Muscle Is the Key to Longevity (Not Fat Loss) | Dr. Gabrielle Lyon

24:45I came and saw you, remember? Yeah, barely remember. I was so high on narcotics. Well, anyway, I did. I came and saw you. There was great music playing. I do remember. And I lost 25 pounds of muscle because I didn't really have any body fat. I was already like at 10 or 12 % body fat. And so I just lost my skeleton and my muscle. And I was worried. You know, I was 65. Didn't know if I could build it back. Didn't know how my body would respond. You know, I know all about this phenomenon of anabolic resistance, which is as you get older, it's harder to build muscle. And you know what? I just doubled down on everything that I knew to do, which was strength training, you know, testosterone therapy, which made a big difference because my hormones were just in the tank after the surgery.

25:32Oh, yeah. 100, 200 or something. Unbelievable. I had, I used creatine. Mm-hmm. I used high doses of protein. And when you say high, we should talk about that. Yeah. So I would have like 50 grams for breakfast in a protein, whey protein shake. I would put in creatine. I would put in mitopure, which is something we're talking about, which is a molecule that helps build mitochondrial health and reduce inflammation. And I was just deliberate in the gym every day for an hour. And I couldn't do anything at first. All I could do was lay on the floor and or I actually couldn't even get on the floor. I was laying on a massage table and I would put a band around my knees and just open my knees back and forth and activate my glutes.

26:12Like that's all I could do. But that was enough to then begin to stimulate the tissue. Yeah. And I just want to say something. I could do like 10-pound weights. Now I'm doing like 50-pound weights. I mean, you're strong. Yeah. And you had mentioned myokines, which I think is important. Yeah. And myokines are these proteins that are released from skeletal muscle based on contraction and duration of exercise. Now, they were discovered in the 2000s, early 2000s, in Copenhagen, by an exercise. She's actually an MD who also is an immunologist. really bendage of fendersen fendersen and um there are thousands of different myokines but what is so interesting is when you contract skeletal muscle and we're just thinking about you had an injury we'll call it an injury or a catabolic crisis but when you went to go contract that skeletal muscle the myokines that released did a number of things so number one stimulates bone, as we know.

27:14So it's not just the pulling, but also helps stimulate BDNF in the brain, which is brain-derived neurotropic factor. Also, it secretes interleukin-6, which people always think about as this cytokine storm from macrophages and other cells. But when released from muscle, it helps balance the inflammatory response. And so there's this pleiotrophic effect. There's this positive effect when these myokines are released from muscle. They do things we don't even know about. And so that's this idea of exercise as medicine. And by being able to dose exercise appropriately, we should be able to get these responses that are beyond just the responses by improving blood flow.

28:00Right? So there's the muscle mass and strength. You're on the ground doing your clamshells to try to then stimulate and engage your glutes, which is really important. We know better leg strength means better mobility, better activities, daily living, but it also means better cognitive capacity. Yeah, definitely helped, for sure. So really, it's such an interesting thing. You've got all these different functions of muscle, most of which have not been ignored, most of which I certainly never learned about in medical school. Doctors don't know how to assess sarcopenia or loss of muscle. They don't know how to treat it.

28:31They don't know the first thing about it. it's kind of amazing to me and i remember when i worked at kenya ranch in the 90s um we had a dexa machine and everybody would get a dexa scan and i was like this is really fascinating and we looked at bone density obviously but we also did body composition and back then nobody was looking at body composition and we were seeing you know all kinds of interesting things that that people didn't know about in terms of where the distribution of fat was where loss of muscle was increased body fat and it was such an incredible tool but now with the imaging to ezra the company the company that's part of function we can now get sophisticated mri assessments to see where you're at and then you can track it longitudinally over time to see what your interventions are doing to help and you know one of the things that i think um you pioneered is this idea of muscle centric medicine we talked about and and not just sort of at an abstract level but how do you actually applied this in your life and your new book the forever strong playbook which everybody should get a copy and you agree you're going to do the training program why don't we start you on that i am and we'll do a before and after let's just see what happens if i follow your your six week program to my muscle yes i'm gonna get even more ripped okay but it's also not fair because kind of genetically you're also very lean but why don't we do that why don't we do a body composition assessment before and strength assessment before, and then do this for six weeks and do a strength assessment after.

29:59And we'll talk about it on my podcast. I love that. And we'll talk about the results from Ezra on my podcast. I love a challenge. And I know you do. So I mean, I'm obsessed. Like I, I, I honestly, I have to be honest. I hated strength training. I hated. Do you remember last time I tried to get you to go to the gym? You know what we said we were going to do. You wanted to go for a bike ride instead. I know. I'm like, I, but now it's like I'm addicted. Well, it's non-negotiable. It's now it's non-negotiable. And even if I'm traveling, I'll go to the gym. I'll bring my little bands. If I can't get things, I have, you know, all these different tricks.

30:33Let's talk about a few of the, the, the practical strategies that people can do, which is why I wrote this book. Now there is this concept of progressive overload. Okay. Progressive increasing the amount of weight necessary to get a particular outcome for strength or hypertrophy. We'll just put it all together. But the reality is, it's about progressive stimulus. And the reason I say progressive stimulus is because, again, you are traveling. And there are many people that are listening to this podcast that, say, are in perimenopause or menopause. And the last thing that we want them to do is to injure their shoulder, which maybe they've presented with frozen shoulder or injured.

31:17Listen, you know, I've had a bazillion injuries. The reason I say it's progressive stimulus is if we take a step back, muscle strength outpaces tendon strength. And it doesn't mean if you are listening to this and you are new to training, it doesn't mean you just have to lift heavier. Heavy is relative. One to two reps in reserve, meaning with good form, there's mechanical failure and then there's technical failure, right? You want the muscular failure, the mechanical part. You don't want the, you don't want your form to be all over the place. If you're supposed to do a squat, but you're lifting it with your neck, that's wrong.

31:59Right. And so what are some of the foundations of a great strength training program that is non-negotiable and everyone can do? I mean, that's three days a week. It's full body. It's all about how you progress over time. And the progressions could be reps, could be tempo, could be adding more volume. There's all different ways to improve muscle health. That's not just lifting heavier. Well, it's interesting that you say that because I was in a bike accident and limited, but I didn't stop training. A lot of people, when they have an injury, they go, well, I'm just going to chill and take this chance to just watch Netflix and lay in bed you know but I have like a broken ankle a broken foot you know kind of banged up pretty bad and I just was like I'm not letting this stop me and I can't lose the progress I've made and so you know I'm working with someone who's helping me adapt to it but I'm also using these things called blood flow restriction bands and yesterday we were in the gym and I was like doing like 10 pounds with these things on and I'm like normally I can do like 25 30-pound curls.

33:05And I was like, ah, you know. And so you can do things without hurting your tendons as you get older and then deal with this injury risk and make your risk for injury a lot less, but get as much or more benefit. Blood flow restriction is something that we've been using in our clinical practice forever. And let me just highlight blood flow restriction. Yeah. So blood flow restriction was originally used in rehab and we use it a lot. A lot of the soldiers use it for rehab for injuries. And what it is, is you'll put a cuff on, and there's various cuffs. I use a Bluetooth cuff called Saga. Have you ever heard of them?

33:39I use Katsu. Okay, Katsu. So this is, that's like a Japanese crispy chicken. That's a very advanced cuff. And what it does is it occludes the blood flow, meaning it will calibrate to a certain millimeter of mercury. And then it looks like, it feels like a blood pressure cuff, but a little bit bit more robust. And what it does is it allows you to train at a fraction of the weight that you would normally train to get the same stimulus. So what does that mean? So you had just said that you do 30 pound curls. You could pick up a five pound weight and it would signal to the body because again, your blood is partially occluded and it sends growth factors.

34:26And there's very standardized ways of doing it. And Dr. Jeremy Leneke, who is one of the world leading experts on blood flow restriction, he was on our podcast and he just gave a masterclass in how to use blood flow restriction. Very particular for outcomes, right? So it's not this kind of just haphazard use. It's what percentage are you including? What exercises are you doing? What is the injury that you're trying to work on. And it's, it's, I, you know, obviously I'm not there, your guys' doctor or neither is Mark, but this can be very safe and effective. Yeah. I use it when I tore my hamstring.

35:07I still use it. I travel with these blood flow restriction bands when I don't have access to a gym as well. That's right. But you can just do body weight stuff and it feels like heavy weights. Yes. I mean, I, I get these incredible pump on my arms. I look, my arms look almost as good as yours after I'm, after I'm done with my workout. But it's extraordinary. And also for more advanced aging people, it's great. And also if you don't have a ton of room, like let's say, you know, someone is on bedrest or someone is injured, by just simply inflating that cuff, even by doing a partial pushup or even pushing against the wall, some kind of muscular movement actually has, again, just profound effects from injury and also maintaining muscle and blood flow.

35:51which is, again, really important. Let's get into kind of the details a little bit, because clearly muscle, as you've laid out, is such a neglected and important part of our long-term health. You call it the organ of longevity. That's right. I agree. I think, you know, if you look at all the things you could do, I mean, when you're younger, you have a lot of trophic factors and hormones that keep you kind of going. When you get older, those change. They do. And you end up, you know, having the dwindles, we call it, in medicine. I never, wait a second, I never heard of the dwindles. You never heard of that?

36:22No. No, you're a geriatrician. I know. We never called it the dwindles. That is definitely not a geriatric word. That is a Mark Hyman word. It's like, you know, you see a slow, gradual decline. You dwindle in your ability to function. David never heard of that either, the producer. Well, anyway, maybe I made it up. It's something that you kind of notice. And like you said, what we see in our aging population, we think, is another part of getting older, which is this decline in ability and function and doing things. And the truth is that that's not inevitable. Now, it takes a lot of more input and work and dedication and diligence.

36:58And I want to really get into what does it actually take? Because, you know, people can hear this and go, well, I'm not going to go to the gym every day. And I'm not going to do it. No, they're not. They're going to hear this and they're going to go, you know what? This is the new standard because this is more impactful than any medication I could ever take. It really is. I mean, you know, losing body fat is important. But I would argue, along with you, that I think building muscle is probably one of the best ways to lose body fat. but also to correct your metabolism, to lower inflammation, improve your cognitive function, to improve your immunity.

37:26Help your sexual function. I mean, pretty much everything, everything. And also we have a direct mechanism. So one of the things that we have to understand is that, you know, in medicine, we have to ask, okay, so what is the mechanism of action? So for example, muscle mass and sexual function, which we published with my colleagues at Baylor, we have a direct action. And that is what does muscle do? Muscle, strong muscle, improves endothelial function. Okay. Improves all vascular health. Strong, healthy muscle mass improves NO2, which is vasodilation. Strong, healthy muscle helps improve metabolic risk factors, helps control blood glucose, helps control fats, and it's under voluntary control.

38:13And you had said something that - Sounds like a good ROI. There's also twofold. We just have to become more strategic at the inputs that we put in. Meaning, what does that mean in terms of inputs that are valuable? You know, as we age, you'd pointed out, when we're younger, our system, you know, it's this idea of mTOR. We've all, people have heard about this, but anyway, it's this protein kinase. It's this growth fact. It's this growth perpetuator. Yeah. And when we think about it, it's in all tissues. So mTOR, and I'll get to why this is even important, not to get too caught up in the weeds, but mTOR, which is responsible for muscle protein synthesis, is in all tissues.

38:55The signaling of our muscle decreases the efficiency, becomes decreased to inputs like protein. And so when we're young, we're highly anabolic. You know, you've met my son, my little one, he's training for the SEAL teams, he's four. He's highly anabolic. He could have five grams of protein and it would still stimulate his muscle because he's growing. He's driven by growth factors and insulin. But when we're done growing, then this input has to change. And this input would then be resistance training, calories, hormones, carbohydrates, and the balance between all of them changes. So we have to get...

39:38The protein. Well, protein is right, the amino acids. And that's probably the most important. The most important is the resistance training input, the mechanical input, and then the protein input. Primarily leucine. So let's get into the protein thing because, you know, this is a hot topic. Still. You know, fat was the boogeyman and then carbs are the boogeyman. Now, lack of protein is the boogeyman. Lack or just protein in general. And yet there's this sort of bias that too much protein is bad for you. We certainly learned that in medical school, you know, that it can stress your kidneys, that you don't need it, that your body wastes it.

40:17It turns it into calories or energy, turns into glucose if you too much. And what you're saying is we need far more protein than most people think. And that, you know, you've got guys like Chris Gardner, who I know well, I respect him. He's a top Stanford scientist, but he's very, very strong in his opinion that we don't really need that much protein. that, you know, you can get all the protein you need from like grass. And I think that there's some challenges with that. And I think especially as you get older, there's challenges with that. I think the RDA, which is the recommended dietary allowance, was designed for preventing deficiency diseases like protein malnutrition, not necessarily optimal health.

40:56So when people talk about 0.8 grams per kilo of protein per day, which is, you know, 0.37 grams per pound, which is, you know, Yeah, a third, basically a third of a gram per pound. It's really so you don't get a disease. It's not for optimal health or muscle building, or it doesn't even adapt to what you need as you get older. So how do you help people understand the right frame for protein about what we need, when we need what, how to eat it, when to eat it? Probably my favorite question, aside from one of my kids. Now, I want to just touch on Gardner and the episode that he did with Andrew Huberman, because we did a response video to that with Dr.

41:34Donald Lehman, who is one of the world-leading protein researchers who's trained me for over 20 years. I don't know if you know this, but I did a debate with Chris Gardner on the Diary of CEO, and they haven't published it because it was so controversial. I would really encourage people, and I will send it to you, I would really encourage people to listen to that episode with Don Lehman. Again, Don is not out in - That's on your podcast. It is on the podcast, and I will send you a link. Which is the Gabrielle Lyon podcast. We're going to put it in the show notes. But I am going to send it to you because it addresses each statement that, because again, it's fascinating to think that how we're communicating science now is like this, which is incredibly valuable.

42:17You and I are sitting down and we are talking. But you and I have both been in medicine for a long time. Arguably you more than, longer than me, thank God. Got a few more miles on there. You and I know that we would sit down and there would be grand round. And then there would be, you know, for me it would be like experimental biology where you have these world-leading experts have discussions and they would come together. And I just say that because typically science is not debated on platforms. So for example, we would take a look at this study and we would say, okay, this is - It's sort of sequestered to the halls of academia, not in public forum, which is now what's happening, which I don't think is a bad thing.

42:55I think it's a good thing. It is, but it creates a lot of confusion. It does. For example, Chris Gardner talking about how we're getting too much protein, you know, many of his fundamental statements were incorrect. And so put that aside. I encourage people to listen to that. Let's talk about where we are in terms of protein and where that information came from. Now, in the 70s, early 70s, there was the McGovern Committee, which then informed the dietary guidelines. That's right. The McGovern Committee was written. Do you know who it was written by? I think I do. A staff writer in their early 30s that had an economic degree.

43:34This person wrote the documents that then informed the dietary guidelines, which arguably we have barely changed. Yeah. And they were actually better when they first came out. And then the industry got involved. They made them change a lot of things because they were basically talking about eating less starches and carbohydrates. But then actually they made them change it. For whatever. But we just have to understand that nutrition is an interesting aspect of medicine because, you know, it's not like endocrinology or not like gerontology. Nutrition has a lot of inputs from food supply or from industry, from politics.

44:11Okay, so this then changes and informs the public. So the dietary guidelines have a list of recommendations. For example, it's 10 % saturated fat. Anything more than 10 % saturated fat is considered unhealthy. Working on that. But let's just frame this out appropriately. And then the protein recommendation is 0.8 grams per kg. Then the carbohydrate recommendation is 130 grams of carbohydrates per day. Now, let's look at just the fat component. By making 10 % saturated fat or more unhealthy, that weaponizes food for almost all animal-based foods. For example, an egg, one single egg that has a total of 6 grams of protein has, I don't know, 16 % saturated fat.

45:08Maybe it has like half a gram, right? six grams of fat there's tons of high quality protein choline fat soluble vitamins b vitamins but because it as a food has 16 saturated fat now this is considered unhealthy let's take one more example if my husband who runs marathons is eating 4 000 calories a day his saturated fat intake can be 44 grams. Because? Because of the 10%, because of the dietary guidelines, which we're going to circle back to protein, because obviously protein is the most essential and important macronutrient in the world. The most important. And people don't realize this, but it's the only macronutrient we need in large volume.

45:53So we need no carbohydrates that are essential. And only four grams of essential fatty acids. And we need very low amounts of essential fatty acids. Yes. But you need like literally multi-gram. You do. And every day, and here's why. We'll get to that. So 10 % saturated fat or more is considered dangerous. However, in medicine, you and I both know that there is a dose and a poison. Is it 44 grams, like my husband on a 4 ,000 calorie diet, or is it 14 or 16 if I'm having a 1 ,500 calorie diet? So the question is, what dose of saturated fat is then detrimental for human health? We don't have good evidence for that.

46:30The next one is protein. So protein, you'd mentioned, that protein is set at the RDA. You said that it was intended to prevent deficiencies. Now, I'm going to ask you a question. What health outcome is related to nitrogen balance? So the dietary guidelines of protein, 0.8 grams per kg, is based on nitrogen balance studies, technique from early 1900s for agriculture to determine what was the minimal amount of protein needed for animals to grow based on nitrogen balance. What health outcome is related to nitrogen balance? I would say it's muscle mass, but I think that's not the answer because it's too obvious.

47:09There's no health outcome that we know of related to nitrogen balance. And so rather than asking the question, is the RDA enough? A better question is, is the RDA a relevant number? Yeah. And the RDA is an irrelevant number. Why? Because it's based on nitrogen balance studies with no health outcomes. So how do we look at the upper limit or the, you know, I mean, there are certain populations, like if you have kidney failure, you have to be careful with protein. But aside from that. But it's not based on an RDA number. No. And this is the thing is that rather than reevaluating and reorienting ourselves to, you know, the indicator amino acid number or some other way of thinking about protein, we've anchored in on the RDA and then we argue about the RDA as if it's a really relevant number.

47:57It's not. 0.8 grams per kg is based on a nitrogen balance study, which is arguably irrelevant.

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49:55I mean, I don't know if you've single-handedly done this or who else is on the bandwagon here, but now protein is in everything. It's like everybody's talking about it. And we don't, right. And we, you and I know, we've been having this conversation. I've been having this conversation for 20 years. And it's great that it's caught up. And then it's getting the visibility it deserves. And there should be good evidence and guardrails. So 0.8 grams per kg, while people are talking about the RDA, is an irrelevant number. We know, again, and I've sent this to you and I. So what should we be eating? Well, the data would suggest beyond 0.8 grams per kg, the data suggests anywhere from 1.2 to 1.6 grams per kg, which could be on the lower end, 0.7 grams per pound, up to 1 gram per pound target body weight.

50:44But how do we make our protein decisions? Meaning your ideal body weight. No, no, your target. So if you're 300 pounds, you're not going to be. Target body weight. Like what you ideally would like to be. Yes, you can say it. Because if I'm 180 and I want to get to 190 with muscle, I have to eat 190. But let's frame this out a little bit. And I make this very easy to think about in the book. The book doesn't have a ton of numbers, which is interesting because we always calculate the macros and calculate the calories. I made this playbook so that it's visual. And the visual component is one third of your plate should be protein.

51:19One third of your plate should be fruits and vegetables. The other third is complex carbs or starchy, sugary carbs that you earn, which we'll talk about. But the protein conversation is really important. 0.8 grams per kg is an irrelevant number based on nitrogen balance studies. All of the data coming out largely for the last 20 plus years is 1.2 will always perform better in a number of ways than 0.8 grams. Okay. higher protein, 1.2 to 1.6, so double the RDA, what happens? Yeah. Improvement and retention of lean body mass. I didn't say muscle because we haven't really been testing muscle. Lean body mass.

52:03Better regulation of blood glucose. Better regulation of triglycerides. So when I was running a weight management clinic at Wash U and also in our practice, in order to tell if someone is following their nutrition plan, we watched their triglycerides. Yeah, of course. Right. 140 grams of carbohydrates or less, we typically see an improvement in triglycerides by 20%. Those are the things that are most highly correlated in an acute way to the amount of sugar and starch you eat. But it's actually related to muscle health. So if muscle is healthy, you have more flexibility. So these indications of metabolic syndrome, elevated levels of blood glucose, elevated levels of triglyceride, elevated levels of insulin, they're not a reflection of metabolic syndrome.

52:48They're a reflection of muscle health. Now, we talk about protein as if it's one thing. Protein is 20 different amino acids, nine of which are essential, but they all have different biological pathways and there's biological needs that are different. So for example, as we age, glutathione. Glutathione production goes down. We might need three times more protein in methionine as we age than we do when we're younger. Methionine is one of the building blocks of glutathione. Right. So it's one of the amino acids. When you are eating for muscle health, all of those amino acids, essential and non, fall into line.

53:26And, you know, someone's listening to this, okay, protein is protein. Why do I need protein? Well, you need protein for everything in the body, but it's not just protein. It's these amino acids. It's these individual amino acids that you need. Leucine is important for muscle health. Right about it. health. For muscle health. You're the one who taught me that lucerne was the rate limiting amino acid for turning on the switch that starts you to build muscle. Yes, but you need all of the amino acids to build muscle, which is, you know, if we begin to just unpack what does that look like. So 20 different amino acids, nine in which are essential, you must eat them for a number of reasons.

54:07The first thing is understanding that we don't need it just for muscle. The body turns over, recreates itself four times a year. On a daily basis, protein turnover is between 250 to 300 grams a day. Meaning you are metabolizing your own body's protein and recycling it and reusing amino acids that were formerly a different protein. Correct. And at night, you are in a catabolic state. But it's not that it's turned on and off. You've got enzymes that are degrading, you are constantly requiring these proteins. It takes it from muscle. So it's not just that low muscle mass is detrimental for mobility.

54:47Low muscle mass is detrimental for healthy aging. And we cannot meet our turnover needs with the kind of diet that we have right now. So we need more protein. So people should be focusing on 0.7 to 1 gram. And that's for For everybody? For everybody. And the way in which you do it is important. When you're young and under 40, it doesn't matter what you do. Protein distribution and timing doesn't matter. Meaning when you eat it. When you eat it, how much you eat at once. But as you get older, you have to learn how to make protein decisions. And there are a handful of steps that you follow to make a protein decision.

55:23Tell it to us. Number one, age. The older you are, the more protein you need. Period. Number two, physical activity. The more sedentary you are, the more protein you need. Really? Yes. Because we were talking about mTOR, which, you know, was mammalian target of rapamize and this protein kinase complex. But can you build muscle just by eating more protein without exercising? Not really. Not really. That's what I thought. You know, people will say that, but if you go back, well, number one, the other thing that we have to recognize is that the studies and the literature out there, it takes a long time.

56:01If you think about sarcopenia, it's in a span of a decade, you're losing 4 % or more of muscle mass. That's a very slow decline if you think about it. Can you imagine trying to look at these 12-week studies and try to get a sense of the input of 1.2 to 1.6 grams per kg? This stuff is not very sensitive with the tools we have. We're not taking someone's muscle and then stripping it down, right? So we have to understand that low protein intake is over a lifetime. These effects are over a lifetime. So the protein decision is the older you get, the more you need. Number one, your age. Number two, activity.

56:42The less active you are, the more protein you need. Because if there's two main ways to stimulate muscle as you age and becomes less sensitive, it's the mechanical input as resistance training, and then it's the protein input. And then your metabolic health. Right? So the next choice would be, how do you determine how much protein? Well, you know, you want to begin to limit carbohydrates if you're metabolically unhealthy and you want to increase dietary protein. Because ultimately, if we match our diet to our muscle health, then we will be able to live a long, healthy life. What does it look like?

57:19Because people are like, God, it's a lot of protein. But why do they think that? Because we've been taught. Right. But what does it look like when you eat it? Like breakfast, lunch, dinner. Very simple. This morning I had a protein shake, which was 50 grams of weight protein. Amazing. And put in 10 grams of creatine. You're like rock star. Your brain function is amazing. And you threw a little urolithin A in there and look at you. I did. I threw a urolithin A in there too. You're doing amazing. I did. So there's a couple ways to do it. The first meal when you're coming out of an overnight fast is the most important.

57:49People talk a lot about fasting. And at some point, if we believe that muscle is the organ of longevity, I don't really care when you have breakfast, but recognize that after an overnight fast, you are in a catabolic state, right? And you're not just your muscles, but you've got enzymes and everything else is repairing and rebuilding in your body. That first meal, your body is primed for nutrients. Doesn't have to be at 8am, it could be at 10am. Between 30 and 50 grams of protein is ideal, okay? What does that look like? it could be a 15 gram, a 50 gram protein shake. It could be. It's actually double what the says on the label.

58:31It says two scoops is 25. I put in four scoops. Well, I love that. But it's a lot of smoothie. I mean, I'm a big guy going to have it, but it's a lot. So let's talk about another, let's talk about something that I do, right? So for me, I might have a scoop of a whey protein shake, which is, it has about 20 grams of protein, two and a half grams of leucine, but that's not enough for me because, you know, I'm burning the candle at both ends and I'm training hard. So I'll add in a scoop of essential amino acids. You're sublimed with amino acids. I do. But I do it very strategically and for a very important meaning.

59:04So I know that you use body health. So do I. Perfect aminos was a big part of my recovery too. Yes. And so there's great evidence for recovery and also for people who say want to control their calories. You have a base of protein and maybe it's 20 grams. And then you add in a scoop of essential amino acids and now you bump up what your body sees. Just like jacked up a little bit. Yes. And there's a lot of data out there on this, especially looking at the aging population, which I think is really impressive. When you're young, you can get a max muscle stimulation at you know, 14 grams of protein.

59:46But 14 grams of protein for you and 14 grams of protein for me, it won't stimulate our muscle. But by doubling that amount or by adding these essential amino acids, you now can create a robust response that's critical for aging well. So you get a protein shake with some extra amino acids. What if you don't want a protein shake? What's breakfast look like? Eggs. You need six eggs to get 30 grams of protein. That's right. So do three eggs plus essential amino acids. I've just solved it. Also, what about Greek yogurt? Greek yogurt is easy. The minimum you want to hit is 30 grams. And what is that?

1:00:21Six ounces, eight ounces? Yeah. So it's a cup of yogurt. We'll have like 20. And then you could have turkey sausage, chicken sausage. If you are vegan or vegetarian, then I highly recommend essential amino acids and then some kind of multivitamin. So what do you do? Again, if you're vegan or vegetarian, it could be tofu. You know, the majority of plant protein comes from wheat in the U.S. diet. Yes. And wheat is a very poor source of these essential amino acids. So we're really talking about improving protein. We're talking about improving nutrient density. Protein quality. Protein. That's exactly right.

1:00:57Protein quality. So what would be lunch? So for me, actually, and also from a dosing perspective, lunch doesn't matter from a protein amount. Yes. And why? Because we don't have a ton of data. Does it have to be 30 grams of protein? Or is your muscle still primed? The way I think about lunch is that that's the place where you just get your extra protein. The most important part about also these meals is balancing carbohydrates. So for lunch for me is, so lunch today is going to be, I prep all my food on a Tuesday, by the way. Prep all my food on Tuesday. Lunch for me, you might laugh at me, is going to be protein waffles.

1:01:35made with cottage cheese, almond flour, and some blueberry compote. Blueberries? You're eating blueberries now? Of course. I couldn't even let you eat blueberries. I know. Yeah, see, I've evolved. So the protein waffles are amazing. So that is one of, it's a recipe that I put in the book. So all the recipes in the playbook are easy. Yeah, there's some great recipes in this book. And there's great images of exercise. You've got a little avatar cartoon of you that is really great. And it's like, wow, this is something I actually could follow. Because I was like, all right, well, I want to vary something.

1:02:04I don't want to do something like travel. I don't want to do my train. You're like, what do I do? And this is really, really great. And then let's talk about dinner. Dinner is the next. I often will have like a couple of cans of sardines. That's like almost 50 grams. Yes. But if I need 180 grams of protein a day, that's a lot of protein. But for who? Well, I'm saying like if I have 50 grams for lunch, for breakfast, and I have a couple of cans of sardines, that's 50 grams. I need another 80 for dinner. Yes. And so, but here's the other part is the more active you are. So protein decisions, it's a U-shaped curve.

1:02:37And if you think about a U, at the top is the worst of all worlds is if you are an older person who is sedentary. This is the worst of all worlds for muscle health and metabolic health. But as you become more active than, you know, say like you're moderately active, your protein need goes down. So you offset the amount of protein you're eating with your physical muscle activity. and then as you move into the more elite activity which i'm not doing and you're not doing the more protein you need so dinner would be what for me it's a lean steak six ounces why lean why low fat because i keep my i actually do better with carbohydrates if i were to allocate how i want my food to be i do much better on a higher carbohydrate diet than on a higher fat diet and it's just personal choice carbohydrates and fats are interchangeable as fuel sources I mean, you mean, you don't mean like flour or sugar.

1:03:37I mean. You mean like a sweet potato or. No, I just eat ice cream for dinner. I'm just kidding. No, I don't. I mean. No, no, I don't. Let's be specific because I think people hear that and they're like, oh, carbs are interesting. But also, how do we think about carbohydrates? Like a big bowl of pasta or. We talk about how much protein someone needs in a day in a 24 hour period, close to 0.7 to 1 gram per pound. But carbohydrates should be thought of as a meal threshold. we never talk about that. People do not talk about that. Just like protein has a meal threshold, carbohydrates should be thought of as a meal threshold.

1:04:10Are you ready for this? The average American is eating 300 grams of carbohydrates a day. That's three glucose tolerance tests a day. Okay? But how do we recreate... About four, because it's 75 grams in a glucose tolerance test. How do we... That's very funny. How do we recreate that? So for me, dinner is around 40 grams of carbs, 40 to 50. Okay. Anything above that for someone who's listening, who is sedentary, begins to distort metabolism. And I cover this in the book. It's something called a carbohydrate threshold. Carbohydrate threshold is how many grams of carbohydrates can you have at a meal before you begin to distort metabolism?

1:04:52What the choices are, again, one third is protein. One third is fruits or vegetables, fibrous carbs. One third is more complex carbs. Is there a place for pasta? There is if you're training hard, right? There's a place for pasta. But for me, you know, I like potato. I like white potato. Yeah. I like resistant starch. I might make the rice. I mean, I eat rice. Yeah. But again, I eat, I also train. Yeah. And I am not grazing all day long. The thing is, you know, what people don't realize is there's this concept of metabolic flexibility. Correct. If you're a diabetic and you have a can of Coke, your blood sugar will go to 300.

1:05:30If you or I have a can of Coke, our blood sugar won't go above normal because we're metabolically able to handle the same sugar load because we're trained and our muscles and our tissues are more sensitive to insulin and we can actually regulate our blood sugar in ways that people can't, given the same exact dose of carbohydrate or the form of carbohydrate. Yes. That's really important. I want to kind of shift gears a little bit. I think this is fascinating. I think, you know, we covered a lot, but I want to talk about some of the sort of added things that I do and I know you do. I mentioned creatine and I think there's a lot of increasing data on creatine.

1:06:05I think we've been using it for a long time. For cognition. For cognition. Beyond muscle. For muscle building. It's a mitochondrial co-factor. And I use a lot of mitochondrial therapies for my own health because I've had mitochondrial issues. And one of the things that I've started using is something called urolithin A, which for those of you don't know we've talked about a little on the podcast but essentially it's a it's a molecule that's what we call a postbiotic as opposed to a prebiotic or a probiotic it's a molecule that's made from using microbiome converting certain plant chemicals lachic acid others from amigranid walnuts berries into this molecule problem is most of us have taken antibiotics most of us i mean i do talks and i like have a thousand people who here has never taken anybody like maybe one person will raise their hand or maybe nobody.

1:06:53And so we've all kind of messed up our gut and have trouble making this. But this molecule is found to have some really extraordinary properties around muscle quality, strength, longevity, muscle function, inflammation, immune health, mitochondrial function. So can you kind of walk us through what the research is on this compound? I mean, they're talking about grip strength and things like that. The thing that kind of blows my mind about the research on this is that even without exercise, it seems to improve your fitness and strength, which seems a little bit weird to me, but it seems to be true based on the data, including VO2 max, grip strength, things that are highly correlated with longevity.

1:07:30Now, urolithin A is a postbiotic that the majority of people cannot make. And this comes from these allagitanins, from walnut, pomegranate. And let's say you could make it, it would be, I don't know, six, four cups of pomegranate juice. It's a lot of sugar. But the reality is, is this urolithin A compound is so fascinating. And the company that we are both talking about is Timeline, because I don't, I don't recommend actually other forms of urolithin A because I think it should really be tested. Yeah. They've spent, they spent like a hundred million dollars researching this stuff. It's, it's crazy.

1:08:05And it's published in JAMA and major medical journals. It's not like a, like there's a lot of crappy supplements out there. And there's a lot of hype and promotion. This is one of those things where, you know, you and I I focus on where's the data, where's the evidence, how good is it, you know, where is it? I mean, I'm a huge fan. And we had Anurag Singh, which is one of their immunologist scientists on the podcast. And there's some really cool stuff that urolithin A is responsible for. What does it do? Its primary role is in mitophagy. And that is the removal and degradation of old mitochondria.

1:08:38Yeah. And, you know, when you think about muscle and you think about urolithin A, the house of our mitochondria, the majority of our mitochondria is in our muscle. And one of the things that urolithin A does is it really helps with this turnover process. And the other fascinating thing about urolithin A that cleans up old damaged mitochondria and helps build new ones. Yes, it does. And the other aspect in terms of energy and metabolism, I think that we're going to start to see emerging data. So we know that it helps improve strength and endurance. Again, grip strength. I think there's also evidence for its use in individuals that are going through chemotherapy.

1:09:18Interesting. Because it helps with this muscle metabolism component. And it's just, it's a really extraordinary compound. One of the things that we hear in our clinic is that people's energy improves. I think that there's also going to be some emerging data on cognitive function. it's also i think a paper just came out in was it in jamma on immune function and urolithin a they just published another recent paper um and it's we typically recommend a thousand milligrams a day that's what i take yeah and you can take it in gummies you can take it in powder you can take it in pills yeah it's pretty extraordinary um it's a pretty extraordinary compound that we definitely recommend.

1:10:02And I think, you know, what I like about it is that, you know, it's sort of a phytochemical, sort of comes in nature, or sort of if your microbiome makes it. But it works on the mitochondria. And the mitochondria are tricky because they're very delicate little organelles inside our cells that convert food and oxygen into energy, or ATP that runs everything in our body. and it's sort of the foundation of our health. And most age-related conditions are mitochondrial diseases. In fact, sort of aging itself is a decline in mitochondria. You see a two-year-old running around like a jackrabbit and a 92-year-old sitting on the couch doing nothing, the difference is their mitochondria.

1:10:43And our ability to improve our mitochondrial health as we get older is partly related to exercise, training, muscle quality, you know, cardiovascular fitness, both muscle strength training and also to, you know, things that we can actually influence by reducing our level of inflammation and toxins and infections and all the things that potentially affect it. But there are a lot of mitochondrial therapies and it's something that has not been really well utilized in medicine at all. And what happens is that, you know, as we think about chronic illness whether it's uh dementia or parkinson's or obesity or diabetes or even cancer you know autism you know mental illness depression bipolar schizophrenia list goes on these are all mitochondrial diseases and you and i went to medical school and i think we had our first year uh we learned biochemistry and we learned about some mitochondria and histology and like that was kind of it.

1:11:46Yeah. There's no like, how do you evaluate mitochondria? How do you test them? How do you treat them? How do you optimize their function? And as someone who at 36 years old got walloped with chronic fatigue syndrome as a result of mercury poisoning, my mitochondria like were in bad shape. Like my CPK, my muscle enzyme for 600. Really? Yes. For years and years and years that's a sign of mitochondrial injury basically muscle damage yeah and i could feel it like rhabdo not at 600 but what's that rhabdo you know as i was just thinking rhabdomyolysis but it was like it was some degree of muscle dysfunction i mean when you get on a statin that causes muscle injury it's a mitochondrial toxin and it actually leads to these muscle pain syndromes and also elevations in this muscle enzyme that i had but it's but what i'm saying is that I got to really learn, okay, what are my mitochondria?

1:12:40How do they work? And I started applying this in medicine. And so urolithin A is a really powerful mitochondrial nutrient, but there's many others, CoQ10, carnitine, creatine, ribose, and N-acetylcysteine, all the B vitamins and magnesium. There's a lot of things you need to actually produce energy. So it's important to really understand how do they take care of their mitochondria? And so this is one incredible tool. And I think it's, of all the sort of longevity. I agree with you. Well, in the supplements, It's quite unique, and it's part of my daily staple, actually. Same. I'm very careful about the...

1:13:15It's actually in this book, by the way. Yeah, I know. You wrote about it in the book. I was going to say that. I did. Because it is something that with all the velocity at which information spreads, how do we begin to make choices that actually can move the needle? And I think that urolithin A is a great one. Absolutely. And I think we're going to start to see it be more involved in what I would love to see is how it actually helps those with chronic illness that are going through therapies like chemotherapy. Well, we have so much more to talk about. Is there anything else before I hit the quickfire questions at the end here that you want to share about what you're doing, what's important, what's in the book?

1:13:56I think the big takeaway is what many of the diseases that we're seeing now are a mismatch for muscle health. And if we don't become careful, we're going to trade an obesity epidemic for an epidemic of sarcopenia. And we have an opportunity to not recreate history. And it's happening right now in a way that we've never seen before with the use of GLP-1s. And then also with now the more liberal discussions on hormone replacement and specifically the anabolic agents, this is the time. And we're learning a lot. Yeah. Yeah. Yeah, the GLP-1 thing is interesting. I mean, it's not black or white. They're not good or bad.

1:14:38They're like any other tool. And when they're applied properly, they can be helpful. When they're applied improperly, they can be extremely harmful. And they can help with the intramuscular adipose tissue. Yeah. And again, the next conversation that I would love to see as we begin on this journey, just in general on reorienting ourselves to muscle health is that anabolic agents beyond testosterone or these myostatin inhibitors, what else do we need to do that affects muscle health? And I will say one last thing regarding this is that a patient can go to their doctor and say, I want a medication that's going to help me lose fat.

1:15:18And the doctor probably doesn't think twice about it. But if a patient goes to their doctor and says, I want a medication that's going to help me build healthy muscle, it's a completely different story. Two organ systems, yet two completely different biases. Well, what's the answer to that question? Which part? What drug can I take to build muscle? There are anabolic agents that are FDA approved that we have to have more conversation about, that have to be more involved in the conversations just in general. And that is... We're not using testosterone more. Yes, and this is the path forward. Yeah.

1:15:53As a mother and a woman, what are the top three things that you do personally to support Longest Heaven? I spend time with the people I love. Oh, that's a good one. Just like you, I'm very community-oriented. I care about relationships, and so I do that. It's true. You reach out to me, and I really appreciate that. Stay connected. I think that's an important part that we neglect. You know, we can eat well and exercise and take all our supplements. But if you don't build community connection relationships, the quality of your life is less, your longevity is shorter. And consistently, it's not transactional for me.

1:16:28I'm a relationship person. That's one thing. What are the other two? I always train. And you mean strength training. I do. Three times a week. Yes. And if I train hard enough that if I miss a training session, let's say it's impossible. Let's say, and it's usually not, but let's say it was. let's say my flight was delayed or i was in the airport and uh the best that i could do is push ups in the airport which i will do and on the plane i did go to australia and did push-ups in that um yeah but whatever people are like that's a crazy person i make it count when i'm in there the crazy people are the other ones that change the world so i'm with you on that okay great i train hard enough that i'm not dependent on the next workout if it's if for some reason i'm traveling yeah but resistance training is a non-negotiable and people will say i don't have time, but you don't have time not to.

1:17:17I train with my kids. There's a slide that I use in my talk and this guy was like, you have a choice. You want to be, you want to exercise one hour a day or be dead 24 hours a day. That's funny. That is awesome. And we make training a family affair. I walk down. I see that in your video. I walk downstairs and my son was on the treadmill sprinting. I'm like, Leonidas, it's 8 p.m. This is way bad time. It's like, mom, I gotta get my training in. This is my second training session of the day. I gotta get it done. I love that. I mean, and so it's not, I'd rather have them decide on the good habits rather than try to break bad ones.

1:17:59Yeah. And what's the third thing? The third thing that I do for longevity, this is a toss up. Obviously the obvious answer is my nutrition. Yeah. But I think the not so obvious answer would be spending time with my husband and really talking about the family and the landscape of how we want to go through life. So spending time on the standards of how we're raising our kids. Your values. Yeah. That's beautiful. Your mindset and values of how you approach life. That's beautiful. Amazing. All right. Quickfire questions. Fasting for women. Sure. When does it help? When does it hurt? If you're trying to get pregnant, I typically don't recommend fasting.

1:18:44Again, there's nothing magical to fasting. It's calorie control. It allows for gut rest. But, you know, if you're more mature and older and want to maintain muscle, don't recommend it. If you decide you want to do it, I train fasted. It's totally your own choice. Choose your own adventure. And, you know, 12 hours is minimum. Like people think that's a fast, but it's not. It's normal. but people eat all night and then they wake up and eat i'm telling you even a meal the night so yeah just at least 12 hours artificial sweeteners good or bad not gonna like this not dead yet not dead yet because what is the evidence that they're actually okay for your health i mean the evidence that they're not because i think yeah it's controversial so i would say things like splenda might not be great for the gut microbiome and there's sugar alcohol Right.

1:19:35So Suzanne Defkoda is someone who I look to to answer those questions. I'm certainly not a microbiome expert. But I think, for example, artificial sweeteners, when used in moderate doses, you know, not abusing it is, you know, the data doesn't say that it's terrible for you. But again. It doesn't depend which one. Because they're not all crazy. That's right. Like is it monk fruit or like, you know, or allulose or stevia or allulose is no problem. Aspartame or erythritol or xylitol or other sugar alcohols, melaton. Those can be problematic. It depends on the kind and it depends on the dose and it depends on the person.

1:20:18For sure. A little bit of stevia or monk fruit or not so. So I don't have problems with those. So this is, again, this is just my personal opinion. I'm okay with it. I think one of the things that we have to understand is the way it affects the brain. Because it does keep you lit in the areas where you don't want to be lit. Which one? All of them. They increase your sweet perception, which causes your brain to light up and to crave more. And so I think there's probably a craving cycle that it activates, but who knows. How about caffeine? All of it. So the people that should not use caffeine is, if you're pregnant, they don't recommend 200 milligrams or more.

1:21:01And, you know, listen, if you have a genetic, perhaps you're a slow metabolizer, then maybe it's not great for you. But otherwise, I think caffeine has been around for a long time, studied for a long time, and can be used well. And I drink a lot of caffeine. People make fun of me. They're like, you're 5 '1", 110 pounds, and you drink more caffeine, you drink enough caffeine to kill a draft horse. And I would say that this is true. That doesn't affect your sleep? No. That's amazing. You're a fast metabolizer. Yes. How about menopause? What's the number one thing women going through that need to know?

1:21:36Be strong. Be strong like forever strong? Yes. Strength is a responsibility. Strength will take you through that time. Physical strength begets mental strength. It's a lever that you can pull, that you have control over. You have to be strong. no amount of hormone replacement is going to be a solution for being strong it does help balance your hormones it helps balance blood sugar and insulin helps balance it's a non-negotiable it's the new frontier of longevity uh it's just it has to happen what about cold exposure good or bad for women cold plunges i love it i do it every day no downside no no and that's i have protocols in the I've been hearing in the misinformation internet cybersphere.

1:22:19But mechanistic, there's the mechanistic data. So when I told you that we just published this paper on sexual function and muscle mass, there has to be a mechanism that then is related in humans. So there can be mechanism, but the mechanism doesn't necessarily translate or hold up. You know, for example, we like urolithin A because we know that there's a proven mechanism translates over to humans. We like essential amino acids because there is a mechanism. We know how this works translates over to human. The idea of cold exposure being different for men or women at this point, there might be mechanistic ideas, but I have not seen that translate over at all.

1:23:01And I think that cold exposure has been used for lifetimes. I have cold exposure protocols in this book. We are very acclimated to our perfect environment. It's not ideal. We want hormesis. It's a way of stress. Same with heat. Okay, we've got a cold plunge out back. I can't wait. I would do it in a heartbeat. If you give me a bathing suit, I'm not wearing yours. I will do it in a heartbeat. All right. Creatine. Is something everybody should take or overeat? Yes. No, I think that it's, again, is there something that everyone should take? No, but creatine is, it's been around for a long time. I think there's a lot of positives.

1:23:36The other thing that I think is really valuable too, we didn't talk about, is ketones. Exogenous ketones? Yes. And you're taking ketones that are preformed, then you can take a supplement. Exogenous ketones, beta-hydroxybutyrate, yes. Tell us about why. Because there's just more and more evidence from a brain perspective, cognitive perspective, you name it, it just seems to improve performance. I think there's a ton of benefits. I talk about that in the book as well. If I could just make a product myself, I would definitely, that would be it. Not being in ketosis from a diet, but adding supplemental ketones.

1:24:12No, for brain function, right? For the ability of neurons and cells. I mean, because again, we talk about brain fog all the time and mitochondrial health. Amazing, amazing. ketones are another one well gabrielle you know we've known each other a long time i've seen you grow evolve develop your career um be a spokesperson for a new kind of thinking about muscle health and just i mean the whole idea of muscle-centric medicine i just think is brilliant and uh your new book forever strong playbook is out everybody needs to get a copy uh it's the playbook for you if you want to stay healthy long time and be functional and feel good um where can people learn more about your work and what you're doing?

1:24:54Well, you can go to my Instagram, Dr. Gabrielle Lyon, my website, drgabriellelyon.com. We have a medical practice called Strong Medical. And we have been around for a while and we just have tremendous, tremendous patients and results. Also my podcast, which you'll be coming on the Dr. Gabrielle Lyon show. I have a newsletter. I have a YouTube, Twitter. Did I miss anything? I'm also a part-time travel agent for my kids. Dr. Amazing. Well, Gabrielle, keep up the good work. Make sure you take care of yourself. Dr. Thanks, my God. Dr. Thank you for all the wisdom you've given us. Dr. Thank you. If you love this podcast, please share it with someone else you think would also enjoy it.

1:25:33You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions.

1:26:03Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient.

1:26:33It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.