unPAUSED with Dr. Mary Claire Haver - Gabrielle Lyon Part 2

Episode Date: September 25, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Gabrielle Lyon, board-certified family physician, founder of the Institute for Muscle-Centric Medicine, and bestselling author of Forever Strong — this time with the practical roadmap for building muscle in your 40s, 50s, 60s and beyond. Dr. Lyon explains why your first meal of the day matters most and why 30–50 grams of protein at that meal can change your body composition on its own. She breaks down anabolic resistance — why the diet and training that worked at 20 stops working at 58 — and the research showing it's reversible: women over 60 got no muscle response from 15 grams of protein, but at 30 grams responded just like 20-year-olds.They get specific: what a 50-gram breakfast looks like, why two eggs won't stimulate aging muscle, how essential amino acids and creatine fill the gap, why the protein RDA is a floor rather than a target, the truth about red meat and saturated fat, the honest state of the evidence on hormones and muscle, and Dr. Lyon's warning about GLP-1 medications and accelerated sarcopenia. Plus: why progressive overload should really be progressive stimulus, where a woman who has never lifted should start, and why getting bulky isn't the risk — becoming frail is.Guest links:Dr. Gabrielle Lyon (Website) https://drgabriellelyon.com/Dr. Gabrielle Lyon (Instagram) https://www.instagram.com/drgabriellelyon/Dr. Gabrielle Lyon (YouTube) https://www.youtube.com/drgabriellelyonBooks:"Forever Strong," by Dr. Gabrielle Lyon https://www.amazon.com/dp/B0C4VSDWQ2"The Forever Strong PLAYBOOK," by Dr. Gabrielle Lyon https://www.amazon.com/dp/B0FL32CJ81"The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book"The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1ZFor full show notes, please visit: [BIT.LY LINK]Never miss an episode—sign up for The 'Pause Life Newsletter: https://thepauselife.com/pages/newsletterMedical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The 'Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.

In part one of my conversation with Dr. Gabrielle Lyon, a board-certified family medicine physician and founder of the Institute for Muscle Centric Medicine. We challenged decades of conventional wisdom about women's health. We talked about why skeletal muscle is the foundation of healthy aging, why so many women are dramatically under-consuming protein, and why building and preserving muscle must be at the center of every conversation about longevity. Now it's time to get practical. In this episode, Dr. Lyon breaks down exactly how much protein women really need. She explains why anabolic resistance changes the equation after midlife and how resistance training, hormone therapy, and even GLP1 medications fit into the picture.

She also gets into when you should be eating protein throughout the day and why sleep matters just as much as the workout itself. We also tackle one of the biggest questions I hear from women every day, which is how you actually build and keep muscle in your 40s, 50s, 60s, and beyond. Part one explain why muscle matters, and this conversation gives you the roadmap for protecting it. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist and certified menopause practitioner and adjunct professor at the University of Texas Medical Branch.

Welcome to Unpaused, where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. The views and opinions expressed on unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. So I hear a lot about when we should eat protein. You talked about 30 to 50 grams. Like, is the amount per day more important than when per day? and is there a wrong time to eat protein or a right time to eat protein?

From a practical standpoint, that first meal when you're coming out of an overnight fast is important. Okay. It doesn't matter when that is, but you are in a catabolic state. Catabolic state is when you're in a breakdown state. You're not feeding overnight. We were meant to eat in discrete time periods, unlike rodents, who are, you know, 24 hours ad-limited feeding, nocturnal beings, but humans, we are meant to eat. to eat in discrete meals.

So that first meal of the day when you're coming out of an overnight fast is really important. Doesn't matter when you eat it. Doesn't have to be eat in the morning or six in the morning. It doesn't have to be before training or after training. But getting that first meal right at 30 to 50 grams and closer probably to 50 to stimulate mTOR, which is in skeletal muscle, is going to be critical. If the listener or viewer only did that one thing, that is enough just based on those early 2,000 studies and they've been replicated. So now we have a large body of evidence. This will change

body composition if they do nothing else. Amazing. And there's more to address there. First meal is really important. Also, before you go to sleep, the last meal of the day. And not necessarily an hour before you go to sleep, but that last meal of the day is also really important. So you're bookending both days or both times once a day. Well, and we talked a little bit about protein timing around training. So you're saying, just get the protein in? I mean, there's a little nuance here. Again, all studies, to my knowledge, are done with that first meal of the day because it's easier to have a kind of a clean slate from a measuring perspective. But if you are eating a higher protein diet, closer to 1.2 to 1.6. If you are plant-based, you have to be at the higher end, 1.6,

then protein timing doesn't matter as long as the totality of protein you're getting in. Okay. That being said, still, we have great data that that first meal at 30 to 50 grams of protein affects satiety, affects body composition, again, for outcomes that we care about. And that becomes really important. How important is sleep? I mean, unfortunately, it's very important. But it's hard for a lot of women to do.

The recovery and the training, you know, when I was in residency, and I'm sure you experienced the same thing, is that you're on calling, you didn't sleep. blood sugar regulation, I put on a continuous glucose monitor one time, it was the worst decision I made, right? Because the days that I didn't sleep, I saw my blood sugar was terrible. And, you know, we're recognizing that sleep is very important for also recovery. And is it true? That's when we grow muscle. It is. Okay. It's in part of it, yep, during recovery. Also, the glial cells in the brain flush, the glyphatic system, you know, one of the, which is why I think it's a major design flaw. Because when you have little kids, my kids still sleep in my bed. I cannot get them out of my bed. I've not had a good night's sleep.

The only time I have a good night's sleep is when I'm traveling. But, you know, we are designed to sleep. And one of the things is having awareness as to your own habit. So I don't know about you, but once I miss a sleep window, I'm up. Does that happen to you? Oh, yeah. Yeah. So you, if you miss, if I miss by 9.30 and I didn't go to bed, I'm up. I'm up until like 11.30. Yeah, if I don't like hit my normal, then like I'll always read when I go to bed and I'll just keep reading and reading and reading. You know, like I've, whatever happens with my circadian rhythm, it's not good. And it's getting worse with age, you know, and I'm fully replaced on HRT. It's not that. So I have to protect my sleep with my life now. There's no, it's non-negotiable. Well, I hope I get there. I mean, really, I just, yes, I hope I get there. But sleep is really important for muscle health. And it's also really important for metabolic regulation. Something else that's really interesting is if someone misses a night of sleep, number one, it can actually suppress muscle protein synthesis, which makes perfect sense. Yeah. But there's a ways to compensate for lower levels of sleep. And that is there's some evidence to support high intensity interval training

to offset a few nights of poor and shorten sleep. So if I'm traveling and I'm jet lags, yes. I always, yes, there is some data to support that it offsets. the outcomes of porcelain. So you touched on amino acids. This is a supplement, right? This is not a food. You talked about this, you know, complete amino acid. Where would you find that?

Like, I don't use that. Where would I find it if I wanted? What, essential amino acids? I use body health, amazing product, very clean. And I use perfect aminos. I use perfect aminos in tablets and in packets. It's extremely convenient because, and especially for women who are, number one, looking to maintain their muscle or even having a lower total calorie count. So if they want to

lose weight, if they want muscle recovery, this is the way to do it. Do you use it in conjunction with a GOP1? Do you think it's important? Oh, it's critical. When we have patients that are on GOP 1s, we always give them perfect amino. Okay. Because otherwise they're, you know, when you look at some of the data and you see that as women age, their total calorie intake goes down. And then you look at when you put them on a GLP 1, now every bite matters, you've got to get that nutrient quality and nutrient density up. Okay. Which goes to creatine. Yeah, my next question was creatine.

Creatine. Are you a fan? I am a huge fan. But let's just think about creatine and where it is found. Creatine is found in red meats. Yeah. You could not eat enough red meat to be able to get to five grams a day for muscle. It is, it's something like one, it's something like.

It's 12 chicken breast or something ridiculous. It's a pound of red meat for half a gram of creatine. Don't quote me on that, but something, it's either a pound for half a gram or one gram. If five grams is the minimum for muscle and 10 to 12 for brain function, that's, no one is going to consume that much. But what I think becomes really important is, yes, we have a lot of evidence for how it supports muscle and how it supports performance. but this brain function aspect of creatine seems to be really promising, and it seems to be most promising in the more mature individual, 60s and up. Again, Darren Kandau, if you've not had him on, he is one of the world-leading experts on creatine.

And, again, the most of the data that I've seen has been in older women, in older individuals, but potentially there's going to be more for younger. I love it. We recommend it. And it's good for a mood. cognitive function, processing speed. Awesome. So what's one thing women are doing or being told to do that you want them to stop?

Well, that you should reduce your red meat intake. That's probably the biggest one. It is highly nutrient dense and especially for young women. Is there ways to make it unhealthy, though? Red meat. Yeah, sure. If you want to go to the gas station and eat, it's the same as eating a donut. Processed.

Yeah. But that's probably one of the biggest things. Okay. Most women have never heard of anabolic resistance. I know. It's like a swear word, but different. So what is it? Anabolic resistance is what is considered a normal aging process of muscle.

Okay. And it is less sensitive to the normal stimulus of skeletal muscle. So I go to the gym at 20 and I eat X amount of protein of healthy, high-quality protein, and I lift heavy. I'm going to have a different response than I am at 58. Yes, ma'am. Next month. With the exact same stimulus. Yes, ma'am.

Substrait into stimulus, and I'm going to have a different response. You are. You know, this is like the unfortunate part about aging. We get wiser. We get sage wisdom. We can now integrate our thinking. And then all of a sudden it's like the body falls apart. And I think it's a design flaw.

But it can be circumvented. I'm embracing it. It can be circumvented. When you are young, you're on the Twinkie diet. You go, you lift weights. Even the lighting makes you look anabolic. I mean, the lighting is making you look jacked already. But as we age, we think about the aging process of our heart and our brain and our ovaries.

Muscle as an organ system follows the same trajectory, but it's manifested differently. How does aging muscle manifest? And I do also want to point out that there are some nuances here. because if you look in the literature, it says healthy sedentary people. It's not possible. That's a diseased archetypes wrong. It's in a diseased cohort. That represents something that is not a healthy state, right? And I say this because where does anabolic resistance flow through this conversation? Anabolic resistance is what we think of as a normal process of aging. I'm not so convinced that it is a normal process of aging. Really? Yes. I mean, I believe that maybe when you are 80 in your 80s and 90s, potentially, you know, that there are

some of these facts. And again, this is controversial. And I would probably be fighting with my mentor because he would say, well, no, it is a normal process of aging. But I would say that we don't have highly physically active cohorts of a normal population. To be able to measure this. How can we say because elite athletes, there's nothing normal about them. These elite athletes that have been training their whole life, their muscle will look different than, you know, anorme like myself. It's going to look different. So I just want to point out that little caveat because I do want to be fair in the literature. Anabolic resistance, now I'm going to go back to the definition, it is the, it is somewhat of an insensitivity to a stimulus like protein or more specifically

branched-chain amino acids, even more specific to that, which is leucine. Okay. How do we overcome become anabolic resistance. And why does it matter? Anabolic resistance manifests exactly what you say. All of a sudden, I've eaten this normal diet. Something has changed, but I'm doing exactly what I did since I was 20. And now all of a sudden, it's not working. You will require more protein for muscle to recognize that signal.

Amino acids are just signaling molecules. If you have your two eggs in the morning, you're not going to stimulate muscle. it's going to be resistant. It's not going to kick in that machinery. But if you hit that 30 to 50 grams, which is, again, four and a half ounces of a meat of your choice, or, you know, we use, this is where essential amino acids come in, which we should talk about how, if someone is thinking about this, how they could augment their nutrient density without increasing total volume of food. Yeah. Because we're using this in our practice and it's transforming people's body composition without having to eat all this food. So anabolic resistance, you can lower it. You can make old muscle act like young muscle by bumping up the quality of the protein, i.e. essential amino acids, all essential amino acids, and doing resistance training. I know that that was a lot of words. Yeah, because I want our audience to understand that you can grow muscle at any age, at 70, at 80, at 90.

It is possible. And it's just harder. It's harder. It just takes a little more diligence and you can have older muscle respond like younger muscle. Anabolic resistance is not a static thing. You can improve and lower the resistance by doing the things necessary for stimulating muscle. For example, and there are some really good data. I think it was Katzanos and Simmons, they looked at a younger person having, when I say younger, in their 20s, having 15 grams of protein, and they get a maximum response of muscle. And that's the next cohort, 60 plus, had no response with that same 15 grams. But once you bumped up that protein intake to 30, the 60 plus responded just like the 20-year-olds. Okay. And I do think that we should segue into what are the practical takeaways people need to do to understand muscle health.

Okay. And the reason I'm saying this is because with the landscape of as we age, our appetite reduces naturally, and with the use of GLP-1s, we're seeing a further suppression of overall food intake, that the quality of that food becomes critical. Now, the dietary protein recommendations are set at 0.8 grams per KG. The RDA hasn't changed. The new dietary guidelines recommend a higher amount, but the recommended dietary allowance stays the same. same, and it is set at the minimum. And people, that's just a point of confusion for people. 0.8 grams per KG of protein, so for some women, that's 45 grams a day, is set at the minimum to prevent a deficiency. Last time I checked Mary Claire, you and I are not looking for how not to be worse than yesterday, right? Right. We're not looking for that. That is the minimum to prevent deficiency. How does... Different than optimal. How does muscle deficient? How does muscle deficient

show up on a daily basis, it doesn't. It takes 10 years for us to begin to see problems. Yeah, overtly. Not in blood work, but overtly. So when we think about how much protein we need, the average woman is getting 1.1 grams per KG, which means people are like, oh, well, the new recommendation is 1.2 to 1.6, they're close. No, that means 50% of people are below that number. Yeah. For women in their 60s, anywhere from 20 to 40 percent, are below the RDA. This, I know. Yeah, they're having toasts for breakfast. And we know.

Almost no protein at lunch and they'll stack a little bit more at dinner. Devastating. Not only the metabolic consequences, but fracture risk increases. We know that protein is what makes bone. These are really important aspects that people have to understand because the landscape, changes in terms of how we talk about protein because anyone listening to your, anyone listening to your podcast in their 50s has heard that red meat is bad for you, that I should be concerned about saturated fat. They've heard all of these things. And we have to fight for the women in the middle that are like,

okay, well, I've tried lowering my protein and now look what has happened. So again, this is a very long-winded way of saying, how do we design a diet? Well, we have to first focus on protein total. you'd asked earlier, is it timing, does timing matter? Timing only matters if you are lower protein. Oh, okay. Timing doesn't matter if you are a high protein person. If you're getting closer to 1.6 grams per KG, then timing doesn't matter. But I will also say almost every single study on protein is done with that first meal

of the day. Easy to measure. You're highly catabolic. There's no reason. why you wouldn't set yourself up. And we do see data that it does transform body composition, assuming calories are within control. Okay.

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Animal, you touched on this, but is it hot. We have to clear this up. Yeah, animal versus plant protein, what's your position? You know, today I had a comment on social media, but I'm a vegetarian and, you know, it was a protein post. And I was just, okay, and I wanted to say why? because they think it's healthier. Or they have problems with killing animals and, you know.

Yeah. So this is a real challenge and I think in the geriatrician landscape as well, dietary protein is not just one thing. It does come in those various qualities, the higher quality and the lower quality. If someone is vegetarian or vegan, could they build a healthy diet? They could. The statistics show us that it's, unusual. It's right. It's hard. The statistics show us that people are struggling with obesity.

People are struggling with menopause. People are struggling with osteoporosis and things that are really movement. So we know that these struggles are well documented. If someone wants to design a diet, the first thing that they have to determine is how much protein are they going to get a day? no less than 100 grams. From my perspective, higher is better. In our clinic, you know, in the playbook, we shoot for closer to 1 gram per pound of target body weight. We also, and people are like, oh, my gosh. So if there's a 130 pound woman listening to this, she's like, oh, I have to eat 130 grams of protein.

No, you would be perfectly fine with 100 to 120 grams. Could you go a little bit higher? Yes. Is protein important for things other than muscle? Yes. it's important for every enzymatic reaction, for all, you know, like you listed, it's there. But how is she going to practically speaking design her diet? She knows that she needs 100 grams of protein.

If she chooses to be vegan or vegetarian, this is where we use essential amino acids. Okay. As an absolute non-negotiable in that first meal. All right. What are the essential? So essential amino acids, there's nine. And if you are going to eat. for example, two eggs. If you're going to eat two eggs, you're going to get 12 grams of protein.

We've already discussed that as you age, that's not going to be enough to stimulate muscle. What you are going to do is you are going to augment that with a scoop of essential amino acids so that your body recognizes that as 30 grams of protein, and it's going to start the machinery. For us, we use, I only work with one company with essential amino acids, and that's body health. we use essential aminos with those two eggs, one packet or two packet, raises that protein quality now to then stimulate muscle. So if a woman doesn't want to eat between 30 to 50 grams of protein, but still wants to maintain her muscle and maintain her lean tissue, i.e. bone and everything else that's important, you have to get those numbers right. Okay. And I'm sure you've got other

questions as to how. So that is one way, a vegan or vegetarian, which it's really important that they get that right. Okay. Well, walk us through. What does a 50 gram breakfast look like? Well, there's two, there's, yes, 50 grams of protein breakfast. You want to know what I had this morning? Yep. Okay. I had two screaming kids. One drew blood to the other, but, you know, it is fine. I had two eggs. I had some cottage cheese. Two eggs is. 12 grams, a small serving of cottage cheese, and I did a pack of essential aminos in orange. That was it. That raised my quality up to 50 grams of protein.

That's not a ton of food. On a Saturday or Sunday, I might have six eggs, which people are like, oh, but that's so much. You could also have Greek yogurt. I know, I think that you eat. Yeah, I make a shake. So you make a shake. Three days a week, four days. You make a shake.

You make a protein shake. Yeah. Your protein shake without overcompet. complicating it, it could be 20 grams. You use weight protein, right? Yeah, I use way. I have also put Greek yogurt in it, so three quarter cups. So you're hitting it. Yeah. So it's about 40 grams of complete protein, and then I do add some collagen, but not counting that as my protein. Because we know collagen has a protein score of zero. Yeah. But the weight protein with the Greek yogurt, that's perfect. That is a high quality breakfast. Do you hear people having pushback on,

what does that look like? It's too much. And that's, if it's too much food, I mean, it takes me a couple hours to get it down, like half of it's still in the fridge. You can't do that. So, oh, yeah. If you don't have it at one time, the leucine level, the amino acids in the blood will never reach peak. So you have to have that shake at once. Okay. Okay.

I just have to drink it faster. What would a 50-gram dinner look like? My favorite is lean steak. Lean steak and vegetables. Plate. One-third of your plate should be lean proteins. one third of your plates can be some kind of fibrous carb and one third of your plate can be starchy carb.

Okay. Very simple. Red meat gets a really bad wrap for aging women and a lot of women feel that it's unhealthy for them. I would say it is very healthy and almost 50% of the fat in red meat is olive oil. It's mono and saturated fat. Wow. So are you pro shakes or anti-shakes?

I'm pro-shake. Okay. They are so convenient. For me, it's like I can hit, because I put extra fiber and add in, I have my berries. So like, I can hit so many of my overall nutrition goals. And it's convenient. I know exactly what it tastes like. I don't have to measure anymore.

Like, if I can get that down, I am like halfway home, you know, for my nutrition goals. I would agree. It's delicious. And it's easy. Yeah. We're busy. It's easy. Someone's, you know, my kids are screaming.

The other ones, you know, like, why are you drawing on the wall? But you have to get that right. Because again, if we're talking about health outcomes that matter, we want to have good metabolic health, like, again, glucose, insulin, triglycerides, they all have to be in check. There's another thing that I think is really important that is critical to understand as we think about designing a diet. The dietary guidelines that have been set have had 10% saturated fat since the smoking days. It's never changed. When we think about 10% saturated fat, it allows us to either knowing or unknowingly demonize all animal products. Eggs, steak, everything.

Those foods will almost never be considered a healthy food, even if an egg has a gram of saturated fat and a donut has more saturated fat than an 85% lean hamburger. Okay? Yeah. We have to shift away from thinking about. foods as a number like this component of the food only saturated fat. Right. Thinking and even protein, but really thinking about the whole food matrix. Because if we demonize saturated fat, then you see people push towards more plant-based

foods and plant-based foods are important, but they're not important at the expense of high-quality proteins and foods that are all nutrient. So the best of both worlds is really a combination of the two. And, you know, I just wanted to say that because the dietary guidelines, we have to ask, are these guidelines to inform the public or are they meant for medical interventions? And where is reducing saturated fat potentially helpful? Well, if you are someone that has a high LDL level, what percentage people have an LDL cholesterol above 160? It's like 6% of people. 6%. So we created dietary guidelines that are potentially going to address LDL cholesterol.

what is, how is that going to help someone who already has healthy LDL cholesterol numbers? Does that make sense? Yeah, no, totally. We're designing something for such a small percentage of the population where it would lead to less healthy behaviors for the majority. But they are now designing or being forced to design diets that then have to fall within that umbrella. And then the other thing for carbohydrates. If, you know, when I think about how do we know if your carbohydrates are in check, that's a triglyceride question.

If your triglycerides are elevated, then you should reduce your carbohydrates. So this now moves us into personalized nutrition. If someone is like, I did the Forever Strong Playbook, my triglycerides are elevated, what do I need to do? Well, then you would reduce your carbohydrates. Then you would reduce your carbohydrates below 130 grams or below 140 grams. And we've seen that in the data. We'll see a 20% reduction.

and triglyceride levels. And so we just have to ask ourselves, are we utilizing dietary patterns and guidelines as medical interventions? And if we are, then they have to be specified as medical interventions or are we using it for optimal health? I love that. I mean, you know, I love that because we do the same thing in our clinic. You know, we have generalized guidelines. But then I get to look at a very extensive lab panel and look at the patient and be like, okay, for your nutrition, for your needs, for your, maybe you don't, your vitamin D levels are great. You're getting plenty, you know, we don't need to supplement this, but your triglycerides are elevated. You've got insulin resistance. Now we need to like target your nutritional goals to meet your health goals.

Right. And then that is how we then move into the era of personalized nutrition. Okay. Let's talk about women specifically because there's just so little data for us. But most of the muscle and longevity research has been done on men. Am I correct in that statement? You are. What changes when you apply this to your female patients to women? Specifically to like our listening population, which are usually somewhere, perimenopause, menopause, postmenopause. So 40 plus.

Yeah. There's a few things. Number one, what we see is with a good resistance training program and calories controlled with higher protein, regardless if they are on hormone replacement therapy or not, which is really shocking because in my mind, I'm thinking, we're going to replace people's hormones and their body composition is going to change. We don't always see that, right? And it's not a... We don't see it in clinic either unless they do the work. And this is really important. What we... It's a tool, but it's not everything. And it's a tool that isn't going to work if you do not have the fundamental principles in check. And so... I tell patients hormone therapy will not. keep you out of a nursing home. It will not. It will not. The biggest needle mover is resistance

training. And people will say, well, what about zone two? Zone two is great. You've got different fiber types, type one, type two, type, you know, there's a hybrid type. People will say, well, it's different in men and women. And is that true? It's probably more dependent on your training because that's the realities that we have agency. So resistance training two days a week will be critical. Dietary protein is critical if you want to build muscle and maintain muscle. One of the things that we do see is that women sometimes what becomes really important is that they have to increase their stimulus. So there's this idea of progressive overload. We don't believe that doesn't just always have to be heavier.

Really? Yeah. So you can change the stimulus. It can be heavier. It can also be a different exercise. It can be a different exercise. It can be a change in tempo. It can be a change in, yeah, so speed, exercise. There are so many levers that you can change. It doesn't just have to be heavier. And that is, you can change volume. There are a handful of other things that you can change beyond just the weight. And so progressive overload should now be termed progressive stimulus. I love that. That makes me feel better because I, you know, I'm human. I get injured. We travel. I'll, you know, and then I'm like, oh, and I'll go back and look, and I'm like, I'm not gaining, you know, my weights are not increasing that much. Definitely, I'm stronger than when I started, or I can lift heavier. But I'm like, I think I'm plateauing a little bit just because life gets in the way. But like, I could switch it up, change it, do something different, and still get enough stimulus. You can. And again, we have to help, if there are all these narratives that create our limitations and that there's one way to do something, then it creates a lot of

limitations within the person, within the listener who is saying exactly the same thing that you're saying. Do I love lifting heavy weights? I do. Do I get injured? Yeah. I decided that I should be doing clean and, you know, cleans at 100 pounds. I'm a hundred and, I mean, I'm a small person. I couldn't move my left shoulder.

I'm like out of the gym for a week now. I know you had hamstring surgery. Okay. So, I mean, from hamstring to shoulder, you name. payment. But the real key is, and there is a lot of information in the space that, you know, what is the impact of estrogen and muscle? What is the impact? Walk me through. What do we know? What do we know about a woman goes through the menopause transition? What happens to our muscle? I'm going to tell you my personal perspective. Because I don't think that I think there's a lot of

mechanistic data. I don't think that the mechanistic data is translating over to women yet that we can say in clinical practice. And here's what I will tell you. That, does the menopause transition change body distribution of fat because of the change in estrogen and the change into testosterone? You and I have seen it. Every cohort shows it. Okay. Now, what does that mean for the quality of skeletal muscle?

We see mechanistic data that there are estrogen receptors on skeletal muscle. But if someone is taking estrogen, it doesn't mean that they're building more muscle. If someone is suppressing their hormonal status or estrogen on birth control, are we seeing that it's changing their musculature or not? I mean, there might be outliers, but what I believe that it comes down to, I mean, again, this is my perspective. I want to be fair, I don't think that we're there with the data. Right. We need biopsies throughout the transition. Thousands of people.

I think that there is probably an influence, which we know, right? to what extent if someone is training and is highly physically active, I'm not sure if it's relevant. Would I want to believe something else I do? Is it possible? Is it plausible? Yes. Have we proven it yet? Maybe not yet.

All that to say, I think that the jury is still out. But what I will say is during the aging process as hormones decline for both men and women. So testosterone declines in both? For both men and women, we do see changes in body composition. But is it because of that or is it because of the activity? And I just think we have to be really fair. It could be one, the other, or both. So I decided to start testosterone three years ago, maybe.

And I didn't meet the qualifications for HSDD, though I have seen an uptick in that area. and I'm super happy with it, and I would feel sad if that went away. But I didn't, like, have distress with, you know, frequency or whatever. But I'm a naturally very thin person, and I'd been lifting, and I knew the studies had shown that women who naturally had higher testosterone levels as they aged, you know, when they looked at quartiles, the women with the highest testosterone levels had more muscle mass. And I was like, well, if I supplement a little bit, maybe that'll help in my efforts to hold on and grow some muscle for my aging process.

And one of the side benefits was, you know, an increase in libido, which was amazing. So was I ridiculous to think that or to use that, you know, because we don't have studies, we're not looking at that data, you know, other than just looking at what woman happens to naturally, by luck or whatever, have a higher testosterone level, you know, what quartile does she land in at 50, 60, 70, and what's her muscle mass? I believe that, obviously, I believe in hormone replacement. And you guys call it in the menopausee group. Oh, God.

Yeah. Yeah. PET. I want to just say it right because, again. PET, progesterone, estrogen, testosterone. Okay. I have seen the benefits in my clinical practice. I believe in it.

Did it improve muscle mass for you? Testosterone. I don't know. It's hard to measure. It's hard to measure. We don't measure muscle mass. I'm eating protein. I'm lifting weights.

and I'm growing muscle. So I don't have, it's my end of one. Right. You know. I think that it's possible if you're doing all the other things right. Again, we see great benefits for the reasons that you mentioned, sex drive, libido, maybe energy, for all of the other things. You also have to recognize that muscle mass changes are really hard to detect. And one of the things that you will see in the literature is, for example,

protein doesn't matter because if you're not doing resistance training, you're not going to see a change in muscle. Muscle is very difficult to detect. I mean, in 10 years, you might see an 8% change. How much is that per year? 1%? A 1% change in muscle mass per year. Again, because I think that it's the quality of that tissue that we're not addressing. It's, again, this big gaping hole.

Will testosterone help it? I mean, hopefully, but also the levels that women are getting are different than the more robust dosing of men. For sure. But also, we know testosterone is important for so much more. There's a lot of debate right now? Is there really? Oh, in my world, you probably don't see a lot of it. So there's researchers who have studied testosterone, like really smart, good researchers who are coming out very strongly saying, They're very academic-minded. I don't think they actually see patients. That, you know, we're overselling testosterone. Like, we need to hold back.

Don't be talking about brain or mood or cognition. Like, testosterone has no place in this conversation. Or we don't have enough data, so we shouldn't be talking about this. But we know about androgen deprivation therapy, don't we? We know a lot about men, you know. And, yeah, when we block estrogen-antrogen receptors, what happens? Changes in brain function, all kinds of things. So, you know, I think there's some gatekeeping of data.

I think that a lot of people want to control the narrative. And I just know clinically in my patient population, I'm seeing very positive results in multiple organ systems. Yeah, we are too. And that is the challenge of academic medicine and research. Oftentimes, unless you're like the guys at Baylor, like our friend Mohakara, who are doing the research and seeing patients. You have one group that are PhDs that are looking at, you know, what is the hardcore data? And then while hardcore data is important, we might not just be there yet in the randomized control trials saying that testosterone for women, say, vaginally will improve sex drive

or X, Y, and C, or any of these other things. But I think that we're going to get there. And I think in the next 10 years, if someone goes to their physician and they're caring about aging and they're not on hormone replacement, that the physician is going to be out of date. Yeah. And it needs to be a part of the conversation. Well, also, which kind of segues nicely into GLP ones. We talked about the beginning of the obesity epidemic. Food Guide Pyramid happened. The late 80s, early 90s, all of a sudden people became obese with diabetes, but they were trying to address heart disease and then they increased heart disease and metabolic syndrome

underneath the umbrella of trying to correct for cardiovascular disease. Remember, so this was just a whole big human experiment mistake. We are at that precipice again. With JOP-1s. We are. Yeah. We are. What do you think we're doing wrong? What do you think we're getting wrong? Okay. My prediction, and I really hope that I'm wrong, in the next 10 years, we are going to to see an accelerated rate of sarcopenic obesity, sarcopenia and osteoporosis, that no one is ready to manage. Is there a way to safely give a GLP1 without that risk? We do in our clinic. So do we. And we manage nutrition and resistance training and lower dosing of these medications. It doesn't have to be very high doses. I think it's a double-edged sword. The data, I believe,

that is coming out and will continue to come out improves muscle quality, lowering the fat within the muscle. I think, you know, there's some data to support that it improves strength and, you know, a whole host of promises, but that could be because healthy muscle is stronger muscle as opposed to connective tissue and fat, you know, there's various... Infiltrating. Infiltrating underneath the fascia around muscle groups within the muscle tissue itself, within the muscle bellies. There's various places for it. But I think JLP ones are improving that, we're going to see more data lowering inflammation. However, if someone goes on a GOP1, and by the way, they don't magically cause muscle loss. Right. They track in line with

when an individual loses weight, we see it's the same percentage. It's not something magical, but the problem is if individuals are abusing GLP1s, not training, seeing the celebrity sphere become very skinny sarcopenic, I believe that we're going to have an epidemic of sarcopenia that we defined as an aging change in muscle accelerated years earlier, right underneath our noses. How are you monitoring body composition in your clinic? Well, like I mentioned before, we don't have great ways of measuring skeletal muscle because MRI is not feasible for most people. But we use bioimpedants and we use adepa.

And we always measure and keep strength metrics. Oh, wow. How do you do that? We're not doing that. We just report. I mean, we usually are in contact with their trainers. And we, whatever it is that their programs are and their lifts, are they evolving? Where are they from a strength standpoint?

So you are 100% of your patients are doing strength training. Yes, they are. So you're not coming to me. Yeah. Okay. Because it's, nothing moves the needle more than exercise. And we were talking about the fat that infiltrates into the tissue. The fat that infiltrates into that tissue.

you, the most effective way to get rid of that is not diet. It's movement. You have to get a flux. If you think about your muscle like a pond, when a pond is stagnant, it gets bugs and all kinds of things. Muscle is the same. Even if you then revert to a healthy eating behavior, if your muscle is full, muscle glycogen, fatty acids, and you're not leveraging this turnover through activity, then your muscle doesn't, I mean, it will improve, obviously because the quality of your diet improves, but the most effective way to improve that muscle quality is through movement. All right. So let's talk about the training prescription, which is, I love, so you have two books. Let's talk about this real quick. So I love the playbook. You know, what's the difference

between the two books? This is, this one book, this book has pictures. This book is written for now who people don't want all the heavy science. The heavy science is all in forever strong. But this is how to do, what to do. So. And you know what? We're going to do a challenge and maybe you will pop on the challenge and talk about your own, lots of recipes. Yes. And protocols. And it tells you exactly how to design a diet to support muscle health. So that's why this is how. That's right. Okay. Protein without resistance does not build muscle. It does not. But resistance without protein doesn't build muscle. Right. You need both. Okay. But both are valuable without the other. Meaning, if you must consume calories, you still need beyond building muscle, again, skin repair, hormones, brain function, precursors, methanine for glutathione production, the Manchester antioxidant. But yes. So define resistance training for Maddie, who does she is lifting weights now, but like forever Pilates, Pilates. for the woman who's doing Pilates and walking and thinks she's covered.

This hurts my heart a little bit because all activity is good activity. Yes. And I believe we should hold people to a higher standard if they want to age well. Okay. When individuals age, again, we touched on these fiber types. When our parents age and we've watched them age, they become thinner and more frail. Typically, there is a transition of fiber types to those bigger, bulkier fiber types, to the more thin, what we would consider more endurance.

Muscle fibers. Muscle fibers. The only way to protect those muscle fibers to maintain that size is to do resistance training. There's no other way. Is Pilates great? Pilates is great. Is it going to be enough stimulus? If Pilates was the end-all build.

And Pilates is great. And people get very offended. But if Pilates was going to build the most amount of muscle, then you would think the Navy Seals and the football players, that's all they would be doing. They wouldn't be at the weight room. They would be doing Pilates. And I would say it's a great place to start, and it's a great adjunct, and it's very hard. And I would like people to lift weights. Resistance, again, it's lifting up against something that is heavy, right?

That's hard for you. And women will say, I have never lifted weights. Is it too late? And you know what I will say? It's never too late. I will say, lady, you have been lifting weights your entire life. whether you have kids, my kids are 40, 50 pounds, and whether you have groceries,

you have been lifting weights your entire life. You are so much less fragile than you think you are. So if you are mature, the one thing I would say is there's a lot of discussion around power and force production. I think that muddies the water. You know, talk to me, talk to the woman who's listening, who's 50, and she's the first woman in her.

her entire bloodline who is going to try to do this. And she's never lifted in her life. Where does she start? She, well, number one, she's amazing. And there's a ton of, typically, she's not ready to go to a gym. She's like, I'm embarrassed. I don't want to go to the gym. It's overwhelming. It's overwhelming. I said, you know what? We're going to start with either body weight or we're going to start with bands. And you are going to recognize that everything that we start is always hard at first. And then after she feels comfortable, she will then progress to machines. She doesn't have to do free weights. She doesn't have to do complex movements.

And then she's going to say to me, Doc, I don't have time. And you know what I'm going to say to her? If you don't have time for strength, how are you going to have time for sickness? And then she's going to go, oh, yeah, okay, I thought about that. Then she didn't go to the gym. And we're going to start her with machines. There's a low injury rate with machines because there's not a ton of variability. You're not getting under a barbell, doing a squat. You're not doing broad jumps.

We're not doing any of those things. And then eventually, you maybe progress with a trainer or someone online to begin to see how to explore different movements because I'm going to give you another prediction. The first prediction is we're going to talk about muscle in totality. When we think about muscle, we think about body parts, biceps, back, legs, improving insulin resistance, improving strength. once we move a little further, what I believe is next is the movement patterns. So it's now no longer thinking, again, this is not for the beginner, but this is for the people that have been following you and have been doing what you're doing. It's now we have to begin to think about how are we moving.

What are the patterns that we are moving in? And I think that that's the next thing rather than bicep curls and leg extensions, which is perfect. And you will be perfectly healthy if you always do that. But when we think about injury prevention over time, we have to begin to think about what are the patterns and how we're moving. Okay. How about the woman who's been doing cardio or whole life? And she's fit by, you know, our usual definition of fitness. She's running.

She's spinning. She's in great cardiovascular shape. But she's still losing muscle. First thing I was saying. These are my runners, you know, my competitive runners. They are very frustrated by this. I have a patient, her name is Sharon. She's 60. When I inherited her as a patient, she was running ultras. She was running 50 to 100 miles. And she wanted to be able to run for the rest of her life. Instead of having her run more, we pulled off two days a week of running and added in compound movements and weights and sled pulls. And she's 60. This woman puts me to shame in the gym. Shame. And you know what? She's gotten faster. and stronger because she's diversified her program.

Awesome. What does heavy enough mean for women our age? Yeah. You know, I was chatting with your team, and there was the Lift More trial. Lift more, yeah. Yeah. And basically the Lift More trial. 80% of max.

I don't think that people really understand their one rep max. I think it's unrealistic. So one rep max for our listeners is the heaviest you can lift and do one repetition, one one bicep curl before you cannot do a second one. So that's your max. Right. Most people are not testing that out or doing that. But basically what this showed, it was this, like you said, 85% of one rep max and heavy enough meant two to three reps of a set should be very, very challenging. What we also see, and this says twice weekly 30 minutes, but what we also see is that the volume is just about the stimulus. And there's a million different ways to get to the

stimulus. Should you be challenging yourself? Does it have to be heavy? It doesn't have to be heavy as long as the volume is there. You just have to fail, right? It just depends. Is that 25 reps or is that, you know, 10 reps? And I understand that this is very contentious in the exercise space, but we are not talking about elite athletes. And it is unfair that we take our perception and the data of elite athletes and sport performance, and we push that onto our general population. It's unfair and it's not right. You know, there's all this talk about zone two training. Well, zone two is different for you than it is for me than it is for my husband who runs 100 miles. So what she needs to do is she needs to get enough stimulus where things are challenging to improve, you know, as doctors,

we're thinking about health outcomes. What are the health outcomes? I want you to have lower blood pressure. I want you to have better metabolic control. I want you to be able to live long and well and be able to stay independent. I don't need you to do a one-rep max and risk injuring your back or be an idiot like myself doing cleans, clean and jerks. I mean, what am I doing? Because it's fun. Okay, well, I have to be a little more disciplined in that because then you're out for a week. Again, this is the long game. Yeah. I'm like in my mind when I'm in the gym, And my gym's in my garage. I've been there.

Convenience. I am thinking about that BDNF. I'm like whenever I'm like getting tired or frustrated or like this is taking so long or whatever, I'm like, no, no, no. You're making those important, you know, messengers in your brain that are going to decrease your risk of dementia. And at the end of every workout, I'm like, one less day in the nursing home. Oh, I love that. I mean, that's very positive reinforcement. Yeah.

Like, I'm down here to, this is my nursing home prevention program. You know, this is, this might sound a little negative because nobody wins the war, right? Yeah, we all die. We all die. But not today, and we can win the battle. And it's just not today. I just want to decrease the time that I lose my independence. I know I'm going to lose my independence one day.

You might not. You might not. Maybe not. But like the trajectory of the women in my family who beat cancer, you know, who run the cancer gauntlet and make it past 70, okay, is not great. It is over a decade of loss of independence and requiring others to care for you in your daily needs. My mom's in it right now, both frailty and dementia. So that's my motivation. And like I want the science to say, okay, there's no promises in life.

But like, how can I stack the cards in my favor? And I just was never taught and learned in med school that I have more control over this than I ever imagine. And it has everything to do with what I put on my plate, you know, and how I move my body. It's all your agency. It's your choice. And that's really important. That muscle and strength is a choice. Weakness is a different choice, you know.

What do you think the longevity movement is getting wrong for women? In the longevity space, the idea of stimulating MDOR is a problem. and that those that suppress mTOR, which mTOR is in every cell, it's for muscle protein synthesis, it's, you know, it's apparent in all things. It's kind of this growth. It's a switch. It's a switch. And one of the things that they were saying is that when you are fasted or you are calorie restricted, mTOR levels are low, which is true. MPK is up. But one of the things is mTORC1 is one complex, and that's the building complex. And then there's mTORC2, which is another complex. And they kind of ride along the same lines, right? Nothing in the body is completely separate. You and I would agree with this.

And there's this big headline that when you inhibit mTOR, you extend life. And that's kind of the premise as to where it comes from. And I will say, what it doesn't tell you is that when you chronically suppress amtore, which, again, there's a ton of different, a ton of problems with even the framework of this, is you also affect glucose. You become glucose intolerant. You change your lipid profile. There's all these whole host of other problems with it. So it's not just muscle. Insulin resistance, weakened immune system. A lot of the data in the longevity space is rodents. Right. Clinical. Right. So it's rodents. And here's the thing that people will say, well, mice are not people. The rodents used are obese model rodents. They're not, quote,

normal human subjects. They are feeding all day 24 hours. They are, in essence, a diseased model. So that's one part. And by the way, mice don't die from the same things we do. And I was They don't die of dementia. No. So mice in these landmark studies of longevity, they die. mostly of lymphoma and connective tissue tumors. They don't get aflosclerosis. They don't get Alzheimer's. And they're, you know, without getting too technical, this is really in the scope of rapamycin. I'm sure you've heard of it, of course, yeah. Talking about it. But basically, they did this analysis. Again, this was a landmark study 2013 found that rapamycin barely touched the markers of aging in those mice. But what it did, it was explained by suppressing.

those specific cancers that kill lab mice. I've read the two biggest longevity books that have come out in the last five-ish years, but I don't want to name names. I'm going to be offended. I've also read yours and Vondas. And so what do you think those blockbusters got wrong about women? I mean, well, first of all, the whole premise that M-Tor suppression is going to help with longevity, they've never worked in a nursing home.

M-Tor is necessary. This idea that we're going to suppress this one pathway and that that is what's going to make us live longer is foolish. It is the same pathway that is stimulated with resistance training. By default, if you believed that suppressing M-Tor was going to extend lifespan, then you would also have to believe that resistance training is going to decrease lifespan. Oh, my gosh. And just the core fundamental arguments are wrong. And ideally, it would just be better if someone says, okay, I made a mistake, and perhaps I'm looking at this wrong. But that is, I mean, that is one of the biggest problems. And then when the data was analyzed, there was a big 2014 study that talked about lowering dietary protein. But it was very self-selected data. And when they expanded the full data set, it actually

showed that those with lower protein intakes died earlier. Yeah. So what are your top five, top three, you know, things you want a woman to take away from this conversation? Like what would be, what are things she can change in her life right now that will change the trajectory of how she's going to age? Yeah. The most important thing is that she's strong.

Okay. I don't care how you get there. I don't care if it's carrying your children around the house and doing push-ups in between. But you do not have time to waste. You must get strong. And you will not get bulky. The greater risk is becoming frail. Becoming bulky is not a real risk.

It's like going to medical school and going, God, I don't want to go to medical school because I might get too smart. It's never going to happen. Yeah. And neither is getting bulky, right? How many women do we know that are too bulky because they've been lifting? It's just not, it's a inherited scientific belief just like you should wait an hour before you go swimming. after eating a meal. That killed me as a kid. I think our parents made that up just to like give themselves a break. The idea that women are going to lift and become too bulky is in line with that. So they have to do that. They have to eat their dietary protein.

High quality protein. Fine. If you want to choose plant base, that is your prerogative. You should be then utilizing essential amino acids if that is going to be a deal and how you are going to do it. But high quality protein and nutrient density or everything and doing it over the long haul. And the third is, again, this could be, is it going to be hormones? Is it going to be sleep? I think the third thing is knowing what you stand for. And when you know what you stand for and you have standards, then everything else allows you to make a good decision and be very discerning. So what do you mean by that? I mean that with our evolving landscape, there's so much information. People have access to other people more than ever before. It is noisy. And if you don't know what you stand for, and if you don't know what your standards are, then you will go off course and you will fall for anything. And as a geriatrician, I saw people at the end of their life, and there was nothing more profound than regret. Not cancer, not Alzheimer's.

It was the regret at the things that they didn't do or the chances that they didn't take. And that's why the third thing has nothing to do with protein or muscle. I think that, you know, and why I'm writing the third book. My third book on Strong Women is I think women become whatever they've been told to become. And I don't want that for my daughter. I don't want that for your daughter. We can get rid of the labels and you can be relentless and you can be ambitious and you can be kind and you can be all the things. I feel like in clinic I'm often writing a prescription for a patient to put herself first.

to really focus on her, to be, and she thinks she's selfish because she's not putting everyone else's needs. That's like the oldest story tale that needs to stop, right? It's like the self-sacrificing of, I don't have time. I'm like, you don't have time not to do it. Who's going to take care of you? I agree. I agree. And that starts with being able to unwind that way of thinking because it's not useful. It's dangerous. And it creates a. set up for the downfall of families. It's not selfish to be doing the things that you put the standards for that you would want your children to do. Okay. How can our listeners find you? They can go to my website, Dr. Gabriel Lyon.com. Also on Instagram and our YouTube,

both Dr. Gabriel Lyon. We see patients at strong medical. And anywhere, again, we have a podcast, which you've been on, newsletter, the whole thing. Okay. Awesome. Well, Dr. Gabriel Lion, thank you so much for joining us on OnPaS. You've been an incredible guest, and I can't wait to share this with our listeners. Thank you for having me. You can find full episodes of Unpaused on YouTube at Dr. Mary Claire. Also, you can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at the paused.com. Un paused is presented by Odyssey in conjunction with good roommate media and long wave digital.