The Ultimate Guide To Maintaining Muscle (Even When You Can't Workout)

Hey, what's up folks? It's Ben Greenfield and I think you're gonna dig today's episode. It's about how to maintain muscle even when you can't move a muscle. We go over some really cool cutting edge research that shows all the latest, greatest things that you can do to actually keep your muscles around. You might need them, trust me. In this episode of the Ben Greenfield.

Fitness show, the protocol they did was five sets of five minutes of occluding of the immobilized limb for I believe three sets during the day was shown to help to salvage more lean body mass than obviously the cohort that didn't do it. So as physical activity gets reduced, nutrient sensing to amino acids gets reduced as well. And this is what causes forms of anabolic resistance being one factor. But I think there's also other kind of multiple factors as well, like microvascular perfusion and things of just kind of the uptake of amino acids is not being uptaken.

He's an expert in human performance and nutrition, voted America's top personal trainer and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield. Power, speed, mobility, balance, whatever it is for you, that's a natural movement, get out there. When you look at all the studies done, studies that have shown the greatest efficacy, all the information you need in one place right here, right now on the Ben Greenfield Fitness podcast. Hey, it's Ben Greenfield. And coming from an ex bodybuilder, this might be sound shocking. But muscle is actually really not just for bodybuilders anymore. You may have heard of the term that strong is the new sexy, but really muscle. And I'm not talking about the big bulky stuff, but just like tight, toned, lean muscle, not necessarily having guns or delts or lats that make you keep your arms held far away from your body when you walk. But lean, wiry muscle, it's heavily correlated with everything from anti aging and longevity to cognitive performance to of course, metabolism and beyond. And it's, it's very, very darn important. Even if you have no desire to strut in a speedo on muscle beach. But you know, I get a lot of questions from people who wonder, for example, how fast you lose muscle when you stop working out or how much muscle you can expect to lose as you age and what you can do about that and, and the best way to maintain muscle when it comes to exercise strategies, diet strategies, supplement strategies, and you know, from cutting edge NASA research that we'll discuss a little bit in this podcast episode on maintaining maximum muscle as you age, to pretty surprising nutrients that have actually been proven by science to keep muscle on your body as long as possible. You're going to discover the answers and many more in today's episode. My guest is Alex James Ritson and, and he's actually finalizing currently a master's degree in sport and exercise nutrition at Middlesex University in London. And he's the co owner of Lean Body Performance, a fitting name considering we're talking about Muscle, that's an online nutrition and training coaching company. And he's actually very well versed in this particular area of interest that he has now. He's studying how protein intake affects lean muscle preservation. So we're going to be talking about everything from the cellular mechanisms behind muscle loss to how we lose muscle as we age, to supplements and nutrients that can stave off muscle loss and much more. So, Alex, welcome to the show.

Thank you so much. It's an honor to be here.

Yeah. And I read a fascinating article that you wrote in a research journal. The article itself was entitled Protein Intake and its Effects on Lean Mass Preservation in Bed Bound and Immobilized Subject. And it was a very good research based article and it generated some questions for me that I wanted to ask you about. But before we delve into that, what got you interested in studying muscle loss in the first place?

Yeah, I mean, if I'm honest with you, I initially delved into a literature review to dive into the literature on what you just kind of neatly put across, which is what is the effect of reductions in muscle mass when you have a subsequent deload or abstain away from training for a while. And the research in that area is relatively sparse. So I just thought what would be better to kind of delve into kind of more research in terms of bed rest and immobilization with a little bit more kind of robust kind of research there. And I was kind of able to kind of draw away some kind of current conclusions from that kind of level, level of research on protein ingestion and it's perhaps kind of effects on salvaging rates of muscle mass throughout those kind of models.

Have you ever been bedbound or injured in a way that kept you from actually maintaining muscle?

Not to an extravagant amount. I've had kind of brief injuries, et cetera, but nothing to the extent whereby I was completely immobilized for two or more weeks, you know.

Yeah, yeah. You know what I find tends to happen with a lot of athletes or a lot of active people is they don't necessarily get bedbound or immobilized. Even though that does happen. People get in a bike crash or whatever. But a lot of times it is that, hey, whatever, I injured my knee and I can't exercise my lower body at all, or I injured my shoulder and I can't do any upper body movements. But I still want to figure out how I can, you know, maintain muscle in a situation such as that. So that, that, that's what I've, you know, I don't think we have a lot of listeners who are in a full body cast, bed bound in a hospital somewhere trying to figure out how to, how to maintain muscle. But instead, you know, for me, a lot of this stuff is relevant when I just can't exercise a specific body part or say if I'm, you know, traveling and have minimal amounts of time to say, you know, lift weights or load the body.

Yeah, absolutely. I mean, there's going to be some certain kind of poignant messages that we put across in this podcast regarding what can we actually salvage in terms of rates of muscle mass, even in subsequent levels of kind of even slight injury whereby you might just be bed rested for a brief spell of time, or for instance, yeah, you quite rightly said just kind of having a brief deloading and not being able to train. And what's the actual extent of the rate of muscle mass loss, you know?

Yeah, exactly. So let's start here. When we get bedbound or when we get into a state where we can't work a specific mus, what exactly is happening to that muscle? I think this will help people wrap their heads around some of the suggestions that we make later on.

Yeah, love it. Great question. So, right, just first off, for all the listeners out there, so they're assigning kind of 40 to 50% of their overall structure to skeletal muscle mass. And that kind of orchestrates roles on nutrient disposal, lipid oxidation, metabolic regulation, and the exchange of chemical energy to kind of contract our work and force transmission. The actual kind of. The importance of skeletal muscle, it can't be overstated, really, because what we do find is that skeletal muscle is very plastic. Us nerds call it plasticity. And it changes and adapts in accordance with different levels of intensity, frequencies and durations and subsequently in bouts or bed rest, unfortunately, it adapts by having skeletal muscle atrophy. So in a recent review by Benjamin Wall in 2013, he kind of showed by looking at all the research on Muscle mass being measured and better rest and immobilization, that 0.5% of total lean body mass per day is shown to be reduced in rates of kind of bed rest, with the initial kind of 10 days demonstrating the kind of reductions in muscle mass.

Now, in that study that you just talked about, where someone's losing 0.5% of lean body mass per day, so we're losing half a percent of our muscle per day when we start to not work that muscle. Are we talking about in that study, for example, total immobilization, laying around or just not loading a muscle, not lifting weights?

So context is so important, Ben. And I think in most of those studies it would be kind of in people who are kind of not got a previous bout of training behind them. So in the context of someone who we're going to touch on this later on, but someone who's probably just come off about training and maybe looking for some super compensation by deloading and just kind of being a couch potato for a week or so isn't going to see these effects. But someone who's been injured kind of completely bed rested or immobilized, the civil severity can be to about 0.5% of your lean body mass per day, with the initial 10 days being a greatest effect. The health implications on this though are quite multifaceted, but they're relatively extravagant. So you'll see kind of reductions in metabolic rate, reductions in insulin sensitivity, increases in fat mass and reductions in functional strength capacity. But with the latter being probably the most extravagant one with, As I highlighted, 0.5% of your total lean body mass being reduced per day, times that by three. And that's what you see for reductions in strength capacity.

Oh, wow. So, so strength. So muscle mass, you lose at 0.5% per day, but actual strength loss is three times. That's a 1 1/2% strength loss per day of actual disuse of the muscle.

Yeah, and in the review by Benjamin Wall, that's exactly what they put across.

Now, is that because you actually lose muscle fibers, Is that a loss in say like oxygenation or blood flow to a muscle, a loss of mitochondria or what's the reason behind that?

Well, there's certainly a reduction in the ones that you just put across, fibers and mitochondria, etc. But I think it's in terms of strength, I think it's a massive neural component that kind of down to that. But in the context of athletic performance we just touched on, which is mitochondrial regulation plummets as well. And you get also kind of increases in tendon elongation and also a rapid increase in, sorry, excretion of calcium as well. So all these factors can affect athletes as well that to a kind of a very severe rate.

What does that mean, an increase in tendon elongation?

So tendons are quite stubborn. Right. And when we actually see from kind of bed rest and immobilization, they're probably the one whereby they won't atrophy so much. But tendon elongation, from what I'm read in a study kind of around this area, is that it makes you a little bit more susceptible to injury. But if anything is going to be a little bit more stubborn to atrophy, it's going to be tendons. But the elongation part, I'm guessing from what I read in the research in the area would indicate it being a little bit more susceptible to injury.

Okay, got it. So this would be with bed rest or with laying around the 0.5% per day or a three times loss in muscle, with a lot of that being related to, just like you mentioned, a big part neuromuscular loss of actual neural feedback from the brain to that muscle, you lose the actual capability to recruit motor units or recruit muscle fibers. Is that correct?

Yeah, absolutely. It's just like I remember recently watching a seminar by Stuart Phillips and he's discussing obviously like how you can, you can attain rates of muscle hypertrophy with kind of low load and high and kind of kind of high load based training. And I think he said in terms of performance, obviously you're going to attain more strength improvements via low load. But that's subsequently just because your body's more used to lifting heavier weight. So it's a massive neural component. And if you transfer that over to bed rest as well, I think it's the same thing. You know, strength reductions obviously get diminished quite rapidly just because they're not obviously seeing that load anymore. They're not kind of being susceptible to that level of contractile load anymore. So I think that's why the rapid.

Reduction that makes sense because when you start to lift weights or you start to strength train, the first benefit that you tend to see comes from a neuromuscular adaptation to training. And then a lot of times, even though you don't see changes in your body in the way that the muscles look, those musculoskeletal adaptations take place several weeks after the neuromuscular adaptations begin to kick in. So it seems to make sense that as you lose it, you tend to lose that neuromuscular component first. What about as you age? So aging is different than bed rest. Right. So as I get older, that doesn't necessarily mean that I'm laying around in bed, but I'm still losing muscle. Why is it that we lose muscle when we age? Have they actually studied this?

Oh, massively, yeah. I mean, this is such a fascinating area. And the thing is, there's not one kind of unique thing that kind of determines rates of anabolic resistance. Again, this is what the nerds of us, myself included, refer to. This anabolic resistance is whereby protein ingestion, that level of sensitivity to protein ingestion is kind of diminished as you get older. But one of the key mechanisms, I think, is just nutrient sensitivity to amino acids, which is induced by physical activity, which subsequently is reducing the elderly. So as physical activity gets reduced, nutrient sensing to amino acids gets reduced as well. And this is what causes forms of antibiotic resistance being one factor. But I think there's also other kind of multiple factors as well, like microvascular perfusion and things of discovery of the uptake of amino acids is not being uptaken. It's quite a complicated area, but research is kind of starting to kind of peel back the layers of exactly what's going on there.

Okay, so you called that anabolic resistance. So we develop this anabolic resistance as we age. And what you're saying is a part of that is due to our inability to actually use amino acids to maintain muscle.

Absolutely. So I think this is also. I think this is induced by a reduction in physical activity that sensitizes the muscle to amino acid ingestion.

Okay, so when we exercise, when we engage in physical activity, we stay more sensitive to amino acid uptake in the muscle to maintain muscle. Now, as we age, let's say, and I plan on this, I plan on lifting heavy rocks and flipping tires and swinging golf clubs and things like that as I age. So I'm gonna stay physically active. How much of this is like the digestive component? Right. Like losing the amount of stomach acid that you have to break down protein into amino acids as you age, or losing the ability to absorb amino acids as you age? Like, how much of it is that versus that lack of physical activity?

I think we just don't know yet if I want to. Ben. Again, they are pinpointing that there is obviously a kind of a signaling defect there as well with MTorq, but also just with the uptake of amino acids, I don't think one Kind of definitive answer is available yet, but I think it's like a combination of all those together. My knowledge on the stomach acid component there would be one that I'm not entirely well versed on.

Would you say that? So if as we age, what you're saying is that that natural decrease in physical activity that might occur as we age is going to lead us to be less sensitive to amino acids, being able to allow us to build muscle or maintain muscle as we age, would you be able to also say that, like in an athlete or an active person who's maybe not old per se? And at the risk of insulting our listeners, we won't necessarily define old quite yet, but let's say that they are in bed rest or they're not able to be as active as they can be. Do they run into the same issue? Like if you're taking in protein powders or amino acid supplements and things like that and you're not active, are you also experiencing this thing that you refer to as anabolic resistance?

So anabolic resistance. So you're referring to people who are just not overly active anyway, even in younger cohorts, would they also experience it?

Let's say I'm injured and I'm taking like a protein supplement or an amino acid supplement. Right. But I'm not able to work out, does that mean that that protein or that amino acid is useless for me in terms of it being able to allow me to maintain muscle?

Okay, I get you now. That's a fantastic question. So in the literature at the moment, you've got about four or five studies that look at young and old subjects in bed rest models with protein intake. And out of the four studies, we've seen a positive effect with kind of protein intakes ranging from kind of 1 to 1.6 grams per kilo body weight being shown to have salvaging effects of lean body mass in young cohorts with only one real kind of obscure study in the elderly. So I think there's more of a sensitization, even if you're bed rested in the young compared to the elderly. So I think there's more to it than just physical activity reductions.

Okay, got it. Now, the number that you just said, you said 1 to 1.6 grams per kilogram.

I know I can't really give a definitive one in terms of the exact protein levels. The reason for that is because the research kind of varies between 1 to 1.6 showing kind of different levels of salvaging in terms of lean body mass.

But when you say different levels of salvaging. What you're saying is if you're in that one to 1.6 grams of protein per kilogram of body weight, all our apologies to the Americans who now have to go do the grams per pound conversion. What you're saying is if you get that one to 1.6, you're getting the amount of protein that's been shown in research to at least allow you to maintain some amount of muscle if you're injured or getting old.

This is absolutely correct. And the thing is, there's also other things to bear in mind. But I just want to touch on that, because although the research says that there's even been a case study done, if we're going to be discussing perhaps athletes here, there was an absolutely fantastic case study done last year on a professional soccer player for Liverpool Football Club. Do you know the team Liverp?

Yeah, I'm familiar with, sure. I mean, I'm not necessarily a rabied soccer fan, but I am familiar, yeah.

Done by the Liverpool St. John Moore's University. And they took a case study whereby the soccer player had a knee surgery. I think it was anterior cruciate ligament. And obviously he was immobilized. And they kind of run through the interventions that they did with him. And what they showed was they. So from the kind of the models that we know of 0.5% of your total lean body mass being reduced per day, they were able to half that extent by protein intakes of 2.6 grams per day. So although I've put across in the literature saying 1 to 1.6 grams per kilo of body weight has been shown in young cohorts to salvage muscle mass. In a case study with an athlete, they increased it to 2.6 grams and showed a reduction of half of what the potential atrophying rates of 0.5% of total lean body mass could have been.

Oh, interesting. So what you're saying is like this idea of, of when you're unable to exercise as much or you're injured, amino acid or protein intake would not be quite as good at building muscle as it would be if you were active because you develop some amount of this, what you call anabolic resistance as you're laying around, but what you're saying is, based on this case study, you could potentially overcome that by just shoving more protein down the hatch. It sounds like almost twice as much protein down the hatch.

So you couldn't obviously completely overcome it. The postprandial anabolic resistance that you see is around About. So this is postprandial anabolic resistance being a reduction in overall muscle protein synthesis is on average like 40 to 50%. But in this athletic cohort of a soccer player, whereby they gave him 2.6 grams per kilo of body weight throughout this case study intervention, he was able to half the amount of potential muscle mass atrophy that they should have seen. With the recommendations that are put across by Benjamin Ball, obviously in that first segment where I kind of touched on the 0.5% of total lean body mass reductions per day. So they were able to salvage quite a significant amount there, which I thought was pretty impressive. But they also did other things though. So I don't think we can just solely put it towards kind of protein ingestion being at 2.6. I mean, they.

What else did they do?

Yeah, so they pulse protein feeds progressively throughout the day, which we knew, which we know from a couple of kind of acute studies, you know, pulsating your protein feeds progressively throughout the day. The transiently trigger rates of muscle protein synthesis was done, which in the research has shown to be of benefit for retentions of lean body mass. They also did electrical stimulation. They also did. What else did they do? They had supplementation of things like HMB, vitamin D3 and fish oils and creatine monohydrate, which is, you know, we can touch on in kind of breaking them all down in terms of what potentially their effects could be on salvaging rates of lean body mass. But all these interventions were done as well. So I think it would be kind of careless of me just to say it was via protein. But it's certainly interesting that perhaps with that in kind of in synergist with maybe the electrical stimulation, which is kind of maybe sensitizing the body to amino acid ingestion, could obviously be of benefit.

Okay, so there are a lot of little things that you brought up there that I want to delve into. The first is you mentioned pulsating the protein intake throughout the day. Yeah, some people will say 20 grams, some 30 grams, some 40 grams, some. What have you found in research if you're spreading your protein intake throughout the day to be the optimum dosing.

So it depends on the cohort. So in younger, healthier cohorts, I believe. Dan Moore, I may be butchering the researcher's name. So I do apologize. But it was about 0.24 grams per kilo of body weight has been shown to maximally trigger rates of muscle protein synthesis in elderly populations. I think it's been around about 0.4 to 0.5 grams. And that's due to the antibiotic resistance. So you need a higher amount of protein to trigger the same response of muscle protein synthesis if you're older.

Okay, so you. So it sounds like what you said was 0.25 to 0.5 grams of protein per kilogram of body weight for each protein feeding that you do.

Absolutely. Depending on, obviously, the age.

Okay, yeah, that comes out to about 20 to 40 grams. Ish.

So what the bros are doing, you know, years ago, is pretty correct.

Okay, gotcha. And then the next thing that you mentioned, after you said that one thing that we could do to maintain muscle is to spread our protein intakes throughout the day, the next thing that you said was estim. Can you explain what they do with ESTIM when it comes to maintaining muscle? Because there's a lot like I've done E stem that's like I've done one called the ARP wave that's literally like a full body intense contraction. I mean, that thing will simulate like a 600 pound squat. And then I've also done the very light E stem that just kind of increases blood flow to the muscle. Do you know what kind of estim we're talking about? Like how long, how often, anything like that.

So off memory, I can't give you a definitive answer in terms of what type of E stem they use, but I know from research they've kind of demonstrated that as little as kind of 10 to 15 minutes per day has been shown to kind of help definitely salvage rates of muscle mass throughout tissues. So I certainly think it provides a level of sensitivity to the muscle to amino acid ingestion. But another one that they didn't use actually was occlusion training, which has also been shown. I don't know if your listeners are familiar with blood flow restricted training. This has also been shown in the research to be a definite viable option, as they showed, like in post operative disuse atrophy in surgical reconstruction of an anterior cruciate ligament. The protocol they did was five sets of five minutes of occluding of the immobilized limb for I believe, three sets during the day, three sets during the day, and it was shown to help salvage more lean body mass. And obviously the cohort that didn't do.

It, the occlusion training that you're referring to, for people who don't know, I think I talked about this on a podcast before, but like, there's this Japanese form of training called Katsu that's Exactly.

Where it came from, I believe. Reading a review by Jeremy Leonecki, this is pretty much what he kind of elaborated on. This is kind of where it initially kind of derived from. Yeah, you're absolutely right. Katsu.

Yeah. So it's literally like putting a tourniquet around a muscle and the muscle gets pumped full of blood, or it doesn't get pumped full of blood, you're restricting blood flow to the muscle so it gets pumped full of lactic acid and then you do the set and apparently you get a big dump in growth hormone. I've done it. It's very uncomfortable. Have you tried that style of training before?

Yeah, absolutely. So in phases whereby I might be dieting and getting leaner and I don't want to over tax myself with kind of heavy loading, it's certainly something to induce rates of muscle hypertrophy. When you look at the facets of what induce muscle hypertrophy, certainly metabolic buildup is one of them that can induce and help signal rates of MTOR and blood flow restriction. Training has certainly been shown to do that.

Okay, so we've got pulsating protein intake by splitting protein into 20 to 40 gram portions throughout the day until we get up to as high as what they use in this study, which was, I think you said 2.4, 2.5 grams per kilogram. That's one strategy. We have electrical muscle stimulation at 10 to 15 minutes per day. We have this use of occlusion training where you're using a tourniquet or Katsu or whatever to cut off blood flow to a muscle group and work it in that manner. And then also you mentioned creatine, you mentioned vitamin D and you mentioned something called hmb. Can you go into any of those supplements as far as dosages, ways that they've been used to stave off the loss of muscle when you're bed rested or you can't exercise.

Yeah, absolutely. Just to touch on the protein one though. So they also kind of prioritize on leucine. So leucine being a key amino acid for triggering rates of muscle protein synthesis. So the thresholds they were looking at there were about 2 to 3 grams per protein feed, which is typically what you'd find in a kind of a 20 to 30 gram dose of high quality protein anyway. But just for people perhaps who are vegetarian, you might be looking at supplementing your protein feeds with that 2 to 3 grams of leucine just to make sure that you maximally trigger that.

But just going, okay, soso just to touch on that real quick. So 2 to 3 grams of leucine. So let's say I'm vegan or I'm vegetarian, or maybe I'm, you know, I don't have access to a nice ribeye steak or whey protein isolate. What I would do is I would have whatever, my seeds, my nuts, my quinoa, my brown rice, protein, whatever. But then I'd also want to get my hands on like a leucine supplement and take 2 to 3 grams of leucine.

Yeah, absolutely. But we just touched on there in terms of, you know, your nuts and your chemo, etc. Just need to bear in mind that calorie intake, overall calorie intake is absolutely important here as well. Certainly being in a calorie deficit has actually been shown to actually increase rates of basal MPS reduction by an additional 20%. So your potential to lose even more muscle mass is going to be heightened if you're in a calorie deficit, for one. But this is where the fine line is, because do you want to get someone fatter to make sure that you can salvage more, perhaps muscle mass throughout their bed rest or immobilized state, or do you want to put them into a caloric deficit to make sure that you don't put on more fat mass, or do you try and find their cute spot of maintenance to try and hold them there? It's a fine line. I think all coaches have to kind of make their own decision on that one. Certainly in the case study, I believe the subject actually lost was in a slight caloric deficit and obviously with that lost larynx of lean body mass. But as they retrained him, his subsequent increases in lean body mass were pretty exponential. I think this is also due to the interventions that we're using that we've already highlighted. But it's a thing to consider. Like, do you put someone in a calorie hypercaloric state so they can perhaps salvage a bit more muscle mass for their bed rest state? Or do you just kind of bite the bullet and go, okay, we're going to just keep your levels of fat mass not being exceeded. Try and keep you at maintenance, and we might see a slight reduction, even more of lean body mass.

Yeah, that makes sense. Kind of like striking that happy balance between maintaining muscle but not putting on too much body fat when you can't exercise. You know, speaking of which, what about the use of. Because I've had a guy named Dr. Minkoff on the show before and he's talked extensively about the use of these Things called essential amino acids, like taking anywhere from 10 to 40 grams of an essential amino acid supplement to help to stave off muscle mass loss or to help an injury to heal faster, things like that. Is there been any research or have you come across anything regarding not just use of leucine, but like essential amino acids?

Yeah, that's been done too. Paddlen Jones took young healthy subjects and put them in a bed rest model, I think it was for like 28 days. And they pulsated essential amino acids I think three times during the day. And as he saw a bit of a more salvaging effect of lean body mass compared to the other cohort who didn't do that, of course. But another thing they didn't actually state in the, in that research paper is that the cohort that had essential amino acids actually put on smidges of fat mass as well. So they're in a hypochloric state as well. So I think that in accordance with the essential amino acids definitely helps salvage some muscle mass.

Yeah, well, from what I understand, like when you're using essential amino acids and you're not active, you get some gluconeogenesis from the high amounts of amino acids and I would imagine that could potentially contribute to fat gain as those get converted into sugars, triglycerides, etc.

Perhaps. So just touching on the additional supplementation that you kind of wanted me to discuss. H and B, vitamin D3 and fish oil. Let's run through it because these are quite interesting areas. First of all, let's touch on creatine monohydrate. So creatine, as I'm sure your listeners would know, is typically used in strength based and power based movements for increases in performance. But in, and in this case it's actually been shown as a kind of supplement to potentially look at increasing intramuscular cellular hydration and the facets of what induce muscle hypertrophy. One of them is cellular swelling and creatine monohydrate has been shown. The research paper is lost on me in terms of the actual name of it. I know it's in regards to immobilization of a upper limb and it was showing that 10 grams of creatine monohydrate was kind of shown to help salvage rates of lean body mass in that study. I can definitely post that study in the podcast comment section if you have one.

Yeah. Any studies that you send over, by the way, for people listening in. I'm keeping track of everything we're talking about. I'm taking Notes here and just go to BenGreenfieldFitness.com MaintainMuscle that's BenGreenfieldFitness.com maintainmuscle and I'll put links to any studies that Alex sends me along with some of the things we're talking about like Compex or Electrostim or Kaatsu or Leucine, things like that in the show notes. But creatine monohydrate, typically you'll see like 5 grams per day as a good maintenance dose. But what you're saying is that when you're injured or you're trying to stave off lean muscle mass that a closer to a 10 gram per day dose of creatine could be beneficial?

Well, that's what they just put across in that research paper. But also in that case study, funny enough as well, they used 10 grams initially for two weeks and then they kind of brought it down to 5 grams. Perhaps it's because the individual might have not saturated the muscle of creatine previously and that's why they're probably trying to induce that. But the case study just after the first two weeks of 10 gram supplementation reduced it down to 5. So it might just been a case of trying to saturate that tissue quite quickly on throughout their kind of immobilized state.

Gotcha. Okay, so the next one that you mentioned is hmb, or I believe you refer to it as HMB as you, as you folks do. But HMB is something I've been actually seeing a lot of research about when it comes to performance, muscle gain, etc. It's kind of like on my list of supplements to try. And I'll admit I haven't done much with HMB yet. But tell me about hmb, what is it and how would it work to stave off muscle loss and what would the dosages be?

Do you know what? HMB is a bit of a quagmire of an area. I think the research in this area is particularly mixed and I think some of the research methodology is not overly great, if I'm honest with you. From the research that's been shown in bed rest models, there was one particular research paper, and it's the only research paper where they saw a salvaging effect in the elderly. And they gave the elderly subjects 0.8 grams per kilogram of body weight plus 3 grams of HMB and they saw a reduction in the rates of atrophying of lean body mass compared to obviously the cohort that didn't have the hmb, which is Quite baffling considering there's been other research papers on the elderly with similar dosages of leucine, which is, you know, which has been shown in direct comparison to HMB to be a better benefit for increasing rates of muscle hyper muscle protein synthesis. Sorry. And reducing rates of muscle protein breakdown. So I'm actually not convinced on it if I'm honest with you. Its effects on muscle protein breakdown are still kind of highly debated considering it's not a secret toad for insulin as well. So I'm still on the fence of HMB if I'm honest with you.

D Ben, what is hmb? For people who don't know, it's a.

Metabolite of leucine and it's been shown.

What's that mean? It's a metabolite of leucine.

So it's a, would be the easiest way of explaining it. So it's a key component of leucine that's been shown just to increase rates of muscle protein synthesis, has been shown to reduce rates of muscle protein breakdown. I'm just not overly convinced by what it's been in comparison to leucine. She's been shown to maximum trigger rates of muscle protein synthesis in direct comparison to it. It's never kind of been better in direct comparison via research. And then when you put it into certain, in the research papers that I've seen, it's not, it doesn't really make too much sense for it to see the benefit that we do. I think it's down to the methodological issues that have been shown and I think in. I'm just not overly convinced with it from the research that I've seen. It's just the effects of what you see with HMB are quite extravagant and I think it's more down to the methodology than anything else. Poor methodology that is.

Yeah, that's, that's interesting especially considering like you can get a ton of leucine from, from eggs, from chicken, from salmon, from beef. I know it's pretty high in, in whey protein and dairy sources as well but, but considering how easy it is to find leucine in relatively high content in food based sources like, like whole food nutrition that you could eat when laying around or when under bed rest or when you want to build massive amounts of muscle and just get swole. It sounds to me like from a budgeting standpoint that leucine or food sources of leucine might be favorable for HMB or compared to hmb.

Yeah, they've done a recent paper where they directly compared leucine to HMB and the effects and they showed that increases in rates of muscle protein synthesis were a greater in leucine, but also reductions in muscle protein breakdown were greater in leucine as well. And they've compared leucine to elderly subjects in bed rest and showed no effect on rates of muscle salvaging. But yet in one study whereby they supplemented with three grams of hmb, they saw very, very, very significant effects of lean body mass retention. I'm just not overly convinced about it at the moment. I mean, of course research is all about being tentative about your, your observations and making sure in light of new research you change your opinion. So obviously I'm always willing to do that. But just at the moment I'm going to be sitting on the fence of HMB because I'm not entirely convinced by it.

Okay, got it, got it. Now, what about you? You also mentioned, of course, vitamin D and fish oil.

Yeah. So vitamin D3, there's some cool research kind of demonstrated here in vitamin D3. They genetically knocked out the vitamin D receptor in mice and they demonstrated an impairment in the kind of regenerated muscle capacity and a smaller, more varied muscle fiber typ. But more recent research in the elderly have shown that vitamin D deficiency is kind of correlated with a heightened risk of falls and thus could be used as a supplement for the most susceptible elderly patients who are kind of frequently bed rested, but in relation to kind of increasing rates of muscle hypertrophy. Certainly more research needs to be done in that manner for sure. But it's definitely again another kind of interesting area for the people who are more susceptible to forms of bed rest and who may be vitamin D deficient, it might be something definitely to consider.

How much vitamin D was used in that study?

Good question. I think it was 800 international units.

How much?

800.

I believe 800 international units of vitamin D. Correct.

Yeah.

Okay, so that's not a ton of vitamin D, considering a lot of supplements now are including 1,000 to 2,000. I always like to mention when I talk about vitamin d that vitamin K2 is always important. When I take vitamin D, I always try and take about, about one tenth as much vitamin K2 as vitamin D. So if I'm taking 1,000 international units of vitamin D, I try to include about 100 micrograms of K2 to enhance absorption and limit the potential calcification effects of vitamin D on the body. But I think one thing, and I don't know if you've looked into this much, is the potential for vitamin D toxicity once you exceed about 80 for your blood levels of vitamin D3. So I, so I personally think that the use of vitamin D should be paired with wandering into the doctor's office and slapping down the 40 bucks. At least that you can do here in the US Just get a blood.

Test for vitamin D. Yeah, I don't think that wouldn't, I think that would be a relatively smart thing to do. Levels of toxicity. I remember briefly running into this on the examine supplement page and running through that. But yeah, I think what you put across there definitely a smart thing to do if you're looking to get your vitamin D3 levels kind of tested and obviously off the back of that getting some supplementation. But in the UK for instance, and they've did this in athletes as well, are relatively deficient. So just getting it tested anyway to see if you're deficient and obviously supplementing off the back of that would be a smart thing to do.

Yeah, a lot of people are deficient. I look at a lot of blood tests of folks and a ton more people are deficient than not. It's like 9 out of 10 people are deficient and you'll run into a few people who are like 80, 90, 100. And most of them I found they're taking, taking like 5,000 plus international units of vitamin D a day. So they' rethey're onon a supplement already. Now I wanted to ask you about some of the NASA research that's pretty intriguing, but before we do, there was one other that you mentioned that was fish oil.

Yeah, absolutely. So research around about three or four years ago now, I think they looked at kind of the postprandial increases in MTOR regarding fish oil supplementation. How would this be? Via kind of, I think it was hyper amino acidemia infusion. So it kind of showed there to be an increase in MTorq signaling, which is a key potent kind of signal for increasing rates of muscle protein synthesis with around about 3 grams of fish oil. And this was shown in young and elderly subjects. But recent research from a wonderful university called Stirling in Scotland, they're doing some absolutely brilliant research there. They've shown in a recent cohort study that young subjects with fish oil supplementation around about 3 grams in kind of synergies with protein intake and resistance based training showed no effect on muscle protein synthesis rates. So it's a tough one at the moment because a more practical based study was done recently where they showed no effect really with increases in muscle protein synthesis in Synergists with resistance based training, protein intake and fish oil supplementation. But this research hadn't actually been done in the elderly yet, and whether this would actually transfer into a bed rest study as well. And if we saw any heightened effects on muscle protein synthesis in the postprandial state. So it's still tentative. It's looking more likely that it doesn't have too much of an effect, but it could potentially have an effect. We just need more research there at the moment.

I know a lot of people are kind of thinking this as they hear you talk about 10 grams of creatine monohydrate, 3 grams of HMB, 800 international units of vitamin D, 3 grams of fish oil, 2 to 3 grams of leucine, maybe throw some essential amino acids in. If people are thinking, okay, well I just want to get as big as possible, I just want to put on muscle. Let's say we've got whatever a high school football player listening in, maybe somebody who's a skinny person who wants to gain weight or get some curves. Have you ever thought about the idea of just stacking all this stuff together as a muscle gaining strategy? Or do you think that type of approach is unfounded or could be a waste of money?

I think it comes down to a matter of economy, I think money, time and mental stress load of actually incorporating all these things together and whether it's actually scientifically needed. I think no. I think being in a hypocaloric state, kind of prioritizing on progressive overload with your training and making sure that you get at least kind of 2 grams, 2 grams per kilo body weight of protein would be sufficient to do all of that anyway. I think creating monohydrates certainly has its place and vitamin D3 in someone who's deficient perhaps would be there too, but I think that's it. And also making sure that you kind of pulsate your feeds progressively throughout the day, which I think you'd probably do anyway to having 2 grams per kilo, but weight if you're relatively sensible with your nutrition. So I think it's unnecessary to kind of throw them all together. As a coach, you want to try and do as little as possible, but to have the biggest effect. And I think just, you know, put some into a hypochlorous state, making sure they're kind of focusing on recovery and progressive overload with their training and having sufficient protein should do the trick.

I think what's, what's kind of interesting is this idea that, you know, a Lot of times in the studies that you're referring to where people are maintaining muscle mass with the use of these strategies, they're not lifting weights, right? Like they're bed bound. And a lot of people, including myself, I get this mentality that if I'm traveling or if I'm unable to lift weights, I should not take creatine or I should not take amino acids, or maybe I don't need to take my fish oil or my vitamin D because I'm not stressing out my body. But it sounds like what you're saying is that these are actually strategies that you can use to maintain muscle when you can't work out, and that you're still going to get a big benefit from a muscle maintenance standpoint, even if you're not, say, loading the muscle when you're using strategies like this.

So things like fish oil, you saturate the transmembrane and you wouldn't have to kind of like, you know, you wouldn't have to be worried about not taking it for two or three days or things like creatine as well. You can saturate the tissue and not have to worry about not taking it for two or three days either. I think they shouldn't be your key thought behind increasing rates of muscle mass or trying to salvage rates of muscle mass. Especially if someone's an athlete and they're just taking two or three days off, they shouldn't really be worried about muscle mass reduction. Because from my practice and from what we can actually glean from the limited data, you wouldn't really see too much for a muscle mass reduction there. If it's just basically a scheduled deload or something like that.

Yeah. Okay, makes sense. Now I want to talk about NASA and astronauts. I was reading an article yesterday about this new exercise device that they developed for the space station Orion. And it's this thing, and I'll put a link to it in the show notes. I noticed people want to look at it. It's called a rocky device, and it's like this ultra compact, lightweight exercise device to help astronauts keep muscle on when they obviously don't have exposure to as much gravity. You mentioned in an article that I read that you wrote about research done in astronauts and muscle mass maintenance, what did you find when it comes to what NASA or other people in the astronaut industry have done to help help astronauts keep from losing muscle that might be applicable to the rest of us?

Yeah, great. Well, funny enough, things like bed rest models actually transfer, well, quite nicely into space models as well, just because of obviously the zero gravity component. So over the past 30 years, in particular, like SkyLabs, Space Lab Cosmos and MYR Flights, kind of highlighted like an extensive kind of biological concern with forms of microgravity. So things like reductions in functional strength capacity, force production, or of course, reductions in lean body mass. A real nice study that came out by Trapp and colleagues in 2007 who was kind of more kind of focusing on forms of space flight microgravity and trying to look at salvaging rates. And they found some interesting stuff. So 24 young female subjects were subjected to kind of 60 days of bed rest. And they had kind of three different cohorts. One was bedrest. One was bedrest and nutrition, where they gave them 1.66 grams of protein plus bed rest, of course. And then the other cohort was kind of 1 gram of protein, but with an exercise intervention that was kind of more applicable to what you could do in space flight. So I think they did things like supine squats and some kind of some treadmill activity which can be done in space. Quite fascinating. Absolutely fascinating when I look at some of the YouTube videos of what they could actually do in terms of activity, exercise in spaceflight. But what they found was in this study was that the bed rest nutrition was 1.6 grams of protein, but obviously with no exercise, wasn't able to kind of salvage rates of muscle mass or strength. However, the bed rest with the exercise component and the 1 gram of protein was able to salvage a greater degree of muscle mass and strength. So what we kind of, what we can kind of glean from that is that the exercise component trumps the nutritional component when it comes to rates of kind of salvaging muscle mass and certainly is more the important factor when it comes to space based programs and should be kind of more the focus. So what you put across there in terms of the interventions that they're trying to put across for exercise is certainly going to have more of a benefit than the actual nutritional component. Not saying the nutritional point isn't important, it absolutely is. But the contractile stimulus is obviously going to be the key part there. So the things that you're seeing in what you're going to be putting across to your listeners in terms of the video and the article on new interventions for exercise to kind of provide a contractile stimulus, which is absolutely amazing. And what they can do in space now is just incredible. To do that, to achieve that.

And even if you can't necessarily move because you're in bed, you could Use something like electrical muscle stimulation.

Absolutely.

Okay, now, kind of playing devil's advocate here. We've talked a lot about protein intake and I know because we've had discussions, questions about this in the past. Protein intake, when especially you're engaged in excessive protein intake, could potentially activate this MTOR pathway that you already discussed, this anabolic muscle building pathway, to the extent that it could increase the rate at which telomeres shorten or decrease longevity. How would you say that one should strike a balance between enough protein to maintain muscle or to build muscle and not getting say, like a shortened lifespan or a decrease in longevity?

Okay. Wow, that's a really loaded question. There's a couple of papers, one by Sharples that I'll post in the comments section and one by Leon Hamilton and Leigh Breen, two key researchers from the uk. We try and touch on this quite briefly, but I'll provide my kind of my two pence or cents or wherever you're listening from and that currency. But basically there was a study by Ruiz and colleagues where they kind of carried out a really, really comprehensive study, really, where they took 8,000 participants and followed them and looked at the influence of muscle strength and cardiovascular fitness on healthy aging. And the subjects underwent vigorous strength tests. And what they found was that individuals over the age of 60 classified in the lowest third of strength, were 50% more likely to die of all cause mortality than the individuals in the upper set of strength. So although maximizing MPS isn't indicative of strength improvement with neural components we've touched on before playing, the predominant factor, increases in muscle mass, would certainly help. Right. So the anabolic resistance, as we know, is quite prevalent throughout the elderly with MTORQ signaling, what you touched on being reduced, leading to a cascade effect of sarcopenia. So studies indicate that protein in cohesion with physical activity does in part help sensitize and salvage muscle mass. So we know that aging leads to anabolic impairments in skeletal muscle mass, which in turn some mass and strength. So factors directly associated with mortality rates in elderly. So it makes sense to me that maintaining physical strength is a key strategy to lead to healthy aging. And the preservation of muscle mass is increased by the MTOR regulation of muscle protein ingestion. Sorry, sorry, sorry. Protein ingestion. So I think they complement each other here, but we definitely need more research in this area.

Ben, here's my take on this. I think that maintaining muscle and having plenty of muscle as you go into old age, and I was telling one of my friends this yesterday, actually that my goal is to actually, I'm pretty lean right now. My goal is to actually put on a little bit of muscle and get a little bit heavier as I go into the latter half of my life for a lot of the anti aging benefits that you, you've just described. But for me, my strategy is that on days where I really am attempting to put on muscle, on days where I am lifting heavy, I'm trying to get close to, I'm not way up around that 2.5 grams per kilogram number that you mentioned they studied in this athlete who was recovering from an ACL surgery. But I'm getting close to about 0.7 to 0.8 grams per, per pound of protein, that 1.5 ish grams per kilogram range on those days where I am lifting heavy, on those days where I need that higher mps, that higher muscle protein synthesis that you talked about. But then my strategy, Alex, is I've been doing an intermittent fasted or a protein fasting approach where I'll have some days where I restrict protein, easier days where I might be doing yoga or sauna or like an easy paddleboard on the river where I know I am not getting a lot of eccentric load on muscle. I'm not getting a lot of need for muscle repair and recovery. So I've, you know, I'm, I'm a fan of, you know, kind of like the, the true Mediterranean diet, not the modern Americanized version of the Mediterranean diet. You know, having those, those periods of time in your life when you fast, when you restrict calories, when you get cellular apoptosis and detoxification and then those times that you're in an anabolic mode. I think it's okay to kind of have both.

It's definitely interesting. Yeah, I mean it's a tough one in terms of what you can glean from the research on that one and whether that's the risk or benefit. But I'm guessing from anecdotal experience is working for you.

Well, I don't know. I'm not 100 years old yet, but I'll ping you in about 65 years unless you know how that's going for me. One other, another quick question I wanted to throw out there, completely random question, but I know some people have talked about it, so I wanted to run it by you. Infrared sauna or sauna in general, and the induction of heat shock proteins as a way to keep the body from losing muscle or to maintain muscle when one cannot say, lift weights. Have you looked into that at all? The use of heat or Sauna for muscle maintenance.

Ben, I'm really sorry, mate. I haven't.

Yeah, I was just curious. I know I threw you a curve ball there, but I know I interviewed Dr. Rhonda Patrick and she talked a lot about how hyperthermic conditioning can lead to an induction of heat shock protein expression that could stave off loss of lean muscle. And that's a strategy that I'll use sometimes because obviously you can't just lift weights heavy each day. But on some of my recovery days, I'll do yoga and get to the point where I'm relatively hyperthermic in a sauna, kind of going after that heat shock protein expression. So. So it sounds like you haven't looked into it, but I'll put a link in the show notes for people who are listening in. Just go to BenGreenfieldFitness.com maintainmuscle and I'll link to that interview that I did with Rhonda where we talked a little bit about the potential use of heat to maintain muscle as well, which perhaps you talked, Alex, about occlusion training and also electrical muscle stimulation, some of these supplements. It's possible that maybe some use of a sauna could help as well.

Well, but I'm a lifelong learner, so if you post those papers, I'll definitely read them.

Yeah, for sure. And of course, all the papers that you mentioned as we were talking, I know you're going to send to me and I'll link to them for all of you smart cookies and geeks out there in the show notes for this episode again, which are going to be@BenGreenfulFitness.com maintainmuscle and also link over to Alex's Twitter account, his webpage, where you can follow him and some of the stuff that he doing with lean body performance. So, Alex, thanks so much for coming on the show and sharing this stuff with us, man. I think we're gonna keep a lot of people really, really swollen.

Bed rest gang, all the listeners. If you've got any questions, please just email me@alexritsonptmail.com for any kind of concerns or questions regarding this podcast and I'll be happy to help.

Oh, dude, we get like 100,000 downloads an episode. You just screwed yourself. You better hire an email assistant. You know, and one thing you could do, too, because I know Alex said his email address really fast, which may actually be his salvation. You can always leave a question in the comment section too, and I can forward those over to Alex and he can reply there as well if you guys would like to see the discussion as it gets generated. That's another option. Either way. Alex, thank you so much for coming on the show, man.

Thank you for having me.

All right, folks. Well, this is Ben Greenfield along with Alex Ritson. And again, the shownotes are@BenGreenfieldFitness.com maintainmuscle. We're signing off. Have a healthy week and have fun maintaining your muscle. You've been listening to the Ben Greenfield Fitness podcast. Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.