The Dr. Hyman Show - Why Building Muscle is Key to Longevity | Dr. Gabrielle Lyon

Episode Date: September 11, 2024

Muscle isn’t just about strength—it’s about longevity, metabolic health, and even immune function. In this episode, I sit down with Dr. Gabrielle Lyon to uncover the critical role that skeletal muscle plays in our overall health. We dive deep into muscle as an endocrine organ, its role in fighting insulin resistance, and why sedentary lifestyles are wreaking havoc on our bodies. From understanding how to build muscle effectively at any age to learning why muscle mass is the key to metabolic health, this conversation will change the way you think about strength training. In this episode, we discuss: Exactly how much protein we need to eat every day The differences between plant and animal proteins The impact of resistance training The metabolic benefits of muscle Why you should spread your protein intake evenly throughout the day How sedentary behavior and insufficient protein intake can lead to muscle loss, insulin resistance, and metabolic disorders View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal This episode is brought to you by Rupa Health, Beekeepers Naturals, Thrive Market, and Fatty15. Streamline your lab orders with Rupa Health. Access more than 3,500 specialty lab tests and register for a FREE live demo at RupaHealth.com. Head to BeekeepersNaturals.com/HYMAN and use the code ‘HYMAN’ to get 20% off sitewide. Head over to ThriveMarket.com/Hyman today to receive 30% off your first order and a free gift up to $60. Fatty15 contains pure, award-winning C15:0 in a bioavailable form. Get an exclusive 10% off a 90-day starter kit subscription. Just visit Fatty15.com and use code DRHYMAN10 to get started.

Coming up on this episode of The Doctor's Pharmacy. For someone who's listening to this, an individual should really attempt to put on as much healthy skeletal muscle mass as they can. When I think about- Is it too late for me? Never. The only time it's late to start is if you don't start.

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Welcome to Doctors Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy with an F, a place where conversations matter. And if you care about being healthy and strong as you get older, you're going to love this podcast with Dr. Gabrielle Lyon, who's a great friend of mine, extraordinary physician who studied muscle-centric medicine, a thing that you probably never heard about, but is one of the most important things you've got to know about to age well. She wrote an incredible book called Forever Strong, a new science-based strategy for aging well. She's got a great podcast at Dr. Gabrielle Lyon Show. Her website, Dr. Gabrielle Lyon, is full of great information

to help you optimize your health. And on today's podcast, we talked about some things that I think most people don't know about, which is the muscle that you have in your body being the biggest organ. We talked about its role in our metabolic health, in our immune health, in regulating blood sugar, in regulating insulin, in our liver health, and pretty much our hormonal health, pretty much everything, right? If you want to live well, you need good muscle. We also dove deep into how to build good muscle, what you need in terms of exercise, what you need in terms of diet.

We talked about some of the science and the controversies in this space, and I think you're going to love this podcast. So let's dive right in. Welcome back to the Doctor's Pharmacy, Gabrielle. It's been such a pleasure to have you on before. And I know our listeners are just going to love this podcast because we're going to get deep into the muscle, into the trigger points and the controversies and the questions about why we should be paying attention to muscle. As I was thinking about preparing for this podcast, I realized there is no specialist in medicine

that is dealing with the muscle. Like there's a rheumatologist who deals with the joints. There's physical medicine rehab that's more about rehab. There's orthopedics that deals with the bones. Well, you know, I came up with this. Muscle-centric medicine. That's right. Muscle-centric medicine, right?

Which is actually a really important framework for understanding human biology that was sort of absent from our training. We never learned about muscle other than what the muscles were, where they attached, and basically some rare muscle diseases like rhabdomyolysis or you know autoimmune muscle diseases or weird musco dystrophy things and it was like it was kind of a non-thing right and and we didn't learn about why it's important what it does in the body how it functions how it's probably the most important organ and yet we don't even have a specialty about it but now we do because you created it but it's i'm working on it You can't get board certified yet in muscle-centric medicine. Working on it. Working on it.

It's a great new project for us. It's good. I think it should be. Because as I began to learn from people like you and other people about muscle, I began to realize that this is not just a bunch of muscles dragging your skeleton around and making you move your arms and legs and body around. It's a very dynamic organ. And it's probably the biggest organ in our body. I mean, I think dermatologists say the skin is, but I don't

know. Muscle, 40% of your body weight. Yeah. It's huge. So this is the biggest organ in your body. It's not just for locomotion. It's highly functional in terms of immune function, metabolic function, hormonal function. So I wonder if we could sort of start by zooming out a little bit and have you sort of explain to people, you know, what the heck does muscle do besides make you walk down the street? Yeah, I think it's a great question. And also you framed up everything nicely with this concept that we have not thought about skeletal muscle as the largest organ in the body. We haven't. Skeletal muscle.

Even as an organ. That's right. And it is the organ of longevity. In this space now, we hear all about longevity. And one would have to recognize that the health and trajectory of how we age and how we live is directly related to the health of our skeletal muscle. The other point that you made is when people think about skeletal muscle is they think about locomotion and activity and sports and, you know, in the 60s, you know, Muscle muscle beach and American Heart Association with cardiovascular activity and aerobic type training.

But the reality is skeletal muscle is a tool for optimal health. It is a tool that we have voluntary control over. And when we think about skeletal muscle, the obvious is there. Mobility, strength, power, flexibility, balance. Which is all important. You want to be able to move around and get up off the floor and tie your shoes. You have to. I went skiing with my dad when he was 74 and he fell and he couldn't get up.

And I had to like drag him up off the mountain, you know. But that shouldn't happen. That shouldn't happen. It doesn't have to happen. The other important aspect about skeletal muscle is the framework of metabolic health. And I think in bodybuilding circles, people have talked a lot about skeletal muscle from a metabolic sync perspective. It's the primary site for glucose disposal, the carbohydrates that you eat. Skeletal muscle is-

It's where you burn your calories that's right so also a primary site of mitochondrial function no matter where you believe longevity or health begins you know you've had tons of experts on this podcast some white might say that it's about the mitochondria some might say that it's about i don't sirtuins, or some might say it's about inflammation. Give me something else. Microbiome. There you go. Microbiome.

Give me something else. One more thing. Yakamoto factors. Is that the right one? Yamanaka. Yamanaka. There you go. I mean, you know, hormones.

Okay. Stress. Perfect. The unifying organ system is skeletal muscle with all of these things. If you want healthy mitochondria, you need healthy skeletal muscle. So take us down. We know that mitochondria are key to healthy aging and having plenty of them and having them in good operating condition and having them souped up

so they are very effective and efficient. And to clean them up and to repair them, and all really important. And a lot of longevity strategies we talk about help us do exactly that, whether it's taking urolithin A or... I love urolithin A. Or exercising or whatever.

But the real thing I want you to help explain goes beyond just having enough muscle that's well functioning so you can be functional as you get older, right? So you can do stuff. It's great. I mean, I want to ski, I want to hike, I want to play tennis, but I want you to unpack like scientifically besides the mitochondria, because I think people understand that the mitochondria is really the factories of energy production and their keto longevity. Walk us through how the muscle plays a role in the immune system, in hormonal health, in stress, in growth hormone, tissue repair, all the things that we don't really think about that it does, but is essential for our health and longevity.

I think it's a wonderful question. And there's a few ways to frame it. And quite simply, there's active skeletal muscle, and then there's inactive skeletal muscle. Inactive skeletal muscle, we can think about from at rest, meaning you're still active, but again, you and I are very active, but we're sitting here. At this moment, we are not active. Then there's also sedentary skeletal muscle. Inactive versus sedentary skeletal muscle. Inactive versus sedentary skeletal muscle. Inactive skeletal muscle, again, we are just sitting here but we're still active on a daily

basis. We have a lot of flux, which I'll get to. And then there's sedentary skeletal muscle. That is never healthy. When you look at the data in PubMed or you look at these large research trials or cohorts and they define healthy sedentary individuals. Skeletal muscle, when it is sedentary, is almost like a swamp. So meaning if you don't usually exercise and you don't strength train and you don't do cardio, even though you're, quote, healthy, you're really not because your muscle is not healthy. You're not. And there is, when you think about what skeletal muscle does. So you're saying there's no such thing as healthy sedentary skeletal muscle.

Correct. So if you're a sedentary person. You, by definition, have unhealthy skeletal muscle. So, I mean, we exercise a lot. So we're sitting here. It's fine. We're inactive right now, but we're not sedentary. And I was looking at some of the definitions of what defines sedentary. And not surprising, there is a lot of ways in which we can think about it. Is it a metabolic equivalent? Is it about how much we're burning? Is it about how many steps? Is someone

having less than 5,000 steps? There's a whole host of ways in which we can define sedentary behavior. But at the end of the day, what is the outcome that we're thinking about? And I think by framing it up, what skeletal muscle does. Ske skeletal muscle is the primary site for glucose disposal. The carbohydrates that you eat must go somewhere. Carbohydrates dominate metabolism. When you have an excess of carbohydrates, they dominate metabolism. You must move glucose out of the bloodstream into tissues. And that's why exercising helps with insulin resistance and diabetes and blood sugar control because it sort of basically sucks up all the glucose. And scientifically, there's two ways in which that happens.

There is the insulin-dependent action, which affects for the science nerds, GLUT4 transporters, to move glucose out of the bloodstream into cells. And then there's the contraction-related GLUT4 transporters. So they're all GLUT4 transporters, but it doesn't require insulin when you are exercising. So if you're exercising, your body will take up glucose in your muscles even without insulin through this sort of sideways pathway. Exactly. And so when we think about why is healthy skeletal muscle important?

Again, we're going to talk about each of these different domains, but from a mass standpoint, skeletal muscle mass makes up 40% of the body. Insulin resistance is at the root of nearly every metabolic disease, right? Can we agree that- It's the central feature of aging, heart disease, cancer, diabetes, dementia, infertility, depression, the list goes on. Yeah, it goes on and on. And there's really some seminal work by DeFronzo and some of these individuals out of Yale,

Pedersen, or Peterson. Pedersen is in Copenhagen. But some of these individuals that really highlighted insulin resistance of skeletal muscle first. Even if an individual is young, 18-year-old college student, with no outside signs, outward signs of obesity or anything, an inactive individual, because of insulin resistance, because skeletal muscle is designed to move, a healthy, sedentary individual without outward signs of insulin resistance or unhealthy skeletal muscle will begin to have a distorted metabolism very early on.

Yeah. So what makes up healthy skeletal muscle? So if you go back to this. I mean, by the way, 40% of kids are overweight. Not only. And probably another 40% are not that active. And then adults with overweight or obesity, what is it? 75%.

75%. 50% of Americans are not exercising. Only 50? I thought it was a lot less than that. Well, 75% are not actually meeting the criteria, which is 150 minutes a week plus two days of resistance training. Yeah. So nearly 75% are not meeting that. Yeah, that sounds more right.

But there's a couple things to unpack here is when you think about why skeletal muscle. Why skeletal muscle? Because at the basis, it is at the root of these diseases of aging. And I know that I'm speaking in extremes and I apologize for that. But when we think about insulin resistance, because that is a primary driver, then we have to think about what happens to skeletal muscle. Skeletal muscle is the primary site for glucose disposal. At rest, it burns fatty acids. People think, well, muscle burns a ton of carbohydrates. At rest, it doesn't. It burns fatty acids. Which come from? Foods.

Fats, but also it can come from carbohydrates. Absolutely. If you were to think very practically, what are some of the lab values of unhealthy skeletal muscle? I'm going to lay it all out for your listeners. High triglycerides. High triglycerides. What else?

High insulin. That's right. High A1C. That's right. High blood sugar. Yes. Small LDL particles. There you go.

Keep going. High ApoB. These are signs of unhealthy skeletal muscle first. And CRP, inflammation. Exactly. When we have this large organ system that is generating low-grade inflammation, this bag of tissue that's generating low-grade inflammation, then it distorts metabolism.

But then the other thing that happens is we have to recognize that skeletal muscle, if skeletal muscle is a suitcase. Yeah. And let's say there's liver glycogen, depending on your size, maybe you have 100 grams. Glycogen is the storage form of carbohydrates. We can store only about 2,500 calories. So for liver, it might be 100, maybe 200, depending on the size of your liver. Skeletal muscle might be anywhere between, again, depends on the person, 400 or 500 grams of glycogen. Now, why does that matter? Because if an individual is sedentary and we know that the average American eats 300 grams of carbohydrates

a day, then we also recognize the metabolic function of muscle, which is glucose disposal, fatty acid oxidation, and it also utilizes branched-chain amino acids. One recognizes that there's nowhere else for these substrates to go. This distorts metabolism. But they go to the organs, too. But if it can't go to muscle, then it has to be... It goes to fat. It goes to fat. Visceral fat. Visceral fat. Bell to fat right visceral fat visceral fat belly fat

belly fat liver fat muscle fat and then what happens is now you have dysregulated metabolism and you have a ribeye instead of a filet mignon exactly that's exactly where i was going so now you have fat that infiltrates it's called myosteatosis that's a big word i know i do not know how to spell it in english't ask me how to do it. It means you get marbled muscle like a nice Wagyu ribeye steak, which may be fine to eat, but not to have as your body. And we also know from cross-sectional imaging that it doesn't have to happen. When you see skeletal muscle that is like a fillet,

it's typically exercised skeletal muscle. What is one of the typically exercise skeletal muscle. What is one of the problems with skeletal muscle is that it is an organ system that requires flux to be healthy. What is flux? Flux is doing activities that deplete energy from skeletal muscle, deplete glycogen, utilize these fatty acid byproducts. Flux of nutrients in and out. Yes, and out. In and out.

So the funny part is, Mark, I feel like we're on a talk show because you and I have known each other. Every time I see you, I have to count another year. That's true. And it's pretty funny. That's true. And one thing that I learned from you very early on, and for the listener, they might not know this,

or the viewer, however they're consuming this, is I learned from you when you, I mean, over a decade ago, I would come to your clinic and I would listen to you talk to patients. And my whole point is, is you always said, Gabrielle, you have to simplify it. That there can be these very complex topics, but it has to be so someone at home can think about it and take action. Yeah, exactly. And so this idea of physical activity, you can, I would argue, it's never too early to start exercise. I'm going to talk about exactly what that is.

It's never too late to start. It's never too early to build strength. And it's never too late to build strength. And why do we underestimate skeletal muscle? Because it's been very difficult to test it. It is very heterogeneous. There are different fiber types. The main two fiber types, type 1, type 2, type 2a, type 2x. But the reality is these fiber types transition. And someone's like, well, why do I care about fiber types? Stated simply, the big bulky fibers, type 2 fiber types,

if you do not keep up with training and doing these things, these fiber types change. I mean, both of our parents, you know, sorry, Dad, but they get skinnier. Skinnier, flabbier. They do. They shrivel. They shrivel.

And they have a body recompositioning that happens. They gain body fat. They lose skeletal muscle. All while their weight stays the same. Okay, right. So that's what we call skinny fat. But I want to get back to kind of the sort of framework of muscle as an organ. We've sort of established that it's the sink for glucose, for energy,

that it helps you prevent insulin glucose, for energy, that it helps you prevent insulin resistance if you use it properly through cardiovascular training and strength training. Two different things, got to do both of them. And it's critical for maintaining your metabolic health. But there's so much else that it does. So tell us about the other hormonal aspects around sex hormones, around cortisol, around growth hormone. Because it's not just a bunch of muscle cells moving your body. It's doing other stuff. Right.

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drhyman10 for 15% off their 90-day subscription starter kit. That's f-a-T-T-Y-1-5.com slash D-R-H-Y-M-A-N-1-0 and take control of your health today and give yourselves the support they need. Let's talk about what we know. We know that exercise can increase androgen receptors. Exercise... It's testosterone. Testosterone, exactly. Testosterone receptors. You know, there's been data out there where they say, okay, well, exercise increases IGF-1, which is insulin-like growth factor. These are transient. And the reality is, as it relates to sex hormones, it is complex. People are different.

I can't provide my patient with 100 milligrams of testosterone and know that that individual is going to put on three pounds of muscle, for example. But the muscle itself, when you have unhealthy muscle, you also get this syndrome of screwed up sex hormones, right? You do. Is it directly related to adiposity, which is directly related to unhealthy muscle?

I think that it is complex because skeletal muscle in and of itself doesn't secrete androgens. But the sensitivity to the androgens can change. The dynamic of contraction and power and mobility, flexibility, the quality and the architecture of the tissue can change. And some of it's downstream, right? The downstream effect of losing muscle and gaining fat is as a guy, your testosterone goes down, your estrogen goes up, you become more like a woman as a guy because your metabolic health secretes. And for women, it's a little bit different.

They get other factors, but they can get all kinds of issues around hormonal dysfunction, like PCOS. And this may not be directly to the muscle producing these hormones, but it's really related to this overall syndrome. It is. It's related to the overall syndromes related to insulin resistance and metabolic dysfunction, which can be infertility, can be PCOS. Again, these things create downstream effects. So while we talk about skeletal muscle from the metabolic aspect, I think that we really have a good sense of that.

When it also comes to the contraction of the tissue, this is where it becomes very fascinating. Skeletal muscle as an organ system releases something called myokines. 600 or so myokines, they're always finding new ones. It is relatively a new science. Yeah, what are myokines 600 or so myokines they're always finding new ones it is relatively a new science yeah what are myokines myokines are what we consider peptide hormones little molecules that are secreted by exercising skeletal muscle based on the duration and intensity of training and really the the pioneering work out of this is out of Copenhagen,

and Bente Pedersen. If you could get her on the podcast, I've been trying forever. You know, it's like the one email. But anyway, I think she's an immunologist as well. If you get her on, I would flip. All right, we'll try. We'll try. So what has she found about these myokines, and what do they do? So these myokines are very fascinating.

When we think about exercise, we think about the input and the health of exercise from the effort, right? You know, when we would go on a bike ride or exercise or run, all of this. But it's not necessarily just that. It's the influence of the contracting skeletal muscle releasing these myokines. Again, these peptide hormones that travel, they act locally, they act cells next door, they act systemically. So basically the intensity and duration, for example, the most famous myokine is interleukin-6, which is also a cytokine when released, which is an inflammatory molecule when released from a cell of the immune system. We've all heard about those cytokine when released, which is an inflammatory molecule when released from a cell of the immune

system. We've all heard about those cytokine storms. Because your white blood cells will release that too. Exactly. They also release interleukin-15 and TNF-alpha, all of which create an inflammatory condition. So these are what we heard about in COVID as cytokines, which are these inflammatory messenger molecules. And the ones that are specific to muscle are called myokines. But they're ones that are probably anti-inflammatory and ones that are pro-inflammatory, right? Yes. Based on the tissue of origin. And that's fascinating. Meaning the same peptide hormones or when released from the immune system, will have a pro-inflammatory effect, versus when released from muscle, seem to have a dampening of that inflammatory seesaw. Now, I think it's important to note that we are talking about things in black and white terms and extremes,

and we recognize that that's not exactly how that works. But I think from a logical perspective, when we think about what is an application that we can do to make sure that we are getting enough stimulus to maintain the health of skeletal muscle, I'm a geriatrician by training. And I always think, what is it that people have to do? And what happens is, is that people don't necessarily train less as they age. They have less intensity in their training. They don't work as hard. They don't work as hard. Because they're tired or because it hurts. Who knows? Probably all of the things because, you know, I coined the term muscle centric medicine and I focus a lot on skeletal muscle because I think that everything

originates from muscle. It's just the way that it is and life is better this way. And that's just how it's going to be. But I recognize that the reality is we talk about the health of skeletal muscle, but low skeletal muscle mass, which by the way, we do have a definition of that in the way that we look at appendicular lean mass index, which no one should ever have to do unless you are diagnosing something if you're a physician, maybe. But the reality is, is low skeletal muscle mass may be an early indicator of low bone mass. Yeah. I mean, we talk about osteoporosis, but we don't talk about our osteopenia. We don't talk about sarcopenia very much.

We don't. And you know that it became a disease. It got its classification of disease 2016. That's amazing. I mean, cause it is. Yeah. I mean, it's something I've been looking at for almost 30 years. We had DEXA machines at Kenya Ranch when I worked there and everybody got a DEXA scan. And it was incredible to see because you see people who, you know, you think were muscular, but actually had a lot of fatty infiltration in their muscles. Or you see people who are, you think they weren't overly overweight, but they were extremely over fat and under lean. And so there's, you know, it just taught me a lot about, you know, kind of what meets the eye when you see someone doesn't always reflect

what's really going on under the hood. And I think that if for argument's sake, for someone who's listening to this, an individual should really attempt to put on as much healthy skeletal muscle mass

as they can. When I think of that, Is it too late for me? Never. And by the way, But there's something called, and, you know, I think it's anabolic resistance.

There is something called anabolic resistance. So anabolic resistance is this phenomenon that happens as you age where it's harder to put on muscle. Well, it's actually a decrease in the, we didn't talk about skeletal muscles and nutrient sensing organ. Yeah. We talked about skeletal muscle from the mobility, strength, metabolic perspective, the immune function. And also, by the way, we should just mention brain function, contracting skeletal muscle. Let me back up. One other thing is individuals that exercise think it's really about the energy expenditure. It's not just about the energy expenditure. It's not just about that. It's also about

this immune interface and these molecules that are released from skeletal muscle. There are two primary ones when I think about the health of brain function. And you know, I trained as a geriatrician, which is over the age of 65. I don't think you'd be my patient yet. I'm going to be 65 in November. But anyway, not my patient yet. Can I be your patient when I'm 65? But those individuals, when we think about exercise, so there's two other components that I really have to mention as this organ system is that contracting skeletal muscle releases irisin and capsepsin B, which is a mouthful. I don't know how to spell it, but it stimulates brain

derived neurotropic factor. That's miracle growth for the brain. In the brain. Yeah. So just to back up, so basically what you're saying is when you exercise, your muscle releases these molecules, these peptides, that stimulate the production of something in your brain that increases your brain connections and new brain cells, neuroplasticity and neurogenesis.

You should do this for a living. I mean, you're really good at explaining. That's amazing. That's so cool. But the other thing is... That's why you see the studies where exercise reduces the risk of Alzheimer's. We just published one. One is on the docket for publication.

Shout out to my girl, Louisa Nicola. Yeah. So, I mean, I think the data is really clear that this is a phenomena. But now we may be understanding the why underneath the findings we're having around longevity and Alzheimer's and dementia and cognitive function, even depression and exercise. Yes. And I think that there is another layer to that. The other thing that I want to mention is that exercising skeletal muscle that releases

these myokines, there is a way that it actually helps with fatty acid utilization and glucose utilization. So these myokines seem to interact with the organ system, with liver, and with adipose tissue for utilization of nutrients of the foods that we eat. So there is the exercise component, which is about energy expenditure. So there's the exercise component where everyone thinks about energy expenditure, and then we think about healthy mitochondria, and then we think about decreasing flux or increasing flux and decreasing this swamp pool in your muscle. But also the training component,

based on the duration and intensity of your training, also affects the myokines that you release that impact how you use calories. This is mind-blowing. So what you're saying is basically exercise is not just helping us maintain our healthy metabolism because we are better able to uptake sugar, glucose, or fats from our body and our diet, but that actually the myokines, these messenger molecules from the muscle, literally help instruct our metabolism what to do and how to regulate the nutrients that we're eating and whether they become muscle or fat or

something else. Right. And I'm going to mention something. Is that right? Yeah, it is. You got it. I'm telling you, you should do this for a living. And I have to mention something else, which I thought was so fascinating is again, when we look at a lot of these studies, we look at it with factors that we can control. For example, we look at calories in, calories out, macronutrient distribution. We look at all of these things. It's very difficult. We have to recognize that science is kind of a science of confusion or unknowing. We're constantly learning and thinking about things. And we are always trying to implement actions for specific outcomes. And why am I saying this? Because you've heard a lot about training in a low-carbohydrate state, right?

Should I train fast? Should I have low carbohydrates? There may be some evidence to suggest that training in a low glycogen state called training low secretes more interleukin-6. Which is bad or good? Which is good. So now it's not just about the energy expenditure, but it's also about these myokines and how you are leveraging your muscle to orchestrate these things. Amazing. So basically, we're really in a new era of understanding muscle and its role in health and longevity. Your book, Forever Strong, which is an amazing book. Everybody should for sure get a copy.

A new science-based strategy for aging well is really kind of the first book of its kind download yeah of of your research in in in washington university as a uh student who had a fellowship in literally studying protein and muscle and aging right this is like where you came from but don't don't also forget that i spent 20 years and i can and continue to be mentored by dr don Donald Lehman, who made some of these discoveries surrounding anabolic resistance. So there's a guy I love, and I don't follow many people on Instagram, but this guy's my hero. And his name's Alain Gustave.

He's a French guy. I don't really know anything about him other than he has this amazing Instagram where he's 78 or maybe 79 years old, and he is ripped. And he can do like... Do you think he'd come on my podcast? If he could do it in French, maybe. I mean, he could literally do 25 pull-ups and does all these incredible feats of athleticism

at 78 years old, which is just astounding to me. We should talk about that. Can we talk about that? Yeah, let's go. When I think about sarcopenia, which is a decreased muscle mass and function, people define that as a disease of aging. My question to you is, when does cardiovascular disease start? Oh, when you're a teenager.

What about Alzheimer's, even? Can be 30, 40 years before you forget anything. Skeletal muscle dysfunction and skeletal muscle deficits begin very early on. And this sarcopenia idea to be a disease of aging, there are what I would consider young sarcopenic phenotypes, 18 years old, even younger, especially with the alarming rates of inactivity and sedentary behavior. So let's talk about, what's his name?

Gustavo? Alain Gustave. Okay. Let's talk about Gustave. 70 some years old, probably training like my husband, ripping out pull-up after pull-up after pull-up. It's insane. Here is the key. If we were to go back and look at his muscle health over his lifespan, there's three sections.

There's early life development, train early satellite cells that nourish musculoskeletal cells that require activity and stress to be able to be robust. Yeah. Then there's midlife, which is, you know, the time where you should really focus on peak bone mass, peak muscle mass. Yeah. And then there's later life, which is the maintenance of what you have. Wait, wait. Because I actually was kind of snobby.

Like, oh, gyms are smelly. You've been saying that for over a decade. They're like, like you know got a bunch of muscle heads in there and i'm this skinny guy it's kind of intimidating and every time i lifted weights it would hurt like hell for a while and i was like this is dumb and of course i thought you know oh you know i can do yoga that's plenty strengthening and i ride my bike and i can run my my bike 100 miles. And I play tennis for two hours, no problem. And I really didn't start until I was 59. And I've noticed a tremendous change in my body. But what I kind of heard you say in the subtext was it's kind of late to start then.

Like, can I make it up? The only time it's late to start is if you don't start. And that's the reality of it. Yeah. It's true. Because I took my dad when he't start. And that's the reality of it. Yeah. Because I took my dad when he was 89. He couldn't get up out of a chair. I said, dad, I'm going to get a trainer. It was amazing to see the gains he made even at 89 years old.

Yeah. There is a time where there's peak muscle mass that happens. Could that peak muscle mass be later? Could you potentially have been under-muscled your whole life and then all of a sudden in your 60s and 70s get to a peak muscle mass maybe however what we see from aging data is that it may be more difficult to put on mass keep in mind we don't have a great way from a population basis to measure skeletal muscle mass. Yeah. We are using DEXA. Yeah, yeah.

Okay. Yeah. But you can always build muscle. And, you know, I've thought for the longest time two things. Number one, you have to lift heavy to do anything worthwhile. I really do believe that, as you know. It's going to be hard if you have injuries or you're older or your ligaments aren't as strong. And it's ligaments, it's tendons, it's not muscle.

Right. And so the best thing someone could do is never stop training. That guy who is 78, I guarantee you he never stopped training. Yeah. Because we go through a series of catabolic crises where if you go on bed rest or if you stop training, it becomes very difficult to get it back. It's not impossible, but it's difficult. It's a steeper hill. It's fast to lose, hard to gain.

I mean, that's ridiculous. It sounds like money. So what can we do to maintain healthy aging and can you still build muscle? This is where when you're young, you're, you're very much driven by hormones. We could say, you know, when I think about muscle protein synthesis, there's four inputs. Yeah. The four inputs. So muscle protein synthesis in English means how you build muscle. Well, it's essentially a biomarker for what we believe to be over time, this way of, of putting on tissue.

For example, let's just say I eat 30 grams of protein, I stimulate muscle protein synthesis, but that doesn't mean I'm going to gain a pound of muscle. It's not a one-to-one ratio. You mentioned anabolic resistance. Anabolic resistance is the inefficiency or the decreased efficiency of skeletal muscle to respond like youthful muscle. Yeah, so when you eat the same amount of protein

or exercise the same amount, you don't necessarily get the same gains. And there's a really long history of where these discoveries came from, which I won't bore anyone, but if they're interested, I talk about it all the time because it's very exciting to me.

Mark's like, continue on. We're not talking about the history of amino acids, but that's fair. We can do that on another podcast. Yeah, another podcast. I have an agenda for this one. I'm going to get to it. But when we think about the amount of protein necessary to stimulate tissue, and some of

the earlier work by Moore looked at 5, 10, maybe it was 20 grams, 15 or 20 grams at that low level. What they found is that younger individuals were able to stimulate muscle protein synthesis with five grams of protein or 10 grams of protein or 15 grams of protein. Whereas an older individual, 60, had no... So you need more protein as you get older. That's right. You need more protein. Which is kind of paradoxical because people have less appetite. That's right. So what does that tell you? The quality of the food that you eat? If they're really nutrient-dense. They have nutrient-dense food. And what's so fascinating

is leucine is one of those essential amino acids that is nearly highest in protein sources in general. So even, you know, there's different qualities of protein, but leucine tends to be high in all of those things. And you have to think from an evolutionary perspective, why across food sources does leucine seem to remain high? And it's because that is a unique amino acid that does unique metabolic signaling for muscle It's like the switch that turns on the muscle building. It's like if you put a bunch of stuff in a soup pot and then you don't turn the heat on, you're not going to make soup.

So the leucine is like the amino acid that sort of flips a switch that starts to make the soup slash muscle. But you need all the soup pieces. So what is someone going to do who's never worked out before? And they're like, you know, I missed my prime. Well, I want to get to the work, to the what to do. I was trying to hit your agenda, by the way. So good, you've got something else on the side there. No, no, no.

This is good. I want to get to the what to do. We're going to get to what you should be doing, what kind of exercise you need, what you should be eating. We're going to get to that. But I just kind of want to summarize. Because what basically we sort of said is that muscle is this underappreciated organ that has been understudied, that's been neglected in medicine, that is probably one of the biggest drivers of disease as we get older. If not the biggest. If not the biggest. And that it's usually responsible for our metabolic health,

our immune health, and our brain health, and hormonal health, all related to optimal functioning muscle. So that leads me to the question of, you know, when I want to know how someone's blood sugar is, I can measure their blood sugar or the A1C, right? What are the diagnostic tests that we can use to measure the amount, the quality of our muscle? Other than saying, you know, like grip strength and how many pushups you can do and things like that. Right, a sit-to-stand test or a metered walking test. Muscle quality is typically defined based on function, functionality.

I don't think it's a great, it's a great proxy. It's interesting because how we measure skeletal muscle mass, we have to think about a lot of the literature is population-based. Someone will say, how much skeletal muscle mass, Mark, should you have for optimal health? I have no idea.

I can tell you that if you have 30% body fat, that's probably too much. I have no idea how much skeletal muscle mass you should have. It is very challenging. You are much taller than me. There's different body habitus. There are charts that we have, quite frankly, I don't think they're great. But I mean, are there diagnostics? Like we have MRI, a CT, ultrasound, a DEXA scan. Do we want to do a muscle biopsy? No, I've done lots of those. We want to measure

their blood tests we can measure to assess our muscle health. I mean, how do we, how do we get to sort of, as a doctor, I'm thinking, how do I start to really assess this with my patients? Because really what I do now is I look at all the biomarkers we talked about earlier that reflect poor metabolic health, like insulin, glucose, A1C, blood sugar, you know, HAPO-B, lipoprotein fractionation, liver function test, a whole bunch of uric acid, things that really help me to understand a person's metabolic health. He'll get their hormones, cortisol, stress hormone. I can tell a lot, and I can infer that they probably have poor muscle.

And those are great bar markers. And part of Function Health, which is a company I co-founded to help people get access to their lab tests, we do all that testing. So you can kind of sort of see the tea leaves, what's going on. But directly measuring it is tougher. So I'll send patients for a DEXA scan, or we have an in-body machine in my office at the Ultra Wellness Center where we actually measure that because we don't have the room for a DEXA scan.

And also, all of those are only okay. So the reality is a DEXA, which is considered the gold standard, looks at bone and fat mass and extrapolates lean body mass. We use interchangeably lean body mass with skeletal muscle mass. They're not the same. So when you see the appendicular lean mass, that's not skeletal muscle? It is, but it's an extrapolation. It's not directly measuring skeletal muscle mass,

and it tells you nothing about if there's fat infiltrate. It tells you nothing about the quality of that tissue at all. We really are behind, and that's the reality of it. We are behind from a measurement perspective. But if someone's got marbled fat- You'll see it on a CT or MRI. Wouldn't you see that on a DEXA scan? Wouldn't it show up as... Because I just remember a guy I saw when I was working at Canyon Ranch, and he was like a weightlifter, but he loaded up on carbs all the time. And he wasn't overweight.

And we did the DEXA scan, and I was like, holy crap, this guy, I thought he was going to be like 10% body fat. He was like 25, 30% body fat because all of his skeletal muscle was just marbled with fat. So there's a challenge there because there's something called the athlete's paradox. And the athlete's paradox is they have fat triglycerides within skeletal muscle that they use for energy. And that's called the athlete's paradox. But they would have great metabolic markers. But you may see fat within those tissues.

It's challenging. So the best thing today we have, and we're going to talk maybe about something new, is a DEXA scan, which is something that's not that expensive. It's low dose radiation. It's like flying across the country, probably familiar to New York in terms of radiation. And it tests for bone density too, which is important to check. Especially if you have low muscle mass, you can assume you have low. And bone density is a huge thing because it affects your risk of all sorts of things as you get older. But hip fractures and spinal fractures and a lot of people suffer from it. And you need to pick it up early because it's a project to fix it.

But you can. But also the same machine will measure body composition. And so I think absent anything know, absent anything else, I think it's a great place to start. Do you agree? It is. It is a great place to start, and you have to marry it with the fifth vital sign,

which really isn't a vital sign, but it should be strength. Strength. So how do we measure strength? Great question. There are lots of charts out there that talk about how much you should squat, how much you should bench press. These are, quite frankly, probably arbitrary because someone should just start and begin

where they're at and focus on improvement because we are not going to train for being better at exercise. You're going to train to be better at life. These are very good questions. So is it true that I should squat, I don't know, two times my body weight? Maybe. If I have an old training age. But should you squat twice your body weight? You don't really like doing squats. I like doing squats. I love doing squats, but I can't do too many because of my back with the heavy weight. Here's what I would, and I talk about this in my book, but here's what someone should do. Someone should know how many

push-ups they can do, even if they're on their knees. You're going to have to push up off the floor. The reality is you can't train to fall. The only way to get better at falling is to train to fall. No one's going to do that. No balance. I mean, you can train your core so you don't fall. People are about to fall and they can't catch themselves. But the reality is people will say, oh, well, you've got to train X, Y,

and Z, and you have to do plyometrics in case you fall. Those are all very challenging moves and very difficult to tell an individual who is largely untrained to do and to actually see improvements from a metabolic perspective. They might get a little bit better at balance, but I think with time, which is finite, you have to focus on the things that are really going to move the needle. So you asked me originally, how do we test for healthy skeletal muscle? There's metabolic markers. The other thing that I would say- The ones that I mentioned are the other ones. Yes. And then I would say, are you strong? Can you lift? How much do you think a suitcase lift is? Well, it depends on where I'm traveling, but it could be anywhere from 30 pounds to 70 pounds. Right. How much weight is one of those doors that individuals sit at the emergency exit in a plane? 40 pounds? How many people do you think that sit there that can't lift 40 pounds?

Yeah. You should test yourself and determine where you are on a strength continuum. Yeah. And that might not be an answer that someone likes because they're like, well, what is that? Well, that depends on where you start. That's like saying- I couldn't do 10 pushups when I was 50, but now I can do like 50. When I was really training a lot, I could do more like 75 nonstop.

But I read this paper in JAMA that says if you can do 40 pushups, the risk of having a heart attack is dramatically reduced. Right. I will say that study was, I think, all men though. Yeah, right. Because I can do way more than that. Oh, boy. Okay, let's go. Yes, we can do the push-up challenge.

So that becomes important to understand that picking a handful of exercises or movements that are safe. I don't even want to say exercises. Squat, push, like a, you know, it could be a push, it could be a pull. Various activities where you measure your strength and focus on improvement. If you are new to lifting, you might improve week after week. First six weeks, first 68 weeks might be neurological adaptation, getting your body ready, understanding the movements. After that, you should begin to progress in strength. If you are an advanced worker outer, it's going to take a lot longer. But understanding that there's this idea where there should be progression.

Yeah. I mean, at some point you'll reach a limit, right? I don't know. I mean, you're not going to be able to bench press 5,000 pounds. You're going to hit a limit, right? Right. And the changes might be incremental that we can continue to build on. But then I would say, let's say you have maxed out in that movement. Then you switch to something else. There should be a lot of skill acquisition that happens. So is that something people need to train or for? Can they do it on their own?

Can you use body weight bands? Do you need heavy weights? Do you need machines? I mean, part of the reason I just never did it was I just didn't like going to the gym. I didn't like all the machines. I didn't, I didn't really know what to do. I was intimidated by it. And I'm sure a lot of people out there feel like that, you know, and I, until I got a trainer who showed me the right form and the right body position and started with the right amount of weight to build myself slowly over time, I wasn't really able to do it. I'm excited to share with you a concept I guarantee you haven't

heard about. Okay. Which is unusual because I'm excited to share with you a concept I guarantee you haven't heard about. Okay. Which is unusual because I know how many people contact you to send you things. And you've heard about almost everything. I learned this from a PhD. His name is Pat Davidson. Do you know who that is? He is a PhD in exercise physiology.

He's very jacked and very tan. And I tease him all the time about this. But the reality is I think about how do we protect people's age? What do they have to do? I said, Pat, I have individuals that I see them go to the gym and I watch them train. I know that they're not training in a capacity that they need to be, even though they're doing fun stuff like ropes and battle ropes, and they're trying to jump on a BOSU ball and all of these fancy feel athletic type things. But at the end of the day, they're not able to generate enough power. They're not able to generate enough force.

They're not focused on strength and or hypertrophy. Strength is obvious. Hypertrophy is muscle growth. I would argue that if you focus on muscle growth, you're going to get stronger. You're going to get more force. You're going to get more power. You're going to be able to do these things. And he said, Gabrielle, think about high ground activity.

I'm like, what the heck is high ground activity? Right. When you're on a mountain? Exactly. I'm like, is there heck is high ground activity? He said- When you're on a mountain? Exactly. I'm like, is there Sherpas here? What are we doing? I don't know what high ground is. And he said, focusing on muscle hypertrophy is the most important thing. If they build and target the growth of healthy skeletal muscle, they will get stronger. They'll have better metabolic control. They will have a better ability to generate more of a VO2 max. They'll be able to do everything better and go back to the basics. And so high ground activity, and people are going to be like,

I didn't think we should use machines our high ground is exactly that lots of contact for example a hack squat a hack squat is a squat that has a backrest your feet are on something your legs or your arms are touching something it's a lot of contact and a lot of feedback so when you are able to engage in that exercise, you are fully focused on the muscle of choice. And by choosing those type of things, and that is what we consider a compound movement, you are putting in effort in the right place, as opposed to going and doing bicep curls, which would be considered a low ground activity. You are not supported. Maybe you're standing up. Maybe you're swinging your

arms. Maybe you're, instead of working. It's better to use these big machines is what you're saying. Yes. And it's called high ground training. So you need to, I need to buy these expensive machines and go to the gym. But think about it. It has to matter enough. Could you do resistance training, body weight and bands and all of those things? Absolutely. Do we need to do that? Totally. But if we are really serious about our health and wellness, we have to put some effort in to do those things. And I get a lot of pushback when people say,

well, do I have to go to the gym? No, you don't have to if you're certainly more advanced and you know that you can move and do things in a way that is safe. Because here's the reality. So basically I should get a trainer and go to the gym is what you're saying? Yes, until you learn. How to do it myself. And another, high ground activity.

So people think about lunges or split squats. Yes, until you learn. How to do it myself. And another, high ground activity. So people think about lunges or split squats. So that's one leg in front, one leg in back. But another way to do that would be one leg in front and then have your foot back up against a block. And why does that work better? Because now you've got your foot fully flat instead of a split squat in the way that you're doing it, or like an assisted deadlift where a single leg RDL.

Basically what I'm saying is- Russian deadlift. What I'm saying is when you increase contact, you are now training the muscle with the intensity. Again, intensity declines as we age. It doesn't have to be heavy. You do have to go to a level of fatigue because you're looking for stimulus. And what about these other kind of tools for people who have injuries

or who, you know, sort of they're hacks to get the intensity without the injury or hurting yourself, like electrical stim exercising or a blood flow restriction or these vasper cooler kind of things wonderful what how effective are those because i mean i'd rather probably like at my age get a bunch of blood flow restriction devices or electrical stim so i don't have to hurt myself because i have a bad back and i don't want to hurt myself so is that is that as effective um i can't say you know I haven't seen any data. This is very difficult to do over time.

It's very difficult to follow someone in control for everything. I've worked with a lot of special operations community. They use a ton of blood flow restriction in injury. I know a lot of physical therapists that use it. Individuals use it to help with rehabilitation, slowly loading up tendons. Again, it's not always muscle injury. It can sometimes be tendons. It can sometimes be ligaments. How do we go in a slow, progressive way to eliminate the potential for injury? So yes, do I think a stim suit is great? I do. Do I think blood flow restriction is great? Absolutely. Does that allow you to do the intensity without the risk?

The stim suit is, it's different. It's different because it's... When you get the muscle hypertrophy and the growth? You will. I mean, again, I'm saying that as if I know everything about it. I'm assuming, yes, I've seen some data to support, yes. I've also seen rhabdo from it. Which means damage to muscles, yeah. From electrical stim, yeah. From electrical stim. But you can also get that from just training. I've seen people with high muscle enzymes after training, yeah.

Absolutely. I think that the real magic is going to be the interface with fitness professionals and medical professionals. The true interface because we can't do what we do without that component. I don't know if you know this, but with Function Health, which I co-founded to be able to test all your biomarkers, we partnered with Equinox because... I didn't know that. Where's my invitation? How come I get it later? What is it? It just got announced. There's a membership and there's a whole thing. But the idea is that you need to look under the hood and deal with the medical aspects, not just the training aspects, too. Yes. I fully agree with that. And then I think that the other thing is that people feel

like strength training, resistance training is interchangeable. That they could go do a class or do something else. And I would say there's nothing more important from my perspective as a geriatrician than strength training. To really focus on resistance exercise. Everything else, I love the idea of having a great VO2 max. Cardio. Which is cardiovascular activity. Here's how I prefer someone do it. Do high intensity interval training to compress the time

because sometimes people can't manage the length of time it takes and the effect on joints or the interest. You should do things. How long, just practically, as we wrap up, practically how much time a week should people devote to strength training? The more intense an individual works, the less time it takes. So you could do once a week super intense? I wouldn't recommend it. I don't think that's optimal. Twice a week, three times a week? If I were to design a new lifter, or even an advanced lifter,

I consider myself an advanced lifter. I train three days a week. And for 20 minutes, 30 minutes an hour? No, 45 minutes. A shout out to Carlos Mata, my trainer. You should come in and get some pushups with us. But seriously, full body, three days a week, very intense. We do push, pull, hinge. Those are all actions.

You know, someone could look that up. We do sled pushes. We do things that are dynamic and hard that continuously challenge me. But for a beginner, they are going to get the biggest bang for their buck. They're going to improve the most. Yeah. Yeah. I saw that. It was amazing actually. What happened? Three days a week, two days a week, full body. It's not about the time, because you could go there and you could be on your phone. It's about the intensity.

It is about the overall volume, the overall amount of work that you're doing. So you could do lighter weights, more reps? Exactly. So that can be considered intensity? It could be, as long as you're going close to failure you know and I never believed that until I started seeing

this stuff out of McMaster University I was like nah you gotta lift heavy but you don't two days a week full body ideally

that's enough to maintain if you're gonna you know five to I don't know pick a number 25 reps

again it's there's so many different ways to do it right which is amazing the only one way to do it right, which is amazing. The only one way to do it wrong is to not do it. Yeah, that's a good line. The only way to do it wrong is to not do it.

You should hear that out there because I was a late starter and I regret not doing this when I was younger. I really regret it. I tried. I tried. I know, I was bad. I mean, at least 10 years ago, I was like,

Mark, you cannot be doing all this yoga. Yoga is wonderful, but come on. Yeah, yeah. I know. And by the way, it is wonderful. So let's talk about the, now that we've talked about the need for training and the amount and all the varieties of kinds of things we can do in this. By the way, all of this is in your book, Forever Strong.

So people can check that out and check out your website, which is drgabriellelyon.com. My YouTube. I have training programs. Training programs. Check out her YouTube. All stuff that I do. Definitely follow this lady. She's amazing.

And she's going places. It's like that Dr. Seuss book. Oh, the places you'll go? That's her. I'm going to the gym after this. I'm going to the gym. Okay. Well, I'm going to a concert.

Are you really? Yeah. Grateful dead. There you go. And the next piece I want to talk about, and we talked about this when you were on last time quite a bit, about protein and about diet and about diet and muscle. And I think your perspective has changed over time. We're learning things over time.

And I think the question is really when, what, and how should you be eating to optimize your muscle health? Great question. Probably my favorite topic. Although I think that I might eventually, I don't know, talk about underwater basket weaving. God, I killed that joke. But in the meantime, protein is the most controversial macronutrient. It just is that way. And I think that it is,

and it will continue to be that way. But what is the reality of why we need dietary protein? We need dietary protein because we need these amino acids. We often only hear people talk about protein as the building blocks. I would say let's scrap that and let's talk about dietary protein when it comes to each of these essential individual amino acids do different metabolic things in the body. They're

not interchangeable. I'll just give you a few examples. Threonine is an essential amino acid for mucin production in your gut. I remember some of the first patients I saw with you, they all had, quote, leaky gut. Threonine for mucin production. Arginine for nitric oxide production, which is a way- To dilate your blood vessels. Exactly. For inflammation, right? You know, tryptophan for serotonin production for your brain. Leucine for skeletal muscle stimulation. As you can see, they all do different things. They're not

interchangeable. So then the next question is, well, that's confusing. How do I eat for that? I would say, you're right. That does sound super confusing. And, uh, Thank God nature took care of it for us. They did. First, most important thing that someone understands is how much protein that they are getting. And that trumps everything. If I were to say what is the protein hierarchy, that would be 1.6 grams per kg, which is 0.7 grams per pound ideal body weight.

Which is double what the RDA is. The RDA. Which is the minimum amount you need not to get a deficiency disease. Correct, and that's 0.37 grams per pound. Or 0.8 grams per kilo. Exactly, which is also based on only high-quality proteins. Yeah.

So that's not based on plant proteins. And you're saying plant proteins are not high-quality proteins. Based on the definition from digestibility and amino acid profiles. It's just, you know, people get very offended by that. It is purely biological numbers. It's not, this is better, this is worse. This is purely based on the spectrum of amino acids. So the first most important thing is getting enough protein.

And people will say, well, we get a ton of protein. Well, we get a ton of protein for what? Do we get a ton of protein to overcome the minimum deficiency? Yes. But do we have enough protein with an appropriate amount of calories to maintain healthy aging and metabolic correction? And I would say we have some work to do. The average individual, the average male gets about maybe 90 to 100 grams of protein. Average female is probably around 70 grams of protein. And we know that in order to protect skeletal muscle,

that we're really looking at closer to 1.6 grams per kg, so 0.7 grams per pound, or closer to 1 gram per pound ideal body weight. So if I'm 180 pounds, you're talking about like 150 grams of protein a day. That's reasonable. Now, that's the first most important aspect. Whether it's coming from plants or animals, if you choose to, and this is just protein, this is not talking about where you're getting your iron or creatine or B12. We're purely talking about protein, not the other micronutrients that are diminishing

and we have deficiencies of, like none of that. Yeah, and that are different in animal versus plant protein. Plant protein has a lot of fiber and phytonutrients and lower protein quality. If someone wants to get their protein from plants, they are likely going to need a certain percentage more, depending on the source, maybe it's 30% more. Overall calorie consumption is going to go up,

but you can get enough of these amino acids necessary for muscle health. However, you have to be careful if you are older and you are not highly active, then if your idea is to eat whole foods and eat whole foods from plant-based proteins, then you have to watch total calories and carbohydrates. Yeah, I mean, if you want to get, you know, four ounces of chicken is a few hundred calories, and the equivalent of that in quinoa is like six cups, which has got like a thousand calories.

Correct. So how do you manage that? Right, and the way in which you manage it is you choose things like tofu or rice pea blend protein powders. So you have to eat processed proteins in order to actually maintain the level of protein you need as you get older, is that what you're saying? I would say that unless someone is very active.

So unless someone was very active, then I would be concerned about the ability to dispose of the carbohydrates and overall calories. I would have certainly concerns about that, just from a metabolic point of metabolic. So basically if you're like run five miles a day and you do all this stuff and then you eat more calories, it's fine. But if you're just an average person who's not doing that and you're trying to build muscle, the amount of protein you need is going to kind of put you over the calorie limit and end up

causing metabolic issues. I mean, it definitely depends. There's many ways to do it well. But what I would say is that understanding that the total protein intake is most important, understanding that that first meal of the day is critical because you're coming out of an overnight fast. There's only two ways to stimulate skeletal muscle, and you have to protect it. And that is through resistance training and dietary protein. We know that when you are in an overnight fast, you are catabolic. The body is using liver glycogen and potentially pulling from amino acids, from skeletal muscle, because these processes, protein turnover throughout the whole body has to be going on. Yeah, you can't like, your body doesn't stop like repairing tissues and making new cells and proteins all night long.

It still has to do that. And you do that in a state by using kind of of recycling protein that's called a topic it's a good thing you recycle proteins you know what you recycle an enormous amount of proteins you oxidize you replace it is a very dynamic process understanding that that first meal of the day is most important i don't care when you have it, but coming out of an overnight fast. So we should be having like, what, French toast, a muffin. Yeah, if you want to completely destroy your metabolism. Starbucks, matcha frappalata, mochaccino. Yes, yes, exactly.

But the evidence is very interesting from a satiety standpoint. So there's a skeletal muscle standpoint. You want to hit between 30 and 50 grams. In the morning, when you wake up. And that's also the same amount. So it's kind of the opposite of what we do in America is we don't eat protein for breakfast. We eat sugar for breakfast. Right. You know, I worked on some of these early studies and one of the, it was two groups and one of the groups, they filed the food guide pyramid,

which was 55% carbohydrates, the RDA of protein and and 30% fat. And they were both isocaloric. And then the other group was roughly 40 grams of protein at breakfast. It was a 40-30-30 split, like the zone diet. So 40, yeah, well, anyway, it was a 40-30-30 split. And what we saw was that those that were isocaloric but just adjusted... The macronutrients. The macronutrients actually lost body fat, maintained lean tissue, and with exercise, there was this fantastic synergistic effect

that the majority of weight that they lost was fat. So basically eating protein in the morning and reducing starches and carbs combined with exercise got the most benefit. Yeah. Even eating the same exact amount of calories. Yes. Right.

That's amazing. So you switch from the standard American eating trajectory to a more balanced distribution. And this is kind of where, we don't have time to talk about this one, but this is kind of where, we don't have time to talk about this one, but this is kind of where that whole 30 grams of protein three times a day came in.

There's actually no evidence to support that. So does it matter, like, you're saying, like, I need 150 grams of protein. Could I have, like, a 900-gram ribeye steak and that gets me going for the whole day? You'll probably do 70. I mean, I wouldn't suggest that because then you're stimulating tissue once a day.

And we've seen that. Do you want it more evenly spread out? Or do you have to do it before exercise? Does this matter? It matters. After exercise? How long after exercise? Great question.

People need to know the practicalities of how do you apply this to get the most benefit? There's a lot of science behind this. There is. If you are young and healthy, it really doesn't matter. As long as you're hitting your total protein target, it doesn't matter. I don't care when you get your protein. I don't really care what kind you get your protein.

Do you have to have Cero for Bex when you're a kid and be fine? I mean, I don't have to. I know. My kids don't, but it doesn't really matter. As long as you're getting your total protein intake in, I don't care if you have it around exercise. Frankly, I don't care.

That's because there's a lot of hormonal activity as you're younger that drives growth. Your tissue is highly anabolic. If you are more mature, if you have weight to lose, if you have underlying inflammation, then understanding first the total amount of protein is critical, recognizing that that first meal of the day, which is where all the data has been, all the data is, to my knowledge, is on that first meal of the day. Again, I worked on some

of these early studies. And what we saw was changes in body composition with carbohydrates managed. That first meal of the day is critical. The second meal of the day, I don't really care about. It's just to get in that protein. And there should be some kind of a one-to-one ratio of carbohydrates to protein. You don't want to overshoot your carbohydrates for no reason. And then arguably, one could consider that last meal of the day being very important because now you're going into an overnight fast. So what's that be? Same thing.

Between 30 and 55 grams. But here's the thing. If you are... Protein also makes you feel full and it also takes more energy to burn protein in the body. Well, it stimulates muscle protein synthesis, which is a... This is where the thermic effect of food comes in, thermic effect of feeding. So fats, maybe 3% of the calories from fats are utilized for the utilization of fatty acids. Carbohydrates might be-

It takes energy to metabolize your food. 5% to 10%. Protein can be 20%. So you eat 100 calories of protein, 25 of those calories or or 20, goes into actually processing and metabolizing and breaking down and burning those calories. I actually believe. So the net net calorie is less. Yes. And I believe that it's actually from the stimulation of muscle tissue

and not the disposal of urea or nitrogen, which are the byproducts of protein. It is from the leucine stimulation of muscle. But let me close out with some very practical things. If you are young, I don't care what you're doing. You can have five grams of protein in the morning, in the afternoon, doesn't matter as long as you're getting your total protein in. If you are older, and let's define older, inactive, have weight to lose, or under-proteined, you are protein deficient or you're eating a sub amount, then understanding that total amount of protein matters first, let's just

shoot a high one gram per pound ideal body weight, but the evidence is perfectly fine with 1.6 grams per kg or 0.7 grams per pound body weight. You're going to ask me, what is your ideal body weight? Pick the last time you felt great. This is human science, which is not a perfect science. Then the first meal of the day should be between 30 grams, could be higher. If you wanted to eat twice a day, let's say you needed 75 grams at that first meal. I don't care. Go right ahead. I just want to make sure that you're really hitting between 30 and 50. Now, does it matter that it's around exercise? Not for that first meal.

That's what I do. I noticed when I do my morning goat way protein shake, which is my healthy aging shake that I wrote about in my book, Young Forever, and I'm working out at home and I have my routine, it's amazing to see the gains I have in muscle very quickly. Let's talk about why that is. This is one of the nuances that if you look at the International Society for Sports Nutrition, they will say it doesn't matter when you eat protein. And I would say I appreciate that, especially if someone is young and healthy. When you are more mature, Mark, you're more mature. Thank you. We have to overcome anabolic resistance. How do we make your skeletal muscle respond like younger skeletal muscle?

You do that by resistance training and the synergistic influence of also the amino acids. The protein with the strength. The protein and the strength training. If you look at the data, it looks like this is, you've seen this in Bob Wolf's lab. You've seen this in Katsano's lab. Your muscle responds exactly like youthful muscle. So you wouldn't be able to tell the difference from a metabolic perspective. If someone is listening and they're like, well, should I train faster?

Go right ahead. But now after you've done, you're done training and you want to take advantage of blood flow, give yourself 30 minutes. And within that 30 minutes to an hour, because now your muscle is primed to receive nutrients, have your protein. Can't be right after? Sure, of course. You don't have to wait 30 minutes.

No. But you shouldn't wait three hours. If you are young and healthy, I don't care. I'm not going to doubt me. I don't care about all those young people. For you. I those young people. No, but for you, if we wanted to joke, everybody's favorite radio station is WIFM. What's in it for me? Asking for a friend, asking for a friend, then for you, I would say that that would be a benefit. If someone wants to lose weight, if they have low-grade chronic inflammation, this is a great way to help get nutrients to the muscle.

That second meal, I don't care so much about. Could it be 30 to 50 grams of protein? Sure. Does it have to be an even distribution? No. Could it be 20 grams of protein? Easily. That last meal of the day, I like making sure that there's two meals that are robust in protein because now you're

stimulating that tissue going into an overnight fast. Is there evidence to support that, um, that meal is the key to metabolism? No. Well, you shouldn't eat late. That's for sure. Well, it'll affect, it'll affect your sleep. It'll cause you to gain weight. It's, it's.

Now I'm going to leave you with one more thing. Yeah. Because I think this is really important. Okay. And that is, if you fail to do the practical, the practical becomes impossible. If you fail to do the practical, what we are talking about is very practical. If you fail to do these very simple things, resistance training two to three days a week, full body,

having dietary protein, I don't care where that's coming from. If you're older, combine it with resistance training. If you fail to do these very practical things, you will find as you age, the practicality of your life becomes impossible. That's right.

I mean, that's really the message here. I mean, the title of your book is really Forever Strong, a new science-based strategy for aging well. And the idea is that strength is important as we get older, because without it, we lose function. Without function, our lives decline and we withdraw and we become old. And so that's why I like to watch this guy on Instagram, because he's like crushing it, and he's almost 80 years old. And the average 80 year old, we don't think of as somebody

who's that ripped and that fit. But the body is capable of that. And it's now exciting that we have the science and that you've done so much of the work and you've written about it. It's really tremendous. And I think for people listening, I think the message is clear.

Your muscle is an important organ. Pay attention to it. Make sure you work out and resistance training and make sure you eat enough protein. And that's it. And it's not that hard. We want the details for sure. They're going to be in the show notes. We're going to link to Gabrielle's work and her amazing podcast, which is called the Dr. Gabrielle Lyon Show. Hard to find, I know. And her great website, which is Dr. Gabrielle Lyon, her book, Young Forever Strong, Young Forever, that's my book. And by the way, our titles had nothing to do with each other. The, you know,

the teams work on these things well before they come out. Yeah, yeah, for sure. And you know what? I always learn so much from you. It's really tremendous. I know how passionate you are about this topic and you've done the hard work and you basically are probably one of the few physicians I know who actually understands muscle, which is kind of interesting because it's like the biggest organ and we've completely neglected it.

So no longer, no longer. And everybody needs to pay attention to this beautiful woman who is doing incredible work to change our thinking about how we need to move and eat and be healthy as we age. So thanks for being on the show. Thank you so much for having me. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social

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