Can bigger muscles really help burn fat and keep you young? | Dr. Vonda Wright

27:17If I put a cast on your leg for one week and you're not contracting that muscle, your body will view it as non-vital and will start using it and you will have atrophy. It's interesting what the body does because, back to the hierarchy of needs, in a situation where we're calorie restricted, our brain still is a very hungry organ and needs energy, and your body's going to take it from somewhere. So if we're not intaking enough food, our body is going to start using the storehouses to convert to energy for the brain, to keep it alive, for the heart, to keep it alive, right? The vital functions. Muscle is an accessory.

28:00Does that change depending upon how much body fat you have? So if you're living with obesity and so you have a lot of excess fat, does that mean in that case it only takes it from your fat or do you have muscle loss? Yeah, it's my understanding you have muscle loss no matter where you start. The absolute poundage may be different, but the percentage is similar. If we want to minimize muscle loss during the period when we're calorie restricting, then we need to feed ourself enough protein so that we have the protein building blocks to maintain our muscle mass. We should also be lifting to try to build muscle that we feed with the protein as we calorie restrict.

28:44Because for instance, you can eat a lot of protein on a 1500 calorie meal plan, right? So if your maintenance is 1800 calories and you're trying to restrict by 300, you can still eat a lot of protein within that number of calories. You have to choose, you have to eat lean meats and lean sources, but it's completely possible. Vonda, I want to come back to this thing about weight versus body composition. You've mentioned muscle loss, but at this point, I'm not clear how that fits in with not just looking at the bathroom scales. What you see on the outside is not what's going on on the inside. And I'm going to give you two examples on opposite sides of the spectrum.

29:30So a number of years ago, I was invited to go to fashion week in New York. And I had never gone and it was amazing and I was a little out of my element. But I looked around me at all these willowy women, like they were as thin as could possibly be and wearing these clothes. But there was very little evidence. At the time, I mean, now models are different body shapes. At the time, I did not see any muscle definition. And we know there exists a phenomenon called skinny fat, meaning you look skinny, you may weigh 100 pounds, but if you do body composition, you have very low lean muscle mass. So that's on one end of the spectrum.

30:18On the other end of the spectrum, which I see more often in my orthopedic clinics, is when I take a picture of someone's knee, for instance, and x-rays are meant to identify bone. But you can see the shadows of the other tissue. So if we have an elderly person who is skinny, often what I see are the bones. I see a couple inches of fat on the outside in a leg that has a total volume that's small and really thin ribbons of muscle in the quadriceps, which should be one of the most robust muscle groups of our body. So age is not a factor in skinny fat. But what I also see is this phenomenon of you have a very wide leg.

31:05It almost goes beyond the scope of our x-ray. You have normal-sized bones in the middle. There's no such thing as big boned. You're like, oh, you're not big because, well, if you're a big person, you have bigger bones. But proportionally, it's still about 15 % of your total weight. So you have the bone in the middle. you have these thick rinds of adipose tissue three four inches on either side of again very wispy muscle and vonda your adipose tissue is the fat so again you're saying that rind right we call that sarco obesity meaning they're that person is sarcopenic very low muscle and obese, very high lipid content.

31:50So you can be skinny fat, meaning really low weight, but very low muscle, high fat content, or you can be low muscle plus high fat content, neither which are great because of the common denominator of sarcopenia, low muscle. So if we shouldn't fixate just on the weight, but people are still saying, well, I want to feel better, I want to look better in the mirror, all the rest of these things, help me to understand what the difference is between thinking about losing weight and thinking about body composition. So our goal should be to lean up. I'm going to call this model that I described this thin person.

32:36This size two, wispy person, which has, if I were to put her in a body composition machine, might have very high fat, very low muscle. She may weigh, let's just call it 100 pounds. But she's wearing a size two because she's this big. If we have a lean person who consistently lifts weights, she might also wear a size two, but have much higher muscle composition and weigh much more, 110, 120. Now I'm making these numbers up, but just to tell you what it looks like on the outside is not really what's going on. You're both fitting to the same size dress, but one is lean and probably weighs a lot more because muscle weighs more than fat versus being skinny fat, which you may weigh less.

33:27For a given volume, muscle will weigh more. A pound of fat is this heaping glob like this, volume-wise large. A pound of muscle is about the size of my hand. Very low volume, higher weight than the total space taking up fat. And so therefore, if I lose some muscle, I could be weighing myself and saying, hurrah, that's brilliant. I've lost. down. But actually, I might just lost all of this great healthy muscle. You would have probably lost part of it in muscle, part of it in fat. You don't want to lose so much muscle as we're losing weight. You probably lose some as we're losing weight. But we don't want to lose 20, 40, 50 percent because then metabolically we go back to what we talked about before.

34:15We're not as efficient at glucose metabolism. We certainly aren't as strong. And to simply live, to sit here quietly in the chair. Muscle requires more calories just to exist. It's higher metabolic. So with less muscle, we're burning less calories, right? At 40, I had my last child at 40. I was training for triathlons at 40, the beginning of my career, the really prime time in my career, as busy as I could possibly be. I had 19 % body fat. I wasn't lifting a ton. I was doing mostly cardio, but I was in great shape at that time, 19 % body fat. Then I went through perimenopause, which hit me like a ton of bricks.

34:58And due to nothing different in my life, I gained 25, 30 pounds because of the loss of estrogen. My body fat composition, because of these metabolic changes, went up to about 32 % because of the metabolic changes. So when I got in front of that and I started lifting heavy and eating enough protein and sprinting. So I really worked on calorie restriction, but lifting and eating enough protein, my basal metabolic rate after perimenopause with 32 % body fat was about 1 ,350 calories, which is not a lot to eat in a day. Once I regained my muscle, got my body fat back down to 22%, I gained eight pounds of muscle in about a year, which is a lot.

35:52My basal metabolic rate was about 1 ,800, almost 2 ,000 calories. So I had more muscle. I had less fat to live, to sit still and breathe into this thing in the laboratory, which measured my carbon dioxide. I was burning more calories just to live because muscle is more metabolically active than fat. Thank you. I appreciate you being so open and talking about it. And I think it's a brilliant way of making real what you're describing of the impact of the muscle. I think it's also really amazing in terms of just the amount of calories you needed just to sustain yourself. So I guess I understand a bit more that your answer to this question at the beginning about, well, if you have a lot more muscle, then actually you're just going to burn a lot more calorie supporting it as well as those positive things.

36:39And is that back to that positive cycle that you were talking about at the beginning, sort of that the more muscle can actually help to keep you healthier, sort of stop weight gain? In so many ways. We mentioned this word body composition. How does that fit into what you're just describing? Is that the amount of muscle versus - Instead of just getting on the scale, I wanted to know what I was made of. I never returned to the same weight I was when I was 40 pre-menopause, but I returned to nearly the body composition. Is that the percentage of fat you're describing? What does that mean? At 40, my body fat was 19, which is pretty low for a woman, but I was doing my thing.

37:26and then when I worked on my muscle mass and worked on my perimenopause I got it my body fat down from 32 percent which is pretty unhealthy in my book to 22 which is very healthy for a woman right and in doing so because I can measure my muscle mass I gained eight pounds of muscle over the course of lifting heavy and everything. So it changed my basal metabolic rate. I had more muscle than I probably did when I was 40 with 19 % body fat, and I was burning more calories. It just shows it's important. So I may weigh more now, but I have more muscle now that I'm consistently working on it. It raised my metabolic rate.

38:16So all these things work together. And when you describe being 22 % body fat, what does that mean? That's 22 % of what? Of body composition. When you get in a DEXA scanner or a body composition machine, it'll tell you fat percentage. It'll tell you muscle. And it'll tell you other or nonfat body composition. And some of them will tell you muscle. But it includes bone and water and that kind of thing. So you pull out the isolated numbers of muscle. you pull out the isolated numbers of fat. And fat can be, depending on the machine you're using, divided into peripheral fat, which is our pinchable fat, and our visceral fat, which is the deep inside our fascial layer, our abdomen that can smother our organs.

39:08So high body fat is a bad thing, but in particular high body fat inside is bad. And I'll tell you what that looks like on the outside for people like, what does that mean? What does it look like? So when you look at body shapes out on the street, there are some people who seemed really skinny around the waist, but maybe more meaty around the hips and in the rear end. And maybe they're shaped like a pear almost. If you're like, what is that body type? A pear. And there are some people who have really thin, lean legs, but a really robust, appley middle. The difference between those body shapes is where we store our fat.

39:46It is considered pear-shaped, where we store our fat in our hips and our rear end, and as more healthy because that's peripheral. That's outside our fascial layer. It is not metabolically disastrous. Versus that which surrounds our organs and makes us look like an apple with two little legs, that is more metabolically active and unhealthy. And so we can measure that by waist-hip ratio, by waist circumference, just to get an idea if we don't have a scanner to tell us where we're hiding it. I would love to switch to, okay, I'm sold on all of this, Vonda. Okay. You've given me this story about why I'm going to throw the scale out of the window and focus on how I can improve that body composition.

40:38now help me to understand practical actionable advice about how I do it. The first thing I want people to do is become students of themselves. You should not take my word for it. You should not take your word for it. You should become voracious readers of solid information. And you don't have to go all the way back to the scientist papers. Many scientists, you have them on all the time. So choose who you listen to wisely, number one. Number two, to become an observer of your body, right? Data is okay. We're talking about a scale. Maybe you, for a short amount of time, use a CGM so you can know how the piece of bread affects your blood sugar, makes how you feel.

41:20Be an observer. Maybe you get some actual blood work done because you've never bothered before because you feel fine. When I'm taking someone to the OR and I'm asking them their medical history and their midlife, and they say, oh, I'm good. I don't have any problems. I say, is that because you know that, because you've had an exam and some blood work, or because you've never darkened the door of a medical office in your life? There is a difference, right? So after you learn, get some data, then you can build a personalized program for yourself, right? Number four is no matter who you are and what your age, you must learn to lift weights because we're not agrarian.

42:03We're not lifting logs in the field or pigs over the fence. We're just not. But decide what your goal is, right? If you want endurance, you can lift very light weights for a lot of reps to failure. I mean, you can get to failure with a five-pound weight. You just have to lift it a lot of times. Let's say, Vonda, that I'm like, I have no interest in lifting weight. You got me through the door with like, I'd like to lose weight, but then you told me I shouldn't focus on weight. I should focus on body composition. Yes. What do I need to do to do that? Your cardio needs to be 80-20, 80 % base training, 20 % high intensity sprinting.

42:41That's about two days a week. And you need to lift weights, not for endurance, not a lot of reps lightweight, not for hypertrophy, which is a little heavier weights, but 10 to 15 reps in general per set, unless your goal is hypertrophy. In aging, my whole focus is longevity and aging. My goal is strength and power. Strength, meaning what I can lift in a single lift, power in what I can lift over time. Because I am trying to keep you from falling down. I am trying to keep you independent in your home and not end up in somebody else's care because you're too weak to get up from a chair or climb your own stairs or open the pickle jar and make your own food, right?

43:28So to lift for strength and power, you have to lift heavier. And the ranges on those lifts are three to six reps for four sets. To build muscle for strength and power four reps times four sets. Because if I get to near failure in four reps, meaning with good form in the power lifts that I do, I can do, let's do bench press. I can do four reps of bench press and I'm almost a failure. I can eke out five, it's going like this, one side's going down, but I'm not doing six. So to get to this place where I'm capable of lifting heavy, if you're starting from zero, it takes time. When I decided to recompose my body after perimenopause, I had lifted most of my life.

44:22I knew how to do it. I just went to trying to lift heavy. But if you're stepping away from the couch for the first time, you need to work through lifting light first, learning how your body works, learning the proper lifting technique before you attempt these. And then this is a great time to hire a trainer to show you because there is technique is critically important when you lift heavy. What sort of exercises do I need to do within this hefty lifting to achieve what we're talking about? I think there's a lot of ways. And so I base my lifting and the lifting that I prescribe for people on power lifting, the upper body push pull.

45:00So some kind of bench, some kind of weighted pull, lower body push bowl, which means squats and deadlifts. I prefer myself and for people to do them with bars and iron. You can do them with free weights. So those are the four core lifts that we do the heaviest, four reps, four sets, because they're compound. They take multiple joints, multiple body balance. They take multiple muscle groups. To support that the way we prescribe is the supplemental lifts, and I'll describe that. We can do eight or 10 of those, not to failure. So for the bench press, for instance, if I'm going to do fifth bench press day, and I'm going to start with that as my heavy sets, to round out the day in upper body, I might do three or four sets of eight to 10 biceps, triceps, lats, delt, rows, right, to augment this, to support the heavy lift I do.

46:02So that is the basic formula. And Vonda, why do you add those additional exercises? Because those are single muscle groups. And is that because they're not necessarily being captured by these sort of core four exercises you're describing? They're used, but not in isolation. And so we're setting up our really heavy lifting by supporting the other muscle groups that support that lift. If you're only doing the powerlifting moves because you have no time and that's all you can do, you will become leaner. Your body will change in not that much amount of time. But sure, as you are lifting the supplemental lifts, your muscle definition will become more.

46:40You will grow more muscle. We're still causing micro tears in the muscle, which will then have to heal. We're still doing some of that. And that is a nice bonus. And your key message here is there's actually only four exercises you're describing are the core to achieve. Yes, in what I prescribe, yeah. There are lots of ways to skin a cat, if you will. Do you know someone who's trying to be more active and might get a boost from the knowledge in this podcast? Showing that the building muscle can be a powerful foundation for achieving a strong and healthy body that lasts. If so, why not send it to them right now?

47:14I'm sure they'll thank you. Can I go on to the sort of sprinting and cardio? Sure. Because I didn't understand very clearly what is required. How important is that versus the heavy lifting you just described? And what do you need to do to get the value out of this cardio side that you were describing? Cardio and weightlifting work on different parts of our total being, right? Cardio builds a big metabolic engine, hearts, lungs, right? The exchange of oxygen, the efficiency of our heart to pump blood out, that's what we're working on with cardio. in addition to, you know, walking just contracts muscle.

47:59It has a lot of good metabolic things. But what I find is that people do a lot of workouts in the middle. They end up pretty tired, but they haven't worked hard enough that our body perceives that as strategic stress. We're going to change our metabolism. We're going to increase our oxygen exchange at the top. or they just walk at a leisurely pace, more than 20 minutes a mile. On a treadmill, four is a 15 minute pace. Three is a 20 minute pace. So in there, you have to work at a pace to have metabolic change. If you work right in the middle, you're exhausted, you're hurt more, but we're not getting the benefits of either side.

48:43And listen, I used to love that. I used to go to a certain gym where The whole point was to keep your heart in the orange zone. But I've now pivoted based on sprint data and walking data to really working people out on those two edges. So could you summarize for me what you should be doing there for if you want to do this cardio side? Based on this work of our metabolic lab, three hours a week of base training at lowish heart rate, which is about at your lactate threshold, which I can measure in a lab. But if you're doing it in public, it's 181 minus your age, not 220. That is your heart rate.

49:23Heart rate, 181 minus your age, or lots of wearables will estimate it for you. It's not necessarily accurate, but it'll estimate, oh, you're in zone two based on population data. So three hours a week broken up into 45-minute sessions, it turns out to be a brisk walk. When I do this, currently to get my heart rate at 130, which is where my lactate threshold is, my treadmill is on 4.5 incline and my speed is 4. That's just where I am right now. And as you get in more shape, the work you have to do to get your heart rate into the baseline, you'll have to do more work. Let's say that I didn't have a heart.

50:03I'm just thinking if I didn't have a heart rate measure and I'm trying to understand that, is there some proxy like that that I could use to figure out whether I'm in this sort of zone two that you're describing? Yes. When I'm in zone two and when I do retreats, people are in zone two. After about seven minutes, they've broken a little sweat, just a little dewyness, no dripping sweat. And they're able to answer questions like, who do you work for? What's for dinner? How do you feel right now? But not a conversation like this, not solving world peace, not talking about the philosophy of life, because if you can do that, it's too slow.

50:40That's really helpful. So you're saying three hours across the week. About 45-minute sessions is what our scientists suggest. And then twice a week after you've totally warmed up. I do this after my zone two when I'm totally warmed up. Everything is fluid. because I do mine on a treadmill. I pop it up to 11 and I run as fast as I can to get my heart rate as high as it can go. I do that for 30 seconds. And then you totally slow it down and you recover back to baseline. Takes two or three minutes. And you repeat that four times. And you can do this on a bike, on a rower, on an alpine, between light posts.

51:27You can do it. Doesn't matter the apparatus. What's become very popular lately, and I'd like to meet this guy. He's a track and field coach. He trains elite sprinters. He is now recommending skipping as a way to train sprinting. So if you haven't sprinted in 20 years, you could retrain yourself by skipping. And did you say that if for whatever reason you had issues with running and sprinting, you could use a bike and set? Get on a rowing machine. It's not about apparatus. It's about your heart rate. Getting it up as high as it can. Now, we should do the medical warning that if for some reason your cardiologist has told you not to get your heart rate up, or if you have no idea what your cardiac plaques are in your midlife, maybe you should get checked out before you go stressing your heart out.

52:16Is there anything different for a woman who's in perimenopause or after menopause that is different from advice you might give to a woman before that stage or to a man? And is there anything that's different across any of this? Men and women age very differently. Men, after puberty, have their big dose of testosterone that continues pretty steadily across their lifespan until midlife, 40s, and then it slowly declines. There's no precipitous drop in that. Women are very different. Our hormones are very different. In our youth, every month, they're cyclical until, and it's different for every woman, perimenopause, the average age is 45 when we do not have enough egg follicles left to produce the load of estrogen we once did.

53:07And our body goes into a little estrogen hunger and tries to compensate. And it's a very chaotic time. But during that time, because estrogen receptors are on every tissue of the body from our brain to our heart to every musculoskeletal tissue and all the soft organs, the wonderful things that happen when estrogen sits in the estrogen receptors no longer happen efficiently. And that ages women. It increases our inflammation because estrogen is a prominent anti-inflammatory in the bottom body. It changes our glucose metabolism such that many women become insulin resistant during this time, and thus the weight gain doing nothing different, right?

53:53Our lipid profiles change, meaning all of a sudden we have high triglycerides, high LDLs, high total cholesterols when nothing has changed. It's all due to the metabolic role of estrogen. So, yes, there are profound differences between the way men and women age and therefore the way we respond to certain stimuli. If women never start lifting weights, what do I see? I see I'm a practicing surgeon. Every time I am on call, I meet women in the emergency room who have become so frail that they've broken. That's why I think every woman should lift. Every woman should feed herself, right? We should all be concerned about our bones because I see the future of women when we coast on our youth.

54:43And it's a lot of suffering. Before we wrap up, I'm conscious that we mustn't ignore these weight loss drugs, these GLP-1 based drugs, because clearly there are a very large number of people who are taking them and listening to what you were describing. They're losing a lot of muscle alongside a lot of fat. And should these people be doing anything different from what you're describing? Or is this sort of the same prescription alongside this drug as it would be without taking the drug? I am not a GPL1 expert, but when I talk to my colleagues, Rocio Salas-Wallace, for instance, she's an endocrinologist in New York.

55:27She also prescribes heavy lifting to her patients on GLP-1. She also prescribes adequate protein for her patients. So we have the fuel to build the muscle. Final question. If you were only able to give one piece of advice, what would you tell them? If you are currently doing nothing, take a walk after your biggest meal. Walking is a core skill. If you do that after your biggest meal, your muscles will suck up the glucose you're making. If you do that for seven days in a row, that becomes a streak. You have overcome a mental hurdle because you don't want to break your streak. You've done it for seven days.

56:09It becomes a resilience factor. I love it, Vonda. I'd like to try and do a quick summary and please let me know if I get anything wrong. So the biggest thing I took away is like, if you lose weight, like 20 to 50 % of that loss of weight is actually muscle. So you've got rid of this thing and it turns out that's really bad. So the goal has to be not to lose weight. I love the way you put it. It's to lean up. Yes. And that's because this muscle is really important to us. It's not just about, you know, looking good on the beach. As we get older, it's critical preventing falls. Let's get out of a chair.

56:46but also you were describing all the ways we now understand that it's metabolically active so it's having all these other benefits and that means like i think your key message is sort of free yourself throw the scale out of the window don't look at that instead look at what you call body composition which is like the fraction of your weight that is actually coming from body fat and you and you shared this amazing statistic yourself about how you could reduce from i think you said 32 to 22 body fat and actually your weight on the scale didn't really change very much It changed some, but I gained a lot of muscle in the process.

57:19And you feel great about that. Yeah. And then you talked about like the core exercises. And I think you said there's like two separate key things that we need to do. One is that you need to build muscle, you know, to get this power. And to do that, you need to do this really sort of hard and heavy lifting. and you said if you were going to get down to the core advice, it's like four repetitions of four lifts with something really hard. So that means that by the time you got to four, that was really hard and you might - To failure. Once you work up to it, it takes a while to work up to it, but that would be the goal.

57:55And you said if you aren't really used to doing that, find a trainer to help you to learn how to get to that. And the core exercises you need to do is like an upper body push and pull, a lower body push and pull. So between that, you are going to do that work that is going to allow you to make that body composition. In addition, there's this cardio. And the key thing you were describing is like two parts, one, which is sort of three hours and you called it as like base training. The way I understood it was like you had a technical definition, like your heart rate 181 minus your age. But actually your other way of saying it was Like if you could answer a short question, but you couldn't have a long conversation, you sort of know you're in that right range.

58:39And I think that was sort of three hours. And you were saying that was maybe like four times a week? 45 minutes a time. And then when you add it on top, interestingly, was something really hard, which I would hate doing. You would love it when you were done. I would love it when I was done. You sound just like my trainer. twice a week you said after this base training when you're like really warmed up so not so likely to hurt yourself you run as fast as you can to get your heart rate as high as it can go for 30 seconds then you lean over you wish to die for two to three minutes and then you repeat it so you do it like four times so you are you are tough we didn't doubt that but that is impressive and that is doing something really powerful for like your whole metabolism and helping with this whole body recomposition.

59:27So it's like this combination between that cardio really baseline and something really hard along with these exercise. And that worked for me and it has worked for the people I care for. As you can imagine, hosting this podcast, running Zoe, juggling family life, It all keeps me pretty busy. So I try as best I can to stay energized and show up well in all those parts of my life by fueling my body with the right food, by exercising, and by adding a scoop of Daily 30 to my meals every day. If you haven't heard of Daily 30 yet, it's the gut supplement designed by our gut health scientists here at Zoe.

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