Cum să crești MASA MUSCULARĂ | BOABE DE CUNOAȘTERE | cu Dr. Gabrielle Lyon

Muscle is beyond this idea of looking good, but it really is the organ of longevity. The outcome that we are pushing towards is maintaining strength, flexibility, mobility, endurance for as long as possible.

How can you explain that?

Healthy brain requires a healthy body composition. You cannot build muscle without proper nutrition. You are not going to be able to lose weight in a meaningful way without a diet that is maintainable. The quality of the training is really important.

Is there a way for obese people to lose fat and gain muscle at the same time?

There's a million different ways to work out in a million different settings. The number one challenge that people have is time. I think we should move as dynamic as we can for as long as we can.

What would you choose between a big muscle or a strong muscle?

My number one importance would be foreign.

La longevitata noastro un mod direction. Doctor Gabrielle Leon. Muscle centric medicine in washington d.c. leon adesco parit kamushki nun samna duar forte. Dean romania. Important. My poutine. Podcast. Gabrielle, hello.

Thank you so much for having me.

And thank you so much. Thank you for taking your time. I'm so honored that you've made it. And I want to thank you for publishing this book. I want to thank you for making this so precious information available for the public. I've read your book from scratch to scratch, and I loved it. I love the fact that you bring medical information, scientifically proven information, in such an easy language, easy to understand for everybody. So I would like to jump straight to our dialogue and I want to ask you, why do you think is the muscle tissue so important for our health?

Well, first of all, the fact that you're willing to talk about muscle is incredible. Muscle is beyond this idea of looking good and being jacked and tan and things of this nature, but it really is the organ of longevity. When we think about wellness, there's this huge discussion about wellness and health and cardiovascular disease, Alzheimer's, many diseases, chronic diseases of more Western civilization. When one begins to think, where is the root? The root, much of the time is in the health of the organ of skeletal muscle, which in its entirety is an organ system. And so making sure that it is healthy, it is robust, is going to be an individual's greatest asset.

How can you explain that? Because, like, when we think about muscle, we think, okay, this is strength. Yeah, I can move with my muscle. I can. What else? Yeah, I can move my body. I can feel better, I can look better. But what is the link between the muscle and the muscle health and the longevity? And like our general health.

Yeah. Well, skeletal muscle as an organ system does a number of things. Like you had just mentioned, it's critical for movement activities of daily life. It is how we generate strength, it is how we have flexibility, how we have balance. But from a metabolic perspective, it's our sink. It's the site for carbohydrate disposal, the site for fatty acid oxidation. It's also our amino acid reservoir. Amino acids, which we have all heard are the building blocks of life, are really what required when individuals, say, have an injury or cancer or a burn or any kind of highly metabolic state. The body pulls from these amino acids to make sure that the organism that is the human survives. And that's just a few reasons why skeletal muscle is really critical. And you mentioned movement. And one thing that I haven't had the privilege of speaking about, which I'm going to do a bit here today, is in the movement, in the exercise, depending on the intensity and duration, skeletal muscle releases little proteins called myokines. And myokines are based on the contraction of the skeletal muscle. These proteins create a cross talk within all organ systems in the body. For example, probably the most famous one is this idea of bdnf, brain derived nootropic factor. And when we think about diseases like Alzheimer's and we think about cognitive decline, when you exercise your muscle, it's not simply the metabolic benefits, but it is also what happens and what the muscle provides to the body. So it releases these myokines that help them with release of BDNF in the brain. And that's brain derived neurotropic factor, which helps with neurogenesis and the maintenance of healthy cognition.

Do you mean that if I go to the gym often and I do a lot of exercises and I exercise my muscle, I'm going to be smarter.

Or I can't say for sure about iq, but what I can say is that you'll maintain your cognition and if not improve the speed of your thinking. There is something that is called cognitive velocity. A colleague of mine, Dr. Andrew Huverun, has been discussing this. And cognitive velocity is this idea of how quickly you think and there's a relationship with how quickly you train your body. For example, sprinting with the improvement of this ability to think faster.

Yeah, I mean, I can say that anecdotally when I go to the gym and I exercise, the process of thinking is smoother, right? I can feel that I can think better and I get new ideas. And that goes hand in hand with what you just said. That Developing good muscles can improve your cognition. What can you say about not exercising then? I mean, if I don't exercise. Yep. I say, look, I'm, I'm a brain guy, I'm just going to sit and read stuff and, I don't know, work with my brain, but I don't want to exercise. Can that harm my brain?

Yes. In fact, it's actually a known risk factor. And if we take a step back and we think about what does the brain need? The brain is an organ system. And actually I did my fellowship in geriatrics, which was all about Alzheimer's, all about dementia. And one of my projects as a fellow was looking at the interface between body composition and brain function. And in our particular project, what we found was the wider the waist length, the higher the body fat, the lower the brain volume, based on FMRI scans. And when you think about skeletal muscle, if that tissue, which makes up 40% of one's body weight is static, is untrained, is sedentary, which by the way, this is a dynamic tissue that is designed to move. And if this tissue is static, we think about low grade inflammation that happens throughout the body. Think about this. 40% of the body weight or so is skeletal muscle. When skeletal muscle is inactive, it will generate, and it probably not linearly, but will generate low grade inflammation. Now we are talking about a human walking around with 40% of their tissue generating low levels of inflammation. This can also create metabolic derangement, blood glucose, triglycerides, all of which eventually then insulin resistance, all of which eventually affect the brain.

Because why, why do you think that happens? Because like we probably were built to move. Yeah. As human beings, we were moving all the time. You think it happens because this tissue is made to move. And now we are not moving and we're just sitting and not using muscle.

It's a great question. Why do I think that sedentary behavior, if I'm understanding it correctly, why do I think that sedentary behavior affects the brain?

Yes.

I think that it affects it for three main reasons. Number one, the brain, the majority of the brain is that brain matter is for movement.

Okay. So if we don't move, we don't exercise our brain. Right.

The function, in part. In part, for sure. And again, some of this is conceptual in this way that if we, if the majority of the brain, or for a large portion, portion of the brain is designed to facilitate movement, all limbs, you know, we've all seen the homunculus. I'm sure that you've seen that in training the homunculus, this is a large portion of the brain is made necessary to facilitate movement for the body. So number one, and then if we were to extrapolate that, that this brain is designed for movement, number two, metabolic regulation, insulin resistance. Type 3 diabetes of the brain is really what is thought of as Alzheimer's disease. It doesn't start as a brain disease, it starts as a body disease. It starts as a disease of dysregulated metabolism in the periphery, which. And again, these things are not linear, they probably coexist. But once you have a derangement of glucose, Insulin resistance. Insulin is the hormone that is released from the pancreas in response to food. And it's necessary to bring glucose out of the bloodstream into cells, because glucose is toxic to all cells. However, many cells need it, that once this becomes deranged, the brain follows suit. And a healthy brain requires a healthy body composition. And then subsequently the last part of that is this idea of exercise and the release of these myokines. This is a defined way in which the brain helps with BDNF production.

A good answer. So basically what you say is that the, like, our muscle are making our body healthier and our brain needs a healthy body to be healthy. And there's this direct link with this bdnf. This is myokines that are made directly from the muscle and they go to the brain and they help our brain like developing, right?

And then blood flow, and then also blood flow just in the movement itself. It's, you know, the body is a unit.

So far we understood that our muscles are, are like really important for our health. Right? But then when we think about muscles, we immediately think about the gym. So I want to know your opinion about like going to the gym every day, maybe five times a week. Because we have this in Romania, probably you have this also in United States, where people just get like a gym membership. They go to the gym, they are exercising, all like the same big muscle groups. Is this a good behavior or is there anything better we can do?

Number one, all movement is critical and we should be moving as humans. There is non exercise activity thermogenesis. And when you think about what it is to be healthy, I think the outcome that we're looking for is a long lifespan. That lifespan should be one that is well maintained and healthy. Right? Nobody wants to live the last 20 years in a nursing home. So when I think about what is the outcome that we are pushing towards, the outcome that we are pushing towards is maintaining strength, flexibility, mobility, endurance, or as long as possible with the outcome of how are we living in a way where we are not at risk of losing our activities of daily living? And also how are we not getting disease of the chronic western society? And so when I think about that, then I think about, okay, well what do we have to do to make that happen? Because there's a million different ways to work out in a million different settings. But for me, if I were to think of a hierarchy, my number one importance would be strength. If I had to pick is it endurance, is it strength? I would say it's strength. And the reason it's strength is because we know that over time, if we've laid out the importance of skeletal muscle, we know that over time that this muscle requires a certain stimulus. And there are changes that happen perceivably with aging. There is a change in fiber type. The big bulky muscles go from being, you know, bigger to more thin. We've all seen that with our aging parents or grandparents, you know, and my thought is, does this have to happen? And I don't believe that it does. I believe that one of the reasons that this happens and then with that is if we lose muscle, we lose our metabolic flexibility, we lose our ability. So it's not just about being overweight, it's about being under muscled. And I'm going to circle back to your question is what do we need to do when we go to the gym? But the only way that we can define that is if we understand what the problem is. And so as we go through aging, it's not so much the endurance fibers that we lose, it's the strength fibers. It's the fibers that are utilized that are bigger and bulky. As we begin to lose these fibers, we then see an increase in blood glucose, which we know is a respecter for diabetes. We then see an increase in insulin, insulin resistance. All of these problems will then affect the brain. And this happens not because of the gain of body fat, but because of the loss of muscle. And there is only one way to maintain these tissues and it's to exert force and have enough volume and stress the tissue enough to be able to maintain strength over time. That being said, I think the quality of the training is really important. Someone could easily. I actually personally only train three days a week, three to four days a week. I do full body exercises and I train for about 45 minutes. The reason I can do that is because my training is high beat focused. I am not training quote for strength. I typically train more in the range of hypertrophy which is thought of 8 to 12 reps. I'm probably closer to 12 to 15. But what I'm doing is I'm progressively overloading. I am thinking about what my weights are and I'm improving the overall heaviness of these weights. And that's just one way to do it. But that becomes really important. Someone doesn't have to go if they are willing to go five days a week. That's amazing. But you had mentioned something earlier, which is the number one challenge that people have is time. So if you are going to be effective, you have to have a well laid out plan. Otherwise you are just going there to do actions. Which again is not bad, but isn't as effective as it could be.

Yeah, great. I have so many questions from, from your answer. But my first question would be if you would have to choose from between volume of the muscle and the strength of the muscle, what would you choose?

I think it's a great question. I think it would depend on the age. So they will say that volume is typically more important than anything else. But if you were to say, for example, I needed enough volume to stimulate my tissue, I might be doing 50 reps. If the wheat was light, that might take me forever. Yeah, but it would be a lot of volume. Right? So it's how much. So you know, typically when we think about it, you're absolutely correct. Volume is considered number one. But the amount of volume that, for example, if I was choosing a lighter weight that I would have to do and many of your listeners would have to do would take a tremendous amount of time. But the data shows that for, for example, maybe a more mature individual, that the heaviness of the weight doesn't matter as long as they're getting enough volume. And that's wonderful if you are younger in terms of your training age. So what do I mean? Let's say someone, let's say my 74 year old dad or yeah, my 74 year old dad has never trained. His idea of volume and load is going to be much lower and he's still going to get the same stimulus. But for someone who is young and fit like you, for you to just focus on volume and say perhaps a lower weight, you will be in the gym for a really long time, I'm guessing.

Okay, but if we, if we just talk about the, the muscle, I mean, what would you choose between a big muscle or a strong muscle? Like a muscle that is maybe not so big in volume but he has a lot of strength in it, or, or A big muscle that doesn't have a lot of strength in it.

Well, you know, I think that the data supports strength. I think that we don't have great ways to measure skeletal muscle. You know, when I was in my fellowship, that. That's really when they started. I mean, it's. You're talking. We haven't been able to directly look at skeletal muscle for long periods of time. And it's not the standard. People typically use Adexa. And Adexa extrapolates skeletal muscle mass. It doesn't directly measure it, but according to the data, one would choose strength over mass. And I agree with that. But I would say that they are both important if it is healthy. For example, if someone is very overweight, there's a lot of discussion around how individuals that have obesity may have more muscle to carry extra body weight. And I would argue, I would argue that we don't actually look at the quality of that tissue. And if one were to examine the quality of that tissue, like we see on a CT or mri, one would likely and often see fat infiltration into that tissue. By definition, that's not going to be a healthy muscle.

And they have volume, but that's not, not a healthy muscle for sure. And we, I have some questions about obesity and we, we're gonna get to that. But getting back to what studies says, so we know that like the, the number one that cause, that cause or cause of death in, in the world is cardiovascular disease. Right. And we also know from studies that the, like the, the best thing you can improve and measure for cardiovascular disease is this VO2 max or your capacity to use oxygen. Yeah. In your training, let's say. So what would you prefer to train if, if somebody has to choose? Because again, we don't have a lot of time. So maybe somebody has like three to four days a week. Yeah. To train one hour. And this is actually a question for me because I don't know what to choose and what routine to follow because I cannot train VO2 max and muscle in the same time at the same week.

I think it's. I'm so excited that you're asking this question because we've been reading a lot about this in research for my second book. And what we've come to determine is that. So there's many different ways to improve a voshi max. There's exactly what you said, this long kind of zone two endurance. And the current recommendation is 150 minutes a week. But if you look at. And again, we have to recognize that part of the data that we get is really based on what's been done. But if you were to look at someone like Martin Gabala, and He is at McMaster University, and this is someone who studied high intensity interval training. And granted, we don't have direct comparisons between zone two that I'm aware of at this time, Zone two and say high intensity crossover designs, very difficult to do because of the nature of exercise. But there are many ways to improve VO2 max. And when I say many, yes, you could do zone two training, but when people are really looking to also improve VO2 max, another way to do this is high intensity interval training.

Yeah.

And that would take 20 minutes a week. And that, quite frankly, is all I do. So I do, I typically do more high intensity training and that is how I utilize exercise or somewhat of a cardiovascular system to improve my VO2 max. And so you do not have to do zone two long types of training to get an output that you're looking for. So for someone like you, who doesn't have a lot of time, I don't think it's necessary. I think that if I had to pick, which is a bit controversial, if I had to pick between zone two, steady state cardio and high intensity interval training, or even sprint interval training, which would be four minutes a week, I would choose high intensity interval training.

Okay. Doing weights, right? Or not necessarily.

No, not necessarily. That's also another good question. So if we were to just Talk about improving VO2 max, high intensity interval training could be done in a total of 20 minutes a week. This would be a pretty intense effort on, say, an airdyne, a bike, a treadmill, a rower, a skier. Could someone do Tabata style training? Yes, that might be more challenging because I, I really do like the machines because the machine can say, okay, this is how many calories that you were doing. This is the RPMs that you're using. It's just from a data standpoint or you think it's easier, but one would not be doing these things with weights. Could somebody. Again, we're trying to separate the quality of the resistance training for strength and even hypertrophy. I think that there's a strength hypertrophy continuum. And then when you think about endurance and cardiovascular activity, this can be done with very focused effort that is uncomfortable and you will see improvements or one should see improvements in a VO2 max.

Do you see improvements in your VO2 max just by doing like weight training and 20 minutes of high interval training a week?

I mean, in all honesty, I haven't Measured it in the last six months, so I can't tell you. But I do continue to improve VO2 max and I think that a lot of people do as well. Do you measure your weight? Do you measure your VO2 max?

Yeah, it's not and it's not so good. It's just, it's 41 and I like my watch is measuring it when I walk in the park. So like the, let's say the Zone 2 training is not so hard. It's just like a fast walk in the park and it's, it's really pleasant usually because I can listen to like to podcasts, to books and stuff like that. But then when I go to, to the gym and I train like I, I've actually made my, made myself a training program with ChatGPT. I just described myself and my metrics and I asked how, how can I improve my VO2 max? And he came with a really nice program because it's not very difficult. So I can like do it for a week and then leave it beside. But it's still challenging.

What is an example of that? I'm dying to know.

First week, Monday, 10 minutes of jogging, then 30 seconds sprint, 90 seconds jogging for six times. Day one, day two cardio endurance. 45 minutes of let's say zone two to zone three. The next day go to the gym and I go like make a circuit. Circuit we call it, I don't know how to say it, like full body workout. The next day it's an aerobic phase. 20 minutes running in zone four. Next day it's again high intensity interval training. This time 45 seconds and 2 minutes of walking. So 45 seconds, printing 2 minutes of walking and that's the whole week. And the next day, which is Saturday, it's 60 minutes of like fast walking. So it includes two days of high interval training, two days of zone two, one day of zone four and one day of gym. And I want to see how it is going to feel. And he says that doing this and like the next week it's more and a little bit more and I'm going to run more and stuff like that. And he says that I can wait for improvements. After one month of following that, I.

Think that's isn't that interesting. So that's counterintuitive to what people would think. People would think that in order to improve your zone two cardio, you would just be doing 45 minutes. 45 minutes. And listen again, I think that there's multiple ways to do it. And are you Thinking about improving mitochondrial function or mitochondrial function, are you improving mitophagy? You know what is what? I think there's all these mechanistic reasons why one would do various exercises, but I think thinking about the ultimate outcome that we are trying to accomplish and then building a program that accomplishes it for that individual. You said something very important and that was for me. I described to chatgpt you, you are a young, very fit, highly educated male who has probably been training for a number of years and it designed a program that was rigorous. But for example, if I were to ask my mom, who has been strength training but probably not doing much cardiovascular activity to design a program for a 74 year old woman, she would cringe if she heard me talk about her age. The program would look a lot different. And ultimately what we have to recognize is there's multiple different inputs that can be provided based on the individual for an outcome. The critical piece is I think we should move as dynamic as we can for as long as we can, which involves sprinting and moving in a way that is challenging. Because once we stop moving in that way, for example sprinting or jumping or doing actions, we become more and more deconditioned in those types of training. And someone would argue, hey, why does my 74 year old mom need to keep sprinting or need to be able to jump? Well, she does it, but what she does need to do is she needs to be able to catch herself if she trips or better yet, don't trip at all and have great balance and great pliability for her body.

Yeah, that's true. Yeah. So yeah, in the end, like my, my goal is to make my body as functional as I is, as it can be and in the time I can invest in the training and I found myself like not satisfied to the gym like all of the time and just staying in the gym, like I like to change the environment and to be able to move in like in, in, in a different ways that the gym and the, the machines in the gym make you move.

Totally.

That's my goal. Yeah.

And I spend a lot of time thinking about it, going back and forth, you know, because on one hand, if you listen to Fat Davidson, who I absolutely love and has been on my show more than once, he's a PhD in exercise and he will tell you that machines are great, that what you need to do is you need to pick safe movements that are well connected, meaning you have a lot of quote ground, which is connection with the machine, to be able to actually train the muscle that you're trying to do. And frankly, he doesn't care. He just says the best predictor of someone's VO2 max, they're not going to have a good VO2 max if they don't have good muscle. So this is a statement that he would make. And again, I think part of it is, you know, how do we maintain a bit of force and a bit of power as we age? Because there's a natural decline to these things. And again, is it a natural decline or is it that we all stop doing it? But I will say there seems to be a risk for injury with joints and tendons. But again, we don't have a lot of great data over time because we don't have a lot of randomized control trials of lifelong athletes or lifelong, quote, normal people that have been training.

When should we expect this decline to come? I mean, how does it feel? What should somebody feel when this decline is coming?

So I'm gonna give you what I've seen as a clinician, so I'm a practicing physician and I will tell you the biggest moment that decline seems to happen is at the change of hormones. And that is typically around perimenopause menopause transition. You definitely see changes in. Again, this is what I've seen anecdotally. Power, muscle mass and fat deposition for women doesn't have to be, but this is what I've seen also for men, when men go through periods where they have a tremendous amount of stress and are not sleeping, low levels of testosterone, which also don't have to happen for men. Men's testosterone does not have to decline. Sex hormone and binding globulin does seem to go up, but this is the time where we see changes in muscle mass, changes in injury patterns. So one would ask, is it an age thing? I, I can't say for certain because of course there are tremendous outliers who have been training their whole life. I will tell you, there is one patient that I had for many years. She was a mid 50 year old crossfitter, just unbelievably jacked and fit and on no hormones. Unbelievable. The key was she started early and continued to train her entire life. And quite frankly, even though she went through menopause, she was able to maintain a physique that many of us will never even reach naturally.

And you said a thing you talk about in your book about starting early and this is so important, so like it's so important for the parents that are listening to this podcast to know that it's so important to send their kids to different sports to start the muscle development early, to be curious about the food they give to their kids so that muscles have the fuel and the building blocks to build and to develop. But is there any hope for people that didn't start early? Because this is something you cannot change, you know, and maybe somebody is listening now and he's like maybe 40 or 45, he didn't start early. But did you have like examples in your clinical practice of people that didn't start early, but they developed a really beautiful and strong muscles?

There's always hope. The body is incredibly capable of change, which is extraordinary. And yes, I do have patients that have not trained or were not active or say that they were active when they were younger and they took a 20 year hiatus. Those individuals, number one, if you have had it, it's always easier to go back and get it. For example, if you, you hear a lot of people about being a high school athlete, that's great. Even if you stop for 20 years, the fact that you were there at one point, you, you know, the, the muscles, the satellite cells, the cells that feed these muscles, these tissues and these nuclei, they are developed and they, well, they can become dormant and they can certainly change. But I think that there are ways in which if you reintroduce training and stimulus that you will get a robust response. And also we see the data, I mean the data says that you could be in your 80s and 90s and begin strength training and you will see improvement. It is absolutely never too late. The one thing that I will say is there's this idea that something is better than nothing. And this might be a bit controversial and off putting, but everything in life, when we say our finances, if you say I'm going to save money, something is better than nothing versus I am going to save X number of dollars each month because I'm going to put this towards retirement or I'm going to put this in a fund that is going to provide X number of investments in return. So there's two strategies. And again, I recognize that I'm making this in such a blanket statement and I don't mean to, but something is better than nothing. But how do we evolve that conversation to say, you know what, I know that aging is coming, we only pass this way once and time continues to tick, it is coming. How do we ensure when the moment of if, if or not if, but actually when sickness, injury, any of these other things that coordinate our humanness change which it is coming, how do we Become stronger, more resilient and robust for the time when it's going to happen. And that requires a plan. And as humans, we plan a lot of things in life and somehow we decide not to plan exercise and we assume that we're still going to be able to weather the storm because the storms come. And so having a great plan of three days, a week of resistance training, if it needs to start with body weight and then bands and then one moves to a single kettlebell and then one advances to a machine, all of that's great. But one has to recognize that we have to provide a calculated stimulus for this tissue and this organ system for an outcome that we know is going to happen.

Yeah, that's so, that's so true. But you know, these things that are going to come, they are, yeah, they're going to come, but they are so far away. Like people ignore them and they like prefer to leave today and to finish the job today and to ignore the sports. Yeah. And I don't know how, how and what is the trigger that that pushes you to move? You know, usually for people it's like bad blood results or like the finding that they have pre diabetes or diabetes or a disease and they start to make a plan and to make these changes. And yeah, we understood so far that like the movement is so important and it's so important to exercise, but what about the foods that we eat? You know, and if we talk about obesity, let's say there is a medical consensus that the most important thing is the food, not the exercise. And there are even like nutritionists that say like sports is not mandatory, you can like, you can do it without the sports, you just have to eat less and like the proper food. What do you think about that? I mean, how, how important do you think is the exercise for losing weight?

Well, both are important for metabolic outcomes and health. And I think that we can all agree on that. If you were to ask me if I had to pick which was going to have a bigger impact, which I don't want to pick because I think that they're both important, but the data would support that actually exercise and training has a greater stimulus than food.

Really?

It. Yes, unfortunately, for the longest time I believed that it was always food first and that apps were made in the kitchen. And while all of that is true, if we are talking about and stimulus to the system, you really disrupt homeostasis by exercise. Right. You push the body, you create these inflammatory and anti inflammatory myokines, you create reactive oxygen species. You're doing all of these things. You're pushing the mitochondria. Do you do that with food? Well, not to the same extent. However, food is critical, obviously on a chronic basis and you cannot build muscle without proper nutrition. You are not going to be able to lose weight in a meaningful way without a diet that is maintainable. You will not support healthy aging without enough dietary protein. But I will say enough dietary protein isn't going to support aging without training. We require both. Why exercise has always been deemed a bit less important. This is, my belief, is because it is optional. Eating is not optional. Everybody does it.

Yeah.

And there seems to be an incredible emotional tie to food, to dietary patterns. You don't have that same almost religious pull about exercise. But nutrition seems to create quite a bit of controversy. And I think in part it's because it's complicated and there are multiple ways to feed a human and the human is incredibly adaptable. And depending on the region of the country that you're in or the world that you're in, people will have standards and cultures of how they feed. And again, it's a relatively new science.

Yeah. And it's a science that is really, really hard to follow and to, to study. Right. And nutrition. Because we are so different, we eat so differently. And you. Yeah, but still you talk, you talk a lot about proteins in, in your book and how important they are. And we can agree to that. And we have a lot of materials about proteins on this channel. But what, what do you think about the fact, and probably that happens in United States also, and it happens a lot in Romania, that proteins are now used in the food industry to promote any kind of food. A lot of the times it's ultra processed food. And we have a lot of labels like with high in proteins, like even on the products that usually have high amount of proteins and you don't have to promote them that way. What do you think about this trend and how, how dangerous do you think are these ultra processed proteins that are artificially added in kind of healthy foods?

It's a wonderful question. And the first thing that we have to do is we have to define. There's no category definition for ultra processed foods. And I'm going to highlight a few things that maybe you've thought about it, maybe that you haven't. But when, for example, you grind up a meat to make a burger, you've now created a process, a processed food that is now a processed food. A whole beef ground up into a burger, this is now processed. A whey protein isolate would be considered an ultra processed food. So the first thing that we must do if we are all going to have a meaningful conversation about ultra processed foods is what are the categories? Is it ultra processed foods with X number of calories, X number of carbohydrates, X number of fats? Are they highly palatable? Are they low nutrient density? Because we know that this drives obesity. The over the overconsumption of calories, especially from over ultra processed foods that are low in fiber are problematic. Now we have to put these in definitions because not all ultra processed foods are bad. Just like I'd mentioned, I can ask you, do you think that a burger is bad?

It depends. What? What it has nothing.

What if it's just beef?

Yeah. If you have it once in two weeks, probably it's not bad.

There's no. But there's also no evidence that red meat is bad for you. Right. Low fat, lower fat red meat. There's no high quality evidence that's true. If we were to grind up salmon and make a salmon patty that's considered ultra processed or not ultra processed, but now it's a processed food.

Processed.

Yeah, yeah. So the, the first thing that we have to do is that we have to, like I said, is really define what it is that we are looking at. And then the second thing that we have to recognize is that we have a world to feed and that is an incredible demand. And how are we going to feed the world appropriately. And then of course, I think helping individuals make good choices. Now you mentioned something that was very student. I don't think anybody has ever brought this up or asked me. And you had said, what do we do when we look at a package that says high in protein? Well, I'm sitting here with my producer Mal, and we've gone to the grocery store and we have looked at ultra processed foods that say they're high in protein. And then we go and we look at the back of the label and it's fortified wheat protein with 500 other ingredients that we can't read. And on the back it says high in protein. And it's. I don't know, 10 grams of protein. Yeah. And then 50 grams of carbohydrates. So what is going to be true and what's not true? And then also what is the quality of that protein? And there are a lot of challenges with labels. So the best thing that we can do, you and I as educators and communicators is how do we educate the public? Which is one reason I was so excited to come on this channel because I'm seeing everything that you're doing for your country. You're, you're the biggest one. You're the only one that I can see. And with that comes a great responsibility. And that is your responsibility and my responsibility to educate our fellow humans to be able to make discerning decisions.

Yeah. And how, the question is how, how will they make that? Because I on my channel promote proteins. They're important and a lot of people as we know they are highly deficient in proteins because you just eat one egg in the morning or two eggs and then you eat, I don't know, a soup and you eat a pizza in the evening and you, you're, you even don't have those 0.8 grams per kilogram of, of your body weight of proteins. Yeah. So you need more. What, what kind of, of proteins should people choose? Because like you said. Yeah. We have to define ultra processed food. Like, and that protein powder, let's say it's also ultra processed. Right. Like the, the protein powder that we put in the shake is ultra processed. And maybe if you're an athlete. Yeah. And you are going to the gym and you follow your diet and you sleep and you taking care of your health, probably that protein powder will not do you any harm. But if you add that protein powder and different ultra processed food, probably, probably Dan, following this is advice of having more and more protein maybe can even hurt you. So yeah, you said that we have this, this responsibility to, to educate our public. But sometimes the question is, is like, is following the protein really the good choice?

Yes. I love this. Can I jump in? Can I jump in?

Yeah, please.

How much protein is too much protein? I need a number. You have to give me a number more.

Well, this studies may confirm that even 3 grams per kg of the body we safe.

Correct. Well read. Well read. So three kilos. So we have never had one study ever to determine an unsafe level of protein. So studies 3 grams per kilogram and above. I mean obviously I never recommend anyone eating that much. But we have never had an amount of dietary protein that would be considered dangerous that we know of. Now I'm going to ask you another question. I got another question. What level of carbohydrate would you consider to be dangerous?

It depends. Depends what, what kind of carbohydrate. But I, I don't, I don't have an exact number. But there is dangerous level.

That's right. That, so this is a really good point because there's been no upper limit or danger to I mean, obviously the, the upper limit for recommendations are, you know, we're looking at 2.2 grams per kilogram. There's typically not recommendations above that safe level. Could be above 3 grams. There's never 3 grams per kilogram. There's never been data to support that. That's a problem. There is definitely danger with carbohydrates. The Average American eats 130, sorry, 300 grams of carbohydrates. We know that when you increase carbohydrates, you increase metabolic derangement from glucose dispos, which then leads to diabetes, type 2 diabetes, which then creates a whole host of problems that we talked about earlier. But the average individual is. So if you look at the US 45%, almost half the country is below the recommendation for dietary protein. And we are a high consumer country, 45% is below the RDA one. We cannot extrapolate that protein is what the problem is. I certainly don't agree with adding extra protein onto extra calories. But what we have to do is, number one is we have to follow the science. And the science shows that dietary protein closer to 1.2 to 1.6 would be more optimal for aging. By definition, that is double the bare minimum. Defining it as then a moderate amount of protein, not a high protein diet. The, the individuals, the majority, almost 50% of the population is not getting Mac.

What, what is the problem that I see in like overhyping on protein? Because we still have a limited amount of foods that we can eat, right? It's like in the gym, like we have limited amount of time, so we have to choose from what to do to build muscle or to increase VO2 max or to mix them both. So we have limited amount of food we can eat to be in normal caloric range, right? Here's a debate. There's a very big scientist. It's called Tim Spector. It's, it's Professor Tim Spector from Zoe. He has a podcast. He has.

Wait, I'm sorry, is he the vegan? Is this a vegan individual?

No, he's not or he's not. I really recommend you to, to follow him. So he's like, if we talk about science, he. His huge index which measures how many times he was cited places him on, on top of 55. Like his rank is 50, 55. He's the 55 scientists in the world as paper being cited as paper that cited him, let's say.

And what is his? What is his. So is Zoe, is Zo a largely vegan vegetarian group? I thought that it was.

It's not. No, it's not. So actually he even have that. So he's, he is epidemiologist and he is basically saying, studying that gut microbiome and he has a really great book and he, he debates the need of so much protein in, and not talking, let's say so much about fibers.

You know, fiber is so important.

Yes. So he, he's not, he's not vegan but he like, he's citing one of the biggest nutritionist nutrition studies that we have. One of them is called the American Gut Project. The second one is, was lead by him and it's called the British Gut Project. And they found that the most healthy individuals as lifespan as disease, as metabolic disease and cardiovascular health, the most healthy individuals were those that were eating 30 plants in a week. And yeah, and they, and they talk about this variability of different fibers that come from different plants and we, if we combine them, we basically what he says, we can get enough protein but also enough fiber to fuel our gut microbiome and to feel good. So, so my question is, don't you think that if we focus too much only on the protein which are very important and he says that it's okay to eat meat, not that much as we eat, but it's really. And he finds in his studies that people that are plant based but they eat meat, they have much healthier microbiome than just the vegans. So those that eat meat from time to time. But the question, the real question is don't you think that, don't you think that if we focus too much on protein we lose the importance of all of these different plants and fibers?

I think it doesn't have to be either or. Right. We know that fiber is important and that plants are important and in my opinion the optimal diet would have both. But I will say if we were to, if you think about the importance. So number one, they're both important. But from as a geriatrician and as a physician that still sees patients, my priority will always be muscle. And as individuals age their overall caloric intake goes down. We know that 40% of women over the age of 60 are below the minimum of dietary protein. So the first statement would be do I think we're over indexing and emphasizing protein? It's not possible because on the immediate that's muscle is what's going to save people's lives. Your other statement is if we reduce our protein or eat enough plants then we can get our protein needs met. That is probably true. But when it comes to clinical practice, most individuals will not meet their protein needs based on plants. The average I would have to look. But the, the. So if we know that the protein intake is already too low and individuals would have to eat 1.2 to 1.6 grams of protein a day to get that from plants, what does that look like? I mean what does that look like? That would be a tremendous amount of food. Have you, have you experimented with that? It would be a tremendous amount of food.

And we. This is so interesting because like there are a lot of Instagram account with really big bodybuilders that are only on vegan diet. But what people are losing inside is that they are probably training for three or four hours a day just to burn the excess carbohydrates and energy they take with those proteins that they need to build muscle.

And they're younger. So you have to understand my training as a physician is in nutritional sciences and geriatrics and have you ever seen anyone in a nursing home? Have you seen people in nursing homes?

Yeah. Yes.

Do you think that they're going to be meeting their, their protein needs by getting a high fiber diet?

I don't know how to answer. Probably if you, if you, have you.

Seen how much they eat? So the average appetite goes down probably the average total caloric intake is 1200 calories. Can someone eat a whole food plant based diet and maintain their bone health and maintain their muscle mass on a lower caloric intake like that? I've never seen.

It would be hard.

It would be hard. I've never seen it but I would love to see it. And so if we fail to over index on Hurricane, we already have low muscle mass already. If someone is young and has a lot of time and a lot of energy to devote to getting the perfect plant based diet, they can totally do it. The majority of individuals that are older are not vegan or vegetarian. Those that continue on vegan or vegetarian, I think it's something like 6%. It's very low. I mean we'd have to look at the percentages but it's very low. And I frankly it doesn't matter if someone is vegan or vegetarian. I used to be vegan and vegetarian but I think as we age we have to think what are the most important aspects of maintaining health and wellness and what is, what is feasible for an individual. And again that's not to say plants are bad but do I think that we're over indexing? We're probably, we are definitely under consuming dietary protein and the 25 grams is proper or Bible or in the 25 grams is probably not enough. But do I think that we are hitting our protein recommendations? The data doesn't support that for healthy aging.

Yeah. You know, for me, as for a consumer, let's say it's so frustrating because I read your book and I see how, how important are the proteins that I have to follow the guidelines. Then I read somebody like Tim Spector, which I respect and I see how important are the, are the fibers. And I would really love for like this science to meet together, you know, and to have a material that will recommend me how to have the right amount of fiber and diversity, plants diversity and the right amount of, of proteins. Maybe I know you, you're writing your second book right now, right? Your next book. And maybe you can add something about that in that book that would be.

I think you bring up a really good point. And the thing is, is it shouldn't be as divisive it as it is. So the whole goal is how do we come together to make really good recommendations. And that's based on strong, high quality evidence. And the again, the best of both worlds is a combination of, of plants and Amy. And what happens is, is, you know, there's lots of biases that happen and the people that suffer from the bias is not the researcher. The people that suffer from the biases are, they're the consumer. And that's what I care about. And so how do we have a well thought out conversation of both? Not epidemiology. You know, we're not looking at low quality data. I think that that's, I think we can do better than that. But I think that we can look at randomized controlled trials and it's a challenge because the epidemiologists will always point away from proteins. And it's just this weird thing and it, it's, you know, we've got incredible scientists that are plugging away at these randomized control trials and there's a lot of policy and a lot of politics involved, at least here in the US and it's, it's, it's tough.

Yeah, I, I can feel that. So if we go to, to our next topic and we talk about obesity, is there a way for obese people to lose fat and gain muscle at the same time?

There is. It's probably not ideal. I think one should pick one or the other to really focus on it. And I think it depends on the level of obesity. Right. The more obese an individual is, the easier it's going to be to lose that fat. If it's maybe a little fat to lose, but they really want to build muscle. Perhaps someone focuses on building muscle first.

But if you, let's say if you're in a caloric deficit, right? Yeah. And you go to gym and you train hard, that caloric deficit is going to make you lose weight. How can you, how can you train in a way that you are burning the fat but still maintaining the muscle or maybe building muscle?

It's challenging. So typically if you are looking for hypertrophy and you're looking for building muscle, you want to start with a 10% calorie access, not a deficit. But then you look at the special operators like my husband and those guys will go through training, depending on where they are in their training and they will be able to maintain, if not build a certain amount of muscle. But it's very difficult and over time they end up using muscle. So it's, it's really looking at the long term strategy. And again, if one has a very clearly defined goal, then that is what they should focus on. I wouldn't focus on losing fat and building muscle at the same time. I would put my attention towards one thing or the other. But let's, let's play out a scenario. So let's say someone wants to use weight and there you go on a calorie restriction. The data would support that the lower their calorie intake is, the higher their protein needs to be.

Right.

We've seen protein modified sparing fast because this is the only way to maintain tissue. Right. So same one is going on an 800 calorie diet. Could that be done on a plant based diet?

I don't know, but maybe, like if you eat a lot of soy and. I don't know, maybe. Yeah, maybe.

But it might be hard. It might be hard. Right? So if someone is. So if we were to think about how could we use various nutrition strategies in various times, if someone really was focusing on losing weight, cutting calories and maintaining muscle, then I would put someone on a higher protein diet, high quality, high protein diet. If someone doesn't care about caloric restriction and wants to eat plants and has an, a tremendous amount of wiggle room for fibers and calories, then maybe someone trials doing these various fiber diets on kind of a bulking cycle. So that, that could be a strategy.

Okay, so basically it's hard to build muscle, lose fat. But, but why is it hard? I mean, can you explain what happens in the body that makes it that hard to build new tissue? In the muscle using the energy you extract from, from the fat.

Well, if you're looking to build new tissue, you have to create enough mechanical tension, you have to create enough stimulus. But then for muscle protein synthesis, you do also have to supply the right amino acids, and that becomes really twofold. Those are the two ways really to build muscle. Of course, there's hormones, but it's really contraction and then providing the new amino acids and then giving time for recovery. If someone wants to lose weight, there is a calorie balance that must happen, and that would be requiring to reduce total calories and also train to maintain that tissue and do that slowly over time, because the faster you lose weight, the faster it's going to be a combination of muscle and fat. For example, people on ozempic or semilutide, we see some of the data is 50% muscle loss and 50% fat.

What do you think about this medication? I, I, I've so, I've saw the data about the muscle loss and the fear of losing muscle. And in part, it's believed that because we lose weight, we don't need that much muscle to move that way. That's why we lose muscle probably on this medication. But what's your opinion about this Ozempic and semaglutide medication?

I think these medications, as you and I are both practicing physicians or physicians. I don't know if you're still practicing. I think you were a surgeon by training maybe.

Yeah, yeah, but I don't practice anymore.

Okay. Well, we've never seen anything like this as effective as this other than bariatric surgery. And I, I will tell you, these medications are tremendous and fantastic and do many, many various things in the body. I think that it's how you leverage them that is important. And also they're here to stay. So how do we give dietary information that is going to allow us to protect the new epidemic that is coming? And this new epidemic that is coming is going to be sarcopenia decades earlier, because we can accelerate a way of starvation that we've never been able to do before. And a level of calorie restriction that you've never been able to do before. This is where dietary protein and resistance training is going to become even more critical.

That's true. And for these kind of patients. And I have a question. Do you have any patient or do you have any cases you know about with patients with obesity following this semaglutide medication and also doing resistant training and at least maintaining their muscle mass all the time?

We do it all the time in clinic. We do it all the time in clinic. I would say nearly every single one of our patients. And we track body composition, they maintain muscle, and we do it slowly. So we use compounding pharmacies, and we dose it in more micro dosing rather than full doses. So we use less than recommended. And our patients do tremendous. And the food noise goes away, and even their desire to drink seems to go away.

Yeah, I've heard of that. And I. And I've heard that they start to. They go for more healthier options for. For the food they eat. And that's also amazing because you take a medication to lose weight, but then that kind of medication is making you eat healthier foods, and that's amazing. Also, how would you recommend people to measure their body composition at home? Is it okay to use those scales? Or there's, like, watches, smart watches that can do that. Now, is it effective? Do you recommend that?

I totally recommend tracking. And we use inbody. It's. Again, it's bioimpedance. There's a margin of error, but it's unrealistic to get an MRI of where your skeletal muscle mass is. But, yes, use it.

Okay, and my last question is, what are the top three mistakes you see people doing in the gym or when they exercise?

The first mistake is they don't follow a plan. They are haphazard in training. Number two, they're distracted. They are not highly focused on the moment and nearly intense enough as they should be. And the third one is, is they're so afraid of getting bulky that they choose much lighter weights than they possibly could execute on.

This is one of the best jokes that you can. You can have with a personal trainer. When you go to the personal trainer and you say, look, I. I want to be trained, but I don't want to be that shredded like you, you know? And it's like, yeah, you need to make a lot of work to be that shredded. So don't worry, you won't be that shredded. Okay. Dr. Leon, thank you again so much for taking your time and to speaking with me and your Romanian fans again. Your book in Romania is called Sonata Mushkilur, the Health of the Muscle. Yeah. And it's. It's a bestseller on Bookzone, which helped us arrange this podcast. You know what? Can I have one more last question?

Only if you come to the US and come on my podcast, which, by the way, is number three in medicine in the U.S. oh, my God.

This is like two. Two invitations that are so great. Yeah. Thank you so much. I would come. Really? Yeah, I would come. I would like to come to us. So I can have one more last question. In your next book, is there anything that you, or let's say, is there anything that while you write your next book that you would change in the first one?

Yeah.

Yeah. What would be that?

No one has ever asked me this question. So this first book, I followed the guidelines for saturated fat and I did so. And I went back and forth on this. Should I do it, should I not? And the recommendation is less than 10% saturated fat. I don't believe that the data supports that from a saturated fat standpoint. And think about it. If it is based on a percentage of calories, then that doesn't make sense because if you eat a diet that's 4,000 calories, is, I don't know, 44 grams of saturated fat toxic or is 12 grams on a diet that I'm eating toxic? So what is the number if saturated fat is so bad, what is the actual number that we would determine that it should be 10% saturated fat? So I would have, and I wouldn't have done it for the first book because I do think that it's important to be evidence based in the way that. Evidence based, but then also supporting the guidelines. And so that's why I did it. I supported the guidelines and I, you know, in, in clinical practice, I just, I just don't see that evidence. But I, I would have changed that, but I wouldn't have because I needed to do the right thing for the first book.

Yeah, it's a very good point because, yeah, we have the guidelines for 10 saturated fat, but they don't mention where, where do you take those saturated fat from? Yeah, if it's from the fish or from the olive oil or from, from the nuts, probably they're not that bad and they will not harm our health. Can you tell me something new from your new book that you didn't tell to anybody else so far online? Like maybe a new finding that it's somehow revolutionary for our daily life?

Well, I think that there's a component of chronobiology that we haven't spoken about. And this is this idea that light impacts us much more tremendously than we know from an energy standpoint, even questionably a metabolic standpoint, a mood standpoint, an overall inflammatory standpoint that I will be touching on in this book, this new book, as well as supplements. But this concept of chronobiology, I think that we're no longer going to have conversations about sleep, I think it's really going to be about circadian biology. And that is. Is somewhat of the next frontier that we are just dipping our toes into.

Yeah, I try to take those morning walks as often as I can and I feel better those days, I can say. Okay, Dr. Leon, again, thank you so much for taking your time. Probably this is not the last time we are talking. If. If the people that are watching us now, if they have questions, I invite them to ask them in the comments. And maybe, maybe we're gonna see each other maybe in the United States, maybe on another podcast like that.

You're invited. You are invited.

Thank you so much and so honored to be invited and to talk to you in this podcast.

Thank you so much for having me.

Thank you so much and goodbye and good luck with your book. I hope it is going to be fast translated in Romania so we can have it that.

Thank you.

Yeah, thank you so much. Goodbye.

Bye.

Excellent. Or a command. Screech at the intercessor Mush the example Shasaka seformati pesubectul cara tainter.