Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#34 Resilience: The More You Have, The More You Have to Lose
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Resilience is crucial as we age, especially when it comes to maintaining muscle, joint, and bone health. In this episode, Dr. Bobby DuBois discusses how building physical reserves early on can help withstand inevitable changes and setbacks as we get older. Just like investing in an IRA, the earlier you start building your physical resilience, the better prepared you’ll be for the challenges of aging.
Dr. Bobby shares insights from his interview with Karen, who experienced a rapid decline in strength after a period of inactivity. Despite previous success with weight loss and fitness, Karen found herself struggling to lift groceries after weeks of illness and time away from the gym. Her story highlights the importance of maintaining muscle mass and staying active, even after setbacks.
Key Points:
- The Impact of Inactivity: As we age, muscle loss accelerates. We can lose 1–2% of muscle mass per year after age 30, and inactivity can drastically speed up this decline. Strength exercises, even when started later in life, can still yield significant gains (study).
- Muscle Memory and Recovery: Muscle memory helps regain lost strength more rapidly than building it from scratch, but the recovery time lengthens with age. Karen’s experience reinforces the importance of staying consistent, even when life gets in the way.
- Protecting Joints: Joint cartilage thins with age, increasing the risk of osteoarthritis. Contrary to popular belief, regular running does not inherently damage joints. However, previous injuries significantly raise the risk of osteoarthritis (study).
- Bone Health Maintenance: Bone density peaks around age 25 and gradually declines, especially after age 50. Engaging in weight-bearing and high-impact exercises can help preserve bone density. Heavy resistance training is especially beneficial for maintaining bone strength (study).
- Supplementing won't solve the problem: Calcium/Vitamin D supplements don't seem to solve the problem.
- Practical Tips for Resilience:
- Keep your protein intake between 0.5 to 0.75 grams per pound of body weight to support muscle maintenance.
- Incorporate cross-training activities during periods of injury or illness to maintain fitness.
- Focus on exercises that build both muscle and bone density, such as resistance training and weight-bearing movements.
Takeaways:
- Aging is inevitable, but weakness isn’t. Building resilience through consistent exercise and strength training is crucial to maintaining independence and quality of life.
- Don’t give up after setbacks—muscle memory and consistent effort can help you regain lost strength.
- Prioritize activities that strengthen both muscles and bones to minimize the impact of inactivity and age-related decline.
Live long and well by staying resilient and proactive. Remember to keep moving, invest in your muscle and bone health, and stay committed to your fitness journey. If you found this episode helpful, please share it with others and rate the show!
So investing in your health is like investing in an IRA for retirement. It's really best to start early and build that nest egg or gain that muscle and bone health to sustain you in the years ahead. Hi, I'm Dr Bobby DuBois and welcome. To Live Long and Well a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman, triathlete and have published several hundred scientific studies. I'm honored to be your guide.
Speaker 1:Welcome all of my wonderful listeners to episode 34, resilience. The more you have, the more you have to lose. Well, in today's episode, we're going to talk about the fact that getting older is inevitable. I don't think we've solved that problem, but there are things you can do to help you get ahead of some of those changes to your muscles and your bones, and that is about resilience your bones and that is about resilience, and resilience is about being able to weather the changes that come with aging. Now the lessons for today you might think are just relevant to people in their middle age and beyond, but what I'd like to make the point is that even for younger folks, in your 20s, 30s, 40s, you have years ahead to make these preparations, and as you get older, you'll be even that much more resilient. Again, it's like investing in an IRA. You want to start early preparing for retirement and growing your nest egg and in health, there are many ways to work on your resiliency. Today, we're going to focus on muscles, joints and bones. There are other types of resiliency and we'll think about and talk about that in another episode.
Speaker 1:Well, before we dive in, I have a couple of requests for you. If you like this podcast, please tell others and they might benefit just the way you are, and that would be very, very helpful. If you haven't rated the show, please do so. And if you haven't done the health type quiz, by all means go to my website, drbobbylivelongandwellcom, and you can do that. Well, I'd like to begin with an interview, and really her story needs no introduction, as it will unfold and will tell us a lot about this episode. Well, karen, welcome to Live Long and Well. I've been looking forward to having a discussion together and I think what you're about to share will be really important for the listeners and the YouTube audience. You've described to me that you had a really a tough experience when you weren't able to exercise for a period of time, and maybe when you were 20, that wouldn't have made much of a difference, but as you got older you found that it was quite different.
Speaker 2:Okay, well, thank you, bobby, I'm really happy to be here. As you and I talked about, my whole life. My weight was very high Sometimes, usually somewhere between 250 to 85 up until about 10 years ago. So I went through the UCLA program there, which was fantastic, and I really worked very, very hard, diligently every day for two years and maybe even three years, and over that course of time I lost 120 pounds.
Speaker 1:That's incredible.
Speaker 2:Thank you. And right after that I had a series of plastic surgeries to take care of you know the extra stuff that comes from that. And once I did that and life completely, absolutely changed for me. And then I had a couple of health issues that took me out for about three or four months at a time where I could barely get out of bed, and one had to do with my neck, which we had to figure out, and the other one had to do with my back, which I actually had to have surgery for. But that was 10 years ago when I was in my early years, and that's still young. So coming back from that actually was pretty easy. You know, maybe really only took me six weeks to get back really to where I was. It took me six weeks to get back really to where I was.
Speaker 1:Why don't you tell us what it used to be like? When I say used to be like just a few months ago, when you would go to the market and you'd come home with lots of groceries, what was that experience like? Because I know that's about to change.
Speaker 2:So I would go to the grocery store once a week and I would come home with groceries for a whole week which are maybe 10 bags of things, potatoes, things that were very, pretty heavy, and I would have four bags in each hand. I'd walk over into my kitchen and I would just pick those bags up and put them on my island and not think twice about it. Then I took a vacation for two weeks and I came back and I got COVID and I was down for maybe three weeks with that and then I traveled again and I came back and I had a sinus infection Down again.
Speaker 1:And all throughout this time, your gym routine came to a grinding halt grinding halt.
Speaker 2:So I went from being in amazing shape and I would say that I could literally pick up 20 pounds in each hand like this, drop them right out on the island to just about. I think this was maybe two weeks ago or three weeks ago. I went to the market, had the same amount of stuff. I walked in. I could barely I would say I had like a 20 degree you know lift on these things and I just stood there dumbfounded I thought I cannot believe that I've lost this kind of muscle mass in such a short period of time, and I think I was down for maybe 10 weeks of not going to the gym. So I went from, you know, a very strong person to what I would consider to be a very weak person in such a short period of time. That shocked me.
Speaker 1:That's a shocker, that's scary, that's emotionally challenging, but you didn't give up did you. So what did you do next?
Speaker 2:Well, I belong to Gold's Gym here and I thought, okay, I'm going to go down there tomorrow and I'm going to buy a training package for 12 sessions. And I chose my trainer and I started three weeks ago and actually it doesn't really take that much time to recoup the. You know, the muscle memory is there. So just today, actually, I went to the store and I came home and maybe there were instead of four bags, I had three in each hand. But boom, I got them right up on the counter. So you cannot give up. Giving up to me is the biggest mistake anybody could ever make.
Speaker 1:So what are the lessons for yourself from this? What are the lessons that our audience should take from what happened to you?
Speaker 2:Well, first of all, I would say never give up. You cannot give up. You have to if you don't want to do it, trust me, I haven't yet gotten into the rhythm of, you know, going to the gym. I have to. I have to get up every day with the attention of going. So you have to, really you have to make up your mind. You know that you want to be a very fit person from today until the last day of your life. And you, just you, just it's Nike Just do it, you have to do it.
Speaker 1:Well, and it sounds like when you had quasi similar experiences, you know, when you were 10, 20 years younger, the bounce back if you lost anything was almost instantaneous. But now, as you get in your 60s, it seems like it's been a very different experience.
Speaker 2:It is. It's really a struggle. I mean, I don't know, it's not an easy task. You've got to get up, you've got to get after it. Yeah.
Speaker 1:Well, and it sounds like you were well on your way to getting back to where you need to be, and it's amazing that you had your experience in Italy. You had your experience with the COVID and the sinus infection, and it wasn't until you tested yourself with the groceries that you realized something was gone. And this can happen for folks in many other ways like, oh, yeah, I'm doing. Okay, yeah, I'm not exercising, not getting to the gym until they're hiking and they fall, so it's a silent problem, unless you are doing things like you did. That said, oh, I have a problem. I'm gratified that you are well back on your way and that you never give up, which is extraordinary and a lesson for all of us. Karen, thank you so much.
Speaker 2:Thank you for sharing your story. Okay, bye-bye.
Speaker 1:Bye-bye. In an earlier episode on exercise I talked about the concept of overuse it or lose it. That is, if you at some point later in life want to go on an airplane and you have a rollerboard that weighs perhaps 20 pounds and you want to put it in the overhead bin today, 10 or 20 years before that, you need to be able to lift overhead way more than 20 pounds because as you age that strength will fall. Or if you want to lift up your grandchild from the floor again, you need to be able to lift that type of weight far more today than you anticipate wanting to do in a decade or so. So the title of today's episode, which is the more you have, the more you have to lose, is meaningful.
Speaker 1:Now, karen's story pointed out that times of inactivity and that's really what caused her the troubles that inactivity takes a toll. It took a toll on her, and especially as we get older. Now I was chatting with my trainer, who's in her 30s, and she told me a similar story where she took off for a few weeks and she noticed that her ability to do weightlifting had fallen quite a bit. Now for her in her 30s, she bounced back almost instantaneously as we get older, that bounce back process is going to take longer and be somewhat more difficult. Now, as I said earlier, aging is inevitable. Now, our weakness isn't necessarily inevitable. And for today we're going to talk about our muscles, what we can do for resiliency, our joints and our bones. Well, let's start with our muscles and we want them to be as resilient as possible. So we lose about 1% to 2% of our muscle and our muscle strength each year after we're about 30 years old or so. So our muscle reserve inevitably is going to fall over time. Muscle reserve inevitably is going to fall over time. But if we build up that reserve, have more muscles when we're younger, that's likely to help us as we get older.
Speaker 1:So what about that period of inactivity? So Karen had probably two months where she didn't get to the gym and, as she described, when she went to the market and trying to pick up those groceries, it was really upsetting to her and how much she had lost. Well, what does the literature tell us? What does the evidence tell us on how quickly we lose fitness? Well, there's aerobic fitness and there's strength fitness.
Speaker 1:On the aerobic side, if you're inactive, can't get to the gym, can't run, can't do some of the things you normally do. You know, within the first week or two you're going to lose almost nothing. Now, if we push that out to three to four weeks, we're going to start to lose some aerobic fitness weeks. But we're going to start to lose some aerobic fitness. And if it continues, like in Karen's case on the aerobic side, one to three months, well, there could be a 10% drop in our fitness, up to a 25% drop. Keep in mind I'm talking about people who can still do their daily activities. If you're basically have to be in a chair because you broke a leg and it's hard to get around, or you're in bed for a period of time, that will take a much bigger toll, much more quickly, on your aerobics activities and your capabilities.
Speaker 1:What about our strength? Now? Here it's a little bit better. You know, probably in the first month or so of no training assuming again that you are walking around doing your usual activities you won't lose too much in the first few three or four weeks. Or whether you're truly injured and you can't do much of anything, all right, so that sounds pretty depressing. We're going to lose a lot.
Speaker 1:Well, what can you do to help us? Well, the whole point of this episode is about resiliency. Let's build up enough muscles so if those inevitable injuries or periods of inactivity pop up, we're going to be better off. Well, this is a reassuring study. It's never too late to begin. So here was a study where they gave people six weeks of resistance training and they did it in 20-year-olds and they did it in 80-year-olds. Now, obviously, the 20-year-olds were stronger than the 80-year-olds, but what they found was, if you looked at their three rep maximum, you know really what they could push themselves to do. Both the younger and the old improved just as much. Again, the old obviously couldn't lift as much as the young, but they both had improvements. What does that tell us? It tells us that at any age, a strength program can be beneficial to us. You don't need to say oh well, I'm 60 or 70. I can't do this anymore. Yes, absolutely you can, and it will help. Well, besides strength exercises, and along with strength exercises, it's important to keep our protein intake up. I've talked about that in prior episodes on exercise and on nutrition and around a half a gram to three quarters of a gram of protein per pound of your body weight. So I weigh about 150 or so. So for me, I'm trying to get 100 grams of protein, maybe 110 grams of protein.
Speaker 1:The next thing you can do to try to help your muscles be resilient is, if you have an injury or illness, is there some type of exercise you can still do? In Karen's case it was so problematic because she really wasn't doing much of anything to keep her fitness and her muscles working the way they could. Are you able to cross train? So maybe you sprained an ankle or pulled a muscle? Can you swim? Can you do pool running? Does an elliptical trainer work for you? Can you do upper body exercises that could raise your heart rate? So these are all things to think about to try to avoid the problems that could occur.
Speaker 1:Now people have said to me, dr Bobby, well, what about stretching? Will stretching help me reduce the risk of injury? Well, the studies and there's been a lot of studies it doesn't prevent injury. Now, I'm not saying we shouldn't stretch, of course, because it helps us feel better, makes us more able to, you know, bend down and pick up something and such. But will stretching reduce your likelihood of pulling a muscle? The data doesn't support it. Interesting, as I was reviewing the literature, there are studies that suggest that stretching, although it may not prevent injury, it does seem to benefit our blood vessels and makes them more able to do what they need to do. So maybe there are excellent reasons to stretch. Perhaps it's not to avoid injury. Okay, that's it for muscles.
Speaker 1:Let's move on to our joints. Can we protect our joints? Can we be even more resilient than we might otherwise? Well, just like our muscles deteriorate, they shrink. We lose muscle over age 30, 1% to 2% a year. Our joint cartilage also gets thinner, it deteriorates, and the joint cartilage is what keeps, say, our bones around our knee from banging against each other. They're the cushions that protect our knee or our hip or other parts of our body and that tends to thin with age. And for 30 to 40% of us, once we get to age 60 or more, we're going to have osteoarthritis on our knees, maybe other joints too, but in our knees, and osteoarthritis is again a thinning of that cartilage which then can bring on pain. So there is a real risk, that associated with the thinning of those cartilage in our joints, many of us may get osteoarthritis. Well, people say well, dr Bobby, I don't want to get osteoarthritis, what can I do, and people often say well, you know, running that's not a good thing, it'll destroy your joints. Or basketball or soccer, you know, it'll add more deterioration to our joints.
Speaker 1:It turns out when you look at a series of runners who have been running long periods of time say up to 40 years and you compare them to non-runners, there doesn't appear to be a difference on their x-rays, on their symptoms and on their mobility, and there's been a bunch of studies like that. Now these are not randomized trials and you could argue that people who have run all their life are different. Now, they may be different in genetics that's possible but they also runners often tend to be a bit thinner and so maybe by running they're not causing the regular day-to-day deterioration as much because their body mass index may be lower. Another study looked at folks who had signed up for the Chicago Marathon and they were, on average, about 43 years old and on average they had run nine marathons. So this is a group that really had done a lot of running for a long period of time, and they found about 7% of them had arthritis. But what they then dug into was that the likelihood of arthritis in these marathon runners wasn't related to how many miles they ran a week or how many marathons they've done or even their pace. So again there's a suggestion from the evidence that running isn't by itself going to deteriorate our joints Now we're going to get into injuries in just a second, but the running itself may not cause that deterioration. So for the runners out there, there's at least some evidence to suggest if you're enjoying it, you're feeling good, you should continue. So there's also been studies looking at knee loading exercises. So if you go to the gym and you're working your legs, you're often loading the knees with a fair bit of weight. It appears in at least some studies that it doesn't affect your joint thickness or cause defects or worsen osteoarthritis if it's in the very, very early stages. So that's reassuring.
Speaker 1:Now we're going to get to in just a moment. That's not the total answer. Well, in preparation for this episode, I had a chance to talk with Dr Carl Field, who's been really a pioneer in the sports medicine world. He's the past president of the American Medical Society for Sports Medicine and we had an interesting discussion about joint health. He made the point that as we age, the meniscus, which is the shock absorber in our knees, does tend to deteriorate some. And it's not that running per se or weightlifting per se causes problems. But if you already have micro tears in your meniscus, if you're doing knee loading exercises, you're raising the chance of an injury to your knee. So something to keep in mind. He suggests that if you're going to do these knee exercises, don't bend much beyond 45 degrees. We often go to 90 degrees or more. So if you're going to do lunges, you're going to do some of these. Just do it more gently, not as far of a trajectory as you might.
Speaker 1:And it turns out that, although running in and of itself may not cause osteoarthritis or knee problems, if you injure your knee so maybe you had a bad fall while skiing or while running if you've torn parts of your knee in the past, that really does increase your risk of arthritis fourfold. And in perhaps one in eight of folks who have knee osteoarthritis, it's due to a prior injury. So again, it's not the normal wear and tear that might happen, it's an acute injury which could set your knees up for further problems later on. But let's say you have osteoarthritis symptoms. Should you give up exercise? And the answer is absolutely no. It's been shown repeatedly that exercise helps osteoarthritis symptoms, and it's definitely something that is helpful if you do the right exercises to help that, and you might talk to a trainer or a physical therapist or your doctor to find out what might be best for you.
Speaker 1:Well, the other question about our joints that often comes up is well, what about all this? I read about glucosamine or collagen or chondroitin. Will they help protect my knees and my knee joints and other parts of my body? Well, in a meta-analysis of 30 trials, many of which did have a combination of both glucosamine and chondroitin, there was no improvement. Maybe there was some improvement in a little bit of discomfort and stiffness in some studies, but apparently not real changes in your joints to protect you. So if you're thinking this is really going to save you as you age, the evidence doesn't really support it.
Speaker 1:Okay, so we've talked about muscles, how to be more resilient. We've talked about our joints. What can we do to help them? Well, what about our bones and our bone health? Can we maintain our bone, our bone density, as we age, and might we even be able to build up a bit of extra bone to protect us?
Speaker 1:Just like our muscles, there is a natural loss of bone and our bones typically grow. Our mass of bones increases up until around the age of 25. Then it's fairly level between the ages of 25 and 50, but then it starts to fall. Our bone density starts to fall. It very much happens in women around the time of menopause, but it also falls in men. And this is a problem because if you lose bone mass, density and strength, you're at increased risk of hip fracture, and in the US every year there's about 300,000 hip fractures. It's a really big deal and your risk of falling and bone loss puts you at this higher fracture risk. So if you were to fall and you had weak bones, you're much more likely to have a fracture. If you fall and you have stronger bones, it's possible you'll still get a fracture, but it's less likely.
Speaker 1:Okay, so what, if anything, can we do? Well, there's been a number of studies on exercise and bone health. Now, as you know, my listeners, I'm not real excited about animal studies because animal studies are not people studies. But there have been a bunch of studies in animals that show that repetitive dynamic exercise helps bone strength in animals, and there have been studies in people. Now, some of these are epidemiologic, cross-sectional, observational studies, but they do suggest that jarring exercises, heavy weightlifting, basketball that folks' bone mass seems to be preserved, more so than other people. Now there have been randomized controlled trials that have looked at people who are lifting weights as part of a strength regimen and the wonderful thing is they found that you can increase your bone mass one to 2% and it works at multiple ages. It isn't just for the people at menopause, it happens before, it happens afterwards.
Speaker 1:But here's the caveat it isn't just a normal strength routine. In these studies where they showed benefit, it was pretty heavy weightlifting. It was now. When I say heavy weightlifter I don't mean that you were lifting 300 pounds, but for what you're able to do. Let's say you can lift 100 pounds or 50 pounds. These studies looked at 80% doing exercises at 80% of what your one rep max is. So if I can do something with 50 pounds one time, then on my routine work in this study I might do something at 40 pounds. Or if I'm able to do a one rep maximum 100, then I'm doing it maybe 80 pounds. So it's pretty intense weightlifting in terms of the weight. It isn't just going to work to take a five pound weight and do some exercises and assume that that will make the benefits and these studies again had pretty good control groups and they're definitely supportive that we can do something about our bones. There was a study in men because we might say, well, it only really works for women and these were men that were between the ages of 50 and 80. And again they did this sort of high-intensity progressive resistance training and they were able to increase the bone mass almost 2% in their hip and in their spine. And there are a lot of guidelines out there that talk about jumping and skipping rope and progressive resistance training. So it will help us with our bones and it's definitely something to consider as part of your regimen.
Speaker 1:What about calcium or vitamin d? There's a lot of discussion about that and many people take it. Is there any evidence that it will help our bones? By all means, talk to your doctor, explore with your doctor the pros and cons. The US Preventive Services Task Force, which is a very well-recognized group that talks about how we can prevent disease and illness, found really no convincing evidence that calcium and vitamin D prevents fractures. Now they're re-examining the data. They're going to come out with a new review. It's possible it will change. The Institute of Medicine says that calcium and vitamin D are something to consider. So the data is mixed. Certainly, eating a diet that has calcium in it if you're able to have dairy cottage cheese milk is a wonderful thing to do.
Speaker 1:I take a multivitamin which often has a little bit of vitamin D in it. That may be something to consider. Whether this will make a change for you is uncertain, and folks who do a lot of calcium and vitamin D at higher doses. Actually there's some downsides to that. I talked about it in my supplements podcast. You can take a listen if you wish.
Speaker 1:Okay, some concluding thoughts. We are going to age. It's going to have an impact on our muscles. It's going to have an impact on our bones. That's inevitable, and periods of inactivity, like Karen shared with us, will take a real toll. But I do believe that if we can increase our muscles, increase our bones, then if we have that deterioration, it won't affect us as greatly. If we have that period of inactivity, it won't be as problematic for us. Now there isn't a randomized control trial showing that your life will be better, but there's enough data suggesting on the bone front, on the muscle front and even on the joint front, on the muscle front and even on the joint front, that it would be beneficial.
Speaker 1:I hope you all live long and well and, most importantly, that you're resilient and that you're getting ahead of the curve. That could be a strategy to consider. I do. Maybe it will be helpful for you Until next time. Goodbye, be helpful for you Until next time. Goodbye. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom. That's doctor, as in D-R Bobby. Live long and well dot com.