Barbell Shrugged - The Forever Strong Playbook with Dr. Gabrielle Lyon, Doug Larson Travis Mash & Dr. Mike Lane #833

Episode Date: January 28, 2026

Dr. Gabrielle Lyon returns to Barbell Shrugged with Doug Larson, Travis Mash, and Dr. Mike Lane to lay out a simple case: muscle is the missing centerpiece of modern health care. Our culture's weight loss obsession has distracted us from the bigger problem, under-muscled, metabolically unhealthy people aging into frailty. Drawing from her training in nutritional sciences and geriatrics, Gabrielle explains why obesity is often a symptom of poor skeletal muscle health, and why longevity depends on preserving strength, power, and mobility, not just shrinking the scale. They break down "muscle quality," including fat infiltration into muscle (IMAT), and why muscle should look more like a clean "filet" than a marbled "wagyu." Doug shares how advanced imaging can reveal hidden issues, including how an old hip injury showed major asymmetry and elevated fat infiltration in a specific muscle he never would have identified otherwise. The point is clear: it's not only about having more muscle, it's about building trained, functional muscle that improves metabolic health and supports the brain and cardiovascular system. From there, the conversation hits GLP-1s and hormone therapy. Gabrielle calls GLP-1s a powerful tool, but warns we risk trading the obesity epidemic for a sarcopenia epidemic if weight loss isn't paired with resistance training and adequate protein. She argues dosing and personalization matter, and muscle-building interventions deserve the same seriousness as fat-loss prescriptions. They close with protein strategy, why the RDA is a minimum, why higher intakes tend to perform better, and why anyone over 35 or dieting should prioritize at least one higher-protein meal, often around 50 grams. Gabrielle wraps with her upcoming release, Forever Strong: The Playbook, a tactical field guide with evidence-based protocols for training, recovery, and durable health. Links: Doug Larson on InstagramCoach Travis Mash on Instagram

Shrug family. Doug Larson here and today on Barb Bell Shrug we bring back a longtime friend of the show, Dr. Gabrielle Lyon. She's a physician. She has a background in nutrition and geriatrics and has a world-class understanding of the role that muscle plays in our short and long-term health and performance. She also has a new book that came out just yesterday called the Forever Strong Playbook. You can get that on Amazon or Audible. Highly recommend it. And in this episode, we talk about the limitations of only focusing on fat loss specifically with regard to GOP1 use, the benefits of hormone replacement therapy. what healthy muscle actually looks like, protecting your muscle as you get older, as well as how muscle mass specifically contributes to your overall health. So if you want to know all about the relationship between muscle and longevity, this shows for you.

Enjoy the show. Welcome to Barbell Strug. I'm Doug Larsen here with longtime co-host, Travis Mash, and one of our new co-hosts, excuse me, Dr. Mike Lane, and we're here with Dr. Gabriel Lyon. I've been on the show a handful of times, and great to have you back. Good to see you. It's so good to see you. We've known each other, Doug.

You know, I've known each other for probably over 10 years now. Yeah, something like that. And you have been very busy. You got a new book coming out, a compliment to your old book, but also you said a much better version of your, not the old book, but a past book. We're going to talk about that here today. Yes, actually.

So it's the Forever Strong playbook. And, you know, when people think about a playbook, they probably think about a workbook. It's totally not that. It's what is the tactical, like a field guide. But what makes this so different is it starts with how to think. And you, all of you have been in the coaching realm for a long time. And people always go exactly with what to do first, how to move, how to train.

But you have to manage how to think primarily as the initial. Yeah, you'll fully agree. But before we dig into that, for people that haven't met you or haven't heard a show in the past, Give us your background. How did you get into training, into science, et cetera? Yeah. Well, I'm a physician, and I trained in nutritional sciences and geriatrics, believe it or not. So I did two years of psychiatry, three years of family medicine, and then a fellowship in nutritional sciences and geriatrics at Wash You. All this to say, quite a long road, but my undergraduate was in nutritional sciences. nutritional sciences and vitamin mineral metabolism with Dr. Donald Lehman, who is the OG in

the protein research world. He was the guy that figured out the amino acid leucine would trigger muscle in a certain amount. And it's been my mentor for, you know, 20 plus years. So I've always been interested in muscle. And during your fellowship, you have to work on a project. And I was working on a project during my fellowship. And, you know, I was imaging women's brains and looking at their body composition and those that had really undesirable body compositions, meaning low muscle and a lot of body fat, those individuals that I saw had brains that looked like at the beginning of Alzheimer's. Yeah, I feel like people don't view being under muscle the same way they view being overfussal.

fat. Like obesity is like obviously not healthy, but most people intuitively know that like you need to be strong and have some amounts of muscle, but we don't do it quite the same way. And I feel like we really should at this point. Like being under muscle is not healthy. There is some early work from Bill Evans. I think he's at Berkeley, I think. And basically what he looked at and found was that the loss of muscle mass was more detrimental over time than the gain of body fat. So, if you think about why that is and what that means is that, you know, since the late 70s, early 80s, we've been focused on this obesity epidemic. If roughly 74% of adultery, they're overweight or obese, we've been hyper-fixated on what appears to be the problem, which is,

quote, obesity, which is in part a symptom of unhealthy skeletal muscle. And all of these diseases, or many of these diseases that we're chasing, whether it's cardiovascular disease, Alzheimer's, type 2 diabetes or obesity, they're not diseases that originate in adiposity first. They're dysregulation of skeletal muscle that happens decades earlier. And, you know, as we move into this current landscape, you know, when we were in the obesity epidemic, we're fighting this obesity epidemic, no one even thought about muscle. No one even made the connection, right, Travis, no one even made the connection. Yeah.

Other than don't make me too buffed, you know. My God. Please don't make me too bulky. Don't slow my child down by getting them too strong. Oh, my God. Your child can barely walk. Yeah, he's fine. And, you know, it's so fascinating when you think about it,

this idea of this obesity epidemic and how it's shaped our entire narrative is that it's all about what you have to lose. It's never a focus on muscle health. The only focus on muscle health is athletics. Is how strong are you? What is your athletic? capacity, not as an organ system and as the primary organ system for health and longevity,

which in fact is what it is. So, yeah. Yeah, let's talk more about that. Like obviously you need to be strong to perform well to run fast and jump high and lift weights and whatever else. But if you're not an athlete and you don't really care about benching 315 or whatever it is, why do you need more muscle mass? I mean, well, first of all, everybody cares about universal chest day.

Let's just get that straight. Obviously. Mike Lane over there, first time meeting him. You guys are going to hate me by the end of this, but let's be fair. We all care about universal testing. You know, when I think about muscle, there are various components to the perspective of skeletal muscle. We're not talking about smooth muscle. We're not talking about cardiac muscle.

There's muscle from an athletic performance standpoint, which is power, force, mobility. You guys know this stuff way better than I do. And then there's muscle from a metabolic component, which fascinating, there's an interconnected relationship. When you pull the lever of muscle to do any kind of activity, strength, endurance, whatever it is, you guys probably don't do a lot of zone too. But whatever that is, you actually, your muscle becomes healthier. Even if your body composition doesn't change, the simple act of doing some kind of resistance,

whether it's anaerobic or aerobic capacity, changes the composition of this muscle. It changes the health of this skeletal muscle. And so if this is the focal points, if you ignore athletic performance, however, it's necessary to be able to maintain and build and keep healthy muscle from a metabolic perspective, then we start to think about there's the physical mobility

and then there's the metabolic component. And then there's this other component that I think has really not been spoken about, which is the most obvious. And that's the mental component. People talk about how do you become mentally tough? How do you navigate your environment? Well, you have to pull the physical lever for that to manage your emotion. I'll give you an example.

So I'm a mom of two kids and a man child. I have a four and a six-year-old. And by the way, this man-child, this is not any man-child, right? Like, let's be fair. This man child is man child of manchild. So he is a former seal. He was a seal for 10 years. He's now in his third year as a surgeon.

He's a surgical resident. He runs to work. He runs to work and back rain or shine. Okay? Doesn't matter. And he's carrying 30 pounds in his back. It's four in the morning. I'm like, honey, it's pouring rain.

First of all, you're waking me up. And second of all, it's a thunderstorm. He's like, but if my standards were only when it's convenient, then what kind of man does that make me? I was like, all right, well, keep running and find your effing socks. Anyway, I bring this up, I just want to frame this up, is that, you know, there's all this talk about meditation and physiological sigh and all of that stuff I have in the book, right? But the reality is when you are at such a heightened state, there's no amount, at least for me,

I'm not a very skilled meditator. I cannot meditate my way out of a paperback, right? If I'm pissed and I'm in that loop, I'm pissed. You put me in a cold plunge in 45 degree water. is nothing that I can think about. You put me on a max out sprint or a really heavy lift that I've been called in for. Nothing cuts through noise and distraction

faster than your physical problem. This period, end of story. And so that's like another lever that, again, we put it in buckets, but it's this interconnectedness. And I'm going to go real esoteric. And I promise I'm going to pull it back, okay? That is awesome. Let's go.

I was going to be real esoteric for one second. I'm pulled back and then we talk about nuts and both. But, you know, this Forever Strong, the first book was very personal to me. It's the first book of its kind talking about muscle as this organ system, which they didn't even decide to identify until the 2000s. And that's important. But this book, the playbook, is it's like a call to arms. It's not about protein.

It's not about muscle. But I think for you that have children and for us, it's about how do we build stronger, more resilient humans? And that's what this is really about. And that's exactly what you guys are doing, at least I think that you're doing, this podcast. It's not about all that stuff. It's about, you know, building for this generation and beyond. So that's it.

All right. Nice talk. No, I mean. Yeah. So like, so getting stronger to build a resilient person, which totally makes sense. So like, so let's say obesity is a problem. But if you don't have the muscle to move your body, like, you can't be. do anything. And matter of fact, I would even venture to say that when someone is super obese,

just starting getting them strong is probably smarter than putting them on a bike or having them go outside and walk because they're so uncomfortable to them. And so like, I feel like we're just way putting the cart before the horse. Like, let's give them that structure and then they can have the, now they have a machine so then they can go do their thing. But like, I'm not going to have them do some terrible. I'm not going to argue with you because I think what you're saying makes a lot of sense. And we do, listen, any activity is better than none. But you and I all know that as individuals age, walking alone isn't going to do it. It doesn't maintain those type two muscle fibers. Doug and Mike, I know that you guys have talked about this. And, you know, we see as people age,

they become more frail. And those people that are going these afternoon walks, again, is it valuable? Totally. Is it moving your muscles and increasing blood flow? Yeah. But if strength doesn't become a standard. And again, wherever you are on your journey for health and wellness, if strength doesn't become a standard, then everything else is going to fall apart. Dr. Andy Galpin here. As a listener of the show, you've probably heard us talking about the RTA program, which we're all incredibly proud of. It's a culmination of everything Dan Garland and I have learned over more than two decades of working with some of the world's most elite performers, award-winning athletes, billionaires, musicians, executives, and frankly, anyone who

just wanted to be at their outfit. absolute best. Artae is not a normal coaching program. It's not just macros and a workout plan. It's not physique transformation and pre-imposed pictures. Artae is something completely different. Aratee is incredibly comprehensive and designed to uncover your unique molecular signature, find your performance anchors, and solve them permanently. You'll be working with not one person, but rather a full team of elite professionals, each with their own special expertise to maximize precision, accuracy, and effectiveness of your analysis and optimization plan. Artee isn't about treating symptoms or quick fixes. It's about unlocking your full potential and

looking, feeling, and performing at your absolute best, physically and mentally, when the stakes are the highest. To learn more, visit Arteelab.com. That's A-R-E-T-E-Lab.com. Now, back to the show. If strength doesn't become a standard, then everything else is going to follow. part. Yeah, I mean, it's not going to help you if you fall and break your hit, you know, like you can do all the cardio you want. So what are you going to do then? You know, you're going to crawl your ass up or what, you know, like, so. Yeah. I love you. This is getting a little, sorry, maybe getting a little less of terror, but going back to your point on the muscle mass, you know, obviously obsession was BMI for a really long period of time. And now we realize that, you know, there's more recent research showing the people that have normal BMI is still have high body fat percentage and super low lean mass. And that's been the obsession. Where would you? you say is like the entry level amount of muscle mass you want some you to have relative to something like their body size or their frame? It's a great question. And I would say that it's a huge missing factor in terms of really good data.

So we've got the UK Biobank, and I want to set this up right, because the reality is we have not been looking at muscle mass. We've been using Dexa, which looks at body fat and bone density and extrapolates lean mass. Looks at body fat, great, but from a lean mass perspective, we're not looking at it directly. We're extrapolating.

We're assuming that of that lean mass, that maybe 40% of that is skeletal muscle. You and I all know that's incredibly variable. In an ideal world, I would love at least 50% of your body weight to be skeletal muscle. Do I have data for that? I don't have data for that.

But we know on the other, end every 10% loss of skeletal muscle, the first 10%, you know, you might have impaired wound healing. The next 10%, so now you've lost 20%, you know, there's all, you know, there's just this elevation of increasingly more difficult, you know, difficulties with aging and recovery just in general, right? Ultimately, you lose 40% of your muscle. You're going to die.

That's kakexia. So the question is how much muscle? muscle mass should you have, I would say as much as you possibly can. And you know, the other thing is for the most part, I think after, I think from a body fat percentage, and I want to say it's very carefully, I don't think body fat matters. I think it's the intermocular adipose tissue that's actually much more relevant. I don't think body fat matters. Unless we're getting up to, you know, maybe 40% or more, like let's say now we're moving into a range where, okay, body fat probably matters a lot more.

But this, the 25% is it 30%? I don't know, I don't really care because I actually think it's the quality. I think that if we take a step back, the narrative has all been about body fat, which has now left a lot of data on the table where we haven't been directly looking at muscle mass. We haven't been doing MRIs, looking at what is the quality of that muscle tissue versus just extrapolating lean body mass,

because it's really the quality and the fat that infiltrates into that muscle, which I think is what is driving this metabolic derangement, is going to be much more important as the people at Rapid, as you guys at Rapid, and just myself. So I'm a physician. I'm pretty sure I see a handful of rapid patients, but that how do we really begin to focus on muscle health? And muscle health isn't that complicated, which is great.

I think a lot of people probably don't know what fat infiltration means in the muscles. if you just want to kind of give like the Lehman's version of it. Yeah. So there is some. Yeah. I'm at. Well, first, when you think about skeletal muscle, you for the most part, wanted to look like a fillet. To gross everyone out, you don't want muscle that looks like a waggo steak.

And in the beginning, people would say, well, those with obesity have more muscle mass. Yeah, probably. But that muscle looked like wagyu. And so it makes it dysfunctional muscle. How do we define dysfunctional muscle? Well, we define dysfunctional muscle with connective tissue infiltration, fat that actually creeps in like wago. If you, you know, cut a cross-sectional area, that's all not healthy tissue. At the time, if you are not emptying the tank, training, using muscle glycogen, then you have what is like a,

it's sedentary muscle which no muscle that is sedentary is healthy it's designed to then so what happens over time and i'm not talking about for the real geeks out there the athlete's paradox which is the mitochondria is located next to um triglystraply right we're not talking about that i'm talking about your mitochondria is over here you have fat that is now infiltrated into muscle it's not being used as energy it's not in a great uh usable location next you know where in reference to the mitochondria it would be, this is what I think is the real problem. But we haven't really studied it yet.

Or they are studying it, but they're studying it from a pathology perspective, like for PCOS, which is the one cause of infertility in women. We actually, sorry, we've actually looked into this a little bit here lately. So we launched the program called Optima Muscle here a few months back. And in preparation for that show, or for that program rather, we did a couple shows, one with Dr. Chris Perry, one with Matt Brown,

and one with Dr. Doug Goldstein. And using myself as an anecdote as an example. So Springbok analytics does muscle mass percentage. And I got mine done. I was 42% muscle. And talking about fat infiltration, they measure muscle quality with fat. All about springback.

Yes. Yes. My muscles as far as fat infiltration to make the main point here, you know, they're mostly healthy. Like they're 1% whatever it is, except. I had a posterior hip dislocation in like 2008 or something like that. And on my on my left side, my quadratus femurus was 46% smaller than my right side. Basically it was like ripped in half and de-inervated.

And any fat infiltration, instead of being like one or two percent was like 24% or something like that. Like that muscle is just damaged and is not operating optimally. And I never would have known unless I would have got that scan done. Yeah. In the back of my head, if we ever find ourselves in a live situation, I know where we can find the best, anyways. Take down. Yeah. I'm not trying that shit.

That's amazing. I do think Springbok is really ahead of the curve. I've also been looking into them because right now it's done in research setting. It's done in the research setting where you're looking at, and that's really advanced, it's looking at legs underneath MRI and activity. So they have craters in there. So they're seeing the utilization of fuel sources while exercising. And not so it's not just what is the composition of your muscle, but how efficient is your muscle? Again, this is the future.

We're so far behind, but I love that you do that with Springback. Remind me, Doug, I need to reconnect with those guys because I would love to reconnect with them. Yeah. Happy to know it. You bet. But even with this, the whole obesity thing, it's not weird because when you look at like, longevity, you look at like what things leave first, you know, like you got power, you got strengths, then, you know, muscle mass, but then you also have, you know, bone density, like all of these

things are happening up front, but yet all, you know, like you said, we're all talking about, you know, like body fat percent who gives a shit? Like, I mean, like, if I can't move, if I can't protect myself, or if I trip and fall and I don't have these nerve responses, or these, I don't have these reflexes anymore, I'm going to fall, you know, like, I don't have that cross-extensary reflex to catch myself, then I'm screwed, but we don't do anything with that. You know, we just leave power alone. Let it go. Why? I mean, that's the brain. It's the brain is direct correlation to the joints, you know, the brain to the muscles, the neuromuscular system. And we just ignore it. And so. Yeah. And I'm not. You're not ignoring it. And,

you know, I do think that for what you guys do, there's a real opportunity because if skeletal muscle is an organ system, we don't have a type of medicine that addresses it. So if we are all in agreement that contracting skeletal muscle releases myokines, which myokines are these peptide hormones that travel throughout the body based on intensity and duration of training. So when I contract, when I contract my bicep, although like it's embarrassing to do it here, but like let's say if I were to do that, yeah, I mean, that's whatever, that contraction, causes a release of these myokines and they travel and cross the blood-brain barrier and help with neurodynesis and memory and cognitive speed, the faster you move, the faster you think.

So there's skeletal muscle is an endocrine organ system like the thyroid. It is an organ system like the heart. But we have never viewed it that way. We view it very binary. What can you do? How much power, four, strength, blah, blah, blah. And or, um, I think that the other part is like, I don't know, how much do you have? But we don't have a form of medicine that goes, okay, so if this is truly an organ system, what are the medications that affect it? What are we going to see as outcomes? For example, GLP1, what influences GLP1s, hormones, anabolic agents have on this? What about beta blockers and all of these other things?

And if we can reorient ourselves to muscle being the focal point as opposed to fat, We're going to be able to change the way our entire culture ages. 74% of their overweight or obese. Is that bananas? That's bananas. I hear numbers like that and I go, really? Is that really what it is? Holy shit.

Yeah. Yeah. It's bad. Go ahead. So focusing on muscle, focusing on performance, focusing on things like hormones. You mentioned GLP1. GLP ones and hormone replacement therapy, et cetera.

Like what is the landscape for that right now? What are your thoughts on getting hormone replacement therapy when you're, say, in your 40s, 50s, 60s, et cetera? Yes. Well, let's start by thinking about the landscape. For the last 50 years, we've focused on obesity. We now have a treatment for that, and that's going to continue the GLP ones. We, from my perspective, this is a very bold statement,

are going to trade one epidemic for another. we're going to trade obesity for sarcopenia because if the majority of Americans are not working out and are obese or overweight, we give them gLP ones, which is they're amazing. They are likely going to lose a bunch of weight and a bunch of muscle and then get off the gLP ones and be in a worse place than they were when they started. And they're going to lose bone density. So we're going to trade one epidemic for another. not to mention that natural loss of muscle, and there's variables because we're not looking at it under CTR MRI for the most part, is let's say it's 4% per decade. Let's just say.

So sarcopenic loss over the age of you pick it. Again, these numbers are all over the place. Let's say, I don't know, 50 or whatever. That's not that much 4% per decade. So what we're going to be able to detect is going to be pretty small. But you introduce a GLP1 and they can lose, what, 14% of their body weight in a handful of months, 50% of that, which is going to be muscle. And then what about the agents that are 24% of your body weight? So from my perspective as a geriatrician on someone who did a fellowship in nutritional sciences, do I think these medications are amazing?

I do. And I think that they have to be used with caution or we're going to swap one. Epidom for another. Who do you think are the right candidates for GOP-1s? I think it's personal choice. I'm very much body autonomy. Who am I to say that that five pounds that you've been struggling with for the last 30 years, you know, if you're a hundred pound per, you know, whatever it is, is my decision

to make. But I will say in our clinic, it's strong medical, unless you are doing the things like training and eating dietary protein and your lifestyle. is not on point, then that's a challenge because, you know, the first part in medicine is to do no harm. Right. Okay. Yeah. So you more or less, you more or less said this, but like there are probably better and worse ways to go about using those medications.

So let's go down that track. I think, well, first of all, the point of muscle as this organ of longevity and the fact that it has intermuscular adipose tissue, which is IMAT. I do believe we're going to start seeing more and more data that the GLP1s reduce IMAT, which is fantastic, right? So now we're looking at a treatment for more dysfunctional muscle, metabolically dysfunctional muscle. So I think that that's amazing. I also think that where the problem comes is the dose kind of begets the poison. The normal dosing, I think, is too much for most people, the scheduled dosing, even if you incrementally go up every month, you know, in our clinic, we microdose it. We don't use it. You know, it doesn't require all of these

really robust doses. So I think that there's a personalization to medicine, which is really critical. There's a lot of that being thrown around the whole 2.5 grams. You know, you do that for four weeks, then you jump it to five. And like, but yet there's so much, there's a lot of, at least there's a lot of anecdotal data that says there was be there's absolutely no point to jump to five there's lots of people seeing great results very you know controllable with just the 2.5 so why do why do they go ahead and do the automatic jump i'm with you on that or even it's 2.5 high maybe that's too high yeah um i mean i think it's a point and i think that that's where personalized medicine comes in that i think is really valuable but they are without a doubt here to say stay

and without a doubt they're amazing yeah um yeah You know, and I do think that we should touch on hormones because like I said, I still see patients. And just I, this is a mostly male listen to podcast. Is that true? Yeah, we're easily 80, 85% male for sure. Okay, well, I'm going to just get all the men's attention right now. 40% of men by the age of 40 will have erectile dysfunction. 50% of men by the age 50 will have erectile dysfunction.

We just published a paper. I was the senior author on this paper, and do you know what it showed? I'm not going to make you guess. More healthy muscle mass and strength, better sexual function. Well, 100%. Yes. Yeah. Yeah.

I know. Very well. Maybe all the motivation somebody needs to change their life. Stronger you are, the more healthy muscle mass you have, the better your erections. 100%. like after i when i finished my man i went back to school late uh dr lyne and so it's so like by the time i was done i was 50 and it was like the worst sip of my life now i mean would you say i definitely didn't have erectile dysfunction in terms like most people but i definitely wasn't my self you know

like i'm like i mean without my wife being here i'm a very overly sexual person and like i'd become very normal and like uh honestly assumed i was just dying i'm like all right i'm 50 this is just the downfall. But then I started training again. All of a sudden, like, I'm like a kid again. It's like an odd just, it was all about bringing back balance, getting my strength training going again, and like complete turnaround. And like my wife would agree, it's like, it's been a great turnaround. So like, just getting strong again. But isn't that amazing? Yeah, yeah, it's amazing. People want to think that the better, the more jacked your legs are, you know, the better your penis works.

You know, people wouldn't, they wouldn't put that together. It's a truth. But the reality is, the reality is that muscle mass is the lever that we pulled for all of these things. Because as you contract skeletal muscle, depending on the activity, you increase vasodilation, you increase NO2, right, nitric oxide production. You maintain metabolic control. You're not having high levels of blood glucose, high levels of insulin, elevated triglystrilystri glycerides, all the things that we talk about are metabolic syndrome are actually symptoms and

indications of unhealthy muscle. So if you course correct, you fix this, I mean, it then trickles down to a rectal function and sexual function. This is, this is extraordinary. And why it's so extraordinary is that it's the only organ system you have voluntary control over. It's the only one. So it becomes a choice.

Yeah, just get your butt back working out. You know, I do hear you, I heard just this morning as I was excited about my wife, by the way, she's a big fan. And so she was super excited about me talking to you, but I noticed where you say, you know, for men, you know, we have erectile dysfunction, throw the blue pill at them. But for the women, it's like, you know, there's, you know, there's no, they just say, oh, you're getting older. And so, you know, it's all in your head. It's all in your head. blah, blah, blah. So, like, I'm curious.

How does this relate to women? This is a really good point. Well, they do have a medication. They finally have an FDA-approved medication. It's called Adi. And Adi is increases sexual desire without a hormonal use. So it's not like testosterone where you're giving testosterone and then testosterone can help sex drive.

So Adi is helpful. And I will also say one other thing is that like women in our practice, we, put most patients on low-doseyalis for vasodilation, whether you're male or female. And so I do like the perspective for the guys listening to this for their wives. Number one, it's not all in their head, right? There is something to be said for being strong, being fit, and how that affects men and women are very different. I actually talk a lot about this on my podcast. The joke is that I have the number once men's health podcast because I have all these urologists and these sexual experts come on the

podcast. But, you know, the biological design is different where women, they need to be not have stress. They, there's just, they require a lot more. But when it comes to sexual function, the same things hold true. That are vascular health. Women have erections too, by the way. 100%. Absolutely. Yeah. So it's the same thing that is good for men is also good for women. Yeah. I mean, to clarify, my wife is not that. Yeah, she's, that's not her problem. It's an important conversation. Dear God. No, no, no, no. But this is an important conversation because we have this conversation for men all the time. But not for women. But not for women. And so it's, it's definitely having its moment, which I think is important. And then I will also say something else. because you guys are, you guys are coaches.

And I will also say there's on the far end of the spectrum, too, is we're hearing a lot of information that men and women should train differently. I don't see the data to necessarily support that. I think a good training program is a good training program. So, you know, I do think that we do have to bring it back and unify those things. Totally. I would say at the elite level, there might be some. Totally.

But overall to health. Yeah. We're getting into nuance there. We're not. It's very nuanced. Maybe they need a little bit more volume, but like, even at that elite level, yes, yes, very minute. We need more volume, yes.

Blah, blah, blah. Maybe fiber types. There's a difference and maybe it's a 1% difference. Yes. But the reality is a program that's going to make me strong. We'll probably make, you know, another guy, depending on training, all that stuff. But it's, you know, it's probably more dependent on the actual training. than it is dependent on the actual sex.

So far. So far. With the, I apologize, my audio cut out for a moment, specifically, you know, guys have the straight-up ED, like, you know, all of a sudden when they can't hit the upright and lock position, they know something wrong. What would be the equivalent canary in a coal mine that you would give your female clients? Like when, you know, you no longer, is it one of those things,

your frequency is no longer what it wants once? Or, like, what would be like before it's like the bedroom's dead? Like, what would be your, you know, like, hey, we need to start thinking about these interventions. You know, I think, I think it's a wonderful question. Men, it's very obvious. For women, it's not so obvious. And it could be any number of things.

So for us, it's interesting. So we look at blood work. We look at testosterone for men and women, free testosterone. We look at estrogen, all, you know, progesterone, F-S-H-L-H, all of the markers. But the first sign for a woman is if her desire is less. It has nothing to do with physicality. and this is just how I practice. And that's actually a conversation that I have with all of the women in my practice,

just to understand because it might not be something that is top of mind for them. They're managing a house, at least for me, you know, for me, I manage businesses, a house, books, kids, all the other things. I might not be thinking about my sexual desire unless someone asks me. So that for a woman is, you know, typically at least in our practice, we think about desire first. Whereas men, men, you know, they'll have a canary in the coal mine if they're having erectile dysfunction.

I mean, that's like, they'll be the doctor so fast. You don't even, you can't believe. They haven't called you back in a year and all of a sudden they're there. And it's, of course, no laughing matter because these are, you know, it's a real serious indication. You know, when we see a rectile dysfunction for men, you have to think, what is the cardiovascular system look like. No, where is their cardiovascular health?

Where is their testosterone? Are they using or drinking a lot or any of those things? So you mentioned desire for women. And then you also mentioned Addy, you said. And that medication specifically affects desire. Is that right? Wait, tell me more about that. I'd not heard of those before.

This sounds really interesting to me. Sexual desire. Yeah. So it is a medication that we use in the practice. and it works on the brain. So typically women, let's say that they don't, if they don't want to take hormones or they have some reason why, it increases sexual desire.

I can't remember exactly the mechanism of action. I have to look it up, but it's taken at night. It's pretty amazing. Let me see. It's called a little pink pill. It's called the little pink pill. So it's FDA approved for both, which is new, premenopausal and postmenopausal women, which is amazing. And very broadly speaking, it helps balance neurotransmitters, serotonin, dopamine.

I think a lot of the discussion is around dopamine because a lot of our women that take it and they're, you know, it can be used off label for men. But they find that it was originally trialed as a. antidepressant, but it didn't work as an antidepressant. But they saw an increase in sexual desire. And what we do see is there's more interest in sex. Their mood seems to be better. They have more satisfying sex and like less stress. There's there's, there's, uh, it seems to improve mood.

Yeah. Dang. Like it seems like I've always thought this. Like if you could, if you could genuinely make a drug that made you actually horny, especially for both parties, like that would be the most popular. drug in existence. They would make all the money. I feel like I can't believe this isn't more well known. Well, I'm telling you their founder, Cindy Eckert, is amazing and she's on a mission to make this accessible to women. And it's been a real life's mission for her to do this. And

she's done it. I mean, we are all starting to talk about it. For a long time, the people that were on it didn't want to talk about it. Yeah. There's something embarrassed or what? I mean, I think, stigma they feel. I mean, it's like guys talking about Viagra. Like, doesn't want to just walk around announcing that to the world. Now they're going to look at my real deal, you know, like. Yeah. But what was the dosage of Cialis, you said, hypothetically? Just for a friend, I know. Well, actually, most people, a lot of progressive providers will be giving, you know, 2.5, 5 milligrams of Cialis daily. Five milligrams of Cialis daily. Wait, let me ask you this. So my.

What about the, when does HRT come into play versus that? You know, like, what's the difference? Yeah, this is a really good question. And I don't know if I mentioned this, but I, my husband is in urology training. So he is going to specialize in men's health. And we talk about this stuff all the time. And HRT is very safe for most people. And it didn't have a stigma.

until sports and until like up until the 1930s they were prescribing testosterone. And then all of a sudden, based on one urologist who said that it caused prostate cancer and then they went on a mission to castrate men. One doctor's name was Abe Morgan Toller. He's a dear friend. He's been on the podcast. Abe Morgan Toller was like, it just doesn't make sense. At Harvard, he studied reptile brains and he saw that there was improvement

in everything when they were given testosterone. And there were testosterone receptors in the brain. And so he went and he pulled the study, the quote studies that they determined that they had been castrating men from. And that medicine, that medical intervention for castration was based on one patient. I swear that.

Based on a blood test that is no longer validated. Good enough. So the idea that testosterone causes prostate cancer is not true. The idea that testosterone causes cardiovascular disease is not true. They came out with a traverse trial that shows that there isn't an increase in major cardiac events. That testosterone is, and in fact, low testosterone is a greater risk for cardiovascular disease, among other things. So it's, you know, humans are really great. We hear something and then we have a cognitive bias for that.

And then we always think about how do we make that answer true, even if it's not and it's totally wrong. And right, even now, do you know that we have FDA-approved Antibaldic agents that are FDA-approved, like Nandula? That is FD-approved for, you know, can be used for, you know, technically off-label can be used for anything that the provider feels like the patient could benefit from. It can be used for sarcopenia or osteoporosis and sarcopenia, and they're not dangerous.

Also, you know, there's, you know, the HIV epidemic, when that happened, one of the things that saved those guys was anabolic agent. It was out anabolic steroids. Mm-hmm. It died. Yeah. They're just losing muscle mass. And I'm going to, I'm going to drop one more bomb, okay?

Mm-hmm. Let's just go all out here. You can go to your doctor now and say, I want a medication to make me less fat. And they go, oh, where's my pen? Oh, GLP one, where's my pen? Where's my pen? You go to your doctor and you go, hey, doc, I want a medication that's going to make me have bigger, healthier muscles.

and they're like, oh my God. I know it's so crazy. Oh, my God. Tell me just, how does that make any sense? And why, if we're going to have a bias, why aren't these biases the same? For what, why? Yeah, why are you critical with both? You mentioned the sports thing.

But that was my perception growing up. Like, when I was in high school, like, if you took steroids, you were a cheater and a criminal. Not because of any No medical rationale. Like, I mean, that probably was out there, but like, I didn't think that. I was not told I was, well, there was something along the lines if you're going to die, but I wasn't worried about cancer and that type of thing.

It was mostly that I was like, I was being unethical. I wouldn't want to take anything and then play sports and then be found out. And then everybody would know that I'm a cheater, you know, which if you're not following the rules, technically you are a cheater. but like that's still the public perception even if you're not playing sports sport might be and that I agree with that if there is an agreement for transparency that if you are participating in this that you are not taking X, Y, and Z. But on the flip side, if then why is there a conversation in a reaction test house for

who is going to cause prostate cancer and anabolic steroids are so terrible for you and even the word animal steroids. But where's the data from that? And I'm not talking about abuse. You give GLP-1s in access. You probably have some major problems. It's the narrative and the framework that you can go and get a medication to take off body fat, but God forbid you ask for medication that's going to give you actually something that could save your life

and make your overall well-being improve. And I think that we're all guilty as physicians to not take a step back and ask broader questions, like what has been informing our views? What is the evidence that X, Y, and Z is dangerous? Why is there such a heavy stigma? And even now, people aren't ready. They're not totally ready for it. But I have to tell you what, they have to start getting ready to have this conversation.

Because, again, I'm not talking about analog steroid use in sport to be bigger and to be more jacked or any of that stuff. I'm talking about what is a medication when paired with appropriate lifestyle is going to help maintain healthy muscle mass. It's just a question. Yeah. I'm not...

But this is a question. Yeah, the big big difference between appeals to tradition, you know, 500 years ago, they would have said you had too much blood and then inserted the healing knife to remove some excess there. And I really like, specifically on your nutritional recommendation,

and I apologize for switching gears of you're just giving a good basement for protein intake. Because how many folks in those gLP ones, they go from a suboptimal diet, but if you eat enough in general, you tend to accidentally get enough macros and micros each day to survive. Totally. But if then you go to eating, and we see this with athletes all the time when they have that hard weight loss and then they just, you know, congratulations, they're not getting up B vitamins and they have some type of negative outcome. You know, they're not getting of sodium, potassium, they've got cramping issues.

So with the amount of protein that you're recommending and that 30 grams for a meal, how do you like to scale that based on body sizes? Yes, exactly. So, you know, guy like me, that's 210, where would you want to set that for meal as opposed to, you know, 110 pound female that thinks, you know, too much protein will get them to be too bulky? Yeah. You know, we'll make you tomorrow with mash as traps.

Yes. I'm about 110 pounds. Doug knows me in person. I'm like 5 foot one. I'm still trying to get bulky. I've been trying for the last, I don't know, 30 years or 20 years. So it's not going to happen. And I often wonder, do we ever and have we ever seen one woman get too bulky who is just naturally training?

I mean, I just, I haven't seen it. It's kind of like, oh, my God, you know, I'm really worried about the boogeyman in my closet said, you know, no one is that. I just wanted to point that out. That is the number one thing that I hear. This will probably resonate with you. But when I was coaching at the gym, I had a doctor come in and he was a very thin person. Great guy, a great friend of mine. I like this guy a lot.

But he's never trained before. And he was worried that he was going to get too bulky. And he said that to me. And I was like, dude, that's like going to medical school or not going to medical school because you're worried about getting too smart. And he was like, oh, got it. Okay, not a problem. Yes, exactly right.

The current protein recommendations, which have not changed in the last 40 years, are based at 0.8 grams per KG, which is 0.37 grams per pound. So if someone is, I don't know if we calculate, if someone is 110 or 15 pounds, you calculate that out, it's like 43 grams of protein. That's great. And that would be the recommendation. And then the RDA, which is based on nitrogen balance studies, nitrogen balance is a technique that had been used in the early 1900s for animal agriculture.

Everyone takes this number, nitrogen balance. understand the flaws of that. It's, you know, looking at nitrogen. Nitrogen is the thing on protein that's supposed to help with growth, collect all the body liquids and all this stuff. And they would say, okay, well, how much is the minimal amount of protein to still maintain and protect growth? Like, protect this entity so it doesn't wither away. It's the minimum. I don't know any technique from the early 1900s with no health outcome. Nitrogen balance has no known health outcome. that we still use. And people are always asking is, is the RDA too much?

Is the RDA too little as opposed to saying the RDA is a completely irrelevant number? It's a totally irrelevant number. Okay. So we just frame it up there. And people might get very angry for me saying that, but if they can tell me one health outcome based on a nitrogen balance, then I, maybe I wouldn't find it totally irrelevant. So that's that part. By the time this comes out, which I'm hoping the week of January 27th, guys, do me a favor.

Okay. Please. The new recommendation is set at 1.2 to 1.6 grams per KG, which puts it in a more optimal range per KG, so that's double the RDA, so it's closer to .7 or for this kind of community closer to one gram per pound of not ideal body weight because that's a very specific number, but target body weight. Could you go up or down? Yes, based on your activity and the kind of activity.

But I never recommend anyone going below 100 grams of protein a day. I like the idea of one gram per pound. I think we can all agree upon that as a great target. And then if we were taking a step further and I think Mike asked a really good question, well, how do you think about dosing? If you're under 35, who gives it? Like, no one cares. It doesn't matter.

The lighting is anabolic. oh, like my jacktricept is just a light and then it's anabolic, right? No, it does. But if you're 35 and older and you want to age well, then you have to start getting smart about your protein. People will argue and they'll say, protein distribution doesn't matter. Well, really?

We do know that there is an anabolic threshold that happens with muscle. And as you age, muscle becomes more resistant to this anabolic response. Now, if someone is eating one gram per pound of tart, of target body weight, does that threshold matter? Arguably no, you know, like hypothetically no, but two things I want you to remember, if muscle loss is like 4% per decade, imagine how difficult it would be to test daily protein ingestion

over a lifetime to see major changes. It would be impossible. Impossible and so difficult to discern, right? So we have to understand people, there's no randomized control trials. And I would say, well, there are randomized control trials that in nearly every study, higher protein,

for example, one gram per pound always does better, or one gram per KG always does better than the minimum. 0.8 grams. 1.1 gram per KG always does better from body composition standpoint, from, you know, when carbohydrates are controlled, from more metabolic control. So we have to like think about, how do we begin to think for ourselves? And then the other aspect is there is a way to argue that

that first and that last meal are really important. Hitting two meals of 50 grams or so make a lot of sense. And we can argue that because most of the data, most of the studies are done on that first meal. That first meal coming out of an overnight fast when you're in a catabolic state, hopefully in a catabolic state, you're not eating throughout the night, then that muscle is primed for muscle protein synthesis and prime to take up those immune acids. The target would be between 30 would be the absolute minimum up to say 50 to really optimize that muscle protein synthesis, which is somewhat of a proxy for muscle health. And that's how I would begin to think about it. Again, if you're under 35, you can do whatever you want. But if you're above 35 and you want to age well,

and you're on a GLP1, you need to have at least one meal that has 50 grams. And there's a studied by Arnell at all. It's a French group and they did protein pulsing. And the group that had one meal that was 50 grams versus multiple three gram or four gram or five gram meals showed greater lean mass retention. Which one, one? The one that had at least one meal that had one meal at 50 grams. Not the pulsing. All right. Yeah, that's interesting. That is good. Yeah, we got to show it down here. Real quick, give us a high level overview of the book as well as where you can find it and learn more about you personally as well.

Yes. Well, the book, let me just walk over here just ignore my pants. Anyway, it's hysterical. No, you know. Anyway, this is not the final version, but this is the playbook. And it's for anybody and everyone, men, women, hey guys, if you want to give something to your lady, it's awesome. But again, it's for everybody. It also reflects roughly 90% of the new dietary guidelines, finally, which is amazing.

There are all evidence-based protocols in here. Heat, cold, foundational five, prehab movements, very specific for certain things and also all evidence-based. And I have to say this was the book that I had original, and there's meal plans in here, the book that I had originally wish that I wrote. And you can find it on Amazon, wherever books are sold. Hopefully you guys got yourself together and included a link.

I'm just dropping hints left and right for you. And yeah, I'm on Instagram. I have a podcast, the Dr. Gabriel Lyons show, YouTube, you name it. Very cool. Right on, Charles Mash. Mash. Mashlead.com.

That was so good. This has been a great day. Like, I'm going to be, The problem is going to be sleeping the night now. I'm so like, yeah, that was great. Beautiful. Thank you, sir. Dr.

Mike Lane. Sorry, Dr. Mike Lane, go ahead, buddy. On Instagram. No, it's all good. Mike Lane, Ph.E. on Instagram. Wonderful. Dr. Lyne, always love having you on the show. Appreciate you being here.

I'm Doug Larson. I'm Doug Larson. I'm Doug Larson. Douglas E. Larson on Instagram. We are Barbell Strugg. Barbell underscore Strug. Also on Instagram. You can go to Artaetlab.com.

A-R-E-T-L-B.com. if you want to work with Dr. Mike Lane and Travis Mash in our RTA program. It's a very comprehensive health and performance program put together by Dr. Andy Galpin. Again, that's R3Lab.com. Friends, we'll see you guys next week.