Feel Better, Live More with Dr Rangan Chatterjee - The Critical Importance of Strength Training and Eating More Protein with Dr Gabrielle Lyon #296

Episode Date: September 20, 2022

My guest today believes that the single biggest problem with our health these days is not that we carry too much fat but that we don’t carry enough muscle. She believes that if we start to focus and prioritise our largest organ – our muscle – we can burn more fat, improve our body composition, decrease our risk of disease and increase our energy levels. Dr Gabrielle Lyon is a family medicine and osteopathic doctor who has specialised in geriatric care. What she’s seen and learned as an end-of-life physician has led her to investigate the importance of skeletal muscle as a means for people to live longer, stronger and better lives. She now focuses her practice on what she calls Muscle-centric Medicine. In this conversation, Gabrielle makes the case that the quality of our lives is in direct correlation to the health our muscles. Gaining muscle, she explains, won’t just help us slim down. It can change metabolism, reversing insulin resistance and other risk factors for chronic disease such as type 2 diabetes and heart disease. And it’s equally important for reducing sarcopenia (age-related muscle loss), protecting our skeleton, improving mobility and balance, and reducing fall risk with age. Many of us aren’t aware that we lose muscle mass from as early as our 30s - so for most of us, it’s something we need to prioritise immediately. Gabrielle explains what type of protein we should be eating and how much, we cover what exact combination of exercise Gabrielle recommends to her patients and we discuss why for women in their peri-menopausal years, muscle loss is a very real problem that needs addressing. Gabrielle is realistic about the amount of effort her recommendations require and I find it really refreshing that she’s not trying to sugar-coat anything to make it more palatable. She’s someone who deeply cares about the health of her patients and wider society and wants to empower us all with practical knowledge that will help improve the quality of our lives. I really enjoyed my conversation with Gabrielle – I hope you enjoy listening. Gabrielle also has her own podcast The Dr Gabrielle Lyon Show https://podcasts.apple.com/us/podcast/the-dr-gabrielle-lyon-show/id1622316426 Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com. Show notes https://drchatterjee.com/296 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Everybody is arguing about longevity and nobody is talking about quality of life. We've been obsessed as a culture, as a society, with obesity. It has been the biggest oversight in medicine to date. I think that we are going to see an epidemic of osteoporosis, an epidemic of older individuals like we have never seen before in the next 10 years. Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better, Live More. My guest today believes that the single biggest problem with our health these days across society

is not that we carry too much fat, but actually that we don't carry enough muscle. She basically believes if we start to focus and prioritize our largest organ, our muscle, we can burn more fat, we can improve our body composition, we can decrease our risk of disease, and we can increase our energy levels. Dr. Gabrielle Lyne is a family medicine and osteopathic doctor who now focuses her practice on what she calls muscle-centric medicine. And in our conversation, Gabrielle makes the case that the quality of our lives is in direct correlation to the health of our muscles. Now, I think that many of us think that increasing muscle mass

is simply important to tone up and look better, but it's actually far more important for reducing something called sarcopenia, which is age-related muscle loss. It's important for protecting our skeleton, improving mobility and balance, and reducing our risk of falls as we get older. It also helps us change our metabolism, reverse insulin resistance, and reduce our risk of developing chronic disease. Now a lot of people are simply not aware that we start

to lose muscle in our 30s, which means that for most of us, it's something we need to think about and prioritise immediately. In our conversation, we talk about what type of protein we should be eating and how much. We cover what exact combination of exercise Gabrielle recommends to her patients. And we discuss why for women in their perimenopausal years, muscle loss is a very real problem that needs addressing and dealing with. Now, we'll say that Gabrielle's recommendations, as you are going to find out, do require a fair bit of effort. And I actually found it really refreshing

that she's not trying to sugarcoat anything to make it more palatable. She's clearly someone who deeply cares about the health of her patients and wider society and is someone who really wants to empower us all with practical knowledge that will help improve the quality of our lives. I enjoyed my conversation with her. I hope you enjoyed listening. And now, my conversation with Dr. Gabrielle Meyer. I was thinking about this today as I was preparing for this conversation. Have we as a society overly focused on losing weight and under-focused on gaining muscle? Absolutely. In fact, I believe that that's one of our biggest flaws and one of the reasons why we

have such a health epidemic across the world. You know, everybody is focused on obesity, and that makes sense because you can see it. It can really affect people's lives. Yet, we haven't been successful at dealing with it. We are talking about decades later. The reality is in medicine, in health, in root cause thinking, you would think that we would get better. We would get better at treating a disease. We have gotten worse. And as you know, of course, the point of change comes from asking the correct questions. And I believe that we've been asking the wrong question and trying to solve for the wrong problem. The reality is, is we are not over fat. And people could argue and say, okay, yeah, we are. But actually, we are under-muscled. And when we think about insulin

resistance, obesity, all these metabolic diseases, even Alzheimer's, right, or dementia, type 3 diabetes of the brain, these diseases, they start in skeletal muscle first. Insulin resistance, These diseases, they start in skeletal muscle first. Insulin resistance, glucose disposal, issues with metabolism, the primary site is skeletal muscle. Yet we've been obsessed as a culture, as a society, just obsessed with obesity. It has been the biggest oversight in medicine to date. You mentioned the term root cause medicine, right? What is the root cause of what is going on with our patients? I think it's a very powerful

phrase, one that I think Western medicine has not fully embraced yet. Although I'm very optimistic, I do think it's changing. On this podcast a lot, we talk about what is the root cause of a variety of different health conditions. And we sometimes speak about things like chronic inflammation, which of course lies at the heart of all kinds of different conditions. But what I've heard you speak before, what you're incredibly passionate about, is that skeletal muscle or a lack of skeletal muscle

also is one of those big keystone areas that actually when we don't have enough, it can also light the heart of all kinds of different problems, right? Yeah, totally. I mean, think about it. Physical movement is optional now. The machine, the human machine was designed for physical activity, not just physical activity. I'm not just talking about walking. I'm talking about bouts of high intensity movement, lifting heavy things, really being physically active. And what's happened is

because our society is so domesticated, it is no longer a prerequisite to living healthy. And if you think about muscle as the pinnacle, right, the pinnacle of health and wellness, it makes up, depending on the person, 40% or more of the individual, right, of our individual tissue. It is the largest endocrine organ. And yes, skeletal muscle is an endocrine organ, but what's so fascinating is it's now become optional to use it or not. You know, when I think, so I did my training in, I mean,

I did my training in nutritional sciences. So I did seven years of nutritional sciences and I did a fellowship in geriatrics and obesity medicine. And what is so profound is that there is an interface between the two, obesity, sarcopenia, Alzheimer's. And if we can address skeletal muscle early, and we are seeing issues with skeletal muscle in lean, quote, healthy individuals, young populations, because insulin resistance and skeletal muscle, which, you know, insulin resistance is this concept of requiring more insulin to move glucose out of the bloodstream. So glucose is toxic. We need it, but it's toxic. And these issues start, they could easily start a decade before, before we are even seeing abnormalities in the bloodstream, before we are even seeing elevated levels of insulin. And that's an issue.

So what's happening is we are missing the mark. These diseases are starting in your 20s and 30s. Yeah. A few terms there. Sarcopenia, which we're definitely going to get to. Yeah. You also mentioned though, which I want to go here, I think, which is we're seeing issues with skeletal muscle early. Yeah. I think that sentence alone leads to so many thoughts in my mind. First of all, what is skeletal muscle for people who are not familiar with that term? Of course.

And then when you say early, what do you mean? How early are we seeing these things? And how worried, I guess, do we need to be in terms of motivating us to change our behavior? And these are fantastic questions. Let's start by thinking about skeletal muscle. Skeletal muscle is really the tissue that you have voluntary control over. When you think about your biceps or your quadriceps, it is the muscle you have voluntary control over. As opposed to, let's say, in your guts, you've got smooth muscle, which you can't control. Your food goes through the digestive tract.

Okay, so when people hear skeletal muscle, I think a lot of people think of strength training. And if I work out in the gym and lift heavy weights, I will grow bigger muscles. Now, of course, not everyone's going to think of that, but I think a lot of people think of that when they hear these terms. Now, I think we've undervalued

the importance of strength and skeletal muscle in health, as you do for sure. And when I'm talking to groups of people, one of the things I often say to them is, hey guys, listen, once you hit the age of people, one of the things I often say to them is, hey, guys, listen, once you hit the age of 30, right? And I might crack a joke there sometimes, but once you hit the age of 30, unless you do something about it, you are losing muscle mass every single year. So first of all, is that consistent with the latest research? And at what age do we start

losing this really important commodity in our body, which is skeletal muscle? Yeah. First of all, thank you so much for providing a platform to talk about it. If we can get this message out there, this will change the world. Now, you said a couple really important things here. Number one, when do we lose it? And I would argue, how do we grow it? How do we maintain its health? From a very young age, your body has this potential, potential for muscle growth. You are very anabolic, meaning your capacity to put on muscle really starts very young. When I say very young, I am talking about, you know, I have two very little children. The more active they are, the better that's going to be for their muscle mass

potential. Now, it's very important from a young age to train. And people are like, oh, you can't tell kids to train. No, children must be physically active. They were designed to do that. The worst, one of the worst things that we can see is childhood obesity. And the reason is, is because skeletal muscle

is definitely affected by obesity. The potency of skeletal muscle to have that hypertrophy mechanism, which you were talking about, you go to the gym and you build muscle, it becomes blunted. The ability to respond, the ability for the muscle to respond to dietary protein, which is really important for stimulating, it's a key component to stimulating skeletal muscle, becomes blunted. The age in which an individual begins to lose muscle can really depend on their physical activity if they have a chronic illness. You pointed out that low levels of inflammation create all kinds of diseases.

Low levels of inflammation impact skeletal muscle. It blunts skeletal muscle activity. And can some of these things arguably be overcome with exercise and diet? Yes. Exercise is going to be a much more potent stimulus than diet, which is wild because of the physiological pressure that an individual can put on its tissue. As we age, there's a natural phenomenon that happens, and this is called anabolic resistance. And I say this cautiously because the majority of the models that we've been looking at for aging are oftentimes sedentary or only moderately active individuals. We don't have a huge body of evidence to actually see if anabolic resistance can be pushed off for highly, highly active individuals. So I'm going to explain what anabolic resistance is.

So I'm going to explain what anabolic resistance is. Anabolic resistance is a decrease in the efficiency of the skeletal muscle to, number one, recognize and utilize dietary protein. So the mechanism of actually stimulating the tissue becomes less. Now, that typically happens, gosh, that could happen in your 40s. And what that means is that so if you eat the way that you did in your 20s, and let's say you wake up and you have two eggs in the morning and a piece of toast or maybe a little bit of yogurt, you will be at a sub-threshold protein amount. You'll never stimulate that tissue. That's a problem. And we'll obviously talk about nutrition. The question of when does this start is very

variable on the way in which a person has taken care of themselves up to that point. Inevitably, anabolic resistance does happen. And that makes it much more difficult for individuals to build muscle, to stimulate the tissue. And that really, I believe that can happen at any age. In an aging population, it can happen with destruction of skeletal muscle. As individuals age and they don't take care of skeletal muscle, you get, we've all seen a marbled steak. Well, what do you think happens to our tissue? We could be walking around with skeletal muscle that look like a marbled steak. And that decreases its ability metabolically for glucose disposal. It decreases its contractile potential. It decreases its

ability or efficiency to turn over and repair. There are all kinds of problems. And again, that can start in your 30s. That can start in your 40s. It depends on your physical activity. And when it begins, it is much more difficult to recover from periods of inactivity than ever before. Yeah. There is just so much there. And I really want this to be an empowering episode. My goal is at the end of this conversation, people understand, man, I need to be looking after my skeletal muscle. I need to be prioritizing that. And we're hopefully going to go through looking after my skeletal muscle. I need to be prioritizing that. And we're hopefully going to go through all kinds of different areas around this topic to persuade people, hopefully inspire them to think, no, no, this is really important. They can do it. They can do it.

Yeah. And the first thing you said that really made me reflect and think was what you said about children. And you were talking about if we're not active enough, if we're not stimulating the growth of enough skeletal muscle, then we become less responsive to the protein in our diet. Less responsive in terms of that protein than stimulating muscle growth. Is that a correct summary of what you said in that particular area? There's a couple things to unpack here. In terms of youth and kids, they are very anabolic. They are anabolic. They don't require a meal threshold of protein. They are primed for activity. They are primed for growth. They are incredibly resilient. Fast forward. So their muscle is not anabolically resistant.

They are primed for it. After growth happens, when we're no longer in a prime growth phase, say, you know, we're not growing bigger, we're only growing wider. There is that potential where anabolic resistance, and again, anabolic resistance setting in early is somewhat unlikely, but really in your 30s and 40s is where I believe anabolic resistance

can begin depending on the individual. And what that means is in midlife, and by the way, you can overcome anabolic resistance. You can definitely overcome anabolic resistance. There is great data that supports that in the literature. And it is not a hopeless kind of experience. So individuals can become anabolic resistance in their 30s and 40s, which for sure can be overcome. So I hope that answered your question. Yeah, it does. So let's just go there just for a second. Let's say there's someone at the moment, I don't know, in their 30s or 40s who are listening to this and are thinking, well, I don't know, I've not really thought about muscle before, but, you know, I'm in pretty good shape. I walk regularly. I look after my diet. I sleep well. You know, and they think, I don't

really have any problems with energy or anything like that. Why should they be concerned about what you just said? Yeah. Well, unfortunately, if a stimulus, an intensive stimulus is not provided, there is a natural trajectory of aging, which we see. As individuals age, we've all seen it in our parents. They get skinnier. They get tinier. We believe that that is the endpoint, right? I think oftentimes we believe, well, I'm just getting older.

I don't need to do things that really stress out my muscle, or I don't necessarily need to change my nutrition targeted to skeletal muscle aging. And I would say that is the prime time to execute and implement the strategies that I'm about to tell you. Number one, just because you can't see the changes doesn't mean they're not happening. just because you can't see the changes doesn't mean they're not happening. Individuals should definitely be involved in some kind of high-intensity interval training one day a week. You must create flux in that tissue.

You must utilize substrates. You want to create a stimulus that changes the metabolism of the muscle in the moment, right? And that could be easily three bouts of 20 seconds all-out effort. Not much, right? It could take you 10 minutes. And three bouts of 20 seconds high-intensity training rest, right? You do a bout, you rest for three minutes,

you do another bout, you can rest for three minutes. Incredibly valuable. Walking is wonderful. Walking is just movement. I don't consider it training. The other thing that we have to understand is strength decreases as we age. An individual should definitely be doing strength training three to four days a week just to begin to build a foundation. Hopefully, we started earlier. But if you didn't, the body is incredibly resilient and it wants to have muscle. It's not like it doesn't want to. It is part of our makeup.

It is mandatory for us. There's very few things in medicine that we can say 100% of the time improve outcome and survivability. The more muscle mass, the healthy, I don't want to say the more, the healthier your muscle mass is, the greater your survivability across all disease states, nearly all disease states, cancer, cardiovascular disease, dementia. These are really big challenges for people. Every single one of those challenges can be improved upon by being fit.

Also, low intensity training for mitochondria is really important. There's a huge push for resistance exercise, which is a non-negotiable. There's also value for doing cardiovascular training. It improves mitochondria. It really helps overall wellness. And a lot of the data for muscle as this endocrine organ, which it is when you contract skeletal muscle, it secretes myokines. Myokines go throughout the body. The most studied myokine is interleukin-6. This is interesting because interleukin-6, people think about as a cytokine released from cells of the immune system, which create a pro-inflammatory state. But exercise is also skeletal muscle, what it secretes. This is an immune regulatory organ. Skeletal muscle, what it secretes, this is an immune regulatory organ.

Skeletal muscle is not just about fitness. It's not just about managing blood sugar. It is an immune modulatory organ. It interfaces with the immune system. So when you do cardiovascular activity, interleukin-6 can increase a hundredfold. And it actually has a different effect on the body and can help counterbalance the inflammatory mechanisms in the body. That is profound. Yeah, it's so fascinating. It really speaks to how the body really is one big interconnected system. Nothing works in isolation because you've already so far mentioned how better skeletal muscle will help you with longevity, Alzheimer's,

type 2 diabetes, immune system function. We're going to get into hormones later on. We're going to talk about all these things. But it's amazing how one thing can impact so many different systems of the body. And I think this again really speaks to this point, Gabrielle, that I think we've thought muscle is just dumb muscle. It's just like a physical thing that we can see. We don't realize actually, this is an active organ, right? It's an endocrine organ. Yes, it's an endocrine organ. It is not just about being jacked and tanned. Yeah, and we also, I think, in society, we think about it, the teenagers and people in their 20s,

they want to look buff, they want to look good, right? So they're the ones lifting weights. But I've come to the understanding over my career that actually it's more important the older you get, right? It's actually more important then. I'm not saying it's not important the older you get, right? It's actually more important then.

I'm not saying it's not important as a teenager. I'm just saying it actually goes up in importance. Now, before we tackle that, you mentioned three very practical things there that I think will be really interesting to people. So can we just dive into those a little bit just to get some clarification? So the first thing you mentioned is

once a week, do some form of high intensity interval training. Now, I want to clarify this because a lot of people when they think of skeletal muscle, they're thinking about lifting weights, whether it be in the gym or at home to work on their strength. Yet when you're doing HIIT training, let's say people do these 20 second sprints all out, they rest for two,

three minutes, and they repeat three times, which can be done in under 10 minutes, which is very, very practical for people. What is that doing to their skeletal muscle? Yeah. Well, one of the things that it does is it's very well documented in the literature that it is really the primary driver as it relates to exercise that improves insulin resistance. So it's one modality to improve insulin resistance. And mechanistically, how it works, I'll just mention that it improves, it's called GLUT4, GLUT4 transport of glucose into skeletal muscle. And that is incredibly valuable in terms of really putting in the effort. We know that you can lower insulin resistance through, irrespective of actually diet,

through just leveraging skeletal muscle. That's incredible. Yeah, that is incredible. And so obviously different people of different fitness levels will listen to this show, right? So someone is going to go, like for me, I'm like, okay, Brill, I'm doing that once a week. I'm going to do that sprinting. I love things like that. But for someone, let's say,

a bit more immobile or a bit older who thinks I can't go all out, is it a relative perception? So can they do speed walking or run as fast as they can? Are you looking basically for a contrast between high speed movement and then low speed? I mean, what is it we're looking at here? Absolutely. That's exactly right.

And for some people, it might be sitting up, sitting from a chair to standing. It is about the personal induced adaptation. It is very personal. And as a person gets more fit, they can do more. It doesn't have to be rowing as fast as you can or sprinting, but it really is exactly what you said. It's putting in effort, pulling back, putting in really intensive effort. Obviously, they need to talk with their physician. We're not telling anyone to go out and do this without the guidance of someone else or a professional that they use. But yes, it is really about exercise. The goal of exercise is inducing adaptation. The reality is, I believe that the body is designed to do these things. And I also believe

that we have softened ourselves as a society. And one of the reasons why muscle health is not at the forefront is because it's not easy. The 30-second bouts, resistance training, all of these things take incredible discipline. Yeah. And as you've mentioned earlier on, they're just not parts of our daily lives anymore. We can get by without doing that stuff. Now, you mentioned children before.

I was reading a study a few years ago that I think the Guardian newspaper in the UK popularized. And from recollection, they were showing that children in the 1970s compared to children, I think it was in around 2012, 2013. Okay. They were just saying

what kids are able to do strength-wise had declined so rapidly. So kids in the 1970s were considerably stronger than regular kids in 2012, 2013. And I think that really speaks to what you're saying, doesn't it? Yeah, yeah.

You know, I was looking at, so I'm working on my first book, and I was looking at some of the statistics from World War II when there was a time we went into rationing. And the average, are you ready for this? The average weight of a male,

do you want to know what that was? I'd love to know. 143 pounds. 143 pounds. The average female was 121 pounds. 143 pounds for a man. That's roughly 10 stone in the UK. For a woman, 121 pounds, I don't know, it's about eight and a half stone for those people in kind of those metrics. That's incredible compared to what we see today, isn't it? It is outrageous. Body weight is astronomically higher. I wish, you know, I wonder what the

current percentage is, you know? But what's that got to do with muscle? Yeah. So, well, I think that what it has to do with is that we are now in a time of excess. We are not worried about starvation. So, in the 1940s, they not worried about starvation. So in the 1940s, they were worried about starvation. In fact, when we think about nutrition, they were prioritizing protein and sending it to all the soldiers. They were encouraged to lower their protein intake so all the soldiers could get it. And they were really keen on muscle health because this is what the soldiers were focused on. As it relates to muscle health, I think what this more relates to is overall excess consumption and what we've done. We have created a world of flux of calories,

of low quality calories, and really a narrative that has moved us very far from muscle health. Yeah. It's really incredible. So in terms of the practical tips, there was the HIIT training once a week, which I think we can all do depending on our own mobility and our level. You've explained how that works, why that's important as a stimulus to our skeletal muscle.

Yes. Then your second recommendation was strength training or resistance training three to four times a week. Right. So resistance training, maybe you could explain what you mean by that. And then what does that actually do for our skeletal muscle? I guess I maybe compare it to what HIIT training does to our skeletal muscle.

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new proteins. That is very adaptive in the body. And what it does is it allows the rest of the body to function in a way where we can burn more calories through exercise. So there's the physiological changes that happen with resistance exercise. And really, the goal with resistance exercise, in my mind, is hypertrophy. What does that mean? Hypertrophy is muscle growth. Doesn't get longer, it can get bigger, right? Hypertrophy.

If you are untrained, it can be very easy. But the better and the higher trained of an individual, the more it becomes difficult to continue to put on muscle mass. When I think about muscle, I think about those as it relates to resistance training, the metabolic stress, the mechanical stress, and the ribosomal biogenesis, the growth of new proteins. And that becomes important because, again, we're building up body armor. Body armor muscle is an amino acid reservoir. The healthier that is, the capacity to dispose of glucose, the capacity to increase total

caloric expenditure becomes essential. And you leverage skeletal muscle to do that. Yeah. You mentioned you improve glucose disposal and glucose and insulin resistance has come up a little bit in this conversation. I think regular listeners of the show will know that insulin resistance, when our body needs more insulin than it used to need to do the same job and move glucose out of your blood and put it into storage, that insulin resistance is at the heart of all kinds of problems like type 2 diabetes, and is linked to things like Alzheimer's and all kinds of chronic disease, right? So not being insulin resistant and being more insulin

sensitive is really, really important for your short-term health and your long-term health. And you're saying that actually one of the things that strength training will do is make you more insulin sensitive. And we're talking about the relationship with weight, of course, if there's higher caloric expenditure. Of course, there's going to be all kinds of knock-on benefits. But you mentioned strength training to use about hypertrophy. Now, if we're talking about society

and how society has changed so that many of us now are over fat and under muscled. Yes. A lot of people, and I would say, again, I'm not a woman, but from what I can gather, a lot of women are fearful of strength training because cosmetically they don't want to have hypertrophy.

They don't want to put on muscle and look really, really muscly. Now, I have to bring it up because I think some people will be thinking that. And it's very difficult. And I also want to correct myself. So I think about it in terms of hypertrophy, but it's not So I think about it in terms of hypertrophy, but it's not because I think about it in terms of hypertrophy by how we look. And I think that that's really important because the last thing that I want to do is, okay, well, now I got to do, I'm happy with how I'm looking. I'm fine. I don't want to go do resistance

exercise. The reason I think about hypertrophy is we have to think about skeletal muscle as, again, body armor, as the amino acid reservoir, as a site for lipid oxidation. Everyone cares about lipids, fatty acids, as a site for glucose disposal. It's not enough to just do kind of the bare minimum. And the reason goes back to that anabolic resistance and that trajectory of aging. Skeletal muscle, you know, it can be the first thing to go. Because it is the amino acid reservoir, the body in need will take from skeletal muscle. And that becomes really important to understand. And yes, we also have to talk about mobility and functionality and activities of daily life.

And the wider the waistline, the lower the brain volume can be. So I would hate for someone to say, oh, well, it's resistance exercise. It's just for hypertrophy. Yes, but not for the hypertrophy as it relates to bikini. Yeah, that's important,

but really the metabolic, the medicine that muscle provides us. Yeah, that's beautiful. The medicine that muscle provides us. That's what we need to start thinking about when we think about muscle. It's medicine for the body. And as you say,

and as a lot of the research points to, after the age of 30, unless we do something, it starts to decline. And it can be rapid. It depends on the person. So for example, let's say someone got sick and they were in bed. Their strength within two weeks is going to exponentially decline. Strength, muscle size, these things happen very quickly. Well, you said body armor. I thought that was a really evocative term.

And it made me think of resilience. Because I thought, and I don't know what your view on this would be. But as you said that, I thought, yeah, the more body armor you've got on you, then you become more resilient to whatever may happen, like unpredictable things that you don't know might be around the corner, whether it's... Which always happen. Which happen, yeah, a crash or you get injured or you get knocked over or whatever might happen.

Your body armor at that point may, I guess, reduce your risk of injury, number one. And two, if you do get injured, may, you know, enhance the speed of your recovery. So is resilience a way that we can look at muscle as well? Absolutely. And what you said is absolutely correct. I remember I had a patient and this patient was, he was a cyclist and he was always really into weight training, which is unusual for a cyclist. He was very physically fit. He got into a horrific, horrific car accident. It took him a year and a half to recover, to come back. He had to learn how to walk again. And the doctor said

the thing that saved him was the amount of muscle that he had on him. It not only saved him in the actual injury, but it saved him in the way that his body, again, he lost a lot of blood. His body went into a very, very chaotic, highly catabolic state. And the fact that he had muscle, they believe, was the reason he survived. Yeah, so this then enhances the muscle as medicine argument even further. This is muscle being life-saving. Yeah. That's effectively what you just said. Having muscle, having good quality skeletal muscle on him,

potentially either solely or certainly contributed hugely to his life being saved. Now that is huge, right? A young fit cyclist having his life saved purely because of the amount of muscle. And I'm sorry to keep hammering home this point, but I am very passionate like you that we've undervalued muscle. And if we don't do something about it, we're going to be losing it. So your second recommendation was three to four times a week resistance training. Now, let's just unpick that a little bit. On an evolutionary level,

of course, you know, our hunter-gatherer ancestors didn't, you know, have these 30-40 minute set periods three to four times a week where they would work on their strength. Their lives were their gym, right? So they were always lifting heavy things, doing stuff. So for example, let's say someone listening to this is active. They move around, they're gardening a lot, they walk to the supermarket, they buy their shopping and they lift and they literally walk home.

Let's say they walk home for a mile lifting three bags of shopping in each arm. I know it's not common these days. I certainly, I do see it in the UK. I very rarely see it in America, if I'm honest. Because of the car focus of culture that I've certainly seen when I'm ever in America. For someone like that who is pretty active

and is lifting things, is it fair to say that they may be okay without some sort of dedicated resistance training? I know it's hard to say. Yeah, I would say no. And let's think about that. Where is, if we fast forward 10 years, what is that going to look like? So they have not, if they are doing the same thing that they did, and they do it for another 10 years, are they actually creating a stimulus for growth? No, they're doing the same thing. Their muscle is accustomed to that. Listen, it's better than nothing, but I would argue that that's baseline.

I don't even consider that exercise. I consider that movement and activity. And the reason is, is we always have to think about challenge. You mentioned resilience. Without those kinds of things, the body has a natural propensity to atrophy. And, you know, I think about this daily as in my own training, I'm thinking, okay, well, what am I doing that is actually challenging me? And what is going, you know, what do I want to do for the next decade?

If, and you see this in the gym for individuals that have always done the same thing, they don't progress. The idea in life in all domains, whether it is your work or your family is growth. And I know that this sounds esoteric and now I'm translating personal growth to muscular growth, but it takes a certain mindset and discipline

to push the body to a level that is a bit uncomfortable. And I believe that pushing the body to a level that is somewhat uncomfortable really creates a capacity to age well. So no, I don't believe carrying groceries and doing things that would constitute an active life cycle, an active life is enough. Those individuals, I believe, and they don't have to go into the gym, they could use kettlebells. And it's very easy initially to put on muscle mass. And you could, and it's also pretty easy to maintain muscle mass. I could go to the gym and I could do five sets per muscle group a week and I could probably maintain my muscle mass. But for muscle hypertrophy, again, it depends on the age of the trained individual. And I'm sure

that you've got a lot of fitness professionals on here and they have seen it. They may agree or disagree, but I really follow the work of a PhD named Dr. Andy Galpin. And he gives great recommendations for progression of hypertrophy. It is absolutely necessary. And when we think about hypertrophy and we just think about resistance exercise, you know, you do have to go through a period of growth and that could be 10 to 20 sets per muscle group. That's a huge volume. Yeah. You don't have to start there, but, you know, again, everyone responds differently. You do have to get to the point where I believe that you are tracking your growth and that you are doing things that are challenging you. And I'm going to say this, and people might not agree, but I think you should have at least

one to two workouts you do not want to do a week. They really kind of suck because they're really hard. Yeah. One thing I really appreciate about you, Gabrielle, is your passion and your desire to really speak truth as you see it and as you have seen your patients. A lot of us these days, especially because of cancel culture, hold back a little bit sometimes because we know how easy it is to end up saying something that results in people getting triggered about stuff.

But you very clearly there said something which a lot of people may not like to hear. But in your many years of clinical experience, the thousands of patients you've come across and treated, you're saying you need to do one or two workouts a week that you don't want to do, i.e. they're uncomfortable. That suck. Where you do not want to do it, I do it. Yeah. Now this is going against, again, the societal narrative, right? You mentioned a few things there, which I really think are worth just highlighting. Because society now is,

again, it depends on who you are, but much of Western society, at least, is relatively easy in the sense that we don't need to move our bodies in order to acquire food, in order to go to work, in order to, you know, order a takeaway or whatever. You just do it on your app now on your phone, right? It's getting easier and easier. So therefore, what, you know, what traditional populations have is their lives were a bit inconvenient. They had to move their bodies in order to just do the basics of everyday living, whereas we don't have to do that now. So in this day and age, presumably there are certain personality types. And I'm interested, have you noticed this in your practice? Presumably there are certain types of

people who can thrive in this environment, but many people just struggle because they're doing what everyone around them is doing. But what everyone around them is doing is frankly suboptimal, which is why we're struggling so much as a population. Yes. Are you ready for something else that I think might be a very unpopular opinion? We have created a narrative in our culture that stress is bad and that fight or flight is what stress is. But what if I told you that there are other stress responses and often

much more cultivated responses like the courage response, like the tend and befriend response, and individuals that can mount those responses, which I believe is actually the default, but yet we've been told that stress is bad and discomfort is bad, is doing nothing other than completely devaluing what the human spirit was designed to thrive on, which is challenge. So do I believe that individuals need to push hard? Yes. And I also believe that there is a pervasive discussion that softens us physically and mentally. And as a physician, I'm very concerned about the physical softening that I've seen in my clinic and my practice. I've been practicing medicine since 2006.

And I will tell you, those individuals that do the best over time really understand and leverage what the potential is for discomfort and embrace it and lean into it rather than turn away from it. And ultimately, it augments the way in which the physiology responses. The way in which the physiology responds. And that is profound. Yeah. You're a mother of two young kids.

I am. With everything that you know. Yeah. And I appreciate they everything that you know. Yeah. And I appreciate they're super young at the moment. Super, super young. Super young. Like my kids now are 12 and nine. So, you know, I'm pretty,

I hope not full on. I'm pretty proactive with their health. Let's put it like that. You know, I had monkey bars put up in the garden. I used to get them. You've got to be able to do monkey bars. You've got, you know, we are pretty active as a family. Now, not as active as I would like some of the time with the kids,

particularly, you know, my son started high school now, well, secondary school. And I can see as certain pressures come on with academic subjects, man, you can just see how physical activity starts to go down dramatically, which is why at the weekends, we really focus on moving. So, you know, my son and I will do a 5K run every Saturday morning as part of something called Park Run. It's just, it's not negotiable.

It's not, no one's putting a gun to each other's head. It's just something we do together. It's just a normal part. So what is a 5K run doing? So this is, I don't know, 22, 23, 25 minutes of moving our bodies, getting our heart pumping. How does that fit into your model of what we should be doing for skeletal muscle? I think that that's fantastic. And I also believe it's a non-negotiable. So what you're talking about is some cardiovascular and a bit of endurance activity. That is wonderful for mitochondria. It is also wonderful for movement. It's wonderful for cardiovascular health. And I typically recommend at least 150 minutes of that

a week. Yeah. So I guess what I was getting to is, have you got in your mind an idea of what you're planning to do with your children as they get older? Because as a parent of 12 years, my experience is society is working against you in order to stay healthy, in order to keep your kids healthy. You simply cannot do what everyone around you is doing

because I just think it is so suboptimal, unfortunately. I agree with you. And luckily, I think that that's where setting a family culture is really important. We are an incredibly physically active family. We're already physically active. And even with the almost three-year-olds, and I suppose that we do have a little bit of an advantage because my husband is a former military. I'll give you an example. This on Father's Day just happened. We went over to the monkey bars and we did a pretend obstacle course. We do push-ups and we do sit-ups and we do that and we make it fun and we do it every day just for fun yeah we are

early on in training them um my daughter has just started into martial arts it will never be an option for them obviously uh it will be up to them but in terms of the culture of the family yeah i just know how important it is as they are young, while their satellite cells are turning over, it's easy to build and maintain muscle and to be really fit. I'd much rather have them focus on that now than suffer later. Because at some point, if it's not addressed, it creates a whole host of problems that are... When I think about health and wellness, and I just think about life, there are certain things that if you do A, you're going to get B. Yeah. Right? Like, it's not miraculous. This is what's going to happen.

If you don't do A, you'll get C or whatever you're going to get. I know that if we don't create a culture of discipline and exercise and nutrition, which is not necessarily easy, if we don't create that, I know what the implications are going to be for my children later on. Yeah. Well, let's look at the implications. You live in America. There's a study from a few years ago suggesting that over 80% of people in America have some degree of metabolic dysfunction. I don't think we're quite as bad in the UK, but I'm pretty sure it's probably over 60, 70%. That is the norm. That means the norm is sick, right? And honestly, I say that with compassion, but we're here to try and help people and and

sedentary sick and sedentary yeah and and another uncomfortable truth which i think is worth um bringing up here i don't know your experience here with patients i i've been a parent as i say for 12 years and congratulations thank you It's not an easy thing. It's really not easy. And I would say one of the most powerful things I've learned is that kids don't do what you tell them to do. They do what they see you doing. And so certainly what I try and do in our house,

and I'm not perfect perfect but I try my best they're always seeing daddy doing squats doing press-ups lifting the kettlebell out in the garden doing sort of bear crawls they're always being absorbed it's just you know

and so often you know I'll just join me and do it with me or do oh daddy we're doing squats all right let's do it I'll do it with you and certainly in the UK there's a lot of talk that girls, particularly when they reach teenage years, it's a big problem in this country with physical activity in females. Now I'm interested, is that the same in the UK? Sorry, is that the same in America? And I don't know,

do you have any strategies for that? And how important do you think this kind of modeling is? I, you know, three years ago or two and a half years ago, I would have had no input into this. But being a parent, what I see already is that the way in which we teach and model, really you see it in these little people. And I believe that it is difficult once individuals get older. I don't know because I don't have a 12-year-old yet. I don't have a teenager,

but I can imagine that it becomes much more challenging. And I would say that seeing the generations around me, I'm a bit discouraged. I'm a bit discouraged in their physical capacity. And I believe that if we begin to teach our children, we as adults, if we begin to impart that on our younger children and even our teenage girls, I think we're going to see a change. I do believe that there is a culture problem right now, unfortunately. I don't know, I think, how to rectify that. I'm not sure, but I will tell you physical activity and hard training fixes many of those things because it takes mental fortitude. It really does. And you mentioned stress. And of course, stress can mean lots of things, physical stress, psychological stress, emotional stress,

all kinds of things. And too much of the wrong kinds of stress that we don't learn to manage, yes, can be incredibly problematic. But there's a lot of great research, isn't there, on how doing more and more physical activity helps you become more resilient to stress and actually deal with stress better, which I find super interesting. Yeah. Just to finish off on your second recommendation, strength training three to four times a week.

Can you just expand a little bit? Is it 20 minutes? Is it 30 minutes? I think a great place to start is, you know, from my perspective, thinking about, you know about volume is number one. Volume is the amount of reps you're putting in, the amount of sets, the amount of work you're doing. Volume, frequency, duration. These are all things that we have to think about when building a plan. And I definitely believe

people should work with a fitness professional. So the recommendations that I am giving are recommendations that I have seen working clinic clinic and just work with other patients. And of course, that is very valuable and it's in the literature. Understanding that three to four days a week is just a great baseline. I don't believe that that is necessarily optimal. I guess it really just depends on the load that a person is using, the volume that they are using. But easily, I recommend typically multi-joint movements, compound movements, whether it's a squat like you are doing, a deadlift, a bench press, kettlebell carries, those kinds of things. Full body movements, I think are very, very valuable. Rather than isolated

activities like a bicep curl or tricep, I do think that that is valuable. And I do that myself. Yeah. I think really starting, depending on what someone is working on, there's some really interesting work in terms of the amount of exertion. So, for example, Stu Phillips in Canada, he will show and has shown that, like, say, for example, we have older individuals who are listening to this.

You don't have to go heavy. You just have to put in the volume and there has to be enough exertion. All of a sudden, the body doesn't get to, you're doing a 12th rep and then the rep, okay, so now I've hit 12 and my muscle is stimulated or I have some kind of hypertrophy happening. It is about perceived exertion where perhaps you're going to failure and you can't quite do anymore and you're working multiple body parts. I think that body parts should be worked at least once a week. But I mean, that's kind of the bare minimum. So all body parts could easily be worked twice a week.

Yeah, a few things come up there. So there's then functional movements, which have real crossover to regular life. So, you know, squatting or lifting things over your head and things, things that actually are very practical, that will use lots of joints, lots of different muscles. But then you compare that to, let's say, a single, you know, an isolated movement like a bicep curl.

Now, clearly, something like a bicep curl is not going to be as practical or have as much functional crossover as, let's say, a squat, which requires your hips, your knees, your ankles, your balance, your abs. But just to highlight that point, if you are losing skeletal muscle, like everyone probably is after the age of 30, and you mentioned anabolic resistance, which is super, super interesting. Presumably, anything is better than nothing.

Absolutely. Yeah, so I think that's a key message because we're so far from optimal that for some people may go, what, four times a week, 40 minutes in a gym, no chance. And I don't want anyone to finish this conversation

and not then go, I'm going to start moving my muscles more. And listen, we've seen, you know, the high intensity interval training, you will get a ton of benefit from no time. And there are multiple ways to stimulate tissue. And I hesitate to say that because, listen, the more intensive the exercise, the less you can do.

Yeah. And typically, the greater the impact. So for example, if you're going on a light, leisurely jog, and that takes an hour, you will get arguably an equal effect in a fraction of the time by doing any kind of high-intensity interval training. Yeah. That being said, I think we do have to prioritize muscle in terms of time. And the idea that could we design a program that could be incredibly efficient?

Totally. Look at what CrossFit did. Incredibly efficient. Yeah. But is that necessarily safe for everybody? No. Is it setting us up for a reframing of a lifestyle? We need to really prioritize muscle as a pinnacle mechanism.

Muscle is medicine that we actually have control over. There's very medicine that we actually have control over. There's very little that we actually have control over. For example, you and I could do an overnight fast and my liver glycogen could deplete 50% and yours could deplete 65%. We don't have voluntary control over that, right? And you can't think your muscle glycogen. I mean, some people may argue that they can, but you can't think your muscle glycogen less. Utilizing and leveraging skeletal muscle is one of the very few things that we actually can directly influence. That's insane. We can actually

influence the amount of stimulus that we're providing? And could you do it cardiovascularly? Yes. But again, you don't have direct control over... I mean, you may, but it is not... I mean, I think it would be very difficult to sit here and to reproduce a physiological state in my body of running your 5K. I don't know if I could do it. But I do know I could walk over to the corner and do 15 squats. And I know I could put that effort in and I if I could do it. Yeah. But I do know I could walk over to the corner and do 15 squats. And I know I could put that effort in. And I know I could induce physiological changes in my body. Yeah.

So all that to say, could we be more efficient? And can it be less time? Totally. I think when you get to the point where you've created a discipline, then you can begin to scale back on time I think that there's a friction for beginning and a friction for execution we just need to kind of rethink that yeah just on that subject of efficiency you know and a lifestyle a few weeks ago my family and I went on holiday to Greece and it's really interesting. Yeah, it was lovely, much needed after a long book tour

and, you know, all kinds of things this year. It's been a busy work year. But it's really interesting. And I shared this in my Friday email last week that, you know, we didn't take many bags. So I packed a skipping rope because I knew we'd be chilling a lot. It doesn't take any, there's no weight, super simple. And what I would end up doing before breakfast, sometimes out in

the sun, looking at the ocean, every now and again, I'd just do some skips. And then I think on the first day, I ended up over the course of the day, doing like 500 skips. And it sounds a lot, but these were in little one minute segments of high intensity. And then I just said in my head, okay, every day you can do 500 skips. And so for seven days, yes, I was chilling. Yes, I was enjoying time with my wife and family. Yes, we were walking sometimes or chilling in the sun by the pool. But I was also getting 500 skips in a day. Now, the reason I share that is because I hope that maybe gives people some ideas that it's not always about a gym, having a personal trainer. Like, let's make this easy. I'm not saying

skipping is for everyone, but what's your take on that? Seven days, 500 skips a day whilst on holiday. Incredible. So you're creating a stimulus. Again, it is what is our endpoint. So you're creating a stimulus. It sounds like you did pretty anaerobic activity. It sounds like you put in quite a bit of effort. Yeah, it was tough. It was tough. That's amazing. Again, that is great for insulin resistance. It's great for utilization of substrate. It is great for disposal of glucose. You could have ate breakfast and then skipped rope, put a continuous glucose monitor on, and I bet you see a decrease. Yeah. So again, it doesn't have to be this thing. It doesn't have to be. I think that is a brilliant idea.

I am going to actually take that idea. I love it. Put it in your book. Do it. Yep. And I think that, again, creating a stimulus is really important. And you did that. And that is in and of itself is amazing. And again, can you do body weight exercises? You can. Those might take longer. And that could be a great starting place for people. Yes, I think that that is very valuable. And again, we go through seasons. As long as you are training and doing something outside of regular kind of leisurely walking and really putting in meaningful effort, you are going to make improvements. Something you said before that I want to make sure I've got right and make sure we've hammered this point home.

Let's say someone in their 30s, let's take a, I don't know, a particular movement. Let's take a bicep curl just because it's easy, low risk of injury. I know it's not a multi-joint movement. And let's say someone at 30

can lift a particular weight 10 times in each arm. Okay, great. Now, if we're saying after the age of 30, for most of us, there's going to be a decline in our muscle mass. Is it fair to say then if you are still only doing 10 bicep curls off that same weight at the age of 40, then relatively your strength has gone down. Like, I guess the point I'm trying to... I see what you're saying. Maybe it wasn't the best articulated question. The idea I'm trying to get at is you want growth, you want stimulus. Yes, you want to see, you want to get stronger. There comes a point, and we don't know exactly when that happens, but there comes a point where you become less strong.

And we don't know exactly when that happens, but there comes a point where you become less strong. There seems to be this tipping point. Maybe it's in your 70s or 80s, but there is a tipping point where all of a sudden you cannot do these major overhead lifts or these really heavy squats. But you at 40, you definitely don't want to be there. You should be stronger at 40 than you are at 30. I don't actually often see that in the gym. I see that people are lifting the same weight or perhaps they're already getting less strong or more weak. You don't want that. 40, you are still in the prime. 50, you are still in your prime.

Yeah, that's empowering. That's still empowering that there's stuff that we can do. Now, is there a difference between women and men in terms of this decline? Because obviously women have perimenopause, menopause. Maybe speak to some of the differences, please, between women and men. Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life

that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour, and I can't wait to see you there. This episode is also brought to you by the Three Question

Journal, the journal that I designed and created in partnership with Intelligent Change. Now, journaling is something that I've been recommending to my patients for years. It can help improve sleep, lead to better decision-making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviors into long-term habits, and improve our relationships. There are, of course, many different ways to journal and as with most things it's important that you find the method that works

best for you. One method that you may want to consider is the one that I outline in the three question journal. In it you will find a really simple and structured way of answering the three most impactful questions I believe that we can all ask ourselves every morning and every evening. Answering these questions will take you less than five minutes, but the practice of answering them regularly will be transformative. Since the journal was published in January, I have received hundreds of messages from people telling me how much it has helped them and how much more in control of their lives they now feel. Now, if you already have a journal or you don't actually want to buy a journal, that is completely fine. I go through in detail all of the questions within the three-question journal completely free

on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal, or click on the link in your podcast app. Yeah, I love this and appreciate this lead-in. Women typically have lower muscle mass than men, just based on body size. We also have less anabolic hormones, testosterone. In terms of when women, we really see a decrease in muscle mass and strength is often around menopause. When estrogen is low, that is really when we see changes in female hormones, estrogen, progesterone, there are receptors, there are hormone receptors for estrogen on the muscle. It is not really well studied yet. It is just, again, in its infancy.

What we do see, and of course, there's a misbalancing of testosterone. Sometimes testosterone remains high while estrogen, progesterone go low. It really just depends on the woman. But overall, during times of menopause, this is when we see the greatest decrease in skeletal muscle mass for a woman. And actually, it doesn't necessarily have to happen. This is the time where I often have women really pick up their skipping rope or their high-intensity training. This is very important also because as estrogen goes down, there is

a mechanism, and we don't actually know why it happens, of less movement. Women move less. The estrogen creates a decrease in that non-exercise activity, which is just kind of, you'll see me, I'm fidgeting, I'm all over the place. It decreases. Menopause is a really important focal point. The idea that women have to gain weight and lose muscle is not true. This is incredibly important

because if they up their dietary protein, really manage their caloric intake, modify their carbohydrate intake and understand that carbohydrates really become a meal threshold ingestion and increase high activity in terms of interval training and resistance exercise,

you can absolutely... And if you are in the scope of being able to do hormone replacement, this would be a great time to do it. That decline in muscle can be circumvented. Yeah, this is a very important message. Very important.

Very important because women are hopeless. They hit menopause and it sucks for them or they've seen their friends go through it and it sucks for them. And it physiologically and physically doesn't have to. I think this is such an important point, right? So again, taking a step back, we're all starting to lose muscle after the age of 30,

unless we do something about it. You powerfully explained why having good amounts of muscle is important for all kinds of different reasons. Okay, great. Now you're saying that when it comes to women, around the time of the perimenopause and the menopause, this can accelerate. So this is an opportunity opportunity instead of accepting it, there's an opportunity to get help, maybe discuss HRT. You mentioned increasing protein,

we're definitely going to talk about food very shortly. Then you mentioned something around carbohydrates. You said meal threshold ingestion. Could you maybe unpack that a little bit? What exactly did you mean by that? This is actually really important. And there's one more thing that I want to just mention before I talk to you about the meal threshold is that when women have a decrease in hormones, they're also more risk for injury. There's estrogen receptors and tendons and ligaments. So it's very important that women be aware you don't want to get injured so that you can't train.

And that's also something to keep in mind. Hold on. So are you saying be careful with your training? Yes. Exactly. So for example, during times of menopause, you might not want to be doing box jumps or doing things that are highly explosive on your own. Because there can be a risk of injury because estrogen is known to have a dramatic effect on skeletal muscle, even if we're still kind of parsing out the exact mechanisms. But it also has an impact on tendons and ligaments.

Yeah. Ligaments. And it's just important to understand. So there's that. If someone's listening and they're currently, because there's a lot of women in their 40s and 50s who listen and watch this show, right? So if they're listening to that and going, okay, that's me. I'm not as active as I possibly should have been previously. I've certainly not been focusing on strength. And then they've just heard this

and they're like, okay, right. I need to sort this out. I need to get moving. Or if it's the partner or someone's daughter or someone's sister, they want to share this, right? What would you ask them to do? Particularly if they haven't done much strength training before,

you're saying go easy on explosive things like box jumps. But is it the same advice that you gave before? Is it a lot of low intensity stuff like walking to boost your mitochondrial efficiency, HIIT training once a week, strength training? Is it the same prescription or you want to elevate it even more at that time? I would say they definitely want to increase and add in high intensity interval training. And you could do it more than one day a week. Really kind of focusing on that, that is going to be very advantageous.

Let's say if you are in menopause, why don't we do two days a week of high-intensity interval training? Is one day a week incredibly valuable? Can it be enough? But again, we are not now looking to just be at baseline. We want to make sure that we counteract any issue that may come up with this decrease in hormones. I do think having a very good cardiovascular base is important.

Is that going to do a tremendous amount for body composition? Not necessarily. Obviously, it helps, it improves, and it utilizes and leverages muscle as an endocrine organ, secreting myokines, very valuable, and nutrient partitioning, also very valuable. But this is where hypertrophy is very valuable. Going in and stressing the muscle, doing the compound movements, even utilizing machines, this is the place and the time to make sure that you are leveraging anything that you have.

And it can be incredibly valuable. So carbohydrates and this meal threshold ingestion. Yeah, let's talk about that. What does that mean for someone who's never heard that term before? So carbs, obviously, we know what carbohydrates are, whether it's, I don't know, rice or potato or fruit or whatever it is. Those are just examples of carbohydrates. We often think about carbohydrates in a 24-hour period. How many carbs are you having per day? You're having, the RDA for us is 130. The average American is having 300 grams of carbs. What becomes very important to understand is from a practical aspect, I know we're going to talk

about carbs, but I will mention, and I really want to talk about protein. The first meal of the day is the most valuable. You have to get your protein intake right for that first meal of the day. If we are talking about perimenopause, menopause, and really anybody, because you are coming into that first meal of the day catabolic. You've been fasting. You have an overnight fast. Hopefully, you've depleted some of your liver glycogen, which is the main organ that is really maintaining your blood sugar levels. When that happens, that first meal of the day, you want to practically optimize for protein between 30 and 55 grams per meal. That first meal of the day, you really want to hit that. If you are a plant-based individual, you need to go more towards 55

because you have to account for protein quality and fiber or whatever is in there. But a minimum amount of protein is 30 grams for that first meal. Okay. This is so interesting, right? So we're now going beyond the menopause and perimenopause, aren't we? You're talking to everyone here at the moment, which is... I am, I am.

But I know you wanted to talk about... Well, no, that's okay. That's okay. No, no, so for all of us, you're saying overnight, we're in a catabolic state, which for people who don't understand, we're sort of breaking things down.

So therefore... Unless you're waking up and eating in the middle of the night, which I don't recommend. So that first meal, and I love the way that you're not calling it breakfast, you're calling it a first meal, which, of course, let's get into timing as well in a minute. But you're saying you've been catabolic, you're breaking things down. So therefore, what?

You need to give your body an anabolic. So growth, you know, put on muscle, you need to give it that anabolic stimulus. Is that why? Yeah. So this is, if people take away nothing else from this interview, this is we are now getting into, we've conceptually talked about muscle. We know that there is stimulus required. We know that we have to do high intensity interval training. We know that you should have a baseline of cardiovascular health. We know how important it is to kind of embrace the suck, as they say. Now we're moving into... So exercise is the potent stimulus. Exercise is medicine. Muscle is the way to go.

We talked about the movement perspective and kind of framing that we are not over fat, perspective and kind of framing that we are not over fat, we are under muscled. Now we are moving into the next most critical aspect of the conversation. The aspect of the conversation that is completely missed. If individual, and I'm highlighting this because if the people listening do the following advice and execute on the following advice that I'm going to give. They will change the trajectory of the way in which they age. Okay? Wow. That is my commitment.

Understanding that the first meal of the day, I don't care when it is, is the most important and it primes your body for muscle protein synthesis. I don't care about your age at this point. This is the time. Listen, if you're young, you know, like my three-year-old or two-and-a-half-year-old, she can have 10 grams of protein and she's fine because they're very anabolic. But if you are an adult and you are listening to this, that first meal of the day is the most important and optimizing for muscle

protein synthesis, turning on the machinery of mTOR, which is mechanistic target of rapamycin, which is the way in which we think about muscle protein synthesis over a lifetime will be stimulated. If you are sub-threshold this amount of 30 grams, depending on your age, you will not stimulate the tissue. It's like being pregnant. You're either pregnant or you're not. You're either stimulating this or you're not. If you are sub-threshold, you do not stimulate this tissue. Why is that? This is fascinating because let's say someone is trying to have some protein at breakfast. I was actually looking at this just before we had this conversation. So there's some wild salmon in our fridge. Great. And, you know, one fillet has about 24 grams of protein in it. Right. Right. So

I think for those people who do eat fish fish and i appreciate we're now getting into super controversial areas of animal protein plant protein we're definitely going to cover that so i think it's important which was never controversial when i you know i've been like i have been mentored for the last 20 years by one of the world leading protein experts it was never controversial a decade ago yeah it's crazy yeah that is crazy And we'll talk about that because I think it's important. But just to make it really practical, for people who do, let's say, eat fish, you're basically saying if you do not hit that 30 gram threshold,

you are not stimulating the necessary optimal mechanisms in your body. And I'm thinking, well, some people can't manage a fillet of salmon. Some people think that's a huge amount. So therefore, this 30 gram threshold, where does this come from? Why is it so important? What's wrong with someone having just 20 grams, for example? And the science around this, and I work with Dr. Donald Lehman, and he's been in this field for the last 40 years. Yeah, he is an OG, a grandfather. He would kill me for saying that. Don't worry, he never listens to my interviews. He would kill me for saying he's the grandfather. But anyway, I work with him on these. He's mentored me again for the last 20 years.

And initially, we thought of protein as an even distribution. And I'll get into that in terms of grams and even distribution. And when we think about protein hierarchy, we often, the literature really says, okay, well, the amount of protein that you ingest in a 24-hour period is the most important. And I would say, yes, the 24-hour period of ingestion is the most important, but why leave it at that? We really need to think about targeting for skeletal muscle. And we know, and this actually was the work that came out of Dr. Donald Lehman's lab is one of his biggest contributions to science is that muscle is a nutrient sensor. Muscle is a nutrient sensing organ. And the way in which it does this as it relates to muscle protein synthesis

is through one of the amino acids, one of the essential branched chain amino acids called leucine. Without leucine, muscle stimulation doesn't happen. Therefore, it is very, very important to reach, and the way it does this, depending on as we age, when you are younger, you need less leucine to stimulate muscle. But as we age, the literature will show, and Don has shown it, and there's multiple other individuals have shown it, that you get up to 2.5 grams of leucine to really begin to trigger this process. When you're younger, it's like 1.8. No one is going to go look at the back of a label and say, oh, this only has 1.8 grams of leucine. And the reason you're not going to do it is because protein is totally underrepresented

and it's not broken down in the label, unless of course you're eating a protein shake or drinking a protein shake. The body requires a bump in amino acid in the bloodstream, specifically leucine, which is in high quality proteins to then trigger this process of muscle protein synthesis. And we want to optimally stimulate that, which is why at that first meal of the day, the higher protein you can get, the better it is so you can turn on that machinery. After that, okay, and let's talk about the filet person. So let's say you go, gosh, Gabrielle, I cannot eat more than one whole filet. No problem. An option for an individual is to add in a branched-chain amino acid to bring up

that level of leucine. What is a branched-chain amino acid? Branched-chain amino acid, you would use it in a powder, is leucine, isoleucine, and valine. It typically comes in a very specific ratio, which is two to one to one. So two leucine, one isoleucine and one valine. The reason it comes in this ratio is because how the body processes it. You don't want to just add one single amino acid just because of the mechanism. It will deplete the others. It's just not ideal. So you can have your filet, you can have a scoop of your branch chains, and now you've raised the leucine threshold. The leucine threshold is what is necessary to trigger the mechanisms in the body to stimulate muscle. Getting that first meal right.

And again, a lot of the literature is, we don't know, we have an idea of how long that lasts in terms of that stimulation. But by really optimizing for muscle protein synthesis at that first meal, you have more flexibility on protein dosing for the rest. Got it. Got it. So this is really important. So a couple of things I just want to say. So let's say someone was going to eat 100 grams of protein in a day. Yeah. Instead of having 10, well, maybe people wouldn't have 10, but let's say five times that they ate of 20 grams protein. Terrible idea.

You're essentially saying from that research that actually you're better off having two meals of 50 grams protein. So you're giving your body that bolus. You're stimulating the necessary mechanisms. Okay, so that's a great takeaway for people, first of all. Okay, great. And then that second meal, so let's say an individual says, well, I only want to eat three meals a day, then the second meal can be sub-threshold because it doesn't matter. You're really optimizing muscle protein synthesis twice a day. And people, I think some scientists would argue with me and say, well, it's just

really about the 24-hour period. But I will tell you, I don't agree with that. And in clinical practice, and again, as someone who is a trained geriatrician, we know that if you are coming up on anabolic resistance, your muscle as a nutrient-sensing organ is less effective and efficient. You want to leverage the capacity that you have control over to overcome some of that anabolic resistance. And that is easy to do and important. And because you are coming off a fast, your body is primed. And there's other ways in which we

could lower that threshold. For example, exercise actually primes the muscle. For protein ingestion, you can actually improve the efficiency of muscle if you go train and then eat some protein. Yeah. But regardless, I really think a great takeaway is understanding the 24-hour protein. And I recommend one gram per pound ideal body weight. So what would that be in kilograms? Well, hold on. We said 140 pounds before is roughly 10 stone, right? So you're saying 140 grams of protein. Now, for a lot of people, that's going to be a super high recommendation compared to what they're used to. It's also different from what a lot of longevity researchers are currently recommending. But I just want to, I think this is

super interesting. I'm happy to talk about that too. If there's time, we can. There's a lot of cover still, but let's hope so. Because I mean, this is such a fascinating area for me. Right. So you're saying that you need this big bolus, right? You need this big bolus. It's not really about the 30 grams. It seems like it's about the 2.5 grams of leucine that you need to stimulate this. So are we essentially saying that for most people, for most common protein sources, you really need at least 30 grams of protein if you're going to have those 2.5 of leucine. And you were saying before, if you are vegetarian or vegan, you may have to start pushing that more towards 50 to make up for it. Is that essentially the message? Yes. And I will say that leucine alone

is enough to stimulate muscle protein synthesis, but not enough to complete muscle protein synthesis. You need all the amino acids. You need all the amino acids. And that is why just taking a powder alone of branched chain amino acids will stimulate the machinery. But it's the equivalent to starting your car with no gas in it. You do need all the amino acids. There's a couple of things here. I've been researching your work over the last two days in preparation for our conversation.

And it just so happens that the last four days have been quite stressful on a personal level because my mother, she's 81 years old at the moment, and she's pretty immobile these days. On Friday, she had a fall. It's terrible. And last night, the same thing happened again. And you've mentioned a few times that you have worked in geriatric care, palliative care. Now, I just want to bring those threads together. Can you just explain, you know, falls is a big problem, right? You've worked in geriatric care.

I have to explain my own personal experience. Put all this together for us. Why is protein, why is muscle so important? Well, I have to say that, you know, my time as a geriatrician was incredibly traumatic. Essentially, geriatrics is end of life. Obviously, I'm not saying that about your mom, but I'm saying in clinical experience, I worked at a nursing home. I did this for two years. I did hospital rounds. I did palliative care. You witness people fall. You witness the aftermath of the fall. You witnessed the complete devastation of individuals

with dementia. And that is ultimately at the core why I became so vocal. Because I believe that if you have knowledge and if you have experience, it is your responsibility. And I will say that it's not always easy to be as forthcoming as I am, right? As you know, there is a bit aggression that comes back at me, but it's not about me. It's about the experience that by me sharing this, we can help your mom. We absolutely can help your mom. And that is a very pinnacle and poignant part of my personal experience. And frankly, one of the reasons I'm so vocal because there's so much misinformation and people that have not worked with aging or have not seen aging parents, everybody in the middle is arguing. Everybody is arguing

about longevity and nobody is talking about quality of life. This idea of restricting protein to live five years longer is ridiculous. Has anyone experienced what the quality of life of having low muscle mass is, poor balance, low bone density? That stuff is devastating. When I think about an aging individual, you must prioritize protein because number one, like you said, they don't have an appetite. They eat less. The calories that they eat really, really matter. And again, we are now thinking about a different season of life. Are we thinking about phytonutrients? I mean, yeah, but that's the equivalent of window dressing on a beautiful home. You have to get the foundation right.

You have to get the food matrix right. Then you can think about your elderberry syrup or your resveratrol or whatever else there is. But if you miss the foundation, none of that matters. But if you miss the foundation, none of that matters. None of that is going to improve your survivability from a fall, which is one of the most critical aspects of an individual who is aging, what they are at risk at. Respiratrol in and of itself, for example, it's not like I'm just picking on respiratrol. I'm sorry, respiratrol. But we have to really take a big step back and look at the big picture

of what the fundamentals are. And that is increased muscle mass, improved balance, have good bone density, and survive and thrive and be functionally independent as one ages. And now I'm going to circle it back to dietary protein. We talked initially about anabolic resistance, meaning the efficiency of protein utilization goes down. The most important thing an aging individual can do is optimize protein. They can optimize their protein. This can help offset muscle wasting. It can help offset the fact that they might not be training as hard. It can help with blood sugar regulation. It can help with improving triglycerides. It can help with blood pressure. These things are very valuable. So for someone like your mom, if we gave her a 30-gram whey protein shake,

whey protein has a high percentage of leucine in it, I would be very happy. whey protein has a high percentage of leucine in it, I would be very happy. And we gave her two meals a day that really optimized for her muscle and a little bit of creatine, five grams of creatine, I would be very happy. Yeah, I appreciate that

because I'm pretty on it with my mom's health and what she's doing. But actually the truth is, also when we're really close, we lose objectivity. Like, I cannot be objective with my mum in a way that I can be with a patient. I know that. Yeah, you're not supposed to be. I'm her son, and I'm trying to do the best I can. But I realized that actually, yes, we've been increasing protein for a while. But we've not been hitting that threshold consistently.

And I think, wow, if mom can't work out or do resistance training, I think what you just said is really important. Having adequate protein intake is going to reduce how much the muscle weighs because the muscle is going to waste, right? But we want to slow it down as much as possible. I've heard you share some pretty staggering statistics. I think you once said a statistic about women over the age of 65, if they fall. Yeah. And it's interesting because there's a whole slew of things that one would think, what is their pre-existing conditions?

Do they have diabetes? Do they have cardiovascular disease? What is their disease risk? And I can safely say that when an individual falls, their risk for all-cause mortality will go up. And it's very devastating. And it might not be immediately, but oftentimes it begins a very rapid decline in health. Basically, if a woman falls, she's 65 or older, her chances of walking and being mobile alone dramatically decrease, dramatically decrease. And obviously, that's not everybody, but 65 or older, any kind of

comorbidity, that risk of being able to be independent again, it's dramatically decreased. And does this speak to the body armor concept where you were talking about before? Presumably the more body armor, i.e. the more skeletal muscle that individual, that woman, that man has, then even if they do fall, that's going to protect them from a lot of the potential negative side effects. Yes. And then the other thing that we have to think about is, did they fall because they have some kind of peripheral neuropathy? Had they had low muscle mass in the past? Do they have elevated blood sugar? Do they have cardiovascular disease? Have they trained their balance? How is their proprioception? A lot of these things stem from

skeletal muscle, can be augmented by taking care of skeletal muscles. So typically, by the time someone has fallen, we already have a good sense. Again, someone could fall and trip. It could be medication. There's multiple reasons as to why someone would fall, but we cannot discount that. When I was in geriatric clinic, we used to test gait speed. We used to watch a gait speed of less than 0.8 meters per second. We used to also test sit and stand and the Romberg test.

We watched this and we know that as these decline, their risk of falls go up. Yeah. Let's go back to food and protein. You've given your view very clearly on what you think people should be doing to optimize skeletal muscle, 30 to 50 grams of protein, particularly at the first meal of the day. Yeah. Now, let's go there. Animal protein versus plant protein. This becomes delicate because of the,

well, as you say, you've been studying this for a long time and it never used to be controversial, but it now is. And I think the problem with the controversy is that many people are scared these days of speaking up. I'll just give you a quick example here, right? A very quick example, which I think you may resonate with. I have a very good friend who used to be vegan, used to have raw food, used to be vegetarian, then went paleo.

That is literally very, very knowledgeable, very health conscious, has tried a whole variety of things. And she is now pretty much carnivore, right? She has a maximum, I think, of 20 grams of carbs a day, and she is thriving. And when I say thriving, I mean, athletically, cognitively, I don't know anyone who can stay cognitively as sharp for her for as long as she can. But she and some of her friends have said to me, we feel nervous about even sharing that because these days there's such criticism that she only eats twice a day, sometimes once a day, but it's mostly animal protein, basically.

So I bring that up because I want this podcast to bring people together. I don't want division, right? I'm not interested in that. I'm interested in helping people with their health. So with all that in mind, can you talk to me a little bit through your lens of how you see animal protein and plant protein?

Yeah, it's interesting. Again, like I said, we never saw all this fighting or arguments before. I mean, just like it seems as if it came out of nowhere from my perspective. In terms of the narrative, it's very interesting. The narrative would tell us that eating meat and animal-based proteins, that that's bad somehow. There is no high quality evidence to support that, first of all. And we know that nutrient-dense animal foods are incredibly valuable for someone like your mom. It has bioavailable zinc, has bioavailable iron, has bioavailable easily absorbed B vitamins.

This is critical. It has creatine in it, it has taurine. And again, if you look at the amino acid composition of say beef or bison or fish or any kind of animal-based product, it is nearly identical to the amino acid composition of our muscles. Plants have, and again, this is not my opinion. I mean, you can go look at Luke Van Loon's data. I was just reading one of his papers where he was talking about plant proteins. It was pretty recent about plant proteins and kind of breaking down the essential amino acids. We don't eat for protein. We actually eat for amino acids. It's 20 amino acids that make up the majority of our body. And of those 20, we have nine essentials. The nine essential amino acids are what we really

need. I mean, we need all of them. And depending on if our body is under stress, we cannot keep up with our essential amino acid intake or production, for example, like glutamine. But these essential amino acids are in particular ratios in all foods. And in plant foods, they're much lower. And for example, fruits and vegetables, plants are incredibly low or deficient in methionine, or wheat or some grains are deficient in lysine. These are just hard, fast biological values. It's not really emotion-based or any of that. So when we think about high-quality protein, we have to think, okay, so what are the essential

needs that we have? And from my perspective, we really have to think of the branched-chain amino acids because when you prioritize for branched-chain amino acids and you prioritize for muscle health, everything else falls into place. When you go plant-based, can you get all your essential amino acids? You absolutely can. However, it is very difficult to do without processing foods. It's very difficult to do without supplements of pea protein,

rice, pea blends. It's very difficult. Can it be done? I'm sure it absolutely can be done. Is that carbohydrate load, which we didn't talk about the carbohydrate threshold, which by the way, is 40 to 50 grams max per meal for a sedentary person because you have to think about glucose disposal over a two hour period of time. So just on that, so you're saying basically for a sedentary person who

doesn't move much, they cannot process and put away more than 40 to 50 grams of carbs per meal. It would be very difficult to do. There's a meal threshold. You can do it and there's going to be derangement. Ultimately, too high of an insulin stimulation, it's just not ideal. Wow. And that's just based on disposal for the brain, the liver, the skeletal muscle, which actually a rest skeletal muscle is not super active. You have to put in the stimulus. So yes, that is a great takeaway for people. You don't want to have a meal that's over really 40 to 50 grams.

But anyway, going back to this difference in amino acid quality, can an individual meet all their amino acids plant-based? Yes. They may require 35 or more percentage increase in calories. So 35% more of that food. You know, it's interesting. I said something about if you calculate the amino acids in quinoa, people were saying, oh, quinoa is a great source of protein. Again, we have to understand when we think about protein, we have to understand that it really is about the nine essential amino acids. And that's one of the reasons why people are so confused. But from my perspective, without muscle, we have nothing.

Could you eat a sub-threshold meal, sub-threshold diet that is plant-based and get in all your amino acids? Yes. Could you eat a sub-threshold meal of animal-based products and get in all your amino acids? Yes. If you do animal-based products, you likely can control for calories. If you do plant-based and are trying to meet that leucine threshold, which would take six cups of quinoa

to equal one small chicken breast when it comes to that amino acid profile, that's not ideal. I think that, but I do think it can be done. Someone posted that I hurt their feelings by saying this. This is not to hurt anyone's feelings. This is really so that we can have transparent conversations of what needs to be done.

The majority of people don't age well on a purely plant-based diet. So an 80-year-old doesn't do well on a purely plant-based diet. And this is just my clinical perspective. From a geriatrician standpoint, we see lower bone density, all kinds of things, and much lower skeletal muscle mass. of things, and much lower skeletal muscle mass. So I'm not sure where all the arguments began to stem from. I mean, I have my perspective, but plant protein makes the correct ratio for plants. Can you combine those plants and get enough amino acids? Yes, but we don't just want enough amino acids. We're talking about optimizing. So that's why above one gram per pound ideal body weight is probably you're going to need to go higher if you

are more plant-based. Not saying you can't do it. You are going to have to go higher. You do have to account for the carbohydrates. And then the last part is we actually don't know the long-term effects of isolated pea proteins. A lot of people are augmenting processed foods that we don't know what those effects are. They don't exist in nature. Yeah. So many great points you raised there. First thing I want to just clarify,

which I thought was really interesting. You said, yeah, you probably can get the same amino acid profile from combining plant foods, but you're going to have to have a lot more calories in order to do that. Now, that's really interesting, is it? Because it's not as if our populations are in deficit when it comes to calories. There's a problem with how many calories, how much energy many of us are carrying on our bodies, right? So that's the first thing to say, which I thought was really interesting. Second thing I want to say is

throughout this conversation, I think you've been very passionate, very articulate and very clear. When you gave that 30 to 50 gram recommendation with the first meal of the day, you said without any prompting from anyone or me, you simply said, look, 30 grams to 50 grams, if you are plant-based, it's probably more towards the 50 grams. Yeah. I thought, this is awesome. This is a practical clinician who recognizes that a lot of people are plant-based for a variety of different reasons, health, ethics, environment, whatever it might be. And you're just trying to make sure they've got some practical guidance. So I thought that was really nice.

And I really respect that. The third thing I wanted to say is that I can tell from talking to you that you're a clinician, right? And that really means a lot to me because as, you know, this July, it's 21 years in clinical practice. I find a lot of people who get stuck

in these theoretical discussions have got zero clinical experience. They're talking about their own health and their own experience, which is fine. But I so strongly believe that if you have seen tens of thousands of patients as I have, as you have, you start to pick up things.

You actually start to see, well, actually what works in real life? Busy people with busy families, busy lives, what can really work? And so bringing that back to protein, I respect everyone's choice to do what they want to do for them. Absolutely. And there's a lot of flexibility when you're young, you can get away with a lot. And when you have a lot of time and you're incredibly physically active, and you're living outside and you're doing all these things. And listen, any diet can work for anybody. But my

concern is also, what does it look like when we age? What does it look like when that window of youth has now closed? That's what I'm concerned about, is when the decisions that you have made midlife and the decisions that individuals have believed so strongly in, that now they are dealing with the consequences of that. That is why I am so vocal. That is why we have to protect people so that they can make their own best decision. But there is a time where that window closes

and the margin of error becomes much smaller that someone can deal with. And that is where we really have to understand that if we can get protein and skeletal muscle right early on, then we can protect it. And I do have concerns about... My goal is to educate. And I am very vocal about animal-based products because everybody is bashing it. And it couldn't be further from the truth. Listen, when people stop bashing it, I can stop talking about it.

But until I know that at least we are having transparent conversations, we don't even address food matrix. For example, what about all the other qualities that are in animal-based products? For example, let's just take whey protein. Whey protein has immunoglobulins. Red meat has a whole host of other components other than protein.

Plants also have these things, and it doesn't have to be one way or the other. But we definitely cannot see and say that eating a food that we have been eating for millions of years is the root of everything, the root of all evil. that we have been eating for millions of years is the root of everything, the root of all evil. And then to say that plant and animal proteins are equal, I think that we are going to see an epidemic of osteoporosis,

an epidemic of older individuals like we have never seen before in the next 10 years. Yeah. So powerful. It really, really is. And I want to be super respectful. I understand that people feel very strongly about the environment and about the planet. That is a nuanced discussion.

It is. And also, we cannot make animal-based products a scapegoat for all these things. They're not that impactful in that way. There are other ways that we can deal with environment. I mean, listen, nobody has the answer exactly, but we have to have less emotional conversations about some of this stuff, right? And more practical. Yeah. When it comes to environment, we're looking at industry, electricity, and transportation.

Yeah. These are the big players. And yes, agriculture plays a role, but to make animal-based products the scapegoat for everything, that's not true. Yeah. And as I say,

there's a nuanced conversation around that, which probably requires a full hour to go deep into that. Yes, sir, it does. Gabrielle, I think as we bring this conversation to a close, it has been such a joy talking to you. I think you've shared so much practical information

that I hope will help people think differently about muscle and protein. Muscle is the organ of longevity. This podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of our lives.

And I think your work very much speaks to that concept. So right at the end, I always like to leave the listeners, the viewers, with some kind of practical take-home tips that they can think about putting into practice into their lives. Now, I know you mentioned lots throughout the conversation,

but I just love you to finish off with some final words, right? Why is muscle so important? And what can people do to start beefing it up in their lives? I love it. I love it. Well, as you know, muscle so important? And what can people do to start beefing it up in their lives? I love it. I love it. Well, as you know, muscle is the organ of longevity and really has the opportunity when leveraged correctly to change the trajectory of our life. And when we think about the two most important aspects about muscle and how we can impact them,

number one, we do think about exercise. We think about high stimulation to increase adaptation, high intensity intervals, throw that in at least one time a week, maybe twice. Resistance training, that can be three to four times a week. Two, failure to perceived exertion, very valuable. Building a base of cardiovascular activity. Again, the recommendation seems a bit robust at 150 minutes of moderate to even vigorous activity. So that's the exercise piece.

Now, the nutrition piece is equally as valuable, and that is understanding your dietary protein need. And from my perspective, one gram per pound ideal body weight would be optimal. You need to make sure that that first meal of the day hits between 30 to 50 grams of high quality protein. If you are more plant-based, you can always use a branched chain amino acid, but you really want to go to that higher end. And then understanding, I would like to see at least one more meal at between 30 and 50 grams of dietary protein. And then following up on the carbohydrates, if you eat carbs, keeping that between 40 grams, around 40 grams, higher 50 grams, 40 grams or less to mitigate insulin if you are at rest and not working out right after.

Super practical. Those would be my takeaways. Super practical, super helpful. And just finally, are you optimistic? Is the message getting out there? Are people starting to change their behavior? Yes, we are starting to change the conversation. And I'm so thrilled.

This has been a long time coming. I believe that we are going to start recognizing muscle as the pinnacle and really the primary site for insulin resistance, which everyone has been trying to tackle obesity, but obesity is symptomology of root cause, which root cause is skeletal muscle. And if we can learn to leverage it by training and really building our resilience and understanding we can learn to leverage it by training and really building our resilience and understanding we can leverage dietary mechanisms to optimize this over time, we absolutely can change the conversation from over fat to under muscled. It will happen.

It's happening. I love it. Muscle is the organ of longevity. Muscle is medicine. You are certainly putting muscle on the map. Thank you so much. And I look forward to doing this again at some point in the future. Thank you. Thanks for having me. Really hope you enjoyed that conversation. As always, do have a think about one thing that

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