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

Welcome to ZOE science and nutrition where world-leading scientists explain how their research can improve your health. Time and again surveys show us that the number one health goal for most people is to lose weight. Consistently outranks improving sleep, boosting mental health and even quitting smoking. For many the number that flashes up on the bathroom scale has become the only thing that matters. But is focusing solely on weight a mistake? Where did this obsession begin? Was it with companies selling scales or with diet plans? Plans that told you you were succeeding even if you felt terrible? That pushing you to ignore the signals from your own body and focus only on one external measure of health. So is it time we stop asking how much do I weigh and start asking what is my weight made of? In other words body composition.

Today I'm joined by Dr. Vonda Wright, a double board certified orthopedic surgeon with more than 20 years of clinical and research experience. Her best-selling books encourage us to rethink our bodies and offer powerful tools for thriving as we age. Vonda thank you so much for joining me today. It's my pleasure, thank you.

So we have this tradition on the show with questions from our listeners in the format of rapid-fire Q&A. We have a very strict rule.

Okay.

You can say yes or no or if you have to a one-sentence answer.

Okay.

Oh I am verbose so that might be hard for me. But I know that you're double board certified so also you like to succeed so I can see you're like I'm gonna do it.

All right. Is the scale the right way to judge if you're losing fat?

No.

Can bigger muscles help prevent fat gain even when you're not exercising?

Yes.

Will strength training in midlife increase your risk of injuries?

No if done properly.

Can you reverse the age of your muscle cells?

Ah I believe yes.

And finally what is the most common misconception about muscles?

That by working to gain muscle you're going to become huge and bulky like a bodybuilder. And you won't?

Only if you intentionally lift in that hypertrophic manner for decades.

So as many listeners to the show who listen regularly will know I've actually sort of been on a 10 year journey to build some muscle. Starting from a very low base. So I've been working out with a personal trainer and over time very slowly I've increased the amount of weight I can lift. And that's sort of all been in the name of feeling better today but also staying healthy for many more years in the future. However, I was really surprised to learn from the podcast research team who were looking into your research that this increased muscle that I have isn't just making me stronger but it could actually be helping to keep unwanted fat off my body. And I'm very excited to get into this but I'd like to start right at the beginning.

What are muscles and what they're for? Because I was brought up understanding that muscles were very simple. They're like springs that you use to lift things. Is this right?

All tissues in the musculoskeletal system, muscle, bone, fat, muscle-derived stem cells or as we call them now satellite cells, even the discs in our back, the annulus and the squishy part the pulposus, ligaments, tendons are all derived from a common stem cell called the mesenchymal stem cell. And here's why that's important. We tend to think as our muscles, our tendons, our ligaments, our bones as just different organ systems. But the reality is they are all cousins. They are all speaking the same language. They are not just static structures doing one job. They are metabolically active, particularly fat, muscle, bone. They are endocrine organs meaning they secrete hormones of their own which talk to each other and talk to other parts in our body.

So when you ask me a question of is muscle just the bicep, you know, the cool thing we see in the mirror, the cosmetic things, the reality is, in my opinion, that's one of the least things they do because yes, they locomote us, but muscle as bone are endocrine organs, critically important in glucose metabolism. They secrete hormones which talk to the brain, which talk to the fat, which talk to the bone. And so the very least of how we look at our muscle in a gym mirror is a fraction of what it's capable of and the same about bone.

That's an amazing picture that you've just been painting, Vonda. A number of those things you mentioned I'd heard of.

You mentioned this thing about satellite cells. At this point many people have heard about stem cells. A stem cell is a cell that retains the ability under certain stimulation to differentiate or change into a more mature lineage such that the mesenchymal stem cell I was talking about can differentiate into mature muscle cells, into mature bone cells, for instance. But the stem cell retains its ability to become anything. There are stem cells within the muscle that are called satellite cells. They are along the endothelial cells of the blood vessels. So they're near the blood, they're in the muscle, but what they do, these stem cells can be stimulated under certain strategic stress to develop into mature muscle cells and replenish the cells that undergo natural apoptosis, which is the programmed cell death that all mature cells go through when they've done their job well and they're retired. It's time to go.

I'd love to talk for a minute more and understand those other roles that you were describing and maybe like focusing in on the muscles. What else are those muscles doing for us?

Muscle is a critical vehicle for pulling glucose out of the blood, turning it into the energy our body needs, often to contract the very muscle where it's made. So you can think of it as a glucose sink, as an energy sink for our body, which is critical, right? The more muscle you have, the more efficient you are at doing that.

And why is that important, Vonda? Why does it matter that I've got these muscles to pull in this blood sugar out of my blood?

Well, I'm sure you've spoken many times about the roles of high blood sugar in the body. And at a very, very simple level, it's like we're barbecuing our body from the inside out, where high blood sugar causes this chronic inflammation in our body, which is the cause of many chronic diseases, which is high inflammation. Sugar causes an internal process that produces these substance called AGEs, which literally I think of it as an internal barbecue. It's crystallizing inside of our body. Doesn't sound good. No, it doesn't sound good. It doesn't feel good. High inflammation is one of the reasons people get joint pain, frozen shoulder. One of the reasons we have the highly inflamed process of unchecked diabetes. I mean, all these things work together.

And muscle is critical for helping control that glucose balance, because when there's too much circulating, it is stored in fat. There's only so much our liver can store, about 2,000 calories worth. And then the rest of it has to be stored somewhere. And I'm going to tell you for sure that I find in joints where we shouldn't have this, because I'm an arthroscopist, fatty stores. It's like putting fat into the closets because there's nowhere else to put it. We have so much excess energy. Our body has to store it somewhere. It stores it in fat, and then it shoves the fat a lot of places. You should not have big layers of fat in our shoulder joint, in the hip joint, for instance. But yet, I find it there pretty frequently.

And so having more muscle helps pull this glucose, this blood sugar, out of your bloodstream and helps to fight what you're describing? That's right. In a more efficient way, instead of just storing it in any convenient but unhealthy fat globule.

I've also heard people talk about having more muscle as you age being really important. Why is that? For so many reasons, right? So when we think of the picture of aging in many countries, not just we're in the United States today, but not just here, we often think of it as this decline from vitality of youth to frailty. And that's not an unrealistic picture. In the United States, for instance, and this is not the case in every country, in the United States, two-thirds of nursing home or people living in assisted living are women, right? Women, for many reasons, have lower muscle mass than men in general. We know that muscle is critically important for preventing falls, for maintaining our strength to do simple things like get up from a chair by yourself. One of the main reasons people end up in nursing homes or assisted living is they can't do simple tasks of life, getting up from a chair, opening a jar by themselves to prepare their own food. All of those are dependent on our muscle mass.

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And when I was brought up, I think that was just viewed as sort of the natural stages of life. So in the same way that as a child, you get bigger and stronger, you get weaker and weaker and more frail. And so you would just be describing what's inevitable through your life rather than something that might be something that you can change. What does the science say about that today? You know what it is? I mean, listen, I'm not a Pollyanna. We do have significant changes that occur through the natural aging process. Aging is the most natural thing we do from the minute of conception.

If we look at today versus let's say the 1900s, no matter where you live, we are a more sedentary being. We are no longer agrarian by and large. We're not raising animals. We're not plowing the fields by hand. You know, many times people say to me, yeah, but at the 1900s, nobody lifted weights. Well, yeah, because they were hooking the plow to the tractor or to the mules, and they were out working functionally all day long. And there are wearing out episodes of that kind of heavy labor throughout a lifespan. But the reason that now in this very sedentary society that we're having this problem at all, and are encouraging people to build muscle is because we're so sedentary in our daily lives. You know, even if we are very conscious of it, like me, I mean, I'm a surgeon, I walk the halls of my, my clinic every day, I'm standing when I operate, and yet there are whole days when I'm sitting, studying, dictating 10 hours a day, 12 hours a day in deep thought. That is not amazing for our bodies. There are reasons we don't age with the muscle that maybe once we did in a different time in our societies.

And so if we do more exercise, are we able to maintain more muscle in old age? Or is that just something that? No. So listen, it's an older study. When I was first at the University of Pittsburgh, I formed this group called PRIMA, the Performance and Research Initiative for Masters Athletes. And we had the ability to study athletes of all ages and skill levels. So there was a study around that time in the early 2000s called the Health ABC. It was funded by the United States and NIH, National Institutes of Health. It took a cohort of 70 year old people, a poppy, it's a population study, so 70 year olds of all kinds, and just followed them to see what happened to them as they aged. And one of the things that that study found using CAT scans is that with aging, people's muscles not only decreased in volume, decreased in structure, became grossly fatty infiltrated, which is called intramuscular adipose tissue, but also became weaker.

And so when I looked at that study, I thought to myself, well, it's a population study. What do we know about our population? Well, in the United States, about 70% of all people do no active form of mobility or exercise of any kind. We just coast along in our youthful vigor for decades. And so I made the hypothesis that, listen, I don't believe this is the way it has to be because thankfully, I get to take care of a lot of master's age athletes. Now, these are not pro athletes. These are people like you and me who have become dedicated to a daily investment in our mobility. And so I studied them. And we looked at people from 50 to I think our oldest may have been 85. And we looked at muscle architecture, we looked at fatty infiltration, we tested strength. And I published a three picture series, which has taken on a life of its own, I should have named it, it has become such its own thing. People don't even remember that our lab produced it. But what it shows is a cross section, which means just a slice, it looks like a ham with a bone in the middle, muscle on top, which represents the quadriceps, muscle on bottom, which is the hamstrings, and the adipose tissue around the outside.

There are three pictures. The first picture, 40 year old triathlete, remember not pro, just that was his sport of choice. This muscle looks like a flank steak. It is structurally defined, it has very minimal intramuscular adipose tissue, which if you want to think in lay terms, it's like marbling. This was not a Kobe beef. This was a flank steak. Just to make sure I've got that, that is like the fat that you're describing that can be within the Yes, the marbling of like you go to the butcher and you see this fatty piece of meat with the marbling inside and a very thin rind of peripheral fat. So that was one of my study patients, a younger study patient, a 40 year old.

The center picture was a control person who did not do consistent exercise or mobility. That person's muscle had lost its architecture. It wasn't as structurally beautiful. It was grossly infiltrated with fat. It was streaked with white lines of fat. There was a very thick rind of fat around the outside. And even the bone in the middle, the cortex, which is the bark of the bone, was very thin. So that person not only had sarcopenia, muscle wasting, they had obesity, they had a thick rind of fat, thinner bones. But when I tested that person, they were very weak.

Now compare this young person who you would expect a 40 year old guy to be still pretty intact. Compare this sedentary person to a 74 year old triathlete who wasn't professional. They just invested every day in their mobility in a structured way. And if you didn't know better, you would have thought I would have taken the next picture of the 40 year old and just put it as the 74 year old because the muscle was structurally intact. There was a thin rind of fat tissue. The bone was still healthy and robust. And when I measured the fatty infiltration into the muscle, there was very little fat streaking. That picture and the description of us shows us the impact of conscientious mobility every day. Now these people were not heavy weightlifters. They were more aerobic time exercisers. But even that maintained the structural integrity of their muscle, kept their adipose tissue at bay, maintained their bone density.

You did the scan of like a 40 year old who was doing lots of exercise. You said like triathlete, lots of running, all the rest of it. And you described it as being almost like a beautiful piece of cut of meat with like very little fat, little bits in it. So it's not like there was none and this nice strong bone. And then you said you did these scans of two individuals who were both in their 70s. And one of them is you're saying like the typical 70 year old now. Sedentary person. It looked like a rump roast, like a sundae roast with lots of fat that you have to remove before you put it in the crockpot.

Right. And can I clarify on the third one, the person who had been doing this exercise. It looked almost like the 40 year old. And so had this person been exercising since they were 18 all the way through. So is this like the perfect triathlete of 40 to 70? You know, in the population of masters athletes that I studied the most, which in the United States, there's something called the National Senior Games, which means you have to be 50 or over to compete at the national level. You have to have won your state games, but you're not professional. Most of those people had not been lifelong elite exercisers. Many of them had just picked it up as their lives became more settled in their 40s and had decided to age in a different way.

But what we know is that there is no age or skill level when you cannot make significant changes in your sports performance, in your growth of muscle. There's a particular example, if you want another example of a woman that I talked to pretty frequently, who was 63 when she started to pay attention to her muscle math and health. Her name is Susan and she is also on the Internet. She just decided enough was enough, feeling tired, not recognizing herself. She said it was enough. So she began lifting weights. And over a period of time, about 18 months, she totally recomposed her body with smart nutrition, with lifting weights. So I only tell you that story to tell you that there is never an end point in improving our physical bodies with the strategic stress we place upon it. That's what our bodies are made for.

So, Vonda, are you saying it's not impossible to end up having the beautiful looking slice of my leg when I'm 75, even if I started working out when I'm 50? Yeah, I would say that's true based on people I work with and examples like Susan. But here's what's interesting.

When I first began being interested in master's athletes and aging research before I began doing my own, of course, you do a lit search, you read things. And so some of the very first papers on can you make changes in very old people were done by a researcher named Maria Fiaturone. And her research was done on 90-year-old men living in nursing homes where they found that by simply doing chair exercises over a short period of time, six or eight weeks, they were able to retrain their neuromuscular pathways enough to recruit muscle. They increased those men's functional health, their functional capacity, about 150%. 150%. It's amazing. And so that was just, we believe, tapping into retraining neuromuscular pathways. It takes longer than six weeks to actually build muscle mass, but it's a really hopeful message that there's never an age or skill level. There's never a time to give up. That's amazing.

Before we move on, I just want to wrap up this story about like these muscles and these satellite cells supporting our metabolism. You talked about how it really helps with managing blood sugar. And you've obviously also talked about just how important muscles are to avoid losing your independence and everything. Do we know whether they're playing any other roles around metabolism?

Another way it serves as an endocrine organ is producing a hormone called irisin, which has multiple endpoints in the body, including improving brain health, improving insulin resistance that works with the pancreas, talks to bone to tell bone to build more bone. Muscle does a myriad of things in the body.

Have we always known this? I think there are scientists deep in their labs that have known it for a very long time. But here's the problem. And I was an academic. It is very infrequently that academics will publish their research in journals that the public can get a hold of. They're often behind paywalls. But here's an example of why we need to get our great work out of the laboratory. We looked at could you use mobility to rejuvenate dying stem cells? We bought these mouse treadmills and we got these little old lady mice. Little old lady mice are two years old. They are just old. They're waiting in the side of their cages, just waiting for the next kibble to drop. And we biopsied their thigh muscles and isolated their satellite cells and found that they were no longer dividing. They had lost their fat, healthy, plump stem cell morphology and were all spindly like tree branches. And they had turned on signaling that would eventually lead to cell death called Wnt signaling.

Well, we took those girls and we put them on these treadmills twice a day for two weeks and then we re-biopsied and do you know that their muscle stem cells were no longer spindly like tree branches, but they had re-plumped up like grapes. And Vonda, what does that mean? That means that they were then capable of dividing and replicating themselves. You know, producing offspring is a sign of health and youth, right? These stem cells went from spindly and dying to being reproductive in a cell way. They could divide. And what would that mean for the health of the mouse as a result?

We had rejuvenated their stem cells, which means that those muscles that were injured while running, that's how we build muscle. We create little injuries and then our body heals it better. The stem cells could then now contribute to that by dividing and those cells then becoming more healthy, mature cells and by producing more normal growth factors. So how did we use that mouse on a treadmill information? We then extended that into human studies where we used treadmills and electrical stimulation to see if the same was true in people. And then we used that, Dr. Ambrosio used that to write pre-habilitation protocols for people who are going to undergo total joint replacement.

Because why wouldn't you want to optimize someone before they're having this large surgery from which they're going to have to recover with three months of rehab? If we knew that we could simply do things like treadmill walking or electrical stimulus to rejuvenate their muscle stem cells. So Vonda, I think we could keep talking about this all day, but I'd love to now go from like hearing about like this incredibly strong story about how important our muscles are, you know, on our metabolic health, as well as helping us as we age to understand how that's related to losing fat back to sort of those initial Q&A at the beginning. What goes on to our muscles if we decide to go into a calorie restricted diet, which is, I guess, the way we've all been told we should lose weight historically and even today, right?

If you start to use these GLP-1 drugs, you still end up not being hungry. So then you go into this sort of calorie restriction. What happens to our muscles?

Yeah. Well, we know that when we just calorie restrict, we lose, depending on who you read, 20, 40, 50 percent of the total weight on the scale in muscle. We will lose fat, but a large portion of what we lose will be muscle because our body has a hierarchy of needs. Our body perceives certain tissues like bone and muscle as not only functional, but storehouses.

You're saying it sort of as though it's obvious, but that's pretty shocking. I generally would think about it as like, well, you lose fat because after all, you're still walking around. You will lose fat, yes. I think many people like me will be surprised that you would lose any muscle at all.

Well, listen, when people are sick in the hospital for a week, it's estimated you can lose nine percent of your muscle mass from laying still. Nine percent in a week? Yeah. Cachexia and being ill and drawing from your muscle as a source of energy can lead to profound changes. If 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.

Does 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. Because for instance, you can eat a lot of protein on a 1,500 calorie meal plan, right? So if your maintenance is 1,800 calories and you're trying to restrict by 300, you can still eat a lot of protein within that number of calories. You know, you have to choose. You have to eat lean meats and lean sources. But it's completely possible.

Fonda, 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.

So 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 in 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 a hundred pounds, but if you do body composition, you have very low lean muscle mass.

So that's on one end of the spectrum. On 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. It almost goes beyond the scope of our x-ray. You have normal size 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 percent 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... The fat rind, right. We call that sarcopenic, meaning that person is sarcopenic, very low muscle and obese, very high lipid content. So 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, this 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 a hundred 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. For 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, but actually I might have 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. We'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. At 19 percent body fat, I wasn't lifting a ton. I was doing mostly cardio, but I was in great shape at that time, 19 percent body fat.

Then I went through perimenopause, which hit me like a ton of bricks. And 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 percent 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 percent body fat was about 1350 calories, which is not a lot to eat in a day. Once I regained my muscle, got my body fat back down to 22 percent, I gained eight pounds of muscle in about a year, which is a lot. My basal metabolic rate was about 1800, almost 2000 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 is 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 and actually you're going to burn a lot more calories supporting it as well as those positive things. And 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? So 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. And then when I worked on my muscle mass and worked on my perimenopause, I got 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 percent 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. So all these things work together.

And when you describe being 22 percent body fat, what does that mean? That's 22 percent 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 non-fat 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. So high body fat is a bad thing, but in particular, high body fat, visceral 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. It 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, you know, 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, OK, I'm sold on all of this, Vonda, 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. Now, 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, become an observer of your body, right? Data is OK. 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. Be 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 into 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, we'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. I just, 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.

Your cardio needs to be 80-20, 80 percent base training, 20 percent high intensity sprinting. That'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? So 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'd lifted most of my life. I 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? 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. So some kind of bench, some kind of weighted pull, lower body push pull, 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 muscle, 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 for the bench press, for instance, if I'm going to do it's bench press day and I'm going to start with that as my heavy sets to round out the day and 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. So 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 power lifting 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. You 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. As the power lifts, in what I prescribe. Yeah. There are lots of ways to skin a cat, if you will.

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Can I go on to the sort of sprinting and cardio 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 like the value out of this? It's 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. It 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. And 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? Yes. 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. 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 four. 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. I'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.

That'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. You 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 instead? 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 and you're midlife, maybe you should get checked out before you go stressing your heart out.

Is 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? 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. And 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 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? Our 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. And it's a lot of suffering.

Before we wrap up, I'm conscious that we mustn't ignore, you know, 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. 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 GPL-1 expert, but when I talk to my colleagues, Rocio Salas-Wallace, for instance, she's an endocrinologist in New York. She 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. It becomes a resilience factor.

I love it, Bonda. 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 percent 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 the 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. Yes. Get out of a chair. But also you're 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 percent to 22 percent 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. And 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. And you said if you aren't really, you know, 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 is 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 in that right range.

And I think that was sort of three hours. And you were saying that was maybe like four times a week, 45 minutes at a time. And then when you add it on top, interestingly, it 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. So 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 sharp 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. It's made of over 30 high quality handpicked plants, including seaweed, fungi and different types of fiber.

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So what are yours today at Zoe.com slash Daily 30? Thanks for listening and see you next time.