45. And of course, that's going to be different for each person. But this is a yes and thing, right? Like, yes. And if you're in that window and you're joining us, like, get at it. Get at it. Let's go. And if you're past that window, even significantly past that window, that doesn't mean that you're foreclosed from so many of the benefits. It just means you may have to go about it differently. It may take a little bit more intention, a little bit more effort and more time to accumulate many of similar benefits.

47:04Jonathan Fields: Is that right? Completely. You know, if you haven't stepped away from the couch in 30 years because whatever, you're busy, people depended on you. I start people as simply as going back to the very first skeletal skill we ever learned. We learned to walk when we're one year old. So I encourage people who are like, I don't know where to start. It's just so hard. I haven't done this. And I mean, listen, you cannot excuse me. I've been doing, I've been a doctor a long time. So I say, well, okay, we're going to start with walking. We're going to start by walking every day after your largest meal. So we get a dual benefit, right?

47:45We're walking and we're pushing our glucose into our muscle with activity. And we're going to do it for seven days. You're going to commit that you are worth it for seven days. And you know, why I say seven days is because in running communities, I used to be a distance runner, that's a streak. And after seven days of doing something, you don't want to not do it. You've done it for a whole week. So you're going to do it on the eighth day and you're going to do it on the ninth day. And do you know, I just had a woman in my clinic today who used to be, uh, do competitive bodybuilding, but life happened and health happened and, uh, her job happened, right?

48:25And so she came to me one month ago, devastated by not even recognizing herself. And we had this conversation, and we just laid out really simple ways to start. And do you know what she reported me today? I'm so proud of her. Every day since she left me, she has taken a walk. and she hasn't missed today. She has a 30-day streak. It has changed her mindset. It has changed the relationship with her husband because now she's actually becoming herself again. It has given her the motivation. Now our next step is to get her back into the gym lifting weights. So it doesn't have to start if you're listening and you're in that boat where it's been 30 years.

49:11It doesn't have to start in a complicated way. We're going back to basic skills. You're going to commit to yourself for a streak because then we can add a little bit at a time. I think that makes a lot of sense.

49:28Jonathan Fields: No, it does. You keep referencing lifting. And I know part of what you have talked about and written about is not only lifting but lifting heavy. So take me into why this matters. I say you need to lift weights because what happens? As we age, we will lose our type 2 muscle fibers first. Type 2 muscle fibers are the fast twitch that keep us upright, that keep us from falling down. We also will, without rebuilding muscle, the population studies show, population studies again, we will decline 3 % to 8 % muscle mass per decade such that by the time we're 70, we're 30 or 40 % down. It doesn't have to be that way, but it can be that way.

50:08I specifically ask people to lift. All lifting is good, but you got to know why you're lifting. If you're lifting for endurance, then fine. Lift your five-pound weight 30 times. You do that. My goal is not endurance. My goal is strength and power. If you're lifting for the biggest possible muscles, hypertrophy, fine. Lift moderate weights 10 to 15 times. That's not my goal. My goal is to be strong enough to lift my own body or an average-sized man out of a dangerous situation, right? It's for safety. So to build strength, you have to lift heavier weights fewer times. So the range is three to six.

50:54Now, I know from taking care of people for so long that people like specific instructions. So in Unbreakable, my book, I have chosen four reps, four sets, because that's how I lift, right? That's how my strength conditioning coach, he's a CSCS, which is the highest certification you can get in strength and conditioning, taught me to lift. So four reps, four sets, that will build strength. But that's also not where we stop. We need strong and we need power. Why do we need power? So when you trip over your bag that you put by your desk, you're fast twitch enough that you don't fall, right? So how do we build power?

51:37Power lifting has to do with tempo. So it's lighter weights but faster. Midlife and beyond, I teach people to lift for strength and power because that's what's going to keep us from falling down. That's what's going to keep us independent and hopefully out of a nursing home.

51:58Jonathan Fields: So walk me through what this actually looks like. So in a practical way, because I don't know what the percentage, you'll know the percentages on this, the percentage of both men and women. But from what I remember, it's higher in women who, by the time they're in the mid-50s, they will have some imaging that says there's either osteopenia or osteoporosis. I think those numbers are pretty substantial. Or they've got some imaging or some diagnosis of something happening in a joint or some arthritis or some compression in the discs in their spine or bulging or something like this. And they've been told, do not lift because this is going to make everything worse.

52:46Jonathan Fields: Where do we go from there? Lots of people are told that. Oh, I have bulging discs in my back. I can't possibly lift. Oh, I have arthritis in my knees. The best thing for me to do is just to rest. That is not what the data shows. The data show people with bulging discs not only can lift but should lift. They have to do it carefully. They have to do it with good form. But the stronger you are, the less pain you're going to have. Everybody has bulging discs. I mean, random samples of non-painful people will show bulging discs. So the PT data and the orthopedic data show that strength is so important for people with low back pain and bulging discs, number one.

53:40Let's take knee pain. I've got knee pain I can't lift. Well, you know why you probably have more knee pain than you have to have. It's because your butt core and hip are so weak that your knees are pounding together. What if your muscles were so strong that they shock absorbed you, right? So I think that whole knee-jerk reaction of, I don't know, I've got some finding on x-ray is bad data. Because what orthopedic surgeons will tell you, like if we're deciding to go to surgery, if we're deciding to replace your knee, we don't treat x-rays. We treat people. And so you wouldn't even know that you had this on your x-ray unless you were symptomatic.

54:29So we don't treat x-rays. We treat the people. So you may have the world's worst x-rays showing the most arthritis, but unless you're painful or have decreased capacity, there are no limits to what you can do. So show me the data and I'll change my tune. But it's the same kind of thing that when people say, oh, don't run, running is going to cause arthritis. There are no data to support that. Arthritis is caused by genetics. It's caused by carrying around too much weight. It's caused by trauma. It's caused by high inflammation. But it's never been shown to be due to the repetitive nature of normal running gait.

55:12Jonathan Fields: So part of what I hear you saying then is that we may have diagnoses, we may have imaging that show that these things exist in our bodies. That does not by default preclude us from doing this. I would imagine you would also advise people to not just show up on a gym on a random Wednesday, load a bar up with like the heaviest weight that you can find in the gym and go for it. Like there's an intelligent way to do this. That's so right. You're really good at summarizing things. You know what? Lifting weights well takes meticulous form. Are your knees over your ankles or, you know, are you stacking your joints?

55:55Are you hinging correctly? Are you bracing so that your back is neutral and not curved? I mean, there are thousands of form errors to get hurt in a gym. So I encourage people, if they're just starting out, this is the perfect time to tell your family, I don't want a toaster. I don't want a new purse, whatever. Buy me a trainer. And then it behooves the person to find a qualified trainer because there are trainers who just get a certificate off the internet. And there are trainers who have an exercise physiology degree or have gotten a certification like the CSCS. Know who you're being trained by, but be trained.

56:38Mobility is going to save your life. Skeletal longevity and doing everything you can to maintain it is going to save your life, right? It can be the savior of your life. It can be the gate that keeps you from it. I think it's really important to think about. Yeah.

56:55Jonathan Fields: And also, I would imagine the thing that That makes you so much more capable of enjoying the life that you have, no matter how old you get. Yeah, nobody aspires to miss out. Somebody joining us is probably, we're at a point where they're kind of nodding along and saying, this sounds like there's a lot of evidence. You're clearly somebody who has an astonishing depth of both practical, clinical experience, and deep in the research. And they're not alone and saying, yeah, this makes a lot of sense. Yes, I want to do this. I'm going to start tomorrow, right? But then they get to the gym. We're going to start today.

57:29Jonathan Fields: Right. Or today. In five minutes. Ten minutes after we're done talking. We're going to get up and take a walk. Exactly. And they start to do some of the things. In particular, let's talk about lifting. Because a lot of people have a really negative association with lifting. And while some people actually really do just intrinsically enjoy the activity of lifting heavyweights, a lot of people will report that it's the thing that they loathe. They'll do it because they know it's really good for them. They have to. but they don't naturally gravitate towards doing it. No, I get that. You have a really interesting invitation around the end of your book.

58:06Jonathan Fields: You ask every reader of Unbreakable to write down their own vision.

58:13Jonathan Fields: And it sounds like part of this is because your ethos says, for a lot of folks, it's not enough to just say, I have to do this. You have to be moving towards something bigger that you want, where you know this is going to contribute to the vision that you have in your mind. Is that right? So I think we, I think we, to truly stay motivated, we have to know what we value. So I've said to you before at the top of this hour that I value doing what I want when I want to do it. It makes me angry to not be strong enough or not to be able to do something. I want to ask for help because I want to ask for help, not because I can't, right?

58:56Well, if that's what I value, then my goal is to stay strong enough to do that. Well, if my goal is to stay strong enough to do that, then it's going to take some work in the form of protein and lifting. Now, I'll be honest with you, and I say this all the time, I am not intrinsically motivated to exercise all the time. It is not my personality nor genetics. Do I exercise all the time? Yeah, I do. Enough. I don't exercise all the time, but four or five times a week, right? I do not love it. I do not love powerlifting until I am walking off the powerlifting floor. I've dropped the weight, the deadlift for the last time.

59:43In that moment, when my blood is pumping and I have done something I've never done before, like maybe I piled on five more pounds than I've ever had, and I feel, I'm going to swear on your podcast, I feel like a total badass. That's when I love lifting. And for that five minutes, that's enough to motivate me to the next time. And then maybe when I tend to, I learned to do this from a bodybuilder named Michelle who runs a group called the Wonder Woman. They take pictures every month of their progress. So you can see the leanness that's happening from building muscle. So I do that, right? I do not love lifting until I'm walking off the floor or I'm seeing the difference, the health in my body.

1:00:38And that's okay. So if your listeners are like, I hate this. Why would I want to? It's okay because I have a bigger value. Therefore, I have a goal. Therefore, I have to act on it. And just be truthful that every time I do it, I don't love it until I'm done. that's the honesty and authenticity it takes to be persistent yeah i love that i mean that and i think so many of us have probably felt that feeling of um i love having just done it

1:01:12Jonathan Fields: you know it's like i feel amazing i feel confident i feel strong i didn't know i could do that and now i have this glow because i've just shown myself that i could do something i didn't think i could do or i question and it makes me feel amazing and now i kind of want to go back even though I know it might not feel great when I'm doing it because I want to see what else I can do. It feels like a good place for us to come full circle as well. So in this container of Good Life Project, if I offer up the phrase to live a good life, what comes up? To have lived a good life to me will have been to be healthy and vital and active and really joyful personally and in the lives of my family, that will have been a good life to me.

1:01:56Jonathan Fields: Thank you. So let's talk about some of the big ahas and actionable takeaways. The thing that's really staying with me right now in the conversation is the MRI images she talked about. The 40-year-old thigh and the 70-year-old triathlete's thigh, almost identical. Dense bone, clear muscle architecture, thin fat layer, and then the sedentary control in the middle of that comparison. same age range, but completely different, degraded, shrunken tissue. That image just does something to you. It makes the abstraction of, quote, staying active, suddenly very concrete and very personal. A few more things I want to walk away really thinking about here.

1:02:35Jonathan Fields: One, sedentary signs. Almost everything that we have been told about what to expect from aging was studied in people who did not move in any meaningful way. That means the data we've been giving about inevitability is not the full story. Second, this term menolescence, this is not just menopause. It's a hormonal, physiological, psychological, and social upheaval. And naming it that way, it changes how you walk into a doctor's office and what you're able to ask for. And third, the critical decade is real. And it is also not a closed door. So whether you're in or past it. The body responds to good stress at any age.

1:03:20Jonathan Fields: 90-year-old men in nursing home chairs improve their function by more than 100 % in six weeks. Your window, no matter your age, is never closed. So the next time you hear that your imaging findings mean that you should not lift or that your muscle loss is just part of getting older, remember this conversation. The data says something different. And as always, this conversation is not medical advice. It's for the general public and information only for specific guidance. Be sure to check with your personal qualified healthcare and or fitness professional. And hey, before you leave next week, I am sitting down with Sari Baden to talk about why the life that you keep putting off might be the most honest thing about you and what it actually takes to stop waiting for permission to live it.

1:04:06Jonathan Fields: Be sure to follow Good Life Project wherever you get your podcasts so you don't miss and do me a quick favor, share this conversation with just one person. This episode of Good Life Project was produced by executive producers, Lindsay Fox and me, Jonathan Fields, editing help by Troy Young, Chris Carter crafted her theme music. And of course, if you haven't already, follow us wherever you get your podcasts so you never miss a conversation. Until next time, I'm Jonathan Fields, signing off for Good Life Project.

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