43: Uncover the Power of Diet and Exercise for Women's Health and Disease Prevention with JJ Virgin

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Breast podcast with Dr. Jen. The show dedicated to empowering women through knowledge, tools and resources to take control of your breast health journey. I'm your host, Dr. Jen Simmons, and I'm thrilled to have you join me on this insightful and inspiring journey. As a breast cancer surgeon turns functional medicine physician, I'm on a mission to empower women to live their breasts, I mean, best lives. This podcast dives deep into all topics related to breast health, including prevention, diagnosis, treatment, and holistic approaches to support overall well being.

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Breast health is health. So no matter who you are, a breast cancer survivor, newly diagnosed in treatment, living with metastatic disease, or you're simply seeking to improve your breast health, this podcast is for you. Join us on this transformative path towards better breast health and a thriving life. And now, let's get to today's episode.

Hi there, it's Dr. Jen. And welcome to another episode of the Keeping a Breast Podcast. I have a lady with me today who just every single time she has the opportunity, she sets the world on fire. She has learned many life lessons, not all of them she wanted or invited, but she for sure has made a lot of lemonade out of a lot of lemons. And she is truly an inspiration to everyone that she comes into contact with. She has written a number of bestselling books and helped countless, countless people through their health journeys. She's a triple board certified nutrition expert, a fitness hall of famer. She's on a mission to change the way that the world sees aging. And she's with us today. So, JJ Virgin, welcome.

Wow, that was the intro I needed to hear. I, you know, I'm going to record it and listen to it again and again.

You know, we have a mutual friend, Kellyanne Patrussi, and when she introduced you at a conference that you spoke at recently, she was talking about the fact that you are responsible for setting so many people up for their tremendous success. And you just have a way of doing that. But I've heard you say that you are sick of women playing small, of being afraid to be big. So talk to me about that.

So, first of all, I think you heard this last year at our mindshare summit when I Sunday morning, we had kind of our soulful Sunday morning, and I just went, I stand for powerful women. And this all started to happen as I really looked at what does it mean to age powerfully and, you know, decided to get into the best shape of my life at 60 and to be stronger than I've ever been in my life. And you know, I started lifting weights when I was 16. So I've always been in the gym.

Which that's very unusual.

I mean, with the high school football team, by the way, because there weren't very unusual.

How was that received? Was that like, oh my God, here's this gorgeous girl who wants to lift weights with us or get the hell out of here. We're stinky guys and we want to do this alone.

They actually were very cool. It was really fun. But there really weren't options back then. I was just looking at some of the things they had in the 50s and 60s. So this was in the 70s and the gyms back then for women, which were the little figure salons. Remember they had figure salons.

Oh my God. What I remember is that little machine that used to put around your back and you would.

Oh wait, I'll tell you something even more funny about that. Look at how fast we just went off tangent. And we will come back. We opened the loop, we'll come back to it. But when we were in South Korea this summer, we went to this amazing gym at the JW Marriott. It was, it's rivals, one of the best gyms I've ever been to in the world. And we're in there and they have those machines, those bands you put around your hips and they shake you. And I'm with Dr. Anne Shippy and we are laughing our butt butts off. We're like, oh my gosh, you know, are you kidding me? Then we did it. And I go, this is the greatest way to, you know, recover from a workout. Reduce inflammation, get lymph flowing. I immediately bought one. So I have one. It's in my recovery. I, I realized I, I think biohacking is a little bit ridiculous because I think we need to major in the majors before we major in the minors. And so we have a, what I call a recovery room in our house, which has a sunlight and sauna. It has that machine, it has a cold plunge and red lights and that thing's amazing. So anyway, yeah, well, and you know.

But, but this was a good place for that digression because, you know, women with breast cancer who are primarily my audience are really concerned about how to stimulate lymph flow. Well, there you go. You know, we, we are, we are living small and stagnant. Yes, right. Like so much of our life is small and stagnant. And that is part and parcel what's leading to all of this disease.

Yeah, Let me unpack that. So. And where this kind of made showed, showed me what was going on, because I wouldn't have really realized the depth of this. And all my life, I started lifting weights again when I was 16. I have been taking people. I've been doing resistance training with people. I was one of the first personal trainers since my early 20s. I paid my way through college, graduate school, doctoral school, doing this before there were personal trainers. And so I've heard for years, oh, I don't want to get big. Right. That was always the big concern. And I really thought that concern had been laid to rest. And then I start promoting creatine online, like I started talking about on Instagram and in my podcasts, and I start getting hammered with people going, yeah, I don't want to take that. I'll get big. And, you know, at first I was like, you know, this isn't going to make you bigger. It's going to make you be able to perform better. And it's going to help with depression and help with bone density. Helps with wrinkles, however, and it can also help have more water in your muscles, which is what we want. I go, but here's the thing. You really want to be packing on as much muscle as you humanly can right now. If you're in your 40s, your 50s, your 60s, it is your time to really focus on putting on as much muscle as you can, as well as really improving your VO2 max. And you would be lucky if you could put 20 pounds of muscle on in a year. That would be unbelievably amazing. It is not easy. And if anywhere along that time you went, you know what? I think I'm getting too big. You could just stop and it would go away. Muscle, like accidental muscle mass improvement, I've never seen it happen, but muscle is your metabolic spanx. You know, it holds everything in tighter and it supports a better metabolism. It's also a sugar sponge, so it gives carbohydrates a place to land that isn't around your visceral abdominal, you know.

Yeah.

So you don't. You're not getting that fat around your abdominal area. And it's also an endocrine organ, so it improves insulin sensitivity. But, you know, so here I am defending, oh, you're not going to get big. And then I thought, I'm answering this incorrectly. I am, I am not doing this the way that really people need to hear, which is. And, and, and I'll, I'll give you the examples. You go online and you look at books for women versus men. And there's one author who has a book for a man and a book for a woman. The men's book is Bigger, stronger, Leaner, and the women's book is Smaller, fitter, Leaner. Then I started. I went, oh, my gosh. And then I started looking, and there's tiny and full. There's skinny bitch. And I go, wow. We have our whole lives been taught to make ourselves smaller, right? To be. To be a good girl, Be small, get smaller, get thinner, get right, get lightweight. When I was in high school, I wanted to be a model because I was six feet tall and I was super athletic. Again, working out with the high school football team did not have extra weight on me. And I went in and they told me I needed to lose £20. I lost 10. And my dance teacher's like, are you anorexic? But that is just what we've all been taught is, is be smaller. And I thought, you know what? Get big. That's been my message now. The minute I hear this, I go, I want to reframe that. I want you to go, get big, get strong, get powerful. Because if not now, when? Right?

Yeah. Yeah, absolutely. Yeah. And like, so many things that we were tied to for so long, like you. You were a coach and a trainer and all that through the fat is bad and carbohydrate is good times, right? And it's still hard for some people to let that go. I still have so many people that won't eat nuts and won't eat avocados because. And they won't use olive oil because it's fat.

Really? Really, It's.

Yeah, it is.

Why? Well, I think of the Women's Health Initiative and how all that bad information still lives on. It is amazing how misinformation can get out there and it does not die. I still remember in the 80s, Susan Powder was stopped the insanity. And I was actually training people out of a place in Santa Monica called the Pritikin Center. And their whole thing was, you eat 10% of your diet from. From fat. That's it. It was a high, high carbohydrate diet, by the way, that was the only time I'm a naturally very lean person. That's the only. Only time in my life I actually ever struggled with body fat was that I also was hungry all the time. I was, like, starving.

I remember Susan used to talk about eating four baked potatoes, right?

Oh, gosh. And remember, to win. Eat to win. Dr. Hos. He. He was. I think it was Robert Hos. It was Martina Navichova's coach. And everything was eat baked potatoes. So we would eat baked potatoes with nothing on them or free sour cream. And then we would eat, you know, pasta with fat free marinara and bagels with fat free cream cheese. And we were just. I was constantly, I would eat every hour. I was like, I had carbs with me at all times.

Well, but that's, what's happening is you, you become so carbohydrate dependent that, you know, because those blood sugar spikes are going up and down and up and down and up and down. And you know, this is part and parcel to the metabolic disease that has led to this, you know, insurgence of breast cancer. And it's starting from the very beginning. Right. Because look at what we feed our kids.

Yeah, you look at it and go, I. Because it's been really fun to be in this industry this whole time. I mean, when I first started, we didn't even have gyms and we had these aerobic studios and the aerobics instructors were celebrities. I mean it's. We've come a long way. Thankfully we're out of the leg warmers and the thong leotards. That was a very bad phase of life.

And Jamie Lee Curtis was so hot.

It was, oh my goodness, it was so hot. But you look at what happened during that time because that was the time that we started to pull all the fat. And when I wrote the sugar impact diet, I actually documented all of this because there was a warring factions and there was, I don't remember their names now. One of them was Ames. One of them was, had. Had looked at the seven sisters hypothesis, cholesterol hypothesis and wrongly stated that sugar caused heart disease or that fat caused heart disease. The other guy looked at this and he said, no, it's sugar that's causing the problems. And this one guy, I think it was Bruce, anyway, he completely annihilated this guy. He like made him a laughingstock, the sugar guy, who was right, by the way. And so what happened because of this was that we went on like, it became a thing where we went super low fat, more vegetarian based at Pritikin, you could have fish twice a week, but it was all vegetarian and very high carb. And then the food companies started getting involved and so they started producing all of this fat free. Remember Snackwells?

Oh yes, right. I gained 20 pounds the year of.

Snack wells, of course, because who eats one or two snack balls? You don't eat the whole bag of snack balls. So you Know, you look at that stuff and it was, it was the first time when we really started to create food that would make you overeat. And now we know and if you look at a lot of those foods, they actually are very umami. And there's this hypothesis called the protein leverage hypothesis. It was discovered by these two guys in Australia with locusts. And now it's been proved, proven in rodents, I think monkeys just now, in humans. And, and what it shows is that we will overeat carbs and fat in order to get enough because we have to have essential amino acids to survive. When you really look at it, we could live just on animal protein. We could not live just on plants. We would die. There would be no vegans in the wild. We would die. We would be have a B12 deficiency, we would have essential fatty acid deficiencies. So but you can get everything you need from animal protein because you can get the protein in the, the fat. You can live without carbs, doesn't mean you should, doesn't mean you don't want the fiber and phytonutrients, but you can live without it. So what he discovered, these two discovered was we would keep eating to get enough essential amino acids that we would have a drive to do this. And so these food manufacturers, when you look what they've created with these like, you know, cheesy potato chips and that kind of stuff is they've done a food drive to mimic what protein would be like. So we would overeat on these foods. And in fact the wild stuff with all these ultra processed foods that, and this is, multiple studies have shown that we tend to eat about 500 calories more a day if given the opportunity. They'll put people, they've put people in labs and, and done food that seemed the same, but one was ultra processed, one was not, and people overate on the ultra processed food. But there was a, another piece to it that's even more devastating because one part of your metabolism is the thermic effect of food. It only accounts for like 5 to 10% of your metabolism. But still that adds up over time. And what they discovered is that people who had ate ultra processed foods also that food had a like basically negligible, negligible thermic effect. You contrast that with protein, that about 20 to 30% of the calories from protein are used in the digestion and assimilation of protein. It's a complete game changer. Plus it', satiating, plus it reduces your cravings, plus you make better food choices. Plus you need protein to detoxify. So, you know, that whole movement that started, I guess, in the 70s that I was so into being in LA in the 80s as a trainer, that was like the Mecca of all of this. And I hate to say I was going right along with it until I realized that I felt like crap. I was hypoglycemic. I gained body fat. I was at USC in their doctoral department doing body fat testing. We were all like, you know, we all were lab rats for each other. And I'm like, why did my body fat go up 15? What has gone on? Yeah, you know, what is going on here? And why am I hypoglycemic? And that's when I made the change. I'd always lifted weights, but I was like, all right, I gotta. In fact, a doctor friend of mine was like, you'll either go eat a chicken or I'm gonna hospitalize you. I'm like, I'll get the chicken.

Okay, sounds good. Yeah.

Yeah.

And, you know, it makes sense because when you're consuming all these foods that are devoid of the things that your body needs to work, it's just going to signal you to eat more of it, because it's looking for the nutrient, it's looking for the nourishment. And most people, you know, I say, I. I know you. You didn't want to talk about broccoli, but, like, no one's getting fat from eating too much broccoli, right? And no one is over indulging on too much meat. Like, you're not doing that. But Doritos are a problem, right?

I still remember in college, I remember this experience so well. This. There was a bag of nacho cheese. Doritos. Remember those?

Oh, yeah.

I ate an entire, like, jumbo bag of those. I was sitting in a frat party, yakking away, eating a chip. Eaten a chip, Eaten it. All of a sudden, my hands at the bottom of the bag, and I'm like, oh, my gosh. What? Like, 2,000 calories of absolute trash. I've been sitting there eating chicken breasts or salmon, you know, or Brussels sprouts. Like, never would have happened. You know, 40 years of doing this, I have never once had someone go, God, I really lost my mind on that, you know, asparagus last night.

Although sometimes there is, you know, a wonderful asparagus dish.

There are. But, you know, doing Freaky Eaters, that show that I did on tlc, we had so many people submit, you know, what they were a freaky eater about? And it was Always French fries and cheese. Those were the top ones. French fries, cheese, Oreo cookies, maple syrup. It was never protein. The only one. We had one weird guy who would only eat raw meat. It was very odd. It was weird for a lot of reasons, but, yeah, you know, the. The majority of them. And he had, by the way, the guy who would only eat raw meat had the perfect blood profiles. It was. He was perfect.

Wow, that's interesting.

It was I. Because they were like, you got to pull this apart. This is so unhealthy. And I'm like, I. The only thing I could show him that was problematic for him because of this was I did a stool test on him to see if he had any parasites because he was eating raw meat all the time. And yeah, that's the only thing I could do. But yeah, blood, his blood markers, perfection. He was lean, he was ripped, he was. Everything was.

Yeah, yeah. And you know, it's hard in those people to fix what's not broken. And we are all bio. Biologically individual. And so, you know, maybe that works for him.

Right.

I can only imagine that if that is what his palate is asking for, you know, it works for him. Parasites aside, I mean, quite frankly, my son. My son would eat nothing but sushi until the end of time if I didn't restrict it. So, you know, it. I totally get that. So continuing on in this way because you have seen the trend go from place to place to place. What are we. What are we still getting wrong now? Because I heard, I heard an Instagram reel just yesterday that sugar doesn't cause diabetes, that fat causes diabetes. And I do think that even looking at the ADA recommended diet, it's not. I don't think we're. I think we're still getting a lot wrong.

There's so much stuff to unpack there because really, what causes diabetes you would have to go through and go trauma, stress. I just did an Instagram Live with Dr. Sarah Gottfried for the autoimmune cure. So she just went through all the trauma implications for diabetes toxins, as we know from the NHANES study, when they looked at this, because we talked about diabesity, was that it wasn't the obesity that was creating the diabetes, it was the toxins stored in the fat cells. But you know, the challenges. We need food for fuel and we don't really. Too much fuel, even if it's healthy, fuel is toxic. It's going to be stored somewhere. Now here's what's interesting. Even if. And I just got this from Dr. Rick Johnson, who I'm kind of obsessed with. My favorite researcher, my favorite. He's a kidney doc and a sugar researcher. He wrote Nature Wants Us to be Fat, and he's been studying fructose and sugar for years. He's the biggest guy cited in the sugar impact diet. And what he just showed me was keeping calories the same. So to a study with isocaloric, you know, diets, one diet was high sugar, one diet was low sugar. The high sugar diet, over time, even though they were maintenance, calories changed people's body composition change to have more visceral adipose tissue. So there's so much, I mean, what I think we're getting wrong now is that, that this is a complex situation. The biggest thing I think we're getting wrong lends right into that is that we are still looking at weight as the metric, and that is what we're getting wrong the most. Because there you have a study that clearly shows that you just put someone, that you put people on the same calories. So you can't say calories in, calories out. You got to look beyond that. That still matters. You want to lose, you want to lose weight, you better be in a caloric deficit. But if you want to lose fat while holding onto and building muscle, you better be prioritizing protein and lowering sugar. You want to get rid of your visceral adipose tissue, you better be lowering that sugar. And so what are we doing wrong? We are not looking at body composition in 2024. Like, I, I, you know, I just had to go to the doctor for why, okay, this was crazy. I had to go to the doctor because I have a luggage induced tendonitis of my elbow. And I say that because people are like, oh, my God, it's because you work out. No, I train to get better at life. However, I also travel very heavy and I travel a lot and we take too many suitcases. So I injured my elbow and this has been going on for eight months. So I finally go to the doctor why the doctor needed to put me on the scale in order to evaluate my elbow. I'm not sure sure what that was about. However, they did, but they put me on a scale and I kept looking at that going, what is, what are you using that for? Like, what, what is that information giving you? And last year when I had some health stuff come up, I went to four doctors four times. I got on a scale. Never any bioimpedance. I thought, what are you doing with this information?

Like, yeah, they're Checking the box. Right. And that's happening so often in medicine everywhere. They're measuring things that they're not doing anything with the data or the data is useless.

Yeah, the data is useless in this one. We know now that cholesterol, you know, in an, just in a vacuum. Okay. If your cholesterol itself, that full number is really high. Okay, let's unpack it. But if you have normal cholesterol, you could still have super low HDL and high LDL with small dense particles. You would not know by just looking at the cholesterol. And you could have be in trouble. Yeah, same with weight. You can be normal weight. And I mean, I just had this happen. I actually, the person who's helping me write my book, I was like, I'm kind of writing it for her. I'm like, are you paying attention? Please go get a dex. I know you've got osteoporosis because she's, she's super thin. She weighs like, she's, she weighs like 20, 30 pounds less than me and she's 2 inches shorter than me. I'm like, oh, my gosh. And so she goes. And she is a typical, like what we call normal weight obesity. She's got sarcopenia in her 50s.

Yeah.

And that's not skinny fat.

Skinny fat.

You don't know that because she would get on a scale and they go, oh, oh, you're bmi. Oh, you're a little bit lightweight. They wouldn't say, oh, you know, so that's the challenge is we've got to stop looking at weight. We've got to start looking at body composition. You got to.

Yeah, I couldn't agree more. And you know, that is absolutely evidenced in the breast cancer population, because breast cancer is a metabolic disease. And we're talking about metabolic health. I mean, that is what your body composition is reflecting. And I know that you talk, talked about prioritizing protein, but as you cross over into your 40s, 50s, first of all, we don't do as well with protein. Our acid production drops down and we, we really have to be extremely mindful about meeting our protein needs. But you need that other half of it too, because you can consume all the protein in the world. And if you're not doing weight bearing, exercise, and if you're not lift things that are heavy, it's not going to help you.

That does not look like a heavy thing right there.

Yeah, Ted was feeling left out.

Well, I've got, I've got both dogs in my office right now. They both.

Did they, did they come to say hi?

Yeah. One's underneath my feet, licking my legs and then the other little. Look at this, look at this little girl. She's so pretty. Anyway.

She is.

Kills me. I don't. So we have a doggy door into our, into my studio, but only the old one knows how to use it. Except this one apparently. Finally figured it out.

There you go.

So, yeah. So when you look at this, probably one of the. Probably. When I think about how do we restore metabolic health. When you hear that less than 7% of the population is metabolically healthy and.

Then that statistic is so frightening.

Well, but it's not even right, Jen, when you think about it. Because when they talk about metabolic health, they say, okay, a waist circumference for a woman of, you know, greater than 34. For a man greater than 40. I'm sorry, but if you are a five foot tall woman.

Yeah.

Your waist should be half your height or less. So, so that's the first part is we, the waist is off the blood sugar. They're like, you know, I think it was 100 or above. No, that's too high. We know that. And then the triglycerides were above 150. No, that's too high. And then the blood pressure was 120. Above 120 over 80. Well, I thought we've now dinged it that you need to be 110 over 70.

Yeah.

And then, gosh, there was one.

But I think those are the definitions of metabolic syndrome, which is like not, not on the spectrum to failing. It's like you've failed.

Right. So that's. But that's what they say is 6.8% of the population doesn't have those, which tells me we've got. It's worse than the 6.8 that we probably. When you really look at this and I, and I remember another study and this was years ago, so it's way worse because now we have, I think 70, more than 70% of the population is overweight or obese, with 40% now plus or obese. And of the other 30%, which I think it's not, it's now 25%. When they did a study years ago, which you would think these norms would, would still be the same or maybe worse, they found that only they were doing MRIs of normal weight people and they discovered that 50% of them were what we call thin outside fat inside that normal weight. Obesity.

Yeah.

And you look at this and go, oh, wow. I mean that when you want to restore your metabolic health. The fastest way to restore your metabolic health is first of all to sleep well, but then second of all to put on some muscle. Because again, besides, you know, the metabolic spanx factor, it's an endocrine organ, it's also an immune organ, but it's going to help you become more insulin sensitive. And the minute you start to get more insulin sensitive, everything shifts for you and it's not enough. We know that if you are trying to diet just by getting in optimal protein, you will minimize the loss of lean body mass. But you're not going to build muscle by eating protein. You have to get up and do more than what your body is used to so that your body has to adapt and get stronger in order for you to build muscle. Right? So the two have to be together because 40 plus we have something called anabolic resistance. And first of all, I find most women aren't eating enough protein anyway because they say they get too full. Which is why I tell people to eat protein first, because I've seen it now enough times where I'll go out with people and they tell me, you know, the candy protein is they were too full. But I just watched them sit down, they had a glass of wine, then they had a salad with glazed nuts and dried fruit and, you know, basically syrup on top, right? That I always say you had 5 calories of arugula and then you had about 500 calories of fat and sugar. Maybe they had a piece of bread. And then, you know, then their protein comes and they're like, I'm too full. I'm like, well, just don't eat that other stuff. Yeah, don't eat that. Eat your protein first.

And the order of how you eat really matters in terms of your caloric absorption. Right.

So a lot of that is more like blood sugar stuff. And when you look at it and then, yes, some of it is your protein assimilation. Like, it really, when you look at protein, you have to look at digestibility and assimilation. And if you ate protein with a load of fiber, that will. Will cause some issues. But if you eat the protein first and you take, I think every woman 40 plus, every really 35 plus should do a trial of protein digestive enzymes, because we are, you know, if you're under any stress or you're aging, you're lowering hydrochloric acid. So and especially if you've been eating a lower protein diet and your body is just kind of went, oh, I don't really need to produce much of this. Right.

You Know, for people who are on vegetarian diets for a long time, they really lose their digestive capacity.

Right. Because your body is going to, is going to adapt to whatever you ask of it. And so if you're not asking it to do that, that's how it will adapt. So, you know, if you eat protein first, I know there's a big push right now to eat vegetables first because of blood sugar balance, but you'll achieve the same with protein. And you know what you're really looking for with blood sugar is having your blood sugar stay in a range between 80 and 120 and come up like 20 to 40 points when you eat and then come back down over the next couple hours and watching that with the CGM to see how you're doing. But for a lot of people, it may not be the food they're eating that's causing that rise in blood sugar. It's the stressful, stressful situations around them. Right?

Yeah.

Back over to anabolic resistance is this thing that happens as we age where we start to reduce the ability for our body to do muscle protein synthesis. And so we have a process called muscle protein turnover. Very similar to our bones, where our bones build up, break down, build up, break down. So we're constantly remodeling and improving. Same thing happens in our muscle. We have to break things down and build things up. And you want to make sure that you are either keeping those even or building more than you're breaking down, ideally. And first thing we need to make sure of is that we're getting enough protein. And protein for us is somewhere at least 30 grams, probably 40 to get two and a half, three grams, maybe even four grams of, of leucine to trigger a muscle protein synthesis, to trigger something called MTOR at each meal and for sure, at least breakfast and dinner. So that you stop the catabolic, you know, you, you stop the catabolism in the morning and then you delayed as much as possible possible at night. But you have to put that together with resistance training. You need the both. You can't just do the one, you know, if you do resistance training but you don't give yourself the building blocks to make muscle, you won't be able to if you do the protein. But then you just decide you're going to do walking and Pilates because you don't want to get big, you can still like, you can still have sarcopenia. And what's interesting, as we age, we have two types of muscle fibers. We have fast twitch and slow twitch now we have these other fibers that can become either one that are these hybrids. And as we age we predominantly lose these fast twitch fibers. It's why you see people slow down and start to shuffle. Like I watch my. I have a 22 year old dog and a 17 year old dog and my 17 year old dog has slowed down so much even though. And we got this puppy two years ago to get her moving and we should have done it years earlier because I'm like, oh, we lost a lot, right? You know, she just slow, she's lost a lot of fast twitch fibers. And what happens for a lot of us is we're walking, which I want you to move more. And like I'm standing at a standup desk and right next to me is a treadmill which I just right before this had a meeting and I was on the treadmill walking during my meeting. So we want to get those steps in. But that is just like, that's like flossing your teeth. You do 8 to 12,000 steps a day. That's just what you do. And then you do resistance training to make your body have to adapt to what's harder than it's used to in order to build muscle, right? Because we've got to have quality muscle that is strong and powerful. Because the biggest things we lose as we age are power, which is how fast you do something, and strength. And that's what you like the heaviest thing you could pick up once.

So how often do we need to be doing this? How often do we need to be doing resistance training?

You know, it's interesting, exercise science, literally when I was doing my PhD, I ran out of classes and I started taking classes in the dental school. And since then I feel like the industry, there's so much information on exercise and hormones and exercise and range of like there's just tons of stuff. And the more you unpack it, because I pretty much spend about an hour a day studying exercise physiology. I like love exercise, but the more I unpack it, and this has now been 30 years of study, I feel like the less I know it's the biggest answer to that is there's going to be some minimum effective dose. And we're all trying to figure out what that is. But everyone wants the perfect equation. And I'm going to give you what I think is a really great equation. But just know that it really just depends. And the most important thing, thing to think about when you're doing an exercise prescription is what's the priority? As we age, there's Two metrics that are, are probably the single biggest metrics for you having a good, long, healthy life. In fact, the first one is the number one predictor of all cause mortality. And yet we never test it. And that's VO2 max. And that is the max amount of, of oxygen you can take in at a high workload on a treadmill or a bike. And it's crazy to me knowing that, that we don't test this. It's bizarre, right? And then the other one is leg strength. And the way you can test that is through a simple hand grip dynamometer that you can get from Amazon for 30 bucks because it's the best proxy for this. Here's the thing. For VO2 max, there's actually going to be a way to use a DEXA scan to accurately predict within like a 95% confidence level, VO2 max. It's going to be out in apparently a month or two. DEXA Fit. I just talked to DEXA Fit yesterday and they told me and I'm like, oh my gosh, that's exciting. Really, really exciting. However, you can also do a, if you Google 12 minute VO2 max test, there is something called a Cooper test. You can do it on a treadmill, you can do it out on a track and it will give you a prediction. It's not as good as going to a lab, but for a lot of people, like going to a lab means going to a local university. Not easy to do. And I hate to put barriers up. So that is a way you can go to a treadmill and do it. Both my husband and I did that as a, like, let's do this now. So at least we have something. Those two factors are the biggest predictors of all cause mortality, those two, and they're in the grip strength.

Because I've heard a lot of, a lot of talk around grip strength.

Well, that's it. VO2 max and grip strength. Those are the two.

Oh, I thought you said leg strength.

Well, grip strength as a proxy for leg strength. We're doing grip strength, not because we want to see how, how great your grip strength is. We're trying to do it as a proxy for your overall. Because think about it, if you don't have good leg strength, you aren't getting up off the toilet, you aren't walking up the stairs like you got, you've got big problems. Right? So grip strength is a proxy for overall strength. And I say that people go, okay, well, I'm going to start squeezing a tennis ball. It's like, no that's not the point. And it turns out too that grip strength, because when you get one of these hand grip dynamometers, you do it in your right, left hand. And if you are not like, if you are more than 10% different between your right and left. And it's. Now, it's one thing if you were like maybe a professional tennis player or something, but if you're not someone who's doing something that's very dominant, hand focused, it's a, it's an early indicator of cognitive decline. Wow. Right? Yeah. I mean, so 30 bucks.

Yeah. Yeah. So can you use that as an indication of how often you need to do that, that weight bearing exercise?

Okay, so, yes, let's get to the exercise prescription. So here's the factors because I started with, you want to know what you need to prioritize. And I have been trying to, you know, I'm very systematic and mathematical. So I've been working on the system to walk people through how to put this together. And here is the way I would put an exercise prescription together. Number one, you always do it based on priority and the priorities. Of course, we would want to look at your VO2 max. We would want to look at that grip strength, and we also want to look at your balance and flexibility. And so a way to look at your balance and flexibility is to stand up with your feet crossed, sit down on the floor, and then stand back up. Now you start with 10 points. Every time you use a hand or a foot or something, you deduct a point. If you can do it and get to eight points, you're cool. Less than that, you're not. The other one that you can do is stand up and you cross your hands over your chest, you close your eyes, you lift a leg up, and you should be able to stand for, you know, at least 30 seconds. And it is really hard. So you, so you've got VO2 max grip strength and balance and flexibility. Now, the first place I start is with making sure that people are getting eight to 12,000 steps in a day. That's step one. And I. It's so easy now because we have these trackers, like, it's so easy. So I am like, like a little obsessive person on my tracker with my 8 to 12,000 steps. And I like to make sure I've gotten in a lot before, you know, like noon. And then at night, if I haven't gotten everything in or even sometimes I just like to, a couple nights a week, I like to go for a walk after Dinner. In my perfect world, I do it every night after dinner. But, you know, life is not perfect, right? But 8,000 minimum. 12,000 is really the goal. More than that. Perfect. Now, here's what's interesting. They did a study where they took two groups and they had three. They had a control group, too, but one group was the walking. Was a walking group that was just told to do 12,000 steps a day. The other group was told to do 12,000 steps a day, but three times a week to make it fast. And the at the end of the time, they'd both done 12,000 steps. Both these groups, but the group that did it fast three times a week, they had improvements in their blood sugar, improvements in their body composition. They lost some visceral adipose tissue. So they had bigger improvements just by adding some speed in. So what I like people to do is get used to doing the walking, and then I say throw on a rucking vest because it's good for bone density, too. Add a little speed in there. So that's step one. Step two, you do that hand grip, and you put that together with the DEXA test. You go, you know, now it's so much easier to get these DEXA body scans. And what you're doing with the DEXA body scan is not just getting bone mineral density, which is a lagging indicator for muscle mass. If you're doing great with your muscle mass, highly unlikely that you will have a. An osteoporosis issue. So you want to look at your muscle mass. You want to see if it's in the upper 75th percentile for your age, which is where you want to be. You want to be really focused on putting on as much muscle as possible, which is why we need a bioimpedance scale at home to track progress. It's not accurate like a dexa, but you're looking at the relative change. You do it every day. It reports to a Bluetooth. You look at the average over time. So the Oxalene Pro is the most accurate home unit, apparently. And I just like it because it's a hundred bucks and it goes onto your phone. And you can look at the trends over weeks so that you're not a crazy person looking every single day like you step on every day, but you look at the trend at the end of the week. So you're not like, oh, my gosh, my weight went up last yesterday, and that was so good. Like, you don't do that because weight does that. That's normal. But you do the DEXA to see where you are in terms of skeletal muscle mass, in terms of visceral adipose tissue, in terms of body fat. And remember, if you have high body fat but low visceral adipose tissue, you're in way better shape than having low body fat. But a lot of it being from visceral adipose tissue because that's the dangerous fat. Then that plus grip strength. You see how much you have to prioritize. Do you need to put on muscle? I think if you're really looking to add more muscle on your body, we should be thinking about doing three times a week of resistance training.

Yeah.

And I've divided the body into three, four parts, but I focus on three, which is upper body pushing things like push ups and overhead presses and dips, chest and shoulders and triceps, upper body pulling things like pull ups and bent over rows and upright rows for your lats and your biceps and your shoulders, upper back and then hips and hip and thigh hinging, squats and step ups and deadlifts. And I actually don't spend much time with core. And there's one other thing I'll do, which I'll tell you after this kind of a, an auxiliary movement exercise. But if you're doing squats correctly, if you're doing push ups, if you're doing pull ups, you are actually using your core. So you can throw some, some core exercises in between if you want, while you're resting. But the focus really is in big full body movements, multi joint, very functionally based. Because we are training at the gym to get better at life. We are training at the gym so that we don't break a hip. That's why once you've gotten in your, your foundational eight weeks or so of training where you've really focused on form, then you start to add in more power moves with some speed. So that when you're out in life and you have to move quickly, you don't fall and break a hip, right?

Yeah.

And again, that's what I'm looking at all the time is how do we get better at life. So the hypertrophy range when I was in school was very tight. Now we know it can be anywhere from six repetitions to 30 repetitions. So let's say you're doing a squat. Every time you bend down is a repetition. You do a set, is a series of repetitions. We know that you want to take somewhere between one and three minutes between sets and actually a little bit longer time is better, you'll get better. Hypertrophy and so you can do longer reps. If you feel more comfortable there, you can do shorter. The most important thing is that you get to a point where when you're about to end, you never sacrifice form ever. But you should feel like I can only do maybe one or two more. That's called your reps in reserve. Like you want to get to, to close to a point where you're like, okay, I'm, I'm done. You don't have to get to total failure, but you need to get close one or two left. So you know, that could be.

Tell my, tell my trainer that because I hit failure just about every time.

Wow. Well, the actually the research is, is counter. Is contradicting that now where it's showing that if you do that you actually limit your gains and limit the intensity that with which you can work out at. And that I'm going to tell her yes, is actually better. And that comes from Dr. Andy Galpin, who I think is, you know, there's two guys I really, really love in the exercise science world. Dr. Andy Galpin and Dr. Bill Campbell, who happens to be a neighbor. So I'm so lucky. And he is doing research on menopausal women. So he is. I'm like, you are my fave human now. But once you've got that under your belt, you can mess around with things. Doing like more strength, which is 1 to 5, 5 reps with longer rest, more power, which is doing about half of what you normally could do but with some speed like a kettlebell swing or jumps onto something or snatches. And those things are really important for us to do. But a sample way I would have someone get started and I actually created a YouTube video on how to get started on strength training on a resistance training program. And I created a cheat sheet for it is simply to do like two or three exercises for each area. Right. And a warm up set and two to three sets and that's it. Like easy peasy. So maybe you're doing squats and step ups and deadlifts and then you're doing an assisted pull up and a bent over row and an upright row and then you're doing a chest press and an overhead press and a dip. Yeah.

And this becomes especially important for my population because once you get a breast cancer diagnosis, if you go down that traditional treatment route, if you weren't in menopause yet, you're gonna be very soon because almost all of the treatments will completely disrupt ovarian function. And I know you know that life Changes after menopause, life changes. And.

And what.

And what you might have been able to maintain metabolically or body composition wise, you can no longer do that after menopause.

Now it depends. Well, I will tell you. And it really depends whether someone can use hormones or not because they're entirely different situations. Right. Someone who's on. I'm actually in better shape now than I've ever been in my entire life at 60. And so if you've, if you're able to take hormones, it's a very different story than if you're not able to take hormones. But here's a bigger takeaway with all of that either way. And if you can't take hormones, it is even more important. Like it is, it is absolutely critical. I can't think of anything more important. And that is why I am a proud exercise physiologist now. For years I was kind of like, I rather study nutrition. Exercise physiologists are kind of like the peasants in the field now. I feel like when you look at longevity, it is the single biggest lever for having successful healthy aging is exercise.

I mean, it's basically what we're seeing in the blue zones is that they maintain an active body and an active mind their entire life.

And they.

Yeah. And that's what entitles them to the. Their longevity that they have.

There's another key thing too. When you look at cancer rates that I just don't understand why this is not out there. But when you look at people who exercise regularly and cancer risk, it is so much lower in people who exercise and likely for a couple different mechanisms. Number one, they tend to be more insulin sensitive and they've also are doing things to help get rid of stress. But also because you think about why people do fasting or some of these, they do it to, to get rid of damaged cells. Exercise is a. People keep talking about intermittent fasting for autophagy. I'm like, exercise, exercise triggers autophagy. And mitophagy, it cleans out the cellular waste. That's one of the big things it does. So you know, in terms of lowering cancer risk, exercise is huge. And it just is never talked about.

Yeah. And I do want to back up to talk about just briefly what you said about hormones because I am someone that is a firm believer in hormone replacement even after breast cancer.

I love that so much because now it's like we did that podcast and I go, I can actually send people to you. Because the difference with people on and off hormones is that everything it's it's everything.

It's everything. And, you know, it's high time for women who have had breast cancer to stop suffering at the hands of ignorance.

Amen. And yeah, yeah, let's just take a moment and take a breath with that statement. But it's so like, I remember I was. I used to work for some of my buddies. I used to go into their office in Rancho mirage. It was Dr. Ordon from the doctors, and I would help them with their plastic surgery patients, and I would do nutrition consults. And. And so people would come in and I wouldn't know at the time. First thing I do is get their labs, and then I would look at their health history, and I could tell before I looked at their health history if they were on or off hormones postmenopausal. Because the difference in their lab markers in terms of cardiovascular risk. Oh, my gosh. Crazy, crazy. And go. You need estrogen to burn fat and build muscle. You need testosterone to build. Like, you can't. You can't recover. One of the first things I started to notice as my estrogen went down was that I could not recover from the gym like I used to. I constantly felt inflamed. My HSCRP went up. Like, I just was like, what just happened here? So, you know, I believe that we actually. With appropriate hormone replacement therapy and optimizing protein and, you know, so a couple other things like vitamin D and fish oil and magnesium, I think that you can be stronger than ever, you know, because you probably have never, like, and especially it's harder if you've always done it. But if you've. If you're someone who has spent their life doing more cardio and maybe some Pilates or yoga because you didn't want to get big, first of all, you better get into the gym now because you actually have made yourself slower by doing that, because you've now prioritized slow twitch fibers over fast twitch. Remember, you have those ones that will shift over, so you lose fast twitch when you do that. So you really need to start building that muscle. But you'll actually see way more gains than someone who's been doing it forever. So you could get like, my husband, at 59, is in the best shape of his life. He's never. He's. He's fitter, leaner than he's been in high school or college.

But that's because you're doing things differently and you're. And you're doing things right and you're getting things right that we got wrong for Many, many years. And I feel like some people, you know, a lot of people are still getting it wrong. And you know, I mean, when I was taught to exercise, because when you go from being an athlete to, and you know, in my day we weren't in the gym lifting weights, we were running and I was a tennis player and a softball player. And you know, we just, we weren't training like that. And I was taught that, you know, cardio is king. And you, you know, that that's what you needed to do all the time to maintain your weight and to maintain your fitness. And it took a shift for me. But, but, but the shift came out of necessity because I was losing my health, I was losing my metabolic health. And that's what these women who are on this breast cancer journey is that they lost their metabolic health, they got breast cancer and now they're trying to get it back. And this is such an important part of getting it back and you kind of can't get around it. And the hormonal part, you know, it's one thing to go through menopause and a whole other thing to be put on these anti hormonal medications where they're real. Like, if you want to see bad cardiovascular markers, check someone out after they've been on anastrozole or letrozole or any of those aromatase inhibitors for a year or two years. Like their lipids look awful. And women who are treated for breast cancer are two to three times more likely to die of cardiovascular disease disease than if you're not treated for breast cancer. So, you know, there's still.

That's crazy. Listen to that. Because I mean, 50% of like this, I, it, it's, it's. I don't know why we don't pay more attention to heart disease since it is what, it's the number one killer.

For women exponentially in every decade of our life past the age of 30, exponentially. And yet there's pink ribbons everywhere. And we think guys die of heart disease, right? Like, I have no idea why that has been so suppressed, but it is. Women don't think about it. And everyone's so worried about breast cancer, it's crazy.

But I do want to just tie a bow on the exercise because here's the thing, cardio still matters. So, but I think we need to. The priority likely, and especially if you've gone through breast cancer, because likely you've lost muscle, you've had some muscle wasting there. So weight training is going to be the priority. So you get your steps in, you add in your resistance training. Then I love a little yoga for the balance. Like I just, I, I said I love and I hate a little yoga for the balance. Like I do yoga class. My husband bailed. He used to do it with me and he's like, I can't do it anymore. I'm like, great. But it's, it forces me to do the balance and isometric work I will not do anywhere else. So, and to do, to move on all different planes. I try to focus when I'm doing resistance training on front and side and rotation planes. But you really get forced to do that and forced to balance in yoga. And that's, we need that, we need to do that.

And it also connects your brain to your body and that connection really needs to be preserved. That alone is anti aging.

Yeah. And resistance training does that too. You have to like, you can't zone out resistance training. You have to focus when you're doing it and then, and then adding in a little bit of, you know, you can do it just by adding a wrecking vest into your walking, you know, or you could add in little high intensity interval training. But you got to add in a little bit of push too, because that will help that VO2 max. And, and we want to make sure we keep that VO2 max up as we age.

I do want to ask you because people are always looking for a way to make it a little easier or, you know, get it, get, get a little better. What are your go to supplements for metabolic health?

Okay, so first of all, I think that foundationally, besides just having a good multivitamin mineral antioxidant formula foundationally, I think we all need to be on fish oil, magnesium, and do labs for your vitamin D and probably a D3K product. Like those just are foundational things.

Yeah.

And as you're increasing your protein. I remember when I first started taking protein digestive enzymes. It's like someone flipped the lights on. I've now reconditioned my gut where I'm fine, but you and you can get there. But you need to likely use some protein digestive enzymes for a bit. The other supplements I love, I love creatine. I think every woman should be on creatine. I can't believe that it took me this long. And I'm like going, what is wrong with me? I'm in the field and I just never thought about it. And it is an amazing supplement. So, so creatine, I have people start now 1 gram and then go to 2 then go to 3 and you'll end up somewhere between 3 to 5 grams a day. It's going to help you work out harder, it's going to help you recover. It helps with bones, it helps with mood. They did a study with postmenopausal women on SSRI and found that they had way more improvement with creatine. Helps with wrinkles, so. And by the way, resistance training helps with wrinkles. So that's very exciting. The other one that I absolutely love is timelines might appear, which is urolith and a. Because, you know, when I was unpacking the research, I'm like, it's kind of like exercise in a bottle. But I don't want to say that because I don't want people to think they don't have to work out, right? But it triggers. You know, we talk about autophagy and urolithin A might appear, triggers mitophagy. It helps you get rid of the damaged mitochondria. So if you feel achy, tired, you know, brain fog, et cetera, this can totally help. It is one I like. I think of the things that I. I'm taking all the time now, and I will not not take. And it's might appear and creatine and then this ginseng. We went to South Korea and got like, schooled on ginseng, and it was very interesting. I came back, started taking this very high quality ginseng and cut my hormone needs in half. And from what I. Wow. So I first. So this happens, you know, I'm taking the ginseng and I don't think anything of it. I just am taking it. I notice we notice an immediate impact with Tim, you know, if you get my drift. And I'm like, wow. Well, this is interesting. So I start taking it, and I get a call from Lisa Coach, and she goes, your testosterone, your thyroid's high, your testosterone's high, your estrogen's high. Now, I'd had a hysterectomy. I was expecting the opposite, right? Everything's. Everything's high. She goes, you need to lower all your doses. And I'm like, what is going on? What is going on? Then I'm at a 4m and I hear crocheted talking about hormone receptor sensitivity and density and how adaptogens can help with sensitivity. And I went, oh, my God, that's it. That's what happened. So I started looking at this, going, you know, if you're on hormone replacement therapy, it seems like to me that you should be on a Good adaptogen to see if that can improve your sensitivities, to see if that you could use less. I mean, how cool is that?

That is amazing. And I hadn't heard that before, so that. That's right.

Why is that not out everywhere? When I heard him say that, I went, well, of course we know about insulin sensitivity. Why is this not talked about?

Yeah, it's a, it's a valid question. So I know we're getting to the end. I have heard you say that you want to play full out at a hundred. So what does that mean for J.J. virgin?

You know, I just did this interview with this guy, Chip Conley, who wrote Modern Elder Academy. He was actually at 52, he went to work at Airbnb as their advisor, right, because he was a hotelier and he was the old guy with all these 26 year old tech startup guys and they called him the modern elder. And he got really intrigued by this whole idea. And you look at it and you look at the blue zones and we talk about what's different, what, what makes a blue zone a blue zone. I don't believe it's the diet, except that they're not eating ultra processed food. I actually think it's that they move and that they have community and that they stay relevant, not revered. And this is what, this is what Chip was talking about is as, as a modern elder, it's not that you're revered, it's that you're relevant. And so when I think of playing full out at a hundred, it's of course, still being able to. I, I'll never forget being in Palm Springs working with a client. And I said, what are your goals? And she was, I think, 75 at the time. She goes, I want to be able to keep dancing in my stilettos. And so of course there's that part, you know, of course there's.

I like that as a goal, right?

I mean, I want to be able to do all the things I can do now. I don't want to be sitting on the sidelines like, you know, I want to be able to play full out, but I also want to be able to contribute full out. I want to be relevant and have a purpose.

That doesn't surprise me that you say you want to contribute, because we started off talking about how much you give back to others. And you, you have definitely built a tremendous brand for yourself, but you've also lifted up a number of people, many, many people around you. And you are famous for saying that a rising tide lifts all Boats. And I know for me, I'm, like, getting a little choked up that when I first met you, I was probably in the lowest low of my professional career. And to. I. I couldn't even imagine being where I am now without you. And I couldn't picture it then. And you asked me to trust you, and I did. And I am so. I am in line with many, many, many people who are so for you and for that person that you are that. That wants everyone to succeed. And I think the information that you shared with my audience today is invaluable, and I hope that it succeeds in helping them to recapture their metabolic health. Because we all know at the end of the day, breast health is health. And the way that people are going to recover from breast cancer is by regaining their health. And you basically gave them the recipe to do that. And I thank you for all the recipes that you've given all of us and the recipes that I'm sure you're going to be giving over and over and over again in helping to elevate everyone to be their best self and to achieve what they should achieve and are meant to achieve. I think you're amazing, and I am so grateful to you.

Ah. This is why I do this. And if at the end of all of this, I can look back and go, I had a little part to play in, you know, in transforming health and healthcare because I helped you create your platform and Dr. Sarah Gottfried and all these amazing people who, you know, just needed a little bit of information, and now they're just changing the world like that is everything.

Well, thank you. I'm sure Sarah is grateful. I know. I'm grateful. I know Kellyanne is grateful. I. I mean, you, Cynthia, all. All the people that you have really helped to. To launch and. And off they went and they soared because you. You helped to elevate them. So you are amazing. Thank you again. And where can people find you?

JJ virgin.com.

Yeah.

Easy peasy.

Yeah. Yeah. And there's so much content out there of you to consume, and I know that you're going to continue to be a tremendous resource for decades and decades to come, and you will be plenty relevant when you're 100.

Thank you. That's what I intend to do. Man, I want to be like Dolly Parton in her cheerleader outfit at.

Is amazing. She is amazing.

Yep.

Yeah, me too. Me too. Well, if you enjoyed this episode, make sure that you share it with your friend. Share it with someone who needs to hear it, and we can all help each other to make this world a better place and to get each other healthier. And doing it together is the way to do it. If you want to go fast, go alone. But if you want to go far, go together. So I will see you next week. It's Dr. Jen. Bye for now.

Thank you for joining me on this episode of the Keeping a breast podcast with Dr. Chen. I hope you found the discussion informative and empowering. Remember, breast health is health, so by staying informed and taking proactive steps, you have the power to optimize your well being. My team and I encourage you to apply the knowledge gained from today's episode to make positive changes in your life and share what you've learned with others. If you enjoyed this episode, please subscribe to our podcast and leave us a review. Your feedback and support mean the world to us and help us to reach more people who can benefit from these conversations. Stay connected with me on social media where I share additional resources, advice, updates and announcements related to breast health. You can find me on Facebook, Instagram and YouTube. Rjensimmons and remember, my Jen has two ends, so until next time, remember to stay proactive, informed and confident in your breast health journey. The key to your health is you.