As a doctor, even I was floored by the menopause – here’s how I transformed my body ...Middle East

Dr Vonda Wright is an orthopaedic surgeon and ageing expert who works with thousands of world-class athletes to enhance their performance and longevity. For 20 years, she led research on musculoskeletal aging and longevity at the University of Pittsburgh. Her latest book, Unbreakable, walks midlife women through how to transform their life from something they are enduring to the best years of their lives, based on her own experience. Here she reveals her best advice for thriving in midlife.

In my 40s I had my dream job as an orthopaedic surgeon, had just had a baby, and was at what I saw as my peak fitness. But then at 47 I completely hit a wall. I did not feel like myself, I had my first night sweats, I wasn’t sleeping; I couldn’t think clearly, I was enraged all of the time. I now know that this was perimenopause, but at the time – and even as an ageing specialist – nobody was talking about this.

I have more than 18 years of formal education, most of it in medicine, and on top of that I’m an ageing and longevity researcher where my clinical studies look at musculoskeletal ageing. And yet menopause hit me like a brick. I was miserably menopausal, worried that the heart palpitations could be related to my family’s history of heart disease. (Thankfully, they weren’t).

When I finally understood what was happening, I decided to get ahead of these midlife changes. I started taking HRT, which helped, but it didn’t magically solve everything. Through my own research and protocols that I’ve developed, I feel like I’ve gone from menopause misery to mastery.

In my 40s I was in many ways at peak fitness – I was running personal bests, and marathons, and I had my lowest ever body fat percentage. But I was mostly doing cardio and getting away with a lot of things because I had youth on my side. But when perimenopause happens, none of that stuff works anymore. Sure I was running and eating healthily and sleeping plenty, but key aspects were missing. As I learned more about what can support the body and reduce ageing, and why, I began to make changes.

Write down what you’re eating – you probably need more protein and less carbs

I used to eat in a way that I saw as healthy, but it wasn’t really supporting me and my health fully. I now focus on the three key macronutrients – protein, carbohydrates and fats – and then build out with micronutrients in whole foods.

I often recommend people follow what they eat for three weekdays and two weekend days, because you can’t make changes until you know what you’re actually eating. And it’s my experience – with me and most of my patients – is that we’re under fed in that we’re under-eating protein. We’re over-fed simple carbs and bad fats, and we just don’t know it! Protein is particularly important during midlife and menopause as it helps to combat age-related muscle loss and may ward off weight gain.

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Crucially you are focusing on macros, not calories, as in other diets. If we focus on calories alone, you can eat a bag of Cheetos that has 500 calories of garbage, or you can eat 500 calories of dense, high nutrient whole foods that’s going to fill you and actually do something for your body.

The reality is that we should be eating mostly vegetables and protein. Vegetables, some fruit, protein, and not all the refined carbs that we eat now. By eating more vegetables, fruits and other whole plants, we’re eating carbs that are also contributing to our fibre intake and upping our antioxidant intake, which can help reduce the cellular damage of inflammaging. During perimenopause and menopause, we can experience an increase in bodily inflammation due to the dramatic changes in hormone levels.

So if we focus on nine fruits and vegetables a day, we’re going to get the antioxidant leafy vegetables, we’re going to get the high-fibre fruits, and seeds like chia and flax all matter too. Getting the variety while still eating quantities that are beneficial – this helps to manage those midlife symptoms.

Exercise is more than just cardio – and warming up has never been so important

My exercise protocol FACE covers the four main pillars of how we’re going to keep our body healthy into the future. Because when we’re in our 20s we have that youthful vigour that means we can bounce back after we go out all night. But from your 30s on you have physiological changes which accelerate in midlife, particularly with menopause. So you need to make sure you remain not only strong, not only heart healthy, but also supple and balanced and quick to react.

F is flexibility and joint range of motion, something that even the most die-hard exercise enthusiasts often overlook.

It is the natural for tendons, ligaments and muscles to contract with age. But if we invest in our flexibility and joint range of motion in a preventive measure, we don’t have to become stooped over shuffling old people.

Flexibility and joint range of motion can take many forms – it can be static stretching, dynamic stretching, yoga or tai chi. But it must be done regularly, ideally every day.

On top of that, you must stretch properly for your workouts. That means dynamic stretching thoroughly and doing static stretches targeting key muscles as you cool down.

A is for aerobics. We have to maintain our hearts, but not in the way we always have.

When we work out nearly every day in the middle range of our heart, like high intensity interval training, we don’t get all the benefits of high intensity, and it’s not saving your body like low intensity does. When you do this, you often don’t see progress.

But professional athletes don’t gun it every day. Instead athletes instead do 80 per cent of their work in lower heart rate based training to build endurance, metabolic flexibility, mitochondrial health, and then they put in near maximum workouts. So that’s what I prescribe, the 80/20 system.

This means any form of cardio (running, cycling, rowing) where 80 per cent of the time you could maintain a conversation but not sing a song. Then 20 per cent of the time working your heart at near full capacity. Aka a longer, more comfortable ride or jog, then some hard out sprints at the end.

Lift with purpose

C is for carry a load aka weight lifting. In midlife and beyond, our goal has to be strength and power, which means building our neuromuscular pathways and our actual muscle strength so we can get up out of a chair unassisted, or lifting our grandchildren, or being able to live independently.

So the focus is on high weight, low reps of compound lifts that you’d see in power lifting. Push pull with your upper body (bench press and pull up) and push pull with your lower body (squat and deadlift). They are multi joint, multi muscle, and frankly they are how our body works in life. You start with the compound lifts and then can augment those lifts with single muscle exercises.

Power also means the ability to be explosive with movements, so plyometric exercises (aka box jumps, squat jumps and so on) also augment those compound lifts, helping increase strength and bone mass.

E is equilibrium and foot speed. You can be as strong as you want, but if you have no balance and you topple over, you can break a bone. I see athletes all the time. I put them on one leg and ask them to do a mini squat on one leg, and they fall over.

It’s usually a fatal fall that gets us in old age, at least from the musculoskeletal standpoint. And equilibrium and balance can be totally retrained. I teach people how to do that by practicing balance every day (try standing on one foot while you brush your teeth) and doing agility drills like the same foot speed exercises we do with pro athletes. These only take a few minutes and can go at the end of sprints.

It’s never too late to start

The changes when combined altogether can seem overwhelming, especially if you’re new to it all. But it’s all about layering habits and accepting where you are right now. Take the stairs, stretch at the train station, do some jumps in the park.

While the sooner you can start this the better to set us up for later life. It is never too late to completely transform with a daily investment in your health.

With all this combined, now I have hope for the future. I plan to live until at least 97 because I want to experience my youngest daughter’s whole life and be as independent as possible. But that is not happenstance if it happens. It takes planning and consistent work, and that is work I’m planning to keep doing.

Unbreakable: A Woman’s Guide to Aging with Power by Dr Vonda Wright is on sale now in hardback and audiobook. Dr Wright will be appearing at events in London, Manchester and online on 15th and 16th September. www.seedtalks.co.uk/tickets

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