Dhru Purohit Show - How to Build Muscle for Longevity and Get Your 30 Grams of Protein Per Meal with Dr. Gabrielle Lyon

Episode Date: October 9, 2023

This episode is brought to you by Birch Living Mattress and Lifeforce.  Longevity is at the top of everyone’s mind these days, and we can’t talk about longevity without mentioning movement, mobility, and safeguarding against falls and fractures. What lies at the heart of these endeavors? Our capacity to build and sustain lean muscle.  Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Gabrielle Lyon to discuss why building and maintaining skeletal muscle is critical for preserving our healthspan, lifespan, and metabolic health. Dr. Lyon is a Washington University fellowship-trained physician in nutritional science and geriatrics and is board-certified in family medicine. She is the founder of the Institute for Muscle-Centric Medicine and has a private practice that services leaders, innovators, mavericks, and executives in a number of fields.  In addition, Dr. Lyon also works closely with special-operations military personnel. Her goal is to change the paradigm of medicine from obesity-focused to muscle-centric and the way we think about health and medicine with high scientific integrity. Her new book, Forever Strong: A New, Science-Based Strategy for Aging Well, is set to be released on October 17, 2023.  In this episode, Dhru and Dr. Lyon dive into (audio version / Apple Subscriber version): -What happens when women over 40 don’t prioritize protein and lifting weights (1:57 / 1:57) -The relationship between satiety, protein, and weight loss (4:02 / 4:02) -Muscle-centric medicine vs the conventional approach to weight loss (12:07 / 8:47) -Why muscle is critical when it comes to longevity (16:21 / 12:47) -What contributes to skeletal muscle loss (18:01 / 14:47) -How Dr. Lyon inspired Dhru to start resistance training and eating more protein (23:52 / 20:38) -The best way to measure lean muscle mass (30:20 / 27:05) -Optimal body fat percentage for women (31:58 / 29:00) -Measuring strength and establishing a baseline (36:19 / 33:00) -Minimal viable dose for resistance training (43:58 / 40:43) -Modifying our diet and lifestyle to match our environment (51:19 / 48:25) -Top reasons why people don’t prioritize protein (55:10 / 52:00 ) -How much protein and carbs to aim for per meal and day (1:05:19 / 57:57) -How Dr. Lyon meets her protein goals (1:11:08 / 1:07:54) -Top mistakes people make when increasing protein intake (1:20:37 /1:16:10) -Structuring meals around protein (1:24:01 / 1:20:56) -Dr. Lyon’s take on carbohydrates (1:35:10 / 1:31:56) -Why calories matter and the importance of tracking (1:43:26 / 1:38:55) -Key takeaways from Dr. Lyon’s new book (1:50:50 / 1:47:35) -Dr. Lyon’s thoughts on Ozempic (1:56:07 / 1:53:00) Also mentioned in this episode: -Preorder Dr. Lyon’s book, Forever Strong -drgabriellelyon.com -Sign up for Dr. Lyon’s 30G’s Recipe Newsletter To get 20% off your Birch Living mattress, head to birchliving.com/dhru today. Right now, get 15% off your first purchase of Lifeforce at mylifeforce.com with code DHRU. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Skeletal muscle is an endocrine organ, and it makes up 40% of the body weight, and as an endocrine organ, contracting skeletal muscle secretes myokines. And myokines are hormones that travel throughout the body, and they interface with the brain, muscle, liver, all the systems. Today we're back at it again with another fantastic episode on the topics of weight loss and body composition with one of the leading experts in the field. And if you're ready to go deeper into the topic of how much, Muscle truly is the organ of longevity for both men and women, today's episode is absolutely for you. Welcome to the Drew Proet podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Gabriel Lyon, and she rejoins us today for a brand new episode on how the key to longevity is protecting and building our muscle.

Dr. Lyon calls this approach muscle-centric medicine. Now a little bit more about Dr. Gabriel Lyon. Dr. Lyon is a Washington University fellowship trained physician in nutritional science and geriatrics and is board certified in family medicine. She is the founder of the Institute of Muscle Centric Medicine and has a private practice that services leaders, innovators, mavericks, and executives in their prospective fields. In addition, Dr. Lyon works closely with special operations military and her goal is to change the paradigm of medicine from one that's obesity focus to one that is mostly.

muscle-centric and change the way we think about health and medicine with high scientific integrity. Dr. Lyon's last podcast episode was such an incredible hit with our audience that we had to have her back on to talk all things on the latest topics of weight loss and body composition, and for her to give us a preview of her new book Forever Strong, a new science-based strategy for aging well. Dr. Lyon, welcome back to the podcast. Pleasure to have you here. What happens for all people? but especially for women above the age of 40 when they don't prioritize protein and lifting weights. Boy, Drew, let me tell you what happens when this time frame hits, which hopefully hits for everybody. When women don't prioritize dietary protein and, of course, lifting weights, their muscle shrinks.

They become less strong and less fit. And people are thinking, well, you know, that's just what happens in your 40s. But the reality is the health of your skeletal muscle really determines the trajectory of the way in which you age. So if you care about good blood sugar regulation, if you care about good cholesterol regulation, metabolism, you name it, mobility, strength, longevity, the health of your skeletal muscle is the pinnacle of everything. Even when it comes to weight loss? Yes, especially when it comes to weight loss. Skeletal muscle is the key, and prioritizing dietary protein is what is going to really help with quality weight loss.

So you said weight loss, but the reality is what people really want is fat loss. They don't care about weight loss. What they're really looking for is fat loss. And the way in which individuals are going to lose body fat is by obviously calorie control, but the other mechanisms are prioritizing dietary protein because protein. because protein isn't like the other macronutrients. It requires a different kind of metabolism. You have to get rid of nitrogen. It also stimulates skeletal muscle. And I'm sure you've heard this thermic effect of food, right, where fat might take less calories to burn versus carbohydrates,

but protein actually takes the most. So when you ingest dietary protein, it augments your metabolism in essentially a way. You know, you recently had a conversation with Dr. E. Right? Yeah. He was amazing. Yeah, he was great. And he talks a lot about satiety.

And one of the things that he talks about is that when it comes to satiety, protein is so key. So talk about satiety and talk about the relationship with protein. Yeah. Satiety is really important when it comes to weight loss. And as it relates to weight loss, dietary protein, I believe, is the most satiating macronutrient. And it's because of the impact on gut hormones, PYY, and just a whole handful of gut hormones that really impact signals to the brain that allow for satiety. And when you think about it, just as it relates to an everyday person, if you sit down to eat either a piece

of cake or a chicken breast, if you really want to know if you're hungry, you'll sit down and try eat that chicken breast. And I guarantee you that is the true test of hunger because you're not going to be able to do it. It's just not going to happen. What you're saying basically is that it's so easy for us to overeat, processed foods, things like cake, et cetera, high concentrations of calories that are also combined with fat and sugar. But protein, protein itself, it's not that easy for us to overeat it. No, and we have this innate desire for it. And what does that mean? That's this idea of the protein leverage hypothesis,

meaning that a percentage of our calories must come from dietary protein, and we will continue to feed if we don't have that. And I think that that's in one part a reason for the obesity epidemic, is this idea that we are under-eating dietary protein and replacing it with processed foods. So, for example, if you're going to be eating twinkies or cereal, your body still has this need for essential amino acids. And you will continue to feed till you get that. And typically we think about it as a percentage of calories.

The lower percentage of protein, the more you are going to be driven to feed. So you came on the podcast like, it must have been what, like a year and a half ago, probably? Was it that long ago? No way. Wow. Yeah, I think so. About. And you presented your core ideas around, you know, being forever strong, which is the name of the new book, by the way.

We have a link in the show notes. And I noticed something really interesting, which was it kicked off this whole conversation of so many more people talking about protein that weren't talking about protein. Did you notice that as well? Yes, I did. As a matter of fact, I did. I'm not saying it was this podcast, but I'm not saying it was this podcast. Yeah, you know, I've been talking about protein since you've known me and since the beginning. So I had the great privilege of studying with one of the world-leading protein experts, and it

really changed my perspective on health. You know, I think a lot about the problems that we face as humans, and one of the problems that we clearly face is this idea of obesity, which is, by the way, very complex. But if we have the question right, then the answer, the same. subsequent answer, would we be able to address the problem? So if obesity at its core is the problem, then we know that and we have a working paradigm for that, right? We can agree. But if obesity at its core is a symptom of something else, then trying to just address obesity at the heart isn't going to work. And that's what really shifted this idea of muscle-centric medicine,

of dietary protein, what is really at the root cause of these illnesses and these challenges that we're facing? And in my mind, how do we correct for that? Today's episode is brought to you by the Birch mattress by Helix. So we all know that getting a good night's sleep is super important, not just for our health in general, but for being a functional and thriving human being. I can tell you that when my sleep suffers, the next day is rough. That's why I'm so psyched about today's sponsor. Birch mattress by Helix. I've been sleeping on my birch mattress for three years now.

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lifeforce.com. That's M-Y-L-I-F-E-F-O-R-C-E dot com, My-L-F-E-E-L-E-L-Lif-E-E-F-E-E-Lif-E-F-E-E-LifF-E-F-E-F-E-F-E-R-E-F-R-E-E-Laf-R-E-FORC-P-E-R-E-E-R-E-R-E-R-E-R-E-R-E-R-E-R-F-E-R-E-R-E-F-E-E-R-E-F-E-E-E-F-E-E-F-E-E-E-F-E-E-F-E-E-W-F-E-F-E-W-F-E-W-W 100% of us eats. We all eat. Sometimes that relationship is good. Sometimes you break up with a food. Sometimes, you know, you just can fill in the blanks. But every person has this unique dynamic with it. And with that comes a ton of confusion.

So the point is we have to provide a framework with really good evidence-based information that will allow people to develop good relationships, good relationships with food, good relationships with their body. And that's really where dietary protein comes in. Because from a very foundational aspect, it helps with the physical infrastructure and the physical, you know, biology of what we have to build. Do a little bit of compare and contrast. Your approach, you mentioned it's called muscle-centric medicine. Yeah. So take that approach with what you feel the standard approach has been when it comes to this whole world. of trying to get people healthy and losing weight and kind of this rat race that a lot of people

find themselves in. Let me tell you a story. Have I told you this story about where muscle-centric medicine came from, like this aha moment? Have I told you that story? No, I don't think you have. Okay. I was doing my fellowship at Washington University in St. Louis, and we were looking at body composition and brain function.

And part of my clinical duties outside of research, so it was a two-year fellowship, two years doing research and two years seeing geriatric patients. And in the evenings, I would run a weight management clinic, and then clinically I would see patients either at nursing homes on the floors or doing a brain, a brain clinic. And the research part of it was doing this cognitive testing, doing all these metabolic testing. And there was one participant that really like hooked me. We all have that one person that really hooks us. And maybe we care a little bit more than we should or we get a little too attached. And we'll just call her Betty. We'll just call her Betty. And she was a mom of three. So friendly, just big brown eyes, just like amazing human. She had always tried to lose the same

20 pounds. Like, that was it. And I was sitting doing her cognitive testing and we imaged her brain. And her brain looked like it, the beginning of an Alzheimer's brain. And I was like, I failed her. We failed her. How is it that she's been fighting this obesity epidemic for her for decades, that she had been told to lose weight, eat less, and exercise more, and to just be physically active and healthy. This is the standard advice. And in doing so, what happened was she ate less, she yo-yo dieted, she did more cardio, and in the process, she completely destroyed her muscle and her metabolism.

So every time that she would gain weight, she would put on more fat. instead of healthy muscle. And that is the standard approach. You know, and I asked around, I'm like, is this the advice that we give, you know, a standard? And that is the advice. Here's the my plate or food guide pyramid and go do some more cardiovascular activity. And the reality is what we should have done is we should have been tracking her skeletal muscle. We should have been teaching her to prioritize dietary protein. We should have been talking about resistance exercise. We should have been actually coaching what does proper weight loss look like. What are the implications? And if we could have changed anything, we would have, you know, it's never too late, but we would

have got her moving earlier, right? Building, you know, we always talk about bone reserve and building peak bone mass. But what about peak muscle mass? These are things that we don't talk about. This is not a vital sign that we look at. And had we done that, we could have protected her. We could have addressed her hormonal status. We could have changed her nutrition. We could have done all the things. And so that's really how it difference.

That's how it differs. If we focus on skeletal muscle as the pinnacle of health and wellness as the key component, then everything else falls into place. Did you ever keep in touch with her? Do you know what happened? No, I have no idea. for a lot of people who are trying to avoid ending up in that position that Betty did, they are trying to get a sense of what is the crucial role that muscle plays inside of the body?

We covered it before, but I think it's worthwhile to revisit again. So talk to us about why muscle is so key when it comes to longevity. Yeah. First, I want to say that it is the most underappreciated organ system in the body. and skeletal muscle is an endocrine organ and it makes up 40% of the body weight and as an endocrine organ contracting skeletal muscle secretes myokines and myokines are hormones that travel throughout the body and they interface with the brain muscle liver all the systems there's an interplay and cross-talk the immune system everything so skeletal muscle is this endocrine organ system that releases myokines so that's one thing

that skeletal muscle does. The other thing is as it relates to metabolism, it is the metabolic sink for glucose disposal. The carbohydrates that you eat, everybody is talking about insulin resistance, blood sugar levels, triglycerides. Skelital muscle is really the hub for storage and utilization of these things. It is absolutely key. When someone gets injured, skeletal muscle is the amino acid reservoir, we are always going through protein turnover, whether it's gut, whether it's liver, whether it's hair, skin, and nails, anything. Skeletal muscle is in a pinch your amino acid reservoir. If you get sick, skeletal muscle.

As it relates to body armor, if you fall, mobility, strength, that's kind of like the obvious. Skeletal muscle is really the key. And that's just a handful of things skeletal muscle is responsible for. And when it comes to the most fundamental of questions, which is if muscle is so good, what are the things that eat away at it? Yeah. And then what are the things that cause it to grow? Let's start off with what causes. Yeah, I love that question.

What a great question. Drew, I'm coming back. I'm coming back for, I don't know, round four of this podcast. These are really, really great questions. When we think about, like, let's just think about healthy skeletal muscle first. The way that we think about healthy skeletal muscle is muscle that has flux. What do I mean by flux? Meaning if muscle is a suitcase and you're eating a bunch of carbohydrates and you're not exercising

and your suitcase gets overstuffed, it becomes unhealthy and everything flows back into the bloodstream for simplicity's sake. over time when there's lack of flux, we don't just get body fat that we see subcutaneous fat. We also get fat infiltrated into skeletal muscle. Skeletal muscle ends up looking like a marbled steak. This is unhealthy skeletal muscle. It has decreased strength, decreased metabolic capacity. Every function of muscle will decrease when it becomes unhealthy.

In fact, if you look at some of the early work by KipPy, Peterson, you can see insulin resistance happening and unhealthy skeletal muscle by 18. And in fact, I mean, listen, I was just looking at some recent data between, I don't know, 2010 to 2017, there has been a 95% increase in people under the age of 20 having type 2 diabetes. And that data is from the CDC. That's insane. But where does that start? That doesn't start with obesity.

it starts with skeletal muscle. The things that make unhealthy skeletal muscle are, number one, excess calories, excess food, processed food that really ends up in a bad place in skeletal muscle from overconsumption of calories and a decrease in flux in utilization. So it's this decrease in activity, which is just killer for skeletal muscle. And then over time, when we see muscle change, we see it changes, you know, skeletal muscle. The other thing I forgot to mention about skeletal muscle is it's a nutrient sensing organ.

Skeletal muscle senses the quality of the diet as it relates to amino acids and it becomes anabolicly resistant, meaning the efficiency of amino acid sensing decreases. As we age, if we are eating lower protein diets, we have no way to, from, a nutritional standpoint to correct for that anabolic resistance. And the way in which one would do that would be to increase dietary protein. And there's some really hallmark, there's a really hallmark paper. I think Ket Stanzos is his name. And it was in the early 2000s where he showed that younger, older muscle will respond like younger muscle when protein is high enough. So, anabolic resistance happens when skeletal muscle decreases its efficiency, meaning it is not

as sensitive to dietary protein. And the listeners at home is going, this is like so much science and what does that really mean? It just means that skeletal muscle becomes very difficult to stimulate. And we see the end point of that when our parents age and they become sarcopenic and their muscles get smaller. We can all visually know, we all know what that looks like. And this is, you know, in part a byproduct of anabolic resistance. But when we look at some of the hallmark literature, you can address anabolic resistance by improving the efficiency of protein simply by increasing dietary protein at a meal

so that that muscle responds like younger tissue. That's amazing. You know, you dedicated your book to your mentor. I know. Who you also introduced us to, and he was on. this podcast, Dr. Donald Lehman, we'll link to his episode in the show notes. One of the things that he talked about on the episode that we had him on is that when it came to stimulating muscle, he said that his percentage that he would give is about 75% comes from

exercise and stimulating the muscle through resistance training or strain training. And 25% comes from the dietary protein that we have. Is that your understanding as well, too? So Don and I have spoken about this often. And here's what I think. as a physician who sees patients, 100% of people eat, 50% of Americans exercise. In fact, 24% of Americans are meeting the daily requirements for exercise. So if I had to pick, I have to pick what everybody has to do, which is eat.

We have to get that right. Is exercise a greater stimulus to skeletal muscle? Totally. But with 50% of Americans doing that and only 20, only 20, 4% actually meeting the requirements, we have to protect the muscle that individuals have. We have to. And if we don't do it through dietary means, which is the easiest lever to pull, then it doesn't matter. It doesn't matter. Yes, skeletal muscle, exercising skeletal muscle, the way in which it affects the homeostasis of the whole body, there's no greater influence.

There is no greater influence. But with those statistics, we have to start. where people are. And that is everybody's eating. And that's why you feel that you are so passionate about, you're passionate about the whole thing. Yeah. Right. Even when we met and you came on the podcast, you were like, look, we got to get you on a good workout program. I started one. I found a group out here called Ultimate Performance. I worked with them for almost a year. Yes, sir. Now I'm working with a different trainer, but they were fantastic. And also a big part of what I did when I worked with them is, you know, they got my protein intake up. I had been in that place where I was kind of confused a lot about protein, you know, sitting in the seat. I get to interview a lot of people,

and I was hearing one person is saying this, another person saying that, and I'm just like, okay. And until I started tracking how much protein I was having through your encouragement, I didn't realize how much I was under eating on protein. How much were you eating? I was probably estimate eating because I would get very full on fat, healthy fats in my diet. I was probably eating, I went up to 140, 140 grams of protein a day. That's impressive for you. But that's where I went up to once I started. And I pretty much stayed at that.

That's great for you. You feel great. Yes. And before I was probably on a daily basis because I wasn't tracking, so I have to estimate. And you have to track. And you have to track. I think I was probably eating maybe less than 100. It probably was like 80 grams.

And so when I went in for one of my first training sessions and I did a body composition measurements, I also had just come back from Italy. But in general, I had built up a lifestyle where sure I play tennis, sure I go hiking every week, but I wasn't prioritizing resistance training. And I wasn't eating enough protein. So I came in for my measurement after our interview and it was my 40th birthday. I spent a month in Italy. I measured in at 26% body fat. Drew. Which is,

Drew. People know me. I'm a thin guy. So I'm in the skinny fat category, which a lot of Indians and South Asians fall into. And then within about six months of prioritizing protein and working out on a consistent basis, I was doing about three, three workouts, string training down here at the local gym with ultimate performance. I got down to 14.5% body composition.

I think at my lowest, I was like 13. and then I kind of was more focused on adding muscle mass from there. So I wasn't trying to get to like, you know, super low. I was just like, all right, I'm fine. So I think right now I'm probably like 15, 16 percent, but I'm just focusing on sort of adding lean muscle mass because my audience knows this, grew up primarily vegetarian, you know, under eight on protein, didn't really prioritize working out primarily because I would work out and I would feel like

I didn't really see the results. But I wasn't really prioritizing even protein when I was. was vegetarian either. So then I was like, all right, I guess that I'm just going to be this way. I'm just going to be thin. And that's just kind of what I'm going to do. Let me focus on my good hair and my looks instead. I'm not really going to have muscles. And then I got serious about it after our conversation. And things have been going great. I added about about 10 pounds of lean muscle mass. True. This is the first I'm hearing about it. We are not friends anymore. I cannot believe this is the first time hearing about it. That's incredible. It was not, it was like, okay, it's not exactly

my last measurement came in at, I think it was 8.9. And since that time, I've estimated, I haven't gone back in for my in-body scan, the estimate as I've gotten about an additional pound of muscle mass since then. So yeah, let's say like, let's call it like 8.9 to 10 somewhere about that. And it took me about a year to do that of consistent training and working out. And, you know, now I'm just fighting to continue to grow that every month. So that's the update on my end. Since the last time that we I'm so excited. Hey guys, are you hearing that? That's pretty incredible. That's incredible. It's incredible to see change and it's incredible to see where you came from and that it's always possible. It is never too late to be forever strong ever. In fact, I was looking at older data

for even very old individuals upwards of 75. They can still get stronger and put on muscle. Yeah. I saw on Instagram the day, I saw like a 90-year-old man like deadlifting weight. And I think the thing is that we have all these preconceived notions about what getting older means. That's exactly right. That's exactly right. Talk about them. You know, what are some of the preconceived notions that people have about getting older? This is probably one of the biggest struggles because how do we create a movement where we can really shift people's perspective that it's a non-negotiable to train?

And how do we do that? And I don't know that answer, but I sure as heck I'm going to try. oftentimes what people think aging has to be is that they are too busy, their metabolism has changed, this is just the way they're going to be, and there's nothing that they can do. And they watch their parents age and you watch X, Y, and Z. The older generation is not accustomed to training. It's just not. And so because of that, large populations, we're looking at when we say this is a health

older individual who is sedentary, I would argue and say there's no such thing. There is absolutely no such thing. Who's arguing for that, by the way? Do people say that? I mean, people will say, well. Oh, I mean like if you go to your doctors off and say they tell you, they do your blood work and everything, they weigh you. They're like, okay, you're healthy, just come back next year. No. But if that person is sedentary, they're not actually healthy. What would be some of the markers that you would be running to show that they are not healthy? You will see, and again, it depends on the person, but you will see. elevated levels of insulin, elevated levels of blood glucose, elevated levels of triglycerides.

But the thing is, skeletal muscle insulin resistance can happen before you have any markers. And I believe it's one of the root causes of obesity. Again, obesity is complex, but really insulin resistance in skeletal muscle can begin before you're seeing outward signs. And that's what people fail to understand is that we do actually have to routinely be testing strength and muscle mass as part of a vital sign. But it's not routinely done. You might get your BMI measured or your body fat. But again, and I put some, I put a chart in the book that shows skeletal muscle, but that's just based on a whole bunch of great data. But these charts

don't exist of where, Drew, we don't know what your optimal muscle mass should be. We don't know. How do we not know that? In fact, we don't even routinely, directly, measure skeletal muscle mass. What's the best way to measure it, by the way? I think the best way, so the best way imaging-wise would be a CT or MRI because, you know, on an MRI you'll also see fat infiltration. MRI or CT is not something that people can do. What they're going to start doing, which is being done in research, which I believe is

going to hopefully come to fruition in the next five years, will be a D3 creatine. So it's a labeled creatine. People will take a pill and creatine exists in skeletal muscle. and you'll be able to measure it in your urine. And that will give you a direct measure of skeletal muscle mass. What's the next best thing that is available to people today? So now we have a Dexa or an in-body, those kind of bioimpedance. And just to clear the air, you know, I think we had one guest previously who misspoke and said

Dexa isn't radiation, but it is radiation, right? Low doses. Yeah, yeah, yeah. You shouldn't do it more than once a year? No, you can do it more than once a year. Okay, got it. I mean, it's a low-dose radiation, but yes. Okay, got it.

And then from there is in-body. Yeah, in-body. And there's other ways to look. In body scan. Yeah, that's okay. Which a lot of gyms have. You can go online. You can search and you can find places around you.

Yep. And then a waist-to-hip ratio. So measuring kind of what your circumference is and those kinds of things. But, you know, overall, we're not as advanced as we should be. We're just not. Because, again, it's been kind of this, I don't know, hiding in plain sight, this organ of longevity is this key and pinnacle to muscle as the center of the universe. as silly as that sounds. Well, with the access that we have now until this new methodologies come, so let's say

somebody gets a Dexa or gets an in-body scan, what are some of the key things that they're looking at, determine whether or am I healthy? So visceral fat is a really big deal. Visceral fat, the lower, the better. The lower visceral fat, the better. And arguably, the lower body fat, the better within reason. Within reason. I mean, typically women are going to be higher body fat percentage.

What is the, what is a good range? Great question. Let's start up with women and then we'll talk about men. You know what? I would say that they will mention, you know, statistics will be like, okay, well, 30% body fat is a bit too high for anybody, men or women. I would argue that the body fat percentages that we are measuring are too high in general. So if you are someone who is athletic, they'll say, okay, well, you could be anywhere from 12 to 15 to 20% body fat, where in that range would be optimal. And I think that that is variable for

anybody. But generally, you would say like for a man, somewhere around like 12 to 15% is, it's going to be healthy. I think that would be fantastic. Yeah, that's fantastic. I think that would be great for a man or even lower, right? So they could be even lower than that. So Drew, next time I come on this podcast, man, you don't have to step up your game. Well, I'm actually sort of working with the trainer. And so because I'm trying to add, there's definitely what I've been told is there's going to be some fat along the way and then I can cut later on. That's right. Is that accurate? That's right. And so for you, I would say if we were to think about designing a plan, we would understand what your baseline calories are and then we'd

increase that by 10 to 20 percent because we don't, we want to put on muscle mass, but we don't want to put on too much fat. That's right. And then for women, we should mention women in terms of how much body fat percent. You know, again, I really struggle with these numbers because we do know that, you know, a certain amount of body fat percentage will create low-grade inflammation. The question isn't how high they can go. In my mind, the question is how low can you go, right? How, what is the lowest kind of percentage of body fat that we can push that maybe we begin to rethink the framework of how we're thinking about things? What are some, so it sounds like you have a little bit of like your own scale, which is optimal,

but generally for women, is there a body fat percentage where you start? start to feel with your patience in your experience where it's like, hey, we have to address this because putting optimal aside, we know that the body's not going to do as well above this body fat percentage, right? Like, let's go out of optimal. Let's talk about like generally people shooting for like a healthier body fat because you can also have some, like, can there be healthier people that are at a higher body fat percentage? I think that there can be. And I think that there would be evidence in the literature. But again, I say that cautiously. Can there be people with higher body fat percentage that are metabolically healthy? Yes. My question is, what is the health of their muscle

look like? And again, we don't have quite the tools that are routine to be able to look at the tissue itself yet. Ultrasound and those things. It's just not, it's not routine care. Got it. I certainly would like to see women, you know, maybe 22 percent. I would be happy with 22 percent body fat if I had to give a number. I would be happy with it even a little bit lower. Okay. Great.

And if I were to say what am I seeing when women go higher, again, it depends on the woman because some women are genetically leaner. For example, the women in my family are just a leaner group. So for them, let's say 15 percent is where they're going to be. They live naturally without doing anything. And then they gain 5% body fat, and it's still only 20%, but they may start to see some metabolic abnormalities. What is an example of that?

Elevated blood sugar. Elevated blood sugar. Elevated HSCRP, a little inflammation going on. So that's an example. Yeah. And obviously when it comes to body composition, like as a medical doctor, you are looking at all these things in context, right? Like you're looking at body composition, body fat percentage, but you're also looking at people's labs. And then you're also looking at their performance as well.

Their strength. Their strength. Yep. And how are you measuring strength? Well, we work with fitness professionals to determine, you know, where these people are at as it relates to squat, deadlift, you know, what are they doing for physical activity, all, you know, the, et cetera, all the things. Right. And what are some of the key things that you're looking for to know that they're heading in the right direction, even on a basic level. So for the people that are listening today, who may go to the gym occasionally, but they don't have a consistent program, what are some of the core things you're looking at? Like, hey, look, this is a good first baseline. First baseline is knowing where you're at. Knowing what, and again, people should, I highly strongly,

highly and strongly, if those two things can be combined, recommend working with a trainer or a fitness professional. If they are not able to do that, then there's lots of online options, but really having someone cue you to do certain things. Like this is, we are so domesticated as a species physically. We were not designed to be as sedentary as we are. You have to get moving. And when you are thinking about where your baseline is, you should know how long it's going to take you to go a mile, right? How fast are you going to run a mile if you don't run? How fast are you going to bike or row? Some kind of something that there is some crossover. How long is it going to take you? You should know how many pushups you're going to be able to do. You should know how many pull up.

are going to be able to do. You should know how many sit-ups you can do. Just basic standard. And then, more advanced, how much can you squat? What does that compound movement look like? How much can you deadlift? So my only concern and the things that all the things you're saying are like valid things and they're important part, and obviously that's your work, I think there's a cohort of people, not everybody, because I think that since you've been on the podcast and a lot of other conversations that have been happening and the work of people like Peter Attia and all that. other friends and colleagues of yours that are in the space, a lot more people have been talking about

the core element of like, forget about these supplements for a second, forget about this, forget about that. Like, let's look at like strength training, protein, and let's look at just like your total amount of calories that you're looking at just as like a measure, right? We actually had this whole summer weight loss series that we did, which was really about body composition. We've had money of your friends and my friends come on and share similar messaging that's out there, right? And I think a lot of them are standing on your shoulders and really Dr. Laman, Laman's shoulders as well too, and kind of sharing a lot of the information of how they've even themselves tweaked their little bit of their health focus. That's there. So there's a cohort of people, even though a lot of people have made progress,

there's a cohort of people who are like, okay, I can't even do one pull up. I can't, maybe I can do a couple pushups on my knees. I haven't tried to squat recently, even though I know kind of what it looks like. Am I doomed? What do you want to say? say to those people. Never. It's never too late. And we see that in the evidence. It's not purely my opinion. It's never too late. It's never too late. But also that's combined with your feeling that, hey, look, just this focus on telling everybody to walk 10,000 steps a day, we're not going to get anywhere. No. Is that your belief? I, that is my belief. And also, that is, I don't consider that exercise. I just consider that physical activity. That's just part of brushing your teeth. You do

have to do, if I were to pick the most important exercise, it would be, or the most important exercise modality, it would be resistance training. Non-negotiable resistance training, which is moving something against force, and that could be bands. It doesn't have to be complicated. I came here with my suitcase and I have bands in there. Yes, I already have my gym plan of where I'm training today, but I still travel with a resistance band. I can do bicep curls. I can do squats with I can do whatever. That is a form of resistance training. And everybody can do that. Let's say they're at home thinking, you know, gosh, I can't do one push up. I can't do one pull up. Cool. What can you do? You can do something. I do not believe that you cannot do anything. You can do something. And here's the

thing that really there's two, and I don't want to get too philosophical. But number one, do people feel worthy of having health and wellness. They have to feel worthy of it like they're deserving. In your experience, what is the main reasons why patients who come to see you don't feel worthy? It's usually past, it's usually some kind of past trauma, something that is maybe outside of their conscious awareness at the moment. How they were raised, adverse childhood experiences. Or maybe they're getting too far in life. And there's kind of this ceiling cap, this limiting belief. They're actually the patients, maybe a lot of my patients are very successful individuals or running families. And sometimes they're like, well, do I really deserve to be this great?

So again, I can give someone the perfect plan. But if the mind isn't right, it doesn't matter. And what do you do for those people who the mindset is holding them back? Do you expose it? You expose it. That in itself just works? Yes. Yes. You know, I trained two years in psychiatry. Did you know that? Yes. I do remember now.

And one of the things is, is you have to under, so part of being a good physician is understanding patterns of illness. But being an effective physician is understanding patterns of people. And you use medicine as the modality to leverage the person to get the best out of themselves. So, yes, if you are not picking up a weight, You're never going to feel comfortable doing it just as you never feel comfortable embarking on something new, right? Courage is earned. So you have to do it. And for your recommendation, for most people, initially that's going to be, you know, even if you have to like save up for a little while, it's so important to find a trainer that even can show you some basic movements that you can do at home yourself.

You can go to the YMCA. Okay, yeah, the YMCA. Great option. Do they have like resistance training vans that you can kind of? They have like silver sneakers. Yes. Amazing. So there's options at all levels.

There's options at all levels and all price points. Yeah. There's options at all price points. But it's really first people have to deal with the mindset piece if that's the thing that's holding them back. Yes. Because your initial question was what if someone says, I can't do a push up, I can't do a pull up. They're just, the question is how, why are they at that point?

What kind of framework brought them to that point? And we're jumping ahead a little bit, but we're going to jump all over. We are. Okay. So many great aspects of the book that are there. But now the question is, based on your experience and that walking is great, we're not discouraging anybody from walking. There's so many benefits to walking.

We've had so many people on this podcast that are there. And a lot of people don't even get into walking. And you actually, in my experience, you get even more excited about the walking when you're doing the resistance training. That's there. Because you're like, oh, thank God. I don't have to do any more training. No, it's like a nice break, but you kind of feel like walking is a good way to like maintain in a way, right?

It's like you just feel like excited. You feel that you feel the passion that comes with movement, right? And regular movement in your life. And I like habit stacking. So, you know, I have a bunch of walks throughout the week where I walk with friends or I'll take a walking meeting or I'll walk with family members. And it's just a nice way to catch up with people or I'll walk and take a phone call. That's like just something that I regularly do in my life. And once I work it into my schedule, it's a lot easier to get those eight to ten thousand.

And when it comes to resistance training, and again, this is jumping ahead to the later part of the book, what is the amount that we're shooting for? We're going to get to protein. We focused a lot on protein in the last conversation. So what are we shooting for to really have it be that regular part of our life that helps us preserve and grow muscle? I think it's really simple. And we can make it really simple.

So everybody here says, okay, I know exactly what I'm going to do. I love the, well, first let's lay out the general recommendations. The general recommendations are 150 minutes of moderate to vigorous activity plus two days a week of strength training. I would recommend you shoot for three days a week, you know, hitting each body part twice, if you can. And that is very simple, and you can do 10 sets total per muscle group. And that can be spread throughout the week.

and you can shoot for 8 to 12 to 15 reps, really kind of pushing yourself if you're going to do lighter weights because maybe some of the older, more mature individuals listening want to do lighter weights. That's perfectly acceptable as long as you are putting in enough effort and enough volume to stress the muscle, to create metabolic change and stress the muscle. So you're thinking less the sort of 150 minutes and you're more, hey, let's get three days a week. Exactly. Where in that three days, you're getting to hit each big muscle group twice. I would love that.

A minimum, yes. So that would be super easy to shoot for. And then for individuals who say, you know, they're really pressed for time. Why not throw in some kind of very short high intensity interval? It doesn't have to be running, right? I mean, you could see me running on treadmill. It's a nightmare. You don't want to see that, right?

it's, they could do an aerodyne bike or they could do some kind of activity that is safe for them where they're putting out maximum effort. So let's zoom out for a second, right? Because for some people, this could feel like, okay, great, I'm on my way and I just need to turn up the dial a little bit, right? For other people, it's like, you know what? I've been doing a lot of cardio. I'm like a younger version of Betty, who you saw in your clinic, whether they're a guy or

girl and not that there's not benefits to that but they're missing the strain training piece and they're like okay I need to add that component in and then for other people that cohort is going to be okay I'm really living a more sedentary life I'm clear that I'm sedentary I need to light a fire under my ass and I need to do this and it's not just to look better as you talked about never earlier it's not about looking better it's actually about living longer but I want to go back to that first question I asked you. What happens when people don't do this? When you were on the podcast last time, you were talking about one of the major challenges with people, especially women, as they get older, and it's related to falls that are there. Can you share that information? Yeah. You know,

one of the things that is a real issue for older individuals is if they fall, especially individuals over the age of 65. If they fall and they break a hip, the unintended consequences of not just the injury, but the immobility, it's devastating. And I think that we all know people like that. What happens is over a period of time, immediately we put people on bed rest. So that is often used as people are recovering, depending on how bad the injury is. You know, again, there's various different protocols. But when an individual falls, there is impact, you know, on all domains of their health. Metabolically, older individuals who go through a catabolic crisis, which, a fall would be considered a catabolic crisis, and here's why. People often think of aging as a

linear thing. There's a slow, steady decline. In reality, that is not what happens. And this is some of the foundational work from Doug Patton-Jones, where he really highlighted this idea of a catabolic crisis. A fall, a hip-break creates this catabolic crisis. The subsequent effect on muscle tissue and muscle strength really creates a downward cascade of health and wellness. There's changes in blood sugar regulation, typically changes in fatty acid oxidation, changes in mitochondria, health with the loss of skeletal muscle, all these different changes. And then when they are also sedentary, then the changes with that. And if they're hospitalized to contract an illness, people get pneumonia. the longer they're in the hospital, again, depending on what is happening, it is just a

downward spiral. And so it's not that treating the hip fracture isn't important. It's how do we prevent that? How do we prevent injury? And that becomes a really critical component. And so how do we prevent it? Connecting all the dots that you've shared so far? The way that we protect ourselves from aging is really focusing.

on this health of skeletal muscle. And there's a dietary component. There's a training aspect. And it's interesting because the younger we start, the better. So we are born with a certain amount of muscle fibers that we can grow. And there's other ways that we can augment it through resistance training helps with this concept of myonuclei and stem cell health, muscle satellite cells. But however, when you build up this reserve, when injury happened, and you're going to your survivability is going to be exponentially higher. Your risk of all-cause mortality and morbidity increases the less muscle mass you have. So another way to put it is your survivability against anything that you face is going to be

dependent in part by skeletal muscle. I mean, it's the only organ system that we can consciously control over. over a period of time. It's it, it's the only organ system. And again, if people are not having resistance training in their life, if they're not working out in a way that stimulates that muscle growth, and then on top of that they're deprioritizing protein

throughout the day, which we're gonna get to in a second, they're setting themselves up for failure. Absolutely, it's probably more important than any piece of advice, any piece of health advice that we could ever give someone, the probably the most important piece of advice would be to do resistance training. We do resistance training because the trickle-down effect of that is life-changing. Now, I will say you can't really out-train a bad diet, but even if you aren't seeing certain changes,

you're creating this metabolic flux, you're maintaining the health of skeletal muscle, which is so pinnacle for your health and wellness as it relates to longevity. It is the thing. So I want to get a chance before we go into a little bit more of the details. And a lot of the details are outlined in your book and you walk people through great recipes and the mindset piece. And there's a bunch of incredible charts in there. Let's start off big picture.

What have been? I'm not saying that you agree with them. Obviously, you disagree with them. But what have been the counter arguments that people have had around this idea that we all need to be, you know, strain training? and prioritizing protein, is it been a little bit of like, hey, look at all these blue zones that are out there and they're just living their normal life. They're active in a way, but they're not at the gym. They're not doing necessarily, you know, resistance training in the way that we would think of it over here. Is that one of them that's out there that you've seen?

I mean, my answer to that would be we don't live in blue zones. We don't live there. How are we going to make up for the environment and the reality of where we live? I mean, we have to be able to offset our life, the reality of where we're living and what we're doing with diet and nutrition. So I'll give you an example. My dad. My dad lives in Ecuador. My dad will walk.

If it is under four miles, he'll walk there or four hours. He'll walk there. How old is he? 74. That's great. He'll walk there. He doesn't really go to the gym, but he does push-ups and carries all his groceries and does all of those things. super healthy, has a higher testosterone level than nearly guys half his age.

It's doing amazing. It's probably in the sun a lot. All the time. And he lives in Ecuador. He's not using elevators. He's not using escalators. We who live in the U.S., we don't function like that, at least to the best of my knowledge. So how do we change our food and exercise?

to offset the domestication of us. It'd be great. If we lived in blue zones, then that's wonderful, but we don't. So we have to accommodate. Are there any other ideas that you've seen floating out there that are the sort of the counter argument? Oh, gosh, yeah. I will tell you one that's really, really interesting that is just the bane of my existence. This idea that we should, for longevity purposes, restrict protein.

So if you are on board with believing skeletal muscle is this organ of longevity, our current recommendations are 0.8 grams per KJ, which is 0.37 grams per pound. The RDA for women is like, I don't know, 45 grams of protein and 54 grams of protein for men, how are we going to protect skeletal muscle? If I told you that the CDC laid out that 50% of Americans are not exercising and only 24% are meeting the recommendations for exercise, the majority of the population is not stimulating their tissue. So the unintended consequences of this idea of restricting dietary protein for longevity, tell me how that makes sense. if we have decided that there are really two main ways to protect skeletal muscle. What are the unattended outcomes of that?

And the information of reducing protein, who does that impact? The dietary guidelines, who do those, who gets impacted? Children, nursing homes, military, schools, anyone on a government program. So now if a bunch of individuals are not exercising and now we're reducing dietary protein, it affects them. And I think that the unintended consequences of that is devastating. You know, we talked about it a little bit last time, but even in the health space, and I was one of those individuals, there's still a lot of people that were not prioritizing protein as part of their approach, right? where do you think that that kind of came from separate from the fact that I was raised vegetarian that I stopped being vegetarian but even still people who and not that you have to deprioritize

protein as a vegetarian I'm just saying like the way that I grew up what are some of the influences that you see that have people even very smart people who think like hey I'm being pretty healthy what are some of the narratives or lifestyle components they have where protein is not really a big part of their life like how does that how does that come to be do you think You know, I think that there was this book, A Diet for a Small Planet, and kind of the influence of a lower protein diet has kind of floated around for a long time. And it's just gotten amplified. You know, there's a bit of history there, which I talk about in the book. And there's this idea that eating is going to make someone a better person or there's going to be some moral influence. And that by, being a good moral person, you eat in a certain way. And part of this came from Sylvester Graham, who actually John Kellogg was a follower of him, of his. They made granola and the graham cracker, all of which this idea to eat very simply, reduce all animal products or don't eat any,

and really focus on this kind of purity of life. And I think that that was a message that happened and then, you know, processed foods and food companies got involved and now there is this ability to sell foods like cereals. And it's, I think, deeply influenced the information and emotion of people. And I think it's very convoluted, quite frankly. You were saying purity of life. I mean, we've talked a little bit before on this podcast about Kellogg and the whole thing of like what reduces sexual desire. Yeah. Did we talk about that last time? I don't know if we talked about it, but I've definitely talked about it on the podcast.

There's actually some interesting little documentaries that are out on it. You can find on YouTube and other places. I had no idea. So there's a whole history section in my book. About that. Yes. Why don't you repeat it for the audience here? Yeah.

So it's this idea that, you know, I've spent a lot of time thinking about how, so I've been studying this for 20 years and it has just gotten increasingly more aggressive, which is wild because, you know, 10 years ago it wasn't like that. And just going back to look at history, history is repeating itself. Again, there was Sylvester Graham, who was really kind of the godfather of veganism, and he believed that you should be pure, you shouldn't be eating animal products. I think you should abstain from sex, no alcohol. Quite frankly, sounds very boring.

But was it influenced by like a heavy Christian perspective? There was. Yeah, there was some Presbyterian influence. Got it. And this was kind of the standard set. He didn't quite pick up steam. I think he died pretty young. I don't remember, but I think he died in his 50s.

But he was very charismatic. And I think that there was a lot of influence that he had. And John Kellogg of Kellogg's was one of the people that was greatly influenced by him. Did he die young? Do you see it? He died in... I think he was around his 50s. He was at in 1851, and so 51 plus four, he was 55.

And when he passed away so young, I think that that kind of influence fizzled out a bit. But the individuals that he had gone to influence, like Kellogg, kept it going. So they, again, made granola, made the gram cracker. And then kind of what happened was in the 40s, there was this idea of how do we create and generate food for our soldiers. How do we feed the military? And one of the things, this is when rationing began to happen. And one of the things that they recognized was that all animal-based products and high-quality foods should be shipped overseas to the soldiers because they needed it. While on home soil, individuals were encouraged to build victory gardens.

And then processed food picked up. But what I guess the whole point that I'm making is we are are now circling back to do self-imposed rationing. There are groups of people that are saying, oh, well, we shouldn't eat animal products and we should push more towards only plant-based products. This is now creating self-imposed rationing. And it's just kind of like history repeating itself in a different vein. On the plant-based side, just to touch on that for a second, because you brought it up, there definitely seems to be a split of people in that kind of camp who are primarily plant-based or advocate for plant-based eating. There's the ones who actually see all the data about how important muscle is

for longevity and a lot of the data that's been outlined in different sorts of books and studies. And they are sort of high protein or like appropriate protein, but still plant-based. And then there's the other plant-based side that's actually like, hey, we have way too much protein and we want to deprioritize sort of protein. We don't need as much and the dietary recommendations are like perfect. Have you seen that sort of split that's there? Yeah. So it does seem to be that there are some people in the plant world that actually are like, no, guys, like protein is important and we don't need to like demonize protein. Sure, we may feel,

which is obviously different than you, we may feel like we want that to come from plants or mostly from plants, but it's been interesting to see some of those guys like kind of debate with each other. You know, there's something going to be coming out called the EAA-9, or the, yeah, the EAA-9. And what this is is, it's this idea of we have 14 essential vitamins and minerals, which we all talk about, this 14 essential vitamins and minerals, but we have nine essential amino acids. But that is actually not something that is shown on the back of a food label. So all protein is not equal, and we need these essential amino acids. and we need to be able to look at these nutrients, these amino acids as nutrients individually.

So what am I saying? I'm saying that could you maintain and even build muscle on a plant-based diet if protein is high enough? You could. Would it be very difficult to do it from whole food sources? It would be. But it's not just about the macronutrient. It is also about these essential amino acids. And we have to move away from protein as just simply one macronutrient.

which is really the majority of the discussion now. The majority of the discussion is animal proteins are different than plat proteins, but it's still protein. That's true. However, the reality is that they're made up of 20 different amino acids. And these nine essential amino acids all have dual roles, meaning it's not just about muscle health. For example, let's take threanine.

Threan is an essential amino acid that's really important for mucin production, which helps with the mucosal lining. of the gastrointestinal tract. We have phenol alenine, which is really important for dopamine production. We have tryptophan, which is really important for serotonin production. We have lucine, which is really critical for a muscle protein synthesis in stimulating mTOR. What I'm saying is that each amino acid has a unique biological role and more than one biological role, above and beyond protein turnover and muscle protein synthesis. Yet what we continue to do is just talk about protein as one macronutrient. So, if you are going to go plant-based, how are you

going to account for these individual amino acids? And right now, there's a lot of talk about protein quality, which is typically either the Dias or PDCAS, and they've only looked at, the Dias, I think, has only looked at 100 foods. And it looks at it based on a limiting amino acid versus there's 15,000 in new foods every year. It's not even accounted for. The essential amino acid scoring system, the EAA9, which is, I believe, in the next few years, going to score these amino acids. So when you look at the back of a protein bar, you'll actually get a score. I think that they're going to instill it in Whole Foods and Walmart, and it's a group called the Wise Code Group. You'll be able to see that not all these essential amino acids are equally essential. For example, let's take

something simple like lucine. Lucine is one of those essential amino acids necessary for muscle growth. Muscle protein synthesis, mTOR, again, these dual roles. The RDA has that at, I don't know, two to three grams per day. But the reality is we probably need closer to eight to nine grams per day. But again, none of that is accounted for when you look at the back of a protein recommendation. right? It's just gross protein recommendations. Overall, we have to become more savvy to this idea that it's not just about the macronutrient

protein, but it is about these individual amino acid requirements. For example, methionine. A vegan diet is very low in methyonine. Methycinine is important for cysteine production and torring production and glutathione. So how do we begin to balance this concept of dietary protein and this other concept of individual amino acids and individual amino acids as their own nutrient. And I think that that's really the next wave of where protein is going. Let's come back to some of the basics around protein. Where and how much do you want people to shoot for? And talk about that in the course of also a day. A day. You know, that's a big part of your book is helping people understand. You've even been a lot of your recent

Instagram reels, like you had one where you're talking about like how to fit in the protein. Those are so painful. But I do it because they're great. They're somewhat entertaining and maybe helpful. People love it. They love seeing the visual. Like sometimes people are visual and they see it and they like just, they get it. If you're watching on YouTube, we have it up here. We'll link to it in the show notes so people can see. So walk us through here. What are you showing the folks how to do? So this idea, this concept is how are we going to build more skeletal muscle, right? The more muscle you have. The more healthy muscle you have, the greater your place for glucose disposal, the greater your protection.

Why do we care about hypertrophy? Number one, you care about muscle hypertrophy because you are building your body armor. How are you going to do it? Exactly how you're doing it at your gym. You are increasing your calories by 10 to 20 percent. For really optimizing muscle health, the way that I think about it is protein is one to 1.2 grams per pound, ideal body weight. Yeah, that's what you remember.

Okay, that's good. Fat, I don't really care about fat, quite frankly. fat and carbohydrates you decide. You actually can decide wherever your preference is. I do like the idea of some carbohydrates from muscle glycogen. Carbohydrate could be 1.2 to 3.6 grams per pound ideal body weight. And then fat, you can fill in the rest. So first, just because I was a lot there for people, especially if you're not watching the video,

but we have a link inside the show. If you watch the video, I'm sorry in advance. No, the video's great. It's cool. People get to see you in your kitchen and making food for you and your family. The big component that you're saying here and that you outlined in the book is that before we get into carbs and before we get into fats and there's going to be variation that's there for people. And both of those are like highly sort of debated things that are out there. Not that protein isn't debated.

Everything is debated these days. Prioritize protein in your day, right? That's the message. 100%. When you prioritize dietary protein, everything else will fall into play. And in fact, there's a ton of evidence to support weight loss by just prioritizing protein. When things are even isochloric, meaning when you have the same amount of calories. So let's say you have, and we worked on some of these earlier studies, let's say you have

1,600 calories on both a higher carbohydrate diet and a higher protein diet. So 1,600 calories. And you just change the ratios of protein, those individuals will lose body fat, maintain lean muscle mass, have better triglycerides and better just overall body composition. And why is that? Why do you think that that's taking place? Well, number one, dietary protein is very difficult to store as fat. It is also utilized by the body.

The body needs protein. It is an essential need. When you eat it in certain proportions per se, for example, enough to stimulate muscle protein synthesis, quite simply between 30 and 50 grams, you stimulate the machinery of the muscle. And that becomes somewhat of a metabolically expensive process. And that is, you know, there's also data to support that prioritizing dietary protein will help safeguard against adaptive thermogenesis, which is, quite simply, when your metabolism slows down when you are dieting. You're sharing with us how important dietary protein is. You're laying the groundwork. Just a couple

clarifying questions. If someone is not working out, which is obviously not what you're recommending to people, right? But you're talking about society as a whole, like people are not doing resistance training. Which we have to figure out a way to inspire them to do that. Yeah, we have to fix it. And I think that really it's about getting people to start younger and it's just baked in their life. I agree. It's baked in their life and it's just like we don't know a time where it wasn't baked in. I agree. Maybe it would be something with the school system, although I'm not hopeful about that. Let's see if it ends up happening. But right now people are not, they won't necessarily automatically start growing a bunch of muscle just from eating a lot more protein appropriate to their,

you know, one gram or 1.2 grams per ideal body weight. Is that right? Correct. They, if you are deficient in dietary protein, which by the way, 40% of women over the age of 65, according to N. Haynes data, they're eating less than the RDA for protein. 40% of women over the age of 65 are eating less than the RDA of dietary protein. which means they are protein deficient. Got it. That's important. When you think about putting on skeletal muscle, those individuals, if they were to increase

dietary protein, they may see positive gains in skeletal muscle because they are protein deficient. Okay. But an individual who is already on a higher protein diet and just adding protein, will they put on muscle? I would say that would be unlikely. You do have to have a stimulus. But is part of your argument that even if you're not working out by increasing your protein intake,

and obviously everybody's going to be on the spectrum, you're not going to lose as much muscle as the statistics that you brought out. You will not lose as much muscle. Dietary protein is the one thing that shouldn't change. If anything, it should increase. When you think about calorie reduction, you reduce your calories from fats and carbohydrates. You don't reduce your calories from protein. Protein should remain stable.

protein turnover, this process of kind of regenerating, renewing protein, that's around 250 grams a day, if not higher. And you're only eating for you, like 140 grams. An individual isn't going to eat the amount of protein that they're turning over. Let's make this real. Like, how much protein do you shoot for in a day for you, right? And walk us through your day of how you get that protein. Well, I'm a relatively tiny person.

I don't need that much. I eat about 120 grams of protein a day. And that's easy for me. I just split it up in typically I might do two larger meals of 50 grams of protein and then a smaller meal in the middle. Easy, 20 grams, maybe. And the last time you're on this podcast, you were talking about the benefit of having 30 grams of protein like kind of early in the morning.

Not early. Like we're not talking about 5 a.m., but your first meal. Yeah. Right? Is that something that you still practice? I do. I do. These are, Drew, they're really insightful questions.

Here's why. The idea of 30 grams of protein three times a day is that necessary. It's actually not necessary. And I know you're mentioning 30 grams in the morning, but I'm pretty sure I spoke about an even distribution. And I want to put some context around that. Please. The first meal of the day is most important.

And nearly all the research in nearly all the research regarding dietary protein as a relates to meals are done with that first meal. It's coming out of an overnight fast. It's easier to look at the mechanisms. It's just easier to look at everything. There's less variable. The muscle is primed for stimulus. It is in a catabolic state. It is primed for stimulus. Between 30 and arguably even 50 grams will kind of max out that system of muscle protein synthesis. Here's something else that I realize I haven't really highlighted before is muscle protein synthesis is a biomarker. It is a physiological process of incorporating amino acids. Muscle protein synthesis is turning on the machinery. Again, it is a metabolic process. Ultimately, over time, the outcome that you

hope for is muscle gain or muscle accretion. But muscle protein synthesis, it's not like a one-to-one ratio. It's not like you stimulate your muscle and then all of a sudden you've put on mass. But what we can see is that when you stimulate muscle protein synthesis, you're beginning to incorporate these amino acids into tissue. And that is what we believe to be as a marker for muscle health. So 30 to 50 grams at that first meal provides you with an opportunity to stimulate muscle protein synthesis. Now, there's a couple other things that happen. Number one, when your diet is prioritizing protein first, we talked about satiation in the beginning, some great work by Heather Lydie,

and that, you know, what it looks at is that those that prioritize protein at that first meal compared to carbohydrates are much less likely to crave something or to go and eat the donut. It seems to affect satiation in a way that augments willpower. You are less likely to crave and reach for something that maybe perhaps you shouldn't. It also can stabilize blood sugar. The ebbs and flows of blood sugar will create a bit of havoc in the body. When blood sugar goes high and you increase your insulin, you have a subsequent drop in blood sugar. This can create a increase in catacolamines and increase in cortisol, and this ebb and flow

will make you hungry and tired. And it's just not ideal to have this kind of variation. It's much better to have stable blood sugar levels. And then, of course, thinking about thermogenesis, the impact of dietary protein on metabolism, I mean, there's no reason why someone would not prioritize protein in that first meal. So going back to what you ate, you mentioned you have two meals. a day and then like a snack, just walk us through. What are you actually eating in that first meal?

So the first meal may be a frittata. It might be however we make it, we prepare it for the week, right? I don't leave anything up to chance. I have two little children. My husband is a surgical resident working 100 hours. We leave nothing up to chance. We prepare all the food. I will have a frittata that's already been made and that might have six eggs in it total or it

might have four eggs and some lean turkey in it, something like that. That will be the first meal of the day. The second meal might be, I don't know, a small beef stick. It might be today I'm going to have, I'm going to have beef sticks for breakfast. I was kind of, you know, been in the car for a while. And then that last meal of the day we eat with the family and that might be beef, some kind of vegetable. And it's just really simple. And maybe midday I might have a shake. So that sounds so simple. and after and it is so simple and it is so simple and yet a lot of what I heard from my audience especially kind of skewing towards the the female demographic that follows is they were imagining that that it's in their experience they're thinking or they're facing against these different

mental roadblocks or preparation bloc blocks of man I'm not able to get that amount of protein what do you think are the common mistakes that you see people that you addressed inside of the book well they don't know how much they're actually getting just like you didn't know. No, meaning this is now for people who are awake after our first episode, the last one that you're on. And they're like, okay, I got to start tracking. Totally. Right.

And they're like, hey, I want to shoot for that ideal, you know, a gram to 1.2 for ideal. They can go even lower. So what I'm hearing you say is people are like, I'm on board. How am I going to get 140 grams of protein? Or how am I going to get 120 grams of protein? Right. And they're kind of hitting some roadblocks. So what are the common ones that they hit?

Some of the common ones are not preparing. I'm going to just be truthful, not preparing. That's the biggest one. It is the biggest one because it's actually you have to eat. And if you prepare, then it's not going to be a roadblock. If you know that you have to eat, then you'll prepare. Maybe you're going to prepare some beef patties or turkey patties. Just make it super easy so that you are never at the whim of what should I eat.

Do you, you know, you see a lot of type A personalities. I do. Right? Do you see a lot, just my experience. and it could be incorrect, but there's a lot of type A personalities that I see that just also just skip meals. Do you ever notice that in your practice before you've had the chance to kind of recorrect it? But once we correct it, yes, I see a lot of type A personalities.

Once we correct it and they're on board, they do better than ever. That's amazing. They do, and especially the athletes, they oftentimes will fast and they skip breakfast. As soon as we implement that first meal, they do so much better. And it's easy for them. Again, you said you stack habits. It's the same thing. Yeah.

And a lot of them do shakes. So a lot of the busy moms and people out there, they'll do a protein shake. That is perfectly fine. Do a protein shake in the morning. And what would you put inside of it? I would do a scoop and a half of protein. I would use a weigh protein. You can choose whatever you want.

I use first form a natural whey. Scoop and a half of protein. You can blend it with 30 grams. of some kind of carbohydrate if you want, and that could be berries. We use blueberries or whatever. And if you're dying for a little bit of fat, put in a scoop of MCT oil. Make it easy. Easy.

That's it. Any other? So besides preparation and besides not relying on because of our lifestyle is so chaotic for a lot of people and busy. And there's people like you guys who have kids, how many kids you have now? Two. Two kids. your husband's in residency.

Yep. And you have an active and busy life. You're an entrepreneur, your mom. You're building business. You're launching a book, et cetera. There's a lot of people that are doing a lot. Yeah. Comparatively to sort of like our world maybe wasn't as in the current way.

It was chaotic in its own way back in the day. But it's more stimulating. And so preparation is a big part of that. And part of that is relying on, you know, things like some sort of concentrated form. of protein that's a little easier to get down like a smoothie. Yeah. And so, for example, before I got on a plane, I packed beef jerky.

I packed some bison bars. I even, don't laugh at me, but I even packed canned chicken. That is some serious preparation. I didn't even know this old canned chicken. Yeah, exactly. And there's a reason. I have it all prepared. Yeah.

And I'm extremely busy. I, again, there's a lot of moving. parts and I packed it in my bag. I'll even give you one before I leave. You might not talk to me anymore after you taste it, but still. So I have prepared. I know exactly what's going to be happening. And you want to know what else I did is I knew that after the podcast, I'm going to be tired and I'm probably going to want something sweet. So I packed some huge chocolate like they're covered in the goldenberries, you know, that sounds. And then also some keto gummies. I know you got to know your weaknesses right I'm going to be hungry after I train today I'm going to be

hungry easy and it's still within my calorie range any other top mistakes you see people make when it comes to like they've they they get it protein is important they understand muscle is key muscle is the organ of longevity yes sir right they get it now they're prioritizing it they want to shift their life they of course the hope is to have them focus on, you know, the working out piece, which we covered earlier, and now they're dialing in the protein piece as well. Any other common mistakes or roadblocks you see them make? A chaotic eating, not being structured.

You really should eat at the same time every day. This is the time that you're eating. You're not kind of going off track because what happens is your mind will tell you to do all kinds of things. When you create structure and you follow that structure, people do better. So you'll say, hey, it's nine o'clock. Nine in the morning I'm having my first meal. It's noon or one, I'm having my second.

Then between noon and four for your next meal or noon and five, if you're like, oh, well, I'm going to go snack or go do this. Well, but that's actually not on your plan. That's not part of your structure. And nothing will pull someone out of their structure if they feel like there's a break in their integrity. You've got to be very conscious. You make a promise to yourself that you're going to do this thing.

You're going to set a goal and you're going to execute on the goal, even if it's subtle. But when you begin to kind of go off course, it's just a very subtle kind of undermining that happens. And every time you do it, it sabotages a person. So put together a strategy and a structure that you stick to. So no chaotic eating. This is your plan and this is how you're going to execute it. And the biggest fear around sort of chaotic eating is that when you get unstructured in one way, it's just easier for you then to not track your protein.

It's easier for you to kind of fall off track. It's not that, like I've heard the argument from individuals like Suchin Panda about chronobiology and how our body actually does better and makes better utilization of the nutrients that we eat when we have a more structured sort of approach generally, right? You have the variation that happens in the year because of the seasons and maybe eating earlier or eating a little bit later depending on the time of year. Yeah. But generally, our body actually enjoys and thrives on that structure.

right do you agree with that i do i recently we haven't released the episode but i recently had such an on and i agree with him okay so in addition to him really you're coming from the place of the mindset piece that if you're eating at different times every single day it's another thing that's out of order it's another thing to think about it's kind of like back in the day when you saw a lot of ceos and executives and i think even presidents have done this before too you know hey this is the only clothes that i'm going to wear yeah and i'm taking that out because i don't want decision fatigue Every new decision I make creates another obstacle in my life. That's right.

And nobody is making more decisions in a day than a busy mom. Yeah. And the other aspect is, Drew, I am a physician who sees patients. And seeing what they go through and what they need and where their pitfalls are allows me to put into place things that will prevent them from having these roadblocks. No more chaotic eating. Structure your plan. Plan it out. Don't go into the grocery store and guess what?

what you're going to get, have it. Like there's no, oh, I'm just going to go to lunch with friends. You will sabotage yourself. Plan it out. Those are the biggest roadblocks. From a practical level, having a family, how do you guys plan those basics, which obviously comes second nature for you. You've been doing this for a really long time.

But just structurally, right? Do you do the grocery shopping? Do you and your husband do it together? Do you alternate? And when do you sit down to actually sort of put together a shopping list based on what's coming up that week. I'm sure a certain part of this is like automated because this is what you guys live and breathe.

Yes. But just walk us through some of that. So one of the things that we do is we meal plan on Sunday for the week. What are we going to be doing? And on like a practical level, like do you do it earlier in the day? Yep. And is it you and your husband sitting at the table? Nope.

It's me saying, okay. So I think this is what we're going to have. And he's like, okay, yeah, no, that sounds good. Okay. So, okay. So because these are the nuances that people want to hear. about. What have you found? When it comes to a family and a family getting on board and eating healthy, right? Some people aren't in a family. They're single and, you know, obviously

they would have to modify. But do you generally find that families do better when it's one person who's sort of leading the meal planning versus like this 50-50 approach? What are your thoughts on that? I think it really depends on what an individual has going on. So for me personally, again, my husband is a surgical resident. So he's working 100 hours. a week. He's in a crazy time in his life. Oh, well, he was a seal before. So I think this is actually so it's less crazy. So it's totally less crazy. But he's still young, so he's going to have to do the gross. Once he's done with all this, he's going to do the grocery shopping forever. Yeah, forever for the rest of his life. So there's balance in that. Oh, yeah. I plan. So basically, I will plan the meals

and say, this is what we're doing. We'll do this Saturday. I'll say, hey, guys, we're going to have egg frittatas. What about some chicken curry? I don't ask the kids because they, you know, I mean, one is two and the other one is four. Just trying to get one from not peeing on the wall, you know, like it's just, it's that. We plan it out. We decide kind of what we're going to have for the weekend and then that's cooked, and that's on Sunday. And the other aspects. And the grocery shop on Sunday, too?

We grocery shop a lot because we run through a lot of food. Okay. But yes, we typically grocery shop, do a large grocery shop. We try to go to the farmer's market. And we go to the farmer's market the first and third Sunday of every month. And you're actually making the meals on Sunday as well. Sometimes, yes, we make the meals on Sundays. Sometimes we have help making the meals, but yes, either myself or someone else will come in and help us prep.

It just depends on how, like, for example, I'm traveling this week. Totally. Which, if you can afford that, that is one of the best hacks in life ever. And obviously there's a bunch of people who can't. But it's actually not as expensive as people think. It's not. There's this guy, his name is Michael Gurdley. He lives in Texas.

and he wrote this whole post about how him spending money, we don't have to bring it up, Tesla, but let's link to it in the show notes. He's an entrepreneur. He has resources and means, but he wrote it in a way that really help people think about how much time in their life opens up when they can get a little bit of help

and that it's not as expensive as they think. That's absolutely right. And it also makes you much more likely to eat healthier. And people don't realize how much money they spend on fucking Uber Eats. I agree. People spend a lot of money on Uber Eats and things like, that for those that are ordering there. And once you actually tally it up and you look at your Amex or whatever you're spending it on, you can kind of see that like actually, okay, it's maybe

comparable or a little bit cheaper and you get help at home, but you're eating way healthier and you're hitting all these goals that you want to life. So we'll link to that in the show notes. Yeah. And I think that if people can afford food prep, they should. But there's other ways to do it. Let's say someone is super crazy, really busy. There's meal services. You could do, you could literally do, if you were really in a pinch, you could do a frozen meal service. Is there a frozen meal service out there that you would sign off on? I mean, I love icon meals. Have you heard of them? No. Yeah. Super simple. Here's your beef. Here's your rice. Nothing complicated. Yeah. And they make it in a price point that people can afford. Got it. So we will plan on Sundays,

all of that stuff. And then the other thing that I do is I always order and have on hand. We have a really organized pantry. I have on hand snacks. for the kids. And they are, there's like seaweed and beef jerky sticks and just all kinds of healthy snacks on hand. So they can grab it. Easy. Yeah. Zooming out for a second. So really if the biggest blockage is the preparation, which goes into the whole component that you just unpacked, it's really making food in a way, sorry to jump around for a second. In a way, we've become so privileged in America and living the Western lifestyle, we've not had to make food a central part of our life, except for the thing that people wake up and feel, hey, I'm hungry.

What do I need to eat right now? But for a long time in traditional societies around the world and still many societies today, like you actually have to think about food on a regular basis. And we need to kind of bring some of that back. Otherwise, our health is going to get off track. That's part of what I'm hearing you say. Yes. And the other thing is, you know, I realize one of the questions that you ask is what is some of the biggest roadblocks is this idea that, you know, everything is this last meal that's such a big deal. You're going to go out to eat. And I think really downplaying this idea of having a cheap meal or having some big meal because that really throws people off track. They're not able to kind of reel it in. It's almost as if they're overblowing this idea of a meal. Does that make sense?

sense. Like meals have turned into this whole glamorized thing instead of just like, hey, just like, what's tasty and good enough? Right. That allows you to focus on everything else that you want to do. Because it's a distraction. When people are thinking about, I'm restricting myself, I can't do this, oh, I just really want that piece of cake. I think that's all just very distracting. But part of also what I'm hearing you say is that if you prioritize protein and if you plan your day accordingly and you're doing meal prep, you're okay with somebody having some of the other things and they may not actually even be able to eat a lot of that stuff. One thing that I see is that when individuals, there's a neighbor of mine, I'm going to give her a shout out. Her name is Annie. And she started training at the same gym that I started

training in. And when they put a meal plan together for her that had the appropriate amount of protein and to like hit some of the goals that she wanted, she was like initially, this is a lot of protein. It's a lot of food for people. It's a lot of food. It actually feels like very filling. Yeah. I had the same experience. It's like, whoa, like, how am I going to eat all this stuff?

Right. And you don't have room for a lot of things. That's right. That are there. It augments willpower. And within that context, you're okay with people having, let me not put words in your mouth, but this is kind of partly what I feel like I've heard you say. Fine.

If people want to have that dessert or they want to do that other thing or whatever, that's okay. But let's hit all these other goals first. Is that your idea? Yes. Okay. Because I kind of was hearing two different things from you. I felt like I was hearing it's not a big deal if you plan everything else. But in another way, when dessert becomes a regular part of your life at every meal, that's when people have all these distractions.

And if you're super excited about it, I mean, I would just want to kind of limit the pleasure that you think you are going to gain from it. From food in general. From the birthday cake or the X, Y, and Z. I think people really fall off their nutrition plan when they over-emphasize how exciting something is going to be. Yeah. There's something interesting that I saw when people start to get really focused and go on a plan like this and I have a similar thing.

In a way, this idea of like over-indulging in one meal starts to go away. It does. And fine, you want to have like literally like there was times, I'm not, I've never really been a big dessert person. I like a little dark chocolate. I'm an investor in Hugh chocolate. you know, I'm a fan of dark chocolate, but I never was really like, oh, let me have that cake. Cake was never really like kind of like an appealing thing for me.

But I like fruit. You know, fruit has always been something that I've enjoyed. But even then still, when I would be out and somebody would order a dessert and they would feel like, oh, this is something that you have to try. I would have a little bit. I'd get the idea and I kind of move on. Right. And it's not just me who is not in desserts. I've seen that from a lot of the people, that when you eat the appropriate amount of high quality calories,

protein, you have the right amount of carbohydrates and fat instead of the diet, and I have a few questions on that as well too. And you're getting those from a lot of whole food sources. You just don't have as much interest in other things that are there. I would say that that's right. Is that just goes back to satiety? I believe it does go back to satiety. And also, in part, you know that you're doing the right thing for yourself, right? You're eating whole healthy foods and you kind of want to stick to the plan. It's, You're doing the right thing, but there's also this other thing where it's like, okay, a little cake here and there's not a big deal. This is the other thing that I didn't get a chance to tell you is that when I added on these 8.9 to 10 pounds of lean muscle mass.

Wait, but the real question is, did you have to buy all new suits or what happened? No, no. Because in a way, I didn't grow my shoulders out. I still need like a few years to work on that. Yeah, I haven't built out my shoulders yet. I got to get some tips from your husband because he looks. like he has really good shoulders. So not yet, not yet. But the interesting thing that happened for me, and I've shared this before on a few episodes, is that as I added more lean muscle mass and I got on this structured plan of working out, which was about three to four days a week, in the beginning it was about three, and then I wanted to go a little bit more aggressive. And so I had about four days on average in a week of training through this group out here. They're great,

ultimate performance, I was very keen on regularly getting my labs done because part of what I was doing in addition to eating more protein is to optimize my training performance. They had me eating more carbohydrates than I was normally used to eating because I was doing the whole glucose tracking and I was trying to be mindful of my carbs and I was on that whole train which the whole wellness world was on at that time. This is about a year and a half ago. Not that I'm not mindful about carbs now. This is a question that we're going to get into for you.

But the interesting thing that I saw is that, yes, I did end up cutting back fat from my diet because I was overeating and being a little bit generous with the calories that I was getting from fat. And that's how I was filling myself up. And now that I was filling up myself from protein and I also was trying to dial in my body composition, I did end up cutting back some fat. But I was able to be a little bit more generous with the carbohydrate. to my diet. And every other month I was getting my metabolic labs done. And I was seeing that my fasting insulin was still staying in the optimal range. Incredible. So let's talk about carbs.

Yes. Because there's so much confusion around that. You know, you're talking about muscle, how important muscle is. You're talking about protein as a big part of that. You've talked about working out. And then you actually have a little bit of a different take on carbohydrates than what a lot of people have talked about in the past. So what's your take on carbs? I do not think carbohydrates are the enemy. And the average, the current, RDA of carbohydrates is 130 grams per day, depending on if you are exercising, could you go higher than that? Absolutely. And could you go lower than that? Yes, you could if you were metabolically impaired, meaning what does that mean? Had more than 10 pounds to lose, or you have elevated

levels of fasting blood glucose and elevated levels of triglycerides and elevated levels of insulin. But what's so amazing about skeletal muscle, which you actually witnessed, is that exercising muscle does not require insulin. You are able to utilize the carbohydrates without insulin. And that is amazing. Also, you earn your carbohydrates. For every hour of moderate to vigorous activity, you could increase your carbohydrates from anywhere from 40 grams an hour to 60 grams an hour, even higher, which sounds like you did. So give us the whole spectrum of things because, you know, lay the land because the audience is there, you know, they're listening to all these different podcasts. They feel like they're getting whiplash. They heard a whole bunch of people in the past

talking about, hey, watch out for carbohydrates. Don't overdo it. I've done many episodes on this podcast with different experts that talk about this. And it would be that you're not disagreeing with them, but that's especially important for people who are living a very sedentary life, who are not stimulating their muscle through working out primarily, but also not getting adequate protein. And when you're living a sedentary lifestyle and you're starting off your day in the morning with a big tall glass of oat milk latte, and then you're eating, you know, an avocado toast with a bunch of grapes, right? And then for lunch, you're eating a brown rice sort of with just the tiniest little bit of chicken inside of there. Right. And then for dinner, you know, to reward

yourself, you're having a slice of pizza and some dessert, you're eating a lot of carbs. They may still be within the range that you're saying is appropriate, but it's a problem for that person because they aren't muscle-centric and they're not prioritizing lean muscle mass. And so all this glucose is floating around their body causing damage. Is that an appropriate way to think about it? I would think, yes, that is. So those experts that came on the podcast that were talking about the problems with carbohydrates, they did have part of the story. But the complete part of the story is really this idea of muscle-centric medicine. Yes, I would agree with you. Okay. Because what is going to utilize, where are you going to put the glucose? If you are sedentary and you're eating

these excess carbohydrates, which arguably you're absolutely right, people should not be, where are you going to put that glucose? The place you put it is healthy skeletal muscle. So if you are not exercising and you are sedentary, then your carbohydrate threshold or carbohydrate need is lower. And one more thing is that dietary protein, let's say for every 100 grams of dietary protein, you'll generate 60 grams of glucose. You don't actually need carbohydrates. I'm absolutely not against them. If an individual is metabolically unhealthy, then you have to control for calories. you have to prioritize protein and you do need to reduce carbohydrates if somebody's metabolically unhealthy so like give us some of those markers somebody came in your clinic and you're deciding what to

you know do with them and what plan to put them on and let's say their labs came back as metabolically unhealthy what would you see in there so take a triglycerides triglycerides over 100 130 over 130s if your triglycerides are high yeah that's one of the first indication that there's too much free-floating carbohydrates in the diet. Yes, this is not a good thing. Yeah. Over 130, I don't like. If your glucose levels are, again, if you're fasting glucose levels are creeping past 100, I'm not excited about that. If your fasting insulin is elevated, this is not a good sign. Elevated means what? Meaning, you know, the argument will say, I personally don't like to see fasting insulin above five, but that is an optimal range. If you are creeping,

up above between 15 and 25. I mean, that's too high for me. That's too high of a fasting insulin level. Yeah, I've heard people like Robert Lustig say, like, even above 10, it's like, hey, we got a little bit of a red alert. Yeah. Right? Three to five might be in the optimal category.

Yeah, you know, I kind of go back and forth because you don't want to be on a low carbohydrate diet for long periods of time depending because then what happens to your body, you know, do you kind of cause pancreatic beta cell death? I'm not totally convinced. The jury is still out for me as it relates to how long an individual can go low carbohydrate. If they need to, I can appreciate that. But if they are metabolically healthy and flexible, I think that there is some benefit to adding some carbohydrates in as opposed to being chronically low carb.

So do you feel like there's some people that, even if it's well-intention, they're causing unnecessary fear by having people focus too much on carbohydrates, kind of in this wellness world that we live in. I think that there's a lot of fear in general in the wellness industry, in that wellness world. And my hope is that we can clear that up and provide a framework, just an evidence-based framework of how we're going to navigate that space. I do think that people have put a lot of fear, whether it's a fear of protein, whether it's

a fear of fat, whether it's a fear of carbohydrates. It's very convoluted. Yes. Also, it sounds like just like big picture, so many of the problems in your life get better when you start training and working out on a regular basis. Tell me what doesn't get better. Tell me what doesn't get better. Yeah.

Besides your body composition, do you want to highlight some of the things that come with regularly training, like some of the benefits to the brain? Yeah. Well, first of all, mood. Mood increases. Brain memory increases. There's attention, spatial awareness. All kinds of things can improve.

And there's a few reasons as to why. And one reason I'm just going to highlight is this idea of skeletal muscle as an endocrine organ releasing myokines, in particular, keptephtepsin, B, and irisin, both influence the release of BDNF, which is brain-derived neurotropic factor. And that helps with neurogenesis, cognition. These things are amazing. Also, increase in blood flow, just some of the obvious. The list goes on, balance, capacity. So I want to move on to another area that people have a lot of fear about that you write about inside the book, and that's fat. So tell us how you think about dietary fat and fat that's included in the context of muscle-centric medicine. Fat's not that big of a deal. I mean, we make, as human, saturated fat. It is not that big

of a deal. Where saturated fat or just fat in general become problematic is if you are ingesting too many calories. If you have too high of a calorie load, then excess fat is an issue, just like excess carbohydrates. But fat in and of itself is not an issue. Let's zoom out big picture, because a lot of people, as part of our summer weight loss series that we did, they were talking about, you know, this whole concept that, look, just because we're eating high quality food in this sort of world of wellness, functional medicine, whatever you might want to say, integrated medicine. Just because you're eating and getting most of your calories from whole foods, which by the way, first of all, a lot of people these days think they are, but they're eating a lot of packaged

junk food, right? Everywhere I look, it's more common than ever because we have busy lives and there's plenty of tasty foods that are out there that people have created. Even I like a lot of these chips or other stuff. They're not the base of my diet, but it's easy to overeat because they're concentrated sources of calories. So even if people are eating most of their diet from Whole Foods, we still need to focus on the total like calories do matter.

Isn't it crazy? It's true. The calories matters as well, which there's been a big shift I would say in the last year that I've seen more people talking about that where two, three years ago I would see a lot of people that would sort of deprioritize this idea of calories, right? So great, we're getting the record straight. Now, within that, some people say, yes, at least for a month, track your calories so you know where they're coming from.

Then other people say, look, I'm not worried about calorie tracking because I'm trying to be realistic. Most people here are not going to track their calories, but I want you to track protein, right? Even a lot of people that are similar to you, prioritizing protein, they'll say, I want you to track your protein. Then there's other individuals that say it's a losing. battle, people don't track calories long term, we need to focus on just teaching people how to eat things that are satiating foods, like a little bit of a Dr. E approach, right? He would come in and

say calories is a losing battle, right? I don't know if he said that on your thing, on your podcast, but he definitely said it on ours. Where do you stand in the context, since we're talking about fat, when it comes to what you teach your patients and then also what you recommend in this book, knowing that a lot of the people may not be as motivated as your patients. So we already know you want to track protein because most people are under eating on protein. From there, what do you think about tracking other calories? Do you track your money? Drew. I think this is where people get confused because a lot of people have budgets, but they may not look at like the day, they like have spending allowance. But overall, but you had to sit down and create a budget, right? Yes. You also track the gas in your car.

And you also track the numbers of, I don't know, your blood pressure or your cholesterol numbers, you get a baseline, right? We get a baseline for everything. It is unfair to say that we should not track calories, at least in the beginning. You have to get a baseline. Beginning is how long? How long would you say people track calories? Two to four weeks.

Okay, two to four weeks. Two to four weeks. Put it in an app. Otherwise, could, you know, there's a way for. forward. There's a way forward that could take you a really long time, whether it's months or years, a way forward where you're just going to begin to clean up your diet slowly. Or you can say, you know what, here's my target. I want to lose weight, build muscle, X, Y, and Z. They owe it to themselves to track. I'm not asking for forever. I'm asking for two to four weeks.

Get a baseline and perhaps you never have to do it again. Get a baseline. And perhaps you never have to do it again. get a baseline, get an understanding of where you are. After that, you should design a diet that is within your goals. And I put in a handful of tracks in the book, whether it is a longevity plan, whether it is a weight loss plan, or whether it is a muscle building plan. Build out your diet, you'll prioritize protein. You can decide if you are metabolically healthy or unhealthy, meaning do you have 10 or more pounds to lose. If you have 10 or more pounds to lose, perhaps lower your carbohydrate. You can either increase your protein or increase your fat, but lower your carbohydrate a little bit. As it relates to designing a diet, figure out what your macronutrient profile is going to be.

Then track it and see what that looks like so you know. Once you know, then it doesn't have to be a complicated thing, but you do have to know because let's say tracking calories is a losing battle. There's a national weight registry. And we know that those individuals that do not regain weight, track their weight, and their calories. Say that one more time. So we know that people that do not regain weight that they lost. Correct. They track their weight and they track calories.

Yes. So that's your goal. If you want to improve your body composition, which is usually for people, they'll say losing fat. Losing weight. What they really mean is losing fat. fat. And for you, it would also be, hey, I want you to drop some fat and build some muscle, which also might be. And so many people in my gym, especially women, are so mind blown that actually their weight doesn't change that much, but they look incredible. Yeah. I'm sure you have

this all the time because you used to also, did you compete? Did I? Yeah, I used to compete. So you know that world firsthand. So really what people are looking for is body composition shift. And again, if you, we have to hold people to a high standard. I know that you're saying and that many people say that people will not track, but I think we can hold people to a higher standard. And I think by holding them to a higher standard, we can actually move the needle. And that is as it relates to body composition, as it relates to tracking, as it relates to exercise, you have to know what you're doing. And in every other domain in life, we track. We just do. And for some reason, this idea of not tracking calories. It doesn't have to be forever, but we do have to get a baseline.

Yeah. And I do believe calories matter. And we do have to have a understanding of where we are to determine where we're going. And it doesn't have to be complicated. It can be simple as long as it's disciplined. Agreed. I mean, I wasn't able to really make progress until I started tracking. Now today, generally I'll still keep a mental note because I, you know, people eat the same things on a pretty regular basis. That's right. And because I did some pretty hardcore tracking for you know, eight months, nine months. I know the food, the amount, you know, I had to get a food scale in the beginning and I would measure everything. I know. Okay, great. That tablespoon of olive oil. Okay, great. That Greek yogurt. Okay, that protein. Awesome. I hit my X amount of, you know, goals. And that's

kind of like the meal that I like to have in the morning. Okay, maybe one day I varied up. I put strawberries. The other day I buried up, I put blueberries. People generally eat the same things seasonally, especially if they have a family, because it takes too much effort and energy to be thinking about different meals every day, right? And so then after that, you don't have to think about it every, you don't have to think about that much. But I'll travel like I did this summer and you come back and you're throwing off your schedule and you're jet lagged a little bit. And that's when you start to fall off track a little bit. And I know that every so often going back into tracking everything helps me reset. You said something really important.

You are aware of where potentially you fall off and where you fail or where a weakness would be. I mean, it's not really a weakness, but you know that when you're going to go and travel, that potentially you'll fall off, but you have a game plan for getting back on track. That is the key to success, knowing where you fall off and having a plan immediately to implement to get you back on track. If people just did that, they will do tremendous. We talked about protein, we talked about carbs, we talked about fat, and all this is in the context of just how important working out is, including your recommendations for what people should be shooting for inside of the week, right? What else is so important?

And why did you want to write this book? You know, you've been talking about muscle-centric medicine for a while. Yeah. But what's important for the podcast, but also what's important that you put in the book, that you really want to help people. understand that it helps them tie this all together. This book can change people's lives and it is rooted in science and it is very easy to read and it is a game plan. And it is a game plan of exactly what to eat, how to design a diet, how to exercise,

and most importantly, how to think about things and how to measure, how to track, their blood, their workouts, all of it. I think that if we can change the conversation from obesity and aging to not what we have to lose, but what we have to gain, we can impact millions of people. One of the things that people do when they start to get really serious about their wellness journey and their health, which, by the way, that's totally okay that how your body looks can be a part of that. For a long time, I think people were getting the message that, oh, you should, really be focused on how you look. You shouldn't really be prioritizing sort of weight loss.

And obviously you're saying we don't want to prioritize weight loss. We want to prioritize body composition, but just the larger idea that, you know what? Sometimes change happens from the outside. Sometimes it happens in the inside. They both are connected to each other. Your confidence goes up when you feel like you fit better into, you know, your clothes if that's your goal. If that's your goal. Your confidence goes up when you see yourself lifting heavier weights in the gym that makes you more likely to want to ask for that salary raise, right? Like all these things are connected. Yeah.

Right? Like is kind of the point that I'm making. Anyways, where I was getting in the question is that when people get serious that this is important to them and maybe there's a bunch of people that are listening right now that that's them, they start to think about, okay, who's part of my team, right? Yeah. So one part of this team is this book that's out there. Yes.

Yes. People can pick it up. Yes. And if you are a provider, this book is for you. if you are just a person who wants to get healthy, yes. Amazing. And people can find it. If you just mentioned your website, just so people know where to go.

Dr. Gabriel Lyon. Yeah. So people are driving and they can always have the show notes, but you can go to your website. You can pick up the book. And I think depending on when they order, there might even be some pre-order bonuses. There's a whole workout library of 80 videos, by the way. 80 videos. So like literally workouts they could do from their home.

Yeah. Okay. So this book is part of their team. Who else can be part of their team? Kind of help us build up gradually as you start to go through. through people having not that many resources and then having more resources that are there? First, I love a team. Because health and wellness is a team sport.

First thing I would say is this book as a foundation. The second piece of this book would be either a health coach or a nutritionist to help implement and create this plan. Then you can add in a coach. Then finally you add in a health care professional to help with monitoring blood labs. and exercise prescription, because I said a coach, yeah. And that's how I would build a team. And a trainer could be part of that as well?

Oh, yeah. Did I not say trainer? I think you said coach twice. Okay. So the health coach and then the training coach. So we need a health coach, a training coach, a health care provider. And I think that that's pretty much, and a nutritionist would be great. And how do people find those folks that are aligned with the muscle-centric approach?

You don't even know this, but you know I created a physician course that I'm going to be launching. Yes. So basically, the nutrition course has all the fundamentals, really deep science of muscle-centric medicine, of how skeletal muscle is influenced, just all the different metabolic pathways. And yeah, so a physician training course, which is coming out right alongside the book, actually. So eventually there'll be a database. And in between right now, you know, it's okay to call around and ask. Obviously, referrals are great, but it's okay to interview somebody that you're going to be working with and say, like, hey, do you prioritize building up lean muscle mass, right?

Or do you prioritize metabolic health? I mean, how many doctors actually aren't even looking at the full metabolic panel that are out there? So you've got to do some digging, but it's worth it because ultimately you'll be able to grow stronger. Totally. In a more lasting way that will actually help you, you know, live a life, you know, not filled with chronic disease. Yeah. I mean, there's two things that I hear a lot. I don't have time to exercise or eat right. And if you don't have time to exercise or eat right,

I don't know how someone is going to have time for sickness. It's just not going to happen. Then the other part is that exactly what you're saying is muscle is the only currency that it can't be bought or sold or bargained for or traded for is 100% earned. And the process and the journey that someone goes to go through to earn that transforms them. It's not about the weight that they have to lose. But it is this journey of becoming forever strong and building muscle and showing up for themselves and seeing what they're capable of that builds this resiliency and strength is just transformative for people. You know, you have your famous quote that you shared on the podcast last time. We're not over fat. We're under muscle. We have a society today, though, unfortunately,

that's all programmed around people being over fat. And we have the, this abundance of new medications, things like OZemPEC, and I'd love to get your take on them. Are these things good, not good, or it depends? Well, everything depends because everything is in context as it relates to medicine. I personally feel that these medications are game-changing for people, people that have really struggled for a very long time to move the needle and just cannot. whether it is a Zempic or Monjourno, I think that it's amazing. I think that with every medication, you have to weigh out the risks and benefits.

There's a lot of discussion about what is its impact on skeletal muscle health. I have never seen a mechanism of action that at least at this time that negatively impacts skeletal muscle health. Right. And so some of what has been out there is that if people, if we're talking about some of the similar things that I've seen. If people are relying on OZempic to lose weight, and what are the other medications called? Monjurna, which is tri-appetite. There's another one called Wagovi. So Wagovi, some of glutes. They're all. Simaglut. They're all. Yeah. So if people are relying on

those, there's a decrease in lean muscle mass, but generally when people lose weight, there's going to be a decrease, is what you're saying. So in our practice, we utilize Ozempic and Mongerno and, you know, a handful of other things. We are not seeing a loss of skeletal muscle mass. Because you're having people do everything else. Exactly. Yeah. I appreciate you sharing about that because it's, even the wellness spaces, a lot of people that feel like they're very concerned about some of these things and some of the side effects that have been reported out there. And obviously, everything makes the news because these drugs are, you know, new. You know, some of the concerns that people have are like, are the usage of these drugs linked to cancers I've seen or the usage of these drugs linked to, you know, there was one recently

that was all over CNN in the New York Times. There was one about like people can't eat the same way. Like what was it again? Right. So gastroporesis. And I want to mention this concept of the cancer. So it's basically thyroid cancer. So there's a black box warning on these incretins as a, as a.

it relates to potential risk for thyroid cancer. I think that if you look at the literature, perhaps that is incidental. That is an incidental finding. Got it. First thing. The second thing is what is more risky, being overweight for decades and decades or utilizing a medication to manage it, at least initially, because we get people off these medications. I know that in clinical practice and in the media, they say, okay, once you're on it, you're on it forever. we don't see that. We see a kickstart in people's metabolism. We say once we get them really dialed in on nutrition and training, we use this as an augmented tool for those that need it. And we've seen tremendous change. The negative side effects, again, everything comes with side effects,

a medication, there's no free lunch. When an individual gets gastroporesis, which is what you're hearing about is slowing gastric emptying, that's exactly what the medication is supposed to do. It's not necessarily, I mean, is it a side effect? Yes, but it's also an intention of the medication. Slows gastric emptying, individuals are less hungry. And your argument would be, well, actually I'll back up and say, some of the people on other side would say, like, look, this cannot be the solution to fix America's obesity crisis. And I'm hearing you say that, yeah, if we're only going to use these drugs and we're not going to do

everything else. We could end up having a bunch of people who are skinny and have a Zempic face, but, you know, that's a little, little joke. People who are skinny, but actually their metabolic health is not that good. But that's because they weren't doing all these other things like prioritizing muscle and their diet is not prioritizing protein. So they might be eating a lot of carbohydrates or, you know, fats in their diet or other things. And their metabolic health doesn't look great, but they are lean. And you're saying it doesn't have to be that way. And your clinic is one example of a clinic that is helping people use these drugs to get a

kickstart. You're not trying to keep them on there forever, but then they're working out and they're prioritizing protein and doing all this other stuff. And I want to mention something else to you that I've been sitting here debating for the last few minutes if I was going to mention. But I want to mention it because I want to highlight the disparity. Please. Physicians can prescribe something to make people less obese.

Okay, no problem. But people cannot prescribe, physicians cannot prescribe things for muscle health. So at this time, for example, testosterone is not FDA approved for women. But we can prescribe anti-obesity medications, but there are multiple medications potentially that would help with muscle health that, you know, we're just not legal to prescribe. Like peptides, potentially testosterone replacement therapy. Yeah, which by the way, you know, again, you're able to prescribe certain things off-label. But that is just an example of how backwards everything is.

Think about that. You can go to the physician to pursue. You can go to a provider and get anti-fat medication, but you cannot go to a provider to get pro-muscle medication. Well, it sounds like, you know, a big reason that you wrote this book too is that there's just not that understanding of how important muscle is. and you're on a mission to change that. I am. I can't change it alone. I need the support of people like you, which I'm so grateful for.

You've supported me for so many years. And the listener, because really this is for them. And this is a movement and a mission I can't do alone. Well, we're all here with you on that mission. I've heard from so many people that that last interview that we did was a big turning point in their life, including my own sisters who say hi, Herschel and Kea. I love them. And my wife as well, too, Yasmin.

She really started prioritizing protein, and it's been a big shift. We're working on the workout component. That's something that she's getting more regular about. So I want to give some major love to my wife. I see you putting in the hard work. How can everybody be a part of this mission with you? Again, tell us where to get the book, and then tell us what else is going on in your world that you might want to direct people to us.

Some great newsletters, et cetera. I do. So I also have a great podcast, which, by the way, you are welcome to come on at any time, the Dr. Gabriel Lyon Show. And that is going really, really well. The book obviously is coming out. And if individuals, I'm not sure when this episode is coming out, but we do have a forever strong community.

There are a ton of offers prior to book launch, like the workouts. I'm going to be having an event in January in Austin, which is going to be amazing. If an individual is interested in, again, there's a forever strong community. I have a newsletter. I have a 30G protein newsletter, which was actually your idea. by the way, my friend. So thank you so much for that. And what's in that newsletter? Just everybody understands. Recipes. Recipes. Every week they get a recipe. What does 30 grams of protein looks like? Amazing. I'm subscribed. Yes. And by the way, it was your idea. So that was really,

really smart. And then we will have a physician provider course, which is application only because we get a lot of questions about what does this mean? What are some protocols? So specifically for the provider. And let's see anything else. I'm very active on Instagram. not much more. And then we have a fully active clinic, which is all remote right now. Oh, beautiful. Amazing. Well, that's a lot.

That's a lot in that world. Dr. Gabriel Lyne, this has been great. The book is out, Forever Strong, a new science-based strategy for aging well, all focused on the muscle-centric approach. Thank you for coming back on this podcast and really getting into a lot of the weeds of the questions that I was getting from my community, some of the questions that I had as well too, that help people all prioritize muscle and age well. I super appreciate you.

Thank you so much. Hi, everyone. Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening.

Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step protocols for whole body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says, try this.