Episode 90: We like to move it, move it

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:06] Dr. NavNirat Nibber, ND: Hello everyone. Welcome back to an episode of Supplementing Health. We are so excited because we have one of the preeminent orthopaedic surgeons with us today. We have Dr. Vonda Wright who has tremendous experience and has a very impressive resume drawing from 20 years of experience. She has coupled clinical and research pedigree with a love of teaching to educate, inspire, and motivate and entertain, which is so important right now. Really, she is in a space which we don’t see a lot of representation for women. So, Dr. Wright is internationally recognised as an authority on active aging and mobility. She believes that with mobility, smart nutrition and building relationships we can harness our own power to control 70% of our health and aging. She specialises in sports medicine and is one of the few female orthopaedic surgeons in the United States and currently serves as an orthopaedic surgeon at Houston Orthopaedic. She is a founding director of Performance and Research Initiative for Masters Athletes (PRIMA) and is the inaugural medical director for the UPMC Lemieux Sports Complex. She has done some pioneering research in mobility and musculoskeletal aging and is really changing the way we think about the aging process. Thank you so much Dr. Wright and welcome to the podcast. We are very happy to have you here.

[02:55] Dr. Vonda Wright: Thank you so much for having me.

[02:58] Dr. NavNirat Nibber, ND: That was quite a bio. Even reading through you have such a prolific career and it is really exciting. You discuss the concept of active aging in your podcast HOT For Your Health. How do you define active aging?

[03:22] Dr. Vonda Wright: I love that you asked that question especially because when I first began thinking about the aging process and how we would optimally want to live, it was way back in 2005 and I was coming out of my fellowship and I was starting to write books and getting hot into the research that we were doing through PRIMA and I have to tell you that aside from myself and a few other lonely scientists who were also screaming from their respective mountaintops that “aging is not an inevitable decline from the vitality of youth down a slippery slope that we can do nothing about”. No one else was talking about it. Because I think the reason is, because at that point the famous celebrities were doing everything they could to backpaddle into youth. As the few of us that were talking about it began to talk about it, we began to think what does it mean to be healthy, vital, active, and joyful across all spaces of our lives? Whether we are truly in our chronological youth, whether we are truly in our chronologic mid age, or whether we are becoming masters, which when we do research we define that as 40s, 50s, 60s and beyond. Once you get to be in your 70s and 80s, we call you grand masters.

[04:50] Dr. Vonda Wright: Being active means really optimising every aspect of your physical body, your physical brain but also, I have always talked about, your bliss which now has come to the fore as many people are talking about mental health and how we optimise that across a lifespan. When I talk about active aging, what I really want to conceptualise is the fact that aging can be a passive process. We can just let it happen. Let gravity take over. Let our energy roll downhill which it tends to do with physics, or we can make the most of every moment that we have. We have 1,440 moments a day, minutes a day to really make the choices that will enable us to optimise our body, brains and bliss. Here is the truth, at least 70%, much likely more 70/80/90% depending on who you read, of our health and aging is determined not by our genetics alone, not by what we are handed by our parents, but actually the lifestyle choices we make; how we sleep, what we eat, how we interact with people, what kind of toxins we allow ourselves to be exposed to passively or actively, even how we take care of our finances and the stress that may or may not be put on our lives. All of those things lead to changes at the genomic level, at the genetic level that can change the way we age. You know what this message is for me? Active aging meaning actively participating in every moment to live more is a very hopeful message. We are not destined to go from the vitality of our youth down a slippery slope to frailty and aging unless we choose to. That is really the framework of active aging that I come to all platforms with. It is hopeful. It is active. It is participatory.

[07:11] Dr. NavNirat Nibber, ND: I love and appreciate that you say that because there is such a rhetoric in the media especially as I think a lot of older millennials are starting to realise, we are challenging some of those notions and the language that was used, you know the concept of ‘anti-aging.’ Why are we fighting this natural process? I just so appreciate that you have emphasised that it is a choice, that active aging is an empowered choice. That seems to be the crux of it because of course, as you say, that hope that comes from when you are engaged in your health care and engaged in that process, I think we can then make much more thoughtful decisions. I love that you are talking about bliss from a mental health perspective. How are you finding that is parlaying into that preventative medicine, particularly in asking individuals especially if they are in their teens or twenties to stay engaged so that when they are in their 50s, 60s, 70s they are still continuing to make those choices? Do you think it can be a reactive process so we can start at any time? Do you feel that it really needs to be started and implemented as early as we can?

[08:42] Dr. Vonda Wright: That is a great question. When I first started studying master’s age athletes, those that are 50 and above, I found that many times their individual stories were that they woke up one day and decided that they were not going to get any younger and now is the time to take care of themselves. So, you have people starting in their 40s, 50s, 60s and beyond, sometimes in their 70s, just realising that “if I don’t do something this is as good as it is ever going to get.” Then some of them go walk around the block, which turns into a race, which turns into a marathon. They pick up a can of peas off the shelf which turns into squatting 100lbs. There is never an age or skill level when we cannot affect our bodies. One side of the story is that you can start at any age. There is no prohibition. Our bodies are dynamically designed to modify and grow and adapt to good stress, the stress you put on it. If we go back a couple of decades to the millennials who are aging up into their 40s, right? What I see is a different conversation. I have a non-profit called Women’s Health Conversations and about six years ago I began studying the millennials themselves because I realised that if I was going to truly do what my life’s mantra is which is change the way we age in this country, I not only had to address those who were in midlife and considered themselves aging but those who were about to enter adulthood. I started studying millennials and I had all of these study groups.

[10:25] Dr. Vonda Wright: What I found was that millennials approach health and life very differently than the baby boomers, their parents. Millennials want to be responsible for themselves. They want to deep dive and not be told what to do in a paternalistic way but come to the conversation with information as participants. Things that perhaps baby boomers would not have considered health care such as massage and meditation and mental health and all of the things that I have found millennials to be concerned about. Even sex for millennials. Sex for baby boomers is about reproduction or about pleasure. For millennials it is about social policy, about having time off at work to have babies. The millennials are concerned about their health, but they approach it very differently than their baby booming parents or grandparents. What is also interesting when I talk to millennials is that I ask them “who is going to pay for all this stuff that you want?” I am not saying it is bad and I am not saying that you don’t deserve it millennials, but who is paying for it? Because this is not cheap. And you know what they told me? They are willing to spend up to 25% of their disposable income after they already pay for their health insurance to get the health resources that they want. I also think that that is a shift from the health care of the past. Not only do they want different things, but they are willing to pay for it. Now, how do we get them to do the things that they need to do for themselves, right? Well, when you are 20 you can just go out and do about anything and fully recover. But as we adult, I don’t mean to say that in any kind of pejorative way about anyone turning 40, but I know in my own life that It was not until I turned 40 that I realized that I needed to pay attention. I needed to go and get the mammogram, prepare for the colonoscopy, get a physical, have a relationship with the doctor that just wasn’t suddenly, “oh, I have a cold, right?” I think the approach to aging and taking active participation and getting people to do it is generationally different, but I think every generation is willing to do it if we teach them how to do it in more than just what you find on the average newsstand way, right?

[13:03] Dr. NavNirat Nibber, ND: You brought up such an interesting point which is that investment and the time and energy and the financial investment. Being in Canada we have a little bit of a different structure so when we are asking people to pay sometimes, again within those political frameworks, there are slight differences, but I think for the patient care populations there is consistency in that they want to be engaged and they want some clear metrics for that. When we are talking about preventative medicine do you ever find it difficult from a motivating perspective? I know you touched on the fact that people are saying they want it and they are willing to invest, but how do you find in your practice that you are helping people to maintain that motivation and just consistency with some of the recommendations that you make?

[14:07] Dr. Vonda Wright: I think motivation is hard. If I had cracked the code on that, I think a lot of us spend our lives trying to figure out how to motivate people to actually care about themselves, right? One way to answer that is as a clinician I have tried every method. Here is what I have decided over the years; it doesn’t matter how someone tries to motivate you externally, until you decide, you yourself. Anyone listening I am pointing to you, I am looking at you. Until you decide that you are worth the daily investment in your health – I am going to say it again. Until you decide that you are worth it. You are worth more than the dog that you take care of. You are worth more than the car you try to take care of. You are worth more than the community you take care of. You as an individual are worth the daily investment in your health. You will not be moved. You must move you in order to make the most of every moment. And people, you are worth it. Sometimes people, usually women, say “oh, but I don’t have time. I am so busy taking care of everyone in our lives.” I get that. Listen, I am a wife. I am a mother. I have a blended family of six children. I get that. Listen, I can only help those people when I am at my best health. When I am sick, everything falls apart. When you decide you are worth the daily investment in your health, nothing else matters.

[15:54] Dr. Vonda Wright: Nothing will keep you from your healthy journey. How do we do that? Listen, I want you to give yourself some grace. We are not all born motivated. In fact, there is some research that shows that motivation to exercise or be mobile is genetically predetermined and about 60% of us do not have a good level of that gene. What do we have to do then? We have to fall back on discipline. We don’t desire it. We have to fall back on discipline. I don’t desire to do a lot of things in my life but I make an appointment and we get it done. I am sure some mornings none of you have the desire to get up and go to work but you have the discipline to get up and go to work. My message about motivation is why do you want to be healthy, vital, active, joyful and are you worth the daily investment? My answer to that question is yes, you are worth it. In investing in yourself you will then get to invest in the other people that you love.

[17:03] Dr. NavNirat Nibber, ND: Right. Yes. I think, as you’ve mentioned, it’s so important to assign value to yourself of course and keep that value at the forefront of everything that you do. Now, do you ever find it can be helpful to outline an individual’s risk? Do you find that with access to more genetic testing and with more access to more specialised testing that those are helpful tools? What role do you find that the testing assessments are taking?

[17:47] Dr. Vonda Wright: You know I think until very recently, I used to say this from the podium, genomic testing was a party trick. It wasn’t really ready for prime time. There wasn’t a lot we could act on. That has been true for a lot of years but at this point we are getting to the point where, when the genome was first sequenced it cost billions of dollars and it took 13 years, if I am remembering right, but now we can swab the cheek of every baby born. Exponential technology doubles in speed and halves in cost every two years. Within the next four years a genomic screen which now costs $1000 will be under $250 or maybe at $100. Why shouldn’t we then identify risk factors for disease from the day of birth? Number one, I think we are getting there. I think the fact that we can sequence our genome will demand precision medicine. Even in my orthopaedic practice I am now moving towards in the New Year a model called Precision Longevity and Ageless Life, meaning that we are not going to only do the standard orthopaedic things that we do for you, but I am going to start drawing an array of biomarkers which tell you how are you doing from an aging standpoint. How inflamed are you? How many senescent cells do you have? How much NAD+, which is one of the energy sources in our body, how much do you have? How can we modify or supplement or activate via the five or six pillars of health to optimise you? I am not trying actually to add hundreds of years to your life. Some people think that babies born today will live to 120 years. Well, okay, what if they do?  But what if only a small part of that life is actually healthy?

[19:53] Dr. Vonda Wright: Right now, babies born, actually the life expectancy now is about 80 years old. The true longevity is about 80 years old. That is the life span. But what is our health span in this country? The health span in this country is 62 years old. Canada is usually analogous to the United States. What does that mean? It means we can get along living whatever way we want until we are in our early 60s when chronic diseases rear their ugly heads. We call it the health span. When you ask me what we are doing to test biomarkers, to design longevity in a precision way, which we are doing, we are drawing tests that we have traditionally not drawn because there were no action steps to them but now there are. The science has caught up to the lifestyle. There are things we can do to decrease senescent cells in your body, to increase NAD+, to look at your inflammation, to augment traditional medicine with things that as you mentioned in our pre-interview that are termed more alternative but in my mind they are not alternative at all. We are learning the science behind them to use them in a real way to equalise the health span and the lifespan. In my own clinic I have mentioned that we have a program called Precision Longevity where we measure 20 biomarkers of aging. I have just teamed up with another company called Age Rate which uses DNA methylation technology to tell you really how old you are metabolically. Then we can measure where you are from a mobility standpoint, from a lactic acid threshold and really design four month blocks of how we are going to optimise this aging process and really jumpstart, if you will, what maybe just a passive process into an active and optimised aging process with the goal that if you are going to live 80 years, you are going to live 80 healthy years and die in your sleep versus living 62 healthy years and spend 20 of your years dying which is currently what is happening.

[22:23] Dr. NavNirat Nibber, ND: Right. Now, you touched on so many amazing points in that. I think that the optimisation piece is so important. What often our listeners come to and perhaps that is why they are here, is that they want to understand the nuance, we are all looking in that nuance space and making sure that things are individualised to our health, to our needs, to our genetic factors. You talked about the pillars of health, I wonder if we could just speak to that a little bit more, particularly in context of the recovery process, the rehabilitation process from injury and for mobility. What are the pillars of health and why are they so important as we age and recover?

[23:21] Dr. Vonda Wright: You know what, I think there is a lot of different opinions about what the five pillars of health are. The five that I talk about almost every day are smart nutrition, chronic mobility which means moving every day no matter what your ability is, being chronically mobile to whatever you are capable of, sleep and restoration, socialization and detoxification. Each one of those pillars could be not only an entire show to discuss it but really, can take years to unfold if you are going deep in one pillar. Listen, it is not that hard. People say to me “tell me one thing I have got to do in each category and let me start with that.” So as not to overwhelm people that is what I do. The one thing I tell people to do in each pillar. I think it will be interesting to you to know that as an orthopaedic surgeon and my main tool is mobility, right, I am a mobility doc. We are the gatekeepers of mobility, we help people to keep moving no matter how their movement is, I used to start with that. Then about five years ago I pivoted and I started with smart nutrition. We are going to talk about that. But you know now what I start the conversations with? About how do I begin to optimise my aging process or my health? I start with sleep and restoration. Here is why. As a surgical resident and fellow and then a new mother, there were nine years of my life, nine, that I did not sleep. I was either on call every other night or I was on call every third night which basically means that you are up for 36 hours at least before you go to sleep. That is what doctors train, no wonder we are tired all of the time. Then I had a new baby, and I didn’t sleep for two years then. There were nine years of my life when I literally didn’t sleep.

[25:37] Dr. Vonda Wright: Now that I am post-menopausal there were a few years when I didn’t sleep again. The reason I have moved sleep and restoration to the top is that unless we are capable of resting, letting our body restore, letting our brain process memories, we will not be able to do the other four pillars of health. Because sleep my friend is not – people think that sleep is a passive process where we are knocked out and nothing really happens. You may be knocked out. You may not be conscious, but your brain and your body are working like crazy to restore the wear and tear of the day. It is working to decrease inflammation, store memories, to kick out toxins out of cells. Unless we optimise our sleep and restoration, by not only getting enough sleep, but by de-inflaming our bodies, by allowing our sympathetic nervous systems which is the opposite of the fight or flight nervous system that we are operating on all day, unless we give our sympathetic nervous systems time to wind down so that we can actually rest, we are not going to be in the shape to do the other four pillars which is mobility. We must move every single day. It doesn’t matter. Just get out and move. Rest and relaxation. Move every single day. Smart nutrition. If you want to do one thing nutritionally to change your life you are going to stop eating refined sugar. White sugar and simple carbs inflame your body. Every organ system in your body is inflamed by simple carbs and refined sugar. I promise you that if you do the hard work of sugar detox, it is worth it. I will tell you in my life, I am an old athlete, and when I am on sugar my body hurts all the time.

[27:40] Dr. Vonda Wright: I stop the sugar and I don’t even feel my body. My body feels like it did when I was 26. We have talked about sleep and restoration. We have talked about mobility. Smart nutrition. Socialisation, we need friends. We need people. We need to get back and have dinner with people. Adults need unorganized activities such as play. It is okay to kick a ball around the yard or throw a frisbee. Our body needs that socialisation. Finally, detoxification. Something that is killing our children in a way we have probably never seen before are plastic toxins. Plastic toxins are being found in breast milk, in our children’s blood. Plastic is ubiquitous in our packaging in this country. Yet the American Paediatric Association as well as a number of other high level associations have put out a warning that we have got to pay attention and detoxify our bodies from plastics. Those are the five pillars of health. The one thing that I am telling my patients, if you need to start somewhere start here. People get overwhelmed and they’re like “there’s just too much” and there is too much. If you do these five things that we have just talked about as a way to start, you will be a long way towards optimising your precision longevity and being ageless.

[29:12] Dr. NavNirat Nibber, ND: It can feel very overwhelming. It can feel that we are constantly being inundated and we are all doomed. I love that you simplify it to the point where, as you kind of alluded to, our bodies know what to do. It knows how to become flexible and make those changes we just have to implement again some of that discipline. I want to focus on a little bit, if we can, on the chronic mobility piece because as you mentioned orthopaedic surgeons can be those gatekeepers of movement. Have you seen a lot of shifts, not just in the language around mobility and recovery from injury, but in the treatment approach? How do you help guide patients through that? Are you finding that there has even been a shift in how we talk about it to include individuals who have mobility restrictions, those who are maybe wheelchair bound or how some sort of sensory difficulties?

[30:31] Dr. Vonda Wright: Two pieces as a framework of what I am about to say. Number one, I do not believe there is ever an age or a skill level where we cannot change the trajectory of our health through mobility. That is framework number one for me. Framework number two is we are actually designed to move. Sometimes we are not capable of moving in the way that we could be optimally designed to because of an injury or because of a congenital problem or a chronic disease, but our bodies are equipped to do whatever we are capable of. That is my other framework. I never cop out to “oh, I just can’t because of a life circumstance.” I think there is always something we can try. I think the entire paradigm of what we are capable of from a mobility standpoint has been flipped on its head because technology has enabled us to be quite frankly like The Borg. I don’t say that in a flippant way, but think about the integration of machines in to flesh and bones bodies and what that gives us the capacity to do that we were never capable of doing before. I think it’s an exciting frontier that we are going to have to figure out how to use together. I think the biggest impediment to mobility frankly is not traditional disability, it is the couch. It is the 68% of people in both of our countries that do nothing every day to use the power of mobility to save their own lives. Listen, in the United States 66% of all of our population is obese or morbidly obese. That is not traditionally thought of as a musculoskeletal disability, such as losing your legs in an accident on a mountain. But hat is a bigger impediment to health than not being able to move because you have had a tragic accident.

[32:44] Dr. NavNirat Nibber, ND: Yes. Absolutely. I really want to quickly just touch on the nutrition and supplementation that supports the mobility and supports our ability to be mobile. Do you ever include supplementation regimes? What do you tend to look for? I know this can be a huge topic but how do you navigate that?

[33:13] Dr. Vonda Wright: The number one thing that I want everyone listening and I am sure you say this all the time, concerning supplementation is that it is completely and totally unregulated and you have no idea what is in the bottle that you are picking up, unless you are careful. Number one, buyer beware. Know what you are getting. Know that it comes from a reputable source. Look for products that come from brands that have secondary lab audits, so you know actually what you are taking. Number two, frankly you can get a lot of what you need from your diet, right? If you are eating whole foods and lean protein or plant protein you are going to get a lot of what you need. I think people very quickly turn to a bottle of pills when what they should be turning to is the grocery store. That is number two. That being said, I do take supplements myself. There are some that I give to my patients. The primary one is vitamin D because none of us, especially in Canada, get enough vitamin D from the sun. Most of us live in a vitamin D deficient state and it is critical in our bodies. That is something that I usually suggest. I would rather people get calcium, magnesium, potassium from their diets. It used to be mantra but now it is a little bit controversial about whether calcium supplementation does anything at all for people. That being said, most of my patients are still on 1200 to 1800mg of calcium in divided doses because our guts can only absorb 600mg or so at a time. When there are really big questions about what to take, you have to consider the source and you have to get your information from a registered dietitian or experts, right? ot just from another magazine off the shelf.

[35:18] Dr. NavNirat Nibber, ND: Yes, it can really feel like the wild wild west when it comes to supplementation. It is so important that, even though the market drives where we start investing a lot of research in or it can drive the current trends, it is really important to keep in context the right individual for these, you know? The same supplement might not work appropriately for everyone. That is a wonderful note to end off on. I am so appreciative of the work you do and you taking the time to explain it to our listeners and what you are doing is so important. Everything you touched on, we crave that information and I think the populations that are being underserved by these blanket recommendations based off research that was in other populations, it is not translating well. As we have this access to so much information, I think it really behoves the industry to push and promote more research. We are in a time of more information. Thank you for what you do. Thank you for your time. Where can our listeners find more information about your practice and about all of the work that you are currently doing? How can they reach out to you?

[36:44] Dr. Vonda Wright: I am glad you asked. If you all are on social media, I am on Instagram @drvondawright. You can find a lot of what I am going there. If you are interested in the orthopaedic side or the Precision Longevity side of what I am doing, you can reach out to me via my website which is the same handle, drvondawright.com and there is an opportunity there to write me a note where we can talk about what it means to live an ageless life, precision longevity or orthopaedics. That is how you get to me. Thank you so much for having me on today.

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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at marketing@aor.ca. We hope you tune in again next week to learn more about supplementing your health.

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