How Muscle Promotes Energy, Regulates Our Metabolism, And Prevents Disease

Coming up on this episode of the Doctor's Pharmacy.

We can find individuals in their 60s and 70s who metabolically look like they're in their 30s. They're physically active. They keep themselves busy. But similarly, we can find individuals in their 30s and 40s who look pretty much like they're in their 60s and 70s. That's a direct reflection of the quality and quantity of their muscle. Hey everyone, it's Dr. Mark.

Like many of you, I'm terrifically busy throughout the week. I'm a doctor, a podcast host, a writer, a speaker, a father, and on top of all as commitments, I have to make time to prioritize my own health along with the health of my patients. Because I have so much on my plate, I value tools that make my life easier. And I'm sure you can relate. And that's why I'm really excited to share with you today a little bit about Rupa Health. When I treat my patients, I look at a lot of indicators such as hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria. I'll have to dig deep down to find the root causes that prevent those patients of mine from optimizing their health and wellness. but that means I'm usually placing orders through multiple labs, which is just overall pain. Plus it makes keeping track of results more difficult for me and my patients. But all that changed when I started using Rupa Health. Rupa Health is a place for functional medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better experience for both you and your patients. It's 90% faster than ordering tests one by one and it lets you simplify the process of getting the tests you need. This is great for me because like most practitioners, I'd rather be spending that time with my patients and not doing administrative work. And that's the great benefit Rupa Health provides. This is a much needed option in the functional medicine space. It means better service for you and your patients. You can check out a free live demo with a Q&A or create an account@rupahelp.com that's R-U-P-A-H-E-A-L-T-H.com this episode is sponsored by butcher box. You probably heard me talk about butcher box before because they've revolutionized the process of buying high quality meat and seafood. I love to cook and I have a super busy schedule, so whenever I can spend some time in the kitchen, I want to have all my favorite ingredients right at my fingertips. I'm also really picky about the quality of my meat and seafood and can't always find what I want, what I trust at my local markets. And that is why I love butcher box. They make it easy to get humanely raised meat and wild caught sustainable seafood. by delivering it right to my doorstep. There are different box varieties to choose from along with different sizes and an easily customizable schedule for ongoing deliveries. Sometimes I realize I'll be out of town when my next order is due and it's easy to change my delivery date to when I need to. There's nothing quite like a good steak and Butcher Box 100% grass-fed grass finished ribeyes have become a new favorite for me. They're a perfect combination of juicy and tender with a rich flavor and they're so simple to prepare too. I love searing them with a savory spice blend and serving them with a huge arugula salad for a quick dinner. ButcherBox is committed to humanely raised animals that are never given antibiotics or added hormones. And since they take out the middleman, they're actually surprisingly affordable. The average cost breaks down to about $6 a meal. There is a major stipulation I always tell my patients about when it comes to animal protein. Quality needs to be a priority. And with ButcherBox, you can feel good knowing you're getting the highest quality meat and seafood to optimize your diet. Right now, ButcherBox has a special offer for new members. If you sign up today, you'll get two ribeye steaks free in your first box by going to ButcherBox.com/ButcherBox forward slash pharmacy. That's with an F, F-A-R-M-A-C-Y. That's 200% grass-fed rib eyes by going to butcherbox.com forward slash pharmacy. And now let's get back to this.

Week'S episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. It might surprise you to learn that muscle is the largest organ in our body. It not only determines our strength, but it is also a key factor in reducing chronic illness, improving health span and longevity, and helping to regulate our metabolism. Essentially, the more muscle we have, the better our body operates. In today's episode, we feature three conversations from the Doctor's Pharmacy on why, as a sedentary culture, we need to pay more attention to muscle. Dr. Hyman speaks with Dr. Stuart Phillips and Dr. Chris Rinsch on the role of muscle and mitochondria in our health. With Dr. Gabrielle Lyon on why protein.

Is essential to eat to build and maintain muscle. And with Mark Sisson on his approach to building muscle. Let's jump in. It's not just muscle for locomotion, but it's a metabolic organ. And it's what degrades as we age. And when your muscle function and your muscle mass declines, not only are you more likely to fall and injure yourself and have trouble with just your daily activities of life as you age, but your metabolic health, your hormonal function, your levels of inflammation, your ability to regulate your blood sugar, your testosterone, All are affected by the quality of your muscle. And what happens for most people who are listening and may not realize this, you could be 65 and the same weight that you were when you were 25, but your muscle can be completely different. You can look the same on the outside, but on the inside your muscle has become marbleized fat, essentially turned into a rib eye from a filet mignon when you're 25. And that has enormous consequences for aging and every single thing that we think of in terms of aging, heart disease, cancer, diabetes, dementia. In some ways, they start in the muscle and the muscle function because without optimal muscle function, we can't regulate our metabolism and we can't regulate inflammation, we can't regulate our hormones. And that all leads to these abnormal cholesterol levels, abnormal blood sugar levels, abnormal levels of inflammation, low hormone levels that we associate with aging. But often it really starts with the muscle. So it's one of the most neglected and important organs. And it starts to go downhill pretty quick, right? When we're in our 30s and 40s and it gets older. As we get older, we lose strength and muscle mass. But what I think is a little scary is that while you can improve muscle mass at any age, recent studies have shown that it may not actually be able to be fully restored. So why should we focus on prevention and what can we do to help improve our muscle mass and function, especially in the mitochondria as we age?

I think you hit on a key issue about when muscle mass begins to decline and when the function of our muscles begin to really go sideways. And a lot of people debate when that starts. I think as your example goes, we can find individuals that we pluck off the street who are in their 60s and 70s who metabolically look like they're in their 30s. And that's pretty much because they're physically active. they keep themselves busy, they probably exercise on a regular basis, but similarly we can find individuals in their 30s and 40s who look pretty much like they're in their 60s and 70s because they spend a lot of time sitting behind a desk, they don't eat particularly well, they're not that physically active, and really that's a direct reflection of the quality and maybe to some degree the quantity of their muscles. So I don't know whether your listeners are familiar, but probably if they've heard the term sarcopenia before, that's the, age-related loss of muscle mass and muscle function. I think for a long time, geriatricians said, that's just a normal part of aging. One of the things that we like to push is that it's not and it doesn't have to be. And that really you should try and be as physically active, which is probably one of the key things, have a good diet. Then, as Chris's company, as Amazentis has found out, you can probably do a few sort of nutraceutical tricks, if you like, and prop up that mitochondria inside the muscle, which is another sort of just local indicator function of that tissue.

Yeah, you know, but it's really, it's really key, too, that it's not just the muscle that there is mitochondria in. There's many, many mitochondria in heart and brain tissue and every single cell of your body, because essentially it's the engine that runs every cell and some cells like the brain cells have literally tens of thousands of these mitochondria. Other cells have less, but heart and brain have the most. And that's when they tend to break down as we age. And I think most people don't understand anything about their mitochondria. They don't understand that they can actually measure its function in different ways that doctors can. Doctors don't know much about mitochondria. We learned this thing in medical school in first year called the Krebs cycle in biochemistry, and we quickly forgot it as soon as we learned it, which is the only time we really paid much attention to mitochondria. And yet it is central to every age related disease and the aging process itself. In fact, it's, it's one of the most under appreciated aspects of our health, which is why we're having this conversation. I think people need to begin to understand how important their mitochondria is. A lot of the kind of healthy aging strategies, you know, low sugar diet, more good fats, quality protein, these are all about ultimately helping our mitochondria and exercise also and strength training are critical for building muscle and helping mitochondria, but the role of mitochondria is pretty interesting in aging. And there's a lot of age-related phenomena that happen that can be reversed by improving the function, the number of the mitochondria. And this is some of the work that's being done, for example, around NAD, which is another healthy aging nutraceutical. But a lot of the intermittent fasting, time-restricted eating, the low carbohydrate diets, ketogenic diets, these things that have been experimented with all impact the mitochondria and affect their function. Can you talk about how the mitochondria affects us in terms of the aging process and why it's so important to focus on them?

I think one of the key things, as you said, is that the metabolic processes inside cells require energy nonstop and it doesn't have to be a muscle cell. your cardiac cells, your heart is working all the time, digestive tissue, brain tissue, it's always metabolically active, there's always something going on. That means that mitochondria are turning out the currency, the energy that we need to be able to function. No cell really ever goes to sleep, even if we go to sleep, the cells are continuously regenerating themselves and renewing themselves. that's a function of mitochondria. So once those mitochondria begin to function sub-optimally then you begin to see tissues begin to break down, not just muscle, but as you said, brain tissue, cardiac tissue, it could even be adipose tissue. And all of these things really begin to tie together to slow cells down, they don't function as well, and they really can't then talk to each other. So this so-called what we call organ cross-talk so between muscle and fat and liver and in parts of our brain, it really begins to break down. And so as I said, it's a central theory of aging, which is to say that once our mitochondria begin to decline in function, then things are really going to go poorly. Exercise is one way to prop it up, but not everybody can exercise or not everybody exercises to the degree that they want. These adjuncts that we're now seeing, you mentioned NAD, Urolithin A, for example, are all of these, I think, pretty cool compounds that once we just thought, oh, not a big deal, but we're now seeing are pretty important.

Absolutely true. I think the phenomena around mitochondria in the research is pretty exciting. There's all these genes that regulate aging that are in the mitochondria, FOCO, DAF-2, the sirtuins. These are really important regulators and they're regulated by diet, but they're also regulated by these various compounds, these phytochemicals in plants, which we're going to talk about in a minute because this is the work that Amazentis is doing. This is the work that they're looking at in terms of compounds that come from plant foods that can actually regulate these biological functions in our body. So you can't obviously just take a nutraceutical and eat crappy and not exercise. It's all a package deal. But it really can accelerate the the muscle improvement and function. We're gonna talk about that. But one of the things that's exciting, and Chris, I wanna ask you about this because we have been hearing a lot about this phenomena called autophagy, which is this idea that we can clean up and recycle old cells and old proteins and clean up the system to repair, rejuvenate and extend life and improve health. And that's why people are doing intermittent fasting or time-restricted eating or ketogenic diets, for example. these all improve this phenomena called autophagy, which literally means eating yourself. But there's another thing that happens in the body called mitophagy, which is an incredible breakthrough in understanding longevity and longevity science, which is understanding this phenomenon of mitophagy. So what is mitophagy and how does it help to address the phenomenon of aging and improve our overall health and energy production?

Mark, thanks for having me today. Mitophagy is really a way of renewing our mitochondria, particularly when they're damaged. So as you get older and as you're more sedentary, your mitochondria get damaged as they work, as they're producing energy. And what you have inside of each of your cells is a process of renewing your mitochondria and under this sort of umbrella of autophagy, as you you were mentioning, we have mitophagy and sort of the self-eating of mitochondria. So basically it takes care of recycling mitochondria as they get damaged so that the mitochondrial pool is maintained very robust and you have basically cells with that are more bioenergetically active than they would be otherwise.

That's incredible. You know, one of the things that I find fascinating is this whole idea that I I've talked about in some of my books called Symbiotic Phytoadaptation. And it's a big word I made up myself. What it means is that we have evolved, and this is my theory, that we have evolved in conjunction with the plant world and the foods we eat to regulate our biological functions. And that there are 25,000 plus different phytochemicals in plant foods. that regulate every single biological function from our hormones to our immune system to our gut microbiome to our mitochondria to pretty much everything that happens in our body. And we really have only begun to appreciate these recently. In fact, Rockefeller Foundation has funded a study which they're calling the Periodic Table of Phytochemicals, which is mapping these all out, identifying their function as much as we know, and talking about how do we actually use these in the promotion of health. in everything, there's protein that we eat, there's protein, fat, carbohydrate, fiber, vitamins, minerals, Etc. But there's this other class of compounds that have not been thought to be essential. And I call, I call these the phytochemicals. And that's why I think we, we actually need these to stay healthy. So they're not necessarily, you're not going to get a deficiency disease, but you might get a chronic disease if you don't have these things. That's my theory anyway. And I, and I, I'm so excited by the work that amazentis is doing because it's really rigorous science that has been published in some of the top medical journals in the world. It's looking at some of these compounds in plant foods that can actually regulate key biological functions, especially the mitochondrial function. So there's this compound that you've studied and you basically figured out how to actually extract and make, which is called urolithin A. And just for those who are listening, this is what's so interesting about biology. You eat a pomegranate, which has these, allegotannins in it, which is one of these phytochemicals. So you eat a pomegranate and that chemical interacts with your microbiome. And then if you have a healthy microbiome, it might produce a beneficial chemical called urilanthan A. But if you don't, it might not. So what you've done is sort of discovered that this molecule is so powerful in regulating mitochondrial function and you really done years and years of research to bring it to market. So tell us about urilanthan A. how does it work? How does it affect mitochondrial function? And how did you kind of figure this out? Because there's a million plants out there and a million chemicals. So this is sort of like, you know, kind of like a needle in the haystack, right?

Good question, Mark. So it all started with, for us, with the pomegranate, we were looking at the pomegranate and, and thinking about what type of health benefits it could bring. And we started looking at the compounds inside of the pomegranate and, and this led to us. understanding more about compounds like ellagic tannins, which are a big family of compounds that are quite large inside of the pomegranate. And upon studying them, we understood that they were transformed, as you were mentioning before, into urolithin, in fact, into a range of urolithins, which are metabolites through the gut microflora processing. And it was originally thought that this is just part of the processing and the digestion of the pomegranate, and so wasn't sure were these urolithins actually doing anything in the body? So we started looking at them. And it was at this point when we were looking at urolithin A that we saw lo and behold that it was acting on mitochondria and improving mitochondrial function. And so it's one of these processes where, as you say, a needle in a haystack, but it was through a very systematic dissection, if you will, of the compounds in the pomegranate and following their sort of journey as we consume the pomegranate.

So you were like, oh, let's study the pomegranate and see what's in there. It wasn't like you studied every plant chemical and found out that there was this one that regulated mitochondria.

No, no. We were really focused on the pomegranate at the time because there had been some general research on the pomegranate and its health benefits. And so we thought, let's take a deeper dive and try and understand what's there. And I think as you were saying, before, what's really emerged from this is the importance of not only the foods you eat, but importance of the microbiome and how they work together synergistically to create compounds and to extract the health benefits from the food that we eat. And so, you know, it was understanding this and understanding also that very few people can actually perform this conversion. In fact, it's been estimated and we've done some of our own studies that have shown somewhere between 30 and 40% of the population can actually convert these compounds, these precursor compounds found in the pomegranate into urolithin A, and that's at even various levels. So what it makes sense is when we studied all this was, you know, we don't need to give more pomegranates to people, but we actually need to give urolithin A to people. And if we do it in the right way, if we dose it right, if we deliver it in a very precise manner, we can then get the health benefits that we are targeting and that we've shown that work.

I've been using pomegranate powder and pomegranate concentrate in smoothies for a long time because of the benefits of pomegranate. And it wasn't around particularly the mitochondrial function. It was around the microbiome effects. and so, you know, one of the things we know, for example, is that there's a microbe in the gut called Akkermansia, which is muciniphila, which essentially creates a coating and a biofilm on the gut that protects it and regulates the immune system. It's necessary to fight cancer. It's necessary to regulate your metabolism. It's related to autoimmune diseases, and it's very low in many people. And it, and this bug loves pomegranate. And so you feed a pomegranate, and it grows, and it can help cure all kinds of issues. What really is fascinating to me is is the story of the microbiome and the food we eat. So could you dive a little bit more into how the microbiome interacts with these compounds that we eat and then what happens to those compounds? How do they then get in our body and interact with everything that's going on? Because I don't think people really understand that. I think it's a very new science and I think it's really an important thing because when you're eating plant foods, it's not just for the antioxidants and the benefits that you get from the fiber and the vitamins and minerals. this other thing that's going on that has to do with how it interacts with your microbiome. And that is the future. So talk to us about that.

Sure. So as I was mentioning before about the ellagic tannins that are found in pomegranates, they're also found in a number of other foods that we eat. We find them in raspberries and we find them in walnuts and blackberries. And what happens is these compounds are then transformed after you consume them in the stomach. They're hydrolyzed into ellagic acid and ellagic acid is then transformed by various gut microflora. So the actual identity of the bacteria have not yet been found, but what we see is that there's a range of different metabolites, urolithin A being the most predominant one, and these are then taken up into the body, into the bloodstream, and then they go to the cells. And we have found in our first clinical study, we found that we could identify urolithin A actually in the muscle tissue itself. So it actually gets right into the muscle cells. We've shown that, and we've shown through biopsies of the muscle tissue, that we impact the mitochondria and the gene expression level of mitochondria in the muscle tissue itself.

That's incredible. How does it work to cause this phenomenon of mitophagy, this sort of self-cleaning service, almost like a self-cleaning oven, right? How does it work to induce the self-cleaning process of your mitochondria?

Well, with urolithin A in particular, it's taken into the cells and what it does is it We've shown that it can stimulate this process of mitophagy. It's not known exactly at what point it acts to stimulate the mitophagy, but it increases the clearance of the damaged mitochondria. And consequently, we see a renewing of the mitochondrial pool inside of the cells. And so you have a much more bioenergetically favorable environment inside the cells and the cells consequently function much better.

So, what you're basically saying is that when you have this pomegranate compound that basically should be made by your microbiome, but most of us don't, and you take it as a supplement, that it cleans up the mitochondria and helps to improve the energy production yourselves. Why is that important? Why should we care?

Well, I think in particularly as Stuart was mentioning earlier, as you get older, the activity in our muscle, basically where the ability to clear the damaged mitochondria decreases with age. And so this causes a decline in the energy levels inside of our cells and in our muscle tissue. And so then we sort of slow down as we get older and the muscle stops functioning as optimally. Our endurance levels drop. and this is part of a process in aging where mobility declines. And so what we're doing by stimulating mitophagy is to increase that energy level inside of our cells and basically making our muscles function at their bioenergetically optimal state no matter how much muscle tissue you have. so this is something, it's a really a new approach as opposed to what people have been doing in the past, which has been administering more protein to try and bulk up on muscle tissue. We're all about trying to make our muscle tissue the most functional as possible as you get older.

So just, it sort of like accelerates the benefits of exercise, right?

So, yes.

I mean, and as you were saying before, it's not a it's not a substitute for exercise. Basically, you want to keep this in your diet as part of your healthy routine, if you will. So you want your exercise, you want to have your right dietary supplements, and you want to eat a very balanced meal. So it's all part of combining the three.

Hey everyone, it's Dr. Mark.

Mark.

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To this week's episode of the Doctor's Pharmacy. Our muscle is our biggest organ in the body. And it's one of the keys to longevity. And the truth is that the silent epidemic out there is this massive loss of muscle in the population. We talk about people being overweight or obese. And we think about fat all the time, but we don't think about muscle. So why should we think about muscle?

You are starting off with a brilliant point. We talk about being over fat, but really the problem is being under muscled. The concept of muscle centric medicine is that muscle is the largest organ in the body. And it is not just essential for locomotion, which is typically what we think about, movement and exercise, but in fact it's our metabolic currency. It is the largest site for glucose disposal. Talk a lot about diabetes, cardiovascular health, Alzheimer's disease, all of these issues of metabolic regulation are largely controlled and contributed to the amount of muscle that we have. So glucose disposal, lipid oxidation, we hear.

A lot about cholesterol.

What's that?

A lot about cholesterol. Well, if you wanna lower your cholesterol and the fatty acids in your blood, you should have more muscle. We also think about cachexia, falls, breaks, injuries. Acheaxia means the destruction, the wasting of the body.

Yes, you lose muscle and you're skinny and you can even be thin and have no muscle.

Right. When you think about muscle, it's the reservoir for these amino acids. The more muscle you have, there is less overall mortality. You are stronger. You are able to fend off disease, illness.

Yeah, I just read this study in JAMA recently where guys who could do 10 push-ups or less have a high risk of heart attacks. And if you do 40 push-ups or.

More, you're at far, far less risk.

And actually, it's protective. And I recently did an aging evaluation. I could do 50 push-ups which was awesome. No joke.

I was just like, Mark, why are you so out of breath when you're answering the doors? I'm doing my push-ups, but yeah. Right. So it's clear that muscle is so much more. than just this concept of locomotion and movement. It is a metabolic organ, and arguably it's an endocrine organ. When you contract your muscle, it secretes things called myokines, which are anti-inflammatory.

So it's like the antidote to inflammation, which is the thing that's causing the risk for almost every chronic disease, whether it's Alzheimer's or cancer or diabetes or heart disease, all related to inflammation.

Absolutely. And these concepts relate to body composition. There is data to support the wider your waistline, the lower the brain volume. And I did a fellowship in- so.

You mean the bigger your belly, the smaller your brain?

-Absolutely. You know, I did a fellowship in geriatrics, and part of that was running a memory clinic. Each fellow's job was to spend two years in a memory clinic. And then also being out of Sam Klein's lab, we did a lot of research, nutrition, obesity research. and we did studies where we imaged individuals' brains. And what you see is absolutely the more metabolically dysfunctional they are, the lower the brain volume.

The big belly, small brain. Exactly. And that is not a good thing. Now, this whole concept of sarcopenia is something that people don't even know what that is. People don't know what obesity is, but it's sort of the other side of the coin. It's this loss of muscle. And, you know, I've written a lot about it, and I've talked about strength training and exercise. and the truth is, I really didn't like it because I like to be outside. I like to play. I don't really like to be in a gym. I do, you know, some push-ups and yoga, but he's gonna be weightlifting now. You've been pushing me. You've been pushing me to do this for a long time. And I finally started working out with.

A trainer, and it's actually been fun.

Yeah.

And I'm a little sore, to be.

Honest, but I think I'll get over that.

But what happens is, as we age, no matter what weight we are, you could be the same weight at 25 or the 65 and be twice as fat and half as right. And in the same way. And what turns out is that your hormones, your biology, everything is regulated by your muscle. So you lose muscle, your cortisol levels go up, your stress hormones go up, your growth hormone goes down, your testosterone goes down.

Bad news.

Your insulin goes up, your blood sugar goes up. And, and yet this is not something doctors evaluate for. Talk about, think about, advise about.

Why Again, because we're focusing on the problem, not the solution. Everybody is focusing on the external issue, which is obesity, likely because you can see it, right? But the solution is muscle, and a lot of physicians are not training themselves. Being a physician largely, unless you're into functional medicine or really lifestyle, can be very challenging. And oftentimes the drugs that physicians are prescribing for their patients are often taking themselves. Yeah. The concept of muscle and why it's not talked about so much is because I think that we're just very behind on the science and that solution. It requires hard work. It requires physical work, labor. People don't like to do that.

Yeah.

These are to take a walk than to pump iron.

That is activity. That is not working out. There's a certain amount of stress and being regimented. You're working with a trainer, having a well-designed program to really begin to work the muscle. And as we age, we get something called anabolic resistance. And that means the muscle has a difficult time utilizing protein. There are all these things working.

So that you could eat a steak, but it doesn't actually turn into muscle.

Well, you can eat a steak, but the amount that you would have to eat as someone who is above 40 versus 20 is different. Because when you're young, you have, like you said, growth hormone, testosterone, all these hormones running through your blood. As we age, really typically beginning around 40, is those levels begin to decline. those levels all affect muscle. As those hormonal levels and growth hormone levels decline, we are, we get this kind of resistance, this, it's not an inability, but it requires more protein, more amino acids to begin to stimulate that tissue. So aging well is very targeted.

-Uhh so what let's just back up a little bit for people. What is protein anyway? Like we know fat, we know carbohydrates.

Protein is the black sheep of the macronutrient family.

Yeah, that is a neglected area, right?

Everybody's talking about carbs and fat. Who's talking about protein? Protein. We've been talking about it for years. It is absolutely the black sheep. It is very emotional for people because.

It has a face.

Nobody argues that sugar, excess sugar, excess carbohydrates are bad. We thought that fat was bad and now we kind of have a new understanding and people are still kind of weighing in on protein. It is very much the black sheep. If you ask me what it is, it is essential for the building blocks of everything. Skin, neurotransmitters, hormones. It is ultimately what life is made of. It is the baseline fundamentals. And not only that, it can- and.

By the way, all your genes do, you have 20,000 genes, all they do is make protein. And they make protein out of the building blocks of protein that you eat.

Correct. And dietary protein is key to getting all of those amino acids. And anyone, you can open up a textbook and look at all the amino acids, they all have different things. I will point out that if you look at the label of any nutritional supplement, it will have a breakdown of carbohydrates, how much fiber, how much sugar, fat. It will have a breakdown of saturated fat, all the other fats, and then you get to protein. And it just has one little line, protein. But not all protein is created equal. You have animal protein and you have plant protein, all of which have are made up of different amounts of amino acids, which affect your body differently.

Okay, well you just brought this up, so we're gonna go there. I was gonna get into a little bit later, but the issue is what kind of protein and how much protein. Because one, there is an argument that we are eating too much meat in the world, that it's causing climate change, that it's destroying natural habitats, destroying soils, depleting our water supplies.

We should talk about that.

Yeah, we're gonna talk about that.

Okay, good.

And that we should all be eating more plant protein and more rice and beans.

We tried that. And you know what that was called? The Food Guide Pyramid.

Yeah.

Well, we eat a lot of carbohydrates, but I don't know if we were.

Eating rice and beans.

We weren't eating rice and beans. We were eating bread and potatoes and chips and, I mean, sugar and- okay.

But even if you swap it out, and the carbohydrate load is in excess, right? So when we look at what we really need, we probably need between 70 and 80 grams of carbohydrates, and the body can make all of that from protein.

Yeah, right.

So let's just get back to this. So we do need protein. And also the studies were interesting. Even the studies that show that maybe excess protein when you're younger makes you sick, it turns out even those studies show that when you're older you actually need more protein.

You do.

And I just was reading about athletes eating maybe between 1.6 to 2.4 grams of protein, which is a lot of protein per kilo. And so we're getting all these mixed messages. One, we should be eating less meat, eating more plant proteins, and/or two, we should be eating more protein as we age. So we're in this sort of incredible, conflicted, confusing environment around protein. So what should we be eating?

How much should we be eating?

And what type should we be eating?

Okay, this is a of no-tall order that we need to discuss.

This is a big, this is what.

People want to know.

Let's take one step back. The information overload comes from kind of the mouse with the microphone. So you have small groups of individuals that are making a lot of noise.

You mean the computer mouse?

You have extreme groups. So you have anti-animal groups, you have PETA, you have vegan groups, vegetarian groups that are just in one aspect making a lot of claims, putting a lot of money. I think PETA spent $15 million on advertising. then you have big cereal companies, Kellogg's, I think that was around a billion dollars in advertising. So you have these groups that are regulated by the FTC. And then on the other side, you have the egg council and the cattlemen and the farmers, or who are under the guise of the USDA. So you have these two kind of regulating bodies and two opposing groups, one which has much more money than say, the dairy council or the egg council, that in and of itself skews the conversation. And that is something really important to be aware of.

We're getting a lot of propaganda, but not a lot of science, is what you're saying.

We are, you know, we have big pharma. We have these groups that are allowed to say certain things that maybe this will lower cholesterol, eat oats, it will lower cholesterol. It will have these certain health benefits. And then you've got egg, dairy, beef, who are not allowed to make any similar claims. We do have a lot of propaganda and bad science that is very agenda driven. And that creates an environment of confusion. Yeah, like the Lancet Commission, which was.

Like, we should eat like three ounces of meat a week maybe.

So we know, so let's talk about the RDA. So the current RDA, which is the recommended dietary allowance. And that was based on studies that we know were flawed, right? Those were based on nitrogen-based studies of 18 year olds that we wanted to, or the, they wanted to provide an amount which would stop disease per, you know, it's baseline for disease.

It's not the minimum amount you need so you don't get sick. It's not how much you need to be healthy.

Correct. So we came up, or they came up with a number, not me, way before my time, unless my Botox is that good, but not having any lately. The RDA is 0.8 grams per kilogram, and that spans from anyone ages 18 and beyond. 18, 50, 60, 80. Okay? That is the minimum amount. There are, there is 30 years of data to support that the minimum amount is not adequate. We know that as you age, you need double the RDA. For body composition, you're looking at double the RDA.

You mean for building more muscle?

For anything in obesity, we know that the higher your diet is in protein, while calories are controlled, the more lean muscle mass you can maintain. And we spoke, when we started talking about this, we talked about why muscle was so important. And this obesity epidemic isn't quite an obesity epidemic. It is really an epidemic of poor muscle mass, low muscle mass, obesogenic sarcopenia, loss and destruction of tissue. We are largely domesticated. So what's happened is we have- Dr. Wait, what do you mean we're largely domesticated? riding cars, we're not doing physical movement. We are eating in a way that is not supporting our current existence. And actually red meat consumption has gone down by 29% since 1975.

But chicken's gone up.

Chicken has gone up. Dairy has gone down.

Yeah.

The concept that we are eating too much protein, the average American American eats between 60 and 90 grams. Women are around maybe a little bit above 60 grams, and men are around 90 grams. So that's the average American. Heart disease, Alzheimer's, obesity, hypertension, all of these comorbidities and diseases are on the rise. Protein is not the problem. Protein's never been the problem. Protein is the defining nutrient for a high quality diet. As you get older, the importance of.

Lean tissue becomes more and more critical. Muscle is the forgotten organ. It's the forgotten... And people think, well, if I'm jogging in my 50s and 60s and 70s or riding a bike, that that's accomplishing what I need to accomplish and it's not. It's actually, it's much more important to spend some time in the gym lifting heavy weights, like the heaviest weights you can lift with without getting hurt. Yeah. Without getting hurt is a key component.

I don't want to.

So my trainer tells me I should do, like, more reps. Like, I do three sets.

Yeah.

And I do, you know, it's pretty hard.

But it's not like my maximum that I can do.

Sometimes it is, but is that, is.

That the same or is it more better to do heavy weights?

How many reps do you do?

Are we talking six or three? 10 to 12.

And then you do three times. That's fine. That's a standard. That's, that's, that's. That hasn't changed in decades. That's still, and there's no right answer there. There's no magic.

It's like whatever you feel good with.

Is that building enough muscle? Should I do more heavier weights? Sure. Heavier weights and fewer reps builds more strength over time. But there's no, I can't tell you that that's where you need to go. But I'll give you an example. It's sometimes the type of weight you're doing. So if you're just doing bicep curls, you know, you know, for the, for the beach, but that doesn't really impact bone density, you know, muscle mass throughout. So hex bar deadlifts. You ever do those?

Yeah.

Yeah. That's the best thing you can do.

What about just a regular deadlift?

Yeah, they're good, but they're, I'm too.

Concerned with my back.

So I lift heavy with a hex bar deadlift. Oh, really?

Yeah.

So, but I do it once every week and I do three sets of that.

I keep adding weights and time.

How much do you do? I do up to 300 pounds on a, on a, I do one, you know, to two rep Max on a, on 300.

Oh, one to two.

Yeah.

I can do 335 on one, but it's too much. I, I wind up taking too long to do it. I'm afraid. Again, I don't want to hurt myself.

Yeah.

So I do. But that's like, that one exercise impacts the entire body.

Yeah.

You know, it's, it's not just what you would see, obviously, from, from doing the, the of the glutes and the lower back and the hamstrings and the quads, but it's pulling on the shoulder muscles like my grip strength is sometimes the thing that gives out more than anything else. But that one exercise then has an effect on the pulse of growth hormone and testosterone through it involves so many muscles, including major muscles, that then when you go do the pull-ups and the push-ups and the dips and the squats and all the other lunges, then you get the impact is greater. The effect, the muscle building effect is greater because you did that.

Yeah, I like that.

I like that.

So you do that first or last or whatever.

If you do it first, a lot of times you'll like, you know, you won't have the strength to complete the other stuff.

So what is the biology of doing it?

You mentioned you you can burn fat.

But why is that better?

Like what does it do in terms of longevity? What do the signs show?

Well.

As we, so burning sugar is in and of itself, it produces reactive oxygen species at a greater rate than putting combusting fat through the mitochondria. So the more energy you can derive through this metabolic pathway that uses the mitochondria, the better off you are. A lot of times people burn sugar in the cytosol of the cell, not.

Even in the mitochondria. The way I think about it is interesting.

So when you eat a lot of.

Sugar calories and starchy calories, it burns.

Dirty in your mitochondria and it releases a lot of waste products, which is these reactive oxygen species or oxidative stress or free radicals are driving aging.

And when you burn ketones, it's more like hybrid, like an electric like an electrolyte burn.

It burns clean, right?

Like a 93 octane.

Yeah, it burns much cleaner.

Yeah.

Is that true?

That's true. I mean that's the simplest way of looking at it. Then there are other nuances to this which are when you become good at burning fat, then when you skip a meal or when you have this very easy to manage compressed eating window, all the good stuff happens when you're not eating.

Yeah.

So when you're the longer you can go, and that's why fasting has become the rage. The longer you can go without eating, the more your body says, oh, this is a great time to do some house cleaning. And, you know, the term autophagy is thrown out probably too much now, but the body does tend to want to clean up and consume damaged proteins. Autophagy means like you're literally eating yourself.

So, eating all the waste products.

Eating the waste products.

Pacman goes around and cleans up the and if you never fast, you just become this increased collection of garbage in your body.

The whole three meals, three snacks, eat late at night, night after dinner snack.

And wake up eating right away, that's a bad idea.

It's a bad idea. And what's ironic to me is that even going back 15 years ago in the bodybuilding and the weight lifting in the general health community, the mantra was don't go more than two hours without eating. bring your Tupperware little meals with you with some amount of protein, some amount of carbs, no fat, skinless chicken breast, and all that stuff. It was a horrible concept. And yet, the thought process was, you don't want to cannibalize your muscle tissue. And if you go more than three hours without eating, you'll cannibalize your muscle tissue. Now, all of that was predicated on an assumption that glucose was the primary fuel that we needed. when we ran out of glucose, it would cause the brain to go into a state of, oh my god, send a signal to the adrenals to secrete cortisol so we can basically melt some muscle tissue and send some amino acids to the liver to become glucose. It was a horrible, again, it was all based on a concept that somehow assumed that glucose was the muscle fuel that we needed. and if we didn't manage glucose, all hell broke loose. Now we know that fat is the preferred fuel for human movement and human activity, and that ketones are not just a legitimate alternative energy source, they're probably a preferred energy source in many cases.

Now as a doctor, I see a.

Lot of patients and I test them.

And I see the results.

And it's humbling because you can come.

Up with all these great theories, but then you see the individual in front one of you. And I've had patients I put on.

A ketogenic diet eating butter and coconut oil all day and they lose 20.

30 pounds, their cholesterol comes down 100 points, their triglycerides drop, their good cholesterol.

Goes up, somebody else does that and all their numbers go terrible and they start getting really bad cholesterol numbers.

And I'm one of those guys.

If I eat too much of saturated.

Fat, I get in trouble. And I think, how do you understand.

Sort of how to personalize this.

All right, so a couple things. First of all, we've never had this conversation, so I don't know what your stance is currently on this, but I've been pushing for 15 years to take the weight off cholesterol as a bad guy. Cholesterol is not the problem.

In the blood or in the diet?

Both. But let's just talk blood cholesterol right now. I don't think cholesterol is a bad guy. Cholesterol is one of the most important molecules in the human body. It's integral to life. The body makes 1300 milligrams a day, whether or not you have any in your diet. And to vilify it and spend a trillion dollars for the last 15 years to try and eradicate it in humans is absolutely unconscionable. Through statin medications. And I shared with you before the show. So I just had some blood work done. between 245 and 290 on my total cholesterol. But my HDL is 98.

That's the good cholesterol.

That's the good cholesterol. You know, and my triglycerides are always below 75, sometimes 45 or 50. My A1C is 4.9, which you know to be.

That's your average blood sugar.

It's really low.

Really low. Fasting insulin is, you know, between six and seven. It can be as high as 45 in some people. So, all markers are great except that if you didn't ascribe to that whole cholesterol theory, you'd go, oh my god Mark, we got to put you on... Everything looks great. By the way, I had a full scan of my carotids and all my blood supply to my coronary arteries, my liver. I mean, they were digging in so deep I thought, oh my god, they're looking to see if I have colon cancer. But they were trying to get it my kidney supply. And they said, you know, you're clean. You got like that blood supply of a 30-year-old, it's clean as can be. That's all that counts, Mark. I don't care what my cholesterol numbers are.

But aren't some people more at risk though?

Some are.

But again, these lean mass hyper-responder phenomena?

Yes, and it all, I think, comes down to, and I'm not a doctor, so I'm only giving you my opinion. You can opine with greater.

I guess.

You have more liability for saying it than I do. I have no liability as long as I say I'm not a doctor. But it's inflammation and oxidation that are the primary culprits here. And so if you have an otherwise inflammatory lifestyle, inflammatory diet, we can talk about sugar, we can talk about stress, we can talk about, you know, and then we can talk about some familial predisposition. Yes, but in general, in general, so back to your two people, some succeed wildly on the ketogenic diet and some not so much. But the not so much, if you're evaluating just on short-term blood markers, I'm not gonna say it's not working. I'm just gonna say that's, you know, if you're keto and you're good at burning fat, you got to transport the fat somehow to the muscle cells. You've got, you know, there are a lot of things going on here. Yeah, we just and we just don't know. Now, some people having said all of that, some women in particular are not good responders to keto.

It may be-- who shouldn't be on it?

Well, so I think pregnant women probably, you know, you just work with, if you want to do this and you insist on doing this, work with somebody who knows what they're doing, right? And I wouldn't, you know, I wouldn't introduce a three-year-old kid to a ketogenic diet, you know?

I think it's something everybody should be on, or...

I think at some point in their lives everybody should be on it because it's the human experience.

So you think cyclical keto, this whole idea.

Yeah.

So do you ever go above the.

50 grams of carbs?

Oh my God, I have... Last night I'm visiting here in Los Angeles. My daughter is a great chef and she made a lasagna last night. Like, I'm not gonna not eat two servings of that. you know, and it was somebody's birthday and we had some pie and, you know, I didn't sleep as well as I would have had I not done that. But I also, like, I'm totally comfortable in, in, in and out.

In and out.

And that's, that's what we historically did.

That's exactly. So when we talk about, you know, we're humans, you know, always keto. No, we were, there were periods of time when we were, there was no access to food. You were, like, automatically, you were obligate ketone when you didn't eat. But because you didn't eat processed crap and industrial seed oils that would infect your insulin sensitivity and all these other things, even if you came across a treasure trove of bee honey or it was late in the season and you had a bunch of fruit, you'd store it as fat, but then you'd go right back to being keto when the food supply was cut off. And you didn't go, as some of these people do, well, you know, whenever I have more than 60 grams or 70 grams of carbs, I get kicked out of keto. Kicked out of keto means nothing to me.

Like, I don't even care what your keto numbers are.

So you don't think about measuring it or tracking it? I think it's a parlor trick. So what will happen is people who are new to keto will go, they'll chase the numbers, right? So they'll say, well, I didn't eat any carbs today, and I just had MCT oil, and I had my bulletproof coffee. bulletproof coffee and whatever, and I'm showing 4.5 millimolar or 6 millimolar. Yeah, yeah, yeah, baby. I'm keto. Well, you're keto, you're producing ketones, but one of the things you got to look for is you're just pissing those out. So your body has not become good at using them yet. You'll get there, but right now your liver is going crazy trying to make ketones and you don't know how to burn them. So once you build the metabolic machinery.

To burn ketones, and once build the facility. It doesn't go away when you have a pie and lasagna.

No, exactly, exactly. So let's talk about that. Once you built that, you spent three weeks, four weeks building that metabolic machinery, you've reset your metabolism to one of metabolic flexibility and metabolic efficiency. Then if you go off the wagon one meal or eat one day of 300 grams of carbs, you might feel bad, but you just come right back to to where you were. It doesn't shift all the way back to being a sugar burner. Now, if you did it for three more weeks of just doing sugar, the body would say, well, I guess we don't need this expensive machinery lying around burning fat all the time now. I guess we're gonna just go back to burning sugar, so we'll let all of these things atrophy.

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