Why Strength Training for Women Is Not Optional for Longevity | Gabrielle Lyon

22:08Dr. Gabrielle Lyon:is so much of that so uh jaco's a really good friend of ours oh that's amazing yeah and I think she brought the books and they'd be like I get him to sign these yep um very funny I think that that's why uh my son is very motivated to train for the steel teams because um again at four because Jack was scared the living bejesus out of this kid. But it was very funny. Caught it all on video. Anyway, yeah, they have a level of neutrality that is trained. And it can be trained in anybody. And we think that it's trained in the big things. It's not. It's trained in the little annoyances that if you do those well, then when something big happens, it's not if it happens, it's when.

22:50Dr. Gabrielle Lyon:But you don't stay in this state. You know, in our family, we have a rule. You get 15 minutes and then you have to move on. And a lot of times we are still deeply thinking about stuff that happened six years ago. There isn't this level of neutrality. Things take on a meaning that is so big, it doesn't help anybody and it certainly doesn't move anyone towards their health and wellness goals. Because again, the more you're able to control your mind, and we don't have programs for that. Well, we've got diet plans, we've got exercise plans, but what about this mindset and this mind frame? You do have to have a plan to build that muscle.

23:32So I think a lot of people, they're going to arrive at this podcast, they're going to be like, I didn't think we were going to talk about mindset.

23:38Dr. Gabrielle Lyon:We can talk about muscle, but you got to get this piece right. Otherwise, you're going to just, it's just going to be another book you read. So, but that, that is my question for you. When you wrote your first book, did you find that even though people knew how important skeletal muscle was, they needed that mindset shift? And is that the inspiration of this book? No, I mean, the book covers how to eat, how to think, how to move, how to recover. It covers everything. I wrote the book that I wanted. It has graphics. It has places to write. I mean, it's, again, I wrote the book that I wanted. yeah, it has muscle and the mind.

24:17Dr. Gabrielle Lyon:It's all a metaphor for strength. And there's a bi-directional relationship between physical and mental strength. People care a lot about cognition. You talked about midlife women. One way to improve brain fog is you train swiftly. It's called cognitive velocity. If you think about sprinting, sprinting is a short burst of activity. It also improves your thinking speed, physical velocity and cognitive velocity. It's all intertwined. So if you want to go through menopause well, you have to focus on building muscle. You cannot be distracted by this level of fasting or this type of diet or this type of exercise program.

25:01Dr. Gabrielle Lyon:Because if you chase novelty, that window of opportunity closes. I mean, it's never too late to build muscle. Everyone should be strength training three days a week. You don't have to lift heavy. There's a lot of talk about, do you have to lift heavy? You don't. You have to have progressive stimulus. But it doesn't mean you have to lift heavy because the one thing that you don't want to do is get injured. Physical and mental strength is a bi-directional relationship. You know, and as you talk about midlife women and the, so the conversation has really shifted a lot online to just lift heavy. Like this is the most important thing.

25:35If you were laying out a problem. But why?

25:37Dr. Gabrielle Lyon:Why do they have to lift heavy? Right. The data would support that it is just about the volume. I mean, if you tell my 74-year-old mom to go lift heavy, she's going to injure herself. Her tendons have not, they're not ready for it. So is it, are we talking about a four rep max? Yeah. That's, you're going to get injured. I'm going to get injured. I've been treating my whole life. So I think that lifting is critical, but this idea that you have to lift heavy, you don't. It's all about progressive stimulus. and stew phillips out of mcmastery university he's done tons of uh studies that support this for people who don't know what progressive stimulus is can you define that because there's some women that are like look i've done pilates and that's where it's stopped yeah you'll be doing that all day if you want to build muscle yeah and like for people listening i'm a big fan of protecting your pelvic floor with pilates and i think pilates coupled with strength training can give you more power to live totally engage your core correctly but i'm also about like if you're not actually stimulating those muscles.

26:38So talk to us about that. What does that bring out the stimulation? And what does that actually look like in practice for women?

26:44Dr. Gabrielle Lyon:So as we age, muscle changes. There's this phenomenon that happens called anabolic resistance. Muscle becomes less efficient. It becomes less efficient at utilizing protein. And some people, there's some data to suggest that the efficiency to training decreases. The actual stimulus, maybe someone has experienced this that they're lifting and they're just not getting the same results. So you have to design a program that is always pushing your muscle to adapt to a bigger stimulus. But that bigger stimulus could be more reps, slower tempo, more volume. There's other ways to do it. Progressive stimulus, again, is the additional stressors to the muscle.

27:30Dr. Gabrielle Lyon:It's not just weight. Should women lift heavy? Well, you can, but you can also lift lighter for more reps. And I think that that's where, could it be, you know, in my ideal world, it's between 10 and 12 repetitions. You know, I put together a whole program. That's it. It doesn't have to be four reps or six reps. And, you know, women will say, well, I've never lifted weights before. And I'll say, yes, you have. You have toddlers. You lift your luggage. You have a grocery bag. Luggage. You've been lifting weights your entire life. You just haven't had a structured program. And when we reorient women to this, then I think it takes away some of this resistance to training because it's critical.

28:12Dr. Gabrielle Lyon:They're never going to age well in the way that they want if they don't focus on putting on muscle. It's just not going to happen. Hormone replacement therapy is amazing, but it is not going to be the needle mover for body composition. Thank you for saying that. As someone who has been prescribing hormone therapy for well over a dozen years, I'm like, I love that it's having its moment, but it's too far up on a pedestal. And we're not talking about its limitations and how it will never be enough. If you are, especially women who are jumping to estrogen because they're like, I need to protect my brain.

28:47I need to protect my bones. And it's like, well, hold up. What are you doing day to day? because the things that don't require a doctor's visit or a prescription have the biggest impact. You are right.

28:58Dr. Gabrielle Lyon:Yeah. You're right. Hormone replacement therapy is critical. I prescribe it. Again, we have a whole clinic, but it is not going to be enough. And I'm afraid that in five years, women are going to be pissed. Yeah. They're going to be like, but I'm on hormone replacement. I'm going to say, you know what? That's amazing. But what about your diet? You know, is your diet higher in protein? Are you doing resistance training? There are ways to transform your body. I worked on some of the first postmenopausal studies that showed diet and exercise. And when I say diet, double the RDA, a higher protein diet, plus resistance training.

29:34Dr. Gabrielle Lyon:It was, I don't know, it was two days a week of resistance training, plus five days a week of 30 minutes walking. That's all it was. And it maintained lean body mass, and it helped build muscle versus a lower protein diet and versus training alone. So let me ask you, because there is a war on the internet, right, where people are like, I am working out. I am doing the diet, like all of the things, but my hormones are changing. I'm gaining belly fat, deep visceral adiposity. I think this is my hormones. Then it's usually a man with no shirt and a profile picture. This is hilarious. Women, it's not your hormones.

30:19It's never your hormones. It's just you eat too much. What does the science say as someone who has researched postmenopausal women?

30:27Dr. Gabrielle Lyon:So estrogen, when estrogen is declining, it changes the distribution of body fat, typically to belly fat. And also there's a decrease in insulin sensitivity, so an increase in insulin resistance. And for those who are listening, insulin is a hormone secreted by the pancreas. It moves glucose out of the bloodstream into cells. And your body, as estrogen declines, becomes more insulin resistant. Why is that not good? Because then with carbohydrates, you require more and more insulin. It's the roots of metabolic syndrome that happen when you are postmenopausal. But I will say there's two things here that people are not recognizing.

31:10Dr. Gabrielle Lyon:Number one, that is not like a death sentence, that if you get diet and exercise right, you can absolutely improve that visceral fat. And you get fat within the muscle, so it's called intermuscular adipose tissue. And I think intermuscular adipose tissue is more important as a biomarker than body fat percentage. But we just don't have great tools to measure it yet. People are not doing CT, MRI. But as women age, if you are training and if you have a diet that is well-matched for muscle health. So basically, one of the things that we're seeing is there's a mismatch between skeletal muscle health and the diet that they're eating.

31:50Dr. Gabrielle Lyon:It's usually too high in carbs and too high in calories. So to that guy who is shirtless, put your shirt back on and come talk to me in 10 years when you're going through andropause, which is not actually a real thing. But yes, I mean, you can lose your testosterone, but you're not going to lose your testes like we lose our ovaries in functioning. It seems like a design flaw, if you ask me. You know what I mean? How is that possible? I'm always like, mom and nature doesn't get a lot of things wrong, but like giving us 30 years and no hormonal protection and like cognitive decline, cardiovascular decline, like this, something's not right here.

32:28Good sleep is everything. That's why Oli's science back support is made with a blend of melatonin and L-theanine for both kiddos and grownups. So when your mind won't switch off, you've got something that can help. Erasing thoughts and restless nights won't stand a chance. Find Oli's sleep solutions for the whole family at Oli.com. That's O-L-L-Y dot com. So what I want to ask you, though, is at the top of this, you had, since we just mentioned male anatomy, I mean, you had mentioned muscle and the connection with essentially your mojo, your libido, right? For people listening, the penis and the clitoris both get engorged.

33:08They both have erections. The same tissues there when you were embryos, all the same, same. So what you're about to say, everybody listen in close because it applies to both. So what do we know from the science about the muscle connection to the ability to have an erection, whether it's a clitoris or a penis.

33:28Dr. Gabrielle Lyon:So for men, 40 % of men are going to have erectile dysfunction by the age of 40. By the age of 40? Yeah. Four zero. Four zero. See, we're in women's health, so I don't talk to a lot of penises. 40 is a lot. That's so dumb. But it affects women. Of course it does. I mean, like, I don't know. I want to be able to have sex with my partner. She turns 40 and there's a 40 % chance that he's going to have erectile dysfunction. Yeah. I, you know, we have to fix that. 50 % of men by the age of 50. Man, why are they just tracking with like their decades? Like, what is that? I mean, because, I mean, listen, I don't know.

34:06Dr. Gabrielle Lyon:It's really funny. There's a drug called Addy. Have you ever heard of that? And there's for a woman to get prescribed a medication that affects her libido versus a man, there's like 38 plus drugs approved, Viagra, et cetera. And there's one drug for women that is only FDA approved for postmenopausal women. It's just so interesting. But anyway, I just published a recent study on sexual function and muscle mass. And the more healthy muscle mass you have, the better your sexual function. And this paper targeted mostly men, but the same would be believed to be true for women. And the question is, why is this?

34:50Dr. Gabrielle Lyon:because healthy skeletal muscle requires exercise, both resistance training and cardiovascular activity. So I said there's three main reasons why we train, or at least in my mind, why you train. You train for muscle mass and strength. You train for insulin sensitivity. You train for metabolic health. And you train for good plumbing. Just like you said, whether it's the clitoris or the penis. You train for good plumbing. The only way to do that is you have to exercise. Everyone wants to know right now immediately, how do I know I have enough skeletal muscle that I will be preventing this? I am in the 60 % by 40 who still can get an erection.

35:32Dr. Gabrielle Lyon:Bring up a great point. And we've been hyper-focused on body fat. We don't directly measure skeletal muscle mass. DEXA measures body fat and bone density and extrapolates the rest. It tells us nothing about the health of skeletal muscle, which is one reason why I believe that people will say, well, if you're obese, you're carrying weight and so you're carrying more muscle. It doesn't mean that muscle is healthy. Muscle, if you imagine muscle, cross-sectional area of the thigh, if you look at that and you want it to be healthy, visually you think it's like a filet mignon versus a ribeye or a wagyu steak.

36:09Tri-tip. Oh, not a wagyu, never.

36:11Dr. Gabrielle Lyon:I love tri-tip, by the way. Yeah, I mean, I'm born and raised in California. We eat some tritone. Yeah, you do, for sure. That's the first place I had it, actually. But that is what healthy skeletal muscle is. And again, it's the main site for glucose disposal. So it really is your metabolic sink, but it's also responsible for strength. And you want that tissue to be lean, and you don't have to change your body composition. Just the simple act of exercising uses fat and glycogen within that muscle. whether your body composition changes or not. I want to link that back to what you said earlier because you had talked about the estrogen decline leading to insulin resistance due to body fat distribution.

36:53And I think this is an important point because that isn't inevitable just because estrogen's gone. But the reason why it's roughly 60 % of women are going to be pre-diabetic, if not diabetic in perimenopause is because of skeletal muscle. For the women who are listening and are like, they don't want to do HRT, they're not interested in estrogen, but they also don't want diabetes, the alternative has been presented here. Yes.

37:20Dr. Gabrielle Lyon:And it's muscle. And early on in my career, I couldn't figure out. I was like, why are all these post-menopausal women coming in, even perimenopausal, that had been cycling on yo-yo diets and having issues with, number one, visceral fat, number two, elevated levels of glucose and insulin, and they are small. And that's really what you're looking for for metabolic syndrome. So metabolic syndrome is BMI or body fat percentage over 30, elevated levels of triglycerides, insulin, glucose, and high blood pressure. But that's not indication of adipose tissue. That's indication of healthy skeletal muscle or unhealthy skeletal muscle.

38:02Yeah. It's very interesting that you bring this up in the context of looking at metabolic syndrome, and especially in the wake of so many GLP-1 conversations happening. I did a whole episode talking about GLP-1s and HRT. And something I said, which I didn't realize was going to strike such a chord, is that if you lose weight, but you have lost muscle, you have not gotten healthier, you have only gotten smaller. Why are we still so fixated on women being as small as possible?

38:34Dr. Gabrielle Lyon:I don't know, but I will tell you with the use of GLP-1s, we are in part really solving for obesity. I mean, this will affect obesity. We see it. We've never been able to lose weight like this before, even bariatric surgery. I mean, this is a rivals bariatric surgery, but we're trading one epidemic for another. We're trading obesity for obesogenic sarcopenia or sarcopenia, which is low muscle mass and function. And by the way, sarcopenia didn't even get an ICD-10 code, which is how we classify diseases until 2016. I know. I mean, so this is insane. Wait, explain to people why that matters because I'm laughing about it, but not everybody's in on this giggle right now.

39:20Dr. Gabrielle Lyon:In order for someone to be able to communicate and treat a disease, we have to acknowledge that it exists. And the way in medicine that we acknowledge when someone has a diagnosis is it gets given a code. And it is now acknowledged in the international classification of disease. Sarcopenia, and we all cognitively know what that looks like when our parents lose muscle or our grandparents and they become very tiny, that's sarcopenia. And by the way, sarcopenia is always thought to be a disease of aging. It's not. We are going to see sarcopenic phenotypes of youth with the use of GLP-1s. I believe it.

40:01It's something that, so to be very clear, my stance is not anti-GLP-1s because I do think they have a time and a place. And I've talked with practitioners who are phenomenal about making sure that these people have personal trainers. They have dieticians. They have everything they need. There are far too many med spas, though, just handing it out and handing it out. I mean, that's irresponsible. And not doing their due diligence.

40:24Dr. Gabrielle Lyon:Yeah, and it's going to come at a cost. And I will tell you this, nobody is prepared for it. Because as you go through cycles of skeletal muscle loss, it becomes more difficult as you age to get that back. And you become very, very vulnerable. And I don't think the world is ready for what the treatment's going to be. because testosterone enough is not going to fix it. Individuals are going to look at various things like machines that stimulate muscle or anabolic agents that have all gotten a bad rap. The treatment for these things, people are not ready for. And so what is going to happen is we're going to have an epidemic of sarcopenia plus osteoporosis, and we're going to have aged people 20 years.

41:06Dr. Gabrielle Lyon:So think about it. Sarcopenia, you'll lose 4 % of your muscle per decade, Mm-hmm. 4 % per decade, which I do think that it's probably more than that. Let's say it's 10%. 10 % per decade. What do you think the use of GLP-1s is going to do? Mm-hmm. Well, the thing as you are talking about this that I just read yesterday is Medscape put out this whole thing of like, wow, like 30 plus percent of people are losing hair on GLP-1s. And I'm like, that means they're losing muscle. If you're shedding your hair, you are losing muscle. and the fact that brilliant doctors are talking about this hair loss and not making the connection that like this person is not eating enough protein to keep up on this.

41:53There is the androgenic aspect that could be getting exposed, but when you look at suddenly you're shedding all this hair, if this was anyone else, the first question would be is how much protein are you eating? And yet that's not the first question. It's a, do you think minoxidil could help? I'm like, oh, what? No, no, you're absolutely right.

42:13Dr. Gabrielle Lyon:And, you know, protein is probably my favorite topic. I've only been talking about it for 20 years. I am eventually going to get tired of this topic. I'm kidding. No, I probably won't. No, I want to say this though for people like behind the scenes. So, you know, why I giggled about the 2016 is because I was studying sarcopenic obesity 10 years before that. You and I met at Paleo FX and you were like, oh, I study sarcopenic obesity, I was like, you're the only other person I have ever met that knows that word that I don't have to explain. And then you were like, this is my mission and all this stuff.

42:46And I was like, damn, the world needs you. Like, this is so...

42:49Dr. Gabrielle Lyon:And it hasn't changed at all. It hasn't changed at all. But... What do you think's missing? What do you think's lacking? Why are we not seeing this change? Because really, I mean, you and I have been in this field forever. I mean, I was studying in animal models, introducing branch chain amino acids and studying their skeletal muscle and aging them rapidly, not letting them exercise and just seeing that intervention. What is lacking or what is obstructing? Why are we not seeing change? Because I've never heard of the street, street lamp effect. No, I don't think I have. So think about this. I know you've been to New York City.

43:23Dr. Gabrielle Lyon:I think you might've even come to our clinic when we had one in New York City, you might on Central Park. And imagine a lamppost and it's 2am and you've got this cop there and you got this drunk guy looking for his keys. Okay, so this guy is on the hands and he's like, where are my keys? Where are my keys? This cop comes over and he's like, hey, man, can I help you? He's like, yeah, I dropped my keys. So the two of them at two in the morning are on their hands and knees looking for the keys. And the cop looks at this guy and goes, hey, man, are you sure you dropped your keys here? And he was like, no, I actually dropped them in the park, but it's black and dark out there.

43:57Dr. Gabrielle Lyon:I can't see anything. And so I make this analogy. This is the same with body fat and obesity. it is the obvious thing that we see so we're like oh well let's just look here when the reality is skeletal muscle is arguably more important you know i was talking to don he's my longtime mentor and i was like don i really think that it's this intermuscular adipose tissue it's the the skeletal muscle that becomes deranged first before we put on body fat you know he's challenging me he's like ah i don't know but regardless if it's the chicken or the egg skeletal muscle becomes dysfunctional, but we haven't recognized it as an organ system.

44:37Dr. Gabrielle Lyon:And because of that, we are still hyper-focused on obesity. And listen, I get it. It's because it's the obvious, but it's not going to solve the problems. I mean, we've been trying to solve that for 60 years. And if that was the right question, then we would have probably solved that. Skeletal muscle requires hard work. It requires discomfort. It doesn't come easy. It's much easier to gain body fat than it is to put on muscle. And I will also say that I think about of your work in being a paradigm shift is that it isn't this obesity focus of lose fat by eating less. It is train in a specific way to build skeletal muscle and shift your diet so that it actually supports skeletal muscle.

45:20And that I think much of medicine is still resistant to because they still fall into the, it's just thermogenesis, you know, like you, you, you just have to burn the fat and then it's, you know, thermodynamics. You just need to like conserve energy and you need to reduce the food coming in. And so it comes down to this really reductionistic thing, which is exactly what you've been saying. I mean, like, think about it. Like we think about Einstein's quote, the definition of sanity is doing the same thing over and over and expecting that you would get a new result from that?

45:50Dr. Gabrielle Lyon:You know, I recently was asked to give a statement for Consumer Reports investigative journalism. They were basically like, and I know it's going to be negative. I'm just sure of it. So they listed out this meta-analysis saying, well, there's no reason to have a higher protein diet. So right now for your listeners, the current protein recommendation hasn't changed since you and I met almost a decade ago. or four decades before that, our protein recommendations have remained the same, and they are set at the minimum amount, the absolute floor. Yes, that was going to be my point. To prevent a deficiency.

46:32And that's it. That's what people need to realize about all of the RDAs. This is the absolute minimum to avoid disease. It is not the amount for optimal. It is not the amount for functional, right? It is the amount that we know if you go below this, you'll be in a diseased state eventually.

46:49Dr. Gabrielle Lyon:That's right. And I would say 40 % of women over the age of 65 are below the RDA. 40 % of women above age 65 are below. That means they're eating below the amount to prevent deficiencies. And if we think about aging and we think about sarcopenia, there is no way to protect muscle. Yes, exercise, but they are called essential amino acids for a reason. So when you look at the data, if you double the RDA, so it goes from 0.8 to 1.6, people always do better. Their body composition improves. Their blood markers improve when carbohydrates are controlled. There's no negative outcome from increasing dietary protein.

47:36Dr. Gabrielle Lyon:And if someone's like, well, the data supports that you could go from 0.8 to 1.1 or 1.2. Yeah. Maybe someone doesn't want to go all the way to 1.6. That's fine. But anything above 1.8, which is for someone who's listening to this and they're like, well, what is that? It's 0.37 grams per pound. So if someone is, I don't know, 115 pounds, that's 45 grams of protein. That's not enough. That's not enough to protect and help with healthy aging. And then the question becomes, what else are you eating? If we knew more about our sleep, what would we do differently? Would we go to bed at a consistent time?

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48:42Dr. Gabrielle Lyon:So we just have to, I think that the information is starting to shift. And there's one other really important point because I think that your audience is really keen and smart is that if you look at the data and they will say there's no change in lean body mass. So they'll do 10 to 12 week studies and they will show no change in lean body mass. with a higher protein diet. And if I told you that sarcopenia is 4 % per decade between subjects, unless there is a change over 10%, it's not sensitive enough to detect that change in lean body mass. Of course, it didn't change. You would need 20 years to make this study show change in lean body tissue.

49:38Dr. Gabrielle Lyon:And so I just think that there is a perspective when someone is out there Googling it or reading it, and it'll say there's no change in body composition. There's no reason why we should have a higher protein diet. You have to ask yourself, well, those studies, what was the expected change anyway? You're not going to see it. I've seen arguments that where people will say, it's not protein you need to worry about because most people are hitting the protein requirements, it's fiber. And so we have to shift the diet back to fiber. And the question is always, why is it either or? And in your book, are you addressing both?

50:13Dr. Gabrielle Lyon:Yeah. So there's a whole how to eat section in the book, of course. And it focuses on protein. It doesn't focus on calorie counting because I think people get really burnt out about that. But it shows them how to design a plate and how to eat for their muscle health. and that's you know it shouldn't be complicated to be effective and there's not some crazy workout plan it's stuff that you can do at home in your hotel room when i'm done with this i'm gonna go back i'm gonna do my workout for real i did mine this morning like it's gonna happen yeah um but the thing is is we have to stop chasing novelty it's not gonna get us what we want and there are foundational truths that we have to recognize across our species and across you know most mammals they eat for 20 protein it's called the protein leverage hypothesis there's a drive to eat there's a biological need so you anchor the diet in protein and listen i think that animal proteins are the best and the reason why and that's beef chicken fish eggs whey is because it's high nutrient density.

51:20Dr. Gabrielle Lyon:The lower your caloric intake, the more very specific meals matter. And it just matters because you're not over-consuming food. So you just have to make better choices. You know, I personally don't like to get my protein from soy or quinoa because while those have protein in it, also has a ton of carbohydrates. And if the average person is eating like almost 300 grams of carbohydrates, that's a lot of carbs and anything really over 100 130 you have to earn through exercise i'm not doing that much exercise and i train every day so you have to pick are you gonna count this carbohydrate source as protein or are you going to go towards a more animal-based protein source and for people listening that's not to say that quinoa doesn't have health benefits and it's not a good thing to include to your diet but you know to your point i don't want six cups of quinoa.

52:14Dr. Gabrielle Lyon:How much can you actually eat? Or 420 almonds equal one small chicken. Yeah. I mean, that's just me. Yeah. But it's also like, how much can you realistically eat? Totally. And as somebody, I was a vegetarian for 10 years. Do you know I was too? I was vegan and vegetarian. Oh, yeah. Until my hair started falling out. For like a minute. And then I was like, I can't do this. Like, this is driving me insane. Because I was so about how do I get my protein? I still eat eggs, right? I ate a lot of eggs. I still eat a lot of eggs. But it is something that you just, it is so difficult when you start talking about 1.8 grams of protein.

52:51It is 1.6. But if you are in that range, it is so difficult to actually be able to consume that just, I mean, totally beans. So I really handle all those beans, right?

53:05Dr. Gabrielle Lyon:No. Yeah. And so we've got to be able to come up with a reasonable plan that people can do. Yeah. And weigh that effectively. You know what I want to ask you because you talked about muscle becoming dysfunctional first. I'm sure people listening are like, hold up, can I walk it back or is it muscles become dysfunctional? It is all downhill. So there are two main fiber types and there is type one and type two fibers. Type one you think of as those endurance fibers that seem to predominate, especially, again, this is probably a training effect in women. And then the type 2 fiber types are those bigger, bulkier fiber types that you think that are used for weightlifting.

53:49Dr. Gabrielle Lyon:They primarily burn glucose, and they don't have as much mitochondria as, say, type 1 fiber types. So if you are walking, which is wonderful, you are not protecting these type 2 fiber types which are necessary for explosive power. So walking is wonderful. And are you generating fuel usage in skeletal muscle? You are. You are improving insulin sensitivity. It's great to do. But you also have to think, what else is muscle for? It's the primary study for glucose disposal and insulin resistance. So But you still need to protect the amount that you have, especially with anabolic resistance that changes the way your body responds to both training and diet.

54:36Dr. Gabrielle Lyon:So walking is wonderful. Yes, you will start to make your muscle look like a filet, but it's not going to be enough. And it doesn't have to be, again, it could be push-ups. It could be bodyweight exercises. It could be anything, but you do have to provide a stimulus. And so you can reverse this function. Oh my gosh, totally. What does it look like? Is this something where it's like you start training, you're doing three days a week of your strength training, you're walking daily, you're doing the neat exercise, just your activities of daily living, but making movement central to your life rather than the convenience that you talked about before, which we love and it's necessary sometimes.

55:16What does that look like? So you're doing all of these things. In three months, am I gonna start to experience this change? Or is this something where like, you need to know you're going to be in this for a year to reverse that. And then after that point, we're going to start to see the gain.

55:31Dr. Gabrielle Lyon:Yeah, I think that we have to disassociate the physical change from the metabolic change. And that's specifically what I'm talking about. Because when we think about filling it right, I think maybe when I say that, people are like, oh, the way I look and how snatched is my waist. But like I'm talking about like you have more energy of less brain fog. You're sleeping better and your erections are working. Which now we have the attention of all male listeners, if you have any, and their wives or partners. You can improve insulin sensitivity by just a bout of exercise. I mean, I'm sold. Yeah. I do 10 sets of 10 pushups all day long.

56:11Dr. Gabrielle Lyon:My team makes fun of me and then they have to do it with me. so you can improve from a metabolic aspect immediately yes over time because you really want to see lower triglycerides better insulin you know lower levels of insulin better glucose control over time but you can still see changes especially if you're correcting your diet immediately you'll get neural adaptations first right so that the brain and the nerves being able to go through that initial part of learning muscle, not muscle memory, but really being able to do those movements. And then you'll gain strength. And then hopefully you gain mass, but for sure you are improving.

56:55Dr. Gabrielle Lyon:And you'd asked me earlier, and I didn't answer this question, how much muscle should someone have as much as they can? As much as we don't have, I don't have a great number. I can tell you how much is not good for sarcopenia, but at some point we don't care about sarcopenia. We know that's a problem, but we don't actually know. I don't know what your ideal muscle mass should be. I don't know what Bryce's ideal muscle mass should be. We don't have those numbers. I hope that we will, but we don't. You referenced earlier, you said the world's not ready for the treatments it's going to take to walk it back from GLP-1s.

57:27And you talked about anabolics being vilified. Can you say more about that? Because I think we have a real opportunity to dispel some myths here. Yeah.

57:36Dr. Gabrielle Lyon:So I want to couch this and be very thoughtful in my answers. Anabolic steroids have gotten a very bad rap. Anabolic steroids, and I say steroids, but they should just be called anabolic agents. When the AIDS epidemic happened, do you know what saved their life? Really? Was it anabolic steroids? It was. Interesting. Yes, it was. Yeah. The Houston Buyers Club. And I interviewed that guy on my podcast. Wow. I was just a baby then. Nelson Virgil talked about how these guys were dying of AIDS and that people were able to go to their doctor to get anabolic agents to protect muscle because you'll die.

58:17Dr. Gabrielle Lyon:You know, 40 % muscle loss, you're dying. You're dying. 10 % muscle loss, you have impaired immunity. So as we think about GLP-1s, 20 % muscle mass loss. So at each 10 % muscle mass loss, we see more significant health problems. So as we think about how we stimulate muscle, and I want to be very careful because you still have to do diet and exercise. You shouldn't be able to go to a doctor and get an anabolic agent, but those treatments exist and they are FDA approved. And they've just gotten a very bad wrap. And I think it's one of the biggest mistakes in medicine. Okay. And so for people listening, because the first thing, you know, we saw this with, I think GLP ones because we've just been talking about it and it's so fresh in people's minds.

59:01I mean, the first thing people say is that these are brand new experimental and we don't know what they do. They're going to make the same argument here. So firstly, no, they're not. They've been around for decades. Secondly is this is not for everyone. Yeah. Medications aren't for everyone. Not every medication is indicated in every situation. So who are these indicated for and who are these people who should consider?

59:24Dr. Gabrielle Lyon:So there are anabolic agents that are FDA approved for anemia. There are anabolic agents that have randomized control trials for osteoporosis. They are used off-label for sarcopenia. You just have to talk to your physician. I would go to a urologist. So I do research with my colleagues at Baylor. And you think about going to people that study androgens. It's called androgens. There's a whole field of medicine. But then I realized, okay, yeah, now it is. So my husband would disagree. So my husband, as a urologist, thinks there's a different organ of longevity. And we'll just leave it at that. But there is a study of andrology, which is testosterone, testosterone-related agents.

1:00:05Dr. Gabrielle Lyon:And they exist. And we're not talking about bodybuilding doses. We're talking about these agents used appropriately help build and maintain muscle. And the world's not ready for it yet. I also want to ask you because I think there's going to be some people that heard like, you know, 4%, 10 % loss of muscle mass. Is there any way to get that back? Yeah. Yes. It's not inevitable. Aging is inevitable, right? Like God willing. But the loss of strength is not. The loss of muscle mass is not. And it's a responsibility. If I were to pick one, and again, it shouldn't be binary, but simply start with training.

1:00:43Dr. Gabrielle Lyon:Don't change your diet. I don't care. even though 100 of people eat you really have to nail that but doing some type of resistance training will improve muscle health no matter what and yeah you can get it back just because you're aging doesn't mean you're going to have this precipitous loss and um and i think that as women are going through menopause ideally you start before right you don't want to play catch up but we did studies with post-menopausal women who were not on hrt in fact they couldn't be to be in the study. And they were able to change their body composition. And I also like what you said because you've been treating menopausal women for 10 years, that it is diet and lifestyle.

1:01:25Dr. Gabrielle Lyon:You have to have that in place. There is not going to be a magic pill or a patch that's going to improve that. You'll improve symptoms, but it's not going to change your muscle mass or body comp in a meaningful way. It's all of the above. It's hormone replacement, it's diet, it's exercise, because you know and then how to think you don't have to deliberate on it yeah sometimes do you think i want to work out i took a very late flight last night to get to california to do an early morning interview that was in the car all day come here do another interview i haven't worked out i'm gonna go back to the hotel room and i'm gonna work out i'd much rather order room service and watch terminalists but i'm not going to yeah i'm gonna suck it up i'm not gonna have a conversation about it.

1:02:09Dr. Gabrielle Lyon:I'm just going to do it. You remember me, how not to die. Do I want to die? No. There's so many things that, and I have listeners who are like, you're so morbid. I'm like, that's my motivation is that I literally have just seen so much in my career that could have been prevented. And I'm like, if, if I can take, I mean, we, we think about, you know, women should be more concerned about cardiovascular disease than they are about breast cancer, but it gets a whole damn month. So, you know, that's what we focus on. And if we even just look at that thing that we are told to be afraid of and dread, exercise alone can significantly move the needle so that you're not that next diagnosis.

1:02:49Like there's so many statistics that fly around in women's health. Like, you know, this is the percentage of women that are going to have a heart attack, have osteoporosis, have a hip fracture, end up with breast cancer. And the reality is that there are genetics and there's nothing you can do about that. But the things that you're talking about in your program are the things within your control that absolutely can prevent these things that we know in some instances, your day-to-day behavior has a stronger influence than your genetics.

1:03:21Dr. Gabrielle Lyon:It's not the big things. It's the little things day-to-day. And it's really understanding where your vulnerabilities are and where you'll talk yourself out of something that prevents you from doing the next right step, right? Discernment is the antidote to autopilot. Your program in this book, I'm assuming it was born out of your clinical experience. This is a program you're putting people through. What are some of the phenomenal transformations that you've seen happen? People have, they have mental and physical freedom. So if I were to say, what is the one? Oh my God, who doesn't want that? They are not obsessed with what to eat and how their body looks.

1:04:00Dr. Gabrielle Lyon:They feel better. They have more energy. You take that off the table and then people are able to do what they came here to do because they are not distracted by body or what to eat or these repetitive thoughts. I mean, yeah, people have totally lost weight and put on muscle. Have we seen their blood markers improve? Yes. But more importantly, we've seen their life transform. And that's what this is about. And I'll tell you one thing else is this is not something that I can do alone. There is an opportunity for a cultural shift, a real movement so that people can be better and stronger and more resilient.

1:04:39Dr. Gabrielle Lyon:And I cannot do this alone. I'm only one person, but there is an opportunity for a cultural shift as to how we show up as humans in this world and how our kids show You are raising your boys to be great humans, and you're doing it for a reason. But that creates a cultural shift. You are telling your boys, little legs, little brain. That is just the beginning because, you know, it starts with enough people believing in the mission and executing on the mission. And then we will start to see the needle move. Yeah. Well, thank you for writing this book, putting this program together, and sitting down and sharing your expertise with us today.

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