The Dr. Hyman Show - The Science Of Protein And Longevity: Do We Need To Eat Meat To Live To 100? with Dr. Donald Layman

Episode Date: April 26, 2023

This episode is brought to you by Rupa Health, BiOptimizers, Mitopure, and Joovv. Skeletal muscle is the currency of healthy aging; it’s an essential lever in maintaining optimal metabolic health, reducing body fat, and supporting longevity. And a major piece of building and maintaining muscle is protein consumption. Today, I talk with Dr. Don Layman about the science of muscle mass, optimal protein requirements for chronic disease prevention, performance, and much more.  Dr. Layman is a Professor Emeritus in the Department of Food Science & Human Nutrition at the University of Illinois at Urbana-Champaign. He served on the faculty at the University of Illinois from 1977 - 2012. Dr. Layman earned his B.S. and M.S. degrees in chemistry at Illinois State University and his doctorate in human nutrition and biochemistry at the University of Minnesota. He is recognized for research on protein and amino acids for muscle health related to athletic performance, obesity, diabetes, and cardiometabolic health. Dr. Layman is also a nutrition consultant to the food industry. This episode is brought to you by Rupa Health, BiOptimizers, Mitopure, and Joovv. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. Get 10% off BiOptimizers' Sleep Breakthrough and get a free bottle of Magnesium Breakthrough when you buy two or more. This is a limited-time offer. Go to sleepbreakthrough.com/hyman and use the code hyman10. Get 10% off Mitopure at timelinenutrition.com/drhyman and use code DRHYMAN10. For a limited time, get an exclusive discount on Joovv’s Generation 3.0 devices (some exclusions apply). Go to Joovv.com/farmacy and use the code FARMACY. Here are more details from our interview (audio version / Apple Subscriber version): The early work that led Donald to muscle-centric health (5:54 /3:42)  Protein, carbohydrates, and insulin resistance (19:43 / 14:04)  Why all calories are not equal (29:51 / 26:15)  Weight-loss research looking at high-carb, low-protein diets (35:14 / 30:58)  High percentages of women in certain age groups don’t eat enough protein (43:15 / 38:57)  How our protein needs and metabolism change with age (46:17 / 41:40)  Meeting protein needs with a vegan diet (52:37 / 47:08)  Protein quality and muscle growth (1:01:29 /  55:25)  Healthy aging, muscle, and MTOR (01:10:35 / 1:06:16)  How much and when should you eat protein? (1:18:07 / 1:15:35)  Me at age 40 vs age 60 Find Don on Twitter @donlayman and learn more through his website, MetabolicTransformation.com.

Coming up on this episode of The Doctor's Pharmacy. We're talking about kind of middle-of-the-road sort of diets. We're not talking about keto carnivore. We're not talking about vegan. We're talking about sort of in-between, which people can exist at the extremes, but the average person really is gonna be best off at sort of this middle ground where they're protein-centric,

they're protein-conscious, and they keep their calories under control. Hi everyone, it's Dr. Mark. As a functional medicine doctor looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables, it helps me find the most effective path to health and healing for my patients. But such extensive testing can be very complicated and time-consuming for both the practitioner, somebody like me, and our patients. But lab ordering became very quick and painless since I started using Rupa Health. I can order, track, and get results from over 35 different lab

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a place for conversations that matter. And if you're confused about nutrition and specifically about protein, how much you should eat, what kind you should eat, is it better to be vegan, better to be a carnivore or somewhere in the middle. This is going to be an enlightening conversation because it's one with the world's expert on protein, Dr. Donald Lehman, who's a professor emeritus in the Department of Food Science and Human Nutrition at the University of Illinois, Urbana-Champaign. He served on the faculty of the University of Illinois from 77 to 2012. He's got his BS and MS degrees in chemistry at Illinois State and a doctorate in human nutrition about chemistry at the University of Minnesota. He's recognized for his research on protein and amino acids for muscle health. And we're going to talk lots about muscle today. And

I'm way more interested in muscle today than I ever was because I'm getting older and I come to understand that muscle is the currency of longevity and how muscle relates to athletic performance, to obesity, diabetes, cardiovascular health. And he's also a consultant in the food industry and very active helping get the word out about protein and nutrition and health. So welcome, Dr. Lehman. Well, thank you, Mark. It's great to meet you, and thank you for that introduction. Well, I appreciate you joining me today. I've known a bunch of your students, and I figured, why not get it from the horse's mouth? So here we are. And I'm very interested in this topic

of protein, particularly as it relates to longevity and aging and how we age better. And I know you were part of the ProteAge group, which looked at a lot of the literature on protein and aging and what's optimum and what's not and what kind of protein and when to eat protein and all these questions. And I covered in my book, Young Fervor, but I really wanted to get into the deep science with you because I think so many people are confused about what to eat, even longevity experts. Many of them are vegans and think that that's the best way to extend your life. Others, you know, are more focused on building muscle and longevity, like Peter Atiyah was a colleague and friend of mine. So there's this whole confusion among the scientific community, the mental community. So the lay person is probably sitting at home going, well,

those guys can't agree. What the heck am I going to do? And I'm just going to eat my bagel and have a good time here because they can't get their crap together. So I'm so excited to have you talking about this. And in your career, you're really, your focus has been on muscle development, malnutrition in children at the beginning. And I wonder how this work sort of led to you coming up with this idea of muscle centric health. Cause let me, let me tell you something, Dr. Lehman as, as a doctor, I don't ever remember a course on muscle other than like, this is this muscle, this is that muscle and anatomy. But I never really took a course on truly why muscle is important, how you take care of muscle. Like I know how to take care of your

heart and your liver and your kidneys, but like muscle is just was a part of your skeleton. So what, who cares? Like, as long as you have it and it's working and it's not damaged, then that's fine. But you, you've really come to understand that muscle is the key to healthy aging. So can you take us through that discovery on your part of how you came to understand that and what that means. Yeah, wow, that unlocks and unfolds a whole lot. So let's wade into it. So I got into the whole field kind of accidentally. You know, I grew up on a farm in Illinois. So I watched animal growth a lot. So I understood about diet and exercise. And I was very interested in science. So I watched animal growth a lot. So I understood about diet and exercise. And I was very interested in science. So I went off and studied biochemistry. And one of the first things I got into was studying protein synthesis, an individual by the name of Arlen Richardson at

Illinois State University. And he was really well known in the aging field. And what we discovered in my master's was that as we age, the process of synthesis becomes less efficient. There are things that change. Our ribosomes aren't as active. The messenger RNAs change. They don't have the long poly A tail. The whole process becomes less efficient. And that's part of the aging process. And I'll come back to that. Then as I started going on into nutrition, I got involved with a group that had a big interest in muscle. I was always interested. I was sort of a pretend athlete. I was always interested in athletic performance. And so muscle was kind of inherent to me. As we started looking at malnutrition, and then I got the opportunity actually to work in Northern Africa with malnutrition. One of the things I found very quickly was with children is if they had nutrition insults really early in life, really in that first year, they would reduce the number of nuclei,

the number of muscle cells that they could develop. And so they had a reduced muscle mass. And what I learned was that that was basically predestining them to obesity. So I started thinking about, wow, muscle really has a big role in body composition. And so early in my career, we ran a lot of rodent studies, kind of looking at malnutrition at different ages, and things like that. And we found that, that relationship of muscle to obesity. And so from there, I sort of got interested in the obesity question. And clear back in the early 80s, people were looking at obesity and fat cell number and brown fat and all of that, and basically doing really interesting research that got them

nowhere. And I finally decided that the reason is they were studying the pathology of being fat as opposed to a way to become healthy. And the way to become healthy was a metabolically active tissue muscle. And so that was sort of the whole kind of background to it. Other pieces of the puzzle is people talk about protein and metabolism. We were studying protein turnover, and we realized just how expensive that process is. I've seen estimates that protein turnover in the body actually accounts for as much as 40% of resting metabolism. 40%. And you know,

some people would say 20, it all depends on how you want to factor out transports and breakdown and all things. But anyway, the issue is it's a really big part. And so that kind of all rolled together to me that if we want to look at health and long-term health, what we need to do is maintain protein turnover because that maintains your body proteins healthy. And it also maintains your metabolism healthy. And that's sort of how, you know, Dr. Gabrielle Lyon and I sort of put together the concept of muscle centric health, kind of protein centric diets. Yeah, what's so interesting is that,

you know, most of us don't think about metabolism as the source in our muscle, but that is the greatest source of our ability to burn calories and regulate our metabolism. I'm not sure. I think the better way of saying is it's the most flexible way to burn calories and metabolism. The heart, the kidney, the brain, you know, and a resting metabolism, something like, and I forget the numbers off the top, I should have looked it up. You know, 70% of resting metabolism is organ based, but muscle is another part. And

it's flexible. How much do you have? How metabolically active is it how much exercise that changes the picture and when we look at energy balance long term we're talking about you know 100 200 calories per day so this is well within the realm of what muscle can manage yeah so i think to me you know as i sort of looked at my own biology and my end of one studies and I've treated, you know, tens of thousands of patients. So I've seen this in my patients, but I, you know, I, I was a very active guy my whole life. I ran, I did yoga. I did not think protein was that important. You know, in my earlier years, we learned about, you know, the importance of, you know, carbohydrates as a source of energy.

And that's what we should be doing. And in the 90s, we learned about the food pyramid and should have six to 11 servings of bread, rice or pasta day. And that's when I was, you know, running every day. And I mean, I literally ran four miles to medical school every morning and four miles back every night, you know, and I was fit, but I didn't have very much muscle. And I look at, I picture myself at 40 and now, and my body looks completely different. And I'm not a, I'm not a gym rat. I hate the gym, but I really only started strength training through bands, you know, three years ago at six years old. And I'm just sort of shocked to see the change in my body composition and my body using the science of having the right type of exercise combined with the right kinds and amount of protein at the right times and i you

know i i'm quote older right and so i have this this tendency to what we call anabolic resistance which means it's harder to build muscle as you get older which what you were saying and and yet i find i'm able to do it by sort of using this sort of science. And I really, which sort of shocked me to realize how much our dietary advice was so wrong about eating, consuming, you know, large amounts of carbohydrates, not paying attention much to protein, worried about too much dietary fat. And it's really created this epidemic of obesity, metabolic syndrome, and all the consequences of that relate to aging. And sort of, to me,

you know, I may be a little late to the game here, but to me, understanding the role of muscle and aging has been so key. And looking at sarcopenia, which I want to get into, which is muscle loss, and looking at how we kind of address that as we get older, or even at any age is so important, because on an abstract level, we can, you know, talk about the science of this. But the question people really want to know is, what do I have to do to build highly effective functioning muscle that keeps my metabolism good and keeps me living well and healthy and a long time? I think part of the confusion is one nutrition is actually quite a young science. I often tell my students that, you know, I actually got into nutrition for learning from the first generation of nutrition researchers. So I'm kind of like a second generation, you know, and aging does affect me now.

The, you know, and so it's a young science. Nutrition really grew out of studying growth in children. And what we now know is that protein metabolism is very different in a growing child than it is in an aging adult. And that's something we've really just discovered in the last 20 years. One of the things we, you know, we've discovered is issues of how much protein do you need and distribution and muscle focus before it was really just about maintaining growth curves. And what we know is that you can have a child eat small meals of eight to 10 grams of protein, and they'll grow perfectly fine. You can have them have five meals a day of snacking

on 10 grams of protein, and they'll be absolutely fine. But that doesn't work in adults at all. Adults, children are really driven by hormones, insulin, growth hormone, IGF-1, etc., where adults are no longer driven. Their metabolism is not driven by those hormones. They're now driven by diet quality and, in the case of muscle, exercise, particularly resistance exercise. And so those are some of the things we've discovered in looking at things like leucine and mTOR is we know there's a balance there of how to affect it for adults. And one of the things I like to tell people is, you know, the average person, if you ask them about protein, they'd say, well, it's really important for children because they're

growing. Well, growth only accounts for about five grams per day of net gain, maximum growth, where everybody, you and I or a 16 year old has to make 250 to 300 grams of new protein per day just to replace body proteins. We're constantly repairing and replacing. And the issue of aging is that process becomes less efficient. And one of the things we've discovered is that from a muscle standpoint, we can make that efficiency better if we choose the right amount of proteins and the right amount of resistance exercise. So the process of aging, we know it's a slope. What we want to do is change the angle of that slope. And we know that's a slope. What we want to do is change the angle of that slope. Again,

we know that protein and exercise can do that. Yeah, that's right. And I think most of nutrition has been focused on fat and carbohydrate and protein sort of the neglected nutrient. Like, oh, you get on protein, whatever, 20% or not, you're fine. You don't have to worry. It's fine. The truth is that it's such an essential part of of our nutrition not only in terms of uh as you said replacing all the 100 grams of proteins we use for all sorts of things from our immune system to structural proteins to you know brain chemicals i mean just peptides i mean we just go through so much every day but it's so important in terms of of keeping your metabolism healthy as you get older,

which is the key to longevity. And the phenomenon that happens is insulin resistance, which is this phenomenon of like pre-diabetes, diabetes, or the continuum from normal all the way through that. And a big way of combating that is not only cutting back on starch and sugar, but it's optimizing your muscle health function and amount. And so can you talk about the role protein plays in weight loss and regulating our blood sugar and regulating our cholesterol and triglycerides and our hormones and reversing prediabetes? You know, tell us about that. And particularly, you know, if we just sort of talk about weight loss, we're all talking about calories. Well, calories, the old story about

weight loss, and I think it's the old story because I think there's a new story, is that it's all about energy balance. Calories in, calories out. As long as you don't overeat and under exercise, you're fine. And that turns out to be not quite the story, because if you eat a high carb, low protein diet, you may not get the same benefit as if you're eating adequate fats and protein and less carbohydrate and starch. So can you talk a little bit through that whole range? It's a lot, I know, but you can take your time and pack it off. But I think it's really where the money is. Yeah. So my whole career we've been studying protein turnover as i said and sort of understood how much that impacted metabolism so i'll come back to the

protein side but in the late uh 90s we had the atkins diet and the zone diet and we had all these diet we had the j Jerry Riven sort of discovering the concept of metabolic syndrome. Yeah. Max. And the debate out there was kind of a carbohydrate versus fat debate. And it wasn't really going anywhere. It was kind of stuck. And I thought, you know, the reason they're not getting it is it's not really a carbohydrate versus fat. It's a calorie versus protein discussion. And so we started running a series of studies looking at substituting protein for carbohydrates. So the protein, what we knew, as I mentioned earlier, is that protein had a big impact on energy expenditure. In fact,

people talk about thermogenic effects of protein, and the Freshman Nutrition book will say it has something to do with digestion, absorption, metabolism, which is nonsense. It actually has to do with protein turnover. Protein turnover is a very expensive energy process. And when you trigger it at a meal, one of the things we found with animals is the amount of ATP expenditure during, say, an hour of treadmill running in an animal is about equivalent to the same effect of giving a protein meal. So you can either eat a protein meal, or you can run an hour on a a treadmill and you spend the same amount of calories. So that kind of triggered us to thinking about muscle.

And we know that there's also satiety effects of protein. We know it repairs body functions. We know that there's this interaction with insulin. So let's go to the insulin story. If you look at insulin resistance forever, everybody sort of tried to target fat. And you can design high fat rodent models. You can define, you can design obesity models and they will cause insulin resistance. But what people, and there's a Randall hypothesis that high free fatty acids inhibit carbohydrate metabolism, and it feeds back through ceramides and diacylglycerol, and it causes insulin resistance at the receptor and all of that. And you can show that that works. But what has also been shown is that

carbohydrates cause insulin resistance. It's an energy balance thing. And what Bob Wolf showed was that if you look at the two of them together in a highlight, you know, with really sophisticated stable isotope metabolism, what you'll find is that carbohydrates always dominate metabolism. And so can you explain what that means? Dominate metabolism? Yeah, I will. So So if you look at the American diet, we get about 50 55% of our calories from carbohydrates and 30 38% from fat. So the dominant issue is carbohydrates. So that means associated with every meal, we have this big influx of sugar, of glucose, and the body has to dispose of it. In fact, diagnosis for diabetes, as you know, is a two-hour glucose tolerance test. And so that means basically after a meal, we have to dispose of whatever carbs came in in

that meal in two hours, or by definition, we're diabetic. And so to do that, say, for example, the average American is eating close to 300 calories per day, 300 grams per day of carbohydrates. So just simple math, put 100 grams in a meal, that means you have to dispose of almost 100 grams after every meal. Well, the body only has a capacity of just easy capacity of disposing of about 30 to 40 per hour. So that means we're distorting metabolism with another 40 or 50 grams of carbohydrate. And the way we do that means we're distorting metabolism with another 40 or 50 grams of carbohydrate. And the way we do that is we basically begin to disrupt muscle metabolism. Muscle is primarily a fat burning tissue.

So wait, wait, wait, wait. What you're saying is that carbohydrates, too much excess carbohydrates from starch and sugar disrupt muscle function and metabolism. Exactly. And it disrupts fat metabolism. So basically, the body has to get rid of that carbohydrate or it causes all the damage we know as diabetes. So it basically shuts down all the fat metabolism. And hence, we get higher blood lipids. Okay, that's not because of eating the fat is because of eating the excess carbs. And so what we have to look at is what is the balance? How many carbs can we use?

So just slow down for a second. You said so much important stuff there. You said that, that when you eat excess carbohydrates, it interrupts your muscles ability to regulate your cholesterol and your triglycerides. I didn't say cholesterol. I said blood lipids. Lipids. So what did you mean by that? Triglycerides particularly, free fatty acids. Which basically are produced by eating too much carbohydrate, right? Triglycerides are measured in a fasting condition, as you know. And so basically they reflect recycling of fatty acids from adipose tissue. However, when you have a high carbohydrate diet, now you have to go into de novo synthesis of other fatty acids, and that will elevate your triglycerides. One of the things that we found in our weight loss studies is if we take individuals and lower their carbohydrate intake from 300 grams,

whatever they're normally eating, down to the RDA, which is 130 grams per day, we will drop their triglycerides by 20% or more no matter where they start at. So we actually use that as a biomarker for a low-carb compliance. If you don't drop, if they don't drop their triglycerides by 20%, you know they're not following a low-carb. You can tell they're cheating

and having that extra bagel. Exactly. It's so predictable. Hey, everyone. It's Dr. Mark. I've been working hard on my book, Young Forever. I'm super excited and proud of this book because it takes my decades of functional medicine experience and distills it into a program anyone can adopt to reverse the effects of aging. As I've dug into

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that's joovb.com forward slash pharmacy, F-A-R-M-A-C-Y to get your discount. Now, there may be some exclusions, but I'd encourage you to check it out. And now let's get back to this week's episode of The Doctor's Pharmacy. So the balance is the muscle has two primary fuels. It uses fatty acids and uses glucose. Its preferred fuel is fatty acids, but when excess glucose is around, it inhibits transport of triglycerides or fatty acids into the mitochondria, you get the accumulation, and carbohydrates themselves will cause insulin resistance, they'll feed back to the insulin receptor and muscle. And so people say, well, obesity causes insulin resistance, but actually just excess carbohydrate causes insulin resistance. Yeah. So that's a very different model because I think

people say, well, you, you, you become diabetic or insulin resistant because you are obese and you're saying a little bit something different. I think obesity, obesity is a symptom of diabetes. It's a symptom of insulin resistance. Which comes first? Well, we tend to not look for those characteristics until somebody comes in and they're obese. They have high blood pressure. And we say, we should look at your glucose. Oh, your fasting glucose is high.

We should look at your insulin. Oh, you're diabetic. But the reality is it's the other way around. It starts with insulin resistance and you're diabetic. But the reality is, it's the other way around. It starts with insulin resistance, and you become obese. Well, that's interesting, because that's exactly what David Ludwig talks about, who's a Harvard researcher about the carbohydrate insulin model of obesity, which is that you become sort of insulin resistant, and that leads to obesity and that it's really the sort of overeating is not the cause of obesity but obesity becomes the cause of overeating in a kind of a perverse way because essentially your your fat cells become hungry and you become insulin resistant so you

need to eat more to satisfy them yeah i don't buy that kind of thinking exactly. I think of it as a muscle centric issue, as you mentioned earlier, when you were, you know, a 20 year old athlete, you could eat any carbs you want. Well, I didn't have muscle, though mass, the muscles were still very actively burning it. As we get older, you know, once we reach 40 and beyond, now that metabolism begins to slow down. The question is, did you change your diet to drop your carbohydrates in half? And most people would say, no, I probably increased them. And so, you know, that's part of the issue. So, you know, I do feel that carbohydrates actually are a more risky metabolism, more risky macronutrient than fats,

because they dominate metabolism. Fats are much more passive in metabolism. I don't really buy the whole insulin obesity theory in quite the way it's projected, but calories aren't equal and carbohydrates are a more risky issue. If you want, again, if you take a muscle centric approach, keeping muscle healthy and and insulin active uh is your goal if you're taking a fat centric approach now you're trying to treat the inflammation or the pathology of being fat and now fats probably do make a difference i'd say you know to people you know if you're committed to being overweight and obese then probably the fat you choose make a difference. But if your goal is to be normal weight, then your calorie total is what matters. So take us through that, because I'm sort of hearing a conflict in what you said between carbohydrates being worse for your muscle and for your overall health. And yet you're saying, you know, all calories are not necessarily

different in that way. So I'm a bit confused, and probably my listeners are confused. Sure. So carbohydrates are an important fuel for muscle. And so out of the 70s and 80s, we got the idea that, you know, blood sugar and carbohydrate loading, and all of that was very important for performance. But now we're talking about very high end performance. So if we're talking about people who are basically sedentary, maybe go for walks and things, muscle wants to use fat. And so loading up the body with a huge amount of carbohydrates, 300 grams per day, means the majority of those are going to have to be converted into fat. Because we can't use, the muscle isn't going to use them. If you're running eight miles a day, as you were, you can burn 300 calories per day. But if you're basically sitting in front of a computer all day, 130 maybe max that you can use. When we're talking-

You mean grams, grams. Grams, that's right. Thank you. When we're talking to individuals about their carbohydrate threshold or their carbohydrate needs, we basically say, well, 130 grams is the recommended dietary allowance. That allows for five servings of vegetables, two to three servings of fruit, and three servings of grains, okay? That's the RDA. Basically, every gram of carbohydrate you use above that has to be accounted for by exercise

at basically the rate of about 60 grams per hour of medium to higher intense exercise. So basically, the average American with 300 grams per day needs to have three hours per day of active exercise, high intense exercise to account for it. Otherwise, you're going to be obese. It's a carbon. I mean, just by simple math, if 55% of our calories come from carbs and 35% from fat, how can fat be the problem? So you're saying that it's our excess carbohydrates that are driving a lot of the obesity epidemic? Absolutely. I mean, that's where we're eating the excess calories. And that's frankly, the easiest one to change you know if you people who are you know the paleo carnivore

type of diets if you reduce your grain consumption most people will get their calories under control yeah i think that's right i think i think we we you know you know calories do matter it's just i think that you know my experience is if i focus on the quality of the nutrients that my patients are eating, and I tell them to reduce the refined starch and sugar, increase plant, you know, rich foods in terms of vegetables and fruit, and have good quality fats, that I don't really have to tell them to lose weight or count calories, that it naturally will sort itself out. And their metabolism will actually increase when they do that. And I hear that's

what you're saying. Yeah. When we teach it in our weight loss clinic at the University of Illinois, the way we taught it was you make your protein centric decision, how much protein am I going to be? And that may be vegetarian, it may be carnivore, but you make a decision about protein, then you can eat all of the high, you know, the colorful fruits and vegetables and berries, the high fiber type of plants you want, those are your fillers. And then the starchy, sugary things, the bread, the rice, the potatoes can never be larger than, you know, basically-to-one ratio with the protein. And if you do that, you literally can't overeat. It's virtually impossible to overeat the protein part.

Right, right, right. People can eat a bag of Chips Ahoy cookies, but it's hard to eat like a 30-ounce piece of meat. Yeah, you know, you go out and you have a dinner, say you had an eight ounce steak and they come to the end of the meal and they say, well, would you like chocolate cake or another eight ounce steak? Very few people will choose the eight ounce steak. You just can't eat more of it. It's very, you know, it's satiating. You just get full of it. Even if you like, even if you're a carnivore and you like it you you just get full of it even if you like even if you're a carnivore and you like it you still get full of it now you you can always eat another donut that is true so you basically um we're sharing you know some of your research around the how um

eating the same calories if it's higher carb low low protein, won't give you the same results as eating the same calories if it's higher protein, lower carbohydrate, right? Right, right. Can you explain that? Yeah, so we did a series of weight loss clinical trials. The reason I'm asking, sorry to interrupt, is because most of us still believe that it's just about energy balance. Calories in, calories out is all you have to worry about. And if you burn more than you eat, you're going to be fine. And the reality is the

choice between carbohydrate and fats, it's pretty much calories in, calories out. They kind of burn about the same. But protein is totally different. So let me describe. So the second of the series of studies that we did was a two-by-two experiment where we had high-carb, low-protein. Basically, it was the food guy pyramid. Followed it exactly. So a great diet, right? And the other diet was a high protein, reduced carb. Basically, we substituted protein for carbs, gram for gram. Okay. This was four months, 16 weeks, 48 women on the study, uh, at the end of it, both groups lost weight. So calories

do matter. Uh, I may not quite get these numbers correctly. Women on the high carb diet, not using exercise loss, 14.8, uh, pounds. I think it was pounds. Yeah. 14.8 pounds in the 16 weeks. The women, and then we had another group, same diet, but doing exercise. So this exercise, we can get into the exercise issue, but they were doing seven days a week, 30 minutes a day of exercise. 16 weeks, they lost a tenth of a pound so went from 14.8 to 14.9 uh so really no difference from the effort but if we looked at the body composition the individuals who are on the high carb diet low protein uh 64 of their weight loss was fat which means 36% was lean tissue. And we believe that is one of the issues for diet rebounds that people are losing their lean tissue, particularly muscle during these restrictions. And therefore, their ability, their resting energy expenditure, their ability to burn calories goes down,

they will rebound. And when they rebound, they'll gain back the fat and not the muscle. Yeah, we're soft for having doing it. So the carb group plus the exercise, what we found is that the composition went to 78% of the weight loss was fat. So now only 22% was lean. So the exercise had a bit, it didn't show up on the bathroom scale, but it showed up in composition. That matters for metabolism, right? Much tremendous effect on metabolism. Next group then is the low carb, high protein. After same 16 weeks, what we found is they lost something in the 17 and a half pounds. So with the exact same calories, they lost three pounds more weight. And what we found was they lost almost 300, they burned almost 300 calories per day more. What we then looked at body composition and their composition was 76% fat loss, 24% lean.

So basically the carbohydrate was seven days a week of exercise was the same as doing a higher protein diet. Without exercise. Without exercise. Yeah. exercise without exercise yeah so just basically changing your diet to higher protein was equivalent to adding seven days a week of exercise which of those looks easier and did the fat remain constant in terms of calories the dietary fat was just slightly higher in the high protein diet so uh in the low protein in the high carb, they had approximately 40 grams per day of fat. And in the high protein diet, they had approximately 50.

So a little bit higher. Same calories per day, though, slightly different macronutrient composition. The last one, we went to the high protein plus the same exercise. They now lost 19 and a half pounds. So five pounds more doing exactly the same effort, same diet, same calories. And now the weight loss was a little over 90% fat, only less than 10% lean. So basically, we saw the synergistic effect. And so one of the things I like to point out is that basically, you know, you know, the synergistic effect of protein plus

exercise, as far as body composition, but the converse of that is that a high carb, low protein diet negates the benefit of doing exercise. Well, that's a big discovery. If you're eating a high-carb diet, you can exercise and you're not getting ahead. Basically, following the food guide pyramid dramatically reduces the effect of doing exercise. That's not a good message. Let me summarize this. So basically, if you eat a high-carb diet, lower protein, and exercise, you're worse off than if you don't exercise and need a higher protein, lower carbohydrate diet. And the other thing I want to clarify is I learned that muscle obviously burns far more calories than fat.

And I heard seven times as much. So if you actually are gaining and losing weight, and I don't know if the seven times is right or not. I just learned that years ago, and I had that stuck in my head. But it's definitely more. But so if you lose weight, and then you gain back the weight, you're losing muscle and fat, but then you gain back the weight you're losing muscle and fat but then you're getting back fat so basically you could be the same weight you were when you started

and actually have a slower metabolism and being burning less calories so you actually eat less and i've seen this in my patient go i don't eat that much and they're very obese and i'm like this is because you've basically replaced your muscle with fat and it's you're such you have such a slow metabolism yeah yeah it's uh i mean that's that's what people refer to as the yo-yo dieting problem is that you lose weight the bathroom scale says you're being successful but you're not correcting body composition uh and you know when you gain it back, adults don't gain back body muscle very well. It takes enormous amount of resistance exercise to gain it back. So when you gain it back, what you gain back is the fat.

And so now what you have is a worse body composition. One of the things my dieticians, when we were doing the weight loss studies, they always used to, when they brought people in, they would always ask them about previous diets. And they always referred to individuals as weight loss virgins, because if they were, they hadn't gone through yo-yo diets, they would be much more successful on any of our treatments. So if they'd already messed up their body composition with previous diets, they were never quite as successful. It's so interesting. And, and, and when you're talking about the protein, those diets, what was considered high protein, like in terms of point, uh, what programs? So we were, you know, so the, the food guide pyramid recommends the RDA. So that is 0.36 pounds per day per hour, 0.36, sorry, 0.36 grams per pound.

Yeah. Anyway, that's the minimum amount for just maintaining optimal amount for. Absolutely. It's the minimum that you don't see deficiencies. And just for frame of reference of women over 65, 40% are below that number. 40% are below that number. So back to the diet. Wait, wait.

That's just a huge bombshell you dropped. Because the prevailing narrative out there is that we as Americans eat too much protein. And you just said that 40% of women over 65, you said, don't get enough protein. Don't meet the minimum. Minimum. Not the amount we need for optimal health, but the minimum. Basically, how much vitamin C do you need to not get scurvy? 60 milligrams.

It's not very much, right? Or how much vitamin D do you need to not get rickets? 30 units. So you're talking about really not optimal levels for health. Maybe you need 1,000 or 2,000 or 5,000 for vitamin D to be healthy, right? And I don't quite remember the statistic on this one, but in women 16 to 26, I think it's 30% are below the RDA. 16 to 26, 30%. Yeah, very young women.

You know, they're all conscious about weight loss and how they're eating extremely low. So we've got the two extremes. Men, not so much. Men tend to make the minimum, okay, but again, not the optimum. We think the optimum is about twice the RDA. So 0.8 grams per kg. Our diets were aimed at 1.5, 1.6. In women, we find the metabolism, there's a threshold of around 100 grams per day.

If they fall below 100 grams per day, we lose a lot of the metabolic effects. So we tried to target women in the 100 to 120 grams per day range. And people say, well, it relates to body weight. Yeah, true. But in our weight loss studies, we had women everywhere from 140 to 300 pounds, and we found that number still worked pretty well. That's remarkable. I mean, that is a lot more than most people are thinking about as being. And now you're talking about a younger person, you're not talking about someone who's like 70, who may need even more than most people are thinking about as being and then and that you're talking about a younger person you're not talking about someone who's like 70 who may need even more than that so we're talking about you know metabolism that's really geared for people over 40

again i mentioned earlier that young people will grow on small amounts of protein distributed. And, you know, when we're young, we can kind of abuse our bodies and it looks okay. I know, I'm not, I'm not, I'm not, I'm not able to abuse my body like I used to for sure. I know that. A 20 year old female on a really low protein diet probably is okay. But you start getting a 60 year old female low protein diet, and they're not going to be as okay, you're going to see it in their skin, you're going to see it in their hair, you're going to see it in a lot of their muscle mass, you're going to see it in different ways. So, you know, we always want to kind of realize that young people and older adults are very different in how we think about metabolism.

You know, we always say that, you know, someplace in the end of your 30s to your 40s, you should be making a pretty conscious diet change. And most people aren't. So you're not even talking about when you get to 50, 60 or 70, you're talking in 30 or 40s, we need more. It's measurable. We can measure these changes in protein metabolism. And people know you can measure changes in bone metabolism starting in the 40s, we need more. It's measurable. We can measure these changes in protein metabolism. And people know you can measure changes in bone metabolism starting in the 40s. So in that fourth decade, you know, after 40, we know that some of the things that we

measure in terms of distribution of protein, protein at meals, we can detect the difference in mid 30s. Wow. Well, you're saying a sort of revolutionary and goes against a lot of the prevailing views out there, which is that- I've told that before. But it's based on your, it's not just based on nothing.

It's based on decades of research and very rigorous research. It's based on 40 years of research where we have actually tested these things and measured that both in animals and in humans. And we're pretty confident in how these work. And we know the mechanisms behind it. Yeah. Well, we're going to get into the mechanisms in a minute, but basically you're saying is that all calories are not exactly created equal when it comes to how they affect your metabolism. Yeah. Absolutely related to to protein you can have a

little bit different kind of debate about carbon fat but protein is 100 different in metabolism and it's the only it's the only essential macronutrient the other two are just calories we have there's essential fatty acids but yes right maybe three grams per day yeah we're eating 70 to 80 grams of fat per day three are essential so yeah yeah yeah exactly exactly so i i just just want to take a little sidebar for a minute and i want to get back into uh the protein conversation about what kind of protein what is the amount of protein what does it look like uh quality of protein leucine a lot of things i want to talk about. But I want to take a sidebar on another study that was very similar to yours, which put people in a metabolic lab and gave them food and measured their metabolic rate

when they had isocaloric, same-calorie diets, but one was, let's say, 60% fat, 20% carb versus, let's say, 10% to 20% fat and 60% carb. So high carb, low fat versus low fat, high carb. And this was David Ludwig's study. And what shocked me in that study was even though they were eating the same amount of calories, the metabolic rate, particularly in those who were already insulin resistant, was 400 calories slower in those who had the high carbohydrate, low fat diet. And the high fat group burned basically 400 calories more a day. Do you have any thoughts on that? Yeah, I can't really speak to that. I'm not sure I'm familiar with that specific study. Kevin Hall has some similar metabolic studies.

It doesn't find those kinds of differences. Well, those are short-term studies. Those were like two-week studies. So that's the difference. Fat adaptation takes a while. So I think that was part of the flaws in that. Yeah, I can't speak specifically to those two studies. Um, my reading of the literature is that from a calorie standpoint, fat calories, carb calories, um, there's just, there's still just calories. Um, I do feel that when you're fat is not insulin genic, right? So if you drink a liter of olive oil,

your insulin doesn't go up. So what I was gonna say is that if you're in excess calorie situations, high carb diets will cause more problems because of the insulin issues. And chronically high insulin, if you look at the time course of insulin resistance, what you'll find is that

as an individual becomes insulin resistant, the body will slowly increase the amount of insulin released at a meal to try and keep blood glucose stable. And it keeps going up and up. And so basically, it damages the pancreas, and you can no longer sustain that. And people then go to external insulin and other kinds of drugs, et cetera, et cetera. But basically, continuously increasing your carbs to force the body to dispose of them causes insulin resistance. Yeah, yeah, absolutely. Okay. Now I want to get, now I thank you for that sidebar. I want, I want to get into an area that may be as controversial as being a Republican or a Democrat or being, you know, Jewish or Muslim or whatever and I would say, you know, information out there online and in movies that seems to convince people that you can get adequate amounts of protein and build massive amounts of muscle being vegan. Now, I just got back from Rwanda. I was on a vacation. It was one of my

bucket list things. And I went to see the gorillas. Now, the gorillas, I've never seen a gorilla. They're huge, massive amounts of muscle. And they are essentially vegan, except for a few insects. And what I didn't know before I went was that they eat 55 pounds of food a day and they eat half the day and they have these enormous intestines. Those giant bellies that they have are not fat. They're their intestines. So, you know, can you speak to this whole idea of can you actually adequately meet your protein needs being strictly vegan, especially as you age? And can you talk about some of the research around, and I'll kind of repeat the question around mTOR activation and the idea that we want to inhibit mTOR, which is this part of our

cellular metabolism that activates muscle synthesis, but it also, when you inhibit it, it actually increases autophagy, which mimics calorie restriction, which is the thing that's been proven to extend life in all animal models. So help us sort of understand, one, can we get adequate protein being vegan, and especially as we age? And two, how do we deal with this basically seemingly contradictory idea that we should inhibit mTOR to extend our life, but we need muscle to be more as we age to be healthy? So help us with that. So, wow, unlocking a lot of different things there. Um, okay. So the vegan story. Yeah, you can be perfectly healthy as a vegan, but it's tough.

Basically, what we know is that to be equal, you have to eat more total protein and more total calories. So your gorillas are stuffing themselves. Basically, the solution to that is they better be physically active. And so being a vegan at 25 or 35 works a whole lot better than being a vegan at 65 or 75. Now you have both physical activity and metabolic rates going down, and it's hard to eat enough to get to it. You know, my comment earlier that 65, you know, 40% of women over 65 don't get enough protein just to be equal. And being a vegan doesn't make that better. So, so, you know, I think there's an age issue in it. My problem with vegans is, is when they sort of take a moral superiority approach to it. I just have no, I have no tolerance for that. You know, if

you want to do it for a personal reason, if you want to do it for some metabolic reason, cardiovascular disease, you've got really high LDLs or something. I'm okay with that. High fiber, okay. I'm okay with that. Is it metabolically better? I don't think so. I think that a balance of animal foods in the United, one of the things you have to look at it is not only can it be done, the issue is can people do it? And in the United States, most people have nowhere near the food knowledge or the food skills to pull that off. In the United States, we get 70% of our calories from plant based foods now, only 30% from animal-based foods. Of that 70%, 51% comes from added sugars, oils, and hydrogenated fats, and another 33% comes from refined grains. So of the 70%, 80% have no nutritional value. They're just crappy calories. And if you look at the 30%

of the calories coming from animal foods, basically, we're getting 65% of our protein, 100% of calcium, vitamin D, B12, and over 60% of iron, zinc, selenium, B6, niacin. So the question is, if we take calories out of that animal fraction, what are we going to eat? Are we going to eat broccoli and Brussels sprouts and green beans? Are we going to eat bread and, you know, candy bars and donuts and french fries? I mean, that's what Americans eat. Right right now of our plant-based protein in the u.s and worldwide 80 of the protein comes from wheat which is absolutely lousy protein source so wheat as a flour particularly not even as whole wheat right um whole grain whole wheat or not grain i mean most people don't eat wheat berries

they eat either whole wheat flour or white flour which isn't that different like I just said you know you know 33% of it comes from refined grains you know so a lot of it

is from but anyway the point is people aren't eating beans and lentils. They're eating French fries and bread. But let's say they work. Because let's just say you want, let's say, 30 grams of protein. Right. And chicken, let's say, has four ounces, which has about 270 calories.

If you want, let's say, beans, let's say black beans, that's two cups of black beans to get 30 grams of protein. We can talk about protein quality. That's 450 calories. So if you want to have 30 grams of protein, that's fine. If you want them 120 grams, that's four times that that's like, you know, 800 calories from protein versus like, versus like thousands of calories. And if you took brown rice, you have to have 24 cups of brown rice a day, which has 1,200 calories times like six. I'm not good at math, but that's like 20,000 calories a day to get enough protein from brown rice, right?

Yeah, so 100% agree. My first point was that if you're going to be vegetarian or vegan, you're going to have to have more total protein because the quality is down and more total calories to your point right now. one carbohydrate to protein. So if I want a diet with 100 grams of protein, by definition, I'm going to have to have 350 grams of carbohydrates, which we already said most people can't metabolize, you know, it's just too many calories. So, you know, it's much harder, it can be done. It's much easier. How could you do it really? Because if you're eating, you know, let's say, the bottom line is that almost all vegetarians reduce their protein intake. The average, all of the studies say that the average protein intake for vegetarians is in the mid-60s. Okay, the average adult intake in the United States is women are around 70 and men are around

90. So they're reducing their protein intake. They're reducing their protein quality. When you're young, you can kind of get away with it. When you're older and you're stressed with sarcopenia, not so much. Okay. We're talking about protein quality because, you know, people say, oh, your beans and grains, you combine them. It's great. You know, you can get full protein and that's fine. But, you know, just doing the math, if math, if six cups of brown rice has 30 grams of protein, you multiply that four, that's 120 grams, that's 31,000 calories, not to mention how many carbohydrate grams are in there. And then when you add protein, the 450 grams of protein, I mean, sorry, 30 grams of protein in two cups of beans, that's 450 calories

times four to get 120 grams. That's 1,800 calories. So, you know, you're going to be eating so many extra calories with also carbohydrates. Unless, my conclusion, unless you actually have pulverized concentrated protein powders that are made from plants and add extra leucine and branching amino acids on top of it, it's going to be very hard to do this. And I've met these guys who are bodybuilders who are vegans, and they eat jacked up plant proteins, powders, not food.

I think, yeah, again, the national surveys, the NHANES data and others all say that average vegetarians are in the low 60s protein per day. So if you're going to try and get to 120 grams, to your point, you're going to have to have isolated purified proteins. You can't do it with eating food because you're just going to get too many calories. So people who are vegan vegetarian, and by the way, I was a vegan vegetarian for like 10 years or more actually when I was younger. So I get this and I understand why. And there's three real issues, health, environmental, and moral. And moral, I can't argue with. Health is more complicated. And I think environmental is very nuanced in terms of regenerative agriculture. And we can talk about you know, I think environmental, it's very nuanced in terms of

regenerative agriculture, and we can talk about that. But I think, I think I sort of want to get into the protein quality, because I read Diet for a Small Planet. And if you combine protein from beans and grains, you get complete protein, and you don't have to worry. And yet, the thing that you talk about, which is really unique and that I learned from Gabrielle Lyon, my friend who was your student, was that leucine is a rate-limiting amino acid in protein synthesis. And in English, that means if you don't have enough of this particular amino acid, you can't turn on the switch, like flipping a switch to turn on your engine to build muscle

unless you have that amount. And typically plant proteins are very low in this particular amino acid, leucine and other branched chain amino acids. So can you help us understand that concept and what do we do about it? Yeah. So there are nine essential amino acids. And interestingly, they're not all equally essential. The ones that show up most in diets, you mentioned leucine, the other two are lysine and methionine. All grains are very low in rice, etc. All grains are very low in lysine. And all legumes, beans are very low in methionine. And they're both pretty

low in leucine. And so you'll see advertisements that say, well, this plant protein contains all the essential amino acids. Well, every protein contains all the essential amino acids, but they're not in the right proportions. You know, the thing I always like to say is that plants have proteins for the sake of the plants. They're building roots and leaves and flowers and seeds, which are pretty different than brains and hearts and livers and muscles. Yeah. You know, your comment about animals, we have evolved to use animals to correct that balance for us, particularly ruminant animals.

They have the ability to take plants and basically convert those back into amino acid balances that are correct for humans. And they eat all day. They eat all day. And they eat enormous amounts of food. So those are the essential amino acids that are missing. Um, what we know and what my lab discovered is that when you're young, as I mentioned earlier, the protein synthesis, particularly in muscle is driven by hormones. But after you start stop growing into your 30s, now it's driven by diet quality and by exercise and diet quality

the body for reasons that i love to think about has learned to recognize leucine um i started studying these branched chain amino acids back in graduate school. I was fascinated by them. There were some early studies, some great researchers that showed that leucine could stimulate protein synthesis in certain kinds of muscle, diaphragm and things like that back in those days. And Al Harper at Wisconsin and some others had also shown that leucine is not metabolized in the liver, where all other amino acids are metabolized in the gut and the liver. Leucine, the branched-chain amino acids, leucine, valine, isoleucine aren't. And so they end up going from the diet, the gut, into the bloodstream, basically in the exact percentage that you ate them. Muscle now can see the diet.

Muscle is getting a dose of what did that meal look like by the amount of leucine that shows up. And for reasons we don't really know, it learned to sense that as a trigger for protein synthesis through a mechanism we now know as mTOR. What my lab discovered was that this leucine signal triggered the initiation process of protein synthesis. And, you know, the last 20 years, hundreds of labs have looked at that process. But we know that, know that as an adult, not so much as a child, but as an adult, leucine, the amount of leucine at a meal is an absolute key to maintaining your muscle health, maintaining your muscle protein

synthesis. And so that's a key part of diet. And to your point, all plants are relatively low in leucine. And so quinoa, for example, to use whey protein at a meal, you can eat 20, 23 grams of whey protein, about 120 calories and stimulate muscle protein synthesis, where quinoa, it takes something like 50 grams of protein and 100, you know, 2000 calories to make the same effect. You know, you just, you just can't almost almost 20 times the amount of calories to get the same amount of leucine. And so, you know, again, quinoa has leucine in it, but it's at such a low amount, and the nutrient density is so low, the relationship to calories is so low that you can't eat enough of it. Yeah, this is such a radical idea that you're talking about, Dr. Lehman, because you would get so much pushback from the vegan community that this is true. And yet this is just basic science.

This is not controversial. This is not in any way challenging, you know, the decades of research that you've done and others have done to prove that this basic biology of building muscle requires this particular amino acid leucine at a particular amount per meal, which is about two and a half grams. And people will say, well, you know, if you do the right complementary proteins, if I take my wheat, and I combine it with corn, and I combine it with pea, and I do this, and I process, I can make a balance. And absolutely, you can do it. All of the the vegans who understand this process now to the point we made earlier, are almost all using supplements. They're using protein powders.

You just can't do it with just pure natural foods. You have to do some sort of processed powder to get to it. Otherwise, you're going to end up in the low 60s. You just can't eat enough food to get to that protein level. And the amino acid supplements that people will get or add a leucine, they can be gotten from plant proteins, right? You don't have to get them from animal protein. So if you want to be strictly vegan, can you synthesize them in the lab from plant components and then add them to a protein powder or where's it coming from is what I'm asking. Okay. So, so I was talking about protein powders where you're isolating a protein from p you know a whole protein and you know it's 70 pure or something amino acids the primary source of amino acids is yeast okay so they're so they're grown in yeast environments

and then they're isolated from that okay so it's an's not a plant, but it's some kind of... Yeah, something you can eat. Something you can eat. Okay, I got it. So ethically, it's okay. And if you're committed to being vegan, you just have to understand that you can't get around the science of needing this amount of leucine per meal to activate muscle synthesis,

and especially important as you're older. So you have to either take these additional supplements or take the extra protein powders with extra leucine. And I know there's, for example, vegan protein powders that are jacked up. I call them jacked up where they add branching amino acids and they add leucine to supplement. And those can be very effective. So I'm not saying you have to eat meat. I'm just saying you have to get real about the science of muscle. Otherwise you're going to end up having poor metabolic health, aging faster, lower hormones, more inflammation, and all the things we see with aging. Yeah.

I mean, if you go back in history, in the 1980s, we got a recommendation for plant-based diets. It was called the Food Guide Pyramid. You mentioned it earlier. And people responded to that, and they decreased dairy consumption, egg consumption and and beef consumption by 35 percent in each category. And they increased grain consumption by 40 percent. And we got epidemics of obesity, diabetes and no change in heart disease at all. So, you know, the the issue is, can you create a healthy

plant-based diet? Well, you can, but you can also create a very unhealthy plant-based diet. And that's what most Americans have done. That's my problem. You know, if people say, you know, do we need a more plant-based diet? I say we need a diet with better plants. I like that. I like that. Okay. So I want to flip this upside down a little bit because there's the aging question and this whole issue of mTOR. And I'm just going to explain that a little bit for people. But basically, one of the key things we've discovered as we age is that there are a number of things that go wrong. And one of them is deregulated nutrient sensing. It's one of the hallmarks of aging. And one of the key pathways that gets dysregulated is mTOR. mTOR stands for mammalian targeted

rapamycin, which is essentially named after this compound, those phantom rapanui on Easter Island that inhibits this particular pathway called mTOR. mTOR is required to build muscle, but also if you over-activate it and don't give it a break, you can inhibit this process that's critical to longevity called autophagy, meaning you clean up your cells and you kind of, it's like the recycling and garbage disposal system in your body. So in other words, if you just cooked all day in your kitchen, but never cleaned up, it'd be a freaking mess. And that's kind of what we're doing with our diet. So how do you reconcile the need for regular leucine consumption to build muscle with aging and muscle being the currency of aging and this problem of needing to give mTOR a break

or inhibit mTOR and not stimulate mTOR with leucine, which is the primary stimulator of it, and saying we need to actually eat less protein as we age or actually avoid animal protein because it's high in leucine, right? Because this is the debate going on right now, and I need you to help kind of navigate it because you're the expert. Okay, so let's talk first about mTOR, and then let's talk about the aging studies. Okay, so first thing to know about mTOR is it's present in every tissue in the body. And it regulates differently. So we've been talking about mTOR in muscle. But how about in liver, or a tumor cell, or whatever, there are multiple regulations of mTOR. We've been talking about leucine and exercise, but the other two are insulin and ATP. So now we have four regulations. What we know is that in liver protein synthesis

is regulated by energy. What we know is that protein synthesis muscle is regulated by leucine. So now we've got different things going on. What we know is in tumor cells, it's regulated by insulin and energy, not by leucine. Okay. So now we're beginning to get this dichotomy going on. When we teach- Yeah, because people don't realize that mTOR is not only stimulated by protein, but also by sugar.

Insulin. By sugar. Insulin. By insulin. Insulin, which is caused by too much sugar and starch, right? Exactly. So now we've got this problem going on is that we have high carbohydrate diets. We have high insulin environments. did some breast cancer research and we know that tumor promotion is far more promoted by by insulin than it is by leucine or or or high protein okay so so we've got this dichotomy going on now one of the things that we also teach about protein for muscle is that it's meal-based. And the reason we want to do that is we want to turn mTOR on and off.

And so we teach it about optimizing protein at about five-hour intervals. Okay. The worst thing you can do with protein is eat it in small doses all day long, like vegetarians do. Okay. Because that chronically stimulates it. And now what you've got is the problems of potential that you're talking about is too much mTOR all the time.

What we want to do is turn it on. And again, mTOR isn't like an anabolic hormone. mTOR is a switch that turns on initiation factors. And what it does in muscle is it turns on capacity factors. There's an initiation factor called EIF4, another one called S6, it's a ribosomal protein. And basically what these do is they increase your capacity for synthesis, particularly of structural proteins, okay?

That doesn't work the same in other tissues. It's a muscle-specific kinds of effect, okay? So we want it to turn it on, and then mTOR should go away. We want it to turn back off. Once you turn on these ribosomal proteins and this mRNA recognition and things, it'll run for two, three hours. You want mTOR to be turned off. So now we get into the longevity studies and you say, how are those run? Well, the way they run them is they put a rodent in a sterile cage and they give them food, ad libitum. So they're eating constantly 24 hours a day. You can open up their stomachs and they have gut fill 24 hours a day, you can open up their stomachs, and they're, they have gut fill 24 hours a day. So basically, we've now turned on mTOR 24 hours a day, and lo and behold, you get problems. Then they what they do is they restrict the animal and then compared to this ad libitum to a restricted. And as soon as you restrict an animal, what does it do? It goes to

meal feeding, because it will eat its food and stop and then fast for the rest of the day. Okay. So now you've gone to meal feeding and now you correct the situation. They're trying to argue it's a protein restriction. It's really a, it's a calorie restriction. Rats and actually rodents overeat by 40%. We're left in an ad libitum cage. At the University of Illinois, we considered a 40% restricted rodent normal. Okay, so a 40% restriction just normalizes them. Basically, we know that obesity shortens longevity. And that's what those longevity studies are showing. Overeating is bad. Okay, we agree. But to basically say it's a leucine mTOR study is basically ignoring the science that basically mTOR and leucine are required to keep muscle healthy. And we know

that longevity, that muscle really is highly critical to everybody having a healthy aging process. So we've got that dichotomy of how the studies were run, but basically mTOR and leucine are critical for healthy long-term muscle. So basically it's about when you eat. I call it the Goldilocks problem. You want to simulate mTOR at the right times and the right amount in the right way with the right quality of protein, but you don't want to do it all the time, day, 24 seven, and you want to give yourself a break and allow mTOR to be inhibited to initiate autophagy, clean up your cells and kind of mimic calorie restriction, or actually be calorie restriction, which then helps you extend your

life. Is that what you're saying? I think that's a totally reasonable way to look at it. Yep. And, you know, you do, I do worry because I see, you know, people who are plant-based as they get older, they get really frail and they get really weak. And I mean, I don't do that. My colleague, Gabrielle Lyon, you know, sees that type of patient and she works in the gerontology. She actually did a gerontology residency at WashU. And that's exactly what she sees. People who are low protein, they become more frail. I think it's 300,000 hip fractures in individuals over 65 per year in the US.

And one third of those never leave the hospital. Wow. So talk, let's say, practically about how much protein you should eat in terms of food and when you should eat it in terms of the day. And then this whole controversy about time-restricted eating. What's the right math here? As asking for a friend yeah i get it i get that email all the time by the way i know i'm sure you do so after we sort of discovered this leucine mTOR relationship and working with colleagues at galveston university of texas doug patton jones and i were looking at Galveston University of Texas, Doug Patton Jones and I were looking at the American diet and we realized that the average American eats 65% of their protein at one meal late in the day. And we started thinking about protein turnover and muscle.

And so when you go, when you go into a nighttime fast, your muscle becomes very idle, but all of your other organs are working perfectly fine. In the middle of the night, your liver is making proteins. It's turning over enzymes every hour. And so you have to keep building proteins in your liver. And so the question is, where do those amino acids come from? Well, during the middle of the night, they're coming from muscle. Muscle becomes catabolic and it's breaking down. And so during that 12-hour fast, you're catabolic, breaking down muscle. When you wake up in the morning and you eat no protein, you're still catabolic. You're breaking down muscle.

Until you have a meal that has at least 30 grams of protein, at least 2.5 grams of leucine, you're catabolic. So the average American, and the other thing we discovered was that the meal effect of protein gives you an anabolic period of about two hours. So what we have in the United States with adults is we have a two-hour anabolic period around dinner and a 22-hour catabolic period the rest of the day. So anabolic means building muscle, catabolic means breaking down muscle, just for the average person out there. We're breaking it down to give amino acids to the liver, the organs, the gut, the kidney, the brain, and then we have to replace those. If we don't replace them, that's aging, that's sarcopenia, that's a steady loss of muscle over time. And so what we decided,

what Doug and I looked at and said, what we need to do is move that protein. We're probably eating too much at dinner. Let's move it to the first meal when you come out of that fast. And so when we did that in animals or in humans, what we found is what we immediately corrected this muscle loss and corrected body composition. So distribution for me is moving is putting more protein into that first meal after an overnight fast. Second meal, interestingly enough, nobody's ever really studied it. So we know that the first and last meal are really important. We assume the middle meal is okay, is important. The study that Doug and I ran actually used an even distribution, and everybody has run with that. You need 30 grams per meal every meal. That was just a coincidence. We

thought the design was cute. The real issue is we move protein to breakfast. So people shouldn't worry so much about getting 30 grams at every meal. It's about the total amount during the day. When I talk to people, I say, I would like to see you get 45 at breakfast. I would like to see you get whatever, 20 to 35 at lunch, depending on how you're trying to control calories and another 45 to 50 at dinner. That's what, that's the pattern that I personally use. And is there anything to the idea that if you don't have at least 20 to 25 or 30 grams at a meal that you can't turn on mTOR? Exactly.

Muscle synthesis. Exactly. So in other words, if you ate 10 grams of protein, it's sort of just you're burning calories. It doesn't actually activate the system. Again, liver versus muscle. Yeah. Or regulated different. So if you have 10 grams of protein at each meal,

your liver and kidney and brain will look okay. They're working. Your gut. They're still fine because they're not regulated by leucine. Muscle is. And so, you know, it's not that it's just burned as calories because frankly, all protein is just burned as calories. Interesting point to think about. It's just that it's not going to protect muscle. And so the minimum amount, so the studies that were run, multiple studies by multiple groups, but one that was sort of the first was by Bob Wolf's group at Texas. And basically, they looked at what was the equivalent of giving 1.7 grams of leucine versus 2.7. And they found that 1.7 had no effect at all. Basically muscle

was totally idle. 2.7 totally turned it on. So we know there's a steep threshold somewhere between 1.7 and 2.7. We've sort of calculated that out and you'll see most people will say 2.5. We don't know whether it's 2.3 or 2.5 or anyway. So basically what you're saying is, is like, you know, if you want to get two and a half grams or so of leucine, you need about four to six ounces of meat or chicken or fish and about 20 to 25 grams of some kind of whey protein. Yeah, exactly. Great. Okay. So that's like a take home, I think, you know, and that's like a take home, I think. You know, and that's good. That made me feel good because, you know,

basically Americans are eating sugar for breakfast. Bread, muffins, bagels, cereal, pancakes, French toast, sweetened yogurt. I mean, your average Yoplait yogurt for breakfast has more sugar than a can of Coke, Browns. The average American breakfast is somewhere between 75 and 100 grams of carbs sugar than a can of Coke. The average American breakfast is somewhere between 75 and 100 grams of carbs and about 10 grams of protein. Yeah. So that made me feel good because this morning I had about 22 grams of goat whey. And then I added extra protein.

I added, you know, it's a combination of pumpkin seed, pea protein, and bovine collagen. So I put all that together and I get about 40 something grams of protein. So I'm, I'm, I'm actually feel like I'm doing a good job. I had almost the same combination, frankly. And, and I know people have been talking, and this is just a little bit of sidebar is, is about the idea of collagen and collagen protein. Can you talk about the challenges with that? I know you're, put your head back. So that tells everybody who's listening, not watching the podcast, he just threw his head back and rolled his eyes. So what is the deal with that? Yeah. So, you know, as a protein expert, we make fun of collagen. It probably is the single worst protein on the face of the earth.

It's deficient in at least three essential amino acids, lysine, tryptophan, extremely high in arginine and glycine. People talk about hydroxyproline, hydroxylysine, but the body can't use those. Basically, once an amino acid is hydroxylated, the body can't use it anymore. And so basically, it's an absolutely crappy protein. If you look for studies, basically, you'll say, well, it seems to improve skin health, and it seems to improve this and that. It makes no sense. And there's no mechanisms to back it up. I frankly think it's a waste of money. I just don't buy it. You know, is there a possibility that glycine or arginine helps with growth hormone to help stimulate some of these things?

Possibly, but I've never seen any science to back it up. So basically you have this protein that has a lot of testimonial, people love it. And yet you have the science says it's absolutely awful. And so that's kind of the bottom line. Okay. A couple more questions and I'll let you go. Because these are all things that people are asking all the time in terms of exercise timing and protein intake. Can you talk about that? Because the protease study did review, especially as we get older, when we should eat protein in relation to when we exercise to get the maximum muscle building effect. Let's talk a little bit about exercise before we do that. So type of exercise for a healthy adult, that weight loss study that we

talked about, basically, we did five days a week of anaerobic, just sort of walking exercise, real moderate intensity, and two days a week of resistance, which was basically yoga and stretch. Wait, resistance was yoga and stretch? Yeah. So the issue of muscle growth, muscle health and protection is stretch. Eccentric motion is actually more important than concentric. Stretch is important. A lot of great research back in the 70s about this. We've kind of forgotten. So if you're trying to build muscle, if I'm wanting to be a

football lineman, then you need to lift heavy weights. You need to lift weights 70% or higher of your maximum lift capability. But if you're an aging adult, just trying to protect your muscle, you'll get a massive benefit just by doing yoga, just by doing stretch. Okay. But you won't get bulk. You won't get bulk, which a lot of adults aren't looking for. And you wouldn't necessarily get definition. You wouldn't necessarily get definition.

Definition would be partly muscle and partly fat. Yeah. I'm going to send you after this, and I'll post it in the show notes, my picture at 40 and 62. I was doing yoga and running. I was like, I did yoga. I don't need to do anything else. That's strength training. And maybe it was, but I can tell you my body looks so different now.

And I'm like. The obvious joke here is please don't. No. I have my. Okay. Okay. Okay. I'm sorry.

What exercise? What was your original question? Well, the question was, you know, timing in relation to protein. Oh, timing and protein. So all of that, what we did, we sort of started this ball rolling is that when we were studying the leucine mTOR question, one of the things we know is that if you go into fasting the longer you fast you start down regulating protein synthesis not only at the initiation phase but also at the transcription phase you fewer ribosomes fewer messenger RNAs so what we wanted was an acute catabolic event so we did exhaustive. And what we showed is exhaustive

exercise causes a catabolic event muscle. And what we showed is if you give protein right after exercise causes recovery. People have run with that and said, well, you should have extra protein post exercise. Well, the research what it actually shows is that's probably only important when you first start. If you're an untrained individual who does an exhaustive bout, it will be catabolic. But if you're well-trained in an event, it really doesn't matter when you have the protein afterwards, other than you're going to be catabolic until your next meal. Yeah. And so, you know, if your next meal is two hours or four hours later, if you want to go out in the morning and exercise before breakfast, that's great. I tend to exercise sort of early afternoon,

I'll go out and exercise at two, I'll eat again at seven. It doesn't matter where it occurs if you're well trained. If you're starting a new training regimen, if your first two weeks of football practice in the fall, taking protein right after that's probably a good idea. It'll reduce soreness probably. It'll help you recover quicker before you have your next football practice in the afternoon. But as far as an average person, it doesn't matter. You know, all these jocks going to the gym with a bottle of protein and gulping, I think it is kind of humorous. Interesting, because in the protein study, it did seem to say that it was important to have protein within an hour or two of working out.

And all those experiments are untrained individuals with maximum exertion. I see. So if you're kind of in shape already, you can kind of get your protein throughout the day. But what you're also saying is that morning protein is essential. You're in a state of breakdown until you turn off the breakdown with the buildup by eating enough protein in the right quality in the morning. You know, I'm not particularly hooked on, you know, is that at seven in the morning or is that at 1030? I don't really care. So, you know, time restricted feeding. Now you're doing that to control calories. And so weight control, that may be a more important issue than three hours earlier breakfast.

So I'm OK with time restricted eating. I'm not I'm not OK with intermittent fasting, but I am OK with time restricted feeding. And and that first meal, I try never to use the concept of breakfast because that implies a time of the day. I always say first meal. And if that first meal is at 11, that's okay. Yeah. Interesting. Holy cow. We just went through so much in an hour and a half. I literally could talk to you for another three weeks, nonstop. So many questions, but this is great. We'll have you back for part two. Don, you really have laid a lot of the groundwork for the science around this.

And there's a lot of opinions out there. There's a lot of propaganda, I would say. There's a lot of misinformation. People are very confused. But I think the take-homes here are really clear. We need to have high-quality protein in more than the minimum amount of the RDA, which is the minimum amount, particularly as we get older and we need the right quality protein, which means we either have to have animal protein or we need to combine it with plant protein, or we need to have special plant protein where it's added processed plant protein, which I'm not a big fan of. And we need to make sure we exercise. So these are really simple ideas, but they are profoundly

effective. And I can tell you in just my own personal life, applying them has revolutionized my health in ways that I didn't imagine. And thanks in part to Gabrielle, who's your student, who's been hounding me for years to start strength training. And I don't lift heavy weights. I just do bands and I travel with them everywhere. And that really seems to do the job for me. And that's the point I was making. It's stretch. It's not the amount of weight. It's about stretch. And I hope everyone walks away realizing, you know, I don't think we said anything about extreme. We're talking about kind of middle of the road sort of diets. We're not talking about keto carnivore. We're not talking about vegan. We're talking about sort of in

between which, you know, people can exist at the extremes, but the average person really is going to be best off at sort of this middle ground where they're protein centric, they're protein conscious, and they keep their calories under control. And that's really the issues. Great, fantastic, Don. And if people want to learn more about Don, you can follow him on Twitter at Don, D, D-O-N-L-A-Y-M-A-N, and on his website, metabolictransformation.com. Thank you, Don, for all the work you've done for decades to get us to where we understand a little bit more about muscle. And I would sort of close by saying, I think muscle is the currency of aging. And if we don't protect and learn how to take care of our muscle, you know, we can maintain

our cardiovascular health, our brain health, but it is so key to all of that. And I think it's just the neglected organ. I agree. I think we, we sort of think it's only for muscles, but it's actually for all of us. And it really is kind of the currency of aging. So great to be with you, Mark. All right. Well, Don, you take care. And for those of you listening, love this podcast, share with your friends and family. Hopefully it will end some of their confusion. Subscribe wherever you get your podcasts. Leave a comment. Tell us what you've learned about your body and protein consumption and exercise. And we'll see you next time on The Doctor's Pharmacy. Hey, everybody. It's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving

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