#696 - Dr Gabrielle Lyon - How To Build More Muscle & Supercharge Your Longevity

27:4138 percent of the first million drafted were unfit for war. They said things like they had flabby muscles, they had poor eyesight because of vitamin A, They didn't have any teeth. Obviously, because of the Great Depression, there was a lot of under -nourishment. This became a real threat. This was the first time that the US really identified that nutrition was a real threat. They issued a series of, I don't wanna say propaganda, but a way of educating. And what they issued was, in one hand, they said, are you going to support Uncle Sam? And in order to support Uncle Sam, here's what you're gonna do.

28:20And what they said was, you're going to eat high quality proteins. You're going to eat liver and eggs and beef and dairy because you need to have strong muscles. This isn't a, this isn't a 40s. No idea. They said, you're going to minimize processed foods and you're going to eat fruits and vegetables and even have some, like it was like sodium electrolytes. They, I was really shocked when I, when I saw that part. And then they said, are you going to help Hitler? and they showed an individual who was skinny and scrawny. And here is the way you're going to help Hitler. You're going to not eat high quality protein.

28:57You're going to eat processed foods. You're going to eat white bread. In the 40s, they established these guidelines and they started this whole campaign about how we could be stronger and more capable, and vibrant, and courageous, and that's what we needed. Then, obviously, all these high quality foods were shipped overseas to the soldiers. They started to, for need, increase in process foods. You have Sylvester Graham and John Kellogg, Sylvester Graham was a minister. I don't know if you've heard of him, but he was kind of the move that the godfather of this, what do you call vegan movement? And he started to talk about the idea that in order to be a moral person, you needed to reduce any kind of animal products, you shouldn't drink, you shouldn't have sex, you should eat very plainly.

29:48And he got a really influential follower. And that was Kellogg, who then made granola and a graham cracker. And so how much legitimacy is there around the Kellogg origin trying to sow the men, cook them into low testosterone? Give me, you put your 10 -file hat on and let's go. Okay, fine. I mean, I wasn't around at that time. I wasn't there. But I think what happened was there was an early recognition that high quality foods were imperative to help in wellness. And when we were going to lose the country, this became a high priority. Then obviously we have a nation to feed and ultimately a global, a global industry and just a global feeding zone, right?

30:40We have to do those things. process foods, which are under two different jurisdictions and commodities in these whole foods, require money, they get money, they make money. Whoever has the money controls the narrative. So whatever the agenda is, whoever has the most fortitude behind that gets to control the narrative. And this is kind of circling back to the question of why is it so crazy? I wake up and I choose violence, Chris. I post something and I go, oh man, I cannot wait. Just, just, and I have to do it. So we talked offline before. And if you have a certain skill set, then you have a responsibility to share that.

31:23Is that true? I think so. I've been a physician since 2006. I've seen a lot of life and I've seen a lot of death. And so why I even started talking about this is because I saw so much misinformation. And here I am as a geriatrician at the bedside of like, like, oh, signing this death certificate, and then this death certificate. And all these people are talking about how, you know, going plant -based is gonna save the world and all this other BS and not thinking about how that is going to influence the midlife people and what that end result is going to be. What is the impact of going plant -based on people that are no longer 23?

32:05I think that we are going to see an epidemic of osteoporosis and sarcopenia like we've never seen before. What is that for people that don't know? Sarcopenia is a loss of skeletal mass and function and osteoporosis is bone density. And could you be young and plant -based? Could you get all the protein? Again, this is a very, just like a very small perspective, this idea that plant and animal foods that it's all just about protein. Protein, we talk about generically, but protein, that's 20 different amino acids. Nine of which are essential. Those nine essential, those are individual nutrients. These things are not interchangeable.

32:47We're not just talking about dietary protein. We're talking about food as a food matrix and the things that ride along with it. For example, if you're eating high quality protein, you're getting creatine, you're getting carnitine, You're getting touring, you're getting ancering, B12 iron. These things are necessary for young children and women. And as you age, it's not like your appetite increases. The lower your quality of protein, the lower your diet is in protein, the higher it needs to be animal -based. Because you're not just eating for dietary protein, you're eating for other nutrients. And so what do I think you could be plant -based and healthy?

33:26I think that you can, I think that the body is very adaptable. I think we're going to start to see ways in which maybe they got microbiome plays a role, but do I think it is an ideal diet for an aging individual? Absolutely not. I don't. And this is the experience. Looking at the way to improve your body composition, what are the principles of optimizing body composition in your opinion? Well, nobody likes to hear this, but you track your money and you track your speed, right? Say yes, Chris. Sometimes. Monday Wednesdays and Fridays. You got to track your food. It's just a reality. I know people want to do intuitive eating.

34:09I'm sorry guys, just get a sense of what you're actually doing. And it's annoying, but if you have goals and you know that you need to hit those, you have to be able to track. Okay, what is your, I'm going to stop you and get tactical each step of the way. What is the most seamless way that you have found to track food? Because it's not my fitness pal, and I will fight you if you say so. So what I do is different than what I think is the easiest thing. Right. What's the easiest thing? Like chronometer, just an app. What's your favorite? What do you tell your clients to use? Chronometer. Why? Because it has just like nearly everything in there.

34:46All these different nutrients. Again, typically the label only has 14 different nutrients. Is that is chrono me to the one where you can take a picture of your food or you can speech it in and say like one Slice of toast with three eggs hard boil blah blah Well again, I haven't been using it because I didn't I didn't tell you what I do What do you do? I haven't you know I want to know what this this tapped into the matrix version is It is called the pen and paper God that's lame. Oh no, are you a lame? What are you talking about? You can write it and then you can look at it. I'm old school. I'm old school, man.

35:20Yeah, old school. Yeah. Okay, so I write it down, but then I know exactly what I'm doing. And also, by the way, my food diversity is not huge. And you're going to be talking to our good friend, Pedro Esculean. I want you to ask him what he had for lunch three weeks ago on a Wednesday. He'll be able to tell you. Is it because it's the same thing that he had for lunch every other day? Yep. Consistency. So once you know what you're doing, then like smooth sailing. Well, I mean, this was what a really interesting insight from Alex Homosi. He says that most people work really hard at trying to alter their diet, and alter their caloric intake, and stuff.

35:58But really, your diet isn't a diet. It's probably five meals that you've got in the locker that you eat very, very regularly. And it's a case of just nudging these five meals, right? Or getting rid of one entire... Okay, I don't do the bollignaise anymore because it turns out that I'm an addict for cheese and that cheese is making it 2 ,200 calories. Right, it's not that complicated. But if you were to go on social media, you would spend at least six months in paralysis. True. What doesn't get measured doesn't get managed. So you need to be measuring the food that you're taking. At first, at first.

36:38And I'm gonna walk you through, And I actually talk about this in my book forever strong. You know, we haven't really mentioned it, but I wrote this book forever strong so that it could be something applicable for everybody. You literally can read it. It talks about the history. I know that you read it. And it's, you know, evidence -based, it's an evidence -based manual. And when you think about how you put together a diet, it's quite simple. Well, what I recommend and what the data would support is 0 .7 grams of protein per pound body weight or a deal body weight if you want to go higher. So simple.

37:18So you're what 88? 180. Call me 180. Okay, 180. Is and you're happy with that weight? Feel great. Yeah, I should recomp. I need to lose a bit of weight. I actually did a Dexa at Fountain Life in Dallas a few months ago. And it came back at 19 .5%. And I was like, if I'm 19 .5%, I'm the leanest looking. I don't know where this weight's gone. It's like all in my foot or something. And then when I do an electrolysis, I'm much closer to kind of 13 .5. Also, I don't know whether the dexal was having an off day. Yeah, clearly having an off day. That's interesting. And then it'll be interesting to see as you track your skeletal muscle.

38:01but again, we have to understand that that is, do we know your optimal skeletal muscle? I would say we don't. So yeah, 180. So I think I tried to hit 180. I tried to go for one gram per pound. Right. But it's hard. Why is it so hard for me to hit high volume protein? You're not hungry. The body, you're not hungry. So dietary protein number one, I wanna mention something that I think often gets overlooked as we talk about, quote, macro nutrients. is that protein need is really the only macronutrient that changes as you age. The intake or need of carbohydrates and fats like who cares? It doesn't actually change.

38:44But the biological and physiological processes of the body require more protein as you age. More protein as you go through if you have a catabolic crisis or if you're going through cancer or if you get burned. And no other macronutrient changes in that way. So we have to get the story of dietary protein right. We just have to because it is the most effective macronutrient when it comes to body recomposition, when it comes to body recomposition, when it comes to understanding that each of these amino acids have diverse biological roles. Again, we are talking about dietary protein, but if we look at these other amino acids like threanine, threanine is essential for mucin production in the gut.

39:36Trip -de -fant is important and essential for serotonin production. Phenolalanine is critical for dopamine production. Lucine is critical for m -tore signaling, which is important for muscle protein synthesis. So we talk about protein, but what we really are talking about are these individual nutrient needs, which by the way I think that that is the next iteration of the protein conversation is really looking at these limiting amino acids. But I'm digressing, so I'm going to go circle back to the .7 to 1 gram per pound ideal body weight. Everybody who does that, in my opinion, is going to do better.

40:17When it comes to people who say, Dr. Lyon, that sounds great, but I get to 90 grams of protein a day and I'm just sick. What do you advise to your clients? What are your best hacks for increasing that protein intake? Are there any recipes, any food types, any, what is it that you give to people? Well, the question is, why are they really struggling to get that? It is very satiating, you know, it does influence GLP and PYY gut hormones. The question is, why are they so full? Is it because potentially they're metabolism, they've had some kind of adaptive thermogenesis, or is it that they just don't have a protein appetite?

41:00So the first thing that we do is we get a sense of what their total calories are. That's the first thing you need to do. You have to know what you are ingesting, again, like you said, what you measure or changes, tracks, blah, blah, blah. Now, understanding that hitting that first meal of the day and hitting it early on, again, a lot of people talk about fasting and pushing that fasting window later, I think that there is something to be said for eating after you are coming out of an overnight fast. Your muscle is primed to be stimulated, whether it's an hour to two hours after you wake up and then stopping eating later on.

41:30So you begin to retrain your body through feeding patterns. The fastest way to increase dietary protein would be a protein shake, whether it's a or even a way concentrate. So it doesn't have to be an isolate, a concentrate. Concentrate has immunoglobulins, lactoferin, alfylactylbumin, other. Again, thinking about food more than just the macronutrients. I think the old school way, and we could tease Stan about this who's kind of evolved more into the more nutrient dense foods, but the old school way is just thinking about the macronutrients. The new school way is thinking about the other low molecular weight molecules and things like amphibians and other compounds that have metabolomic properties, other intermediate properties.

42:18One of the things that I used to was, I got into fasting when David Sinclair first came on the scene, probably five years ago, Ish. I went to go out to see him in Boston and he tells me all of this amazing stuff and I still think there's a lot of there there with it, but I noticed that my composition suffered. I didn't, I felt soft. I looked soft comparatively. And one of the other thing, I've been through every bro science diet. I did carb back loading, then I went into carb night, then I did skip loading. Did you ever do skip loading? No, this is impressive. I've never even heard of that one.

42:57Right. So skip loading was go carb free throughout the week and then on a Sunday eat as many carbs as possible. It was advised to try and have a full box of cereal just for breakfast. And it was like, if you can get yourself to like a kilo of carbs by the end of the day, that was considered a win. And just every single different one, what I realized was, I'd kind of inculcated this sacrifice reward dynamic. I often cheat. If I am going to cheat on my diet, I'll do it in an evening time very rarely in the morning. I think this is quite common. How many people are picking up a Mars bar first thing in the morning, but they're maybe do it on an evening, the world powers depleted, they're in the house, whatever, whatever.

43:35But my sleep is really, really negatively impacted when I eat even within like two and a half hours of going to bed, which is awful because out here in Austin, everyone wants to go for dinner at eight o 'clock at night. I'm like, right, okay, dude, but by the time I finished eating, that's nine, which means that I can maybe get some good sleep by midnight. And it's a Tuesday, right? So yeah, I'm coming round to the idea that still, you know, have the window if you want to do like a 16 .8 if that's what you like the sound of or like you know even in 18 .6. But I think that pivoting that window a little bit earlier and then trying to maybe cut off calories at 6 p .m.

44:12at night something like that sounds like a pretty good way to start it. I think it's a great way to start and then understanding the next macronutrient that I think about is well before I say that I number one the data supports that the 24 hour dietary protein intake is most important. Meaning how much protein you have during the day, right, within a 24 -hour period. I would say that protein distribution matters and there is kind of two schools of thought. One is that just make sure that you're getting it all in. It doesn't matter how you do it. I would say if you believe that, then you wouldn't believe any meal distribution study or any study that that indicates muscle protein synthesis happens because it happens at that first meal.

44:58For all the majority of the literature that I've ever seen, it's always about this first meal, which in my mind means that a meal distribution matters. It's not just about this 24 -hour period where you're just having one meal in the day. So for the listener who's thinking, gosh, you know, they're thinking two things right now. They're thinking, does Chris really have 19 % body fat? And then the second thing that they're thinking is, well, how am I actually going to move the needle if I want to lose weight? And I would say, obviously, you figure out your chloric intake. I talk about that in the book.

45:30There's, it's just super easy. It's a calculator. And then you begin to segment out how you were going to ingest dietary protein. I wouldn't go above 50 grams per meal, you know, for someone like you, I'd probably hit 40 to 50 at that first meal for sure. It's not very much data for that middle meal and then potentially that last meal But probably closer again 40 to 50 and then 40 to 50 grams of protein in the food is A massive amount like it's a very very large amount of meat That's it's like two two scoops of way protein. Oh, that's true If you were looking to do it through supplements, but if you're looking to do it Let's say that we're having it through salmon or we're having it through eggs.

46:13I mean, how many eggs? What's an egg? Eight. That would be six. Yeah, six eggs would be about 30 grams. When you've got six eggs, there's no joke. Okay, hang on, hang on. You brush past this, forcing 50 grams of protein. Six eggs. So it's five grams per egg -ish. Yeah. Right. Okay. So you're talking about 10 eggs. 10 eggs is a lot of eggs. We better get started. I, it's so it seems. But this is my point, right? you look at this plate and I think even for me now I see it now in myself. I'm like, oh God, every single, I think you did an Instagram, you did an Instagram post about this, right? You hit your protein.

46:49You hit your protein goals for the day and then you realize, God, I've got to do it all over again tomorrow. I have an amazing team that makes me, they tell me I'm more relatable if I look like an ass. So. Yeah. How's that going? No, grossing. Oh, it's so terrible. But yes, this is, you are not alone in that. Now, I'm gonna challenge you. Austin, so we live in Houston. I have been down to Austin, and they have a lot of restaurants. I can't even believe, I mean, they have a lot of restaurants. You go and you order, and one of those restaurants, a, like, filet. And this, my friend, is your eight ounce filet.

47:25That true or not true? Oh, time seven, I mean, you're getting almost 60 grams of protein. And that tiny little filet that you spent $75 on. So can we do that? For enough, I should go for filet more on first thing in the morning. Okay, so we are making sure that we measure, because that's the only way that we can manage this stuff. We are prioritizing protein within a 24 hour window, we're aiming for 0 .7 grams per pound of body weight or ideal body weight. We're also then considering that there is a little bit of protein timing going on here in that much more than about 40 to 50 grams of protein in any one meal is probably going to be a little bit wasted, presumably from an efficiency perspective.

48:10But just, I'm pretty sure Stan taught me under 20 grams, under 20 to 15 grams, it can actually be metabolized in a different way. So it's like, the sweet spot appears to be more than 20 less than 50, something like that. I would say that that is right. When you're getting below 20, again, you're not hitting that loosey and threshold. and Lucy is one of the essential amino acids. It's that branch chain amino acid. And my mentor of 20 years was the guy who put the science behind a lot of the literature that we stand on today. This idea of protein dosing, this idea of a meal threshold, this was some of his work that he put out into the world, which is incredible to see this innovation before they knew that Lucy somehow stimulated muscle, but he really connected the dots and then translated it over to humans.

49:04And this idea that something below a leucine threshold to the average leucine threshold for an adult is two and a half grams. By the way, the RDA for leucine, and we'll talk about this in another podcast, is between two and three. For the whole day, but the actual, the actual influence and more optimal amount is two to three grams of losing per meal. Yes, there's an imbalance here between what is being recommended and what is optimal. I mean, the aging population is the fastest growing population. I was just looking at data earlier. But so the idea of the 20 grams or less is it will get counted towards calories, but it's not going to do anything for muscle in that way.

49:53Okay, so just to round out the timing thing, which I think some people will be considering, because everyone likes to obsess over stuff that doesn't really matter, is the big hammer mover of this, not less than 20, not more than 50, spread it out over, you know, no one's eating less than like 100 grams, no matter how slight you are. Therefore you need at least three meals a day. Are you bothered at all about a post -exercise window? No. No. No. I think that is it beneficial? I would say that the literature would say no. As long as you're eating that protein, does it have to be right after you train?

50:36It doesn't. I will say could there possibly be some benefit eating after you, if you are untrained and you train and then you are older and you are prioritizing protein, would your body be primed for a bit more efficiency? Quite possibly. Could I get a lot of pushback on the scientists from the scientists? In that, yes, it's something that I was having a conversation about this morning. And from the literature, they would say there's really not great data that the post exercise window is helpful. My argument would be, well, there's probably a place for it. It just seems like there's bigger there's bigger fish to fry here totally totally And the yes, you have to protect body composition at all costs We have to stop focusing on what we have to lose and we really have to hone in on what we have to gain What are we mentioned earlier on that?

51:38Your body is the average of the five most common meals that you cook I've never heard that. Well, I've just made it up. That's why. Why are your most eaten meal preps? Like what has most of your body been built on over the last few decades, do you think? Eggs, frittata, turkey, beef, dairy. I'm actually a lower fat person. And then I try to - I don't agree with high fat either. that my body really doesn't like it. Yeah, I don't do well on that. And then adding in a lot of anthocyanins, some macchiaberry, which is that really rich purple color. And I just try to add in, whether it's blue algae, I mean, I try to add in really colorful things.

52:27Why? Because I think that there are biochemical properties in them that again, we just, there's so many, we just haven't gotten to it. Cool, okay. What about superfoods? If you were to rank order, you want to get the best protein profile, you want to get the best nutritional profile while getting protein in what's your top five? Well, before I answer this, do I actually need it? No, but if it tastes disgusting, then it doesn't count. So yeah, maybe, but not for you, for personal taste. Liver is disgusting, but it is so high in nutrition. Women that are anemic, individuals that need vitamin A, that's how you'll vitamins, liver is amazing.

53:14Amazing iron source. Absolutely. One ounce is a day. I mean, whatever you can stomach without throwing up, holding your nose, eating it, however you have to do it, I think it's valuable. I don't think I want to do that. I've got to hack for it. I've got to hack for it. I've got to hack for it. Salt the living shit out of it when it's frozen. throw it in an aphriot for two minutes either side and it doesn't really taste like liver anymore. It probably doesn't, it probably tastes like cardboard. Two minutes. Either side? You crazy? You crazy. You're crazy. Hard -pap. You're crazy, lady. Okay, okay.

53:46So liver's first, but you've got an issue with that. You're bigger to, bigger to, to get it against liver. Okay, so what's second? A lean beef. A lean beef is amazing. Again, why? Because it has creatine, anceurine, touring, iron, zinc, selenium, these are all bioavailable vitamins and minerals, really important. So that would be my next one. What cuts would you be looking at? I don't actually care. So I get really lean cuts. I get it from buff cow. Have you ever seen a peed monties cow? Yeah, I'm with, I'm sponsored by peed monties. Yeah, they're great. They don't sponsor me. Come on guys. I'll intro you to the guys.

54:24I've got an entire freezer filled with peed monties. And I literally had some filet before I came in. But only, but how many ounces? Two, eight. Fair, fair. So a lean beef is amazing. The next thing that I would say with the next superfood from a bioavailable source of protein could be eggs. Eggs is great and way protein, also great. But again, a way concentrate. Again, chicken. and I don't eat a bunch of chicken. Salmon is good for omega -3 fatty acids, but it is a little on the fattier side. And over time, you do have to worry about mercury. We test out of my clinic. You do have to worry about some heavy metals and two no -those kinds of things.

55:07One of the things that always feels like a rate limiting step on salmon for me is I really struggle to make good salmon at home. Like it's kind of, it's just not, you know, throw a steak in the air fryer, it comes out, you get it wrong by five minutes either side, it's still edible. you throw salmon in a frying pan and care for it like a small baby chick and it just ends up atomizing itself all over the kitchen. It's very easy to get wrong and that just limits how much I can eat salmon at home. I like it when I go out for food but I think it's it's like rough to try and make good at home. I would agree.

55:43I would totally agree. So basically we've covered liver, Hold your nose and eat it. Lean beef, piedmonties, choose a buff cow. Eggs, way and salmon. So I hit my five. That's good, that's good, Mike. Okay, fair enough. Talk to me about the relationship of sleep and muscle building of what we're going on here. Yeah, there's, I actually just interviewed Dr. Emily Lance on my podcast, and she is out of the Galveston group. She's a scientist out of the Galveston group. And one of the studies that she worked on was that I was looking at sleep and muscle protein synthesis. Sleep one night of sleep deprivation can suppress muscle protein synthesis by 18%.

56:26Can you imagine cumulative over time? That's not good. That's my life. That's me. That's being a club promoter for a decade and a half. Yes. And I will say one of the other things that we see. So muscle protein synthesis on one hand is suppressed. But there is some data coming out that if you are sleep deprived Then kicking up training so like the military personnel they go through four days or five days of hell week I should know this because I've never heard the end of winter hell week. It's just you know, right exactly like that's hard But there is some evidence to support that training during that time during a time of sleep deprivation can help support the tissue, which makes perfect sense.

57:09It can mitigate some of the effects from lack of sleep. So we hear about downstream some of the concerns that people have around. You are more likely to like salty foods, more likely to reach for highly processed foods, more irritable, lower willpower, all the rest of that stuff. But what you're talking about here is a much more direct mechanism them from even if you go full bedrust, cullion and wrangle your willpower and you don't eat the cookie and you do the thing, you are still creating a glass ceiling on your ability to build muscle just based on how much time you had to sleep. No amount of breath work or meditation or like ratchet hip hop is going to be able to get you past that.

58:00So yeah, I think I mean, it's just it's just another Another reminder that everybody is probably forgetting and again, I'm we're getting tactical on this one I quite like the fact that we're doing this you need to try a sleep tracker whether it's an eight sleep mattress Whether it's a whoop whether it's an aura ring obviously if you use whoop that would be great because I think that they're an awesome partner But the main thing that you learn when you use a sleep tracker is you are not sleeping anywhere near as much as you think you are Like that's I can save you from having to buy one right it's great if you do it and it's important to learn this lesson first hand But the lesson that you learn as soon as you start using a fitness tracker is oh I Thought I was getting eight hours of sleep, but it turns out I was actually in bed for seven hours 45 and my active sleep was six hours 20 Oh Fuck like that's that's the realization that's what you spend most of your time and now for me even if I don't have this on, I know I'm like, look, if I need eight hours sleep, I gotta be in bed for nine hours.

59:01Like I have to. Even if I try and crank my sleep efficiency as best as possible, bit of latency, bit of loss sleep efficiency, some micro awakening start the night. It's like, guess what? It's hard to hit. And by the way, and no offense to the sleep ninjas out there, sleep is annoying. There's a lot of other things that I would rather be doing than sleeping. Sleepy one. It is, right? But I will tell you that in when I was a fellow and we were in the memory and aging clinic, one of the risk factors for Alzheimer's was, we always asked about sleep deprivation over time, because when you sleep, this is when the brain cleans itself these glial cells, that and actually sleeping with a phone by your head.

59:41Yeah, I mean, anyone, no one in my audience still has their phone in that bedroom. Can't be real, no one, not one person I know. No one at all, or else they are no longer allowed to listen. Okay, so when we're looking at this sort of relationship, sleep, to a muscle building, is there anything else I want to get onto training? But before we get into that, we've talked about diet, we've talked about recovery. Is there anything else we're missing in kind of the middle you that is life beyond now training stimulus? I think the big picture is eating whole foods. It doesn't have to be complicated. It should be high protein from my perspective.

1:00:20There's no reason that when you have the luxury to eat that That way you don't. It is a luxury and a privilege to be able to prioritize dietary protein. Other countries don't get that. And it is a highly nutrient dense source of calories and a non -negotiable, especially as individuals age. You know, when you had mentioned that when you were really into fasting and you were reducing food intake, that that, it just, it may not be an ideal mechanism, right? Just like... Fluffy. I was fluffy. We don't want you fluffier, we just ruin your image. So I'm not supposed to be fluffier. I'm fucking 19 .5 % body fat, compared to that Dexascan in Dallas.

1:01:02That should ruin your day for at least a week. I think I need to go on a slight cut. Here's a question I've had in my head, actually. There is somebody that's listening who is both over fat and undermuscled. There is someone who just doesn't have the body composition that they want and they know that they are off on both ends of the scale. If it was me, not knowing your world, what I would do for me is I would probably die it myself down because I'm going to get the aesthetics way quicker by becoming Lena first, which I can crack out in the space of six months and then building my muscle up from there.

1:01:44But what would you do? What would your advice be? Would you just try and recomp through everything? Like how do you go about this? because motivation is going to be gauged as much by the mirror as it is probably by anything else. So we need to satiate that in people. Yeah, if it were me, I would focus on what I have to gain versus what I have to lose. If I had very little muscle and a lot of body fat, then from my perspective, I would not actually be focused on anything aesthetic. I would assume that I was not as strong as I should be and not as physically capable as I needed to be. I would focus primarily on being a human that was physically strong.

1:02:23And I'm not saying necessarily training for strength, but maybe you would train for some strength and some hypertrophy, but I would just start putting in the reps. I would start putting in the reps. I would obviously see what my baseline diet is. Prioritized dietary protein is very difficult to store protein as fat. It's very difficult. Like you said, you're like, ah, it's 90 grams. If I have one more buffed cow, I'm going to shoot myself. It becomes very difficult to overeat dietary protein. And there may be some impact on this adaptive thermogenesis. You know, the body is very smart. So if you start reducing calories to rapidly, the body will adjust.

1:02:57But dietary protein, and from my perspective, one of the reasons why it has this more thermic effective food, thermic effective feeding is that it's so valuable. And it does stimulate muscle protein synthesis that the machinery of that may take more energy. than the energy required to utilize carbohydrates, could be 10%, fats could be 5%, and protein could be anywhere between 15 and 20%. Again, depending on the study that you look at, and foods are not just primarily one thing. If you are an individual who needs to lose weight and build muscle, could you do both at the same time you could, would it be as effective?

1:03:38No, I would say you start with what you have to lose because that individual, what you have to gain, because that individual didn't get there by focusing on what they had to gain. I guarantee you they have spent a lifetime yo -yo dieting or having some feeling of just, you know, it doesn't feel good in your body if you're not feeling well, right? I think that we can all agree on that potentially again. I don't know. This is what I would do. I think that I like your framing around people are told that there is something that they have to lose. It's all about getting rid, getting rid, getting out of this body.

1:04:19It really is a, it's like an anti -building mentality within your physiology. And I don't think that that is particularly constructive. Okay, so we've danced around it, right? We've got all of the things in place, but we actually need to go out there and build some muscle now. We need some, we need some training stimulus. If you only had 10 exercises for the rest of time to build and maintain as much muscle as you could, what would they be in why? 10? 10, that's it. Okay, it seems like a lot. I would definitely do a squat, right? I would do a I would lower a lower on my back, a wider stance just because, yes, so I would definitely do a squat.

1:05:09Why? Why low bar? Why wider squat? Just my physiology is the way I'm built. Okay. Okay. I'm built. So I actually decided, side note, that it was a great idea to do a 50 hour event that was nonstop. and so as I was training for that, I tore my hamstring off the, I evolved it around 80 -some percent off the bone. It just really wasn't my smartest decision. Yeah, so it's been this process of repair. Let's just say that. So I've had to modify some of my training. So a squad, a wider sand squad, some kind of deadlift, whether it's a sumo deadlift or some kind of deadlift, because just the mechanics and also the full body movement of a squad.

1:05:52I would also say a farmer carry. We have to also begin to choose and this is what I think about this is I think about all the older patients that I've seen being able to carry groceries, being able to carry a toddler, being able to, you know, it's amazing. When we think about traveling, you know, I travel a lot. I also have two very little kids. I have a two -year -old and a four -year -old. If you want some birth control, I will send them right over to you. Right over to you. And you'll see, you know, be careful, You'll hear people say, oh, be careful about putting this overhead. You know, the weight limit shouldn't exceed this.

1:06:25And it's just a whole backwards way of thinking about it. No, no, no, no. You are afraid to then go into the gym and lift a 50 pound weight, but you will have no trouble lifting your or struggling to lift your 50 pound toddler to put them x, y, wherever you're putting them. Why given the fact that you've already got a good bit of midline activation with your squat and especially with your deadlift plus you've got grip work with your deadlift, What are you getting out of the farmer's carry that you haven't activated already? Well, you're getting motion and you're getting something that translates to real life.

1:07:00It's, you know, when we are, if we're really talking about health span, we have to talk about the things that will destroy health span and the reasons why we require help. Why do we go into a nursing home? What are the things that really affect quality of life? the number one thing that affects quality of life is physical mobility in my opinion. And I've seen this. So not being able to, can you imagine? Not being able to climb upstairs, not being able to carry your groceries, not being able to put them up. I mean, I was just traveling here to Las Vegas and there was a couple in front of me that couldn't put their luggage on their carry -ons on the conveyor belt.

1:07:39Theiva had been, oh, I'm the conveyor belt. Sucking conveyor belt, oh okay. And you know what, I was like, do I help them? Do I help them? and they're never gonna get exercised. So I was like, so you watched this person struggle with a one rep max, and the luggage carry. But I, I know, it was terrible. I really struggled. I'm sorry. But no, because if that is the one moment they're going to be able to pick something up and move in a rotational way to put it there, which is how we move or not. Homeboys, Grandad's got doms for the next two weeks because you didn't help him move his 15 pounds suitcase.

1:08:10Okay, three, we've got a squat, But Bob Elbach squat, low moment arm, wide stance, a deadlift, and a farmer's carry. What's next? So the exercise, I think that this is not necessarily a weightlifting exercise, so we didn't specify, but doing some kind of an interval on an assault bike or an airdine, being able to push out above a 90 % VO2 max, just really hitting it. You prove to yourself you can do it. It feels awful, but it is a way to improve insulin sensitivity. It's extremely effective. And I really do think that as we are training in the gym, it's not just about the machines, it's not just about the bands, but it's about being fit and capable for real life.

1:08:52It's true. God forbid there is an emergency, you better be able to show up and be a capable human. Well, this is the, this is, you know, I think, Peter Ritey is biggest flex from a training perspective at the moment, or his kind of biggest obsession when I spoke Dr. Molledisia, and he's saying, you know, V or two max is one of the best predictors that we have of someone's longevity. And I was like, what? Well, I thought it was all zone two. I thought it was all to do with resting heart rate and variability and blood oxygenation and galvanic skin response. He's like, this straight up V or two max, what do you V or two max?

1:09:28So that was surprising to me to hear that. And I do think that we are, I think that there is someone of a discrepancy in the literature when it comes to muscle mass and strength. Right now people will say strength matters and muscle mass. It's not about the actual mass, it's really about the strength. I think that we are at the precipice of literature changing as we begin to directly measure skeletal muscle mass through some of these more advanced ways like this D3 creatine. And I think that that may challenge. Right now, if you're to max is the greatest predictor, I think we're also going to see a change in the literature when it comes to muscle size and strength.

1:10:10I mean, that is going to be next. And I, yeah, so I'll say that. No, just that it's interesting how there are theories about the way the way that the human body works, but we don't have the measuring tools to be able to make it happen yet. So what we do is we find proxies for that strength is a pretty good proxy for muscle mass There's very few people that are very strong without being at least a little bit muscled But what's the genuine mechanism that's going on here? Is it the only thing that we can measure accurately is hand grip or bench press or vertical jump or whatever? I actually just had a conversation with I work with a PhD her name is Alexis Cowan.

1:10:51She did her PhD at Princeton. She's now at Penn She's really helped with the Institute of Muscle -centric Medicine And we were going back and forth about grip strength. I think that, again, this is another, you know, Chris, my perspective is just because something is spoken about over and over and over again doesn't make it true. It doesn't mean that we're looking at it from the right perspective. And yes, we could say grip strength is a biomarker. But if we take a step back, we have to ask ourselves, are we potentially born with a certain threshold for grip strength? Is it really the end all be all?

1:11:21Are we sure that that's true? and the next layer to that just goes in line with when we're talking about skeletal muscles. So right now we're talking about VO2 -max, but again, that's because perhaps we've had the tools to measure it and then bringing to the conversation, which is often missed is that we don't highlight the things that we're doing well. I'm sorry, we highlight the things that we are potentially doing well without the insight of potentially the things that we're not and the oversights in just measuring indices. What is your favorite evidence -based protocol on an ad -ine or an assault bike for improving VO2 max?

1:12:06Great question. I actually work with a trainer. I don't do any of the protocols myself. What does he make you do? Carlos. Carlos is a major asshole. I'm in the worst. I mean, so Friday, right before I left, we just did Max effort. It was 20 seconds all -out effort trying to push me above or 290, 90 % and then he would give me 10 second rest. So I don't know if that's... I felt like I had to... Okay, so it's about a style thing but holding it for doing it into 30 second intervals, how many rounds do you do? He only had me do three minutes. Thank God. Yeah, that's still... That's six rounds, right?

1:12:46That's all... It's horrible. That's enough to kill you. Okay, cool. So you've got only four things. Anything else? Anything bothered? Run, no, no, let's keep going. So we said a squat, we said a deadlift, sumoedelif, we said a carry. I definitely think that you should be able to do an overhead carry. I think that you should be strong in an overhead position, even though obviously it's probably not totally stable. For the reason that I just like, I'd like to see you be able to do that over time. I also think being able to do things like pushups, getting off the floor, you have to be able to do pushups, you have to be able to develop that upper body strength.

1:13:27Also let's see what else do I think is a nonnegotiable? I mean I think a Turkish get up is great. Takes coordination, it takes capacity, you have to get balance, and then Gunnar Peterson would say, Gabrielle, you have to add in something rotational. So any rotational whether it's a swing or a Something rotational he said because you know throw punches The bag something like that. Yeah, I mean the the floss of it's interesting You've brought up two things that get you down to the ground with the push up and then specifically Turkish ghetto Which I was thinking about earlier on Aaron Alexander from the Align podcast has he is one of these huge proponents of sitting desks, right?

1:14:10So a floor desk and I have in the other half through there. I have this tiny little what look I think it's meant for Japanese calligraphy. So I think it's meant for when you're sat doing your fancy Japanese like penmanship or something and I've got varying heights of meditation cushion behind it and his whole thing is get yourself down on the ground spend an hour half an hour to an hour a day with your hips below your knees if you can. And I have to say, sitting down there feels so nice. Like glute mead opens all of that out when I get into that kind of cross -legged position. And you can lift your hips up and actually lean forward, which feels really lovely and you're lower back.

1:14:55That feels like it kind of decompresses a little bit. Like it's so nice. Like all of that's really, really good. So I am in, I'm down for ground stuff. Yeah. That sounds very interesting. I cannot wait to see that and it's never going to be made public. I mean, it's remaining it's remaining private. That's if I went full Austin psychedelic bro mode, I wouldn't be at a standing desk. I would be on the floor and I would be like twirling a what is it like a fucking ayahuasca stick between my fingers while I'm doing it. Okay, so let's say that you've got three more three more things that you can introduce.

1:15:36I do think again, so we talked about how we would use grip strength, so you're developing grip strength, you're developing, you're being able to carry. I don't know if we talked about a swing, but I do think that you should be able to swing. You should be able to do some kind of dynamic movements. Think that that is important. And again, how do you translate these things to real life? Turkish get up, so we have squat, sumo deadlift, we have a throw up on the devil's tricycle. We have some kind of push up, right? Pushing up after off the ground. We have kettlebell swing. Final carry. Final carry.

1:16:13What else? I know. See you gave me 10. And then you might say. Phil Heath wanted 11. And Bumstead also rolled his eyes at me only giving him 10. So you've got bags of spec capacity. You and you need to date. I mean, I mean, also you should feel like what? Where are we going to get Jack, Jack, to get Jack's arms from here? I was actually thinking that, but you said, but your question was that you could only do for... For the rest of time, to build and maintain as much muscle as you could, what would they be? Maybe I would be tempted to maybe throw in some sort of pull -up, like you haven't got much of that scapular retraction.

1:16:51I guess in the deadly, that's a lie, in the deadly, if we have. Okay. Hmm. There. There. Carth raises. If Alex Hormosi was here, he would say calf raises because he calls, he keeps on texting me and telling me that calfs are the front garden of the body. I'm like, at best they're the backyard, right? At best they're the backyard. They're not even on the front of your body. You can't make this. Wait, by the way, women don't care about calves. He would say, that's because you haven't seen my calves. That's what he would say. I know that he would. He would say, what about these calves? And I would say that's your backyard.

1:17:35But okay, yeah, cool. I think what's really interesting, I'm loving asking this question to pretty much all of the health and fitness people that I speak to. It's really indicative of where they're coming from from a health and fitness perspective. You know, it's obvious that you've got that like sort of geriatric care background because you're thinking training for life, right? Like no one else has said, oh yeah, I'd love to put a farmer's carry in. Because, like, so what? Like I just presumed that my deadlift or like my row or something is gonna be able to get me through the carrying side, but the, you know, that control -atrial -moving thing, that being able to stabilize the trunk while the hips move underneath you, I think that's really important.

1:18:16So, yeah, we've ended up, I think we've got like maybe a library of 80 exercises. Now, you're the first person in all of them that hasn't said dumbbell side lateral raises, but that's hilarious. That's okay. But I will say my perspective comes from, you know, I talk about, I did my training as a geriatrician, but my patient population, we take care of elite warfighters. My patient population is, we service elite warfighters and like CEO, maverick guys that are just super physically fit. And they, I would say, I mean, I don't know what all of them are doing, but I would say the majority of them have a lot of well -rounded training programs.

1:18:57Right? And my perspective is as a mom. I have two little children. Can you imagine if I went down to pick one up and one's pissing on the wall and the other one's doing something else, I'd have to grab the other one. I have to be able to move fast enough so my new drapes don't get ruined. That's obviously the priority. When it comes to tempo, rep ranges, set ranges, what are people getting wrong in your opinion? I think there, now first of all, there's a phenomenal paper and that I think that anyone who's really interested in these repetition continuum, the paper is called Loading Recommendations for Muscle Strength, Hyper -Truthy.

1:19:36Hopefully I'll get it right. Local endurance, a re -examination and the continuum repetition, or the repetition continuum. Very, very sexy title for a paper. Please translate. Amazing. And really, basically, it highlights that we've got this strength, hypertrophy, endurance. So we've really put things into buckets and that maybe the evidence doesn't support that, that there's multiple ways to get stimulus. So what do I think that people are getting wrong? potentially that, you know, if you're just going eight to 12 reps, maybe that's just hypertrophy. But for older individuals, they potentially could do lighter weights and go for longer and still get hypertrophy of influence.

1:20:23So I think that this rep range continuum could be reexamined. Okay. What's your thoughts on time and attention? and all valuable. Tempo stuff. All valuable and all ways to change up your training program. Because what you're looking for is really a physiological adaptation, right? And there's multiple ways to get that, multiple ways to improve muscle hypertrophy and strength and endurance. So what you're looking for is where your stimulus is and where you need to potentially push on the lever to improve. In my mind, again, as a physician, and do have to track improvements. It's not just that you're tracking your, whatever you're eating, your beef or twinkies or et cetera.

1:21:11You also do have to track weights the same way. Now I think a baseline recommendation, you know, in my book, I want people to know how many pushups they can do. This morning I did 600 pushups here in Vegas working out with Ben Newman. It's a terrible idea. Why? 600? Why? Stupid number. I wait too many. I said this and obviously it wasn't all at once, but I was just seeing myself. Man. What an idiot idea that is. You should have done less. You should have said, have you thought about doing fewer? Yeah, exactly. And by the way, they all did probably more than I did. But again, so that's the number one thing I think people are getting wrong is that it's either, and I used to say, you know, my own personal belief is that you have to work really hard.

1:21:57And that's just a belief that's not necessarily in the evidence. I think that there's something to be said, there is evidence to support this idea that the influence of what you are doing, whether you're lifting light, whether you're lifting heavy, that the molecular influence is somewhat different, right? And that makes sense. But my belief had always been that you should train harder and that was the only way to do it. And that is not necessarily what the evidence supports. which is disappointing by the people that want to punish themselves with 600 press ups on a morning in Vegas. No, it is, I can see why that would be a like a personal insult.

1:22:39When it comes to people tracking their sets and tracking the workouts, there is an app called Heavy Set, which is by far the most seamless and least intrusive of the workout tracking things that I've ever found. It's phenomenal. It links up, I don't have one, but it links up with your Apple watch. It can track tonnage, it can track progression, it can, you can work in supersets and drop sets and rest pause and my or reps and all sorts of other craziness and it'll tell you what your proposed one rep max is based on all of the calculations. It's really good and I think it might be even be free if you don't need to use anything fancy.

1:23:17That's heavy set. It's definitely available for iOS. It might be available for Android as well. What else? What else? What? given this global perspective of stop focusing on fat, start focusing on muscle, these are the principles from a dietary perspective. These are the principles for a training stimulus perspective, sleep is important. Is there anything else that we're missing from this card? Yeah, I want to point something out because it's important for the conversation. We've talked about skeleton muscle, we've talked about nutrition influence in skeletal muscle, we've talked about the history, we've talked about exercise.

1:23:54I would say that a lot of people will recognize these things as important. Contracting skeletal muscle releases myocines. Myocines are hormones, they are molecules that are released from contracting skeletal muscle. There's 600 or more. The first Myocin I think was discovered in 2000 by Patterson in Copenhagen. So this is not that old. And I just want to reframe the conversation into what does it mean from a muscle -centric medicine perspective, a medicine perspective, contracting skeletal muscle. We've all heard about these cytokines, cytokines like interleukin six, interleukin 15, and the cytokine storm, and you know, it had its moment.

1:24:42Exercising skeletal muscle, the degree at which you are exercising, will influence the amount of inner -leukin six and inner -leukin fifteen that when released from skeletal muscle interfaces with the body differently than those interleukins that are released from macrophages. So there is a a blunting effect from an inflammation standpoint, which I think is important to point out. Why is that important? Because it's leveraging skeletal muscle tissue that you have conscious control over to augment your immune system and to augment your inflammatory response. So it's a something that you can do consciously that is going to tap into a system which is largely run on autopilot.

1:25:31Yes. Yes. And contracting skeletal muscle releases glutamine. Glutamine is a semi -essential amino acid that, you know, the requirements depending on if you're under stress or highly catabalt state, etc. But contracting skeletal muscle, when it releases glutamine, glutamine serves as a fuel source for lymphocytes, white blood cells. So doing an action consciously, I mean, you can't tell your heart, I don't know, you live in Austin. there might be people that could tell their heart to pump at a certain rate. But for the most part, unless you're whimmed off, you're probably going to have a difficult time telling an organ system to do just the thing.

1:26:12It's the only thing that you have that kind of control over. So this influence of contracting skeletal muscle, we talked about Alzheimer's, it releases BDNF and irison and capsaicin B, which stimulate BDNF release in the brain, which help with neurogenesis, with brain function. This is critical in changing the conversation of muscle as it is thought of in this way of looking good naked and training all important and the only things that we have actionable control over, but also reframing the conversation from an immune perspective, from a perspective as an endocrine organ, really, really critical.

1:26:54Very interesting. Yeah, I am, I'm going to be, I'm going to be watching carefully, I guess, over the next few years to see if the, the pivot does happen. It seems like diet culture, which is what it is currently, right? It's diet culture is very ingrained. It's the dominant ideology for improving fitness and improving health. And I suppose, you know, if you were to take somebody that is however many hundred pounds and get them to lose 30 % of their body mass, like a lot of their outcomes are massively going to improve. But I would guess that for a lot of the people that are listening to this podcast, they're actually thinking, okay, like I understand that that's important and you know, in like a charitable aspect, I want to remind people, whole foods and do all the rest of it.

1:27:41It's like, okay, like what's the next step? What's getting yourself maybe from 50 to 70 or from 90 to 95. Yeah. Yeah, I wonder how much of this muscle -centred medicine is going to be something important. I mean, like I say, the benefits are massive because it's one of the few things that you can do that is hard, that is immediately gratifying or in the short to medium term is gratifying and also has long -term health impacts. and you can't say that for many other training modalities. You know, you get really great at rowing. You don't look that different. You may feel great, and you know, the metrics on your whoopal say, oh, wow, my resting heart rates in the 40s.

1:28:26But really, you know, if you train push -pa -legs for six months and you eat 0 .7 grams per pound of body weight in protein, you look worlds apart if you're someone who's even like up to a probably pretty well done trainer, right? Like if you've been training for even a while and you stick to that, you're going to look great. So yeah, you have the opportunity to kind of come for the gains and stay for the longevity. I think that's, I think it's a relatively easy cell. I think it's an easy cell and I'll tell you some of, you know, one of the aspects of being a physician is, and I say this all the time, is that a good physician recognizes patterns of diseases, right?

1:29:07A good physician, that is your job, that is your craft. You need to be able to recognize patterns of illness. An effective physician, an effective physician recognizes patterns of people. And that is how you move the needle. We can talk about all of this stuff, but the reality is there are certain archetypes of individuals. And one thing that I will tell you is that individuals must feel worthy of doing the thing that is going to move the needle. There is a self -worthiness threshold that people have. They will only ever be as fit and lose as much weight or gain as much muscle. If they start to feel too good or look too good, it's a whole litany of, do I deserve this?

1:29:57Do I feel worthy of this? Can I really have these things? And I have been a practicing physician for a very long time. And then the second layer to that is understanding that you have to close the gap. You show me who you are today and the habits you are doing today. I can tell you a handful of things. Number one, I can tell you how successful you are. There is a spectrum and an archetype of innovators and mavericks and CEO archetypes. I can tell you based on your habits where you land on that spectrum. Number two, the actions that you take now in your health and wellness. Today, I can tell you what your life will look like in the future.

1:30:44Your present is your future, especially from a health perspective. of. An individual that moves the needle has to be aware of their weaknesses. We are in a culture where it's all about, what are your strengths and how are you doing and you're so amazing. I don't care anything about that. I need to know where you fail, where you fall off, and you have to know that because it's predictable. Every single time, for example, every time, Chris, I bet you, if you did not mitigate when you did those live events, you probably, if you were not aware that at the peak of that event, there was going to be a component of vulnerability.

1:31:24Right after you would have fallen off your nutrition plan, you would have felt a little depressed and you would have stopped training. Did that happen? Or did you mitigate that? Yeah, we worked around it. You worked around it. You planned for it. You probably went in with a more neutral mindset thinking, this might go well, this might not, this is my first thing, this is so cool, you neutralized it. It wasn't that big of a deal. And again, I'm putting words in your mouth, I don't know. You neutralized it. You must be able to close the gap between who you want to be, your future self, and who your, the actual actions that you are taking.

1:32:00Because time is limited, and if you continue to do the same thing, then you have to fast forward and the pain of failure over everything else is more effective in moving a patient to action. You said in a different interview, I heard you say, if you think you don't have time for fitness, how are you going to have time for sickness? And I think that's a good way to look at it. Everybody is busy. Everybody has lots of things to do. everyone has more emails to answer than time to complete the workout. But yeah, I feel it. Dr. Gabrielle, ladies and gentlemen, where should people go? They want to keep up to date with your work.

1:32:41They want to check out the new book. Where would you send them on the internet? Well, you can go to my website, drgabrieline .com, and you can find all our offerings there. I also have a podcast, the Dr. Gabrielle, which I've been trying to get you on Chris for, I don't know, at least like six months. I'm going to convince you, I'll say, I bring you like some Frittata's whatever. You can also get my book on Amazon. It's called Forever Strong, depending on when this comes out. And I have a great newsletter. I put it out. A ton of free content, YouTube. And I have a full practice. We have a team so people can check out my website.

1:33:20How are you? Gabrielle, I appreciate you. Thank you.