The Dr. Hyman Show - How Muscle Promotes Energy, Regulates Our Metabolism, And Prevents Disease

Episode Date: August 22, 2022

This episode is brought to you by Rupa Health, ButcherBox, and Comvita. As you lose muscle, you lose mitochondria and your metabolism slows down. Then there is the fact that the natural loss of muscle mass and strength as we age is associated with all-cause mortality and linked to the incidence of many chronic diseases like cardiovascular disease and stroke, hypertension, insulin resistance, and type 2 diabetes. This is why muscle mass is not only essential for maintaining a healthy weight, but it’s also a key factor in reducing the risk of chronic disease and improving your healthspan and longevity.  In this episode, I speak with Drs. Stuart Phillips and Chris Rinsch, Dr. Gabrielle Lyon, and Mark Sisson about the importance of supporting our body’s largest organ, muscle. Dr. Chris Rinsch is co-founder and CEO at Amazentis where he oversees the company’s operations in Switzerland. For more than two decades, he has been an innovator in the life sciences arena.    Dr. Stuart Phillips is a Professor in the Department of Kinesiology and a member of the School of Medicine at McMaster University. He is Tier 1 Canada Research Chair in Skeletal Muscle Health. He is also the Director of the McMaster University Physical Activity Centre of Excellence.    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.  Mark Sisson is the founder of the popular daily health blog, Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint. This episode is brought to you by Rupa Health, ButcherBox, and Comvita. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com.   If you sign up today, ButcherBox will give you two ribeye steaks for free in your first box. Just go to butcherbox.com/farmacy to claim this deal.   Learn more about Comvita at comvita.com, and enter code Hyman25 for 25% off all Manuka honey and bee products. (This offer does not apply to bundles or sale items.) Full-length episodes of these interviews can be found here: Dr. Stuart Phillips and Dr. Chris Rinsch Dr. Gabrielle Lyon Mark Sisson

Coming up on this episode of The Doctor's Pharmacy. We can find individuals in their 60s and 70s who metabolically look like they're in their 30s. They're physically active, they keep themselves busy, but similarly we can find individuals in their 30s and 40s who look pretty much like they're in their 60s and 70s. That's a direct reflection of the quality and quantity of their muscle. Hey everyone, it's Dr. Mark. Like many of you, I'm terrifically busy throughout the week. I'm a doctor, a podcast host, a writer, a speaker, a father. And on top of all those commitments, I have to make time to prioritize my own health along with the health of my patients. Because I have so much on my plate, I value tools that

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It means better service for you and your patients. You can check out a free live demo with a Q&A or create an account at rupahealth.com. That's R-U-P-A-H-E-A-L-T-H dot com. This episode is sponsored by ButcherBox. You probably heard me talk about ButcherBox before because they've revolutionized the process of buying high quality meat and seafood. I love to cook and I have a super busy schedule. So whenever I can spend some time in the kitchen, I want to have all my favorite ingredients right at my fingertips. I'm also really picky about the quality of my meat

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getting the highest quality meat and seafood to optimize your diet. Right now, ButcherBox has a special offer for new members. If you sign up today, you'll get two ribeye steaks free in your first box by going to butcherbox.com forward slash pharmacy. That's with an F, F-A-R-M-A-C-Y. That's 200% grass-fed ribeyes by going to butcherbox.com forward slash pharmacy. And now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Fee and one of the producers of The Doctor's Pharmacy. Essentially, the more muscle we have, the better our body operates. In today's episode, we feature three conversations from the doctor's pharmacy on why, as a sedentary culture, we need to pay more attention to muscle. Dr. Hyman speaks with Dr. Stuart Phillips and Dr. Chris French on the role of muscle and mitochondria in our health, with Dr. Gabrielle Lyon on why protein is essential to eat to

build and maintain muscle, and with Mark Sisson on his approach to building muscle. Let's jump in. It's not just muscle for locomotion, but it's a metabolic organ, and it's what degrades as we age. And when your muscle function and your muscle mass declines, I know you more likely to fall and injure yourself and have trouble with just your daily activities of life as you age, but your metabolic health, your hormonal function, your levels of inflammation, your ability to regulate your blood sugar, your testosterone, all are affected by the quality of your muscle. And what happens for most people who are listening and may not realize this, you could be 65 and the same weight that you were when you were 25, but your muscle can

be completely different. You can look the same on the outside, but on the inside, your muscle has become marbleized fat, essentially turned into a ribeye from a filet mignon when you were 25. And that has enormous consequences for aging. And every single thing that we think of in terms of aging, heart disease, cancer, diabetes, dementia, in some ways they start in the muscle and the muscle function because without optimal muscle function, we can't regulate our metabolism and we can't regulate inflammation. We can't regulate our hormones. And that all leads to these abnormal

cholesterol levels, abnormal blood sugar levels, abnormal levels of inflammation, low hormone levels that we associate with aging. But often it really starts with the muscles. So it's one of the most neglected and important organs. And it starts to go downhill pretty quick, right? When we're in our 30s and 40s and it gets older. As you get older, we lose strength and muscle mass. But what I think is a little scary is that, you know, while you can improve muscle mass at any age, recent studies have shown that it may not actually be able to be fully restored. So why should we focus on prevention and what can we do to help improve our muscle mass and function, especially in the mitochondria as we age. Yeah, I think you hit on a key issue about, you know, when muscle mass begins to decline and when the function of our muscles begin to really

go sideways. And a lot of people debate when that starts. I think, as your example goes, we can find individuals that we pluck off the street who are in their 60s and 70s who metabolically look like they're in their 30s. And that's pretty much because they're physically active. They keep themselves busy. They probably exercise on a regular basis. But similarly, we can find individuals in their 30s and 40s who look pretty much like they're in their 60s and 70s because they spend a lot of time sitting behind a desk. They don't eat particularly well. They're not that physically active. And really, that's a

direct reflection of the quality and maybe to some degree, the quantity of their muscles. So I don't know whether your listeners are familiar, but probably if they've heard the term sarcopenia before, that's the age-related loss of muscle mass and muscle function that I think for a long time, geriatricians said, you know, that's just a normal part of aging. And one of the things that we like to push is that it's not, and it doesn't have to be, and that really you should try and be as physically active, which is probably one of the key things, have a good diet. And then as Chris's company, as Amazentis has found out, you can probably do a few sort of nutraceutical tricks, if you like,

and prop up that mitochondria inside the muscle, which is another sort of just local indicator function of that tissue. Yeah, you know, but it's really key too that it's not just the muscle that there's mitochondria in. There's many, many mitochondria in heart and brain tissue in every single cell of your body because essentially it's the engine that runs every cell. And some cells, like the brain cells, have literally tens of thousands of these mitochondria. Other cells have less, but heart and brain have the most. And that's when they tend to break down as we age. And I think most people don't understand anything about their mitochondria. They don't understand

that they can actually measure its function in different ways that doctors can. Doctors don't know much about mitochondria. We learned this thing in medical school in first year called the Krebs cycle in biochemistry, and we quickly forgot it as soon as we learned it, which is the only time we really paid much attention to mitochondria. And yet it is central to every age-related disease and the aging process itself. In fact, it's one of the most underappreciated aspects of our health, which is why we're having this conversation. I think people need to begin to understand how important their mitochondria is. And a lot of the kind of healthy aging strategies, you know, low sugar diet, more good fats, quality protein, these are all about ultimately helping our mitochondria. And exercise also and strength training are critical for

building muscle and helping mitochondria. But the role of mitochondria is pretty interesting in aging, and there's a lot of age-related phenomena that happen that can be reversed by improving the function, the number of the mitochondria. And this is some of the work that's being done, for example, around NAD, which is another healthy aging nutraceutical. But a lot of the intermittent fasting, time-restricted eating, the low-carbohydrate diets, ketogenic diets, these things that have sort of been experimented with all impact the mitochondria and affect their function. And so I think, can you talk about how the mitochondria affects us in terms of the aging process and why it's

so important to focus on them. Yeah, so I think one of the key things, as you said, is that the metabolic processes inside cells require energy nonstop. And it doesn't have to be a muscle cell, your cardiac cells, your heart is working all the time, digestive tissue, brain tissue, it's always metabolically active, there's always something going on. So that means that mitochondria are turning out the currency, the energy that we need to be able to function. So no cell really ever, quote unquote, goes to sleep, even if we go to sleep, the cells are continuously regenerating

themselves and renewing themselves. And that's a function of mitochondria. So once those mitochondria begin to function suboptimally, then you begin to see tissues begin to break down, not just muscle, but as you said, brain tissue, cardiac tissue, it could even be adipose tissue. And all of these things really begin to tie together to slow cells down, they don't function as well, and they really begin to tie together to slow cells down. They don't function as well, and they really can't then talk to each other. So this so-called what we call organ crosstalk, so between muscle and fat and liver and in parts of our brain, it really begins to break down. And so, as I said, it's a central theory of aging, which is to say that once our mitochondria begin to decline in function, then, you know, things are really going to go poorly. You know, exercise is one way to prop it

up, but not everybody can exercise or not everybody exercises to the degree that they want. And so these adjuncts that we're now seeing, you mentioned NAD, urolithin A, for example, are all of these, I think, pretty cool compounds that once we just thought, oh, you know, not a big deal, but we're now seeing are pretty important. Absolutely true. And I think the phenomena around mitochondria in the research is pretty exciting. And there's all these genes that regulate aging that are in the mitochondria, like FOXO, DAF2, the sirtuins. These are really important regulators, and they're regulated by diet, but they're also regulated by these various compounds, these phytochemicals in plants, which we're going to talk about in a minute, because this is the work that Amazentis is doing. This is the work that they're looking at in terms of compounds

that come from plant foods that can actually regulate these biological functions in our body. So you can't obviously just take a nutraceutical and eat crappy and not exercise. It's all a package deal. But it really can accelerate the muscle improvement and function. We're going to talk about that. But one of the things that's sort of exciting, and Chris, I want to ask you about this, because we have been hearing a lot about this phenomenon called autophagy, which is this idea

that we can clean up and recycle old cells and old proteins and sort of clean up the system to repair, rejuvenate, and extend life and improve health. And that's why people are doing intermittent fasting or time restricted eating or ketogenic diets, for example. These all improve this phenomenon called autophagy, which literally means eating yourself. But there's another thing that happens in the body called mitophagy, which is an incredible breakthrough in understanding longevity and longevity science, which is understanding this phenomenon of mitophagy. So what is mitophagy and how does it help to address the phenomenon of aging and improve our overall health and energy production? Well, Mark, thanks for having me today.

Mitophagy is really a way of renewing our mitochondria, particularly when they're damaged. So as you get older and as you're more sedentary, your mitochondria get damaged as they work, as they're producing energy. And what you have inside of each of your cells is a process of renewing your mitochondria. And under this sort of umbrella of autophagy, as you were mentioning, we have mitophagy and sort of the self-eating of mitochondria. So basically it takes care of recycling mitochondria as they get damaged so that the mitochondrial pool is maintained very robust and you have basically cells that are more bioenergetically active than they would be otherwise.

That's incredible. You know, one of the things that I find fascinating is this whole idea that I've talked about in some of my books called symbiotic phytoadaptation. And it's a big word I made up myself. What it means is that we have evolved, and this is just my theory, that we've evolved in conjunction with the plant world and the foods we eat to regulate our biological functions. And that there are 25,000 plus different phytochemicals in plant foods that regulate every single biological function from our hormones to our immune system to our gut microbiome to our mitochondria to pretty much everything that happens in our body. done to appreciate these recently. In fact, Rockefeller Foundation has funded a study,

which they're calling the periodic table of phytochemicals, which is mapping these all out, identifying their function as much as we know, and talking about how do we actually use these in the promotion of health. And so in everything, there's protein that we eat, there's protein, fat, carbohydrate, fiber, vitamins, minerals, et cetera. But there's this other class of compounds that have not been thought to be essential. And I call these the phytochemicals. And that's why I think we actually need these to stay healthy. So they're not necessarily, you're not going to get a deficiency disease, but you might get a chronic disease if you don't have these things. That's my theory. And I'm so excited by the work that Amazentis is doing

because it's really rigorous science that has been published in some of the top medical journals in the world that's looking at some of these compounds in plant foods that can actually regulate key biological functions, especially the mitochondrial function. So there's this compound that you've studied, and you basically figured out how to actually extract and make, which is called urolithin A. And just for those who are listening, this is what's so interesting about biology. You eat a

pomegranate, which has these elagitanids in it, which is one of these phytochemicals. So you eat a pomegranate and that chemical interacts with your microbiome. And then if you have a healthy microbiome, it might produce a beneficial chemical called urolithin A, but if you don't, it might not. So what you've done is sort of discovered that this molecule is so powerful in regulating mitochondrial function and you've really done years and years of research to bring it to market. So tell us about your lithium-A. How does it work? How does it affect mitochondrial function? And how did you kind of figure this out? Because there's a million plants out there and a million chemicals. So this is sort of like, you know, kind of like a needle in a haystack, right? Good question, Mark. So it all started with, for us, with the pomegranate. We were looking

at the pomegranate and thinking about what type of health benefits it could bring. And we started looking at the compounds inside of the pomegranate. And this led to us understanding more about compounds like elagitannins, which are a big family of compounds that are quite large inside of the pomegranate. And upon studying them, we understood that they were transformed, as you were mentioning before, into urolithin, in fact, into a range of urolithins, which are metabolites through the gut microflora processing. And it was originally thought that this is just part of the processing and the digestion of the pomegranate. And so it wasn't sure, you know, were these urolithins actually doing anything in the body. So we started looking at them. And it was at this

point when we were looking at urolithin A that we saw lo and behold that it was acting on mitochondria and improving mitochondrial function. And so it's one of these, these processes where you, as you say, a needle in a haystack, but it was through a very systematic dissection, if you will, of the compounds in the pomegranate and following their sort of journey as we consume the pomegranate. So you were like, you were like, Oh, let's study the pomegranate and see what's in there. It wasn't like you studied every plant chemical and found out that there was this one that regulated mitochondria.

No, no. We were really focused on the pomegranate at the time because there had been some general research on the pomegranate and its health benefits. And so we thought, let's take a deeper dive and try and understand what's there. And I think, as you were saying before, what's really emerged from this is the importance of not only the foods you eat, but importance of the microbiome and how they work together synergistically to create compounds and to extract the health benefits from the food that we eat. And so, you know, it was understanding this and understanding also that very few people can actually perform this conversion. In fact,

it's been estimated, and we've done some of our own studies that have shown somewhere between 30 and 40 percent of the population can actually convert these compounds, these precursor compounds found in the pomegranate, into urolithin A. And that's at even various levels. So what it makes sense is when we studied all this was, you know, we don't need to give more pomegranates to people, but we actually need to give urolithin A to people. And if we do it in the right way, if we dose it right, if we deliver it in a very precise manner, we can then get the health benefits that we are targeting and that we've shown that work. I've been using pomegranate powder and pomegranate concentrate in smoothies for a long time because of the benefits of pomegranate. And it wasn't around particularly the mitochondrial function. It was around the microbiome effects.

And so, you know, one of the things we know, for example, is that there's a microbe in the gut called acromantia, which is mucinophilia, which essentially creates a coating and a biofilm on the gut that protects it. It regulates the immune system. It's necessary to fight cancer. It's necessary to regulate your metabolism. It's related to autoimmune diseases, and it's very low in many people. And this bug loves pomegranate. And so you feed a pomegranate, it grows, and it can help cure all kinds of issues. What really is fascinating to me is the story of the microbiome and the food we eat. So could you dive a little bit more into how the microbiome interacts with these compounds that we eat and then what happens to those compounds?

How do they then get in our body and interact with everything that's going on? Because I don't think people really understand that. I think it's a very new science and I think it's really an important thing because when you're eating plant foods, it's not just for the antioxidants and the benefits that you get from the fiber and the vitamins and minerals. There's this other thing that's going on that has to do with how it interacts with your microbiome, and that is the future. So talk to us about that.

Sure. So as I was mentioning before about the ablagannins that are found in pomegranates, they're also found in a number of other foods that we eat. We find them in raspberries and we find them in walnuts and blackberries. And what happens is these compounds are then transformed after you consume them in the stomach. They're hydrolyzed into a lactic acid, and a lactic acid is then transformed by various gut microflora. So the actual identity of the bacteria have not yet been found. But what we see is that there's a range of different metabolites, urolithin A being the most predominant one. And these are then taken up into the body, into the bloodstream,

and then they go to the cells. And we found in our first clinical study, we found that we could identify urolithin A actually in the muscle tissue itself. Wow. So it actually gets right into the muscle cells. We've shown that, and we've shown through biopsies of the muscle tissue that we impact the mitochondria and the gene expression level of mitochondria in the muscle tissue itself. That's incredible. So how does it work to cause this phenomenon of mitophagy, this sort of self-cleaning service, almost like a self-cleaning oven, right? How does it work to induce the cell-cleaning process of your mitochondria?

Well, with urolithin A in particular, it's taken into the cells. And what it does is we've shown that it can stimulate this process of mitophagy. It's not known exactly at what point it acts to stimulate the mitophagy, but it increases the clearance of the damaged mitochondria. And consequently, we see a renewing of the mitochondrial pool inside of the cells. And so you have a much more bioenergetically favorable environment inside the cells. And the cells consequently function much better. So what you're basically saying is that when you have this pomegranate compound that it basically should be made by your microbiome but most of us don't and you take it as a supplement

that it cleans up the mitochondria and helps to improve the energy production yourselves why is that important like why should we care well i think in particularly as um as stewart was mentioning earlier as you get older uh the the activity in our in our muscle the basically where the ability to clear the damaged mitochondria decreases with age and so uh this causes a decline in the energy levels inside of our cells and in our muscle tissue. And so then we sort of slow down as we get older and the muscle stops functioning as optimally our endurance levels drop. And this is part of a process in aging where mobility declines. And so what we're doing by stimulating mitophagy is to increase that energy level inside of ourselves and basically making our muscles function at their bioenergetically optimal state, no matter how much muscle tissue you have. So this is something,

it's really a new approach as opposed to what people have been doing in the past, which has been administering more protein to try and bulk up on muscle tissue. We're all about trying to make our muscle tissue the most functional as possible as you get older. So it just sort of like accelerates the benefits of exercise, right? Yes. I mean, and as you were saying before, it's not a substitute for exercise. Basically, you want to keep this in your diet as part of your healthy routine, if you will. So you want your exercise, you want to have your right dietary supplements, and you want to eat a very balanced meal. So it's all part of combining the three. Hey everyone, it's Dr. Mark. As with any time of year, supporting our immune systems is key to optimizing our health. But with fall right around

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or you can enter the code hymen25 for 25% off all Manuka honey and bee products. That's C-O-M-B-I-T-A.com. And now let's get back to this week's episode of The Doctor's Pharmacy. Our muscle is our biggest organ in the body, 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 and we think about fat all the time,

but we don't think about muscle. 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 do 40 pushups or more, you're at far less risk and actually it's protective. And I recently did an aging evaluation and 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, 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. Absolutely. 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 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 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 some pushups and yoga but- He's gonna 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 uh and it's actually been fun and i'm a little sore uh 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 way to 25 or 65 and be twice as fat and half as muscle. Right. And the same weight.

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 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. Yeah. 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. That is activity.

That is not working out. 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. What does that mean? 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. 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 it's causing climate change, that it's destroying natural habitats, destroying soils, depleting our water supplies.

We should talk about that. Yeah, we're going to talk about it. Okay, good. 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 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. 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 this. This is a big deal. 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. 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 egg 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. Yeah. 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, or, you know.

So we know. So let's talk about the RDA. So the current RDA, which is- It's the Recommended Dietary Allowance. 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, but 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. 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- Wait, 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. Protein's never been the problem. Protein is the defining nutrient for a high quality diet. As you get older, the importance of lean tissue becomes

more and more critical. Muscle is the forgotten organ. And people think, well, if I'm jogging in my 50s and 60s and 70s or riding a bike, that that's accomplishing what I need to accomplish. And it's not. It's actually much more important to spend some time in the gym lifting heavy weights, like the heaviest weights you can lift without getting hurt. Without getting hurt is a key component. I don't want to. So my trainer tells me I should do, like, more reps.

Like, I do three sets. Yeah. And I do, you know, it's pretty hard, but it's not like my maximum that I can do. Sometimes it is. But is that the same, or is it more better to do heavy weights? How many reps do you know it's pretty hard but it's not like my maximum that i can do sometimes it is but is that is that the same or is it more better to do heavy how many reps do you do are we talking six or five ten to twelve and that's good three times that's fine that's standard that's that's that hasn't changed in decades that's still and there's no right answer there there's no magic it's like whatever you feel good doing. Is that building enough muscle, or should I do more heavier weights and fewer reps? Heavier weights and fewer reps builds more strength over time. But there's no – I can't tell you that that's where you need to go.

But I'll give you an example. It's sometimes the type of weights you're doing. So if you're just doing bicep curls, you know, that's, you know, for the beach, but that doesn't really impact bone density, you know, muscle mass throughout. So hex bar deadlifts, you ever do those? Yeah. Yeah. That's the best thing you can do. What about just a regular deadlift? Yeah, they're good, but I'm too concerned with my back. So I lift heavy with a hex bar deadlift. Oh, really? Yeah. So, but it once every week, and I do three sets of that. I keep adding weights until I get— How much do you do?

I do up to 300 pounds. I do one to two rep max on 300. Oh, one to two reps. Yeah, I can do 335 on one, but it's too much. I wind up taking too long to do it, and I'm afraid—again, I don't want to hurt myself. So I do—but that's like— that one exercise impacts the entire body yeah um you know it's it's not just what you would see obviously from from doing the the weight of you know the glutes and the and the lower back and the hamstrings and the quads but you know it's pulling on the shoulder muscles like like

my grip strength is sometimes the the thing that gives out more than anything else. But that one exercise then has an effect on the pulse of growth hormone and testosterone through a, you know, it involves so many muscles, including major muscles, that then when you go do the pull-ups and the push-ups and the dips and the squats and all the other lunges, then you get the impact is greater. The effect, the muscle building effect is greater because you did that. Yeah, I like that. I like that. So I should do that first.

Or last or whatever. But I mean, yeah, if you do it first, a lot of times you'll like, you know, you won't have the strength to complete the other stuff. So what is the biology of doing it? You mentioned you can burn fat, but why is that better? What does it do in terms of longevity? What does the science show? Well, as we—so burning sugar is a—in and of itself,

it produces reactive oxygen species at a greater rate than putting, combusting fat through the mitochondria. So the more energy you can drive through this metabolic pathway that uses the mitochondria, the better off you are. A lot of times people burn sugar in the cytosol of the cell, not even... The way I think about it is interesting. So when you eat a lot of sugar calories and starchy calories,

it burns dirty in your mitochondria and releases a lot of sugar calories and starchy calories, it burns dirty in your mitochondria and releases a lot of waste products, which is these reactive... Oxygenous species. ...oxygen species or oxidative stress or free radicals that are driving aging. And when you burn ketones, more like hybrid, like an electric... Yeah. Like an electric... It burns clean, right?

Like a 93 octane of fuel. Yeah, it burns much cleaner. Is that true? It's true. I mean, that's the simplest way of looking at it. Then there are other nuances to this, which are when you become good at burning fat, then when you skip a meal, or when you have this very easy to manage compressed eating window, all the good stuff happens when you're not eating. Yeah. So the longer you can go, and that's why fasting has become the rage, the longer you can go without eating, the more your body says, oh, this is a great time to do some house cleaning.

Yeah. And the term autophagy is thrown out probably too much now. But the body does tend to want to clean up and consume damaged proteins. Autophagy means like you're literally eating yourself. Correct. So eating all the waste products. Eating the waste products, yeah. And Pac-Man goes around and cleans up the place.

Correct, and if you never fast, you just become this increased collection of garbage in your body. The whole three meals, three snacks, eat late at night, after dinner snack, and wake up eating right away, that's a bad idea. It's a bad idea. And what's ironic to me is that even going back 15 years ago in the bodybuilding, in the weightlifting, in the general health community, the mantra was don't go more than two hours without eating.

Bring your Tupperware little meals with you with some amount of protein, some amount of carbs, and no fat, skinless chicken breast, and all that stuff. It was a horrible concept. And yet the thought process was, you don't want to cannibalize your muscle tissue. And if you go more than three hours without eating, you'll cannibalize your muscle tissue. Now, all of that was predicated on an assumption that glucose was the primary fuel that we needed. When we ran out of glucose, it would cause the brain to go into a state of,

oh, my God, send a signal to the adrenals to secrete cortisol so we can basically melt some muscle tissue and send some amino acids to the liver to become glucose. Exactly. It was a horrible—again, it was all based on a concept that somehow assumed that glucose was the muscle fuel that we needed. And if we didn't manage glucose, all hell broke loose. Now we know that fat is the preferred fuel for human movement and human activity,

and that ketones are not just a legitimate alternative energy source. They're probably a preferred energy source in many cases. Now, as a doctor, I see a lot of patients and I test them and I see the results. And it's humbling because you can come up with all these great theories, but then you see the individual in front of you. And I've had patients I put on a ketogenic diet eating butter and coconut oil all day and they lose 20, 30 pounds. Their cholesterol comes down 100 points. Their triglycerides drop. Their good cholesterol goes up. Somebody else does that and all their numbers go terrible

and they start getting really bad cholesterol numbers. And I'm one of those guys. If I eat too much of saturated fat, I get in trouble. And I think, how do you understand sort of how to personalize this? All right, so a couple things. First of all, you know, we've never had this conversation, so I don't know what your stance is currently on this. But, you know, I've been pushing for 15 years to take the weight off cholesterol as a bad guy.

You know, the cholesterol is not the proximal cause. In the blood or in the diet? Both. But let's just talk blood cholesterol right now. I don't think cholesterol is not the proxy. In the blood or in the diet? Both. But let's just talk blood cholesterol right now. I don't think cholesterol is a bad guy. Cholesterol is one of the most important molecules in the human body. It's integral to life. The body makes 1,300 milligrams a day, whether or not you have any in your diet.

And to vilify it and spend a trillion dollars for the last 15 years to try and eradicate it in humans is absolutely unconscionable. Through statin medications. Through statin medications. And I shared with you before the show. So I just had some blood work done. I'm between 245 and 290 on my total cholesterol. But my HDL is 98. That's the good cholesterol. That's the good cholesterol. And my triglycerides are always below 75, sometimes 45 or 50. My A1C is 4.9, which you know to be. That's your average blood sugar, which is really low. Really low. Fasting insulin is between 6 and 7.

It can be as high as 45 in some people. So all my markers are great, except that if you didn't ascribe to that whole cholesterol theory, you'd go, oh, my God, Mark, we've got to put you on a— Everything looks great. By the way, I had a full scan of my carotids and all my blood supply to my coronary arteries, my liver. I mean, they were digging in so deep, I thought, oh, my God, they're looking to see if I have colon cancer. But they were trying to get at my kidney supply. And they said, you know, you're clean.

You got like the blood supply of a 30-year-old. It's clean as can be. That's all that counts, Mark. I don't care what my cholesterol numbers are. But aren't some people more at risk, though? Some are. But again... Is lean mass hyper-responder phenomena? Yes. And it all, I think, comes down to... And I'm not a doctor, so I'm only giving you my opinion. You can opine with greater, you know, I guess you have more liability for saying it than I do. I have no liability as long as I say I'm not a doctor. But it's inflammation and oxidation that are the primary culprits here.

And so if you have an otherwise inflammatory lifestyle, inflammatory diet, we can talk about sugar, we can talk about stress, we can talk about, you know, and then we can talk about some familial predisposition. Yes. But in general, so back to your two people, some succeed wildly on the ketogenic diet, and some not so much. But the not so much, if you're evaluating just on short-term blood markers, I'm not going to say it's not working. I'm just going to say that's, you know, if you're keto and you're good at burning fat, you got to transport the fat somehow to the muscle cells. You've got, you know, there are a lot of things going on here.

Yeah, we just don't know. And we just don't know. Now, some people having said all of that, some women in particular, are not good responders to keto. It may be. Who shouldn't be on it. Well, so I think pregnant women probably, you know, you just work with, if you want to do this and you insist on doing this, work with somebody who knows what they're doing. Right? And I wouldn't, you know, I wouldn't introduce a three-year-old kid to a ketogenic diet. Right. You think it's something everybody should be on?

I think at some point in their lives, everybody should be on it because it's the human experience. So you think cyclical keto, that's the idea? Cyclical keto, yeah. So do you ever go above the 50 grams of carbs? Oh my God. Last night, I'm visiting here in los angeles my daughter is a great chef and she made a lasagna last night like i'm not gonna not eat two servings of that i mean you know and it was somebody's birthday and we had some pie and you know i didn't sleep as well as i as i would have had i not done that but i also like, I'm totally comfortable in the fact that...

So then you go in and out. In and out. And that's... That's what we historically did. That's exactly. So when we talk about, you know, were humans, you know, always keto? No, we were, there were periods of time when we were, there was no access to food. You were like, automatically, you were obligatory keto when you didn't eat. But because you didn't eat processed crap and industrial seed oils that would infect your insulin sensitivity and all these other things,

even if you came across a treasure trove of bee honey or it was late in the season and you had a bunch of fruit, you'd store it as fat, but then you'd go right back to being keto when the food supply was cut off. Yeah. And you didn't go, as some of these people do, well, you know, whenever I have more than 60 grams or 70 grams of carbs, I get kicked out of keto.

Kicked out of keto means nothing to me. Like, I don't even care what your keto numbers are. So you don't think about measuring it or tracking it? No, I think it's a parlor trick. So what will happen is people who are new to keto will go, they'll chase the numbers, right? So they'll say, well, I didn't eat any carbs today, and I just had MCT oil, and I had my bulletproof coffee and whatever, and I'm showing 4.5 millimolar or 6 millimolar.

Yeah, baby, I'm keto. Well, you're keto. You're producing ketones. But one of the things you've got to look for is you're just pissing those out. So your body has not become good at using them yet. You'll get there, but right now your liver is going crazy trying to make ketones, and you don't know how to burn them. So once you build the metabolic machinery to burn ketones,

and once you build the facility— And it doesn't go away when you have a pie and lasagna. No, exactly, exactly. So let's talk about that. Once you build that— you spent three weeks, four weeks building that metabolic machinery, you've reset your metabolism to one of metabolic flexibility and metabolic efficiency. Then if you go off the wagon one meal or eat one day of 300 grams of carbs, you might feel bad, but you just come right back to where you were.

It doesn't shift all the way back to being a sugar burner. Now, if you did it for three more weeks of just doing sugar, the body would say, well, I guess we don't need this expensive machinery lying around burning fat all the time now. I guess we're going to just go back to burning sugar. So we'll let all of these things atrophy. I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. Just a reminder that this podcast is for educational purposes only.

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