The Ageing Doctor: These Are They Early Signs Of Arthritis! If You Run & Don't Do This, Start Now! The Secret Cause of Alzheimer's!

28:25And it can cause, it can aid in the neuroprotective effects. So what does that mean? Under normal metabolism. We develop free radicals due to normal metabolism, cell work. We develop oxidative stress, and osteocalcin works to decrease that oxidative damage to repair cells in the brain. So that's number one. Number two, it stimulates the release of something called brain -derived neurotrophic protein, BDNF factor. which stimulates the growth of neurons in a part of the brain called the hippocampus, which is involved in memory. And here's the opposite side of it. We know in people that have low bone density, they also have higher brain cognitive dysfunction with age and vice versa.

29:23There's an association in the literature with osteoporosis and cognitive decline in vice versa. I heard you and the business insider interview do describe that being a critical decade. Yes. For bone health. What is the critical decade? I think the critical decade for most of our health, Stephen, is no later than 35 to 45 for men and women. That's because we know for women, that's when estrogen starts to decline or become chaotic. So when we're in our 30s to 40s, that is the time to get all of our health habits together. It's time to get a physical to see what your baseline labs are. I think it would be critical for men and women, particularly men, to get a baseline test of our own so that in the future when we're thinking about supplementing test of our own, we're supplementing back to your particular level.

30:17Because in the future, let's say when you're 50, a man's test of our own could be 600, which falls within the normal range. But if he's still feeling low energy, not himself, a lot of tendon and ligamest injuries, well, his young testosterone might have been 800 or a thousand. So I like people to get baseline labs that they've never entered the doctor before, around 35, all things, so that we know what we're returning you to. Number one, number two, if you have been so busy with your career and stepped away from any semblance of mobility and resistance training. Now is the time because had I known then what I know now, when I was 40, I was training for triathlons.

31:03I was an aerobic athlete, right? I ran, I biked, but what I would have done then with what I know now is I would have been lifting a lot of weight to build maximum muscle while I still had the most hormones to start at a better place. Because you can build muscle, but it's better to start from a higher average. So get some labs, make a relationship with the doctor, get all your preventive screening, do not blow that off. Develop the habits that are going to carry you through a lifetime, whether it's smart anti -inflammatory nutrition, whether it's getting into a resistance training program, building up your cardiac machine.

31:46I saw that you were running a lot now and we want the highest possible VO2 max that we can as we enter into midlife because we never want as we age to cross something called the fragility line. So VO2 max is the measure of, it's the ultimate measure of fitness, how much oxygen you are capable of pulling out of the air and diffusing across your lungs into your blood. World class athletes, I was just at the US Olympic Center in Park City, Utah. Those athletes have a VO2 max of 75, 80, sometimes 90, right? Mirror mortals are considered excellent when they have a VO2 max of around 50 for women, around 50.

32:35So you can build VO2 max and should in the critical decade because once we hit midlife, we will decline 10 % a decade if we don't consistently build it up. So what does that look like? So if I started at 50, 50 years old, my last VO2 max was when I was 50. And it was 50. It was pretty good because I was an endurance person, right? Just in whole numbers, by the time I turned 60, it's going to be 45, 70, 40. 80, 35, I never ever ever ever want to hit 18 if I'm a man or 16 if I'm a woman because that is the level of VO2 max when we can't get up from a chair by ourselves. When we can't walk across the room because that takes cardiac function.

33:29And so the higher we get our VO2 max in our youth, the more runaway we have, even if we don't continue to build it up. Yeah, I've got a family member that can't walk upstairs without being out of breath and it's so debilitating because when you have grandkids and the grandkids start running around They want to play with them. It's so sad watching this particular family member See the grandkids come the grandkids say let's play the grandkids run off and this person can't go after them So they just have to watch they literally watch the the grandkids Playing in the garden because they can't play with them I think it's such a sad thing It's one of my big motivators to try and stay healthy is just to be able to extend my health span.

34:07That's right. So that I can be healthier, hopefully until the day that I die. Might be great, but that's what I want to talk about running. I want to talk about the A2 max. Yes. To close off on the subject of bones, there's two times that I want to hit. One is this term osteoporosis. Yes. Now I have no idea what osteoporosis is. I've heard it a couple of times in my life, but I don't know if it's something I should be thinking about worried about or what it means. Yes. Astro -process is the word we use to describe low bone density. Okay. So the way we measure osteoporosis is using an x -ray called a Dexascane dual x -ray.

34:45And it just measures, it compares your bone density to that of a 30 -year -old healthy person. And it gives us something called a T score. So it's like when you're in school and you're graded on a bell curve and the center of the curve is average and that's the average for a 30 -year -old. When you get a Dexascan score and it's positive, fantastic. You have bones of a 30 -year -old. If you get a T score on a Dexascan that's from zero to minus one, it's okay. Minus one is the definition of osteopenia meaning watch out your bones are getting weak. The definition of osteoporosis is minus a T score of minus 2 .5.

35:31Increases your risk of fracture by 40 % or more. All the bad statistics that I talked to you about come with osteoporosis. And how many people have osteopenia osteoporosis over the age of 15 America? Well, two million men have osteoporosis, interestingly, isn't that interesting? You don't think about it as a men's disease. And one in two women will have an osteoporotic fracture, so at least 50 % of women. But it's not inevitable. That's why I'm so interested in catching people early and the critical decade. It's not inevitable, but it will be inevitable if we don't catch it. But here's the thing that's bothersome in the United States and in many other countries with people I deal with, you cannot get a Dexascan paid for until you're 65.

36:20By 65, the damage is done. Why are we waiting? Even with people who have had a fracture, there's a gap in follow -ups such that they should all have a Dexascan because the number one thing that predicts future fracture is past fracture. So public service announcement, if you've had a fracture, get a Dexascan. Even if it was a traumatic one, like you had made a car accident. But definitely if you have fallen, if your dog pulled you down, if it was a low trauma fracture, get a dexascant, because then at least you'll know where you are and can then plan a course for building your bone. Are there any early warning signs that I might be suffering from osteoporosis or on my way to osteoporosis?

37:05You know, I think you can get clues from your own family. Okay. If your mother shrank, If you're looking to be able to look your mother in the eye, like me, my mother looked me in the eye, 5 '4", and now she's way down here. We lose height in both men and women due to a compression of our spine vertebrae. We lose height. So if your dad's shrink, if your mother's shrink, that's a good indication that you have a family history where osteoporosis can exist, or if your mother had a maybe asthma you've had to be on high dose steroids your whole life or an autoimmune. That's very bad for bones. So from a medical standpoint, from a family history standpoint, from a personal standpoint, usually fracture.

37:54What about if I'm a smoker? Does not have an impact on my bone health and chances? Yeah, I'm really glad you asked that. Smoking is a poison to bone healing, whether it is fracture. Well, he'll more slowly. In fact, we have a very much higher rate of non -union, which is where we fix a fracture and it still doesn't heal in smokers. We know that there is a big body of data within the orthopedic literature for people who have spine surgery who are smokers. They are not only less healing, but they're more infected. So the noxious chemicals and smoking are very bad for bone. Good thing I don't smoke.

38:30Is that smoking vaping or is it just... It's all vaping might be more dangerous. We just don't have as much literature. Sure. Okay. And the last thing before we talk about running in the VRT Max and endurance and sports and all those things is the link between Alzheimer's and burnout. Is there a link? That goes back to what we were talking about before. And there's a correlation. We, I don't believe we worked out the causation, but there's a correlation. We see people with Alzheimer's and people with a dangerous osteoporosis are sometimes the same group 30 % of the time, people with brain disease also of osteoporosis.

39:12And it may do, be due to this connection that we've talked about between the two organ systems. You hadn't called that passed away from Alzheimer's? I do. My aunt Ida, she was brilliant, she was a teacher, and she stopped remembering, she didn't remember herself, she didn't remember the farm that we all were all raised on. That's a really hard thing to witness. Sometimes people with Alzheimer's lose the inhibition and they become angry and enraged and afraid. She never did that, but that's a hard thing to witness. How did that experience change you or change your focus or add to the sort of reservoir of thoughts, concerns, reference points in your life?

39:58Well, you know what it is done it is put in urgency and even And it still is a day to day battle. I don't want, I think sometimes people think, for me personally that, because I talk about these things all the time and I do lift heavy and I do the thing, I live the life I prescribe for people that it's easy and it's not easy. I told you I had finished this book I was writing. And there was a big gap in the consistency of this lifestyle. But what motivates me to get back is the question of, What would it be like to live without a brain that's preserved? I mean, I don't know. Sometimes I think about, if I was aging and I had to choose one, would I choose an able body or an able brain?

40:43Isn't that hard? I don't know that you do have to choose, but I can't fathom what life would be like without an able brain. And so for me, that motivates me to lift, to make my skeletal muscles secrete the proteins that go to the brain and build better brain to eat the foods that are not going to clog my arteries. It just has a motivator because I want to be this way until I die. What would you choose if you had to enable body or enable brain? My, it was super clear for me. I'd rather have the able brain. Me too. Me too. I would rather... Because that's your relationships. That is, that is the fullness of life.

41:21It's a pretty brainless all -cross. But these things are also fundamentally interconnected, aren't they? That's why when I look at the Alzheimer's stats around bone health, I think, well, if you were had osteoporosis or something and you weren't moving as much maybe, maybe, you know, what a huge motivator for my patients is now that you've brought this up is Alzheimer's disease is thought of as the third phase of diabetes, right? And so everybody is aware of diabetes and it means you don't process sugar and you have glucose intolerance and your pancreas is no longer functioning. and the bad sequela that can come with that.

41:57What people are not aware of as much, at least as a people who come to my clinic, is pre -diabetes. And if you don't mind me diverging a little bit, because it's so important to this question you just ask me, and can we prevent it? And if we got to choose what would we choose? But I have people coming into my office all the time and I look at their labs. And they have a fasting glucose. They've had their labs drawn, they've done what we've said, get in front of your critical decade, they've had their fasting glucose drawn and it's 110, which is. I'm going to tell you. And their hemoglobin A1C is nearing six.

42:33So fasting glucose is the glucose that remains in your blood after you have eaten for 12 hours. In a normally functioning pancreas metabolic system, we want our fasting glucose to be around 85. right? That's normal. Means we eat something, insulin comes out of our pancreas, the sugar is put into our muscle and then the blood sugar is around 85. If it's staying up 110 consistently, we know from the literature that you have a 70 to 100 % chance of developing full -blown diabetes within 10 years. But what I see in people coming into my office is I'll say, did anybody ever tell you you were pre -diabetic?

43:19And either the answer is no, or the answer is, oh yeah, somebody told me they said, just make a few, you know, focus more on your exercise. And what I think the reaction to pre - the diagnosis of pre -diabetes should be is running and screaming to get healthy. Because if we know that with a consistent blood sugar in the pre -diabetic range, and we're casually told by our healthcare provider, oh, just go try to exercise more. You know, just casually approach this, don't eat so many carbs. That is not serious enough because we know from a preventative standpoint, from a precision longevity standpoint, which is all about prevention, we can prevent you from getting to diabetes in the next 10 years if we're really, really serious about lifting weights, about cardio health, about anti -inflammatory nutrition.

44:12Following, so I don't view pre -diabetes as a casual thing at all. Because if in 10 years you're gonna get diabetes, and in 10 more years you're gonna have Alzheimer's disease, and I could have prevented that by paying attention when I was 40, it's almost inexcusable that we're not paying more attention to it. 96 million people in the United States have pre -diabetes. 96 million according to the American Diabetes Association. I just gave a talk at their annual convention. 96 million have a preventable characteristic that we can prevent them from becoming diabetic and getting Alzheimer's disease and yet it is too casually spoken of.

44:57That's like almost one in three. That means that the three of us in this room, so Jack's got pre -diabetes. Perhaps. Potentially you're an endurance athlete, weren't you so? I've been a endurance athlete and I've been I don't have it today at ran out but I'm a little obsessed with continuous glucose monitoring. So I've been wearing it for about 18 months and and it's so interesting. I told you that you know I just finished this book and I've gotten a little bit off my regular intensity and it changes my blood sugar. So I run a little I because I haven't been lifting four times a week, only twice a week, because I haven't been sprinting twice a week.

45:37Like I normal, my normal regimen is I lift heavy four times a week. I on the other days, I do about four days of base training zone two, two of those days I sprint. I always eat a lot of protein. That is my lifestyle. And my blood sugar is 85 when I do that. And I'm a midlife woman. And you know, the metabolic things that happen to midlife women, even I've been backing off a little bit, starts to creep up my blood sugar. So this is a constant, daily habitual lifestyle that we all need to lead. And so when I see that, and someone as healthy as me, when my patients show up, and they've casually been told that they have something that's gonna kill them, I don't think that's enough attention.

46:22That's what I've been thinking a lot about recently is, what diet is gonna lead me to better cognitive performance as someone that spends a lot of my time talking. Yes. But then also on one stage, I'm in boardrooms, I'm meeting some in negotiations, I'm reading emails, I'm writing books, etc. So I'm always thinking if I can just get a 5 % edge. Well, I can tell you, for instance, the dietitians and chefs that make the food for the pro -athletes that I've taken care of across my life, they're not only eating meat. They have a very well -balanced diet that includes lots of vegetables, lots of high protein.

46:55They take amino acid supplements if they need to fill in the gaps, right? If they're not getting enough loose scene or something. But they just don't go down one pathway. I haven't seen that in the pros that I take care of. He told me he's given me a very sharp mind. Has it? An extremely sharp mind. It's so interesting as a podcast when you sit here and you have all these conversations. Because some days you show up and sometimes these conversations last for four hours and your brain and mouth just don't feel like they're connected. And then on other days I come here. You're like boom, boom. And it's automatic.

47:27Yeah. It's like I don't have to think and it's just flowing off of my mouth. And the variance, the big assets, the causal factors are obviously sleep is one of them. The other one is how many carbohydrates I've had in recent hours. So if I've had a lot of carbohydrates, something, you know, like, if I've had bread, my mouth in my brain have no connection. If I've had lots of sugar, my mouth in my brain completely done. Agreed. Agreed. You know, because of this CGM thing, I found that if I only eat protein for breakfast, which egg white omelette or, you know, whatever, just protein, that I needed a little complex carbs in order for about 10 o 'clock in the morning to be able to function at a high level with my patients.

48:11So now I've added 50 grams of carbs in the morning, but that's not a lot of carbs, not very much. I just needed that little complex, but interesting, right? And what's your eat? I eat 130 grams of protein a day. There's no upper limit on how much protein you can eat in a single setting. I try to get at least 30 because there is a lower thresholds for 30. And so if I do that, it takes three meals and a couple snacks a day. I, that's a lot of volume of food. So I try to eat really dense. So a couple Greek yogurt is like 18 grams and a really pure beef stick is another 16. So at this time, at this point, I've memorized the most dense foods that I can to get that much protein.

48:56It's a lot of protein. It's a gram per pound. It's a gram per pound, and that's what I need to build muscle. Studies have shown that eating high protein alone without lifting as much as I want myself and others to do will help maintain muscle. And then I eat a lot of vegetables. I don't know. I hope people are not going to throw them at me, but I donate fruit except blueberries fruit is nature's dessert. So if we're going to eat fruit, eat it as dessert, I eat blueberries with my yogurt. And then carbs, I only eat complex carbs if I eat them at all. Quick one, I want to talk about something we all need to take seriously, which is cybersecurity.

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50:13A new IDC white paper found that companies using Vanta save over $535 ,000 a year, and it pays for itself in just three months. For a limited time, my community gets $1 ,000 off Vanta .com slash Stephen. That's V -A -N -T -A .com slash Stephen for $1 ,000 off. You're only a very big advocate of muscle. You know, when we talk about longevity, something that you continually come back to as the most important thing for people's longevity. I think I would put muscle and bone near the same category because you can have all the muscle you want, but if you break your hip, you still have the downstream effects.

50:52Now, you're much less likely to break your hip if you're strong, but I think muscle or bone are really important. What if you're 65 years old, 70 years old, and you haven't got strong muscles right now, your muscles have declined, let's say, over the last couple of decades. Is it too late? Never. It's never too late. It is never too late. Your body will always rise to the strategic stress you place on it. So there are a lot of and growing number of what used to be anomalies all over the internet of people in their 60s, 70s, 80s, and beyond in a gym powerlifting, becoming competitive bodybuilders.

51:34So even if you're starting not being able to get up out of a chair over a very short amount of time, six months a year, you can reverse the trajectory of your frailty. But it takes consistency, right? I do wonder that. I think about my father, then he's approaching his 70s now. And I don't think he's done weight training for the last 15, 15 years. Yeah. And there is a part of me that did wonder, is it too late now to start doing weight training? because it's almost like a two -sided problem in the fact that you haven't done it. Yes. So you find it harder, so you don't do it. So you find it harder, and then you sort of spiral down to this sedentary state.

52:16Well, and you know what you do for that is nobody expects you to start with powerlifting. Scott's deadlifts, nobody expects that. Moving our body through a range of motion, doing body weight, progressing to free weights, progressing to light kettlebells, progressing to bands. Once you see that your body is capable of adapting and progressing, you will get there pretty rapidly. I used to do this program called a start, where I would take people fresh off the couch, and over three months we would get them to a 5K race, because 5K is a meaningful distance for people who are sedentary. And over that course of three months, We did a series of body weight and kettlebell type exercises in a circuit followed by walking and people started with 51 % body fat Not being able to get through the warmup not being able to hold himself up in a plank and in three months They could plank for two minutes.

53:19They could walk for three miles They could keep going for the entire ten -minute circuit it without having to stop. So there is never an age or skill level when our body will not respond to the strategic stress you put on it. So get a trainer for your dad. If he'd accept it. If he would accept it. I'll call him after this. Fine, I'm trying to build muscle. Are there certain amount of days of the week or repetitions I need to do to build the muscle? I think about this a lot when I'm out here in LA. I'm I'm trying to make sure that I don't lose my muscle, but I spend a lot of time sat down in here, recording podcasts.

53:57So is there a certain amount of times I need to work out that muscle before I lose it? You know, I was just reading this morning actually that even with a 10 -week hiatus from, let's say you're lifting consistently, even with a 10 -week hiatus, you will retain muscle memory so that you don't make serious declines, which is sort of relief to me because I'd spend a little while with this book. So you retain muscle memory and you can quickly, once you get started again, get back up to the place you were. So all is not lost if you take a few days off. But the minimum, if we're really working at it, is a couple days a week, progressively lifting harder for men in midlife.

54:40It's about eight reps, four sets, for women, once we've trained to the place we can lifting heavy, four reps, four sets. And when I say that out loud, I get a lot of comments about somebody's going to get hurt. Well, it's true. But you have to work your way up to that like any sport. You have to work your way towards that level because what we're trying to do by lifting heavier, especially for women is replace the anabolic stimulus that estrogen once was. You must work hard enough. Estrogen creates growth. We must signal our body by the intensity of our work to build muscle and lifting heavy does that.

55:19So if you're starting on the couch, start with bands, start with lightweight, start with the Mambi Pambi pink weights that I rail against, but don't stay there, continue to work your way up in a progressive way to heavy lifting, total body at least twice a week to maintain. Do I need to increase the weight load to build muscle? because I wonder when I go to the gym, sometimes, you know, I might be using smaller dumbbells, but I'm doing more repetitions. Yeah. Is that still going to build muscle? Well, it depends what you want. So, so lighter weights, higher reps is, uh, will, will, uh, function for hypertrophy, for big, bigger, total muscle, but not necessarily power and strength in law, in midlife and beyond.

56:04I am lifting for longevity and power. So I'm not as interested as I once was in the bigness of my muscle. I am interested in can it move powerfully over times? Can I get up off the floor? Can I lift my suitcase above my head? So lifting for power is lower reps higher weights. So it just depends what our goal is. You may be focused on hypertrophy right now, which is fine because you've not reached the critical decade. So if I'm looking for hypertrophy. Yeah, higher reps lower weights. So 12, 12, 15 reps low weight. And then if I was looking for power, then maybe six, eight, six, eight, that's right.

56:43How many do you do? I do four. You do four. So big weight for big weights for reps, four sets. Interesting. I didn't know them. Interesting. And just to give some sort of foundational knowledge, just to why muscle is so important, because some people still might not be aware of the link between longevity and muscle. A lot of this is to do with, from what I understand, glucose. So it has to do with muscle is the sink for glucose. It is a key factor in preventing insulin resistance, not to mention strength, staying upright, not falling down, causing a fracture. right? So muscle is a metabolic endocrine organ.

57:29It releases, when it releases, you know, one of the things it releases is skeletal muscle contraction by sub -scurls causes the transcription of a protein called clotho, which is the longevity protein. About 30 years ago, it was described in nature. It is the protein when muscle contracts, that's transcribed. It works on every organ. We know that it's critical for the longevity and repair of organs because my who are born without the ability to make clotheau die old, very young. Chronologically they're very young mice, but they die very old mice because they have not enjoyed this protein clotheau.

58:10We make clotheau by the contraction of skeletal muscle. Here's a study I did years ago that showed that I measure Clotho level, circulating in the blood of older masters athletes, people 60, 70, 80, younger masters athletes, 40, and sedentary people. And what I found that the highest levels of circulating Clotho, the longevity protein, were in young athletes, not surprising. The second highest level of longevity protein clotheo were in old masters athletes, 70, 80. The lowest level of longevity protein were in young sedentary people. So even old athletes had more circulating clotheo than young sedentary people.

59:02So just the contraction of skeletal muscle can add to your longevity through this protein. Another protein that's released with skeletal muscle contraction called galinin, it is transcribed. Goes to the brain, works at a place called the nucleus serulis, which is critical for resilience. It makes you more resilient. It helps you able to problem -solve. And then, you know, a very popular protein that is transcribed with skeletal muscle contraction is called irisin. It's the exercise protein, which, you know, it works on bone, it works on fat to brown fat from white fat to brown fat, which is has higher thermogenesis and has higher mitochondrial load.

59:48So muscle, just in doing its thing, not just looking pretty in a gym mirror, does all these metabolic functions. And so that's why we think it has such a key role in longevity. So if I'm trying to protect my muscle as I age, are there any supplements that I should be taking? I mean, do they sell cloth or supplements? I don't. You have to make it. Contract your own muscles. Well, you need to feed your muscles. I always quote people one gram per ideal pound. Because listen, I'm an actual practicing person, doctor. And here's what I know, people need really specific instructions and they can't be confusing.

1:00:31So, is there a range of protein people need? Yes, there is, but people can remember one gram per ideal pound. So you got to feed your muscle with protein. High quality protein. The highest quality protein has the greatest percentage of an essential amino acid called lucine. Lucine is not made by the body, it has to be taken in from the outside. It's a branch train, amino acid, and you get it from way protein. The best source in the universe of lucine and way protein is mother's milk, but most of us don't drink that as adults, so we get it from dairy products. You can get it from plants for everybody that is a plant lover.

1:01:09You just have a much lower percentage. You have to eat a lot more of it. So high quality protein. Number one, Number two, there's a lot of research for creatine supplementation for both men and women. When I first started being aware of creatine in 1992, it was during the Olympics. I was working with a bunch of wrestlers at that time. We would give very, very high doses. We would cycle the creatine. We would come on and off now. Stetaly five grams a day. We'll help build muscle. It will help build brain. It's really interesting. A couple of months ago. I asked the people in my office if they used creating.

1:01:48And a couple of the guys put their hands up. None of the women put their hands up. And I asked them why I said, why don't you use creating? They said that they thought it was for bodybuilders. Well, it started out for bodybuilders, but it's for everyone. Actually, it's very well studied. So I actually had this debate with my girlfriend last year at Christmas time because I was taking creating and asked if she wanted some and she made the same comment to me that it was for bodybuilders and that she'd put on weight if she had it. And then I said, no, that's not true. So she Googled it and she saw that it's good for like cognitive performance, skin, hair, muscle, bone, et cetera, et cetera.

1:02:23And now she takes it every day. Perfect. I think there's a big reeducation piece to be done there because we almost used to think of it like a steroid or something. And it's not at all. You know, despite podcasts like this and despite me screaming from every mountaintop, I find that there still is an incredible knowledge deficit in the general public about the principles of how to be the healthiest we can be. And in even bigger gap in the ability to take action for ourselves. I mean, and it's not a judgment. It's simply an observation that we know what to do, but we don't do it. it. And we know what to do and we don't do it.

1:03:05Even if we see in our family, someone who's going through the throes of diabetes, or even on Alzheimer's, it's still not enough motivation. And I think that's the real problem to solve. Motivation. How do you solve that? Sometimes, sometimes we solve it by scarce, right? You know, someone has a tremendous health problem. But sometimes that's not even enough. I have found that it is never going to be motivating enough to try to say, okay, if you do this today in 20 years, you're going to be much better. There's this temporal disconnect. People just don't get it. What they're going to be like at 70.

1:03:40I think we have to make you feel good every single day. It's like when we were talking about your brain, when you're doing heavy work and cognitive work, if you can feel better every single day, you'll continue the behavior, not for a promise. So I think that is the way to talk to anybody. It's the way I talk to my patients. Can I make you feel better tomorrow? Can I make you feel like a bad ass? Because you lifted heavy weights today. It's hard though with things like bone. You're telling someone that they need to be getting I don't know, like their calcium and stuff like that. I think, well, I can't see my bones.

1:04:15And osteoporosis is so far away that it's hard until you see someone fracture or you fracture yourself. I agree with you. I mean, D as well as crucial, isn't it for bone health, I was reading that there. It is. It is magnesium. Vitamin D magnesium, lesser known things, strontium zinc boron in micro nutrients, but big things, vitamin D magnesium. Sleep. Sleep. Talked about that a little bit as well. How important that was. You mentioned that I'm running now. Yes, you are. Thank you for noticing. I never mentioned it. And a million others are supposed to join you, I noticed. Yes. We're going to try and get a million people running.

1:04:52That's great. You're going to save a lot of lives. Oh, thank you. Well, much of it's because of the work that people like you do and that come on my show and inspire me to think about things like my VIA2 max. And I'd definitely been just weight training for the last couple of years, not really thinking about my bones or my VIA2 max. So this has been quite a big shift for me. But when I think about running, I definitely hated it. I still hate it a little bit. But I hate and love it now, which is progress. What are the things I should be thinking about? because people talk to me about runners' knees and stuff like that.

1:05:25And I don't want to get injured. Right. But I'm running quite a lot. So I hear from a lot of runners that, oh, OK, I'm going to lift with my arms because I'm running. So that means my legs are going to get stronger. Well, what I know from 30 years in practice is that runners who only run are hurt a lot. And here's why running builds a big cardiovascular engine. But it does not build muscle mass below your belly generally unless you're running up hill all the time and you're building glutes. But so what happens running is a single leg sport. If you look at a gate analysis, you're on one leg at a time.

1:06:11You're never on two legs and walking you're in two legs on running you're in one leg. So if this is, if my hands are on someone's pelvis, when we're running, we can't be going like this every single stride. So oscillating like we're walking on a catwalk in fashion week. We want to be running like this straight. Well that takes tremendous glute strength but strength because it's the glutes that balance the pelvis. If we were in my office and you came in with pain as a runner, I would stand you on one leg to see even if in a controlled environment, you could do a single leg squat and keep your pelvis stable without your knee falling in.

1:06:55And if you can't, it just tells me that we have a lot of butt core and hip strength to do. And my lower back, something I think about, because when I train, especially I'm training for a football match at the moment, in the UK. And I always seem to get a glue injury. And it's almost like 100 % predictable that if I don't stretch properly, even if I stretch a little bit but don't stretch fully. When I run into that football pitch within five minutes, I feel like a little, it's almost like a little tear in my glute almost. What am I doing? What do you think is happening? It might be useful to you as you're training to have a motion analysis, to have someone stand you on one leg and look at the way that one motion pattern is different from the other because if it's predictable like that, there's an imbalance in you.

1:07:45and so it can likely be trained. I mean, I can give you an example in my life if you wanna see how that works. So when I run and when I increase my speed and distances, I predictably, predictably. Get left Achilles tendonitis and I get right hip flexor, sharp stabbing pain. Predictably, that is because my left big toe from wearing high heels all my life has arthritis. So when I run, I don't run through the center of my foot. I run through the side of my foot. Reopinches. Where my pinkie is. So instead of running through like this, I run through like this, puts extra stress on my Achilles tendon, changes my gait enough that it's tight all up through the left side of my body and my right hip flexor is taking the brunt of that.

1:08:40But that is a motion pattern deficit that I know I have. So if you are predictably getting the same injury all the single time, it's probably due to something's too tight on one side, something's too weak on the other side. And if you get an evaluating, you could probably train it out of you. Yoga and my gut is the home of our digestion. And it's also a gateway to better health. But it can be hard to know what's going on in there. Zoe, who sponsors this podcast, has one of the largest microbiome databases on the planet and one of the world's most advanced at home got health tests. Their blood sugar sends so much I have in this box in front of me goes on your arm so you can see how different foods impact your blood sugar.

1:09:19Then there's the at home blood sample which is really easy and analyzes your body's blood fat. And of course the famous blue Zoe cookie which tests your metabolism. I want to can't forget there's also a poo sample which is a critical step in understanding the health of your microbiome and you post it all to Zoe and you get your results back which will help you to understand your body's response to different foods. Using your results, Zoey's app will also create a personalized nutrition plan for you. And this is exactly why I invested in the business. So my question to you is how healthy is your gut?

1:09:52Head to Zoey .com to audio kit and find out. And because you're one of our listeners, use code Bartlett 10 for 10 % off your membership. Head to Zoey .com now. I've invested more than a million pounds into this company perfected and there are also response of this podcast. I switched over to using matcha as my dominant energy source, and that's where Perfect Ted comes in. They have the matcha powders, they have the matcha drinks, they have the pods, and all of this keeps me focused throughout a very, very long recording day, no matter what's going on. And their team is obsessed with quality, which is why they source their ceremonial grade matcha from Japan.

1:10:26So when people say to me that they don't like the taste of matcha, I'm guessing that they haven't tried Perfect Ted. Unlike low quality matcha that has a bitter grassy taste, perfect taste is smooth and naturally sweet. And without knowing it, you're probably a perfect head customer already if you're getting your match at places like blank street or Joe in the juice. But now you can make it yourself at home. So give it a try and we'll see if you still don't like matcha. So here's what I'm going to do. I'm going to give you 40 % off our matcha if you try it today. Head to perfecthead .com and use codiary 40 at checkout.

1:10:58Or if you're in a supermarket, you can get it at Tesco's or Holland and Barra or in the Netherlands that are behind. And those of you in the US, you can get it on Amazon. On the subject of obesity and weight, we talked last time, really fascinating thing that you said to me, which stayed with me is that the more weight we're carrying, the more harm it's doing to our bones, in a really disproportionate way. Because you clarify that again, but also talk to me about, give me the case for keeping my body fat down as I age. So what we were talking about is joint health and the fact that every bone, if in your knee, for instance, if your feme, if this is your femur, the end of every bone has a bumper of cartilage.

1:11:39Cartilage is a matrix of collagen fibers that has cells in it and its entire job is to shock absorb. So the bones don't do so much of this. Bones are pretty fragile, but they glide. cartilage has a, in physics, a coefficient of friction that is less than ice. So it's smoother than ice, it glides, right? If it's perfect, cartilage is very subject to the forces of weight such that in our laboratories, when we were doing cartilage research and wanted to damage cartilage, all we had to do is drop a marble on it. So it doesn't take much. So if we're carrying around a lot of heavy, extra weight, And we don't have the muscles to support that.

1:12:21Instead of muscles actually like a shock absorber and protecting our cartilage, we're banging more. Now, remember, banging is good for bones. It's not good for cartilage. So we want to make sure that we have a healthy weight so that we're not exerting so much load. Because it's seven to nine, we talked about last time, seven to nine times body weight pressure across the joints. And so that's why we want to compose our body and have a body composition, not a weight, a body composition of more muscle than adipose tissue. This kind of goes back to what we're saying earlier, because you can say these things, but still changes still far away from many, many people.

1:13:04And I was just wondering, in the people that you've seen make radical changes that you've worked with, all their key things that happened. We talked a little bit about someone hits rock bottom, they get a bag bag diagnosis, they're forced. But is there is there anything else that one can do to will themselves to change to keeping a journal some kind of exercise? I think it's really helpful to know as much about yourself as possible. So if I in taking someone into a program we're going to build, I don't I weigh them, but what's most important is I do a body composition so that we can go through step by step and say in your current body, you have, I'm making these numbers up, 32 % body fat.

1:13:46You have very little lean muscles. So even though you may be okay with the way you look in a mirror, you're skinny fat, meaning you have too little muscle and too much out of post tissue and we just, and we talk about all the things we've talked about about why we need to build more muscle. But when you see those numbers, numbers don't lie nor are they judgments. But if you're just looking in the mirror, you may say, oh, Well, that's okay. Or you may hate the little belly roll, but it's not, you don't hate it enough. But when you see that you have very little muscle mass and a very high percentage of fat, those data alone are sometimes a motivation.

1:14:23And then if we know that we're going to redo that test in three months or six months and track changes over time, that can be an added motivator. besides tragedy, data can be a motivator, wanting to feel like yourself again, in women in midlife, someone sometimes just say, I just want to feel like myself again. Well, we're different people after our estrogen goes away and so it takes a different kind of work to feel like ourselves again. But at the end of the day, so tools -wise, I think journals are helpful, tracking, keeping a record of how you felt on a day, what you did that day. CGMs and stuff as well.

1:15:03Anything that turns the lights on has been really. That's right. Data. CGMs are, you know, I learned what I was going to learn it three months, but I've had it on for 18 months just because that data spurs me on. Like, oh, I was really stressful. Oh, our day, my sugar spiked up even though I was an eating. I must have been very high cortisol. I'm releasing so much from my liver. It just informs me about the inner workings of my body. But also, at the end of the day, you have to love yourself enough, Steven. And I can't make you love yourself. And I can't, a number of harassment in my office cannot make you value yourself enough to invest in yourself daily.

1:15:42And at the end of the day, that's what it's going to take. I've talked quite extensively on this podcast about menopause. It's really fascinating to me. I think in part because I didn't even know what it was. Even a couple of years ago, probably a year and a half ago, I had no idea what it was. What are some of the pervasive myths about menopause that people still need to sort of get past? Despite everyone talking about it, despite you having lots of conversations about it, I still find a lot of people who have never heard of Perry Menopause, which is the decade leading up to the day of Menopause, which is 365 days after your last menstrual cycle on average in this country.

1:16:25It's about 51. People have not heard of Perry Menopause. They've never heard of hormone replacement therapy and they don't know what to do about it. And they're ashamed to talk about it because somehow needing things in this country, if you're a woman, have gone unnoticed. For instance, like, oh, I'm just going to suffer through my mom never talked about it. So I think the myth that you have to suffer is a myth. There is more known now than there's ever been about how using lifestyle to feel better. I always encourage women to make their hormone replacement decision based on science and not fear and to make it early.

1:17:08How are they? I encourage my patients even in the mid 40s to read the books, watch the podcasts, identify a clinician. So when it's time for them to make their decision, they've got everything lined up. And you can take hormones while you're still menstruating. There's no reason not to. In fact, that's what birth control is. Birth control is 10 times the dose of hormone replacement therapy. So under careful supervision, you can make your decision very early. What I want people to do is educate themselves. I call it menopausal literacy because we have a very low level of menopausal literacy in this country.

1:17:54I want them to make their hormone replacement decision, meaning, am I going to go on them? Where am I going to get them? Can I find a clinician to help me? Number three, I would like them to, as we talked about earlier, build their unbreakable lifestyle, develop the habits early, not when they're in the throes of menopause and feeling desperate, but early, of lifting weights, of cardio that includes base training and sprint intervals, anti -inflammatory nutrition, early so that it's just the way you live, so that when you're feeling so bad, you're not trying to learn all these things at once. And there is a significant link between menopause and bone density because you lose some of those critical hormones like testosterone?

1:18:45Like estrogen and testosterone. So estrogen on bones acts to control the cell that breaks down bones. We talked about in bone health, there's a cell that breaks down bones called the osteoclast with a C and a cell that builds bones with colon osteoblast. Estrogen helps control the osteoclast. So even in menopause, when there is no estrogen, we're still building bone, but breaking down bone out strips building bone. So replacing hormones helps rebalance bone breakdown and bone rebuilding. And if we lose our estrogen around the time of this perimenopause, menopause, we can lose 15 % of our bone density.

1:19:33And if we don't catch it, because insurance only pays for dexascans when we're which is far too late, in my opinion, we're behind the eight ball. So I encourage everyone, once they start going through a pariamenopause to get a Dexascan, whether they have to pay for it at their gyms, save up their coffee money, it's worth knowing your bone status. What are some of the most obvious but pertinent, muscular skeletal syndromes of menopause? I'm glad you asked that. In July, my group and I created a nomenclature called the Musculoskeletal Syndrome of Menopause. Because women were showing up in my office, saying things without prompting.

1:20:15Because I'm a doctor who listens. I sit down on a stool. We have a conversation. I do not chart in front of you. So people talk to me and out of nowhere, women would say to me, Doc, I feel like I'm falling apart. And I don't know what's going on, but I feel like I'm going crazy because I've been told nothing's wrong with me. And I started noticing that more and more as women started coming in with their shoulders not moving, which is an entity called Frozen Shoulder. And so as I started looking at this pattern and reading the very few studies that were done, we've known for 30 years that the incidence of arthritis, inflammatory arthritis in women after 50, is much higher than inflammatory arthritis than men.

1:21:04We've known it for 30 years. And as I started researching, remember how I said earlier that every musculoskeletal tissue is derived out of the same type of stem cell, the mesenchymal stem cell. All of those tissues, muscle, bone, tendon, ligament, fat, muscle drive stem cells are all sensitive to estrogen. And without it, several things happen. there's something called arthorralgia, which is total body pain, meaning your body hurts so much that you can't even get out of bed. That was one of the biggest things I had. I'm an athlete, and I could barely get out of bed because I was so inflamed due to the lack of estrogen.

1:21:47Estrogen is a huge anti -inflammatory agent. So I was totally inflamed. My body hurt. That's called arthorralgia. women come in and I'm not kidding, they come in and they say my arm won't move. Literally it won't move or I can't hook my bra. That is due to the inflammation of losing estrogen. In Asian cultures it's called the 50 -year -old woman shoulder because it happens to 50 -year -old women. It is a sign of the inflammation of losing estrogen. We know about sarcopenia, the loss of lean muscle mass, about 20 % when you lose your estrogen. We've talked about loss of bone density. We have of increased incidence of tendon and ligament problems, Achilles tendon, tennis elbow, Patelor tendon because the collagen fibers of tendon and ligament have estrogen receptors on them.

1:22:36And so everything starts to work less well without the presence of estrogen. So I saw all of those things, and we gathered the world's data, which isn't a lot, a lot more research needs to be done. And we gave it a nomenclature. We called it and published it as the Musculoskeletal syndrome of menopause because I tell you for sure Stephen If someone goes into their doctor's office, which in this country is so restricted in the time that we can spend and Says I have this and this and this and this and this six things in 15 minutes It is difficult to get through that But if someone comes with a nomenclature of I think I have the musculoskeletal syndrome of menopause My arm doesn't move blah, blah, blah.

1:23:24Immediately, you don't have to go through a differential diagnosis of 600 things. You're like, oh, as a doctor. This paper on the muscular skeletal syndrome of menopause has currently been downloaded almost 300 ,000 times. And to put that in context, some of the biggest journals in the world, medical journals in the world documented, they did a survey of how many times their best articles had been downloaded. the best scientific journals their articles are downloaded about 10 ,000 times. This Musculoskeletal syndrome menopause has been downloaded nearly 300 ,000 and it's not because yes, it's a good paper.

1:24:05The need is so great, Steven, to communicate what the heck is going on with people that I made it open access, meaning you don't have to pay to get this article.

1:24:18And I come up number one to print it, to read it, to give it to your doctors so that they can understand that you're highly inflamed. That's why your total body hurts. That your shoulder doesn't move because you're inflamed. That your knee hurts because you have the arthritis of menopause. And just to build the understanding of what is actually going on with people. Fascinating. I didn't mean 300 ,000 downloads. I know. It's amazing. New York Times, Baselab. A research paper. 30 ,000 pounds over on something crazy. Crazy. Congratulations. Well, you know what? Research is a team effort and we all work together, but thank you.

1:25:01It's needed. Used to word their arthritis, which we've not talked about yet, but you used to describe your big toes as well. Yes, I did. What is causing arthritis? I don't want to get arthritis. Oh, who does? There are two kinds of arthritis. There's an autoimmune, meaning your body. is identifying yourself as not yourself. And that's called rheumatoid arthritis. That is very different than the way I used it today, which is osteoarthritis, which is wear and tear arthritis. So wear and tear arthritis can happen through thousands and thousands of repetition on a joint. We were talking earlier about running.

1:25:37It's a thousand steps a mile. It can happen due to trauma. I have a lot of, I used to take care of the University of Pittsburgh football team and I had a lot of 20 year olds with knee arthritis because the impact was so great as line men hit each other that they would wear out their cartilage. So, wearing terror arthritis, osteoarthritis is loss of the cartilage layer on the end of bone. It causes aching pain, it causes swelling,

1:26:11it into the degree that you have it, we can treat you conservatively through a variety of ways. Or at the end of the road, we can replace your joints. I want to just circle back on. We were talking now about the collection of symptoms that are associated with menopause, and you were talking about how arthritis is a factor. Are you telling me that to avoid the muscular skeletal symptoms of menopause, I should be taking hormone replacement therapy? Here's what I'm telling you. I'm telling you that every musculoskeletal tissue has alpha and beta estrogen receptors. We know that when those sit empty, you will manifest some of the musculoskeletal syndrome in menopause, 80 % of us do.

1:27:00What I'm telling you is that estrogen sitting in those receptors can prevent bone loss, can prevent muscle loss, can decrease the inflammation of arthralgia and frozen shoulder. So everyone gets to make their own decision. People are thinking beings, they have agency, they get to make that decision to get out of pain and to prevent the musculoskeletal syndrome of menopause based on science and not fear. One of the things I'm a little bit concerned about these days is back pain. Yeah. Lower back pain in particular. I read that little back pain as the single leading cause of disability globally, significantly affecting individual's quality of life and productivity, which was published on the World Health Organization article.

1:27:51In 2020, lower back pain affected 690 million people globally. And its prevalence is increasing due to a number of different factors, one being aging. But also, I just think generally how we're living more sedentary lives than sitting on these chairs and stuff like that. Back pain. Yeah. Common thing. Only seems to exist in the Western world. I had someone come here from the who studied the Hedser tribe in Africa and they don't have back pain there. Yeah. How do they live? Not like this, right? They're like, what? They don't have chairs. Yes. Well, back pain is endemic in our population due to our lifestyle.

1:28:26We're sitting here for several hours. I'm probably sitting like this all hunched over at some points. Our, our cores are relaxed. We're not, our, our front cores are relaxed. Our, our lower back is relaxed. There's no stimulus to keep our cores strong sitting in a chair. And we do this 10 hours a day at least, right? That's number one. Number two, then 70 % of people do no meaningful exercise any time of the week. So we never rebuild it. So we get low back pain due to muscle weakness and another reason we get low back pain particularly in women or very elderly men is compression of our vertebrae compression fractures of our spine.

1:29:11That can be very painful. It presents us low back pain. I want to differentiate for people listening the difference between low back pain and and nerve impingement that needs surgery. Low back pain is that aching in your low back, the stiffness. When you go to a doctor with low back pain, there should be telling you how to get stronger, sending you for physical therapy to stop smoking if you're smoking because that poison's bones, right? All the lifestyle things. If you have pain starting in your back, but shooting down your leg like electricity, down the back of your leg like literally, think about how lightning would feel, that is because a nerve is being impinged as it comes out of your spinal cord, that is something that needs to be examined and looked at.

1:30:01But I just want to differentiate that because a lot of people mistake the two. And a lot of, I think it was 80 % of Westerners will experience lower back pain. And it got me thinking about standing desks and things like that. Do you advise people to use standing desks? I do. And walking treadmills. Because there's so much work that we do during the days. That isn't deep work. We're emptying out our email. We're returning some phone calls. We're doing the less heavy brain heavy parts of our job. All can be done standing. Or I've encouraged groups of people that I work with to hold their meetings doing wall squats.

1:30:40Just don't sit at the board table, pull up a wall, everybody squat, better be a pretty quick meeting because that takes a lot of strength. But to build in that kind of mobility, the only time we really need to sit is when we're solving world peace. The rest of it we can stand. And in fact, studies have shown that if we're trying to learn something, it's better to be moving as we learn because the kinetic energy of learning is better for our brains. For instance, I used an example yesterday, actually, when I was teaching people how to time manage, and I said, when I'm listening to long -form podcasts like this, I can't sit for three hours, but I can walk and listen, and I retain more, for instance.

1:31:26So, that's been proven that if we're in exercise, we retain more. in terms of studying. You've done a lot of studies. They're so fascinating. Have you got a favorite? The very first one we did on Master's Athletes answering the question at what age do we really slow down? Because if you believe Hallmark and all the rest in peace balloons that go around on your 40th or 50 birthday, slowing down is an inevitable part of aging. But the fact of the matter is in our studies showed that when I looked at track and field athletes in every race from a hundred meters to ten thousand meters, and I looked at the top eight finitures in every age group in every race, that we do not significantly slow down until we're past 70.

1:32:22So between 50 and 70, the guy who won the 1 mile race finished it in 4 minutes and 34 seconds. The same year of the study, the kid that won the high school mile race, did it in 4 minutes and 17 seconds. The 70, 70 year old who won the 1 mile race in it in a little less than 7 minutes. It just shows you that if we're slowing down dramatically before our 70s, we've either decided not to train so hard. We're just not trying anymore. We've been terribly injured, right, and we can't. But it's not because of biology. Because of psychology. Exactly. No light bulb goes off. We think though. We think that when we experience that first twinge, that first pain, we start to get a little bit tied.

1:33:10We think it's natural. So we kind of relent to it. We just give in. And then that's that slow spiral downwards into a lifestyle which becomes self -fulfilling, I guess. We stop trying hard. We stop playing hard because we stop trying hard. Because we think it's inevitable. We think, no. Aging is inevitable. How we age is up to us. You're working on a book. Oh, you just handed in the manuscript for it. We're very, very excited about this book. Unbreakable. Unbreakable, go strong. Live long, age with power. and it really picks up the conversation of aging and longevity that I've been talking about for a long time, but really focuses on the longevity of women.

1:33:50So the book is framed around the pillars of aging, which I call time bombs, the time bomb of metabolic dysfunction. The time bomb that we think means our DNA is our destiny, which it is not. We can modify ourselves. and several others, and really explain the science of what's going on, and that aging is not an inevitable decline from vitality to frailty unless we cop to that attitude, right? And then the second part of the book lays out a lifestyle that I call unbreakable. It's about muscle, it's about bone, it's about nutrition. But the most, a very important part is what you just said. It's about attitude and mindset.

1:34:31And so I help people set standards and goals for what they want based on their values. If I didn't value independence, if I didn't value having my brain till the very end and all the other things that I value, then my goals would be uninformed. I could say, I want to earn a marathon at 80, but that's not enough unless it's connected to my values. And then further along, we talk about building resilience, because brain resilience can be built in the same way that skeletal resilience can. And I believe it takes both of those things to progress and to age with power. And then the final sections of this book really take us to the next level.

1:35:16How do we now that we've optimized our health and decided that we are not the victims of time? I don't believe that. I believe we can. The shape our future. What do I do for peak performance? How do we continue to squeeze performance out? And what are the cool technologies that can help us? I'm very, very excited. Yay. Can we pre -order it, yeah? Not yet, but you can get on my wait list on my website. Okay, I'll link that below for anyone that's keen to get that book out. I'll be on that list as well. I'll give you one. Is there anything else that we should have talked about that we haven't, Dr.

1:35:53Vonder? Last week I was speaking at the American Diabetes Association and talking about midlife in metapause, which you and I have talked about, and all the metabolic changes that go on when estrogen walks out the door. And we've already talked today about prediabetes and how we need to put on a big alarm because of all the metabolic changes that will lead to diabetes and Alzheimer's. But when I look at those two things separately, paramedicase and all the metabolic changes and the lipid changes and the fat distribution and the insulin insensitivity and prediabetes, they are nearly identical. And what we know is that this is another alarm to sound if we have not paid attention in the critical decade of our lives and become pre -diabetic and then are a woman and lose our estrogen.

1:36:44It compounds the normal metabolic changes that happen with insulin resistance to the loss of estrogen and after menopause women have more diabetes and therefore more Alzheimer's. And so if I can back all this up and start people thinking about it when we're 35, that is work worth doing. That's exactly what you're doing. It's exactly what you're doing. I think, you know, the reason I'm so compelled by menopause as well as secondary reason is because I have so many wonderful women in my life, including my partner who might not be as fortunate to be exposed to all the information that I get exposed to by doing this.

1:37:17So many of the questions I'm asking you, almost pre -preparing me to be a supporting act in her life. She's what, 32 now. So, you know, critical, critical years. You know, it's Steven, if I could get more men to take the attitude that you've just expressed to have the curiosity to learn about the changes in midlife women and not only bodily changes, but I add a tutinol and the sexuality changes. I think we could save a lot of marriages, but I find that for the lack of knowledge there is amongst the women, there is even less knowledge among the men, but if it's a partnership. So I think your attitude and curiosity is is lottable because I think we could save a lot of relationships if everyone felt that way.

1:38:05Yeah, because for me, it is created a ton of empathy. And with empathy, you approach challenges differently with a different perspective. and there's less blame and there's more, I think supporting encouragement. So that's really why I think it's important it's off for men to understand these things because when you start noticing differences maybe in someone in which she's feeling or your mother or grandmother or even your daughters, you might not be some of those, you know, naive doctors who think someone's losing their mind or that they're just being different or it's their personality and you might understand that there's something deeper going on.

1:38:44And also something that's at least in part, you can do something about. Absolutely. Which I think is the most important conclusive point. We have a closing tradition on this podcast where the last guest leaves a question for the next guest. We're not knowing who they're leaving it for. And the question left for you is, how do you know when is enough? I think how you know when it's enough, when it becomes, if it pertains to work or striving for something or is when you don't love it anymore. When it becomes aggrined and you don't love it, that's when it's enough because it's not feeding you. Amen.

1:39:26Dr. Vunderright, thank you so much for the work that you do. You're such a star. I think every day she go follow you on Instagram because you've built an incredible community of one Instagram where you give away so much of this knowledge absolutely free of charge. But I also think everybody should go to your website. Thank you. They should buy this book. Kind of this book is maybe they should just get on the wait list for the upcoming book as well. Unbreakable. Unbreakable. And they can get on that wait list on your website right now. Yes. They can join your Instagram community which I think is phenomenal.

1:39:54It's so wonderful to see. How usually people have a following but I really feel like you have a community. Yes. I see it in the comments sections. I see that the people are really, really engaged and there, as you saw from the amount of people that downloaded that paper that you published, there's a real first and hunger for this information. And I get so many messages from the last conversation we had, but from these conversations generally about from women, from their husbands, who are so thankful for you, like so thankful it's, you know, because I have lots of conversations about lots of things, but this particular conversation provokes a certain type of energy that is very atypical.

1:40:35You know what I mean? You understand it because you feel it every day, but I really feel it as well. So thank you for doing the work that you do in for turning the lights on for so many people that are living in the darkness as it relates to information and that information is no doubt undoubtedly saving many millions of people's lives. I hope so. And that's work worth what we're doing. So thank you so much Dr. Wunder. Thank you.

1:40:59Some of the most successful fascinating and insightful people in the world have sat across from me at this table and at the end of every conversation I asked them to leave a question behind in the famous diary of a CEO and it's a question designed to spark the kind of conversations that matter most, the kind of conversations that can change your life. We then take those questions and we put them on these cards. On every single card, you can see the person who left the question, the question they asked, and on the other side, if you scan that barcode, you can see who answered it next. Something I know a lot of you have wanted to know, and the only way to find out is by getting yourself some conversation cards, which you can play at home with friends and family, at work with colleagues, and also with total strangers on holiday.

1:41:41I'll put a link to the conversation cards in the description below, and you can get yours at thedirey .com.