How to Build and Maintain Muscle for Metabolic Health and Longevity

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

Where you really get benefit from muscle is it becomes incredibly active as you train it. And that's where the real magic of muscle comes from. We can improve fasting insulin levels. We can improve fasting blood glucose levels.

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Week'S episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. Skeletal muscle is important for so many reasons. Yes, it is what allows us to carry heavy objects and move about our lives feeling strong, but it's also widely overlooked as a vital part of our metabolic health. From how well we control glucose and insulin, to how well we age, to how much energy we have, skeletal muscle regulates many processes. In today's episode, we feature four conversations from the Doctor's Pharmacy about prioritizing our muscle composition through strength training. Dr. Hyman speaks with Dr. Gabrielle Lyon about why building and maintaining muscle is a non-negotiable. He then talks about the effects of strength and assistant training on muscle. Next with Dr. Sarah Gottfried about why strength training is so important as we age. And finally with Dr. Todd LePine about protecting our bones from osteoporosis.

Let's dive in. Pretend I'm a first year medical student and I don't really know much. And you're up in front of the class as the professor of muscle. By the way, we don't, we don't, we know we do take a class on the musculoskeletal system, but it's really about bones and muscles and movement. It's not about anything else. So So what would you be explaining to the medical students about what muscle does, what its myriad functions are, and why it's so critical to our health and why we need to pay attention to it, and then take us through how we would diagnose what's going on and how we would start to think about treating it. So sort of take us through like a little curriculum.

I would love to.

And get, you know, kind of school us on this. Cause I think, you know, from a high level, people have no clue. And I think most doctors have no clue. It's really quite amazing how little we understand about the role of muscle in our health.

Yeah.

And by the way, it's not just about looking strong and feeling good. Yeah. That's like a side effect. It's actually what the metabolic functions of the muscle are.

Correct. When if I were to teach a medical school or medical class, what I would tell them is when we think about skeletal muscle exactly right, it's really important for exercise performance. That's all the obvious. But where muscle really excels is its metabolic, it is our metabolic currency. And I will say this, it is the only currency that cannot be bought or sold. It has to be earned. Skeletal muscle is an organ system of metabolic currency that must be earned, which makes it very unique. So you have direct input into the health and function of skeletal muscle. Yeah, it means like your kidneys, you.

Know, hey, kidneys, I need to work out my kidneys. They just do their thing, right? But your muscle, you need to actually.

Do something with it. and you have the capacity to do that. The metabolic function of skeletal muscle, number one, it is the primary site for glucose disposal. For the viewer, the listener, that is the carbohydrates that you eat, the primary site for disposal is not liver, it's actually skeletal muscle. The more healthy your skeletal muscle, the more muscle mass you have, the more site for glucose disposal. Why that becomes important is because as we think about diseases that plague us now, We see elevated levels of blood sugar. We see elevated levels of insulin resistance. These are things that we can directly look at in the blood. Skeletal muscle can have challenges with these things with insulin resistance decades before. This can happen decades before. So carbohydrate disposal is number one. Number two, it is a site for fatty acid oxidation. Fat, everyone is worried about triglycerides. Well, muscle is a site for oxidation of fat, which is also burning the fat. Right.

Right.

Means burning fat, beta oxidation, mitochondria, skeletal muscle is the largest site for all these mitochondrias. You know, we have a ton of mitochondria and skeletal muscle, which is amazing because, again, skeletal muscle are things that.

We can have input into. The mitochondria is that basically the thing that actually creates energy in our body and it goes down as we get older and it's why you see 90-year-old barely able to move and a two-year-old running around like crazy is the number and function of their mitochondria. And muscle is where you have the most mitochondria and where you can have.

The most impact on your mitochondria by certain types of activity, exercise, and diet. That's absolutely correct. The other two really important, well, there's more very important aspects of skeletal muscle. Skeletal muscle serves as an amino acid reservoir. If you are to get injured, if you are in a highly catabolic state, highly catabolic state means Do you have an infection? Did you get an illness? Do you have cancer? Are there things that are ramping up your metabolism so much so that it's requiring your amino acids? It's requiring extra building blocks. Skeletal muscle is your amino acid reservoir. It improves your survivability in nearly all kinds of illness. The higher your skeletal muscle mass, the greater your survivability. against nearly any illness, which is pretty incredible. Because muscle is protein, right?

Muscle is protein. When you eat a steak, that's muscle, right? That's protein. And that is full of amino acids. And so what you're saying is when our health is compromised or we're starving or can't find food, like our bodies will use up that. And by the way, people, there is no requirement for carbohydrate. For fats, you have a very minimal requirement of essential fatty acids in a gram dose, right? For protein, it's the only macronutrient you need in big, big big doses to survive because all your DNA does is make proteins from amino acids. And so that is a critical function of your body that regulates everything that's going on in your system. It's the main communication system. It's how we produce our immune cells and immune function. And so it's just, it's just so critical. And that's why this, this Reservoir is important.

So what you're saying is if you don't have this and something bad happens to you, you're screwed. Absolutely. And the protein turnover. So as we age our body, well, just on a very Baseline level, the body goes through protein turnover. Your liver is turning over, your intestines are turning over, your muscle is turning over. All these organelles and all these systems in the body require rebuild and repair. You're going through this constant state of protein turnover. The body turns over anywhere between 250 upwards to more than 300 grams of protein a day, which is really fascinating. If you do not have the capacity, if you know, we're clearly not eating that. the other component to that, it will come from muscle. And this is why dietary protein is so important, which I know that we're going to get to, is because we do have to be able to replenish and be able to replace these amino acids to be able to support protein turnover as we age, as we go through life, and our body becomes less efficient at doing this. That's another aspect of skeletal muscle, making sure that you have strong, healthy skeletal muscle as an amino acid reservoir. Another very interesting aspect of skeletal muscle is it functions as an endocrine organ and it secretes myokines. And myokines are peptides that travel throughout the body. And for the listener at home thinking about how the thyroid produces thyroid hormone, skeletal muscle, exercising skeletal muscle also produces something called myokines. Myokines travel throughout the body, they interface with bone, they crosstalk with liver and adipose tissue. They affect brain. So it's so powerful, they affect the immune system, it helps regulate inflammation. There are very specific things that muscle does. And what's so fascinating about skeletal muscle. So we talk about glucose disposal, we talk about fatty acid oxidation, number two. Number three, we talk about skeletal muscle as an amino acid reservoir. We also talk about it as a endocrine organ secreting myokines. So those are really- and mitochondria.

And mitochondria.

And mitochondria. So four metabolic functions, yeah. And mitochondria. It is your place for mitochondria. And we could literally go on and on about skeletal muscle. And that's what makes it so critical as it relates to how it functions as an endocrine system and as an organ system in and of itself.

Yeah, it's incredible. So as we age, this is an inexorable loss of muscle and so we do something about it. Like when we're younger, we have a lot of hormonal support, natural young hormones that are helping us keep our muscle. But as we age, if we don't do something about it, starting in the age 30s, we start to lose muscle. And then, you know, when you get older, you know, you end up in a situation where you're kind of going to fluie. You get high blood pressure, high cholesterol, high blood sugar, you get inflammation, you have high cortisol levels, low growth hormone, which is needed for repair and healing. And all that is, is caused by the low muscle mass. So we're kind of treating the wrong thing. You know, you, when you to go to your doctor for diabetes, you know, they don't talk to you about muscle. They say, here, take these diabetes drugs to help your blood sugar control. But it, it, they all pale in comparison to exercise diet and particularly, you know, types of exercise that actually help you build muscle. And it, in, in muscle is, is really critical to burning calories, to actually increasing your metabolism. People say, I have a slow metabolism.

But they're really saying is, I don't have enough muscle. Well, and when I think about slow metabolism, what I think about is it's not so much that the muscle is so metabolically active at rest, where you really get benefit from muscle is it becomes incredibly active as you train it. And that's where the real magic of muscle comes from. Not only that, when you train skeletal muscle, you can improve these biomarkers that we think about that, as you mentioned, go up with aging. We can improve fasting insulin levels, we can improve fasting blood glucose levels, we can improve triglycerides. we can improve HDL. And in fact, not only can you improve these things with one bout of exercise, obviously it takes sustained exercise to have these long-term effects, but with good training... Dr.

I mean, I can't just do one bicep curl and that's it?

No. Dr. But with training, skeletal muscle then becomes sensitized and we can see sensitization two days later. meaning it's more sensitized to the glucose that you're eating. One of the biggest problems that we see that really creates this wave of negative impact is insulin resistance. And skeletal muscle, insulin resistance, skeletal muscle makes up more than 40% of the body. I don't know, you're pretty buff, probably makes up more than 50% for you, but for most people, right, it's 40% of the body. This is a huge site. of insulin resistance.

Yeah.

And one of the problems is when, by the way, there's no such thing as a healthy sedentary person. There is no such thing as a healthy sedentary person. We talked about how sarcopenia can begin in your 30s, but issues with insulin resistance and insulin resistance is probably the first and then dysregulation of glucose can begin at 18 years old. If you are sedentary, your skeletal muscle can become insulin resistant. And, you know, we see this out of, this was originally out of Kit Peterson's lab. She was testing on Yale students, but the initial work showed insulin resistance in 18 year olds that were lean and healthy but sedentary.

Wow.

It's crazy. And I think, you know, well, I think you can also see this in even younger kids, right? In 2, 3, 4, 5 year olds who have type 2 diabetes. It's already happening, I think. I think you know, as a, as a physician, I'm sort of very curious why you think it is that, you know, our, our whole medical system has completely ignored this, you know, and, and why we're, we're, our traditional approach is so different than what you call your muscle Centric medicine. So can you talk about, like, muscle Centric medicine, how it differs from this traditional approach to health and aging and why, why it's such an important reframing of the process of health and aging?

Let me, can I share with you how this happened, where muscle centric medicine actually came from? I think that you as a physician would appreciate this. I was in my fellowship and I was doing obesity medicine research and I was also seeing geriatric patients. So it was a combined fellowship in obesity medicine and geriatrics. And I remember, you know, you know me personally, you know, I'm a very warm, loving person for the most part, and I really care about Dr. Those around me. And I started to see these patterns over time from the dementia wards to the obesity clinic. And the blood markers early on were very similar. And I realized I had this, this moment of insight where I looked at this person's brain, one of these, research participants brain, and her brain in her mid 50s looked like an Alzheimer's brain.

Wow.

And I realized that the one thing that they had in common wasn't that it was obesity. It was that they all had low muscle mass, low or unhealthy skeletal muscle. It wasn't an obesity problem. And at that moment when I went and I asked some people about it and I realized that while we traditionally give this advice to move more, eat less, that that wasn't solving this problem of skeletal muscle, that there wasn't a discussion on dietary protein, there wasn't a discussion on How do we maintain strength with aging? How do we early on look at the importance of skeletal muscle? There wasn't even a way that we were measuring it. In the obesity clinic, we weren't measuring muscle strength. In the geriatric clinic, we were, but we also weren't looking at skeletal muscle. You could look at a DEXA, but again, that's extrapolation for what the actual muscle tissue is. And at that moment, I realized that we were looking at the wrong thing. And that's what my book, Forever Strong, is all about is how do we shift the paradigm just because something has been done one way and we've been doing it for decades, that way isn't effective. We are only getting more obese. We are only getting sicker, yet we continue to talk about obesity. It's because we're not looking at the right tissue. This is a muscle problem.

So we're barking up the wrong tree, basically, right?

You're laughing because you've heard me talk about this for like, 10 years.

Honestly, I would say that I always knew about sarcopenia. I always talked about it at some level, but I never really understood it until I started listening and talking to you and learning from you about protein and muscle and exercise. And honestly, I was kind of lazy. I didn't think that I did yoga, I rode my bike, I played tennis, I exercise all the time. I thought, oh, that's good enough. And the reality is that I didn't really start even lifting weights until late in my 50s, 80s, 90s year. and I've been doing it for the last three and a half years and it's totally changed my body, my health, my mental look and my function. I mean, I actually noticed so many changes and I was sort of resistant to it, like resistant to resistance. It hurts. I was like, I would do 10 push-ups and it would hurt. But now, you know, I can do 75 push-ups and it's like, you know, I actually, I'm so inspired by this guy on Instagram, Gabriel, I don't know if you've seen him. He's this French guy. I can't really understand what the post is about, but he basically posts himself working out without his shirt. he's 78, he's ripped, like completely ripped. He can do like 30 or I don't know, pull-ups he's doing all these crazy acrobatic things. He looks like a 20 year old gymnast. And I'm like, holy cow, it's possible to do this and to get there at any age.

It's not that it's only possible, it's essential. And everybody can do it and it's never too late. And this is a movement that has to happen. It's something that we can do together. If we can all realize that we need to stop chasing body fat and really focus on skeletal muscle because it's this the thing that we can do, it's much more empowering. And, you know, you had mentioned something else that was really important, that when we are young, we are driven by hormones. So it's much easier to maintain and build skeletal muscle. You could be on the Twinkie diet, not saying you should, but you probably will look at a weight and put on muscle. We've all seen those kids in high school. The reality is, is as we become less active, as we decrease that flux, that energy output from the muscle. We're not moving muscle glycogen, which is the storage form of glucose. The muscle becomes less and less healthy. And over time, it also becomes weaker. It becomes less efficient and effective at sensing dietary protein, which makes protein more important as we age. The aging implications of skeletal muscle are very clear. very consistent and something that we actually can do something about. And that's what's so important. You can always get stronger. This ICD-10 diagnosis of sarcopenia is a diagnosis that we can reverse and manage. It's incredible.

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And now let's get back to this week's episode of the Doctor's Pharmacy. When you lose muscle, what happens? You get more insulin resistant, so more pre-diabetic, you slow your metabolism, you have higher stress hormone, cortisol, you have lower growth hormone, which is the hormone to repair, rebuild and renew your tissues. you have lower testosterone, so you actually end up in a vicious cycle of losing more muscle and having it replaced with fat. You have increased inflammation. And so you have all these horrible things that happen that are related to aging that increase diseases in general, but when you lose muscle, you also get weaker and more frail and disabled and immobile and you lose your independence and you end up more in the hospital or nursing home. it's because of this muscle loss, sarcopenia. So we've got to fight this entropy related, age related loss of muscle function and of muscle mass. And we have to do it with resistance training. Now there's a lot of ways to do that, weights and bands and body weight and there's a lot of ways to do it. But we have to do it in combination with eating the right amount of protein. Now if we don't build more muscle, we're going to waste away guaranteed. It's basically use it or lose it. Now, I personally thought, okay, I'm running, I'm playing tennis, I'm biking, I do yoga. That's kind of strange training. I'm like, I don't really like the gym. It's smelly, it's stinky. A lot of big guys with big muscles that kind of intimidate me. I just, I better not do that. I'm a skinny guy. So I basically never went in the gym. And then, occasionally I was like, I'm going to try to lift weights or do push ups, and then I would do it and I would hurt like heck for five days or six days. I'm like, I'm not doing this. so it was really bad. But then I, I decided about 60 years old that I better get on it. And, and now at 63, I, I'm habituated to strength training. It doesn't take me much time. I've dramatically increased my muscle mass, my agility, my strength, my stability, my core. I mean, it's pretty amazing. And I feel way more fit and, and strong than I did when I was 40 or, or younger. So basically, how does this work? Well, the idea of hormesis is that when you stress yourself, the body has to respond by activating some kind of healing response to deal with the stress, which is a good thing. And it's kind of a miracle how this is on. We have this innate healing mechanisms that are designed to respond to difficult situations. We've had to deal with way more stressors from an evolutionary point of view than we ever had Comforts, right? We have way more genes that adapt us to starvation than to an abundance of food, right? So it's just how we're designed, and you have to activate those healing systems, and they're degraded by our diet, by our environment, by our lack of exercise. But the science is really discovering how do we activate these Pathways? How do we, how do we do that? And, and one of the, the key ideas around health, around longevity, whether it's hot and cold therapy, whether it's hypoxia therapy, whether it's hyperbaric oxygen, whether it's fasting or time-restricted eating. And of course, exercise is these are stresses. And the idea that what doesn't kill you makes you stronger is such a central idea for longevity when your system's stressed a little, not too much. Obviously, you don't want to go lift 300 pounds and throw out your back, right? You don't want to go in 30-degree water for two hours. You're going to die of hypothermia. So you have to have the right dose and the right amount and do it properly so you don't hurt yourself. But, you have to understand how to use exercise to activate these hormesis pathways. There's two real important ways. One is HIIT training, which is intensive cardiovascular fitness, and that works by increasing the VO2 max and your mitochondrial efficiency and your ability to burn calories. It's really important. But, strength training is also really important. If I would probably pick between the two, I'd probably hate to say it, but I probably pick strength training, especially as you get older. It's one of the most powerful things you can do. And you don't want to choose, but if you have to choose, and I do actually a HIIT strength training routine, which I get both cardio and exercise kind of strength, I kind of cheat, but it's okay. So we know really deeply how this works. What does strength training do? How does it improve all the hallmarks of aging? How does it look at the root causes of disease and aging? I talked about this. book Young Forever. If you haven't gotten a copy yet, please get a copy. It's the number one New York Times bestseller. Thanks all of you. Thank you so much. And here's how it works. Exercise improves your mitochondria, which are important to produce energy in your body. And as we age, we lose mitochondria in terms of both their number and their function. So they become less efficient and we get fewer of them. So when we do strength training, we build up more muscle and we get more mitochondria and we make them work better. which is really, really important. It also improves your blood pressure, cholesterol, lowers risk of heart disease, strength training improves your mood, your motivation, your cognitive function increases something called BDNF, which increases like miracle growth for your brain. It helps prevent dementia by doing that as well and increases neuroplasticity, makes new brain cells. It's pretty impressive actually. Obviously improves your muscle strength, your bone health so it can steam up osteoporosis. and prevent you from being frail as you get older. It helps with sleep, helps with libido and sexual function because it helps testosterone boosting in men and women. There's a lot of benefits to strength training. So what should you do to incorporate strength training into your routine, into your exercise routine? Well, just first understand that preserving muscle, building muscle, optimizing muscle function are the keys to the fountain of youth. So try something, anything, please, weight lifting, resistance bands, body weight, those are the three main ones. And, there's a lot of things like TRX and this is often using body weight. But, I love it and I find my body works better, it feels better. And, I don't really like going to the gym that much, sometimes I go, but I basically do a home strength training program. I use Tom Brady's system called TB12 Sports. You buy the bands online. you can get the app for 50 bucks. I don't have any relationship with them. I'm not selling it for them, but basically it's changed my life. So that's why I love it. And it's portable. I travel with it everywhere. I can use it any place, a hotel room, any place. There's a floor and a doorknob, basically. And it's incredible. And I find I can do my routine in half an hour. I'm in and out, and I. I love it, and I feel so good afterwards. The bands tend to cause less injuries. Then you get older, you might be more prone to injury. You can start with lighter bands and work up to heavier bands, but if you haven't done any. training. And I started off working with somebody to make sure my form was right, that I was doing it right, that I had my body position right, because you can hurt yourself. So you want to make sure you do it properly. Never too late to start. My dad was like 89. He was, couldn't get up out of a chair. He was sort of frail. And I'm like, Hey, Dad, you know, I know you walk every day, but you need to do strength training. And I got him a trainer, and he got so much fitter. We were end up playing tennis at 89 years old. Pretty impressive. So what puts people in nursing home is not a disease usually, it's their lack of ability to do their daily activities. And that's what you don't want, right? You want to have high functioning. What is the biggest risk factor for death as you get older? One of the things is falling. If you fall and break your hip, it's like getting a terminal diagnosis of cancer, like pancreatic cancer. You're basically 50% likely to die in a year. It's really bad news. So you don't want to fall. If you have more muscle, you can brace yourself. You can resist your falls. so you probably won't fall. So basically try to do three times a week of strength training, 20 to 30 minutes and helps in every possible way in terms of your fat burning, muscle function, energy, longevity pathways. It's dope. So whatever you do for any of your health practices, aside from what you eat, this is one of the most important. And if I had to sort of pick two things to do for longevity would be cut out starch and sugar and and eat the right protein to get muscle building and strength training. Do strength training. And let's just talk about protein for a minute. You know, I wish it were true that you could get all the protein you need from beans and grains and plant foods to get the proper muscle building as you get older. It's just not possible. You need to eat enormous amounts of plant foods. You have to have six cups of brown rice to get 30 grams of protein. You have to have two cups of beans, you have 30 grams of protein. You just can't get enough. However, you can, if you have protein powders, so you can get plant protein powders, and if they have added to them the right amino acids, particularly leucine, which is a rate limiting amino acid for building muscle, and that's super important to get. If you have seen all these big bodybuilders who are vegans, that's how they do it. It's not from eating grains and beans. They have all these extra supplemental proteins in order to actually build muscle. So it's possible, but you have to know what you're doing. You just need the right physiological compounds to build muscle. And it's just science. There's no debate here about what the science is. You can go look in my book, Young Forever. I, I quoted all the studies, look at the data, the review of all the data by the top world's protein experts, and this is just how it works. So make sure you have protein about an hour or two after you do strength training. And I love whey protein. It's my favorite. I use goat whey, but that's a great, that's a great way to build your muscle. People think, I'm gonna work, you know.

Get my heart healthy, my brain healthy.

And get my joints healthy, but no one's like muscle. But muscle is actually the currency of health.

Muscle is the currency of health. You know, I think I was taught a model that was very disease centered, not health centered. And, you know, the work that you and I do, I think, is turning the ship so that we can be more health centered. And a big part of being health centered is to make sure that you preserve your muscle mass as you get older. So we know that maintaining your muscle mass, maybe even growing it as you get older, is one of the most essential markers of health span, that period of time that you feel fantastic and relatively free of disease. So one of the things that I found when I was on 100% plant-based diet was that I was losing muscle. And, you know, yes, I had a high-stress life. I think cortisol was part of the story. high cortisol can be associated with breakdown of muscle. But the other thing to think of with insulin and with blood glucose is that the math comes out to what are your inputs? So what are you eating? But also how are you disposing of that glucose? And that's where the muscles become so important.

Yeah, right.

I mean, it's interesting is a muscle is really where your metabolism is. So your mitochondria and as muscle goes down, insulin goes up, your blood sugar goes up, your blood pressure goes up, your cholesterol goes up, your, you know, sex hormones go down for, for, in terms of testosterone for men, growth hormone goes down, cortisol goes up. So you got this whole soup of hormonal change that is characteristic of rapid aging.

Yes. Yeah.

So I, I think it's, you know, I, I've come to really appreciate it more and I, and I always talked about exercise and strength training. but I was kind of lazy and I never did. Well, I like being outside.

I was just cool to put in the time, I have to say.

Well, even after, I mean, even after, I like yoga, I like tennis, I like biking, I do other stuff.

And I was pretty good cardio.

I might have them right. And yoga's good. But actually, it wasn't. And I actually started doing strength training about a year and a bit ago. And my body has completely changed. I'm going to be 62 shortly. And I just, It's amazing to see what happens when you start to actually use your muscles as they were intended to be used. Unfortunately, we have to do strength training now because we're not living lives where we're actually active and carrying shit and moving stuff around and actually using our bodies.

So we have to do it.

But it's just amazing. It's made me feel better, more energy, it's helped my metabolism, it's helped my whole way of moving through space and life and the ability to do stuff and have fun. So I don't find myself declining at all. I find the opposite is happening. and, you know, I'm planning on going skiing, helicopter skiing, which is obviously a big luxury, but I've been dreaming about it my whole life and I've always.

Terrified, what can I do it?

Am I strong enough?

And now I'm like, I can do anything, you know, which is pretty amazing. Well, that's such an inspiring message because the truth is it's never too late to change the way that you move. And what you've done with strength training, you know, what I imagine is that you probably have increased your muscle mass. your lean body mass. And that's associated with slowing down the biological clock. So it's so good for you. It's, you know, I think of it in the service of that means you can, like, dance with your great-grandchildren at their wedding. You know, that's one of the things I hope for myself.

There you go.

There you go.

And to do those things that you've always sort of thought about doing, like the helicopter skiing, I mean, how fantastic to live. your life in that way, not sort of signing up for the slow decline that we see in so many folks. We know after age 40 that most of us are gaining five pounds of fat and losing five pounds of muscle unless you're doing something active like strength training.

Osteoporosis, this is kind of a big deal. It's one of those invisible killers that that people kind of ignore. Heart disease, cancer, diabetes, dementia, we're all scared of that. But osteoporosis actually kills a lot of people.

Silent killer.

Yeah. So how common is this problem?

It's very common. It's common because it's underdiagnosed. And this is a condition where what I would say is that you want to preempt the condition. You want to diagnose the condition, which is, you know, you mentioned osteopenia. So osteopenia stands for it's Latin for bone poverty. So before you develop osteoporosis, which is a technical definition when you measure on a DEXA scan, you've got to have a T-score, you know, greater than negative 2.5. That's, there's, they have a standard.

There's just a definition of how we.

Measure it on an x-ray basis.

And it's a statistical in terms of your bones compared to the normal healthy population. And osteoporosis, when you have that, you're at much higher risk for fractures of the bone. So, you know, a lot of times older people, when they fall, they'll break a hip. If you break a hip, you're at a much higher chance of dying in that first year after a hip fracture because of complications related to the hip fracture. So, osteoporosis is a condition that you don't want to have. You want to preempt it. You want to, you want to, 'cause the horse is out of the barn.

By the time you say, I mean, it's really the thing that often is killing people because if you're old and frail, you fall, you break your hip, and you end up with a blood clot, and you get pneumonia. It's really a killer. And life expectancy a year after a hip fracture is dismal. It's worse than cancer. It's like 50% life expectancy. So it's no joke. And there's about 10 million older Americans that have osteoporosis, and about 43 that have osteopenia or low bone mass. That's like 53 million Americans who were headed for disaster. And it's one of those things that most doctors don't check. They don't really think about until the horse is out of the barn and you've already broken a hip or you've already got osteopenia or osteoporosis. And often it can start early. So why are we seeing this incredible rate of osteoporosis? Because we as a society drink so much milk and have so much calcium and we're told to take calcium. What is going on? Why are we seeing these incredible rates of osteoporosis?

You bring up a really good point, which is that most patients and most doctors think, oh, I just need more calcium for osteoporosis. I need to drink more milk for my osteoporosis. And I'll never forget it when I was in my primary care practice, I had a patient who was an older woman who had severe kyphosis. So she had the hunchback. And guess what she did for a living? she was a farmer and her family had a dairy farm. And guess what? She drank milk every day of her life. And she had the most severe case of osteoporosis I've ever seen.

It didn't work out so good for her.

Exactly, right. And I think as I mentioned earlier as we were talking is that for every 200 grams of milk that you drink, you have a 9% increased risk for osteoporosis.

Okay, so every glass of milk that you have, You increase your risk of osteoporosis by 9% of a fracture or osteoporosis? A fracture though. I mean, this is incredible. I encourage people to check out this brilliant article in the New England Journal of Medicine. You can just go online and Google, it's called Milk and Health by Dr. David Ludwig and Walter Willett. And it really is one of the most well-researched, profound analyses of all the data on milk and whether or not there's any data to support its health benefits. And I do believe it's nature's perfect food, but only if you're a calf. Because for humans and adults, it seems to cause a lot of issues, including osteoporosis. So it doesn't decrease fracturous. So, but that's not the cause of osteoporosis. What are the real causes in our society of osteoporosis? Why are we seeing these high rates? Because it seems like a design flaw. Why are we seeing such high rates of osteoporosis in this population?

Well, I mean, the risk factors for osteoporosis, obviously, as you get older, you will lose some bone mass. I mean, that's part of the aging process. And I always want to look at the risk factors.

So, women are more prone towards- Is.

It aging or is it what we.

Do while we're aging? Inflamaging.

Inflamaging. Is it what we do while we're aging that makes us age faster? Yeah, actually it's inflammation. Chronic inflammation is one of the big things that's tied in with osteoporosis. And there's a term called inflamaging. so as you age, your body can develop more inflammation. So chronic low-grade inflammation, patients who have colitis, patients have rheumatoid arthritis are at higher risk for osteoporosis. Patients have heart disease.

That's right. Yeah, absolutely. That's right.

Absolutely.

So, so there's, there's this phenomena where, where we're seeing high rates of osteoporosis. And as I, as I dug into it, and I, you know, one of the things we had to do at Canyon Ranch was we had to give lectures. three or four times a week. And one of the lectures I gave was on osteoporosis. I got really smart about it. And we also at Canyon Ranch, it's a lot of preventive screening. And we used to do a lot of DEXA scans. Now, DEXA scan is a special machine that is a low dose x-ray. It's like flying across from New York to LA, that amount of radiation you'd get when you fly in a plane, very low dose. And it looks at the bone density. So you can see on this very low dose x-ray whether or not you have thin bones or strong bones and where they're weak or where they're thin. and so we treat a lot of patients, but I gave these lectures and started looking, why are we seeing such high rates in this society? And we came up with so many different factors. Our diet, we know that sugar, alcohol, caffeine, salt, and even what is consumed in massive quantities, about 10% of our calories is soda, phosphoric acid in sodas and the colas is incredibly dissolving of your bones. stress makes your bones soft. And of course, lack of activity, we're all sedentary. We don't use our bodies. And you mentioned aging, but if you keep up your muscle mass and if you keep up your activity level, you can maintain your bone mass. We often talk of osteopenia or osteoporosis, but we don't talk of sarcopenia, which is the loss of muscle. And that's what goes along with bone loss. So you have all these factors. and we're literally peeing out calcium in our urine because in some countries like in Africa, they have like intakes of calcium of 200, 300 milligrams a day, but they don't really have osteoporosis. Here we have intakes of 1000 or 1500 milligrams a day and we see high rates of osteoporosis. What's the difference? It's not the total calcium, it's the calcium balance.

Exactly.

It's what you're peeing out. compared to what you're taking in. So in Africa, they're not doing all these bad things and they're not losing their bones and their urine. And we actually have tests where we can measure if you're peeing out your bones. Yeah, exactly. When you do that at the ultrawest bone resorption test. We measure markers of increased bone turnover because there's this constant dance between bone build up and bone breakdown. Exactly. And so we've got to kind of make sure we're constantly pushing the bone.

Build up and not so much the bone breakdown. Exactly. Yeah, the osteoclast, the analogy of it is like somebody building a wall and osteoclasts, which are the cells that break down bone. And then there's the osteoblasts, which the cells that build up bone. And normally our bodies are constantly doing it in a balanced way. So there's just as much bone breakdown turnover and then you rebuild the bone. When you have too much osteoclastic activity, which happens in chronic inflammatory conditions, then what you're doing is you're breaking down more bone than you're building up.

Up.

And the other important thing, which is also, it's not actually determined by DEXA scanning, is the quality of the bones.

Yeah.

So tell us about the quality of the bone because you can look at a scan and see it's good or.

Not good, but what if it's more fragile or brittle? Exactly. So you want flexible bones. You want bones that bend.

You want bones that are a little.

More rubbery, if you will. Yeah. Because, and I remember this very well because when I was in my training, one of the things that they used to give for patients with osteoporosis was fluoride. Do you remember using fluoride? And what they found is that, guess what? You did get denser bones with taking fluoride, but guess what? The bones were more brittle. So they broke. So you want actually healthy quality bones, not just the density, but the quality of the bones.

And what determines the quality?

The connective tissue that's in the center of the bones. It's not just the calcium, it's the connective cartilage tissue that's in the center of the bones. that makes it healthy. And that's also, this is a very simple thing to remember is one of the big things that increases a person's risk for osteoporosis is smoking. And I always tell my patients, you know, you ever see somebody who's a chronic smoker? What do they have? Wrinkles. Okay.

They have more wrinkles.

Right.

Smoking upregulates matrix metalloproteinase enzymes, which are breakdown collagen. And that's why patients who are smokers have higher risk for cardiovascular disease, higher risk for osteoporosis, because they're actually breaking.

Down their connective tissue.

Wow.

Yeah.

That's another reason to stop smoking. Exactly.

Right.

Right. Well, actually, one, it's all, it's funny because if you have a, a, a woman who's a smoker, they oftentimes, if one of the things I'll tell them is, well, you don't want to have.

Wrinkles and they'll stop smoking because, you know, you know, the vanity, I name is woman. That's right. That's right. Well, you know, you mentioned something I want to come back to, which is this whole idea of inflammation. and we've talked about all kinds of conditions on this podcast in the house call. And the truth is most chronic illnesses are related to inflammation, heart disease, cancer, diabetes, dementia, depression, autoimmune disease, obviously. But osteoporosis just seems a little bizarre to be related to inflammation. How does that work? And how do we identify what the.

Factors are that are causing the inflammation that leads to osteoporosis? Well, you know, there are measures that you can do to check for sort of low grade inflammation, things HS or high sensitivity C-reactive protein, GlycA, looking at their diet. So an anti-inflammatory diet helps to decrease inflammation. Looking at essential fatty acids are also important. Looking at whether or not there's any silent gut inflammation. When you do stool analysis, you can check for markers, which I call like CRPs of the gut, which is Calprotectin. So if you have chronic gut, low-grade gut inflammation, that's going to potentially increase your risk for osteoporosis. If you have sort of low-grade osteoarthritis, rheumatoid arthritis, which is more severe than osteoarthritis. It's more of a significant joint destructive inflammatory arthritis. Those are things which break down bone very, very slowly. It's a slow leak.

And our American diet is our standard American diet is a very inflammatory diet of processed food, sugars, refined oils, and lack of protective anti-inflammatory which are the phytonutrients and plant foods. And so we get this incredibly upregulated immune system, which is why we're all suffering from COVID in America. We've over 11 million cases, over a quarter million deaths today as this recording. And I think we're uniquely susceptible because we're so inflamed. And osteoporosis is one of the victims of inflammation. Our bones are one of the victims. And it's from leaky gut, it's from our processed diet, it's from lack of protective foods. So we really have an opportunity to really change that dynamic and shift the balance from from bone breakdown to bone build up, right?

Exactly. Healthy bones. Yeah.

And how do we normally treat this with traditional medicine? What is the general approach in terms of diagnosis and treatment?

Well, diagnosis, as we mentioned, is really with DEXA scan. And I always like to emphasize, especially, is women tend to have osteoporosis more than men, but men can get osteoporosis. And there are certain medications that can do that. But I actually think that one of the ideal things to do is to actually get your bone density checked when you have no symptoms whatsoever. When you're at peak bone mass, which is around 30 to 35 years of age, you want to know what your bones are then. What your baseline is. Right, exactly. Because I can't tell you the number of times that I've seen a patient and they're a woman, especially a woman, they're entering into menopause and I ask them, have you had your bone density test checked?

No.

Well, I said, well, you need to actually have that checked. And if you have one when you're at peak bone mass, which is around maybe 20, 25 to 30 years old, and then you get one as you're entering menopause or the perimenopausal area. Then you can see, okay, where are your bones going? Where are they going? You have two points. One data point doesn't show you much. Two data points show you a trend of is going up, going down, staying the same.

Very, very important information. So make sure you get your bone density early and at intervals that are depending on what your bone density shows. If you're great at 30, you can probably wait till you're 50. But if you're menopause, you want to check more. And men get osteoporosis too. Absolutely.

Men get osteoporosis. Osteoporosis disease. It's not exactly, anybody can get it. And again, high levels of alcohol, high.

Levels of caffeine, the PPIs, which acid blockers. Acid blockers, big ones. Okay, that's the third leading most prescribed drug in the world, and it's an acid blocker. And if you take this for height burn or reflux, you're gonna get osteoporosis because you're inhibiting mineral absorption, right? That's like Protonix, Prilosec, Aciphex, Nexium, all those drugs.

Chronic steroid use is a big risk factor for osteoporosis, a huge one. And then, as I mentioned earlier, smoking, and then just sedentary lifestyle. If you're not stretching your bones, you're.

Not putting stress on your bones.

There's a, I remember when I was in my training- Use it or lose it, basically. Use it or lose it. And there's actually an interesting thing, it's called Wolff's Law, which is that bone responds to stress. and I remember reading this article looked at astronauts. They were in their young 30 years old and they went up into outer space. And guess what? In outer space, you float around, there's no stress on your bones. And when they came down on planet Earth, they actually lost a significant amount of their bone mass because they were not having the body and it says, oh, we don't need our bones. We're just going to jettison it's like a balloon where you jettison the ballast. and you get rid of the bones that you don't need. So, our bodies naturally will make stronger, better bones when we respond and use stress, weight resistance exercise, bands, resistance machines, et cetera, is very, very important for maintaining good bone mass.

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