The Dr. Hyman Show - Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Muscle Health and Longevity

Episode Date: August 31, 2021

My team and I are excited to introduce our revolutionary platform, Dr. Hyman+, which offers premium content, perks, and information available exclusively for Dr. Hyman+ members.  In this teaser episode you’ll hear a preview of our latest Dr. Hyman+ Functional Medicine Deep Dive on muscle health and longevity with Dr. Gabrielle Lyon. To gain access to the full episode, head over to https://drhyman.com/plus/. With your yearly membership to Dr. Hyman+, you’ll gain access to: Ad-Free Doctor’s Farmacy Podcast episodes Access to all my docu-series, including Broken Brain 1, Broken Brain 2, Longevity Roadmap + bonus material Exclusive monthly Functional Medicine Deep Dives Monthly Ask Mark Anything by you and only for you

Hey everyone, it's Dr. Mark Hyman here. Now my team and I have been working hard on something that I'm so excited to share a little bit about today. It's a revolutionary new platform called Dr. Hyman Plus, which is a premium membership exclusive for my community. With Dr. Hyman Plus, you get a ton of private content and special access that no one else gets. This yearly membership gives you exclusive access to ad-free Doctors Pharmacy podcast episodes, access to all of my docuseries, including the Longevity Roadmap and Broken Brain 1 and 2, plus all the bonus content. You get monthly functional medicine deep dives where one of our doctors goes deep into a health topic to tell you everything you need to know to heal.

You'll also get access to a monthly Ask Mark Anything Q&A where I answer the Dr. Hyman Plus community's biggest health and wellness questions. This Q&A is only accessible with a membership. Now, because I'm so excited to share this premium membership content with you, I'm releasing a teaser of the brand new Functional Medicine Deep Dive episode diving into one of the most important topics in health. I hope you enjoy it and head over to drhyman.com forward slash plush. That's drhyman.com slash PLUS for more information. Okay, here we go. What's up, guys? I am Dr. Gabrielle Ly Lyon and I'm here to talk to you about arguably the most important aspect of health today, and that is muscle health and longevity. On today's agenda, I'm going to tell you why, sarcopenia, which actually is disease of skeletal muscle,

and most importantly, what you can do at home to augment skeletal muscle. All right. First and foremost, we have to correct the paradigm of thinking. Right now, our society is very focused on this concept of being over fat, always focused on obesity, focused on quote weight loss. And I will tell you that is an incorrect way of thinking about it. That is one of the reasons why it is so hard to treat. The paradigm about thinking about obesity is wrong. We are functional medicine, root cause approach, adipose tissue, being over fat is symptomology of impaired skeletal muscle. So we are not over fat.

In fact, we are under muscled. Okay, the current state of health affairs, we're talking about obesity, diabetes, Alzheimer's disease, cardiovascular disease. What do all of these diseases have in common? These are diseases of skeletal muscle first and foremost. The impairment begins in skeletal muscle first. And we are going to talk a lot about that.

You are going to understand very deeply why skeletal muscle is the organ of longevity and how impacting skeletal muscle changes everything about the way that you age. All of these diseases, obesity, type two diabetes, Alzheimer's, cardiovascular disease do begin in skeletal muscle. Yes, they have components of inflammation, whether it's low grade inflammation, they all have metabolic impairment. Alzheimer's disease, for example, is insulin resistance of the brain. All of these to treat and prevent require healthy muscle because muscle is at the very core of your metabolism and really determines everything about how you can partition nutrients. And we will talk more about that protein, carbohydrates, and fat. And in this talk, we're going to primarily focus on

protein and you will see why. Okay. This is time for the paradigm shift of thinking about skeletal muscle, just looking good in a bikini and moving it over to it being the largest organ system in the body. It is the organ of longevity. Skeletal muscle is the largest nutrient sensing organ in the body. You heard me correctly. Skeletal muscle actually senses nutrients. And in particular, it's highly keen on sensing amino acids, which is dietary protein. It is directly affected by dietary protein intake. This organ system, which accounts for more than 40% of your body weight is exquisitely sensitive to dietary protein. It is directly affected by mechanical load, which we all know,

that's the lifting heavy things, putting them down, lifting heavy things, putting them down. It is also an endocrine organ. It secretes myokines. Myokines act locally and systemically. They act throughout the whole body and they improve the way in which we live. I'll give you an example. When you exercise, skeletal muscle secretes these myokines. One in particular is called EDNF, brain-derived neurotropic factor. And this in part accounts for the changes that we see in cognition and the good mood that we see and the improvement in memory. Another myokine is interleukin-6, which people talk about in terms of a cytokine being inflammatory, but actually interleukin-6 can have anti-inflammatory properties when secreted by skeletal muscle. And there's a whole bunch of different kinds of myokines. That's not the purpose of this talk, but it's something to be aware of and something that I talk quite a bit about. Now, the other aspect of skeletal muscle is that the hypertrophy, which we can impart upon,

we actually can make this organ system grow. And by adding tissue mass, we can actually improve our immunity. We can actually improve our survivability and we can improve our metabolic function. I'm sure that I've now sold you on why skeletal muscle is so important. Now let's think about muscle as a metabolic sink. So it does all of these things, right? So we talked about, you know, how skeletal muscle serves the body in terms of it improves immunity by adding mass. It does all these things by secreting myokines. And really one of the other things that it does, and this is a

key component to understand is that muscle is a metabolic unit. It is the metabolic sink of the body. And you're like, well, what does that mean? Well, that means it really determines everything about your metabolism. What is so great about muscle? It's also the tissue that we can change. It is responsible for 80% of insulin stimulated glucose disposal. So the carbohydrates that you eat or the carbohydrates that you don't eat, skeletal muscle is the primary place for deposition. Number two, people are talking a lot about cholesterol. Lipid oxidation, one of the largest sites of skeletal muscle. If you get injured, skeletal muscle is the amino acid reservoir. For example, if you,

I don't know, get pneumonia or break a hip or have an illness where you're in bed for two weeks, the body pulls from amino acids to help you get stronger, to protect you. It utilizes those amino acids to help rebuild the body. Definitely in times of highly catabolic states, which is highly active, the body is breaking down, typically very inflammatory states, the body utilizes its skeletal muscle to protect you. And my favorite topic is that it's part of the, it is the site of branched chain amino acid metabolism, which is one of the things that makes skeletal muscle so unique. Now, skeletal muscle changes with age. And that is one of the privileges of getting older. And we've all seen it in our parents. There is a

decrease in sex hormones, testosterone, estrogen, progesterone, a decrease in growth hormone, right? So we know that growth hormone is peaked earlier on in our life. The prime muscle building years they say is between 20 and 30. I would say if you're really fit, you can get up to 40. Other aspects is that testosterone decreases and you know, whether you're a man or a woman, testosterone decreases, insulin resistance increases. What does this mean? This means that there's arguably a change in a carbohydrate threshold, a carbohydrate tolerance. The skeletal muscle goes through this over a period of decades, somewhat of a transformation in insulin resistance and skeletal muscle goes up. Capillary perfusion decreases. This is one of the other changes

with age is we begin to rely on exercise much more as we age than we did in our youth because the baseline ability for the capillaries to perfuse blood and to perfuse nutrients to our muscles decrease. And the fourth thing, major fourth thing that happens with aging is that protein signaling decreases. And this is interesting. Skeletal muscle is a nutrient sensing organ. And the ability for skeletal muscle to sense our dietary protein that we ingest actually decreases. What I've seen in clinical practice, and you have probably seen if you've spent years in the gym, is that people are very habitual and they do the same thing that they did in their 20s, 30s, and 40s, both dietary-wise and exercise-wise. They become very comfortable with the familiar.

And that may be they become very comfortable with going on the treadmill or they become very comfortable with their five pound weights. And if you train and eat the way you did in your youth, this becomes very detrimental as we age. One of the other very profound things that happen is something called anabolic resistance. And I alluded to it when I mentioned that protein signaling changes as you age. This is something that happens to skeletal muscle tissue. And it's very unique. What we originally thought to aging, but what we're finding is that anabolic resistance can start in your thirties and actually can start any time in which an individual becomes obese. Why is this so important? This is so important because anabolic resistance makes it much more difficult to build muscle.

And anabolic resistance is, again, this phenomenon in the muscle. And I put aging reduces the efficiency of protein use. I also should add in obesity reduces the efficiency of protein use. I also should add in obesity reduces the efficiency of protein use. There's a decrease in capillary blood flow. Again, that's the blood flow to the muscles. There's reduced membrane transport, reduced metabolic signaling, which is very important, and luckily something that we can push. And there's reduced flanchnic extraction of nutrients. This is just that there's a reduced ability for the gut, the GI system to uptake some of the nutrients in particular amino acids. This is extremely common and it happens to nearly everybody. It is part of this biological process of aging. We are seeing it much more.

And when I say seeing it, we are seeing this epidemic of being under-muscled because we haven't employed the correct strategies to prevent or at least augment the destruction of skeletal muscle. Great news. We absolutely can fix it. I put this image on here. I thought this was an interesting image. And this is really to highlight for those individuals who are not in a more mature age group, that anabolic resistance, which I alluded to earlier, does happen in obesity, but it also happens with sedentary behavior. It is not, you know, typically it has always been thought of as a disease of aging, sarcopenia and anabolic resistance, which sarcopenia is the decrease in muscle mass and strength and, you know, thought to be one of the contributors to anabolic resistance,

but anabolic resistance, which again is that, you know, those multitude of things that happen, but the big picture of anabolic resistance is that it's decreased ability for the tissue, the molecular aspects of skeletal muscle, a complex called mTOR has a decreased ability to sense amino acids. Now, anabolic resistance can be in a highly catabolic state, which is really any, and this is just an example of a highly catabolic state, which is really any, and this is just an example of a highly catabolic state, which is kidney failure, but it could be any chronic illness. Obesity, which we have control over is a highly anabolic resistant state, sedentary behavior, aging. And then this goes down to a low anabolic resistance state, which is a healthy, physically active lifestyle, which by the time this talk is over, you are all going to be inspired to do because listen, there's a lot of things that we cannot control. This is one of them. The way in which we augment

skeletal muscle for health and longevity is something that we can control. Now let's keep our marbled fat out of our tissue and leave it with our stakes. Sarcopenia, which is another aspect of aging that I must bring up is typically defined as age-related loss of skeletal muscle mass and strength, wasting and atrophy. There's a progressively reduction in size. Muscle fibers are replaced by fat and fibrous tissue, which you can see. And again, something, you know, we get a kind of a glimpse of it when we see a marbled steak, but ultimately this is what happens to skeletal muscle. And while we think about it as a disease of aging, it can start much earlier. Something interesting is that the fiber type changes. There's largely two types of fiber, type one and type two. I won't go into detail about them, but I will tell you that type two

fibers are affected first. And those are your big bulky fibers that, you know, when a weightlifter you see is like strong muscles or the guns, when you have periods of sarcopenia, or when you begin in that process, those muscles, those kind of bulky muscles decrease first, they actually transition to type one, which are the, the postural muscles, the thin type muscles. So contrary to thinking, sarcopenia is not a disease of aging, but it can begin in the third decade of life with inactivity and poor diet. What are the unintended consequences of sarcopenia and inactivity and poor dietary choices. Well, this is my daughter Aries and she's saying, yikes. The unintended consequences are this crosstalk of a decrease in skeletal muscle and obesity. And we see sarcopenic obesity,

which is now a decrease in skeletal muscle and an increase in obesity. And sarcopenic obesity, which is now a decrease in skeletal muscle and an increase in obesity. And sarcopenia actually is a very new diagnosis. We've seen it for decades and decades, but it only got the proper ICD-910 code in 2016. And the physicians watching will understand this, if you look at any of your medical summaries, you'll see that there's a diagnostic code. And sarcopenia is very recently diagnosed. And one of the reasons is it's very hard to quantify. And we'll talk a little bit about that. But the unintended consequences of having decreased skeletal muscle is that it changes everything about your metabolism.

I define skeletal muscle as the metabolic sink. And I told you all the different things that it does. It's number one, responsible for the large part of glucose disposal for lipid oxidation. It's your amino acid reservoir. And it is, let's see, what else did I not mention the site for branch chain amino acid oxidation metabolism. Well, what happens is I not mention? The site for branched chain amino acid, oxidation metabolism. Well, what happens is as you lose skeletal muscle, you lose your ability to process and to manage excess calories and in particular excess carbohydrates. So what happens is, is we begin to see a contribution and an increase in fatty tissue into the skeletal muscle. And if you think about it, like stuffing a suitcase is you stuff the suitcase in the cell

so much, if you have impaired glycogen, which is a storage form of glucose, you have impaired muscle impaired glycogen, which is where the glucose goes and everything spills back out. So you get glucose that spills back out into the bloodstream. You get fatty acids that spill back out into the bloodstream because they want to go to skeletal muscle to be processed. But if the skeletal muscle is defective or full of fat or full or a lower amount of skeletal muscle, everything goes back out. And you also see that with protein and branched chain amino acids. A long time ago, or a couple of years ago, people were saying, oh, well, protein contributes to type 2 diabetes. Well, it actually doesn't. But what you see is

you see increased substrates in all aspects of the bloodstream due to no place to put these substrates. There's no place to put the nutrients. So as my daughter says, yikes. Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus all the content from my docuseries, and of course, any future ones we're going to release, plus monthly Ask Mark Anything episodes, plus monthly functional medicine deep dive episodes,

I guess, right, that's why we call it Dr. Hyman Plus, head over to drhyman.com forward slash plus, that's drhyman.com slash PLUS to learn more. I'll see you there. Hi, everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional.

This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.