The Dr. Hyman Show - Are we eating too much (or not enough) protein for good health? with Dr. Gabrielle Lyon

Episode Date: July 3, 2019

These days, we hear a lot about carbs versus fats. But what about protein? It’s become the forgotten macronutrient. The diet-wars have been tough on protein, as strict vegans and believers in Paleo strongly disagree on the best forms of it to consume. But protein plays an essential role in good health. So despite the emotional response it elicits in many, it’s about time we pay it more attention. Protein is responsible for the growth and maintenance of new tissue (the building blocks for a strong body!) and makes up certain hormones that act as messengers, as well as the enzymes that we need for metabolic reactions. Today on The Doctor’s Farmacy, I talk with Dr. Gabrielle Lyon about the importance of protein and why we should shift our dietary focus. Dr. Gabrielle Lyon is an integrative physician who completed her fellowship in Nutritional Sciences and Geriatrics at Washington University, St. Louis. She is board-certified in Family Medicine and completed her undergraduate work in Human Nutrition Vitamin and Mineral Metabolism. Dr. Lyon works closely with current and retired Special Operations military operators as a part of the Task Force Dagger Foundation. Find more information about Dr. Gabrielle Lyon at her website https://drgabriellelyon.com/ Learn more about Dr. Lyon’s work with taskforcedagger.org 

Coming up on this week's episode of The Doctor's Pharmacy, the more muscle mass you have in midlife, the better your trajectory of aging. Welcome to The Doctor's Pharmacy. This is Dr. Mark Hyman, and that's pharmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And I think you're going to love this conversation today with a good friend of mine, an extraordinary physician, a leader in the world of protein, which is not something you hear a lot about except in a negative way. We're going to talk about all aspects of protein in terms of health, in terms of aging, in terms of what does the science actually say and not the media headlines. Dr. Gabrielle Line is a functional medicine doctor. She completed her fellowship in nutritional sciences and geriatrics at Washington University, one of the

best medical schools in the world. She is board certified in family medicine. She completed her undergraduate work in human nutrition and vitamin and mineral metabolism. She's been studying nutrition in an academic way for seven years in school, which is a lot. She works closely with retired special operations military operators as part of Task Force Dagger. We're going to talk about that. And she serves professional athletes, executives, anyone looking to level up their health. Her Manhattan-based practice focuses on combining physical and mental optimization. She's been featured in multiple media outlets.

She's taught me a lot about protein. And welcome to the doctor's pharmacy. Thank you. Yes, we've had many conversations about protein, haven't we? Yes, and this is a controversial area because we, on one hand here, science says that we need the right kinds of protein and the right amount of protein in order to maintain our muscle mass. And we're going to talk about why muscle mass is so important in this

concept you created called muscle-centric medicine, which I think is a really cool name. And at the same time, we also hear about the need to reduce our intake of animal protein and the dangers on the planet and climate change and the destruction of habitats and the inhumanity of the animal. So there's all this like duality going on where people are super confused. And to be honest, it's even confusing for me. And I know a lot about this. So you're one of the world's experts in this. You've studied protein and protein metabolism, muscle function for decades now. And I think I want to start by asking you about this idea of muscle-centric medicine,

which is something people don't think about. You know, our muscle is our biggest organ in the body. Yeah. And it's one of the keys to longevity. And the truth is that the silent epidemic out there is this massive loss of muscle in the population. We talk about people being overweight or obese. Right. And we think about fat all the time, but we don't think about muscle. Absolutely. So why should we think about muscle?

You are starting off with a brilliant point. We talk about being over fat, but really the problem is being under muscled. The concept of muscle-centric medicine is that muscle is the largest organ in the body. And it is not just essential for locomotion, which is typically what we think about, movement and exercise. But in fact, it's our metabolic currency. It is the largest site for glucose disposal. Talk a lot about diabetes, cardiovascular health, Alzheimer's disease. All of these issues of metabolic regulation are largely controlled and contributed to the amount of muscle that we have.

So glucose disposal, lipid oxidation. We hear a lot about cholesterol. What's that? A lot about cholesterol. Well, if you want to lower your cholesterol and the fatty acids in your blood, you should have more muscle. We also think about cachexia, falls, breaks, injuries. Cachexia means? The destruction, the wasting of the body.

Yes, you lose muscle and you're skinny and you can even be thin and have no muscle. Right. When you think about muscle, it's the reservoir for these amino acids. The more muscle you have, there is less overall mortality. You are stronger. You're able to fend off disease, illness. Yeah. I just read this study in JAMA recently where guys who can do 10 pushups or less have a high risk of heart attacks. And if you can do 40 pushups or more, you're at far less risk. And actually, it's protective. And I recently did an aging evaluation. I could do 50 pushups,

which was awesome. No joke. I was like, Mark, why are you so out of breath when you're answering the door? I was like, I'm doing my push-ups. But yeah. Right. So it's clear that muscle is so much more than just this concept of locomotion and movement. It is a metabolic organ. And arguably, it's an endocrine organ. When you contract your muscle, it secretes things called myokines. Yeah, wow. Which are anti-inflammatory. So it's like the antidote to inflammation, which is the thing that's causing the risk for almost every chronic disease, whether it's Alzheimer's or cancer or diabetes or

heart disease, all related to inflammation. And these concepts relate to body composition. There's data to support the wider your waistline, the lower the brain volume. And I did a fellowship. So you mean the bigger your belly, the smaller your brain? Absolutely.

You know, I did a fellowship in geriatrics and part of that was running a memory clinic. Each fellow's job was to spend two years in a memory clinic. And then also being out of Sam Klein's lab, we did a lot of research, nutrition, obesity research. And we did studies where we imaged individuals' brains. And what you see is absolutely

the more metabolically dysfunctional they are, the lower the brain volume. The big belly, small brain. Exactly. And that is not a good thing. Now this whole concept of sarcopenia is something that people don't even know what that is. People don't know what obesity is, but it's sort of the other side of the coin.

It's this loss of muscle. And, you know, I've written a lot about it. And I've talked about strength training and exercise. And the truth is I really didn't like it because I like to be outside. I like to play. I don't really like to be in a gym. I do, you know, some push-ups and yoga. But he's going to be weightlifting now.

You've been pushing me. You've been pushing me to do this for a long time. And I finally started working out in a gym. I do some push-ups and yoga. He's going to be weightlifting now. You've been pushing me. You've been pushing me to do this for a long time. And I finally started working out with a trainer. And it's actually been fun. I'm a little sore, to be honest, but I think I'll get over that. But what happens is as we age, no matter what weight we are, you could be the same weight at 25 or 65 and be twice as fat and half as muscle. Right.

And the same weight at 25 or 65 and be twice as fat and half as muscle. Right. And in the same way. And what turns out is that your hormones, your biology, everything is regulated by your muscles. So you lose muscle, your cortisol levels go up, your stress hormones go up, your growth hormone goes down, your testosterone goes down. Bad news. Your insulin goes up, your blood sugar goes down. Bad news. Your insulin goes up, your blood sugar goes up. And yet this is not something doctors evaluate for, talk about, think about, advise about. Why is that? Again, because we're

focusing on the problem, not the solution. Everybody is focusing on the external issue, which is obesity. Likely because you can see it, right? But the solution is muscle. And a lot of physicians are not training themselves. Being a physician largely, unless you're into functional medicine or really lifestyle, can be very challenging. And oftentimes the drugs that physicians are prescribing for their patients are often taking themselves. The concept of muscle and why it's not talked about so much is because I think that we're just very behind on the science and that solution. It requires hard work. Yeah.

It requires physical work, labor. People don't like to do that. Yeah. They just take a walk to pump iron, right? That is activity.'t like to do that. Yeah. Because you have to take a walk to pump iron, right? That is activity. That is not working out. Yeah. There's a certain amount of stress and being regimented. You're working with a trainer, having a well-designed program to really begin to work the muscle. And as we age, we get something called anabolic resistance. And that is the muscle has a difficult time utilizing protein.

There are all these things working. So you could eat a steak, but it doesn't actually turn into muscle. Well, you can eat a steak, but the amount that you would have to eat as someone who is above 40 versus 20 is different. Because when you're young, you have, like you said, growth hormone, testosterone, all these hormones running through your blood. As we age, really typically beginning around 40 is those levels begin to decline. Those levels all affect

muscle. As those hormonal levels and growth hormone levels decline, we get this kind of resistance. It's not an inability, but it requires more protein, more amino acids to begin to stimulate that tissue. So aging well is very targeted. So let's just back up a little bit for people. What is protein anyway? Like we know fat, we know carbohydrates. Protein is the black sheep of the macronutrient family.

Yeah. That is all we need to know. Everybody's talking about carbs and fat. Who's talking about protein? Protein. We've been talking about it for years. It is absolutely the black sheep. It is very emotional for people because it has a face.

Nobody argues that sugar, excess sugar, excess carbohydrates are bad. We thought that fat was bad and now we kind of have a new understanding and people are still kind of weighing in on protein. It is very much the black sheep. You asked me what it is. It is essential for the building blocks of everything. Skin, neurotransmitters, hormones. It is ultimately what life is made of. It is the baseline fundamentals. And not only that, it is-

And by the way, all your genes do, you have 20,000 genes, all they do is make protein. Right. And they make protein out of the building blocks of protein that you eat. Correct. And dietary protein is key to getting all of those amino acids. And anyone, you can open up a textbook and look at all the amino acids. They all have different things. I will point out that if you look at the label of any nutritional supplement, it will have a breakdown of carbohydrates, how much fiber, how much sugar, fat. It will have a breakdown of saturated fat, all the other fats, and then you get to protein. And it just has one little line, protein. But not all protein is created equal. You have animal protein and you have plant protein, all of which

are made up of different amounts of amino acids, which affect your body differently. Okay. Well, you just brought this up, so we're going to go there. I was going to get into a little bit later, but the issue is what kind of protein and how much protein? Because one, there is an argument that we are eating too much meat in the world that is causing climate change and it's destroying natural habitats destroying soils depleting our water supplies we should talk about that yeah we're going to talk about okay good and and that we should all be eating more plant protein and more rice and beans we tried that and you know what that was called the food-mm. The Food Guide Pyramid.

Yeah. Well, we ate a lot of carbohydrates, but I don't know if we were eating- Rice and beans. But we weren't eating rice and beans. We were eating bread and potatoes and chips and, I mean, sugar and- Okay. But even if you swap it out and the carbohydrate load is in excess, right? So when we look at what we really need, we probably need between 70 and 80 grams of carbohydrates and the body can make all of that

from protein. Yeah, right. So let's just get back to this. So we do need protein and also the studies were interesting. Even the studies that show that maybe excess protein when you're younger makes you sick. It turns out even those studies show that when you're older, you actually need more protein. You do. And I just was reading about athletes eating maybe between 1.6 to 2.4 grams of protein, which is a lot of protein per kilo. And so we're getting all these mixed messages. You know, one, we should be eating less meat, eating more plant proteins, or two, we should be eating more protein as we age.

So we're in this sort of incredible, conflicted, confusing environment around protein. So what should we be eating? How much should we be eating? And what type should we be eating? Okay, this is of no tall order that we need to discuss. You know, this is a big, this is what people want to know. Let's take one step back. The information overload comes from kind of the mouse with the microphone. So you have small groups of individuals that are making a lot of noise.

You mean the computer mouse? You have extreme groups. So you have anti-animal groups. You have PETA. You have vegan groups, vegetarian groups that are just in one aspect making a lot of claims, putting a lot of money. I think PETA spent $15 million on advertising. Then you have big cereal companies, Kellogg's. I think that was around a billion dollars in advertising.

So you have these groups that are regulated by the FTC. And then on the other side, you have the egg council and the cattlemen and the farmers who are under the guise of the USDA. Yeah. the cattlemen and the farmers or who are under the guise of the USDA. Yeah. So you have these two kind of regulating bodies and two opposing groups, one which has much more money than, say, the Dairy Council or the Ag Council. That in and of itself skews the conversation. And that is something really important to be aware of. We're getting a lot of propaganda, but not a lot of science is what you're saying.

We have big pharma. We have these groups that are allowed to say certain things that maybe this will lower cholesterol, eat oats, it will lower cholesterol. It will have these certain health benefits. And then you've got egg, dairy, beef who are not allowed to make any similar claims. We do have a lot of propaganda and bad science that is very agenda-driven. And that creates an environment of confusion. Yeah, like the Lancet Commission, which was like, we should do like three ounces of meat a week, maybe. So let's talk about the RDA. So the current RDA, which is-

It's the Recommended Dietary Allowance. Correct. And that was based on studies that we know were flawed, right? Those were based on nitrogen-based studies of 18-year-olds that we wanted to, or they wanted to provide an amount which would stop disease, you know, it's baseline for disease. It's the minimal amount. In other words, the minimum amount you need so you don't get sick, it's not how much you need to be healthy. Correct.

So we came up, or they came up with a number, not me, way before my time, unless my Botox is that good, not having any lately. The RDA is 0.8 grams per kilogram. And that spans from anyone ages 18 and beyond. 18, 50, 60, 80. Okay. That is the minimum amount. There is 30 years of data to support that the minimum amount is not adequate. We know that as you age, you need double the RDA. For body

composition, you're looking at double the RDA. You mean for building more muscle? For anything. In obesity, we know that the higher your diet is in protein, while calories are controlled, the more lean muscle mass you can maintain. And we spoke, when we started talking about this, we talked about why muscle was so important. And this obesity epidemic isn't quite an obesity epidemic. It is really an epidemic of poor muscle mass, low muscle mass, obesogenic sarcopenia, loss and destruction of tissue. We are largely domesticated.

So what's happened is we have- What do you mean we're largely domesticated? We ride in cars. We're not doing physical movement. We are eating in a way that is not supporting our current existence. And actually red meat consumption has gone down by 29% since 1975. But chicken's gone up. Chicken has gone up.

Dairy has gone down. Yeah. The concept that we are eating too much protein, the average American eats between 60 and 90 grams. Women are around maybe a little bit above 60 grams and men are around 90 grams. So that's the average American. Heart disease, Alzheimer's, obesity, hypertension, all of these comorbidities and diseases are on the rise. Protein is not the problem. Protein's never been the problem. Protein is the defining nutrient for a high quality diet.

So you've been studying protein science in a way that I don't think many people have. And you say there's 30 years of research that kind of contradicts a lot of the perspectives that people have. It does. that kind of contradicts a lot of the perspectives that people have and shows the importance of protein for longevity, for health, for preventing disease. And yet at the same time, we're hearing that if we eat meat, it's going to kill us. That there's this huge sort of media push around eat less meat, eat less meat for health, eat less meat to save the planet. It's a problem. So how do you reconcile those two things? And you mentioned, you know, that there are extreme groups that are pushing

this, but it's not just extreme groups. There was a major report in Eat Lancet about the need to actually reduce our global meat consumption, that there isn't enough land and agriculture to support this for a growing population of the world. And in my mind, I also believe that we do need the right kinds of protein in the right ways, but it's hard for me to sort of reconcile these two things. So how do you explain that? I'm really glad you brought that up. Now, the 30 years of research clearly isn't my own. I'm not that old. I have been, though, trained by some of the best people.

And one of them in particular, my mentor, Dr. Donald Lehman, who is a professor emeritus at University of Illinois, has published multiple studies and is certainly one of the world-leading experts. And we have these discussions over coffee all the time. And you do bring up a very good point, especially when it comes to greenhouse gas and sustainability. Let's look at the U.S. The U.S. and this is from the EPA. Some of the state is from the epa the u.s contributes 15 to greenhouse gas 15 from out of the entire world right that we contribute 15 total from everything from everything that includes transportation agriculture land waste all of that. Our contribution in the United States is 15%.

Out of that 15%, 9% is agriculture. I'm going somewhere with this. So out of the entire world, we are 15%. Out of that 15%, 9% is agriculture. Out of that 9%, 5%, around 5%, 4.6% is fruits and vegetables. What it's taking to grow and decompose and that 4.5%. Cattle and dairy, 3.6%. Out of all of- And that's feedlot stuff.

That's not- No, no, that's everything. That's not regenerative ag. It is. It's everything. The greenhouse gas, so for greenhouse gas, all of cattle, all of dairy contributes 3.6%. So if you were to say, go meatless Monday, and let's say we were going to cut that in half, you still have to have some protein.

You can't become protein deficient. So let's say we reduce, kill all, you know, we eliminate all the cows and we're now at 3.6%. We cut that in half. What is that, 1.3%? That's in America, though. That's in America. Globally, there's a lot of meat being grown.

So, I mean, yes, and we should discuss that. But I can tell you in America that if you also look at that 9% of agriculture, you have a component that comes from waste and a component that comes from overfeeding. So we are in an obese, obesogenic environment. 10% is of this contributing factor to greenhouse gas is waste and overeating. So overeating is one part.

Food waste. We waste 40% of our food, right? So we're wasting and weating. So overeating is one part. Food waste. We waste 40% of our food, right? So we're wasting and we contribute. So out of that number, that 9%, we're contributing one third of that, just that 9%. One third is food waste. Another 10% is overeating. So while the discussion is somehow targeted on cattle and dairy, which make up 3.6%, that is not the big target for our 15%. We have electricity, transportation, transportation, I think 29%, electricity, another 30%. So everything outside of that 9% is largely controllable by us. When you look at the number, and this is not for the world, but this is for the US.

If we wiped out all of the United States and all of the cattle and everything, our contribution to sustainability, climate change is 15%. That is very small. Yeah. Well, it's significant, but it's, yeah. In the whole scheme of everything, it is- But globally, it said that our agricultural system as a whole is responsible for a third to half of all greenhouse gas emissions.

Our global system, the world, you mean. The world, yeah. But- And that includes everything. And 50% of that is natural. So we have wetlands and termites and rainforests and things that 50% of all greenhouse gas is naturally produced. Climate change is certainly happening. However, there is a natural aspect to some of these things. We live on a green planet. If we didn't, we'd be in Mars. and natural ecological processes are all bad. That's not necessarily true.

I mean, we are certainly contributing 49% of the- So what you're saying is pretty radical. You're saying that our meat production and animal production is not a big contributor to- No. Even though a lot of data seems to contradict that. But what data? If you look at the EPA

and if you really look at the contributing factors, Donna Lehman wrote a great paper on sustainability less than a year ago about this topic. You really tease out all the numbers, just like the whole protein controversy, it doesn't hold up. A lot of the discussion about how protein causes cancer, how protein is bad for you, it's all epidemiological-based data. Yeah, so let's talk for you. It's all epidemiological based data. Yeah. So let's talk about that. So the first issue is, is it a big factor in climate change? What about feedlot versus regenerative ag? Because it's not just the feedlots, it's all the corn, the soy grow, the rainforest we cut down, the soil erosion. That's true. All that's true.

All that is a big, huge issue. So it's not just the cows themselves, it's what we do to grow the cows. All of that is absolutely true. And regenerative ag arguably will draw down carbon, which means grazing cattle, but you can't grow as many cattle on grazing and rangelands as you can and feed a lot. So the volume of meat that we need to produce to have 90 grams or 12 ounces per person per day globally is a lot of meat. And even if it was the healthy thing on the planet, how is that sustainable? I think it's a great question. And I certainly don't have the answer. I think we should control what we can control and see if we can't

regulate those things otherwise, really decrease our transportation, eat locally, stop shipping our foods, which all of these things are having a great impact on greenhouse gas and climate change and impacting the globe. Why not do that first rather than sacrifice our health? We know excess calories are bad. We know excess carbohydrates are bad. We know this drives insulin. We know insulin drives cancer. Yeah. So you have these really big glaring things that can be fixed. Yeah. Why go right for meat? Why don't we clean up our end?

Like, let's eat local. We don't need to be getting avocados from Mexico. That's true. I don't need to have kiwis from New Zealand. I'm going to eat local. I'm not going to maybe fly as much or I'll use public transportation. And also the other thing with cows is we use their leather and all kinds of other things. So we're not just talking about meat. In addition, if we want to talk about cattle, cattles are upcyclers. They're upcyclers

of food. So for every one gram of poor quality protein, for every, I'm sorry, it's for every 0.6 grams of poor quality protein, which we know with the deficient in amino acids, plants, those kinds of things, they make one gram of high quality protein. So why not? Again, I mean, I feel very passionately about this because we are completely misled. So we should take care of the fundamental things that we can handle while maintaining our health. And probably ultimately the health is going to be a blend of plant and animal. But rather than just attack this one small area, let's do the things that we know. Stop overeating, stop wasting your food and stop traveling and stop eating stuff from a different country when you live in Manhattan. Yeah, that's true.

So that brings up the other issue, and you sort of mentioned it in what you just said, which is quality of protein. Not all protein is created equally. Yet, you know, the argument that is being made is that we should eat more plant-based proteins. We should eat more rice and beans. And what's wrong with that as a way of getting your protein? That's a great question.

Well, if you're 20, you could probably manage that. But with rice and beans comes carbohydrates and excess calories. Let's just take quinoa. And actually, remember I was up at Lenox a couple of years ago and I did a talk about the protein perspective for the crew and I had a chart that broke down what plants you would have to eat to match a chicken breast. Okay, let's get into it. So for one chicken breast, one small chicken breast, maybe four ounces, you would need about six cups of quinoa to equal that amino acid profile. Plant protein and animal protein are not created equal.

It would be wonderful if people wanted to eat plants and could sustain a healthy metabolism. If you are, so you've got one chicken breast, it's 150 grams, and now you've eaten quinoa, six cups or so, which is a lot, maybe four to six cups. Now you've eaten 600 calories to try to get that amino acid profile at one time. That clearly is not sustainable. Rice and beans, that is not a sustainable way for a population that is aging. And when I say aging, I mean anyone over the age of 20. Yeah. Well, it's interesting.

There's a movie coming out called Game Changers. You might have heard about it by James Cameron, where he documents the power of vegan diets for athletic performance and shows world-class Olympic athletes being vegans and actually having massive muscle amounts. And do you know, that's a great point. You know why that is, why that can happen? Muscle is stimulated two ways. one resistance exercise or exercise yeah and number two dietary protein if you grossly reduce one of those things which in that crew was dietary protein their exercise balance sets out balances that out so you can be a vegan as long as you hit the gym five days a week for an hour. At least.

Like a crazy person. Yeah. You know? And then we also have to think about, you know, there is a percentage of the population that can do well being vegan. But the NHANES data, which is a huge data set that's the best that we have, it's a survey data, shows that actually vegans and vegetarians are one half of 1%. Of the population.

Of the population. This is a very small group of people that can maintain and do well. Plant protein and animal protein are totally different. They have different levels of amino acids. Animal protein has the building blocks required for muscle tissue. Not to mention bioavailable zinc, B12. So you say also that leucine, you talk about leucine as one of the key amino acids that is needed to reduce muscle. It's sort of the rate-limiting amino acid. If you don't have enough of that, you can't make... You stimulate that pathway, the protein kinase pathway, which

is mTOR. And there's been a lot of talk, a lot of discussion around mTOR about how this is a cancer. This is a key component in cancer. And that's why you shouldn't eat protein because you're going to stimulate mTOR. Right. Well, mTOR is also stimulated by exercise. It's also stimulated in all other tissues, pancreas, heart, all these other tissues, largely by insulin.

Carbohydrates are the problem, not protein. mTOR signaling, which is a, it allows our body to nutrient sense, has been maintained since the beginning of time. Growth is not a bad thing. Growing bigger, growing stronger, growing bone, growing muscle, growth is not a problem. And when you think about cancer, cancer is a disease of the genome, right? And it is an inability to then begin to repair and regulate. There is not something that is actually, protein is not causing the cancer. Now, if you have cancer, certainly you push that mTOR pathway. That can be a bad thing. And that's perhaps where a ketogenic diet comes in. But the concept that upregulating a pathway, which has been beneficial

throughout creation, is completely erroneous. Let's talk about risk ratios, relative risk. Can I just throw that out there? Yeah. Well, this is part of the story around meat because it seems like every week there's a new study that comes out that says meat's going to kill you if you eat more meat. It's going to be a problem. There was one just last week. How do we interpret those as scientists, laypeople, eaters? So hard. So so hard i will tell you that um really finding good scientists that you trust are key there was a big paper that came out that linked igf uh to animal protein and um you know aging all of this stuff. And there- IGF is a growth factor that comes from often eating carbs and sugar, also stimulated by protein, that actually has been linked to cancer and other things.

Right. So this article in Cell came out, and it really talked about how people should have 30 to 40 grams of protein a day, which is a protein deficiency, essentially. It's now below the RDA. The leading scientists in the world wrote a letter to the editor that went through all the flaws of the paper and how it was hand-selected data, how it was very unethical. And they had statisticians. And it was signed by the top world-leading experts who have dedicated their life to studying

this, who are not agenda-driven. They are not funded by these boards, but they really, truly care. National Cattlemen's Association. Never got published. It never got published because one of the researchers was an editor of the journal. And I posted that on my website. It's available, this letter to the editor. It's like censorship, scientific censorship.

It's exactly like scientific censorship. So it becomes very difficult to get the- To counter the argument. To counter the argument. And listen, everybody wants to talk about protein or they want to talk about cancer and IGF- So why are those studies not true then? If all these studies come out that show that-

But they're not all the studies. Then if you go and you look back at the research, it doesn't hold up. So now you have the mouse with the microphone. So why doesn't it hold up? So let's talk about risk ratio. Let's talk about relative risk. Relative risk is what is your risk of doing this thing and getting this disease? And it is a standard of-

So if you eat eggs, what's your risk of getting heart disease? So this is the standard of looking at good data. When you look at the relative risk of smoking and cancer, that's 12. Or 20. Right. In order for something to be considered a risk, It needs to be above two. And this is something that has been in the scientific literature for, since it's been around. So in other words, if a study comes out and the ratio or the risk is less than two, which

in other words, you could say is 200% increase, right? Then it's kind of meaningless. It's meaningless. Right. So then if you go so now we know that cancer and smoking is a 12 and by the way when we talk about cancer you know there's lung cancer number one and that the the mortality hasn't changed we haven't been able to really do much in that area in the last 60 years and then you have the other cancers. You've got prostate, breast, colon, which all have links to obesity, right?

And that is very clear if you look at the National Cancer Association, any of these journals. Anyway, so if you go back, so when we say cancer blankedly, we really have to be, what are we talking about? So we go back to the risk ratio. The risk ratio over and over and over again of protein and cancer, guess what it is? 0.1. 1.1 to maybe 1.3.

This is the data. There's never been anything that has ever come out to show that the risk ratio is higher than that. So in other words, instead of 12, it's 0.12 or 0.3. It's 1.1. Has to be 2 to be significant. Yeah. That is where people have to understand there can be a lot.

So when they say your risk goes up by 30%, what that means is it goes from 1 to 1.3, not 12. No, it's not relevant. Right. So it becomes a talking point. The media says meat kills. But it's actually not even relevant. It's irrelevant. So you have these small studies that are handpicked,

NHANES data, epidemiologic, which we know is poor at best. It never proves anything, by the way. Just for people who aren't familiar with science, there's two kinds of main studies. One is an experiment where you take 10,000 people and you feed them steak every day for 20 years. And the other group, you feed them rice and beans for 20 years and you see what happens. That study is never going to happen. Never going to happen. It's billions and millions of dollars.

It's too difficult to implement. People eat whatever they want. So they look at big populations. They follow these people for 20 years. Every maybe five or six ten years they give them a food questionnaire say what you eat last week right and then they try to correlate it with different outcomes and they try to control for variables but it's very difficult to do that and and then that means that when you look at these questionnaires first of all these have

been invalidated by a lot of science that they're not really accurate, that people over-report good stuff, they under-report bad stuff, depending on what the meme of the day is. If meat is bad, then people aren't going to say they eat as much. Or maybe if they're healthy, they may not eat as much. So if they're healthy users, it's this effect where if you're conscious about your health and you exercise and you eat great and you don't smoke and you hear that meat's bad for you, you're going to eat great and you don't smoke and you hear that meat's bad for you, you're going to avoid meat because you don't want to get sick, even if that's not true. So it looks like they eat less meat and they get less heart disease or cancer, but it's actually not because of that. It's a...

It doesn't. And like you said, it doesn't account for other things like total caloric intake. It doesn't account for obesity, smoking, drug intake, drinking. Yeah, they try to control these factors. But one of the biggest studies on meat that I reviewed in my book, Eat, Fat, Get, Din, and Food, What the Heck Should I Eat? Was the NIH ARP study, which is National Institute of Health. And what is it? The ARP, the elderly thing, which I try to avoid when I get there.

Throw it in the garbage when I get there. Thanks for me, because I'm over 50. They said it was half a million people, and they found that there was a significant increased risk of all these diseases, cancer, heart disease, and everything with people who ate more meat. But when you actually looked at these people in the studies, the ones who ate more meat ate 800 more calories a day, were more overweight, smoked more, drank more, didn't exercise,

ate less fruits and vegetables, more sugar, drank more, didn't exercise, ate less fruits and vegetables, more sugar, processed food, didn't take their vitamins. Of course, they had more disease. It wasn't because of the meat. It was because of all this other stuff. So I think that you are highlighting something that is so essential to understand. Things are not that confusing. Again, it is small groups with a lot of funding and a lot of money that is agenda driven. Do we probably need to consume high quality protein while doing it responsibly? Yes. Do I know what the answer is? I don't think anyone knows what that answer is. But again, rather than attacking the high quality protein source that we have, because ultimately that is at first going to affect those with lower income.

I mean, that's going to be the first people that that affects. The people that maybe can't afford grass fed or eating. I mean, and they're already we know that lower socioeconomic status. You're also dealing with comorbidities. Obesity. economic status, you're also dealing with comorbidities, obesity. So focusing on this cattle protein argument as something deleterious to health is absolutely incorrect. We know the protege study came out and we know that that requires protege study was a study that had all the world leading experts come together and do a position paper saying that

as you age, protein intake is clearly, the needs are clearly higher, a minimum of 30 grams per meal. You know, really you're looking at 30 to 50 grams per meal, which is- Four to six ounces of- Yeah, per meal. And it has to be animal protein. Well, if you can now, this is another important point is you can use a lower quality protein but you have to augment with branch chain amino acids so that is a possibility so you can easily be a vegan but you have to take high leucine protein supplements the whole branch

chain so it's leucine isoleucine and valine you want to take that together because the the way in which the system works is it's not giving one. I mean, they usually work together. It's part of the branch chains. You wouldn't want to give one and push the system away and deplete the others. If you are vegan and vegetarian, vegan or vegetarian, or having a lower protein meal, let's say a fish that is 15 grams of protein, add in five grams of branched chain amino acids. That is certainly a solution

to not wanting to eat a higher protein diet. But please understand that the RDA is the minimum and it will not protect, it won't protect my dad. It's not gonna protect my mom. I mean, typically when you think about what a better recommendation is for protein, it's what is your ideal body weight? What is your ideal body weight, Mark?

Oh, what I have now. Perfect. What is that? 185. Your protein intake should be 185 grams, around 185 grams divided throughout the day. And obviously you could go less. That's a lot. Well, is it?

Or is it an optimal protein diet? So that means I got to eat, oh, wow, a pound or more of meat a day. Yeah. It'd be interesting to see how you felt. Maybe we could at least, you could probably get to 150 and still be great. But if you're eating 90, you're too low. Protein need is based on muscle mass. It's not based on sex.

It's based on muscle mass and age. And there's no danger to it. Cancer, kidneys, all this stuff we hear about. Show me. No one has ever shown that to be true. When they talk about heart disease and protein and red meat, it is not accounted for. It's saturated fats. They've never, you know, it's epidemiological data based on saturated fats. When there was a recent article that came out that showed high fiber and protein,

and when calories were accounted for, there was no difference. We are grossly misinformed. And hence, that's why we have a whole world of sick, overweight people. So if you were sort of in charge. Well, in my household, I am in charge. So if you were in charge of what people ate, you would be recommending they eat more protein and more animal protein. I do, in my clinic.

See hundreds of patients. And what do you see happen when people do that? They have more energy. They're neurotransmitters. Their thinking gets clearer. If they've suffered from depression, they improve. And obviously, this is personal. I don't have any evidence other than my own practice. They, number one, lose body fat while maintaining muscle. As you know, muscle is metabolic currency. It is everything. You want

to age well. The more muscle mass you have in midlife, the better your trajectory of aging. Yeah. And it's seven times more in terms of its ability to burn calories than fat. It has a high level of thermoeffective feeding. And in fact, for every 100 grams of protein that you eat, 60 grams gets converted to glucose. You don't actually have to the idea of the carnivore diet, while maybe it's not sustainable for individuals and you're decreasing your phytonutrients, the need for carbohydrates can all be obtained from eating protein. Because protein gets turned into carbohydrate. Leukoneogenesis, absolutely, which is why when individuals are on a ketogenic diet can

get pushed out of ketosis because of protein. If they eat too much protein. Having optimal protein is absolutely essential. And as you age, you know, a great target, even if you're young, I mean, so if you're not eating protein, what else are you going to be eating? Fat, which is pretty inactive in the body in terms of metabolism, or carbohydrates, which then stimulates insulin, high levels of insulin, as opposed to protein, which is a very permissive amount. It's a phase one insulin release,

very small amount. These are just all these myths confusing people. And I will tell you, in my personal practice, my patients are on an optimal, not high, optimal protein diet. And what we start with is we gradually increase them to their ideal body weight. They lose body fat. They feel amazing. Hormones regulate. And how does fat play a role in that?

So you're saying eat less carbohydrates, but what about- As needed. Let me see you get your protein target first. So what percent of your diet should be protein? It's a great question. I would say it depends on the amount of calories that you're eating. And the lower your caloric intake, the higher your protein percentage. Because you begin to utilize your muscle for energy.

It is very variable. But should it be 30%, 20%? Easily. So the recommendation is 30%. Arguably, I would say it could likely be higher than that. I mean, think about it. We've been wrong on every macronutrient yet. We've been wrong on carbohydrates.

We've been wrong on fat. Why would we not be mistaken on protein it would be foolish to think that we haven't missed the boat so how do we then create enough this protein on the planet for everybody because it seems like there's a supply and demand issue we are not at risk for not having enough food i think globally i think we need to cut back on some of those things that i spoke about if we're worried about climate change and sustainability, transportation, eating non-locally. But just to push back on that, I mean, I think there's been a huge amount of work done looking

at our food system. And our food system as a whole is the number one cause of climate change and the number one solution. It's not the energy sector. So even if we all stop driving and flying and going on boats, it wouldn't solve the problem. So that has to be taken into account. And the question is, how do we do that? It's not just about meat, although, you know, you're starting regenerative agriculture, no-till farming, and all kinds of other innovations will help to actually draw down carbon, according to Paul Hawken and his book, Drawdown. But we can't ignore the fact that the food system itself is the biggest driver. Okay.

So we have to sort of think about where does meat play a role in that? Do we have to eat meat? Can it be chicken, fish? Can it be plant protein supplemented with amino acids? It can be all of those things. It's certainly individual. It is absolutely individual i will tell you protein is a very high source or cattle-based animal-based protein red meat is a high source of iron yeah you i mean the the other option is you have a group of people that the draw on the health

system becomes great i mean people need to be much more responsible in general on their feeding. It doesn't mean they have to eat meat at every meal. But if you're not, you should be eating it certainly in discrete amounts and perhaps not eating in between. Yes, can you have fish? Certainly. Should you be then supplementing with other things

to then offset that? Yeah. So let's back up a little bit. How do you know if you're not getting a protein? You have sarcopenia, but you go to the doctor. I measure it. But doctors don't ask you, well, geez, what level of sarcopenia do you have? I mean, I measure it.

You do, but what should doctors be looking at? You should be tracking skeletal muscle. How? They can do. So the gold standard is a DEXA. That's like an x-ray special low low dexa sorry an underwater wing hydrostatic weighting most people don't you should certainly get a dexa they have other so just to be back on a dexa scan it's basically like what you use for

bone density but you can measure body composition and fat i just had one done and i'm all muscle folks 6.2 body fat i mean so you're but now the key for you is how do we maintain your tissue? For you, you're at a very critical point in your life because you've been fit and active your whole life. Now you need to continue to maintain that. Yeah. Yeah, you see, you see the dwindling muscle as people age. It's the main reason people end up in nursing homes.

It's not because they're sick. It's because they can't get up out of a chair. Right. And that's because they don't have muscle. Right. They fall. They break a hip. So when we are making these big arguments about how bad protein is for us, the alternative

is clear. I mean, the trajectory of aging and the implications of that. I mean, I did my fellowship in geriatrics. I worked at a nursing home every week. I was the death fairy that goes through the hospital for palliative care and you see the end result of life. And when you go back and you talk to them about the choices that they've made, I mean- This is powerful stuff, Dr. Lyon. We are in a period of great confusion and controversy and extreme views. And you're

presenting a level of science around this that I don't think many people have heard about. So if people really want to learn more about the science of protein and have the ability to sort of think for themselves about this, where would you direct them to look? I would direct them to some of the experts in these areas, the professors. So Dr. Donald Lehman, Dr. Stu Phillips, Doug Patton Jones. These individuals are not new health bloggers. I mean, they are world-leading experts with 30 years of research. So what was that paper you said?

Because I think that would be a great place for people to start. Which one? The Protein Age. The Proteage, the Proteage paper. It's P-R-O-T-A-G-E. It's a great paper. It's very easy to read. And you can find it online?

Yep. So just Google that. Yeah. That's good. I would start there because I think you're going to get a very different perspective. And I think we have to sort of thread this fine, nuanced needle of the right amount of protein for health and well-being and healthy aging, the right way to raise the protein. It's tricky. I mean, it's tricky.

The food system is broken. It's trying to fix. It's like our health care system. It's a broken system. So powerful. So we learned a lot today. We learned that there's one of the biggest epidemics in the world is not even talked about or diagnosed by your doctor called sarcopenia or muscle loss. We've learned that as we age, we need far more

protein than we thought. Easily done. We've learned that plant proteins, although they can be okay, are inadequate to actually create muscle synthesis and grow muscle, especially as we age. They need to be supplemented so you can't actually be a vegan and be healthy without a little extra work. Yeah, a lot of extra work. amino acids that people aren't understanding, that the science around meat has been completely manipulated in ways that make it seem like it's a problem. But most of the studies are population studies that just can't prove cause and effect in any way. Even if the ratio you said is over two, it still doesn't prove cause and effect. It just generates a hypothesis for future studies to prove it. So we've learned so much. We learned that maybe it's not causing cancer. Maybe this

pathway of mTOR and aging is not what we thought. And it gives us a lot to think about, a lot to think about. And I think this is the beginning of a much deeper conversation that we need to be having around the forgotten macronutrient, which is protein, and tell the story in a little bit different way. Yeah. Yeah. So, yeah. And, you know, I would encourage everybody to go to Dr. Lion, sorry, DrGabrielleLion.com. That's D-R-Gabrielle with two L's, Lion.com.

You can get a weekly newsletter. You can learn about what she's doing. You can learn about the incredible new field of muscle-centric medicine. Yes, sir. And I'm going to hit the gym and I'm going to get my amino acids. Perfect. And I want to mention one more thing. I'd love to just mention my work with an organization called Task Force Stacker.

Very near and dear to my heart. My significant other is a Navy SEAL. And functional medicine is important for the public and very important for those that have served our country and protected our freedom. So Task Force Dagger is a organization which I work with the active and retired military operators. And they can find more about that at taskforceagor.com or an IG, taskforceagor, on my website. Yeah, it's important. In fact, thank you for mentioning that because they are in some ways neglected medically and they often have suffered great injury during the course of their training and work.

There was an article in your time recently about lead poisoning because they shoot up a lot of things in internal practice places called blast houses and they blow up things, shoot guns and it's full of lead and mercury and heavy metals that causes them to be quite sick and ill and even affects their metabolism. So yeah, I've treated a bunch of these guys and I think it's really an important area of work and thank you for doing that. Yeah. And I may have gotten the website wrong, but it's task an important area of work. And thank you for doing that. And I may have gotten the website wrong, but it's taskforcedagger.org. Okay. Taskforcedagger.org.

So it's just really important. And they do rely on private sector funding. They are not getting funding from the military. So we're really trying to raise awareness because they are doing some incredibly, incredibly important work. Well, thanks for raising our level of awareness about protein, about helping the military, about things that are certainly confusing topics. And hopefully we have a little more insight about how to think about this.

And I can't wait for your book whenever that's coming out. And now we're going for a steak. So thank you for joining The Doctor's Pharmacy and listening. If you like this podcast, please share with your friends and family on Facebook, Twitter.

Please leave a comment. We'd love to hear from you. And we'll see you next week on The Doctor's Pharmacy.