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

Do you track your weight, hoping to see the numbers drop? What if the scale is deceiving you about true health, muscle, and healthy aging?

Many believe they understand the key to a vibrant later life, but conventional wisdom often overlooks a critical truth. 

This oversight could be inadvertently putting your future well-being on a slippery slope of decline, even if you feel like you're doing everything right. You might be losing something far more valuable than just fat.

A best-selling author, Vonda reveals why muscle is not merely for aesthetics but a metabolic powerhouse crucial for energy, glucose control, and preventing age-related frailty.

Learn how to truly 'lean up' and why it’s vastly more important than just losing pounds. 

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Transcript

Jonathan Wolf: Vonda, thank you so much for joining me today. 

Vonda Wright: It's my pleasure. Thank you. 

Jonathan Wolf: 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: you can say yes or no, or if you have to, a one-sentence answer. 

Vonda Wright: Okay. I am verbose, so that might be hard for me.

Jonathan Wolf: But I know that you're double board certified, so also you like to succeed. I can see you're like, I'm going to do it. Alright. 

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

Vonda Wright: No. 

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

Vonda Wright: Yes. 

Jonathan Wolf: Will strength training in midlife increase your risk of injuries?

Vonda Wright: No, if done properly, 

Jonathan Wolf: Can you reverse the age of your muscle cells? 

Vonda Wright: I believe yes. 

Jonathan Wolf: And finally, what is the most common misconception about muscles? 

Vonda Wright: That by working to gain muscle, you're going to become huge and bulky like a bodybuilder.

Jonathan Wolf:  And you won't?

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

Jonathan Wolf: So, as many listeners to the show who listen regularly will know, I've actually 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 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 are they 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? 

Vonda Wright: 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 of 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. 

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

You mentioned this thing about satellite cells. Could you just… 

Vonda Wright: 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 program cell death that all mature cells go through when they've done their job well and they're retired, it's time to go.

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

Vonda Wright: 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. 

Jonathan Wolf: 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?

Vonda Wright: Well, I'm sure you've spoken many times about the roles of high blood sugar in the body. 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 substances called AGEs, which, literally, I think of it as an internal barbecue. It's crystallizing inside of our body. 

Jonathan Wolf: Doesn't sound good. 

Vonda Wright: That 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 2000 calories worth, and then the rest of it has to be stored somewhere.

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 into a lot of places. You should not have big layers of fat in our shoulder joint, the hip joint, for instance. But yet I find it there pretty frequently. 

Jonathan Wolf: And so having more muscle helps pull this glucose, his blood sugar, out of your bloodstream and helps to fight what you're describing. 

Vonda Wright: That's right. In a more efficient way, instead of just storing it in any convenient but unhealthy fat globule. 

Jonathan Wolf: I've also heard people talk about having more muscle as you age being really important. Why is that? 

Vonda Wright: For so many reasons. Right? So when we think of the picture of aging in many countries, we're in the United States today, but not just here, we often think of it as this decline from the 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 that 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. 

Jonathan Wolf: 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 would get weaker and more frail. 

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? 

Vonda Wright: So 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. 

Many times people say to me, But in 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. 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. 

Even if we are very conscious of it, like me, I mean, I'm a surgeon, I walk the halls of my clinic every day. I'm standing when I operate, and yet there are whole days when I am 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.

Jonathan Wolf: So if we do more exercise, are we able to maintain more muscle in old age, or is that just something that…

Vonda Wright: 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 master's athletes. 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 Institute of Health. It took a cohort of 70-year-old people. 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.

One of the things that the 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.

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. 

So I studied them and we looked at people from 50 to, I think, our oldest may have been 85. We looked at muscle architecture, we looked at fatty infiltration, we tested strength.

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 the bottom, which is the hamstrings and the adipose tissue around the outside.

There are three pictures. The first picture, a 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, as marbling.

This was not a Kobe beef; this was a flank steak. 

Jonathan Wolf: Vonda, just, just to make sure I've got that, that is the fat that you're describing that can be within the muscle. 

Vonda Wright: Yes, the marbling. You go to the butcher and you see this fatty piece of meat with the marbling inside and a very thin rhine 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 rhine 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 rhine 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. 

If you didn't know better, you would've thought I would've 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 rhine 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. 

Jonathan Wolf: You did the scan of a 40-year-old who was doing lots of exercise, you said like a triathlete, lots of running, all the rest of it. And you described it as being almost like a beautiful piece of cut of meat. 

Vonda Wright: Yes. 

Jonathan Wolf: With very little fat, little bits in it. So it's not like there was none and there's nice, strong bone. 

And then you said you did these scans of two individuals who were both in their seventies. And one of them is the typical 70-year-old now. 

Vonda Wright: A sedentary person. It looked like a rump roast, like a Sunday roast with lots of fat that you have to remove before you put it in the crockpot. 

Jonathan Wolf: And can I clarify on the third one? The person who had been doing this exercise.

Vonda Wright: It looked almost like the 40-year-old. 

Jonathan Wolf: 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? 

Vonda Wright: In the population of master's 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 forties 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 talk to pretty frequently, who was 63 when she started to pay attention to her muscle mass 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.

I only tell you that story to tell you that there is never an endpoint in improving our physical bodies with the strategic stress we place upon it. That's what our bodies are made for. 

Jonathan Wolf: So, Vonda, you're 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. 

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Vonda Wright: 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 literature search. You read things.

Some of the very first papers on, can you make changes in very old people, were done by a researcher named Maria Terone, 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 by about 150%. 

Jonathan Wolf: 150%. 

Vonda Wright: 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. 

Jonathan Wolf: That's amazing. Before we move on, I just want to wrap up this story about these muscles and these satellite cells supporting on 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? 

Vonda Wright: 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. 

Jonathan Wolf: Have we always known this? 

Vonda Wright: 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 infrequent that academics will publish their research in journals that the public can get 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. 

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.

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. 

Jonathan Wolf: Vonda, what does that mean? 

Vonda Wright: That means that they were then capable of dividing and replicating themselves. You know, producing offspring is a sign of health in youth, right? These stem cells went from spindly and dying to being reproductive in a cell way. They could divide. 

Jonathan Wolf: And what would that mean for the health of the mouse, as a result? 

Vonda Wright: 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.

Jonathan Wolf: So, Vonda, I think we could keep talking about this all day, but I'd love to now go from hearing about this incredibly strong story about how important our muscles are, to our metabolic health, as well as helping us as we age to understand how that's related to losing fat.  And back to those initial Q and A at the beginning.

What goes on with 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, 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? 

Vonda Wright: Well, we know that when we just calorie restrict, we lose, depending on who you read, 20, 40, 50% 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.

Jonathan Wolf: You are saying it as though it's obvious, but that's pretty shocking. I generally would think about, it's like, well, you lose fat because after all, you're still walking around…

Vonda Wright: You will lose fat. Yes. 

Jonathan Wolf: But I think many people like me will be surprised that you would lose any muscle at all. 

Vonda Wright: Well, listen, when people are sick in the hospital for a week, it's estimated you can lose 9% of your muscle mass from lying still. 

Jonathan Wolf: 9% in a week.

Vonda Wright: 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. 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.

Jonathan Wolf: 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? 

Vonda Wright: 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 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.

Jonathan Wolf: 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. 

Vonda Wright: 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, 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.

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 of inches of fat on the outside of 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 sized bones in the middle. There's no such thing as big boned. 

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 rhines of adipose tissue, three, four inches on either side of, again, very wispy muscle. 

Jonathan Wolf: And Vonda, your adipose tissue is the fat, so again, you're saying the fat.

Vonda Wright: We call that sarco-obesity, meaning that person is sarcopenic, very low muscle mass and obese, very high lipid content.

So you can be skinny fat, meaning really low weight, but very low muscle, low fat content, or you can be low muscle plus high fat content. Neither of which are great because of the common denominator of sarcopenia, low muscle. 

Jonathan Wolf: 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. 

Vonda Wright: 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, 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 into 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. 

Jonathan Wolf: And so therefore, if I lose some muscle, I could be weighing myself and saying, hurrah, that's brilliant. I've lost muscle. 

Vonda Wright: Yeah, 10 pounds down. 

Jonathan Wolf: But actually, I might have just lost all of this great, healthy muscle. 

Vonda Wright: You would've 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% 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.

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.  

At 40, I had my last child at 40. I was training for triathlons at 40. The really prime time in my career, as busy as I could possibly be. At 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, 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%. 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. 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. 

Jonathan Wolf: Thank you. I appreciate you being so open and talking about it.  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 just going to burn a lot more calorie supporting it as well as those positive things. 

And is that back to that positive cycle that you were talking about at the beginning, that the more muscle can actually help to keep you healthier, stop weight gain.

Vonda Wright: In so many ways.

Jonathan Wolf: We mentioned this word, body composition. How does that fit into what you are just describing? Is that the amount of muscle versus… 

Vonda Wright: 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.

Jonathan Wolf: Is that the percentage of fat you're describing? What does that mean? 

Vonda Wright: So 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%, 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. So all these things work together. 

Jonathan Wolf: When you describe being 22% body fat. What does that mean? That's 22% of what? 

Vonda Wright: 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 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. 

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. 

Jonathan Wolf: So high body fat is a bad thing, but in particular, high body fat, high visceral fat, inside is bad. 

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Vonda Wright: And I'll tell you what that looks like on the outside for people who are 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 seem 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 is 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. 

Jonathan Wolf: I would love to switch to, okay, 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 to do it.

Vonda Wright: 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. You don't have to go all the way back to the scientist's 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. Data is okay. What 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. 

Jonathan Wolf: Let’s say, Vonda, that I have no interest in lifting weight. It's 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. What do I need to do to do that? 

Vonda Wright: Your cardio needs to be 80/20. 80% base training, 20% high-intensity sprinting. That's about two days a week, and you need to lift weights.

Not for endurance, not a lot of reps, light weight, 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 for 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.

Let's do bench press. I can do four reps of bench press, and I'm almost at 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, 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.

Then this is a great time to hire a trainer. To show you, because technique is critically important when you lift heavy. 

Jonathan Wolf: What sort of exercises do I need to do within this hefty lifting to achieve what we're talking about. 

Vonda Wright: I think there's a lot of ways. 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 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, if it’s 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.  To augment this to support the heavy lift I do. 

So that is the basic formula. 

Jonathan Wolf: And Vonda, why do you add those additional exercises? 

Vonda Wright: Because those are single muscle groups. 

Jonathan Wolf: And is that because they're not necessarily being captured by the sort of core four exercises you're describing?

Vonda Wright: 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'll 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'll 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. 

Jonathan Wolf: And your key message here is there's actually only four exercises you're describing are the core to achieve… 

Vonda Wright: The powerlifts in what I prescribe, yeah. There are lots of ways to skin a cat, if you will. 

Jonathan Wolf: Can I go onto the 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 the value out of this cardio side that you were describing? 

Vonda Wright: 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 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 have now pivoted based on sprint data and walking data to really working people out on those two edges. 

Jonathan Wolf: So, could you summarize for me what you should be doing, therefore, if you want to do this cardio science?

Vonda Wright: Yes. Based on this work of our metabolic lab, three hours a week of base training at a low-ish 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. 

Jonathan Wolf: That is your heart rate.

Vonda Wright: 181 minus your age. Lots of wearables will estimate it for you. It's not necessarily accurate, but it'll estimate 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. 

Jonathan Wolf: Let's say that 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? 

Vonda Wright: 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. 

Jonathan Wolf: That's really helpful. So you're saying three hours a week across the week. 

Vonda Wright: 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. 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. 

Jonathan Wolf: And did you say that if for whatever reason, you had issues with running and sprinting, you could use a bike instead?

Vonda Wright: 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 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. 

Jonathan Wolf: Is there anything different for a woman who's in perimenopause? Or after menopause, that is different from advice you might give to women before that stage, or to a man? 

Is there anything that's different across any of this? 

Vonda Wright: Men and women age very differently. Men after puberty have their big dose of testosterone that continues pretty steadily across their lifespan until midlife, forties, 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.

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. That ages women.

It increases inflammation because estrogen is a prominent anti-inflammatory in the body. It changes our glucose metabolism such that many women become, 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'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. 

Jonathan Wolf: 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.

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 the same prescription alongside this drug as it would be without taking the drug? 

Vonda Wright: I am not a GPL-1 expert, but when I talk to my colleagues, Dr. Rocio Salas-Whalen, 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. 

Jonathan Wolf: Final question, if you were only able to give one piece of advice, what would you tell them? 

Vonda Wright: 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.

Jonathan Wolf: 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 if you lose weight, 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. 

Vonda Wright: Yes.  

Jonathan Wolf: That's because this muscle is really important to us. It's not just about looking good on the beach. As we get older, it's critical. Preventing falls, 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 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 the fraction of your weight that is actually coming from body fat.

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.

Vonda Wright: It changed some, but I gained a lot of muscle in the process. 

Jonathan Wolf: And you feel great about that. 

Vonda Wright: Yeah. 

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Jonathan Wolf: And then you talked about core exercises, and I think you said there's two separate key things that we need to do. 

One is that you need to build muscle to get this power, and to do that, you need to do this really hard and heavy lifting.

And you said if you were going to get down to the core advice, is four repetitions of four lifts with something really hard. So that means that by the time you got to four, that was really hard.

Vonda Wright: To failure. Once you work up to it, it takes a while to work up to it. But that would be the goal.

Jonathan Wolf: And you said if you aren't really used to doing that, find a trainer to help me learn how to get that. That's a beautiful time to do that. 

And the core exercises you need to do are 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 two parts. One, which is sort of three hours. And you called it base training. 

The way I understood it was like you had a technical definition, your heart rate 181 minus your age, but actually, your other way of saying it was 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.

And I think that was sort of three hours. And you were saying that was maybe like four times a week, 

Vonda Wright: 45 minutes at a time. 

Jonathan Wolf: And then when you add it on top, interestingly was something really hard, which I would hate doing. 

Vonda Wright: You would love it when you were done.

Jonathan Wolf: I would love it when it was done. You sound just like my trainer. Twice a week, you said, after this base training, when you're 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 like four times.

So you are tough. We didn't doubt that, but that is impressive, and that is doing something really powerful for your whole metabolism and helping with this whole body recomposition. 

So this combination between that cardio baseline and something really hard along with these exercises. 

Vonda Wright: That worked for me, and it has worked for the people I care for.