Barbell Shrugged - [Muscle Centric Medicine] Muscle Health for High Performers w/ Dr. Gabrielle Lyon, Anders Varner, and Doug Larson #712

Episode Date: September 13, 2023

Dr. Gabrielle Lyon, is the founder of the Institute for MUSCLE-CENTRIC MEDICINE®. Dr. Lyon is a nationally recognized speaker and media contributor specializing in brain and thyroid health, lean body mass support, and longevity.   She’s been featured on The Doctors and has been published in Muscle and Fitness, Women’s Health, Men’s Health, and Harper’s Bazaar, and seen on many podcasts, including The Doctor’s Pharmacy, School of Greatness Podcast, Feel Better, Live More Podcast, The Skinny Confidential Him & Her podcast, and Women of Impact.   Dr. Lyon received her doctorate in osteopathic medicine from the Arizona College of Osteopathic Medicine and is board certified in family medicine. She earned her undergraduate degree in Human Nutrition from the University of Illinois Urbana-Champaign, where she studied vitamin and mineral metabolism, chronic disease prevention and management, and diet composition’s physiological effects. She also completed a research/clinical fellowship in Nutritional Science and Geriatrics at Washington University in St. Louis.   Dr. Gabrielle Lyon on Instagram Anders Varner on Instagram Doug Larson on Instagram

shrug family this week on barbell shrug we are hanging out with dr gabrielle lyon and guess why one most importantly great friend of ours i love dr gabrielle lyon she's one of the coolest people in our space she does incredibly cool work the whole idea of muscle-centric medicine is something that is just like very very cool and if you listen to the first show that we did with her probably like three or four years ago like pre-pandemic if you remember those days we spent like two hours talking about muscle-centric medicine so we tap in on that as well in this show we're also going to be digging into her book which i think everybody should check out and you can head over to drgabriellion.com to make sure you can stay up to date on when the book will be launching as well as her instagram at dr gabrielle lion

on instagram and in all of the other social media places. But I'm very excited for this book to come out. I also am going to be getting an advanced copy. So I will be getting on the Instas talking about it as I read through it. A lot of times I get these books and I don't really read them that much. I just know that I just know the people, but hers, I believe is very worth the read. It's going to be worth the time investment. She is at the top of the class when it comes to what she does. And I'm very excited for it to come out. And we get into a lot of the topics that she covers in the book in today's show. As always, friends, you can head over to rapidhealthreport.com. That is where Dr. Andy Galpin and Dan Garner are doing a free lab lifestyle and performance analysis

that everybody inside Rapid Health Optimization will receive. That's over to rapidhealthreport.com. Friends, let's get into the show. Welcome to Marble of Drugs. I'm Anders Varner, Doug Larson, Dr. Gabrielle Lyon. Hello. I miss you guys. I miss you. It's fun to get to chat. My long lost friend with kids the same age. I feel like we went through all this growing up from just meathead status to parent meatheads, which is a very different level of meathead. Actually, yeah. How long have we known each other now? Oh my goodness.

Oh, it's like five, five plus years. Strong New York, way back in the day. Today on Barbell Shrug, let's talk a little bit muscle-centric medicine. This is like when I hear Dr. Gabrielle Lyon's name, all I think is she's going to talk to somebody about eating protein, building muscle, lifting longer and getting kicked off YouTube for having differing opinions. Your TED talk. Yeah. How did you get how did YouTube come after you? Well, it wasn't YouTube. I actually got flagged by the guidelines last month.

So the month of May, I did a TEDx talk. Well, actually, I had done it in February, took months to get approved. It was an eight minute talk, I sent 52 references for every single statement I made. So collectively 52 references for an eight minute talk. And it was flagged for being outside of guidelines, because it didn't go with whatever the narrative was or the scientific information they didn't find appropriate all of these things but it was the second most viewed TEDx talk in the world in May and maybe YouTube's guidelines flag you oh Ted this is Ted this Ted's guidelines oh TEDx guidelines Very fascinating, because when you see some of the things that are and so it simply means that it would have been quoted and that it says, you know, kind of warning and word of caution. What is so interesting is I called this talk the midlife muscle crisis. However, whatever everything that you thought about obesity was wrong. And I started off by saying, we don't have an obesity epidemic. What we really have is a midlife muscle crisis. And both of you can attest to that being dads and

training and, you know, kind of working through that dad bod, which neither of you have, but we don't, it's not an obesity problem. It's a muscle problem. Yeah. I remember talking about this with you, like in 2019, probably when we were probably at strong New York, when, whenever we were at your office last time, you were saying like, everyone has a body fat percentage. There's, there's charts and whatnot for that. Like everybody knows they should get their body fat tested so they could see what their body fat percentage is.

But like muscle mass percentage is just not a thing. How is that not a thing? It's not a thing. And we haven't even been testing for it up until recently. You know, the, the way that we think about testing for it is a DEXA scan. And that's what everyone talks about, DEXA or skin folds or an in-body. All of this is an extrapolation of muscle mass, but it's not directly measuring skeletal muscle mass.

Up until recently, now they started using a D3 creatine, which is a pill that you take. It's not even direct to consumer yet. You know, we're not typically seeing it be used in offices, but it's used in research to do. We're finally now directly measuring skeletal muscle mass because CT and MRI are not realistic for people to do. Right. Sure. It's not, not, not scalable. It's expensive, et cetera. Yes. And, you know, so when we think about the whole conversation, everybody loves talking about body fat. Everybody loves talking about obesity. And the reality is, is we have not gotten any better at treating it. Despite all the knowledge that we have, people are

more overweight, more obese, more sedentary than ever before. It's not an obesity problem. Yeah. If we were actually in your best conspiracy theory uh brain why is ted x mad at you i i watched your you actually texted me to watch it and i was like you think i didn't see that on youtube before you texted me are you crazy as soon as it popped up that's my friend i'm so excited for you um but at no point in listening to that, did I not, was there like a, Ooh, she went there. I didn't have any of that. I was like, this is just her talking about getting strong and like empowering yourself to live a better life.

You know, I, um, I thought about that a lot because I took a lot of time to write the talk and I very conscientiously went away from things that would potentially be controversial. For example, it's not like I went after vegans or vegetarians, or I said that plant-based protein is low quality. I didn't do any of those other things other than speak about the importance of high quality protein and training and being strong and potentially that we've really missed the mark. And that was it. And for whatever reason, that was found to be extremely, I don't even want to say unsettling because that's making it a personal thing against us. But I will say something else that I noticed is what they did

promote was there was a CEO that was talking about how we should replace all meat with fungi. And he was promoted on the main page. It was shocking to me that the sustainability claims that they were talking about were what was actually being promoted when the sustainability conversation. There's no way you could get that out in eight minutes or even 10 minutes or even 20. There's some real bias, I think, within the media. So that's my best conspiracy theory. Oh, wow. Like dig in. We can sit around for a couple of hours and talk about that one. I would love to pan out for the people that this may be the first time that they are hearing you. And what is muscle centric medicine? How did this kind of like

this term get coined and how did you get here? Yeah. Well, the concept of muscle centric medicine? How did this kind of like this, this term get coined and how did you get here? Yeah. Well, the concept of muscle centric medicine is that muscle is the largest organ in the body, right? It's an endocrine organ. It's not the skin skeletal muscle above and beyond looking good naked or being in a bikini. It really is an endocrine organ and it is the pinnacle of health and wellbeing where, and this is the pinnacle of health and wellbeing. And this is something that the fitness industry has known forever. This is something that is really the trophy of the fitness industry. I was in my fellowship. So I did my undergraduate in human nutrition, vitamin mineral metabolism at the University of Illinois with Dr. Donald Lehman, old school protein guy. And I became very interested in body composition

and skeletal muscle, you know, did my undergraduate with him. And he mentored me for 20 plus years, even to this day, went to medical school, then did residency, a couple of residencies, and then a fellowship. When I went back to fellowship, which was at Washington University in St. Louis, I studied obesity, human nutrition, and geriatrics. And you guys are thinking, oh, well, how does that all tie together? That's kind of different parts of the spectrum. So it's not. This geriatrics is over the age of 65. It really focuses on longevity and how we age.

And then obesity, we all know what that is. And then the tie was nutritional sciences. So at the time I was doing nutritional science research and I was looking at body composition and brain function. Every fellow has a responsibility to do some kind of project, especially if you're a combined fellow. So anyway, you guys know me personally. I tend to be, you know, I'm a female physician, so I'm warm, touchy feely. And I remember this one participant and her name was Betsy. She's in her mid, I don't know, mid fifties. And she was a mom of three. And I'll never forget Betsy. She was just one of those women that really struck me.

And part of the job was looking at her brain. We did euglycemic clamps. There is a metabolic ward. There's a whole bunch of different studies looking at her brain. We did euglycemic clamps. There is a metabolic ward. There's a whole bunch of different studies looking at her body composition and how that was interfacing with her metabolism. Well, I imaged her brain and her brain in her fifties looked like the beginning of an Alzheimer's brain. Shrug family, I want to take a quick break. If you are enjoying today's conversation, I want to invite you quick break. If you are enjoying today's conversation, I want to invite you to come over to rapidhealthreport.com.

When you get to rapidhealthreport.com, you will see an area for you to opt in, in which you can see Dan Garner read through my lab work. Now, you know that we've been working at Rapid Health Optimization on programs for optimizing health. Now, what does that actually mean? It means in three parts, we're going to be doing a ton of deep dive into your labs. That

means the inside out approach. So we're not going to be guessing your macros. We're not going to be guessing the total calories that you need. We're actually going to be doing all the work to uncover everything that you have going on inside you. Nutrition, supplementation, sleep, and then we're going to go through and analyze your lifestyle. Dr. Andy Galpin is going to build out a lifestyle protocol based on the severity of your concerns, and then we're going to also build out all the programs that go into that based on the most severe things first. This truly is a world-class program, and we invite you to see step one of this process by going over to rapidhealthreport.com. You can see Dan reading my labs,

the nutrition and supplementation that he has recommended that has radically shifted the way that I sleep, the energy that I have during the day, my total testosterone level, and just my ability to trust and have confidence in my health going forward. I really, really hope that you're able to go over to rapidealthreport.com, watch the video of my labs, and see what is possible. And if it is something that you are interested in, please schedule a call with me on that page.

Once again, it's rapidealthreport.com. And let's get back to the show. Her brain in her 50s looked like the beginning of an Alzheimer's brain. You know, at the time I was doing nursing home rounds in these Alzheimer wards, and I felt so incredibly guilty and responsible for this trajectory that I knew that ultimately she was going to end up like. And I thought, you know, what is our personal responsibility? She'd been given bad information that she should, you know, she's chasing the same 20 pounds her entire life, constantly yo-yo dieting, constantly being given the same information that we hear nowadays, cut back your calories, you know, just lose weight. And I realized in the process,

not only did she lose weight, we destroyed her metabolism and destroyed her brain. And we had no other alternative solutions for her. No one was telling her to eat a higher protein diet to protect her skeletal muscle mass. No one was telling her that she needed to do resistance exercise. And so at that moment, I realized that the one thing that all my sickest patients had in common wasn't a body fat problem. It was a muscle problem. Yeah. It's probably actually the, uh, like if you were to just, and I think about this when I see people like at the airport, the airport is like my favorite, Oh my gosh, this is what America looks like place in the whole wide world. Like try, try, try sitting in a comfortable seat in, in

regular coach on like Southwest. Can't do it. You're sandwiched in between two people that probably can't bench press. Just saying, not judging any other pieces of them, just not back squatting their body weight. That's for sure. But like when you, when you see a 35 year old, they probably still have enough muscle to help you move your couch. So they don't have to face these things. But when you're staring at the geriatric population or significantly older populations, you see people with zero muscle mass, and those are the ones that are the worst off. And then the people that actually have some muscle, it's probably glaringly obvious when

you play the game all the way at the end of the spectrum, who's doing well and who's doing not and what actually is helping them. And it's totally predictable. And my concern is that we're so tech based now that people are moving less. So 24% of adults are able to meet their physical exercise requirements, whether it's cardiovascular or strength training. And we know all our kids, we all have kids are all very active, but what's happening is the example set by parents filters down to the children. Children don't care about what you say. They care about what you do. My concern is that that skeletal muscle, that the foundation is laid very

early. And it's not that we can build muscle easily the older we get, because the truth is, is we can't. Can we build muscle? Yes, of course. Is it as easy as it once was? No. And then what becomes so critical is this capacity to maintain muscle. And that declines if you are not training and you are eating a popular diet, whether it's a standard American diet or it's any kind of new fad. And the trajectory of that is going to be devastating, even more so than it is now. Do you think to some extent we're on the right track with how popular and pop culture like strength training, CrossFit, home gyms, et cetera, are now? Like more women are strength training than ever.

Maybe not like older people necessarily, like they grew up in the high carb, low fat cardio eighties. And now they just kind of still use that knowledge base in their, their current state. But lifting weights is mainstream these days. Like that's a lot of people that would not have been lifting weights in the same body 20, 30, 40, 50 years ago are now lifting weights on a regular basis. What I actually really appreciate that question, Doug. And what I think is happening is that those that adopt a certain lifestyle, that the spectrum and the division is going to be so much greater than we've ever seen. There's going to be a small percentage of people that are hyper interested and extremely aware of aging and what they're going to do decades before, while it is more popular

to some, I would say the majority of individuals that, that, that, that chiasm is just going to grow. So what I would like to think is that it is more popular, but the statistics would say that 70, more than 70% of us are either overweight or obese yeah i think you're living in a bubble man imagine that i'm like what are you talking about all my friends lift weights everyone i know lifts weights like people don't lift weights that's crazy this is the division that we're going to see so what we're going to ultimately see is those people that are fit are going to have it a lot easier and they're going to be a lot more capable and this the division is is going to be even greater than before yeah that's actually what

i want what um that that division freaks me out an enormous amount because you have this this population that continues to get healthier and healthier and like we kind of play in this game of like not even just the healthy people or the strong people that like lifting weights, but like people that are trying to play this game at the top of the mountain. And then what, as you play in that spectrum of people that actually care about this stuff, but then there's this breaking point of people that like, don't do it at all.

And I don't think actually think about any food that goes in their mouth. It's just like, Oh yeah, I like that. And that bottom, like probably, it's just like, oh yeah, I like that. And that bottom, like probably 70% of the population, what happens? Well, this is really interesting. We have always thought about insulin resistance. So the pancreas makes insulin. Insulin is a peptide hormone that helps move blood sugar glucose out of the bloodstream into cells. And we've always thought about the things that make people unhealthy. We think about metabolic syndrome. We think about elevated levels of blood glucose and elevated levels of insulin, all things that I know you guys check. We think about that as an older population. And

when I say older, I'm talking about forties, right? I'm not talking about, you know, 50s, 60s, but we think about it because now we're all the older population. But the reality is, is there's evidence to suggest that these metabolic changes begin much younger, 18 year old kids, 18 year old college kids that don't have extra adiposity or extra body fat are showing signs of insulin resistance. So some of this, this data came out of Kit Peterson's lab, Kit Peterson's lab, I think they're at Yale, you know, a handful of years ago. This is really profound. And at the core, it's a muscle. One of the issues is the skeletal muscle insulin resistance. So at the core, it's a skeletal

muscle problem before they're having abnormal blood glucose, before they're having abnormal insulin readings, you know, so that the big concept is it's not a disease of later. This inactivity, by the thing you don't like. Yes. By like just by going and focusing on what can I go get? What can I add? Which is more muscle. You then in turn fix a whole lot of the stuff. And one of the things that you mentioned earlier was your metabolism. And I don't think a lot of people actually put two and two together that the amount of muscle mass you have and your metabolism are very closely related.

Yeah. You know, one of the things that I always think about when it comes to muscle is the multiple domains. I'm not a fitness expert. I'm a physician. And when I think about, no, I am not. There are way better at exercise and way better at, you know, I don't design programs. I don't consider myself a fitness professional, but I am a healthcare professional.

I take care of real life people. And when I think about the hallmarks of aging and the things that really cause people to age, and I think about at the root, I think about skeletal muscle. I think about it from this place of glucose disposal, which is, it's really your metabolic currency. The healthier your skeletal muscle, the more carbohydrates you're going to dispose of, the more free fatty acids you're going to burn. It is your ability to maintain, you know, the trick word of metabolic flexibility of using the right kind of substrate at the right time. So it is your metabolic sink, not even as it relates to how many pushups you can do, but as your currency. Again, as a physician, I also think about it as your amino acid reservoir.

If you get sick, where are you going to pull from? You know, your body is constantly going through turnover, protein turnover. It's your skeletal muscle. So it is your body armor when you fall. But also if you were to get sick, this is the tissue that actually protects you. Your lungs don't protect you. All these other things don't because you have to be able to pull from these amino acids, which are the building blocks of life, as we know. And the storage, the reserve of that is, or the reservoir is skeletal muscle. And then I think about skeletal muscles as endocrine organ. When you are contracting it, it releases myokines.

People always care about immunity. It interfaces with your immune system. It interfaces with your brain and your bone. There's all kinds of things that we don't even have a great handle on because the science is relatively new. We stand on the shoulders of giants and think that this is all just common knowledge. But the reality is, is a lot of the health related properties of skeletal muscle, not talking about performance based attributes, but this myokine interface, this immune system interface, this is all newer. And we don't actually know the dosing as of yet to how to prescribe exercise other than

for performance. Anyway, I could go on and on and on. But you know, I don't want to bore you guys to death. No, that's why we're here. We're here to hear about all this. And it's not purely just a muscle mass, the like the quantity of muscle that you have, it's a it's a it's a muscle contraction issue, too. It's a movement issue as well. Like you mentioned insulin earlier, like insulin, gluteuteal transporters that that are responsive to insulin are also responsive to muscle contraction and so if you're trying to like um to improve insulin sensitivity and whether you're diabetic or not you're trying to not kind of quote unquote overuse your insulin you want to be moving a lot and that that in and of itself will help with that particular issue as well so

it's you need a lot of muscle mass but you also have to be using it. So you can't just be a big dude. You gotta, you gotta be out there like actually working out and not just sitting on your ass all day. I love that. Actually in my book, it's one of the strategies someone could throw a continuous glucose monitor on and you could see in real time if you eat food and then you get up and you do pushups or you get up and you know, you do some air squats or movement, you can actually see the utilization of, you don't see the utilization of glucose, but you'll see that your glucose numbers will trend down if you have a continuous glucose monitor, because you're leveraging skeletal muscle to help dispose of glucose without these transporters.

It's just purely that movement based activity, which is, you know, last time I checked, we can't go exercise our liver and I'm not talking about drinking, right? We're not talking about that. So yeah, I'm coming in hot with the jokes. And that's, you know, when you ask the question about what is muscle-centric medicine, it is a very empowering way of thinking about health and wellness above and beyond this fitness, but how does skeletal muscle interface with wellness? How does skeletal muscle interface with the prevention and treatment of disease? So how does this play in with hormone levels over the course of your life? I know if your testosterone goes down, as an example, you're likely to start to lose muscle mass. Like to what extent is it just working out versus managing your hormones and kind of taking

care of the medical side of it? Yeah. We cannot deny that hormones play a role in muscle mass and certainly hypertrophy, right? These are the things that we know that there are effects. Does that mean to say that number one, all hormones decline as we age? Well, there are certain fundamental truths that we know women's estrogen as they go through menopause, meaning they don't have a period for a year, their estrogen and progesterone declines. Also potentially testosterone. As for men, you know, my dad is 74 and he still has testosterone in the 800s. Well, so, you know, the question is, number one, I suppose, do these hormones always decline? Well, for women, we do, we know that they do. For men, there is andropause, which is not a real technical term. I think that lifestyle does play a role and there are also

arguably an inevitable way in which people age. I say that cautiously because there's no such thing. The studies talk about healthy, sedentary individuals. We haven't really studied number one. There's no such thing as a healthy, sedentary individual. And number two, you know, we don't really study populations other than older individuals that, you know, there's a small group of elite athletes that are older individuals, but this is not the standard. Yo, you just said there's no such thing as a healthy, sedentary individual. Is that what I heard? Expand on that. I want to hear more about that. It's crazy. We make these statements. We make statements. We're always trying to evolve with the literature, just in general. I say we, I mean, I think the healthcare professionals, whether you are a fitness professional or a medical physician or whatever you are. And if you look at the data, you'll see many, many decades of papers

that say, you know, I challenge people to go look at this healthy sedentary, older healthy sedentary, as if that that is a population that is healthy. That's not. So that's a disease-based population. And we make observations about this group because potentially they don't have elevated C-reactive protein, or they don't have elevated inflammatory markers or comorbidity or other diseases. But the reality is, is being sedentary at any age is unhealthy. And yeah, it's a huge mistake that people don't necessarily think about. Yeah. Go ahead, Doug.

To what degree is strength and hypertrophy or strength and muscle mass related as far as longevity goes? Andy on the show has said many times, like there's been many studies to show that like leg strength correlates very well with longevity. Grip strength correlates very well with longevity. It's kind of implied in there. You got to have some muscle mass if you want to be strong, but to what degree are those the same and different? I think that over the next decade, we're going to see a huge change in the conversation regarding that. We talked about earlier that people will always say it's always strength and not mass, but on the same hand, we haven't been measuring skeletal muscle mass directly. We've been measuring it indirectly and utilizing the term lean body mass to also equate to skeletal muscle

mass. That's not the same. Lean body mass is everything other than adipose tissue. What percentage of that is skeletal mass versus bone versus blood versus all other components of the body. So right now, up until recently, people will talk about the evidence will suggest that it's about strength. Like he, Andy is always, you know, he's definitely right. Is it about leg strength? Is it about grip strength? I don't know what I think about grip strength, but I definitely believe it is about leg strength. And then the next question you asked is about this kind of where does the mass fit into it? And the literature would suggest that mass is not nearly as important as strength. I think that's incorrect. There are some very interesting research coming out that Dr. Bill Evans has done, and he's done it with, I don't remember the other individual. I want to

say it's Rathmussen, but it might not be, where they're now beginning to look at D3 creatine and actually for the first time ever looking at skeletal muscle mass with it. By looking at skeletal muscle mass directly, they are seeing that strength and mass are related. And that in fact, it's the loss of muscle mass, not the gain of adipose tissue that significantly impacts disease. And this is what I think that we're going to see over the next 10 years is a real, that the gold standard that we've been using, potentially we've been looking at it incorrectly, and we're going to see a whole change in the data sets coming up. One thing that I've, and I feel like I know the answer, but want to ask this question anyways, when you see somebody that's like 300 plus pounds, they have to get up and

carry that body around. There's a lot of muscle in there, but those people are also incredibly sick. So where is the balance between, I have tons of leg strength because we've all seen somebody that comes into the gym, 100, 120 pounds overweight. They could back squat a house. They're incredible because they've been carrying this weight around their whole life, but they're still wildly unhealthy. So is body fat still a part of the equation? Like where's the balance in muscle to body fat? And where does it kind of like start to really fall apart? I really appreciate these questions.

I think that they're smart and intelligent, and they allow us to highlight certain aspects of the conversation. Muscle mass in and of itself has nothing to do with the quality of the tissue. We've all seen big cows that are look like marbled steaks, ribeye cuts, there's fatty infiltration within that tissue. And the same thing happens to individuals that are overweight and obese. Fat deposition does not just affect visceral fat. It's not all outside of the organs. It's also within the organs. And skeletal muscle is no different. It's not just the mass. It's also about the quality of the tissue. We don't have great ways of directly

measuring quality unless you're doing some kind of scan, unless you're doing an MRI scan or CT scan, which again, these things are not scalable. And I think very important to point out. The other aspect of that is looking at certain biomarkers, looking at triglycerides. And again, these are variable, right? Because it takes decades for these things to expose themselves. So whether it's elevated levels of trig expose themselves. So whether it's elevated levels of triglycerides, whether it's elevated levels of glucose, whether it's elevated levels of insulin, there are markers that will show up. But again, I think that these markers show up later. Do I think that there's some realistic way of saying if you're over 30% body fat,

that's probably an issue? Yes, it's probably an issue. Yeah, I think that it's just so early on in the conversation of actually looking directly at skeletal muscle mass, I still can't answer the question of how much muscle Doug you should have, or how much muscle you should have Anders, even if I look at something like an appendicular lean skeletal mass index is still can't tell you. Yeah. You think if we could very easily and accurately measure muscle mass, eventually we could get to a point where there's some type of like an ideal ratio. Like we have, we have body fat percentage. We have muscle mass percentage, say you're 200 pounds, 15% body fat. And so you have 30 pounds of fat on you. Should you have 60

pounds of muscle? And that's a two to one ratio. Should you have 90 pounds of muscle? So three to one ratio, or could we, could we eventually get to something like that? Do you think? Yes. I think that we will. And I think it's, it is going to be based on, um, um, more anthropometric measures. So yes, I think that we're going to get there. We're not there yet, but as soon as we get there, it will allow us to proactively focus on what we have to gain instead of what we always have to lose. And I think that that, when that happens, it's going to change the game. It's going to change. Yeah, I totally agree. Just even in you guys talking about that or asking the question

and that answer, you also get to a point because there's probably a rough average. I want to say it's like 40 pounds of total lean muscle that you're actually able to, and that's across whoever it's across that, that number is somewhere around 40 pounds of lean muscle mass that you're able to. And that's if you're training well and being smart and eating the right things. Um, and if that ratio is two to one, well, now we know you can hold on to 20 pounds of body fat at, if you're at peak lean muscle mass. Um, but until we know those numbers, it's probably just, yeah, you kind of look on the chart. You look good instead of having a BMI. Yeah. You're looking good. I, you know, I do put some, it's like, you're a little obese, but

like you look good with your shirt off. Um, I do put some of that stuff in my book. I did with the help of one of my PhD friends, we did put together some charts. But again, is it end all be all? No. And do we have a sense? Yes, but they're all based on disease. So they're based on sarcopenia, which is a decreased muscle mass and function. We've all seen what sarcopenia looks like. We've seen our older individual, older individuals, you know, our grandparents that have shrunk, you know, and that's where really these charts come from. They're based on, they're not based on optimizing anything. I think we also do a lot of this like longevity tests or like the longevity idea is like you need leg strength so you don't fall because fall risk is very real and you need grip strength. So if you do fall, you can crawl over something and actually get up and you go, well, that sounds like the end of my life. Anyways, I don't want to get up like, God, that's a terrible option. There's got to be a better way, you know, a decade and a half before that, that comes up.

Well, you bring up a really good point. And I do want to just highlight this very briefly is the conversation around longevity is really about protein restriction. And if we were to talk about what dietary protein recommendations are, according to the RDA, which is recommended dietary allowance, it's 0.8 grams per kg, we all know this, to cover 97.5% of the population. Okay, so it's two standard deviations either way. And this is the bare minimum to meet requirements. Okay, this has nothing to do with aging. This is just a requirement type issue based on nitrogen balance studies, which nitrogen balance are not, you know, that's not a health endpoint. So in a lot of the literature or a lot of the books that are coming out are talking about protein restriction, how that's going to help longevity. Well, you and I just

spoke about, well, if you fall, when you get older, what is the real risk? The real risk isn't living till you're 120. The real risk is if you fall and you break a hip. How do we address the real strength issues, the real metabolic issues in real time and not some nebulous time where you say, okay, do protein restriction and you're going to live six months longer or you're going to, you know, what is living longer mean? Is that six months, six years, six weeks? Again? And some of the recommendation, which I think is very dangerous is, is they recommend less than the RDA. And that becomes very, very dangerous when we know that there's established data, that that's a minimum to prevent deficiencies and it's not adequate to protect skeletal mass.

In kind of just the muscle conversation, you've really got like two parts, right? You've got the protein, you've got to eat so that we can build the muscle and then we need the resistance training so that we can one, like break down the muscle, teach our body to repair itself. Is there a kind of like a, I can't do both. You should do one of these for sure.

Or do they both need to be done at the same time to have things work? Exercise is a much greater stimulus. So if I were to say, okay, what is the equation? 75% training. And we all know that to be true, just cognitively. We see these Olympians who they're eating whatever they're eating, but they're training. And we all know that to be true. Just cognitively, we see these Olympians who they're eating whatever they're eating, but they're training all up. Yeah. Right. They're training. And we also know people that are training like maniacs, but they don't, are not

necessarily so particularly tight on their diet and they're still jacked. And, uh, you know, exercise is really the major stimulus. Nothing is going to be more potent than that. 24% of adults are meeting their exercise requirements. 100% of people have to eat. Yeah. They got to eat multiple times a day. I mean, just twice. But the reality is, one, you can go your entire life without exercising and you'll still live. Two, you cannot go your entire life without exercising and you'll still live. Two, you cannot go your entire life without eating and still live.

So based on that, if I know 100% of people are going to be having to eat, then we have to nail that part. And that's where this book, so my book, Forever Strong, is all about clearing up the confusion. It talks about the history. It talks about how much. It talks about, you know, how, you know, how much protein do you need? How do you define and design a diet that is reasonable that you can follow, whether it's for metabolic correction, whether it is for just for longevity, or is it for gaining muscle? What are the things that you have to do and where, where, what have we gotten right? What have we gotten wrong?

Where's all the BS? What do we do? I would like to talk a little bit about keeping this muscle that I've been working for the last 27 years to build. Yes. And, and this is really something that will never happen. But if I just stopped training, how long do I keep to keep all this before I just turn like turn into my, the other person that the other Anders Varner that never lifted weights and is just super soft walking around? Is that even possible? Or is it just a part of me? Well, so during bed rest, because

you're young, you're more robust. Well, congratulations. You're more robust. You're well, congratulations. You're more robust. But the data would support that if you are if you are put on bed rest, meaning you don't get up at all, they bring this to you, which is the number one treatment that when people go into hospital used to write orders, admitting mass, leg muscle mass in seven days. I think it was seven days. I think I was just looking at that this morning. What was it? It was yeah, it was something pretty striking. Now, if you are older, you'll lose exponentially. You'll you will lose. So listen, so I say three percent The reality is, is the data is variable. And, you know, it would take your parents, they would lose the amount of muscle mass. So muscle mass and strength exponentially rapidly, versus if you were to lay there for 30 days. I've seen this. Yeah. And I do have some good numbers here. but I don't know. You'll have to, you'll have, I'll have to reread my book and you'll have to

read it. Yeah. Yeah. Um, we've, uh, we've talked a lot about the medical side, but haven't really dug into likely one of the biggest problems in our entire country, which is obesity type two diabetes. Um, I imagine there's tons of research linking muscle to helping people with diabetes. Can you dig into that a little bit? Oh, yeah, yeah, yeah. Well, when you think again, this kind of goes back to the foundation of thinking about skeletal muscle, and there is tons of data to support healthy skeletal muscle and exercise as it relates to its effect on insulin and glucose. So type two diabetes is typically something that is lifestyle driven, where they're not requiring insulin. But this

is that they have elevated levels of blood glucose and elevated levels of insulin, all of which at the core can be really radically changed and affected by having healthy skeletal muscle. And that's simply mitigating excess calories, monitoring carbohydrates, leveraging dietary protein. We know that dietary protein is very difficult to store. Also protects lean body mass. I say that purposefully, all tissue and skeletal muscle. And, you know, the information out of Lehman's labs, he, you know, he saw that he did the earlier studies where individuals would have isocaloric diet, meaning they have the same total calories. They just changed the ratios of proteins, carbohydrates

to fat where they front loaded a protein to around 40 grams versus a carbohydrate breakfast. And they saw changes in triglycerides. They saw lowering triglycerides, decreased fasting insulin, better glucose control, changes in body composition. So it wasn't just purely based on reducing the amount of calories, but it was also calorie controls, but changing the macronutrient profiles of the diet. On top of that, just helping people heal their own bodies. Like I feel like, you know, you talk about like sedentary people. When you're sedentary, I would imagine, I don't really know.

I would imagine it takes a very long time for your body to heal from anything you're doing. It's because there's no practice. Lifting weights is like the easiest way to practice, just getting your body to heal itself and, and go through this process. And if you're carrying around all, there's so much sludge in your system, like all this junk you're carrying around that you actually can't go. And it's,

it's so hard to get healthy because your body doesn't have this database of how to fix itself. Yeah. You know, and I really like how you're talking about this sludge. I often think about one of the issues with this kind of marbled steak, right? This, this fat infiltration into tissue is it really is this disease of sedentary behavior because the flux, there's no flux. You're supposed to have muscle glycogen and you're supposed to use it, right? The storage form of glucose, you're supposed to exercise and use it. It's just not supposed to be stagnant. And exercise is this free thing that you can do to leverage it, to really think about

how you're going to age and also fatty liver disease, all this stuff. Let's, let's dig into this book. Oh, go ahead, Doug. I was gonna say real quick, I just want to clarify one thing. Earlier, you were talking about D3 creatine. And it sounded like that was in relation to measuring muscle mass. I'm not familiar with that. Can you tell us what that is? Yeah, it's a new, it's novel. It's been used in research for a long period of time, long period of time. I think 2018, even before that, they started doing some studies in rodents. Again, it's not available to the public yet, but hopefully Bill Evans will bring it, you know, him and his colleagues will bring it. But it's a pill where someone measures. So creatine is only found in skeletal

muscle. So it's a pill that an individual will take and it will be able to show you there's a readout and it will show you how much it, you know, within this, the stick, how much skeletal muscle mass you have. Yeah. Like you measure it in urine. So you dip the urine or whatever. Yeah. I mean, they'll probably send it to a lab. It is again, it's not used. It you measure it in urine. So you dip the urine, whatever. Yeah. I mean, they'll probably send it to a lab. It is again, it's not used. It's only used in research right now. Gotcha. Okay. So urine sample, I was thinking you would take that and then go get scanned and the scan would be able to see the muscle mass and measure it as a percentage, but it's just, it's just a urine analysis and based on how much you pee out, they just

make an estimate. Yep. Well, I mean, it's actually a direct measure, so it'll be, it's a tagged creatine, but I'll send it to you and you can take a look at it. I haven't used it. I have not used it. I interviewed the guy that discovered, invented it, discovered it. He invented it. But this is what I do think is going to be the way of the future. Yeah. Why do people, I would imagine, and you've kind of made, made your career out of talking about muscle and in the medical space,

what do people push back on you about? I can't imagine like you walk into a nice popular now that Mr. Hotez guy. And he's like, yep, for sure. Dr. Gabrielle Lyon, she knows everything. I would imagine like the standard medical community does not agree with a lot of, especially if Ted's kind of like blocking your Ted talk. Something's going on. Well, I did give a talk at Obesity medicine and I really, again, I just think that the

name is funny to talk about from, you know, the obesity medicine conference. I think that where people don't, where do they push back? Hmm. I think that it's just understanding how important the health of skeletal muscle is and how it can be leveraged in a way that is meaningful, not in a fitness sense. So it's not, for me, it's not about fitness. But it really is in metabolic regulation, in the prevention of Alzheimer's, in issues with inflammation and aging and all of these other domains of health and wellness. So I don't know where they push back, but I will say it's a little forward thinking. People are still very stuck on pathology

and pathology is not going to get us anywhere. Yeah. Is there like a compliance side to it where you can sit down with a thousand doctors and you go, Hey, you got to get everybody to start doing some resistance training and eating protein. And they go, well, guess what? How much I'm going to have about 4% of my clients actually do that. But if I give them this pill, it will actually, they'll, they'll take it. And we're going to get an extra five years out of their life, even if it's unhealthy. And I think that that's where physicians need to step up and be the example, because you're never going to take advice from someone who isn't executing on those very things. So as physicians become more savvy to understand that, you know, we can prescribe medications to treat obesity,

but it's much more difficult to prescribe medications to treat muscle mass. Right? We all know that, oh my gosh, you're on a very fundamental level, the pharmaceutical treatments are still that we can treat obesity, but we can't treat skeletal muscle mass, right? You think that's still like really tied up in if you like testosterone and steroids is all about cheating. Like if you take steroids, and you're an athlete, you're like you're cheating at sports. And that that that kind of thinking is still like that. It's kind of, it's like, it's like this dark cloud over testosterone. It's like, it's like a bad thing, but really it's like everybody has testosterone. Everybody has muscle mass. Like you want every, you know, all of your

things to be within the optimum, normal, healthy range. And if it's not, then you should go fix it. I think that there are a lot of peptides and anabolics and things that were used a long time before sports colored the waters. And those things are no longer available because of the influence of sport. Yet we can prescribe medications to treat obesity, but we cannot prescribe medications to make people stronger or faster. And I think that that is a huge disservice because if we really talk about, you know, we're not talking about abuse. We are talking about, we are talking about how do we leverage things to become the best version of ourselves in a way that should be available to everybody.

And I will say it is not even or equal. You can give someone a drug to make them less body fat, but I can't give someone a hormone to make them have more muscle mass. Yeah. Is if you were to give somebody TRT that, even if they're training just one, two days a week, just doing the bare minimum. Are you able to see increases in muscle mass in a meaningful way to overcome obesity, type two diabetes by getting higher testosterone levels into people? It is not just one thing. Yes. Does it help? Yes. Yes. From clinical experience, it absolutely helps. And again, it's not one thing you and I were talking about this sleep. You know, a lot of

people have sleep apnea. Typically if someone has a greater than 17 inch neck, they have sleep apnea. If someone has had a head injury, women also get sleep apnea as their hormones change. The respiratory drive can decrease depending on it, decrease depending on which hormone is changing. These things all affect your ability to recover, to put on muscle mass. Yeah. Yeah. And, you know, there's other things that I think really influence. I think that there's something that we haven't talked so much about in the general health

and wellness space, because I don't think there's a ton known about it, but there is a gut skeletal muscle mass axis. So skeletal muscle mass and this gut microbiome, I think that there's a lot more to it than we understand yet. But again, I want to hear about this. I love some gut health and muscle. They work together. But I think that there's a, there's a gut, there is a skeletal muscle mass, um, gut access, whether it's short chain fatty acids, whether it's this, there's, um, uh, uh, a postbiotic and a large a tannin that makes something called urolithin a, have you guys heard of urolithin a urolithin a helps with mitophagy when you think about where mitochondria are they're they're stored in

skeletal muscle right that's one of the major places of mitochondria there's a compound called urolithin a that 30 of people are able to make the rest have to supplement and this helps with mitochondria function and it's directly related to how this was metabolized in the gut. It's a postbiotic. And so I think that we're going to start to see this gut muscle connection more and more. It's crazy. Yeah. Yeah. Doug, who we interviewed was at San Francisco State? He was talking something very similar about... Jimmy Bagley? Yeah. Yeah, we were doing gut microbiome stuff, but I don't remember how it was related to muscle mass from that show.

Yeah. Go back and listen to it. I think it's still very new. What about the... Yeah. If I remember correctly, whatever we were talking about, there was not a ton of research and that was three, four years ago. So cognitive function. And this, so they did this data, they they've studied this compound for 10 plus years, and then they made it into a supplement. But this is this urolithin A affects mitophagy in the way that mitochondria regenerate.

And there's, it was in JAMA open, you know, these are very good studies. So yes, there is, I think that there is a gut muscle connection that this whole microbiome thing is going to be on the next frontier of stuff. Yeah. Can you talk a little bit about how muscle and cognitive function work together? Yeah. It's interesting. Is it a direct influence or is it the way in which you utilize skeletal muscle that has the impact? And I think it is probably a marker of overall health and wellness. So I did my fellowship in geriatrics, which means again, I told you about that. And we looked at body composition and brain function and those individuals. And of course,

there's multiple layers to this, right? So there's genetic components, but those individuals that have their metabolism under control, meaning their biomarkers of insulin and glucose, triglycerides, and these factors are under control and inflammation is lower, then they seem to do well over the long-term cognitively. That the wider the waistline, the more challenges with obesity, we do see a correlation to lower brain volume. This is an issue. There's type three diabetes of the brain. You don't just get insulin resistance and glucose isn't just toxic to other organ systems. It is also toxic to the brain. I've heard Alzheimer's called that type three diabetes.

Yes, it is. Is Alzheimer's at some level, just a brain volume issue, you're losing brain volume. So you're losing cognitive function. It is complex. Alzheimer's disease, there's multiple different inputs, whether it's tau proteins, whether it's vascular aspects, I think that there's a lot of it's just highly complex. It's highly complex. But yeah, but one of the biggest risk factors is being obese and having compromised metabolic function. And these things... Obesity is rough.

Yeah. That's really, really rough. Again, obesity is rough, but if we believe it's a disease of skeletal muscle... Yeah, you can go do something about it. Then you can do something about it. You know, there's lots of things that, that help with the protection of Alzheimer's. We know sleep is huge. There's glial cells there. The way in which the brain cleans itself is sleeping. One of the things that we used to always screen people in when I ran a cognitive clinic was, do you sleep with your phone by your head? That's also a risk factor. Yeah, that's me. Tell me about your book. Yeah. I want to hear all about this.

Two years to write and two babies later called Forever Strong. Those things get in the way. You would have been done so much faster. Yeah. Unbelievable. Oh my gosh. Hard to write a book when you're not sleeping at all at all my our daughter still comes into the room my does too it's terrible yeah i slept in my five-year-old bed last night for at least an hour i don't even know what to we don't even know what to do about it but um this book was a labor of love and it's dedicated to dr donald layman um which I'm so super proud of.

I don't know if I would have finished it if I was writing it for myself. I probably wouldn't have finished it. But it does a really good job at explaining the history, understanding the concept of muscle-centric medicine. People will be able to figure out which meal plan that they want. So it has meal plans. It has tracks, whether it's a longevity track, whether it's a weight loss track. It's a lot of good information.

And it talks about some of these challenges that we talked about, and most importantly, what you can do about it. And that's what I love. And also has a mindset component to it. You know, I have the privilege of taking care of some of the most incredible people ever. And over a period of time, you learn what makes people very incredible. And it really is the archetype of the person. Each person displays a particular archetype of execution and same as it relates to weaknesses and understanding the things that get in the way and also the things that catapult them to success. And I included that in the book because, again, as a physician, you are privy to inside people's lives in a way that I think other professionals are not.

And we can learn from people. So I include all that. I love that you, and I feel like I said this at the beginning, but it's such a more empowering conversation to talk about the things that you can go get versus the things that you have to stop doing. And if people can just realize that going and building muscle one, super fun, you get to hang out with your bros, lift weights, eat some protein afterwards. It's the greatest thing in the whole wide world. That's why we've been doing it for so long. But like the, you don't have to sit there and starve yourself. In fact, that actually isn't the way to go about it.

And I feel like all of our parents are probably roughly about the same age and they all have been on every single diet that has ever existed. And guess what? Now they're in their sixties and they're still on those whatever diets they're chasing. And the thing that concerns me about the older population, and this is why this book is great for parents, is that there's this narrative now about how we should always go plant-based. And while we're young enough where it's not really going to impact us so much, who it really impacts is these older generation, where they need at least 50% of their dietary

protein from animal-based products because they have other nutrient needs. They have other B vitamin needs. They have other creatine and carnosine and taurine and all these other, you know, low molecular weight compounds that they will not get if they're fully plant-based. And it becomes very concerning because we have to really look out for these older populations. We just do. So because it becomes so confusing for them that, that concerns me. Yeah. I don't know if you're qualified to talk about the future of humans, but I'm very interested in your thoughts because if I, if I were to like, say we just continue for the next 30 years and I'm 70 years old and we take this like

big look at the population, we've got crazy childhood obesity. Teenagers are beyond obese at this stage. We've got all the old people, all the boomers are going to be dying off in the next 30 years for sure. And then the entire population coming up is going to be basically obese. What happens to humans when we have all of these technological advances? We never have to leave our couch. Everyone is sedentary. I say everyone in that it's an

overwhelming majority of people are sedentary, don't know how to lift weights, don't know how to eat properly, no matter how much information's out there. And then all of a sudden boomers are gone. And the people that are 20 to 40 right now, where there's massive, massive numbers of obesity, type two diabetes, all these things. Where what happens to our our species? Do you remember the movie WALL-E? Because we all have kids. Not yet. On those like those things where they just drink and eat.

I think we're going to be like WALL-E. Yeah, I feel like we're going to go. We're going to have like a like two billion people in the United States to like 700 million one day. And it's just going to happen overnight. Yeah, I... Those numbers are very unconfirmed, by the way. And again, what Doug was talking about, who he said all his friends train and lift weights, there is going to be a huge dichotomy, just a huge gap for those that are going to be super fit and capable and physically capable and those that are not. And it is going to be scary. But as long as we continue to show up and be an example and execute again, is it all about dietary protein resistance training? No, it really is about skeletal muscle. It is about

understanding that it is an organ system above and beyond this idea of just being fit. It is the most crucial organ system that we have because if that falls apart, everything falls apart. Yeah. What would be more fun than going and getting jacked and healthy? Good question. I would love someone to make my bed. Someone to pick up my kid's room. That would be more fun. Put away your shoes. Dr. Gabrielle Lyon, where can people find you? Well, I have a podcast, by the way.

Yes, you do. And that's called the Dr. Gabrielle Lyon Show. Very original. I wanted to call it something else, but people said they wouldn't be able to find it. Great branding. And they can go to my website and they can pre-order the book if they would like. We have tons of free stuff that we're doing with a pre-order.

I have a great newsletter and a YouTube channel all under Dr. Gabrielle Lyon. All kinds of things. We put out a lot of free content. And of course, Instagram. I was hanging out on your YouTube channel before we got on this just to

catch up on all things you cool doug larson right on uh gabrielle it's been too long too many years uh so it's good to hang out and talk to you we gotta do this in person next time yeah i would love it you guys are welcome on the show anytime come on down for sure right on i am on instagram douglas e larson yeah to echo said, uh, there's, if we continue lifting weights, not only do we have to deal with the health, not have to deal with the health issues that you were just talking about for the last hour. Um, and we get to lift weights with our friends and all that, but I also get to keep people like you in my life and, uh,

very, very grateful for barbells and heavy weights because it brought me to you. And we get to do these shows and you're just like a part of our lives for a very long time, which is super, super cool. So thanks for coming on. I'm Anders Varner at Anders Varner. We are barbell shrugged at barbell underscore shrugged. Make sure you get over to rapidhealthreport.com. That is where Dr. Andy Galpin and Dan Garner are doing a lab lifestyle and performance analysis that everybody inside rapid healthization is going to get. That's over at RapidHealthReport.com. Friends, we'll see you guys next week.