unPAUSED with Dr. Mary Claire Haver - Muscle is the Organ for Longevity with Dr. Gabrielle Lyon

Episode Date: September 22, 2026

In this episode of unPAUSED, Dr. Mary Claire Haver sits down with Dr. Gabrielle Lyon, board-certified family physician, founder of the Institute for Muscle-Centric Medicine, and bestselling author of Forever Strong, to explain why skeletal muscle — not body fat — determines how well women age. Dr. Lyon shares the case that changed her career: a patient in her mid-fifties who had done everything she was told — dieting, cardio, the food pyramid — yet showed signs of accelerated brain aging. The problem wasn't her fat. It was her muscle.Dr. Lyon explains why muscle is the body's largest site for glucose disposal — meaning low muscle mass can cause insulin resistance and prediabetes even in lean women — and why muscle quality, not just quantity, drives the metabolic dysfunction usually blamed on obesity, yet still isn't measured in routine care. She and Dr. Haver dig into why 60–70 grams of protein a day isn't enough to protect muscle through perimenopause and menopause and why women should aim for closer to 100 grams alongside resistance training, how sedentary muscle lowers your carbohydrate tolerance before blood sugar and insulin become dysregulated, and the myokines — including BDNF — released when muscle contracts that support brain health, metabolism, and long-term independence. Dr. Lyon's takeaway: resistance training and adequate protein are the two things women actually control as they age, and no hormone therapy can make up for them if they're missing.Guest links:Dr. Gabrielle Lyon (Website) https://drgabriellelyon.com/Dr. Gabrielle Lyon (Instagram) https://www.instagram.com/drgabriellelyon/Dr. Gabrielle Lyon (Facebook) https://www.facebook.com/doctorgabriellelyon/Dr. Gabrielle Lyon (LinkedIn) https://www.linkedin.com/in/dr-gabrielle-lyon-00175a1a8/Dr. Gabrielle Lyon (YouTube) https://www.youtube.com/drgabriellelyonThe Dr. Gabrielle Lyon Show (Apple Podcasts) https://podcasts.apple.com/us/podcast/the-dr-gabrielle-lyon-show/id1622316426Books:"Forever Strong: A New, Science-Based Strategy for Aging Well," by Dr. Gabrielle Lyon https://www.amazon.com/Forever-Strong-Science-Based-Strategy-Aging/dp/B0C4VSDWQ2"The Forever Strong PLAYBOOK: A Six-Week, Science-Based Plan to Sharpen Your Mind, Strengthen Your Body, and Get Healthy at Any Age," by Dr. Gabrielle Lyon https://www.amazon.com/Forever-StrongTM-PLAYBOOK-Science-Based-Strengthen/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/New-Menopause-Navigating-Through-Hormonal/dp/B0CKBZ4K1Z

This is a little controversial. Let's do it. I do not think that body fat is an incredibly relevant biomarker. Me neither. The underarching organ is muscle. What we saw was the more healthy muscle mass someone had, the better their survivability, blood markers, glucose regulation, insulin.

Healthy muscle really seemed like the organ of longevity. A 30-minute walk a day can decrease the risk or type 2 diabetes by 50%. But do we think walking is enough? The act of training produces hundreds of different myokines. all of which do different things. And we only know about 5%. The American woman is consuming 50, 60, 70 grams of protein per day.

And you're saying that's not enough. I actually really wanted to address this because I'm sure that you have physicians listening to your podcast. 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. For decades, women in midlife have been told to eat less, to weigh less, to take up less space, to shrink.

The diet industry built a $40 billion empire on this message and women have been chasing it for a lifetime. Smaller portions, fewer carbs, less protein, less food, less of yourself. And then perimenopause hits. The weight comes anyway. The muscle leaves, the energy collapses, the body redistributes, and the prescription from most providers is the same one that got you into this. Eat less. Here's what I know now. The crisis-facing women in midlife is not too much fat. It's not enough muscle. We're not over fat. We're under-muscled.

And the difference between aging well and aging poorly, between independence at 80 and frailty at 70, between a body that can carry you through the second half of your life and one that cannot, is built on a single tissue that most women have been taught to ignore. Skeletal muscle. Skeletal muscle is the largest organ in your body. It's the largest endocrine organ in your body. It releases anti-inflammatory signals every time it contracts. It is the primary site where your body disposes of glucose.

It is the metabolic floor under your hormones, your bone density, your brain, your heart, your immune system, and your survival of any future illness you will ever face. 40% of women over 60 in this country are protein deficient. The average American woman consumes 60 to 70 grams of protein a day. That is not enough to maintain muscle in a teenager, let alone in a perimenopausal woman fighting anabolic resistance and hormonal catabolic shift at the same time. We've been telling women to restrict the one nutrient their bodies need

at the exact moment in life when they need it most. Today's guest has spent her career trying to fix this. Dr. Gabrielle Lyon as a board-certified family physician and the founder of the Institute for Muscle Centric Medicine. She earned her undergraduate degree in human nutrition with a specialization in vitamin and mineral metabolism at the University of Illinois. She received her medical degree

from the Arizona College of Osteopathic Medicine. She completed a combined research and clinical fellowship in geriatrics and nutritional sciences at Washington University in St. Louis. She is the founder of Strong Medical. Her patients include world-class athletes and the most elite operators in the United States and Canadian military. She is a TEDx speaker and the author of a best-selling book Forever Strong and host a podcast of the same name.

She is here today because the conversation about women in midlife has been wrong for 40 years. And she's one of the few voices in this country with, the credentials, the data, and the courage to say so. I'm Dr. Mary Claire Haver, a board-certified obstetrician and gynaecologist and certified menopause practitioner. I'm also an adjunct professor of obstetrics in gynecology at the University of Texas Medical Branch. Welcome to Unpaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Because there was so much to cover with Dr. Gabrielle Lyon, we have broken this episode into two parts.

This is part one, and we will publish part two later this week. This podcast is sponsored by Midi Health, the first virtual clinic created for women by women for the treatment of menopause. Don't let anyone tell you menopause is something you have to suffer through alone. Midi can help. Visit join midi.com to learn more. There's something I've learned about getting dressed. You don't need more options. You need a few things that just work. And I think jewelry is a perfect example of that, because of the right.

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Please support our show and tell them our show sent you. Dr. Gabriel Lyon, welcome to Unpaused. Thanks for having me. So you trained as a geriatrician, and I think in this big longevity conversation that is exploding all over social media and the press, very few people are talking about actually taking care of older patients. And I love that about you. I used to associate geriatrics with just end-of-life care and end-of-life decisions, but it's so much more than that.

Like, walk me through what your training kind of encompassed. Yeah, well, geriatrics is typically considered over the age of 65. Okay. So I am 58? You're not there yet. So this is in seven years. You are not there yet. But geriatrics is really specific.

I did my board certification in family medicine. And family medicine physicians, as you know, spound from kids. to older adults. But geriatrics is really the specialization of that aging individual. And, you know, in the health and longevity space right now, we're hearing a lot of information that as a geriatrician, and I trained at Washu in nutritional sciences and geriatrics. I did a combined research fellowship, which is unusual as a geriatrician. And the impact that that had shaped the trajectory of the books, what I talk about, because it was so inspired. firing in a way that if we can get ahead of aging, then we can change the trajectory of how people age.

Okay. We're going to dig into this. You've become the loudest voice, I think, in the country on what women should be doing to age well. No. Why did you write Forever Strong? Yeah. You know, in medicine, there's always that moment, that one moment that changes everything. Typically, it's either a personal experience or a patient. And I was getting up very early, 4 a.m. in the morning, and I was doing nutritional science research. And I was tasked to, as any fellow, a project. And my project was looking at body composition and brain function. And one of the responsibilities was going up early, doing muscle biopsies, doing fat biopsies, but also doing brain imaging. Doing brain imaging in fMRI, looking at the way, well, number one, the structures of the brain,

the way that the brain is processing information. And I just absolutely fell in love with one of these patients. She was a mom of three in her mid-50s, and she had done what everyone had told her to do, and she had lost the same 30 pounds for the last 30 years, put herself last, and also did cardio and food guide pyramid, and I imaged her brain in her mid-50s, and her brain looked like the beginning of an Alzheimer's patient. And I don't know about you, but if there's a problem and everybody is saying one thing that eat less, exercise more, and you're seeing these patients and in real life how this affects them, that you feel responsibility to do something. And I think that that's what medicine is about. And so here I am sitting at the epicenter of this metabolic hub. And the answer was, well, it's just the way that it is.

this person struggled with obesity and the things that ride with obesity, which we know are metabolic syndrome. We'll talk about that later because that really is a reflection of muscle. But diabetes, Alzheimer's, cardiovascular disease, they are thought to ride alongside obesity and body fat being the problem, but it wasn't. And as I imaged her brain and her body, I just had this flash of insight that it wasn't a body fat problem. It was a muscle mass problem. Did you see in that cohort, and for our listeners, you know, in the patients you were examining, what was there correlative with how much muscle they had and their cardiovascular disease rate, metabolic function, brain health?

What we saw was the more healthy muscle mass someone had. Regardless of fat. That's a really important point. Regardless of fat, the more healthy muscle mass they had, the better their survivability, the better their blood markers, the better their glucose regulation, insulin. fatty acid profiles, we all talk about cholesterol, muscle, healthy muscle really seemed like the organ of longevity. And it was the organ system that nobody was talking about. But when we think about muscle and as women are thinking, you know, maybe they're in their 50s and going to the

gym is for the guys and lifting weights is for the guys. Yeah, totally. I grew up with that. Right. And this idea that we should focus on body fat and lose body fat as if that is going to be what changes the trajectory of aging, it's for the last 50 years. We've been focused on what we have to lose. And that has been the largest oversight in, I would say, all of medicine, because it's not about what we have to lose. We have control over skeletal muscle, which is, you know, as I think about aging, staying out of a nursing home, having metabolic health, and even hormone replacement, the one thing that you have full control over is muscle. Everything else will augment it or take away from it. You say, and I've read in the book, that we don't have a fat problem in

this country, we have a muscle problem. We do. We do. I mean, if you think about it, 75% of people are either overweight or obese. And the majority of people do not exercise. The American College of Sports Medicine just released their new set of guidelines, which focuses on resistance training, critical for muscle mass. It's non-negotiable. There is nothing that one could replace with exercise. It is something that has to be done. But it's not a fat problem. So muscle, insulin resistance, which people know your pancreas produces insulin. Insulin moves blood glucose out of the bloodstream into cells.

And insulin resistance is at the heart of a lot of issues that we see, cardiometabolic issues and just metabolic issues in general. But skeletal muscle making up, and actually I was just looking up some of these numbers, they say that it's 40% of your body weight. For women, it's actually less. Have you heard muscle is 40% of your body weight? percent of our body. I mean, in general, of course, they give us all the male data and we can memorize that. It's based on young men. Forty percent of our body is, again, you will hear this and see this in the

literature, 40 percent of one's body weight is muscle, but it's not. And it doesn't talk about the quality of the muscle. Muscle can look like a marbled steak. Right. So we'll talk about, I want to talk about muscle quality and muscle in general. You know, most women, and I kind of grew up thinking, that muscle is something cosmetic. You know, we talk about getting in shape for summer or toning ourselves for summer, which is just ridiculous. We should think about muscle every day of the year.

But it's something you want to build just to look good, but you're saying it's something else entirely. What is skeletal muscle? You know, most of us know that we contract it and it moves, right? That's how we move. The muscle is attached to bones and ligaments. That's how we move throughout the world. But there's so much more than that. Actually, the movement component of muscle is just a sidebar.

So what is the main function of muscle? Muscle is your largest metabolic sink. And what does that mean? As we go through life, we eat food. We eat carbohydrates. We eat fats. We eat proteins. Your muscle is the primary site for glucose disposal. The carbs that you eat, it has to go somewhere. And I remember when I was in, I actually had a practice in New York City. So I just finished fellowship, moved to New York City. and we were doing the in-body. You've seen the in-body. I have one. It's a big store in the clinic. There you go.

It shows bioimpedance. And I couldn't figure out why this lean woman was showing signs of type 2 diabetes. I did her in body and her muscle mass was so low. And she was close to sarcopenic. And there's some interesting definitions of sarcopenia. But her, I couldn't, for this moment, I was like, I don't understand. looking at her, she didn't look, quote, skinny fat, but her blood glucose levels were elevated, her insulin levels were up, her triglycerides were just out of whack. And it really solidified that

what we thought that we were looking at was body fat, which she didn't have a lot of. And I guess if I were to frame this appropriately, it wasn't as if this woman was 30% body fat. She was maybe 20, normal, average body fat. And the, The picture was it wasn't a body fat problem, it was actually a muscle problem. So when we think about muscle beyond mobility, beyond strength, all of those things are really important. As it's metabolic anchor, it is the site for glucose disposal. Someone could have low muscle mass and show signs of prediabetes, even if body fat is not deranged.

And that's number one. It is also the site of fatty acid oxidation. When you are in your clinic and you are looking at what we call metabolic syndic, it's not metabolic syndrome. Metabolic syndrome is we see high blood pressure, we see elevated glucose, elevated insulin. Right. Lipids that are out of range. Abdominal circumference. That's right. Abdominal circumference, people will say, well, this is a body fat problem. It's not. Those are early signs that muscle is unhealthy. Talk to me about muscle quality. What does that mean? I mean, muscle is muscle. Right. Yeah. Muscle quality is

probably. And we're talking skeletal muscle. We are. We're not talking smooth muscle, like the muscle around in the uterus, skeletal muscle quality is probably the biggest oversight that we have in medicine right now. Because do you remember when they came out with the studies saying that people that suffered with obesity had more muscle mass? Yeah, totally. And this is still repeated. It has nothing to do with the quality of the muscle, the fat that infiltrates into the muscle. So there is fat, there is fat that infiltrates underneath the fascia between muscle groups. There's fat that infiltrates into the muscle tissue, like a marbled steppe. And then there's something called the athlete's paradox, which is fat in relationship to mitochondria,

which is important for, say, an athlete, someone who is running a marathon. But what happens is that when someone is sedentary, so there's no such thing as sedentary, healthy muscle. Muscle must move, it must contract to use those fats and those fuels. And what happens if someone is sedentary over long periods of time, not only do they become insulin resistant, which we should touch on the idea that, Even 18-year-olds that are in college that look perfectly healthy, kind of insulin resistance, if they are not moving and training appropriately. But what happens is this fat that infiltrates into this tissue changes metabolic outcomes.

It changes insulin resistance. Also, now what was formerly PCOS, PMOS, these are muscle problems first. And that becomes really critical to understand even beyond, again, strength and mobility, but as a metabolic focal point. And there's more to this because contracting muscle does a whole different thing. So this is the biggest oversight I see, and here's why. When you get a DEXA, which is the standard, it shows nothing muscle quality. The only way that we're really looking at muscle quality right now is CT or MRI. Okay.

Not accessible to people. Ultrasound is a potential, but it's not common. So when we're trying to look for muscle quality, you're trying to see how much fat has infiltrated the muscle. Is that what you're talking about? Yes, and we are not there. So the bioimpedants can't do that. We're not there, but I believe that this is a little controversial. Okay.

Let's do it. I do not think that body fat is an incredibly relevant biomarker. Me neither. Okay. I don't think body fat percentage. I think body fat doesn't matter. I think the percentage of body fat, yes, as you get higher, it comes with comorbidities. But the quality and the amount of skeletal muscle is a much greater predictor of mortality and health outcomes.

Body fat is just a sidebar. And it's the thing that we can see. And as we are seeing this increasing in treatment and exposure to what was formerly known as PCOS as a muscle, in part, part of a muscle problem, that it's the percentage of fat in skeletal muscle that is what drives insulin resistance. It's the percentage of fat that infiltrates into that tissue that drives Alzheimer's cardiovascular disease and these other metabolic outcomes that we have always associated with obesity. So if I was going to like try to investigate this, CT or MRI, what do you tell the radiologist, you know? We will get there. It's another five years out. Okay. Because the radiology people, they've been seeing this forever. Yeah. I mean, the scans have not changed, right? But how we interpret that. It's the technology. And again, it's not so viable because body fat is very easy to measure. And there are strong correlations. But the big overwhelming miss is that we have no idea about the quality of that tissue. And that's really where it's going to go. And if we can get to the quality of tissue as routine, then I think we're going to be able to change the trajectory of the way people live. Are there any strength or power measurements that we can do that would approximate this? That's a really good question.

Muscle quality is traditionally spoken about in what you're saying based on strength, based on metrics of get up and go, power metrics. I think that it really depends on training status. For example, if you were someone who never grew up training. I look at my mom. She has always done some kind of activity, but she has never really doubled down and focused on resistance training. So the idea that these bigger lifts, say for example, squat, bench press, these numbers are made up numbers as to what someone should reach. And that becomes important because it just puts into perspective what we need to shoot for.

But one more thing on muscle quality that I think is empowering for people is that regardless of body composition changes or not, you can improve muscle quality simply by doing exercise. And I'm going to say that again, regardless if body composition changes or not, you can improve muscle quality simply by doing exercise. regardless if body composition changes. If someone maintains their muscle mass, maintains their fat mass, just as is, the simple fact that they are doing some type of resistance or cardiovascular activity changes the quality of that muscle. In fact, it's a potent stimulus of affecting any movement. Any movement. And that becomes really empowering.

Yeah. Because it's not chasing a scale or even. I mean, the data backs this up. a 30-minute walk a day for a sedentary person can decrease the risk of type 2 diabetes by 50%. And the mechanism? You're not burning that many calories. You're not. And what do we think that the mechanism of action is?

It's got to be muscle. It's muscle. Yeah. And that becomes really empowering. So just the simple act of moving. But on the same hand, do we think walking is enough for staying out of a nursing home? Probably not. Probably not.

And then that is where the conversation then shifts to, well, what do we have to do? I just saw a research graph. Literally, I was preparing for this. And it showed three trajectories to disability, right, with aging. And if you do the status quo, you most likely will lose for a prolonged period of time your ability to care for yourself. Then there's the people who walk who maybe do some yoga, some gardening. They're active, right? But they're not resistance training.

So they have a better trajectory, but they do tend to end up there. And then the only people who stayed out of disability were the people who lifted on a regular basis. Isn't, you know, so I studied nutritional sciences, and you and I've talked about this at length, the idea that we have micronutrient nutrient deficiency. So we have macronutrient profiles, protein, fats, and carbohydrates, which I know that we'll talk about because the way that you eat, right now, the dietary problem is a mismatch of muscle health. So we're eating a diet that is out of the range of what our muscles need and require for health. But as I was thinking about the landscape, nutritional sciences were very good and it's very easy to say you need mariclair you need 100 grams of protein here's why you need 100 grams of protein here's what's going to happen if you eat excess

here are the micronutrients that you need you need vitamin b12 you need zinc you need calcium but when it comes to movement we are in an exercise deficiency syndrome or disease and we have to begin to think about what do we have to add in and how do we design a macro plan and then also the quote, micronutrients of movement, and I think that we're really underserved. Welcome back to another midi pause. I'm Dr. Mary Claire Haver, host of Unpaused. Let's talk about something that can be really emotional during menopause. Hair loss. Losing your hair can feel incredibly personal. For many women, hair is deeply connected to identity, confidence, femininity, and even how we recognize ourselves in the mirror. So when your hair suddenly feels thinner,

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That's one reason Midi Health has become such a valuable resource for women navigating midlife symptoms. Midi takes a more comprehensive approach to menopause care, connecting women with clinicians who understand how interconnected these symptoms really are. So instead of treating hair loss as a purely cosmetic issue, they look at the bigger picture, whether that's hormone shifts, stress, nutrition, sleep, or other health factors contributing to the problem. They also help guide women through potential treatment options and support lifestyle changes based on individual needs. And honestly, that kind of validation matters.

So many women spend years feeling dismissed when they bring up symptoms like thinning hair, fatigue, or mood changes. But menopause affects your entire body, including your hair, and you deserve care that reflects that. So if your hair feels different lately, don't panic. but don't ignore it either. Ask questions, explore your options, and know that support exists, and you don't have to navigate it alone. Go to join midi.com, join M-I-D-I-D-com,

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Follow and listen to You Must Remember This, wherever you get your podcasts. Do you believe in the calories and calories out mantra? I believe that calories matter. Yeah. And I also think that the data supports the percentage of those calories. They also matter. And again, this can go in a million different ways. but how we think about eating from muscle health is probably the most critical as it relates to aging, menopausal transitions, because there's a way that you can eat to protect muscle health, and then there's a way that you don't.

And just think about what happened with the food guide pyramid. So, you know, the food guide pyramid for, I mean, everybody has seen the food guy pyramid. Yeah, yeah. He's listening to this. We all know, and it's just kind of a big disaster. But the initial guidelines, do you know where they came from? why they even... No idea.

Okay. This is going to blow your mind. The food guidelines came, I think it was around the early 90s, 80s, early 90s. And it was because they were seeing massive increase in cardiovascular disease and death. And so they attributed this to saturated fat and cholesterol in foods, right? And so these food guidelines came out. They moved to 6 to 11 servings of carbohydrates, and you should reduce your salt intake. and it has a whole beautiful list of all these things that you should reduce.

Do you know how many people were smoking at the time? Huge percentage of the population. Instead of addressing smoking, they addressed nutrition. But it wasn't a nutrition problem. It's a smoking problem. And since that time, smoking has gone down. It's now maybe 15% of the population. They also – and there's a whole bunch of things that they said, for example, reduce red meat.

but red meat consumption is now since the 70s is down 40%. So why does that become so relevant is that we had the question wrong. We asked the wrong question. We said if people are having heart disease dying of heart attacks, strokes, any of these other things. It must be their nutrition. It must be their nutrition. And for the last 50 years, based on this premise, we've been modeling nutrition around a false paradigm. And the obesity epidemic started kind of right underneath people's noses.

All of a sudden we see an increase. Food Guy pyramid comes out. There is a drastic rise in obesity type to diabetes. While trying to solve for a problem, they started one. Yeah. Yeah. So while trying to solve for this problem, they started one. And that has now shaped what we see today. What is a myokine? This is the other part of myokine. muscle that is really fascinating. Muscle is an endocrine organ. When you contract skeletal muscle, it release hundreds of different myokines. These little peptide hormones, they affect a number of things. They affect the brain. Okay. Well, let's kind of, yes. So let's talk about why we think exercise is important. So this is the work factor. People believe that exercise is important for,

if we were to think about these superficial aspects, we think about increasing blood flow, helping with cardiovascular function, right, V-O-2 max. We also think about movement, right, improving insulin resistance and utilizing the calories. I mean, I think that as a doctor right now, but as a young woman, I only thought about it as a way to maintain my figure. And you did a great job. So calories. Right, that was it.

So this is one way that we think about leveraging muscle. But the other part about muscle is the action. of contracting it releases these peptide hormones. And this is a new reframe for people because the science isn't that old. So you're talking about the group in Copenhagen. She is a immunologist who's also an exercise physiologist. And she started looking at myokines, which are these peptide hormones or these proteins that are released from training muscle. Here's the thing, and there's hundreds of them. The most common is interleukin-6. Interleukin-6. Someone might be like, well, is Isn't that a cytokine, right?

The cytokine storm, interleukin-6, when we're very sick. But myokines that are released from muscle have a different effect, what we call a pleiotrophic effect. What do they do? Myokines release from muscle help with lipid oxidation, help with carbohydrate metabolism, beyond the exercise. So there's the exercise component of using muscle glycogen. There's the exercise component of using fatty acids.

And then there's the muscle component of what the muscle releases and the interorgan cross-talk between the brain, the pancreas, the liver, as you increase in activity, whether it's strength training or endurance type activities, the amount and kind of myokines, whether it's interleukin-6 or BDNF, which you've heard up, which, by the way, BDNF is released in the brain. It's not, people think that it's released into the blood and then crosses the blood-brain-berry, but it actually doesn't. So these might. Myokines do a number of things. And we can kind of talk about interleukin-6, which, again, is the most famous or various ones. But I think the big takeaway is the act of training produces hundreds of different myokines, all of which do different things. And I love it. They cross-talk to multiple organs.

And we only know about 5%. Wow. And the other thing that I think that we're going to get to in five years, in five years, we're going to be able to look at muscle quality. We're going to be able to look at the percentage of fat that is infiltrated into tissue. We're also going to be able to look at these work factor myokines in a meaningful way. Is your exercise effective? Like measuring levels? Yes. And again, it's not being done right now.

It's being done in research. But they're so variable because obviously these what we call myokines are released from various cells from macrophages as well, which is one of the reasons why muscle is important for immune function is it balances these influxinging. amatory cytokines. Is there such thing as too much muscle? I've never seen it. Okay. But that's a great question. I've never seen it. Yeah. And you've, you've seen a lot of muscle. I've seen a lot of muscle. I've seen the people you work out with. Talk to me about BDNF, because that is something I've heard of. And for our audience, for our lay people listening out there. BDNF is brain-derived neurotropic factor. And brain-derived neurotropic factor is what we think about as fertilizer for the brain. A large portion of the brain is designed for movement. When we stop moving,

that's right. When we stop moving, we are not engaging those areas of the brain. There are a number of things that become important for healthy brain function. So as a fellow, as a geriatric fellow at Washington, one of the things that we did was run a aging and memory clinic. Why is that important? It's important because Alzheimer's is critical. Type 3 diabetes of the brain. There's a metabolic factor, but exercise is something that we always tested, movement, and exercise was something that we always asked and always tested. And so your question is, what does BDNF do in the brain? And one of the things is it helps with synapses, it helps with connections.

It also helps with, I would say exercises what helps with blood flow and also improving peripheral insulin resistance, because peripheral insulin resistance also relates to cerebral insulin resistance. Okay. And that's insulin resistance in the brain. Yeah. Because that in itself is an organ system. If you want to think faster, you have to move faster. Something called cognitive velocity. This idea of a lot of people at the age, they limit their fast movements, sprinting activities. It doesn't also have to be running. It can be on the bike. So someone is listening to this and is like, okay, I now believe we do not have a fat problem. I believe that the underarching organ is muscle. What do I need to do and why does it matter for muscle health? Well, number one,

we know we need muscle for maintaining our nutritional status and our metabolic health, but also beyond that, beyond strength, which we'll talk about, the idea of movement and being able to be independent, when you move fast, you also affect your synapses and your neurotransmitters. You think faster. So insulin resistance, you know, there's a lot of cross-talk. on the channels about how do we measure it? How do we know, you know, and what I try to explain to my patients is this is something we can pick up a decade before diabetes, easily, and start making interventions to where you never become diabetic. But like, how do you, how do we measure this? Like, how could a patient ask her clinician, okay, am I insulin resistant? What would they ask for?

They would ask for the exact factors and blood markers that they would think about metabolic syndrome. Okay. Fasting insulin. I like it lower, you know, as low as we can get it. People will say, well, you know, five is, is that the perfect range. I'm not sure what you guys look for in your clinic. People ask for.

We hope for less than 5.3. Okay, 5.3. Fasting glucose, fasting insulin. But also you have to. And we do the Homa IR. Yep. So you do Homa IR or triglycerides, all of which become really important. In research, we used to do eoglycemic clamps.

Euclycemic clamps are considered the gold standard data, but there are problems with glycemic clamps. It is where you're tagging and measuring where insulin is going and how the liver is using it, how muscle is using it. But the problem is, it's highly controlled. The meals before, the meals during, the meals after, all of that, just highly controlled. So yeah, that is the way that people would measure insulin resistance early on, whether they're using home I.R or fasting insulin glucose tolerance test. Yeah. Well, we did that a lot in pregnancy, you know, when we were screening for gestational diabetes. So I have to do that. extensive. But in our clinic, we're doing fasting insulin, fasting glucose, and then calculating

the whole IR score from that and counseling around that. And I think that that's, I mean, that's what we do. I will also say that when we think about insulin resistance, you had mentioned something really important is that it can start decades before. And that is really critical to understand. You don't have to wait until your doctor says, you know, you're pre-diabetic or they're having cognitive impairment. So say your patient gets this insulin resistance diagnosis. What is your prescription? First thing that we do is you have to address nutrition. Typically it is a mismatch. Insulin resistance is a mismatch of two things. It's a muscle problem and it's a nutrition problem. If we know that muscle makes up probably 30% for women, that is 30% of the tissue. If they are

not training, becomes insulin resistant. It can become inflamed. It creates byproducts that create inflammation in the body, which, again, seramides, diaclycerols, things that we're not typically measuring, but the most effective way to decrease that right now, I mean, GLP-1s may come to the conversation regarding muscle quality. For sure. Exercise. We'll get there. Movement, exercise.

Okay. The other thing is, once we talk more about nutrition, is really balancing the nutrition. So myself and my mentor, Don Lehman, what we believe is that there is a mismatch between muscle health and our nutrition. And it's something that we call carbohydrate tolerance. Carbohydrate tolerance is the amount of carbohydrates that one can eat without deranging metabolism. Okay. And we can talk about that. It's... What is it? Yep. What is it? Do you know how much the average American eats in carbohydrates a day? Hmm. I do not. I'll guess it's going to be bad. Let me guess something bad, like 200, 250? $300. 300 grams of carbohydrates a day. The RDA, rhaber.

recommends 130 grams per day. We're eating 300, essentially three glucose tolerance tests a day. How do we metabolize? I think most of that is sugary drinks. It is. It is. But if we think about it, if people are in alignment with what muscle does for glucose disposal, then we recognize that you must have activity. How does activity play in with glucose disposal? You're looking at anywhere between 30 to 70 grams, an hour of carbohydrate utilization. So 30 grams, you would have to do some kind of maybe slow walking, right? 70 grams of carbohydrate. So as your heart rate gets higher, you're using more carbohydrates. You know this. But what happens is if we already know that roughly 75% of people are not exercising or meeting their baseline recommendations,

they are doing multiple glucose tolerance tests day after day after day. You have to correct. for that. And when you calculate out disposal, someone eats or drinks a sugary beverage, which they're no longer doing because they're listening to your podcast. They're not drinking diet or they're not doing your Starbucks. Yeah. You guys are not drinking your frappuccinos. But if you were, you have to calculate how much glucose, and we've done these calculations, can one dispose of in a two-hour period, right? Because an oral glucose tolerance test is, you know, you have a bowl of 75 gram load. 75 over what?

Two hours. Two hours. There's a clinical definition if your blood sugar remains elevated, which is pre-diabetes diabetes. Exactly. Exactly. So when we have a glucose load and we have to dispose of that over a two-hour period, you will be able to dispose of safely without causing a metabolic dysregulation with insulin and glucose around 50 grams.

Okay. With no exercise. That's right. If you eat and you are sedentary, 40 to. 40 to 50 grams over a two-hour period. That means that anything above that number, you must be training. You have to earn those carbs. As you think about a diet, as people are thinking carbohydrates, which there's no bad foods, it's really how you design a diet, which we're going to talk about, is that a very practical takeaway is if you are not around exercise, 40 to 50 grams of carbohydrates

is your upper threshold. But beyond that, but beyond that, that, now you're moving into, and being sedentary, now you're moving into the zone of insulin resistance or elevated levels of blood sugar or insulin. I've never heard it talked about that way. Well, we had to do the calculations, and this is why nutritional sciences is so valuable in the context of physicians treating patients is the primary fuel source for muscle is not carbohydrates at rest. It's fatty acids. The muscle burns primarily fatty acids at rest. In order to get it to begin to utilize carbohydrates, you have to move. You must do physical activity.

Wow. Yeah, because when we're sleeping, there's no, you're running off of your stores. So when people say muscle is the most metabolically active organ, it's actually incorrect. It's not metabolically active. It's like two to three grams an hour. It doesn't burn a lot of carbohydrates at all. The brain, the other organ system, there's obligatory use. It's crazy how much the brain burns.

Yeah. So if you're talking about, you know, if the muscle itself over a two-hour period is going to burn 20 grams of carbohydrates at rest, you know, you're not, you can't have these for Apparachino's. You're just, you're setting yourself up for a major problem. This podcast is sponsored by Middy Health. You've heard me talk about my menopause toolkit. It consists of nutrition, exercise, hormone therapy, and other medications, stress reduction, sleep quality, and community connection. When you put those pieces together, they don't just ease symptoms.

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The American woman, I look this up, is consuming 50, 60, 70 grams of protein per day. And I think that drops with age. And you're saying that's not enough. And the biggest question we get is, how much should she be eating? How much nuance goes into that answer? Well, I want to clarify and say, I am not saying this. And the data is very strong in the literature as to how we make protein decisions. Because the FDA says that's enough.

And the new dietary guidelines came out. I was there. It was amazing. Don Lehman wrote the protein portion of the dietary guidelines. And those new guidelines are all reflected in the playbook. Awesome. Okay. Protein decisions.

First of all, let's talk about what protein is. Protein is 20 different amino acids. These amino acids make proteins, nine of which are essential amino acids. The body cannot make them. But when you pick up a protein bar, it just says protein. Right. It doesn't specify the 20 different amino acids, all of which do various unique things in the body. For example, triptophan for serotonin production or threanine for mucin production in the gut.

while we think about dietary protein is one thing, it is not. And that becomes really important because as we age, our needs for each of those amino acids change. Wow. And now your audience is like, wow, I'm so confused. You're talking about amino acids. There are nine essential dietary protein. You know, I thought pepides. Peptides. I thought quinoa was protein. And here's what I will tell you is that we make our protein decisions based on a few factors. Protein, when we think about a dietary protein comes from plant and animal sources. Higher quality proteins, this is just based on biological numbers of the essential amino acids, high quality proteins come from animal foods.

Fish, eggs, beef, chicken, yogurt, dairy, you name it. Low quality proteins, again, based on the biological value and numbers of these essential amino acids. Are things like soy, which is the closest to an animal profile. We have things like hemp protein, pea protein, but again, the quality is different. Meaning how many amino acids they have. How many of the essential amino? Exactly right. And collagen protein is very low, if not devoid, in some of these branch chains.

Right. And tryptophan. So, again, all of these amino acids and protein sources have different impacts. To uncomplicated, let's put that as a lot of. side for one second and say, why is protein important? Why does it matter? And how do we make those decisions? Protein decisions, dietary protein decisions, number one, people have to recognize it is the most important essential macronutrient, especially as we age. When we are young, you know my kids, they're jumping off your doc, four and five years old. They are highly anabolic. They can have

two grams of protein, and they're building, they're growing. But as we age, we're no longer growing up. We have to account for protein turnover. Protein is important because our bodies are repairing and replacing itself four times a year. We become less efficient at doing that as we age. So let me back up to that, because I don't think a lot of people understand this. And I don't think, like, I kind of knew, but it didn't, like the gravity of it didn't make sense to me until I really realized I was aging. the muscle I have today is not the muscle I'm going to have in 10 years. The bones I have today are not the bones. We're constantly breaking them down and building fresh. That's correct. And that process gets harder with aging. It changes. And this process, there's protein turnover, which is this body rebuilding and repairing itself. But also the tissue itself, the muscle tissue becomes less sensitive to the signals. And you're thinking, okay, so muscle, how do I build healthy muscle? If we think about how we're building healthy muscle, we have to think about the influences. The influences are the following.

Mechanical tension, insulin, energy, right? Total substrate. And muscle is uniquely sensitive to amino acids. And particularly one of those amino acids called lucine, one of the essential amino acids. Now, the balance between, say, the hormone aspect. So if someone is thinking about muscle, and I'll give you a video. for this, because, again, how do we take the science and we translate it so people can do something about it, is at the center of muscle, think about a complex. It's called EMTOR,

which is a very popular protein kinase in the longevity space. Emtore is essential for muscle protein synthesis. How do we build and maintain healthy muscle? The influences of mechanical tension, the influences of hormones, the influences of amino acids, the balance between those change. So when we are making our protein decisions, you have to pull each of those levers. If you are getting enough dietary protein, then perhaps through leucine, then you are less dependent on hormonal status. If you are young and you have high, robust hormonal status, then you are less dependent on that lever of the amino acid leasing. So the balance, when you are young, you can get a weight. Do you remember when you're in high school? Did you everything? Like the Twinkie diet.

I mean, I remember going off-corn diet. Okay, off-campus and I would eat French fries. That's it. We went to this place. I had French fries for lunch. That's it. I was very fit, very active, and I was able to maintain my body weight. And then all of a sudden, the Twinkie diet with French fries, unless you're, you know, like my big jacked husband, just like, I don't know what happened, but all of a sudden, you're like, gosh, I can't lift as much. And I was kind of a little bit of redistribution and things change. And part of this comes down to, are we evolving our diet to keep up with our aging milieu, this hormonal milieu? Now, making protein decisions, and I hear this a lot, because again, I've been doing this for a long time, that it's just based on one thing

and then there's one right number for everybody. Yeah. There is not. No one should go below 100 grams of protein a day. Okay. What's that based on? Yes. Why? This is based on. This is based on one of the benefits of dietary protein is again that input that input on skeletal muscle when you are younger the dosing doesn't really matter but as you age you have to hit a threshold now there's a few things here when someone doesn't hit their threshold of two and a half grams of lucine which equals 30 grams of protein which equals five and a half ounces of say steak or or a handful of eggs or a brick of tofu, if someone wakes up in the morning

and they have two eggs and then fruit and go on their day, they have not stimulated muscle. They're getting in protein. But again, because muscle is aging, it is very sensitive to these inputs. You have to get this right. So when you go below 100 grams, if you were to think about it,

there's a handful of metabolic properties that protein has. I promise you for the majority of my life I was below 100 grams. This is not ideal. The only way that you would be able to make up for that is if you were highly active. Okay. However, as we think about nutrient density in the quality of our diet, protein becomes – it's just irreplaceable.

And one of the things that you'll hear a lot about is this idea of satiation of protein being one of the g-lp-1, nature's gulp-1, right? It sends signals to the brain. Right. Leptin, grelin, p.y-y-y-y. There's other kinds of peptides, hormonal peptides that are released in the gut that affect the brain and satiety. Dietary protein does a lot more than muscle. And when you get into that between, we'll say 30 to 50 gram range, you hit that 2 and 1⁄2 grams of lucene, you turn on the machinery.

The muscle is ready to rebuild and repair itself. But if you are below that number, what we've seen, and we've seen some of this data in the early 2000s at University of Illinois, I worked on some of these studies, less than 100 grams, proteins seem to lose the effect of improving insulin, improving glucose, and improving triglystoride. So basically, and we can talk about this, when I did my undergraduate at the University of Illinois, I've been studying nutritional sciences since for the last 20 years. We worked on some of the earliest studies of both postmenopausal women. I mean, again, there was a handful of those cohorts and then just regular people, right?

And what we did is we looked at those individuals on a food guide pyramid. They had, it was, yeah, food guide pyramid is 0.8 grams per KG, the basic protein intake. So in, you know, in imperial units, it would be roughly 60 to 70 grams of protein a day for a woman. That's right. Based on that. And then we looked at a group that had 1.6 grams per KG. So the current recommendation of protein, which is 1.2 to 1.6 grams. per KG. And what we saw was those individuals that were in the food guy pyramid group,

they were not, and calories were controlled. This is really important. You asked me at the beginning, are calories equal? Do you believe in this calories and calories out? And I said, well, yes, but there's a few caveats. So in some of these early studies, which I will send you, 2000, 2005, and we'll link them in the show notes. I will link that, or I will get them to you, and you will link them. They were isochloric. They had 1,600, between 16 and 1,800 calories in both groups. Okay. One group followed the Food Guide Pyramid had the current recommend, the older recommendation for dietary protein, which is what women were doing 60 to 70 grams. And then the other group had 1.6 grams, so they were at least at 100 grams of protein. And breakfast was around 50 grams,

between 30 and 50 grams. Those individuals with no change in calorie, overall calorie, just the change in the macronutrients, protein was roughly 30%. They improved body composition. They decrease fasting insulin, they improved blood glucose, and they improved triglycerides. So I actually just posted about this. I looked at a cross-section of observational studies. They went back and looked at the Nhangs data, the WHA data. They followed these women in these cohorts for decades, right? And they looked at nutritional studies, thank God. They, you know, they tracked their nutrition, and then they tracked frailty and their frailty scores. And there was a correlative response of how much protein women were eating and their risk of frailty. So the lower their protein intake, the more

likely they were to be frail. And then they said, okay, the only way to reverse that and get them out of frailty, protein was important, but you couldn't do it without resistance training. Like just piling on protein. And then if they had an adequate diet, piling on extra protein wouldn't get them out of frailty either. They had to do the movement component. That's absolutely true. And This goes back to your question was, how do we make protein decisions? You need the stimulus and the substrate. And here's how we make protein decisions. You make protein decisions, number one, based on age. The older you are, the more protein you need. You make protein decisions based on physical activity. And it's a U-shaped curve, which is fascinating. If you are highly physically active,

you know, very, very high. We're talking about athletes, people that are just marathoners. those people need more protein. If you are sedentary, you need more protein. Wow. From the mechanistic way, when you think about you have to pull one of those levers. So if you do not have the mechanical tension or the movement, then you depend on dietary protein. So the worst of all worlds is a sedentary aging female with a low protein diet. Wow. And then personal choice becomes the other thing. Once we have how much protein someone is going to eat, right? So it's based on age, physical activity, and personal choice. So when someone is thinking, how do I get the right amount for me, no less than 100 grams, because it also loses that thermic effect. People will say

it's a thermic effect of food. To explain this is not all calories, calories from carbohydrates, calories from fats, calories from proteins, because they do different things in the body, they have different biochemical footprints. And in order to, and I'm sure you've heard this, it's difficult to overfeed dietary protein. And this is, I actually really wanted to address this because I'm sure that you have physicians listening to your podcast. And I was sitting at a roundtable of very prominent physicians, and they were saying that you should not overeat protein. And the only reason to go above the RDA, which is set at the minimum 0.8 grams, is if you are doing resistance training. and anything above the RDA.8 grams, if you are not doing resistance training, turns to fat.

That is not true. It is not the first pathway. The first pathway for protein is oxidation, meaning you're utilizing it, you're burning it. The other thing is it's used for gluconeogenesis, meaning the generation of glucose. We don't have a need for carbohydrate, but we do have a need for protein and protein is used for rebuilding, but it's also used in a process of creating more blood sugar, creating more glucose at a much slower rate. I wanted to just bring that up because that is misinformation. And you and I now and also all physicians have access to AI. AI is not always correct, even if it is, even if it is in medical databases. I'm always testing it for menopause information and it's just not good.

And this is the, yeah, and this, this just has to be addressed because you and I both attack things for women from different angles. And if women don't get this nutrition piece right, and well-meaning doctors are going on here and saying, you know, what are these concerns about protein? And it says extra protein turns to fat or it's going to create cardiovascular, like all of this stuff that's, this is not true. And from a biochemical aspect, that's not what happens. It's oxidized. And I just wanted to bring that up because it's, if we don't get that right, no amount of hormone replacement, no amount of training is going to overcompensate for a nutrition plan that is not done right for an aging woman. 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 Lyon, thank you so much for joining us on Paws. You've been an incredible guest. I'd love to hear from you about this topic and anything else that's on your mind.

You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at the pauseolife.com. Full episodes of Unpaused are available on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with good roommate media and long wave digital. This episode was sponsored by Midi Health. The first virtual clinic created for women, biowmen, for the treatment of menopause. Don't let anyone tell you menopause is something you have to suffer through alone. Midi can help.

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