The Hidden Epidemic Of Muscle Loss: The Real Cause Of Obesity And Chronic Disease with Dr. Gabrielle Lyon

Coming up on this episode of the Doctor's Pharmacy. I recommend not going below 100 grams of protein a day. That is the bare minimum that anyone should have.

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Hi, my friend. How are you?

Great. Great. So I'm super excited because you got a new book out called Forever Strong, a new science-based strategy for aging well. Now, it's kind of like young forever, but I like strong forever, but forever strong. I like it. I like it.

By the way, that is just serendipitous. How about that? You know how these processes go.

I do. I do. It's great. I don't mind at all. So listen, I think, you know, you you have kind of given a recent Ted Talk, which, you know, was the number one, I think, new talks, number two, new talk on Ted. So it's huge. And, and you opened the talk and you said, you know, we don't have an obesity crisis in America. We have a midlife muscle crisis. Can you explain what you mean by that?

Yeah. For decades, we're talking about obesity as if obesity is the root cause. But the reality is obesity starts somewhere. And I believe that the primary site is skeletal muscle and that we don't have this obesity epidemic. But what we really have is an issue with skeletal muscle and it's long been overlooked because oftentimes when we think about skeletal muscle, we think about exercise or fitness or looking good in a bikini, but skeletal muscle is so much more than that. And it really is the pinnacle of health and well-being. as it relates to longevity, living well, activities of daily life. You know, we were teasing because your lawn guy was out there being able to move and function in a way that takes us through our journey. And ultimately, if you don't have healthy skeletal muscle, none of your other organ systems matter. It really begins with muscle.

Well, you know, Gabriella, it's so interesting as I'm reflecting back on my medical school education, and I'm sure as you reflect on yours, you know, muscle was not something we paid much attention to. It's like, here's the muscles that move the bones. And basically that's it. And if you had some horrible muscle disease, like rhabdomyolysis from some injury or some genetic thing or trauma or toxin, that was a thing. Or if you, you know, got a pulled muscle, that's a thing. But muscle cramps, maybe that's a thing. But, like, we never learned about muscle as an independent organ. that's regulating most of the functions in our body, from our hormones to our blood sugar, to our cholesterol, to our levels of inflammation, to our circadian rhythms. Pretty much everything is regulated by muscle. It's not just moving around your bones, it's a whole dynamic neuro-immune endocrine organ. And it's like, well, how did I not learn that in medical school? And it turns out that neglecting muscle is a huge problem in medicine. It's been like a dark spot. We talk about something called sarcopenia, which means less muscle, but we don't really treat it. We don't pay much attention to it. We don't diagnose it. We go, you're obese or you have osteoporosis, but we don't walk around saying that the biggest problem threatening our population as we age is a disease called sarcopenia, which no one ever probably even heard of, and doctors don't diagnose or treat. So, Like, what changed in medicine that now we're starting to actually have this conversation?

I really appreciate that you're bringing up the fact that we don't diagnose or treat skeletal muscle disease like sarcopenia. Do you know that the ICD-10 code for sarcopenia came out in 2016?

So that, for everybody listening, is the international classification of diseases. And so it wasn't even considered a problem until 2015 is what you're saying.

2016, it was actually considered a problem. And we've been dealing with sarcopenia. And for those that are watching or listening, sarcopenia is defined as a decrease in muscle mass, muscle strength and function. And it, we've all seen what happens to our aging parents. They get smaller, they can't go to the grocery, can't get up off the floor. We've all, we all know what sarcopenia looks like. It just hadn't been defined. It wasn't given a ICD classification, a disease code till 2016. One of the reasons why I believe it's been so underrepresented is that skeletal muscle is difficult to test for. Skeletal muscle, we don't routinely test for it. ADEXA, which for those that are listening, is largely body fat. And then the rest is extrapolated for lean body mass, which includes bone and organs and tissue. And within lean body mass is muscle. But that's not the primary source of lean body mass. So overall skeletal muscle has been very difficult to visualize. We don't routinely image it. And not only that, we don't routinely test it, as in how much do we have, what is the amount? And then thirdly, we don't actually look at the quality of our skeletal muscle. So in the beginning, when we say we don't have an obesity epidemic, but we have a midlife muscle crisis, We don't directly look at the quality of our tissue. And that creates a trajectory of issues because if the paradigm of thinking is wrong, if we believe that obesity in and of itself is the problem, we don't have a chance at fixing it. There's no root cause medicine because obesity is symptomology of impaired muscle in part, right? It's all kinds of things. It's insulin resistance and mitochondria dysfunction. There's a whole host of things that happen. But last time I checked, we can't do much about it, but we can always do something about muscle.

Yeah. So 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 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 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, 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 start to think about treating it. So sort of take us through, like, a little curriculum.

I would love to.

And, and get, you know, kind of school us on this, because 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 don't go, 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, burning the fat.

Exactly.

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. Mitochondria is basically the thing that actually creates energy in our body and it goes down as we get older. And it's why you see a 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 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 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, 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 reserve. another very interesting aspect of skeletal muscle is it is functions as an endocrine organ and it secretes myokines and myokines are peptides that travel throughout the body that and for the 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, you know, as we age, you know, this is an extra 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 flu. 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 caused by the low muscle mass. So we're kind of treating the wrong thing. You know, when you 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 they all pale in comparison to exercise diet, and particularly, you know, types of exercise that actually help you build muscle. And muscle is really critical to burning calories, to actually increasing your metabolism. People say, I have a slow metabolism.

What 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 do one bicep curl and that's it?

Dr. Well, no. 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. And one of the problems is when, by the way, there's no such thing as a healthy sedentary person. There's no such thing as a healthy sedentary person. We talked about how sarcopenia can begin in your 30s, but issues with insulin resistance and, you know, 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 two, three, four, five year olds who have type two 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 approaches 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 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 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. 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.

I mean, you know, 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. And the reality is that, you know, I didn't really start even lifting weights until late in my 58th year. and, 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, 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 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.

Yeah, it's pretty remarkable. I mean, you think about, you know, just what a neglected area of medicine is and it turns out it may be one of the most important areas that that we need to focus on, particularly as we age. Hi, it's Dr. Mark. Well, you probably heard me talk about how much I love infrared saunas on the podcast. They're great for muscle recovery, calming the nervous system, circulation, and immune system support. I also understand that not everyone has room in their budget or their home for a full infrared sauna experience, but that doesn't mean you have to miss out on all the benefits of infrared light therapy. My friends at Higher Dose have an entire line of products designed to provide the same benefit as a sauna at a fraction of the size and cost. Their line includes the bestselling detoxifying infrared sauna like it, which is really cool. And I use it at the end of the day to kind of just chill out. Very quick. Listen to a podcast with it. The grounding infrared PMF mats, which are great for pain inflammation with 20 pounds of crystal therapy and a rejuvenating red light mask. I like to use the PMF mat after I get home from a long flight. It really helps my body relax and sleep better than ever. With their state-of-the-art products, you can enjoy relaxation, detoxification, stress relief anywhere, anytime. So elevate your wellness scheme today by going to higherdose.com you can use the promo code HYMAN to check out and save 15% off site wide. That's higherdose.com and the promo code is HYMAN. Just go to higherdose.com/hyman and get your higher dose product today. What if I told you there was a delicious way to support your immune system, your digestive system, fight inflammation and get in some collagen and amino acids to support your skin, joints and bones and support your sleep and your brain daily? Well, there is. It's called Bone Broth. And my favorite convenient way to drink bone broth daily is with Kettle and Fire. They make super easy to use bone broth that you can get delivered straight to your door to make soup stews or just sip on by themselves, which is what I often do. I've tried so many different bone broths and this is the best one. Head over to kettleandfire.com/hymen today to see all their products and use the code hymen to save 20% off your entire order. That's kettleandfire.com/hymen. And now let's get back to this week's episode of the Doctor's Pharmacy. You know, in your book, you talk a lot about forget Forever Strong, a new science-based strategy for aging well. You talk about a lot of the misconceptions and societal fixation on fat and not paying attention to muscle and longevity. You talk about how a lot of your patients' health conditions that you were seeing were actually symptoms of unhealthy muscle and not the typical diagnoses that they were getting, right? Like when you get a diagnosis of diabetes or hypertension or cholesterol or whatever, that's what you think your problem is. But actually it may not be, it may be something else. So can you talk about how these health conditions were related to unhealthy muscle and what some of the misconceptions are? And you've kind of touched on a little bit, but just kind of dive in a little bit more because I think it's important to drive this home.

One of the really important concepts to understand is a lot of these diseases that we associate with obesity are, again, issues of skeletal muscle. and is it the chicken or the egg? I really do believe that there's enough evidence to support that there is major, major issues with skeletal muscle first. Again, within the literature, people will say, is it liver or muscle? Again, when you think in humans, research in humans, glucose disposal happens in skeletal muscle. Over time, as glucose rises, you have issues with insulin resistance, issues with insulin resistance. You ultimately get elevated triglycerides. Everyone should know what their triglyceride levels are. So in clinic, I was seeing elevated levels of triglycerides. And just for the viewer or listener, over 150 triglycerides, over 150 fasting blood glucose that was not quite in diabetic range but was over 100, elevated levels of fasting insulin. And one of the first things that we would always do is we retrained them to eat dietary protein. We figured out how many cal-- I know that-- I don't know where you are with calories in calories out yet, We are, you know, maybe you're into it, maybe you're not at this point, but I'll get you there. Yeah, I'm going to get you there. Anyway. Give me another 10 years, I'll get you there. Anyway, we would figure out how many calories they were eating. We would figure out what their ideal body weight. And the way that we would talk them through what their ideal body weight is, what was the last body weight that they were happy with? The way it looked, was it in college? Because I believe we can get back there. And I've seen it hundreds of times. We get people back to their college weight. What we do is we prioritize dietary protein and there are very specific tracks on how to do it. You and I as friends and you and I as colleagues have talked all about dietary protein and I've created three different tracks that are all evidence-based. You know, the first thing that you did was when you picked up this book, you said, wow, this is really thick. It has over 200 references.

I mean, it's hundreds of references.

You got a lot of muscle in that book. Yeah, a lot of years, took two years to write. And one of the things that we do immediately is we correct for dietary protein. Here's why. You can go, first of all, 24% of adults are the only ones who meet their requirement for exercise.

24%, yeah. And it's not a very big requirement.

Wait a second. Ready? 24%. 100% of people eat.

Mm.

While the exercise is critical and probably has a bigger impact on metabolic homeostasis, which is simply the balancing, probably the bigger impact, the reality is, as it stands now, 24% of adults are meeting those requirements. 100% of people are eating. If we can nail the thing that everybody is doing correctly and appropriately and set them up, for how to age well, for how to lose weight that is evidence-based, that will also protect them, that will lower blood pressure, improve triglycerides, improve body composition while they're going through weight loss and maintain skeletal muscle, then this is how we begin to reverse the trajectory of aging. So first thing we do is we decide how much protein this person needs. and in the book there's a handful of options, again all evidence based. The current recommended amount of protein with the RDA, which is a recommended dietary allowance, is 0.8 grams per kg. 0.8 grams per kg has not been updated for decades. It is the bare minimum to protect against deficiencies. It is not optimal amount is the bare minimum. The other important point about that is it doesn't, it is not also geared towards plant-based so individuals, as as some individuals move more towards plant-based or other alternative sources of protein, the recommendation for 0.8 grams per kg, which we all agree is too low, including the European consensus, including the the aging research that is based on high quality proteins. So what I am saying here is that the amount of protein that we're ingesting is much too low with all the variables that are happening. Right? And that's really important to understand.

Yeah, no, no. I just want to reinforce that point. So what Gabrielle is saying is really important, which is that the dietary guidelines around the, we call the recommended reference, the DRIs or dietary reference index or the recommended RDAs with the recommended dietary allowance, which used to be, those are based on the minimum amount you need of something to not get a deficiency disease. In other words, how much vitamin D do you need to not get rickets? 30 units. How much vitamin D do you need to optimize your immune system and to build bones and to have healthy muscle? Maybe four or 5,000. So maybe, you know, 10 or 100 times. I'm not saying we need 100 times the RDI of protein, but 0.8 grams per kilo is usually the number that people think of is what I should get. It's not, it's what the minimum amount that you should, you need to not get something like marasmus or kwashiorkor, which is a protein deficiency disease, right? So this is really important to understand. So I want you to dive into what we should be eating because there's so much controversy about protein. On the one hand, you've got the paleo folks and the carnivores on the one end saying always you eat is meat or we need more meat and we don't eat any, any grains or beans that they're harmful to us. And, and the other hand, you've got the, the vegans are saying, no, no, meat is bad for you. You should only get your protein from grains and beans. And by the way, did you see Game Changers? Because those guys are ripped and they perform at extreme levels, and they're, they're incredible fit guys with tons of muscle. So kind of, what is this whole about, you know, being, being a vegan as a problem? Because it's not. And, and we see people do really well. So can you kind of address that? Because it's, it's, it's in the zeitgeist, people so confused and, you know, and people don't know what to do. And they think, they think that if they eat meat, they're going to be damaged. And this is even when our, there are guidelines that are often telling us to eat less meat and, and people who want to save the planet eat less meat. And so we're kind of, we're kind of confused. And the question is, what's important for you? You know, I, I basically saw this guy who was like, I mean, he, his diet wasn't great. So you can be a healthy vegan, but he was a vegetarian. He'd want to kill animals. but he was like, you know, 100 pounds overweight, you know, ate tons of carbs, was super unhealthy. He says, well, I, I don't want to hurt any animals. I said, well, aren't you an animal and aren't you hurting yourself? And don't you think you need to take care of what's going on for you? So can you help us sort of navigate this? Because it's such a big issue. And I, I'd love to sort of.

Spend some time digging into this with you. Gladly. I, I do want to point out that we are a precipice right now. Oftentimes, and up until this point, we have always thought about protein just as a sole macronutrient. There's fats, there's carbohydrates, and there's proteins. 20 different amino acids, nine of which are essential. Those, when do you hear these essential amino acids addressed? You don't. And you started out this conversation by saying, We don't need carbohydrates. The amount of fat that we need is very minimal. right, to meet our fatty acid needs, our essential fatty acids need, but the protein is essential. And again, we talk about it in a blanket statement protein, but the reality is, is those individual amino acids that we require. And in fact, when you look, if everyone at home could look at a packet of their protein bar, they'll just see protein. And it doesn't talk about the actual quality of the protein or the individual amino acids. or the digestibility of the protein. So, yeah, you could say, oh, you.

Could look at total fat, but it could be all trans fat or it could be all omega-3 fats, and it's very different in your body, right?

Exactly. And I'm just gonna lay this out there 'cause I do know that you have physicians and healthcare providers and health coaches. There's a very recent paper that came out and it's Perspectives. It's called Developing a Nutrient-Based Framework for Protein Quality. and I will send it to you. Everybody should read it. Developing a nutrient-based framework for protein quality. It will take out the emotion. So how I am setting this up is protein has a face. It is incredibly emotional for people, whether it's saying red meat causes all the horrible diseases, including climate change, everything. I mean, we don't even have cigarettes don't even do all that. We must understand that while it is very heated, if we can begin to take away the emotional charge, we will begin to see protein for what it is, just amino acids. And when we understand that there are certain amino acids that we need, these essential amino acids, and that they come in the form of high quality proteins, for example, beef and fish and fish and chicken and eggs, that we are able to weigh protein, we're able to not only meet these minimal amino acid needs, but also when we think about food as a food matrix, it is not just the macronutrient protein, it is also the things that ride alongside it. It is the creatine and the anserine and the B12 and selenium, zinc, all of these things. So anyway, I just want to lay that at people's feet because if they don't understand, it is not just the macronutrient overarching protein, it's the individual amino acids and the things that ride alongside of that. this is my last statement about that. It's like when you talk about eating plants.

Carnitine, for example, right? Carnitine is a critical mitochondrial compound important for longevity. And where does that word come from? Carnitine. Carnitine means meat, right?

And just as we think about fruits and vegetables, we think about fiber and all the phytochemicals and the anthocyanins. Well, dietary protein, animal-based proteins have the equivalent to that. So, just to understand, protein is not just protein. They have different amino acids that make up each protein. Again, there are 20 different amino acids, nine of which are essential. High quality proteins are simply defined based on those amino acid levels and numbers. And if this is getting too science for sciencey for people, this is all laid out very simply in my book. And we eat for those essential amino acids. And we eat for the branched chain amino amino acids, which are leucine, isoleucine, and valine that all come in the right amounts to feed skeletal muscle. When you meet the need for skeletal muscle, you have the potential to meet the need for the rest of the body. When you meet the need for skeletal muscle, you have the potential to meet the needs for the rest of the body. So understanding that protein quality is different and I typically recommend one gram per pound ideal body weight. If you are vegan or vegetarian, you are going to need to be on the higher end of protein intake, potentially even above that. Now, I will say that there are going to be some studies, the ASN conference in Boston just happened. There are studies that are going to be coming out that are emerging that show that the lower the protein in your diet, that it must come from animal-based products, and they've run it through.

AI and Algo- the lower the protein.

In your diet, the lower the ones overall diet, the higher the animal based products must come from to meet those individual amino acid needs. And they've used AI to look at, I think it's over 100,000 foods or it's astronomical amount, but they used AI to see again, if a diet that is based on whole foods can meet the individual amino acids, and there was simply no way that it could be done. And it looked at from a vegan diet, it was 4,000 calories to try to match up those amino acids. And again, if you're going for the.

0.8 grams, right, it's got to be from animal food. If you're going to eat two or three grams per kilo, you might be able to get more of it from plant protein, but you're going to be.

Eating so many calories, right? But I think this is a really important point to understand because this evidence is now coming out. Again, the ASN conference just was released or, you know, just happened in Boston. And the- what's the conference, Gabrielle?

The what?

It was the nutrition. It's ASN. So I think it was whatever that stands for.

American Society for Nutrition.

There you go. There you go. So it was usually experimental biology. They were combined. So it was experimental biology and the nutrition conference were together, but they've they're now taking away some of that. So now it's the nutrition. Anyway, so the whole point is that in order to meet all the amino acids, the lower your dietary protein intake, that it has to come from animal-based foods to be able to meet those other needs. And I think that this has not been discussed before, again, because protein quality at this level has not been shown before. Again, there creating a new coding system. So I think that that's going to be fascinating.

What you're also saying is that even if that's true, even if you get 0.8 grams per kilo and it's all animal, it might meet your minimum requirements, but it's really not optimal. It's not what you should be eating. So the argument even goes stronger in your direction because if you're trying to get to 1.6 or two grams per kilo, and we'll talk about what that number may be needed for different age groups and so forth, that you actually need to be paying way more attention to that.

And I also think that high quality protein is critical. I really do, especially again with this new evidence coming out. It's when we say, so the people listening to this are very nutrition forward and they're very interested in optimization in their health. And when we make global statements like meat is bad for us and we should cut back our animal products, who does it impact? Who does it ultimately impact? It impacts those young children, right? It impacts those in nursing homes. It impacts those in government programs. If we were to do, quote, meatless Monday, it does two things. It culturally damages the way in which people think about food going forward. This, though, you know, I have a four year old. She's going to remember that they were telling her to do meatless Monday. So there's a whole cultural political food, but there is a whole cultural political conversation. that then indoctrinates people, which can create a lot of problems because high quality animal-based food is a luxury. It is so important to our nutrition. The best possible diet is probably a combination of animal-based products with fruits and vegetables. I think that we can all eventually, we'll all eventually get to that point and understand and agree that if you want to age well, then you must be able to consume high quality protein. And I truly believe this. Again, I have seen this in clinical practice and numbers for people. What does that look like?

Well, before you jump on there, I want to stick on this issue of the protein quality because I think, you know, if you look at, you know, what I learned, for example, when I was young, I was a vegetarian. I read a book called Diet for, I think, a small planet.

And that changed everything. That book I wrote about that, that book changed the trajectory for everybody.

Yeah. And the book, I remember very well, I was, I read it when I was like 20 something and basically said that if you combine beans and grains, you get a complete protein. So you don't need to eat meat. Now, what, what do you say to that? Because, yes, if you eat one or the other, you might be missing some eating masses, but if you combine them, you know, what's the problem with that? And why, why can't you be a healthy vegan? or can you?

You can, but it's very myopic, right? So you could be a healthy vegan and you could certainly be a healthy vegan if you were not going to do Whole Foods and you were going to supplement. If you were going to supplement creatine, you were going to supplement all of these nutrients individually. The majority of people can't do that. The majority of people don't have the time, the energy, the finances to do that. And I guess at the end of the day, the question is, why are we doing what is the driving force? If it is because you don't want to eat animal products, that is one thing. But if the driving force is because eating that way is going to make a huge difference in climate change, that's not true. We are not going to eat our way out of climate change. If you are eating that way because you are concerned about heart disease or any of these other things, that is not the way to do it. We do know that supporting healthy muscle is at the foundation of health. We know that there is a decrease in overall or increase in survivability in all-cause mortality the more healthy muscle mass you have. If you fall and break a hip, your chances of survivability go up when you have more healthy skeletal muscle.

What would you say to the people who watch Game Changers and were like, no, those guys, look at that guy. He was like, did the rope thing for like 25 hours or something. Some, Great heroic feats of strength.

There will always be outliers.

How do they get like that? I mean, I have a theory. I want to hear what your theory is.

I mean, here's what I think. I think when you are young, you have a lot of flexibility. When you are young, you have a lot of flexibility. Time and age and stress and environmental.

Impacts have not caught up to individuals. Yeah. I've also seen them. I asked them because I see met these guys. I'm like, what are you doing? So, oh yeah, I take like, you know, 12, you know, vegan protein shakes a day. so they're taking highly processed, you know, kind of often, you know, grown in ways that are equally environmentally destructive, they're sprayed with chemicals and, and large amounts of these processed foods that, that have to be were eaten in order to actually meet their protein requirements.

Yeah. And I, and I also think that, that we, we're circling back on a narrative, by the way, you remember, you weren't around that time, but during World War II, people at home were really encouraged.

I'm old, but not that old. I recently went to a dead show and I saw this great shirt. It said, I may be old, but I got to see Jerry.

You know, at it, around World War II, people at home were encouraged to grow victory gardens. I don't know if you've read much about the history, but they were encouraged to grow victory gardens while soldiers were sent all the meat. They were given at least a pound of meat. They actually, I was looking at a paper from, I don't know, it was like 1940 and soldiers were, they were giving them 250 grams of protein a day and they showed improvement in injury. They showed all these positive outcomes. So it was almost like, it's almost as if now with the narrative, and I don't want to go too deep into a rabbit hole, whole about it. I talk about this in the book. It's almost as if we are now circling back to an old conversation that is then just packaged differently. So back then it was build your victory gardens, send all the meat and send all the high quality protein to the soldiers because they're fighting for it and they need that. Then packaged food comes in and now all of a sudden it's how do the grain and the packaged food companies come in and now we should be eating this. And now we should be self rationing animal based products. And now this is what we're supposed to be eating. And I think that that's a huge mistake. Not only that, but what packaged food can say versus what a commodity, what a whole food product can say, like milk or beef is what's for dinner. It's one statement. They can't make claims about it's going to support healthy muscle, or it's going to do X, Y, and Z, all these commodities which these whole foods that support farmers say is part of a healthy diet. But they can never counterbalance the, you know, because they're governed under two.

Different.

Bodies, they can't say, you know, they can't come after Impossible Burger or Impossible Meat, any of those things. And I think that that creates a lot of confusion. So you asked me, Where do I think some of this confusion is? I think some of this confusion comes from money, and I think it's an old narrative recycled. And without understanding where our history has brought us, we are bound to repeat it. And I'm seeing it being repeated again is quite frankly what I see that's happening.

Yeah, it's quite shocking actually when you think about the misinformation and the average consumer out there is getting buffeted about by all these different narratives and ideologies. not able to actually determine, you know, what is true, what's not true, and whether or not, like, you're actually supposed to eat more meat or less meat, or whether it's going to cause heart disease and cancer, or whether it's going to actually save your life.

But there's, that has never been shown. So there is no mechanism of, I mean, so there has not been any studies, any high quality evidence that shows red meat cancer.

Yeah, I mean, people do say that, you know, processed meat like, you know, bacon, but the data is so weak on that, you know, when you look.

At processed meat, processed, okay, what is the mechanism of action? So now we're talking about something else. Now we're not talking about whole lean fillets. Now we're talking about, you know, is it, is it the processed meat? Is it the packaged food? Now you're in a whole different scope. And then what is the actual cause in it? It's created quite a challenge to the point where evidence can be presented like Annals of Internal Medicine. They did, you know, looked at our.

Current.

Meat intake and there wasn't evidence to support that we should reduce what we're taking. And in fact, our red meat consumption is down like 30%. Yet cancer rates, yet obesity, yet heart disease, all time, all of these things are up. Yet red meat consumption is down.

Yeah, it's true. It's true. Actually, we, when you look at the data on consumption patterns, our meat consumption has dropped dramatically over the last 50 years while our grain consumption has increased dramatically. And, and, and that actually is leading to this obesity and diabetes epidemic that we're seeing. And I think, you know, it's hard for people to come to port with this because we've been sort of brainwashed. I think that meat is dangerous or bad. And, you know, if you have it, okay, once in a while, but it shouldn't be major part of your diet. So what you're saying is, you, you know, you want to construct a very different diet. and it varies depending on your age, right? So let's talk about what should our protein consumption look like? What's the amount of protein we should be eating? What should be eating each meal? When should we be eating? And what kind of protein matters? And, you know, what changes as we age?

The first thing that one would want to consider is where are they at in life when you are young? So let's take my daughter or a teenager or someone who's young, they can really get away with anything because again, they're driven by hormones. They can follow the guidelines, whether it's 0.8 grams per kg. Again, is it optimal? No. Are they going to still be able to build muscle, manage protein turnover, have all this healthy skeletal muscle totally? As long as they're moving, creating flux and providing some kind of stimulus to the body, I have no issue, right? So I think it's important to discuss high quality nutrition with younger individuals but I don't think that we should harp on it because we just shouldn't. Now, as we get into our 20s, this really between 20s and 30s, this really we begin to think about what is the overall goal. And I don't want to spend too much on age in the way of the younger generations because you can be overweight and have diabetes and be young. So it really is, are you metabolically healthy? Are you metabolically unhealthy?

Healthy.

So that's one question. And I would say that if you are metabolically healthy, then the amount of dietary protein would be one gram per pound ideal body weight. If you're 20, that might be on the higher end. But if you're really focused on building muscle in your 20s and 30s, which really the idea is that you build as much muscle as you can while you can do it, because the way in which we age is not linear.

I didn't start until I was 59. Am I screwed?

No, but also, Mark, you're very active. You've been very active your whole life. Whether you were doing yoga or we were riding our bikes around, whatever, you were still active. You may not have been lifting weights and you were probably consuming a suboptimal protein diet, which by the way, by facts on that, I know that that's true, which you are not now doing, but you always had healthy muscle. So, when someone-- so, let's just say the first most important aspect is one gram per pound ideal body weight.

One gram per pound. That's not-- you were talking about less than a gram per kilo, which is 2.2 pounds. So, this is like more than double.

Correct. Everyone can start there. So, the RDA-- so, how do we consider a high protein diet? High protein diet would be-- you could say double the RDA, which would be 1.6 grams per kg. So, 1.6 grams per kg would be considered a higher protein diet or even moderate because now you're doubling the amount that is to protect you from deficiency. I think that depending on someone's it take, you could start with one gram per pound ideal body weight. No one is going to get there. Most people are not going to get there. But I think it's a great place to shoot for. And notice, this is really important. I'm not saying one gram per pound lean mass. Mark, what's your lean mass?

Well, I'm about 10% body fat, 175 pounds. So, I don't know, I'm not good with math, but you can figure it out.

Exactly. Nobody knows their lean body mass. No one knows their lean body mass. So, you know, it really is, there's no reason why people shouldn't be consuming a higher amount of protein. There's nothing that is dangerous about it.

It's not for your kidneys.

It doesn't, it does all men. that is all myths bad for your kidneys. Unless you have kidney failure, right? Unless you have active kidney disease, then that's a problem. So a dietary one gram per pound ideal body weight. Could you go less than that? Absolutely. Could. Now let's think about what does that look like? The first most important hierarchy of understanding is total protein. Total protein throughout the day. Now, what is a Baseline? I recommend not going below 100 grams of protein a day. that is the bare minimum that anyone should have.

For anybody, like if you're five feet tall or you're six feet tall.

How tall am I, Mark?

You're little. You're like five feet.

Yeah. Because we have to support these essential amino acid needs, and we have to support these individual amino acid needs, and we also have to support these other low molecular weight compounds. We must get these in our diet. So the lower the total calories of your diet, the higher the protein the lower your total calories, the higher you must prioritize dietary protein. If you are older, if you are postmenopausal, if you are in your 60s, in your 70s, many of you out there are not eating a ton of calories. The majority of you are not eating a ton of calories. Appetite goes down. You must increase dietary protein. This is the way you will protect your muscle. This is the way you prioritize nutrient density. When you think about nutrient density, how many nutrients, how much nutrients, right, are in whatever it is that you're eating. For example, Skittles might have calories but no nutrients. A lean cut of meat might have a ton of nutrients, and that would be nutrient density. It's nutrients per calorie.

So what does that look like in a meal?

Let's talk about meals. There's a few ways, and I have never actually really talked about this in depth before. So there's three tracks in the book, and all are evidence-based. once you determine how much protein you're going to need. If you are looking for, let's say, and there's calculations, you can calculate it, you know exactly what you need. There's different calculations. Again, it's all based on activity levels and goals. But let's say you were a mid-life woman who wanted to lose high quality weight, who just wanted to lose body fat. you are pre-diabetic and entering around menopause, then I would have you do three meals a day. I would say, okay, let's regulate your blood sugar. Your first meal is going to be 30 grams of protein. Your second meal is going to have 30 grams of protein, and your last meal is going to have 30 grams of protein. I'm going to have you eat your protein first and prioritize high quality protein. What does that mean? It could come in the form of a whey protein shake, It could come in the form of eggs for breakfast. It could come in the form of, I don't know, turkey, salmon, turkey bacon. You choose, right? Like there's many, many ways in which you can get your protein. You could even have yogurt. I know you don't like dairy, but you could have like- I like sheep yogurt. Okay, so there you go. And why is it 30 grams of protein three times a day? There's a lot of, it's interesting, there's a lot of information in the literature that would talk about protein distribution. It's not nearly as important in many people as we once thought. Here is why it is important.

You mean protein distribution, meaning what you eat when and what time of day and all that?

Exactly.

Because you say, oh, if you don't have a certain amount at a certain time, it won't work. You have to eat it all a certain amount. For example, when I first started talking to you, you say you have to eat 30 grams per meal or it all gets burned as calories and not used as protein. Is that not true anymore?

Let me clarify, okay? I'm going to clarify what we know from the science. So initially, they looked at protein distribution over time, which is exactly what you said. It was how much protein per meal and what was the effect. Well, all the meals were really done on the breakfast meal. So the breakfast meal, when you're coming out of an overnight fast, is where you can really measure muscle protein synthesis. Muscle protein synthesis is a biomarker It's a biomarker for health. It's a biomarker for muscle health. It doesn't necessarily translate to a percentage of muscle mass that you're putting down, but it truly is just a biomarker that the protein is doing what it's supposed to do, that the muscle is sensing it. So 30 grams of dietary protein, that first meal is the most important. The first meal to set yourself up for blood sugar regulation, we know that your muscle is catabolic, meaning it's breaking down. that once you have at least 30 grams, and again, this is for a perimenopausal woman who needs to lose some weight. So this is the scenario, the case-based scenario that we're going through. I'm happy with her having 30 grams of protein at that first meal. She's probably not that hungry. She's probably gone through periods of really chronic fasting. Maybe she's has to usually did a I don't know, a donut and some coffee. So now we're retraining her. So the 30 grams of dietary protein in that first meal, while carbohydrates are managed. So I never recommend more than 30 grams of protein with that first or 30 grams of carbohydrates at that first meal will stimulate her muscle, which we've talked about is really essential for muscle health, but it also will make her satiated. It will stabilize her blood sugar. She's not going to go for when she goes back to the office and cookies out, she's probably not going to go for it. And the evidence supports that, that she is much less likely to grab the cookies or the things that are out there. So, because it regulates your appetite.

It suppresses your appetite.

That's right. Suppresses your appetite, impacts this thermic effect of feeding, thermic effect of food, meaning her metabolism is going to revved up, be revved up. I mean, your metabolism is revved up anyway, but because the utilization of protein is significant for the body, primarily for the muscle, especially when you're eating that 30 grams of dietary protein, you've now done yourself a metabolic favor. You have now stimulated skeletal muscle, which also burns energy, which is essentially calories. You now have set yourself up to not be hungry, and now you're protecting skeletal muscle. So by the time you go to that second meal, now you're not really as hungry. You know you're going to get your baseline dietary dietary protein in, your blood sugar is regulated, you're protecting skeletal muscle, then you're able. So based on that first meal, you're going to feel better by that second meal. Yeah. Second meal. And then is 30 grams of dietary protein. You could do a one-to-one ratio of protein to carbohydrates. Again, I have a whole list. I actually have freebies for the book. If people are interested in ordering the book early, we've created a whole bunch of things people to get right away. And then that last meal of the day before you're going into sleep or an overnight fast is when you would want to hit protein again. So now you've set up a minimum of 30 grams of high quality protein three times a day, which is 90 grams. You're going to get some protein from some of your other sources. So the minimum you're going to be getting is 100 grams of dietary protein, which is a good start. Should people go higher eventually? But could we warm them up Totally.

So, Gabriella, if you're doing that protein intake, let's say I'm just eating a gram per pound, but I don't lift weights or do resistance training, will I get benefit?

Yes, you will. And another strategy would be to divide your protein intake by two meals a day. Your first meal, the evidence supports that first meal is the most important. It stimulates muscle protein synthesis and it has all these other growth factors. And we don't even know how long that those growth factors last, Eif4, all these things might go on for hours afterwards. So the first meal of the day is most important and that last meal of the day is most important. But what here is the aspect here. When individuals age and they are not physically active, there is this change in physiology called anabolic resistance. is the decrease in efficiency of the muscle to sense dietary protein. And that becomes important to note. There's ways in which we can overcome that anabolic resistance and is exactly what it sounds like. You are more resistant to the input. So skeletal muscle is a nutrient sensing organ. Skeletal muscle is a nutrient sensing organ. senses the quality of your diet. It senses the amino acids of your diet in particular, leucine, which is one of those branched chain amino acids, which comes from high quality protein. You need it in particular amounts to then stimulate this. So you, Mark, you, how much do you weigh? Let's calculate.

175. So that means I should be 175 grams of protein a day.

Well, you can negotiate that. It could be higher or lower. You're very active. so if we did, let's see, yeah, hold on, divided by two, it's 80.5. So let's say you did easily, let's say you get between 50 and 60 grams of protein at that first and last meal a day. I'm totally okay with that. Here's why. Because you've maxed out the system for muscle protein synthesis at that first meal. around 50, maybe 55 grams.

So if I eat more than 30 grams, it's still getting utilized. It doesn't go to waste?

It's all getting utilized. And again, we talked about protein turnover. The amino acids all are metabolized differently and they all play different diverse roles. Each amino acid has at least two roles. For example, arginine. Arginine is amino acid that is a precursor for NO2. NO2, is nitric oxide. Nitric oxide causes vasodilation and can help lower blood pressure. Leucine is another amino acid that stimulates skeletal muscle protein synthesis. Threonine is another amino acid that helps with the enterocytes, the cells in the gut, produce mucin for gut health. So while we're eating for skeletal muscle, all of these amino acids do other things.

Interesting.

And that's what's so critical. There are other amino acids that are precursor for neurotransmitters. So you use all these amino acids. It doesn't go to waste. It may not benefit muscle, but these amino acids all have diverse roles and multiple roles in our process differently. And that's why I am so passionate about this message. This message is about becoming stronger as a society, becoming stronger as a culture, and understanding that if we can get our nutrition right, we can get our muscle right. If you get your muscle right, then everything in your life, whatever it is that you're doing, you're going to be better capable to do it.

So let me just get this straight. So what you're saying basically is one that our basic minimum amount that we should be eating is wrong. Like it's not 0.8, we should almost double that. Yeah. Two, the more exercise we do, the more we need. Three, the quality really matters and you need a certain amount in each meal, like 30 grams to actually activate protein synthesis. And four, the quality around protein, depending on where it's coming from, is critical because if you don't have certain amino acids, and I learned this from you like leucine, if you don't have two and a half grams of leucine at a meal with protein, you don't turn on the muscle building system. And so, you kind of, these are all really important things to take home. And also, we under need to understand what we need to do to build muscle in addition to eating protein. Because I always think about it, you know, like eating protein, like putting a, you know, piece of meat in the pot in this, on the, on the stove to make soup or something. But unless you actually turn the stove on, you ain't gonna make soup or cook the meat. Right. So how do you actually do the next step, which is the exercise part? I want to, I want you to about the kind of exercise, the quality of exercise, and what's going on.

Yeah, and just overarching, you can just by improving and increasing dietary protein, you can actually put on some muscle. I mean, it might not be a lot, and you probably, if you were to do that, you may have been in some deficit, but by really just improving your dietary protein intake and correcting for calories and carbohydrates, you can lay down some muscle. But muscle requires a stimulus. it requires an input, it requires gene expression, and then ultimately muscle protein synthesis. On a very high level, there are a couple things that we need to think about, obviously resistance exercise. So when we think about resistance exercise, we need to think about how are we going to do it, the amount that we're going to do, and really the impact. And the biggest thing with resistance exercises, I think that there's multiple ways to get an adaptation, and that's really what you're looking for. You're looking for a stimulus. And whether that stimulus is body weight or it is bands, I know Mark you like to use bands, or it is actual weight, it is about volume and progressive overload, continuously challenging yourself over time. If someone is just starting out and I have a whole exercise library, a whole exercise plan in a book, by the way, Mark, I would challenge you to do that. I would love to see, I would, and don't be scared. There are different tiers, like different levels, but I would challenge you to see, you know, what is that actually, what is it actually like? And you can train three to four days a week. Again, it is all about, there's many different ways to do it. But if someone is just starting, training three to four days a week, I think is perfectly fine. Hitting each muscle group, you know, again, there's many different ways to do it. do it at least twice a week. The other aspect is, again, progressive overload, having enough volume to stimulate this, to stimulate your tissue and improving. And then the other aspect I think is really important is adding in some kind of high intensity interval training. I do think that high intensity interval training is key. Also many different ways to do it. Could start with one day a week, could take 20 minutes, 10 minutes of active training and total minute, totally a total 20 minute session. And I think that that's perfectly adequate to start. If people want to throw in some cardiovascular training, they can. There is some benefit. There's a lot of talk about zone true training. Again, it really is about what is the stimulus. I think the most important thing from a physician standpoint is flux. And that means when you have muscle glycogen and when you have a full suitcase of muscle, that you're actually doing activity to empty that tank. So for me, again, I am not a fitness professional. I'm a physician. And the way that I look at it is what is the activity that is going to create flux and move the markers that I care about in my patients, which are triglycerides, HDL, which is blood sugar, insulin. These are things that we can see impact with healthy skeletal muscle. So that's where I would start.

That's great. I mean, I think it's not as daunting as people think. But, you know, the question often is people are older, they're worried about getting injured. Do they need to start working with someone? Form matters, you know, I think I've injured myself before by not doing things the right way and by, you know, incorrect form. So it's really important, I think, to do it the right way. What do you recommend for people want to get started? I know your book is full of really practical takeaway suggestions for everything.

People can do it at home. So we've created an exercise library so people can do it at home and we've created programs. I had the help of Don Saladino and Kara Lizowski. Both of them helped me. Both of them have been training for years and years. Again, it does not have to be daunting. There's multiple ways to do it. It really is about a stimulation to creating an adaptation within skeletal muscle. I do think that you should know and assess yourself in the beginning. You should know how many push-ups you can do, how many air squats you should do. You should be getting stronger, right? And we should be getting stronger together, but you should be tracking your improvements because we track our blood work. You should be tracking not necessarily just body composition, but you should be tracking your performance over time. Again, multiple ways to do it. It doesn't have to be hard. It doesn't have to be complicated. It just has to be consistent.

Consistent. So is it three days, five days, six days?

It could be. You could do six days. I train six days a week because it really is about how is the overall volume. And there's many different ways to make that happen. So, for example, if you're going to train three days a week, your volume has to be adequate to stimulate skeletal muscle. You know, you'll probably stimulate skeletal muscle. You'll certainly be doing enough to maintain, but if you're looking for hypertrophy, which is muscle growth, then you're going to have to have a well-designed program. It might take you a little bit longer if you're just doing three days a week. If you want to do six days a week, you're going to be doing less volume on each of those days. So there's, it depends. What do you have time for? How do you do best, right? I'm very busy. I have little kids. I like to train six days a week. I don't necessarily need really long sessions.

And I'm hitting my body parts at.

Least, I'm hitting them at least twice a week. And so that's just a very practical way to do it. But I do hear what you're saying and people really, you can do movements that are safe and there are certain movements that everyone should be able to do. And then you can learn movements. For example, I don't expect someone to just be able to know how to do a deadlift. This is some, a movement where you should learn how to do it. You should be coached and cued, but everyone should be able to pick pick up heavy things and put it down, whether you're doing a farmer's carry or you're doing a band workout, there should be basic things that you are preparing for life.

So, your book basically is a roadmap. One, how to take care of your muscle, why it's important, what you should be eating and when, and what type of exercises you need to do. And, it's really kind of shifting our focus from focusing on the fact that we're trying to lose fat, to a focus on how do we gain muscle as a way to both increase our overall health longevity, but also to lose weight and improve metabolism. Right. Because metabolism exists in your muscles. That's where most of your metabolic function is. And so when people say I have a slow metabolism, it's often because they're under lean. Right. They're, they're over fat and under lean. And that is a huge problem. And, you know, when we look at America, you know, 93.2% of us are metabolic and healthy, and most people are under lean. So, you know, people don't realize what an epidemic this is. And I walk around and now I'm alert. Like I look around and say, okay, how do I assess people's muscle? You can tell by looking at people, you know, are they kind of wasted and flabby? And it's amazing how very, very overweight.

People can have so little muscle. And we're going to get to a point where it's going to be the next vital sign. I really do. They're starting to look at measurements of something called D3 creatine. where you take a pill over a few days and you can actually measure directly how much skeletal muscle mass someone has because creatine is obviously just in skeletal muscle. And I believe that it is going to be able to be available to physicians right now. It's just used in research, but we are going to have ways that are not cost prohibitive to be able to actually say, okay, here is where you are. Here is where you should be. How are we going to work to kind of close that gap? yeah.

I mean, I think it's like a new biomarker for muscle.

Right.

That's a great thing. I can't wait till we get that. Yeah.

So there are things that I, I think that are really going to change. And I think it's also really important to understand our history and how we got where we are, because if we don't understand, then we, we can't look at some of the evidence to support what is in front of us. So the protein research has been there for decades, and why hasn't it been out there? Why is it being kind of confused and all this information, who knows? But the evidence is there and this book is very evidence-based and well done and transparent. I think that that's important to know. And also, if it sounds daunting, just try to hit that first meal a day to optimize dietary protein and the last meal. So again, there's different tracks in the book to teach you how to do it. I don't really care so much about your middle meal, you know? So it really just depends. So I just want to highlight something because I want the listener to go away and go, okay, today, if I am overweight and I need to lose weight, I am going to try to eat three meals a day with 30 grams of protein. If I am happy, if I am happy with my weight, like I'm like Mark, then I'm going to hit my first meal to have at least 50 grams grams of protein. My last meal to have 50 grams of protein, at least.

And what is, like, 50 grams of protein? Is it like a 24 ounce T-bone steak?

Like, what is that? What are we talking about here?

Seven.

Seven ounces would be 42, you know.

About a seven ounce steak. So basically, that's, like, less than the size of a steak you'd get when you go to a restaurant.

Yes.

It's not a huge amount. Right, right. And, and often, you know, say to people, think about the palm of your hand. You know, if you're Shaquille O'Neal, that should be the size of the protein. If you're like five feet tall and have, you know, 10 pounds, well, you.

Probably need like a smaller piece of protein, right? And there's multiple, and there's also multiple ways whether you want to do a protein shake again. Ultimately, where we are going is it is about the amino acids and they're going to be coming out with a new scoring system. You know, back in the day they had PD-Cast, but they are going to be coming out with a new scoring system where you can actually see the score on label. And that is really going to change the way in which we look at protein because it's going to make it very transparent.

Yeah, that's interesting. So right now, you see fat, it's saturated fat, trans fat, you can see like right what it is. So it'll be more of a granular view. I think this is amazing. I can't believe it's taken this long for a coherent doctor to write a book about muscle, but it has because it's been the neglected organ. And I think, I always say muscles the currency of longevity. If you don't have muscle, you're not going to age well. And I said that in my book, Young Forever. It's the foundation of your book, Forever Strong, a new science-based strategy for aging well. I encourage everybody to get a copy. It's quite amazing. And, I also want to give you a chance to tell people about your Institute for Muscle Centric Medicine and the resources or support that people can get through that Institute to help them on their journey to our Optimal Muscle Health.

You just kind of close with that.

Yeah.

Thank you so much. So actually, we do have a full clinic where we do see patients and people can go to the Institute for Muscle Centric Medicine. Right now it is remote. They can apply to be a patient. We are also educating providers, providers, healthcare providers, health coaches, Physicians, and we have a whole curriculum for Physicians on this concept of muscle Centric. and what are the biomarkers and what are some of the hallmarks of muscle health, things that I think are just so valuable. And my newsletter, we provide tons of free resources and all of that can be found on DrGabrielleLyon.com and by the way, we also have a recipe. People are going to be so confused about what to eat. We have a recipe newsletter called 30 Gs, which by the way, Drew supported that and you supported that. So, all kinds of ways. Oh, and by the way, I have a podcast.

Yay. People can listen to your podcast. What's it called?

It's called the Dr. Gabrielle Lyon Show Original. I know. I just wanted to make it easy to find. Where I interview a lot of the researchers to bring this information from research to public. So it's a lot of great information. And again, that's all for free.

Well, thanks. The bed to bedside, bench to bedside. That's great. So, thank you so much, Gabrielle, for what you're doing for your book, Forever Strong. I already got a copy right now. If you love this podcast, please share with your friends and family. I think they'll be useful information for everybody. It's something you probably haven't heard before. And, we'd love to hear a comment from you about how you've taken care of your muscle, what you've learned about it. I've certainly learned a lot about my muscle and it's quite amazing at 63 years old. I have way more muscle than I did at 23. So, it's kind of cool. And, aside from the vanity aspect, it's kind of fun. I feel very strong and fit. I'm going trekking up in the mountains in Nepal next week. So, it's amazing to sort of still keep going at any age. And, and I'd love for you to share it and your thoughts. And also, we'll see you next week on the Doctor's Pharmacy. Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Drs. Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize to enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger, Hi everyone.

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