How to Future Proof Your Body with Dr. Nima Alamdari

0:02When you are pioneering anything or introducing new ideas to the culture, you get criticized. You do? Yeah. Did you hear about that? I didn't find the one. I found someone I respected and we made it the one. In a sort of longing kind of view of love, people understand each other as if by magic. Nothing in itself is addictive on the one hand. On the other hand, everything could be addictive if there's an emptiness in that person that needs to be filled. I now know that nobody changes until they change their energy. And when you change your energy, you change your life. I'm Gwyneth Paltrow. This is the Goop Podcast, bringing together thought leaders, culture changers, creatives, founders, and CEOs, scientists, doctors, healers, and seekers, here to start conversations, because simply asking questions and listening has the power to change the way we see the world.

0:58Here we go. Today, I'm joined by Dr. Nima Almandari, a renowned expert in muscle metabolism and physiology. With an impressive background as a Harvard Medical School faculty member, he's also the chief scientific officer at Ritual and a clinical advisory board member at P-Volv. Dr. Nima brings decades of research into how nutrition, exercise, and science intersect to support a longer, healthier life. In this episode, we're exploring how women can future proof their health, particularly during the transformative phases of perimenopause and menopause. We'll cover everything from the importance of muscle mass and strength training to the rise of GLP-1 drugs and their long-term effects.

1:42Whether you're just starting your wellness journey or looking for advanced tips to elevate your routine, this episode is for you. So let's get into it.

1:53I'm really excited to have you on the pod today. And I'm really looking forward to diving into everything from nutrition to exercise and really thinking about how women can future-proof their health, specifically while going through perimenopause, asking for a friend. So I would love to start with just a bit about your background. What are you a doctor in and how did you kind of begin this longevity journey? Yeah, thanks. I'm not very good about talking about myself, but I guess my journey began in the UK, hence my funny accent. But I did a PhD in muscle metabolism and physiology at the University of Nottingham and then ended up taking that on and becoming faculty at Harvard Medical School, again, all in the field of muscle metabolism and physiology and basically how nutrition, drugs, genetics and exercise can play a role both within health and disease.

2:51And it's really, you know, born from passion of just asking questions about how the body works and, you know, being into sports and just really applied that in career. So, yeah, I feel like a bit of a science experiment in myself because I apply, you know, this field that I've been engaged in and really that's taken on career. So I've worked within, you know, sporting and exercise arenas as well as nutrition and diet and nutrition planning and both within academic centers as well as, you know, in industry. Was there some nurture in this? Did you grow up in an environment that prioritized nutrition and exercise?

3:30No, I think I was the original member of the family, I guess. Yeah, my parents were both professors and academics in different areas. My father was a chief scientific officer in architecture. And then my mom was a professor and dean of the university in aeronautics. Oh, wow. But yeah, they were academics. Yeah. So I think I took a little bit of that inquisitiveness, you know, on into my own interests. Yeah. And what year was this that you started that you went to college, if I can ask? Yeah. So the year 2000 was when I graduated from my undergraduate and that, you know, that was the start of this muscle metabolism and physiology area.

4:11um so it's been you know over 20 years now that's been like dedicated to like muscle metabolism and physiology research and directly involved in university clinical trials and kind of asking questions of you know how we can influence the human body whether it be for you know performance purposes but also for longevity and health span so you have a focus if i'm right on women's health and aging, right? Yeah. Is there, well, first of all, how did you kind of fork off into women's health? And is there a difference between how women metabolize than to men? Like, is muscle metabolism different for each?

4:58There's definitely, you know, I would say that I, you know, I don't necessarily specialize in women's health, but more recently have got much more engaged in women's health research. And really, from my standpoint, that there's a need there, not only because, you know, in clinical research, I think that women have been, you know, underrepresented, you know, within research as well. So that, you know, a lot of the questions that have been asked over the past few decades, predominantly been, you know, measured within men. And so there's a real need to, I think, get in on that and be pretty clear that, you know, women are not small men that's not my quote i think that's lacey sims quote but it's true and the physiology is different so that's been a important area for me to get engaged in just from an underserved area and then you know i think that you know there's the aging process itself that we sort of touched on a little bit i know you're asking for for a friend but this you know this this muscle journey really begins in your early 30s and it disproportionately influences women compared to men that there is a slightly more heightened need to come in on that more proactively and the reason for that is that the loss of muscle mass as we age and particularly for women you can lose three to eight percent of your muscle mass you know within a decade and that accelerates after the age of 50 one to two percent per year after 60 years old that can become three to five percent per year and so these are sort of quite scary stats because this you know affects your activities of daily living you know your functional health ultimately your health span and longevity and you know as an outcome so i think that's really important to know and you know within the perimenopause menopause and postmenopause this becomes heightened and there's more of an effect just because of the hormonal change with women where 30 % of women over 60 experience sarcopenia, which is the age-related loss of mass that actually has a functional consequence.

7:08What's the consequence? So sarcopenia, I don't want to be too morbid, but in terms of functionality, reduction of strength, reduction of muscle function, and basically a reduction of your activities of daily living. so basically like simple tasks right you know that you're counting on as part of graceful aging or having kind of quality years those things can suffer so you can think of folks even my own family members that as they age you can see get a level of frailty or in later years and that is the i think the consequence of sarcopenia is basically being more prone to issues you know falls, fracture, prolonged recovery, and ultimately, I guess, more susceptibility to disease, which is a reality of what happens with sarcopenia.

7:58Right. So I'm squarely in perimenopause. And so these are, this is, I'm sure my listeners by now are like, would she stop fucking talking about being in perimenopause? But I find it, I really find it utterly fascinating that it's such a difficult period to traverse through emotionally, psychologically, physically, everything. So, you know, obviously maintaining muscle mass for anybody who is aware of these kinds of like is tantamount, super important, but is it actually possible? Like, for example, I saw this funny thing on Instagram the other day where I followed Mary, Mary Claire Haver. She's a menopause expert doctor.

8:41And she had reposted something of this woman, like what not to say to a woman in perimenopause, like, have you eaten protein? And she's like, literally, she's like eating protein is like my full-time job. And it's true. It's like this intersection of eating protein and lifting weights. It's, you know, what everybody tells you to do all the time, but is it, does it actually work? Can you really maintain healthy muscle mass through this period and like into our seventies and et cetera? Yeah, absolutely. I think you're totally right. I'd say even from the science consensus, there's advocacy, right, for exactly the things that you're mentioning with regard to exercise and eat protein.

9:21I think there's just this big between like how to do it and like how practically to think about it and like what exercise modalities are easy to engage with, right? Particularly if you're kind of not used to that, not everybody's a trained athlete, right and not everybody has experienced load bearing or resistance bearing type exercise so i think we're in this period to try to kind of come in on that hence why i'm aligning with companies like pvolve that are thinking hard about how to make this practical and how they can with the population that needs this type of training and needs this type of guidance but ones that are effective the american college of sports medicine has come up with guidance for the population let's say for america and i'm a big fan of the american college of sports medicine but it sort of stops at saying 150 minutes of aerobic type exercise do strength training a couple of times a week do some level of balance training two or three times a week and do a level of flexibility training two times a week and i don't think it's helpful enough right to kind of engage on what type of training one needs to conduct and what can be most effective so i think that the training modality and having accessible forms of programs like what pvolp has done but putting those to test um i think that's what's really interesting here and having groups that kind of come in on clinical studies that are proving those aspects out they just recently did a clinical study for women on women putting exercise training to test it exactly ask whether this can do something as you had mentioned and have come out with proof points that by training this way and focusing on those areas of strength balance and flexibility you can put numbers now on those outcomes improve muscle function improve muscle strength improve hip strength balance and flexibility and double double digits percentages which is pretty amazing that is amazing

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12:28So will you tell me a little bit about P-Volv because I know that you're involved in the company and it seems pretty amazing. And you've got Jennifer Aniston now doing it who is a good friend of mine who I love and she loves it. So what is it exactly? How does it work? What is your role at the company? Yeah, I'll start there. Well, I'm on the clinical advisory board. And I think that it's a really good position to be in. I see myself as a, I guess, a translator of academia into translatable outcomes. And I think the more that companies can align with academics, that's where we're going to get real solutions to people that need it.

13:07And so that's kind of squarely where I am, where I help P-Evolve in terms of thinking about science and connecting them to I think the right training modalities or the right people that can actually put and programs and measure them do these in like high quality settings and also help just get proof points and efficacy as part of their development program but proof and efficacy as part of proof points for customers so really just help shaping the training programs but also connecting them with research institutions to do the work. Amazing. And what does it consist of, for those listening who've never heard of P-Volv, tell us what it's about.

13:47Yeah, well, it's an extremely strong training program. Effectively, it's a method and the principles of it are some of the things that I just mentioned, but the basis of it is low impact exercise training that can help your everyday life. They call it functional training. And by functional training and functional outcomes, those are all the things that we kind of touched on, which are those tasks and activities of daily life. So sort of mirroring training and exercise modalities, combining that cardiovascular type training with resistance based training with range of motion that fits in your future.

14:24And so the company is really centered on future for proofing the body. The reason why I was attracted to being on an advisory board and being part of a, let's say, guidance for the development of training and connecting it to science is that I believe that there's a difference between the way that you move. I run marathons, so I know really well the hardship, right, didn't kind of come on the body with like repeat training or high intensity impactful training. at the end of the day folks that are seeking solutions need to be pretty conscious of the way that they move so that there's not cost i know too many rugby players that have had all sorts of surgeries right and we're all doing extremely high intensity interval training as part of our regimen you know when we were younger but that has a cost on the body later in life and so i think that's the unique differentiation point with people to other training programs is the lower impact nature.

15:23I think the range of motion that comes in and really not just an emphasis on resistance training and cardiovascular training, but ones that are coming in on that function and coming in on that balance, coming in on that mobility, stability, which as we know and talked about is important as part of health span and longevity thinking. You said something interesting there. You talked about future proofing health. what is the philosophy behind this? And what are the kind of mechanics to get, how do we do that? How do we future-proof? I think it's going to keep me busy in career, right? So I hope we continue to have a job.

16:03So I do think that we're in a world right now where I think longevity has really kind of come up, right? We have a lot of talk about longevity and extension of life. But I think in terms of future-proofing, where I'm most excited about is not necessarily on the extension of life and getting older, but is on that quality of life that's coming through. And so the health span, the health span aspect. Yeah. And I think when we say future proofing, I think that's exactly what we should be thinking about how we can think about what we eat to how we move nutrition, our physical activity that can set us up as early as possible.

16:39So we can enjoy our years of doing these marathons now and being at a transition point from thirties to forties by discipline now is coming into my life right i can understand that my metabolism has changed and i have to think differently about the way that i move right and i have to make accommodations and put some of these strategies at play for myself too and i think that's an effort to future-proof one's body and i think it's an important area to i mean invest in as companies like pvolver doing but it's an important area for just one to think about what we can do to get away from prescriptions and medications and drugs being given to us.

17:17And that shouldn't be the first line of intervention, right? And I'm a big believer that this area, although a little bit mysterious when it comes to exercise and what's right, is the medicine that we need that should be the first prescription to give to people versus being on a cocktail of medication as a first line. Yeah, absolutely. I think exercise and nutrition are obvious cornerstones of how to build health span and then therefore hopefully lifespan, but with a health span quality. Yeah. So, you know, and then I promise I'm going to stop asking you menopause questions. No, no. So during perimenopause and then into menopause or however, whatever timeframe we want to look at, what happens?

18:03Estrogen plummets, right? Is it, we lose the ability to actually make and maintain muscle? Like what actually goes wrong? Well, obviously everybody's a bit different, but I I'd say at a, at a high level, we're constantly in this balance of a protein synthesis, let's say muscle protein synthesis and muscle protein breakdown. So this cycle and this balance is basically what's keeping us standing up and keeping a strong musculoskeletal system together as we age this balance starts to tip it starts to tip a little bit in the muscle protein synthesis side of it becomes more resistant to the effects of nutrition and activity and exercise so there's more weight than to to this area at the same time the breakdown aspect accelerates so we find ourselves in a potential vicious cycle of less synthesis and more breakdown and hence you're getting this atrophy.

19:02When it comes to menopause and post-menopause, one of the major regulators, and that's what I think separating somewhat men and women, is the decline of estrogen. And estrogen is one of the anabolic centers and one of the anabolic regulators of muscle mass. So this is causing an exacerbation of the issue and the degradation of muscle and strength. And that's why we need to think about it, or women in particular need to think about how to counter that because I think it's important not to feel onerous about life events but it's a moment in time right it's a metabolic and hormonal change that one needs to be conscious of because yes there are things at disposal whether it be a physical activity or nutritionally that can help and for example I take these amino acids in powder I take a bit of creatine I take protein Like, is this all the right stuff to be taking?

19:57It is, yeah. There's some really good researchers looking at all of these aspects with regards to what is optimal, right? And both physical activity and diet comes in here. The national recommendations on protein intake, which I should probably convert for, I keep thinking kilograms all the time, but it's 0.8 grams per kilogram of your body weight is the national recommendation for protein intake. And a lot of researchers, myself included, believe that that is too low. And that needs to be much higher to the extent of over 1.2 to 1.6 grams of protein per kilogram body weight. So basically double the recommended level.

20:42So how you get that into your diet, particularly at these moment where one needs to think harder about the intake and how to plan for it and how to integrate it as a change and being proactive is important so aiming for 20 to 30 grams of protein per meal so i'd say depending on your body weight like on the lower end of that so 20 grams spread across the day to maximize that muscle protein synthesis that we discussed and block that protein breakdown is important. And those amino acids, if you're taking amino acids are the building blocks, right? For us also similarly, they're in protein and that's equally a strong strategy to help maintain muscle mass.

21:24Yeah. Because otherwise you're like gagging down like a chicken breast or it's horrible. It's like, it is, it's like a terrible, it's like a really a part-time job that you're like, it's hard. Yeah. I think it's a real strategy, right? I think it's a real strategy over and above of the diet. Yeah, so you don't need to force feed yourself.

21:50I would love to get your opinion on, this is what I'm trying to do during, I was never a breakfast person. I hate eating in the morning. I like to wake up. I was kind of a natural intermittent faster without even knowing before it was a thing, right? Because I would wake up and not be hungry for hours. So I would exercise and then eat later. And now my nutritionists and doctors say, okay, you have to, before you exercise, I have to eat something to do with cortisol levels. So I try to eat something before I exercise. What's your opinion on that? Is it important to get up and eat some protein to help regulate cortisol and to get the body into the building blocks going?

22:29And should I be taking my amino acids before I exercise or after? Yeah, I think that the most important thing in all honesty is targeting the right amount overall in the day. I think that's like the most important thing because that's - So 20 to 30 grams, how many ounces is that? I can't do convert. I should have because I was an expat forever and now you live in America and you should - That's right. We've swapped, right? So, yeah. So, you know, most, I think if, you know, if you're thinking, you know, chicken breast or, you know, a scoop of protein, most of the or a small portion of chicken is around 20 grams, or a good yogurt is about 15 grams, right?

23:11So just in terms of - Like for a cup of yogurt or like three quarters of a cup of - Yeah, exactly. You know, the sort of Norwegian yogurts out there that you can find at some of our local grocers, they're pretty decent now for the level of protein that they contribute to. So I think in terms of just thinking about like portions and what those are, like those are obviously the food types that can kind of come into play. but just going back to that i think that the most important thing is that is what you get in the day because that level of consistency of getting the right target up on your daily and being you know having consecutive days that that's what's going to help preserve the muscle and preserve the strength and combinations of exercise okay and it doesn't matter what time of the day just as long as you so so you're saying theoretically you could intermittent fast and then have a meal with a lot of protein in it and that's okay yeah so i think it's acceptable i think that that's okay because you think that's the most important but timing does play a role so timing does play a role but it's not the most important so i still would say that spreading it in the day is helpful and the reason for that is that as we spoke about like muscle protein synthesis right which is the signal that you get off protein or amino acids as soon as you consume them that there's a signal that incurs in your muscle and that's what's stimulating this cascade right of synthesis and helping to feed your body so it's good to stimulate that several times a day rather than stimulate it let's say like one time a day in a big big dose so there is value certainly but in terms of like you know should you have it first thing in the morning versus should you wait for your morning workout you know not a major difference if anything the body's a little bit more sensitive to the effect of protein after exercise.

24:54So, you know, if I go for myself on my runs training for these marathons, I tend to just have some carbohydrate in the morning, go and do my exercise, basically eating pretty light, but it's hard to eat before exercise. It makes me feel sick. Yeah. It's the same here. You tend to get that gastrointestinal discomfort, particularly with protein that sits and sloshes in the stomach. Yeah, it's not a good thing. So I tend to wait for protein at post-workout, particularly if you're doing it in the morning. Okay, that's good to know. Have you met Jennifer Aniston, by the way? Spoken to her, yeah. And we had a lot in common because she's...

25:36What I love about Jennifer is her affinity for science. She, I think, values the scientific basis in what she's doing and her personal journey is I got to know her through P-Volv. I look up to her so much. She's amazing. Yeah, her journey, I think, being born from some injury, coming into a program like that, it also is pretty inspiring because she sort of had to live it to, I think, seek solutions to sort of move the right way and seen benefit from doing that. And I think what's great about Jen is she's obviously got a platform. so articulate that, you know, I think it can inspire people to be proactive, right?

26:17Not to wait for injury or ailment to kind of get into the right way to move, but to sort of be thinking about that earlier on. Aren't the founders of P-Vol both women? That's right. Yeah. Yeah. I find myself because I'm a chief scientific officer at a company called Ritual. It's also, you know, women-led, you know, Kat Schneider is, you know, my partner in crime there. But I seem to find myself amongst brilliant women, which is maybe not a bad, bad place to be. And yeah, with my mother being, you know, I think quite a prominent figure in her field to my wife, say the radiologist, she's at Cedars-Cyanide here, and my sister's an anesthesiologist crushing it, you know, in the Seattle area.

26:56I'm just surrounded by these brilliant, smart women. And yeah, I think it's great. So just kind of picking up on that a little bit, I mean, I would love to know how, because I think, you know, women tend to have very different leadership styles than men. It's why I love working with women and I have so many women founder friends. Do you perceive at all that working with women and their leadership styles, like, and the way that they innovate, has that shaped your work? I mean, have you, are there any moments specifically where you can think of think about you know how how women's particular angle and perception on something has really catalyzed your work I mean absolutely it certainly amplified my work and I think just happiness honestly you know in the workplace and and I'm motivated inspired by you know the women I work with it's it's an interesting thing I kind of joke sometimes I people might feel me but I think that you know we're in an era where women are just doing such amazing things and like leadership and women is you know a real thing one something that should be celebrated so I don't that I don't discern between men and women you know in terms of capability but I certainly you know from my own family and having such an inspiring mother who's done you know a TED talk herself on you know you know being a minority and kind of you know needing to move and you know ultimately achieving great things.

28:28I think I'd sort of take my work with some of those learnings coming through from my own family. But I think ultimately, you know, when you see people perform and thrive, one just wants to be part of that, right? Whether it be female or men, it just so happens that in my career it has been predominantly female. So I'm happy to be part of that. And I love to celebrate that too. It's inspiring. That's amazing. So I'm going to switch topics here for a minute because we're talking about protein and maintaining muscle mass. And it's funny, so we have this class of GLP-1 drugs that are in the news all the time.

29:08It's been really interesting to watch the evolution of these, right? It's like they felt really controversial at first. And now I'm reading the impact that they're having on mental health and they lower more inflammation. And it's like, it seems like there are these miracle drugs, obviously suppress appetite. So people can lose weight easily, but it also, there are call outs around really having to maintain again, eating enough protein because there's a diminishment of muscle mass sometimes when people go on, on these drugs as well. And so I feel like we're at a time where this is now not a controversial subject because so many people are on them or micro dosing them kind of, what is your, what is your general, what are your thoughts on the rise of these drugs and how they're being used now?

29:55I would love to know. Oh, totally. It comes, I just wrote an article this week on the subject of GLP-1, because I think it's just fascinating, this era that we're in. I think it's not so common, right, where you get this sort of, you know, adoption, let's say, from the, you know the drugs that hits culture so rapidly and i think just we're probably at the beginning of seeing how global you know this becomes and what considerations we need to have but i think from from my standpoint something that is glaring which i'm like definitely interested to be talking about more and i think it's going to be coming up is we've been in a period where in general the western population has been pretty sedentary right you know i think it's something like 70 percent of older adults are pretty sedentary and they're they're having eight or more hours a day of minimal activity in sedentary behavior that's been a problem for this loss of muscle mass and strength right just as we talked about you know the considerations for health span glp1s that are coming in are only going to catalyze and accelerate this issue for the population that's taking them so whether it's microdosing or you know being on a you know a long regimen the glp1 drugs when you're losing weight 30 to 40 percent of that weight loss that you're getting from glp1s are coming from the muscle itself which is pretty fascinating right where you have a course of glp1 treatment 60 weeks and you can be losing two decades worth of your muscle in what in that one year.

31:32Wow. Right. And is that because the appetite is suppressed? There weren't people protein. Okay. Yeah, it is. So, you know, you've got, you know, you've got a population that, you know, the, you know, the drug is working, right. It's the suppressing the appetite that you've got limited physical activity. And then you're coupling that with, you know, eating less and ultimately, you know, having less protein, amino acids in support of that muscle mass. so whilst you you know you're shaving off and melting those you know you're getting to a healthy way it's coming at the expense of what they're calling sarcopenic obesity where a simple way to think about that is you know being skinny fat right and i think that the consequences to that are could could be a vicious cycle there because you're you may be in a position where you don't have the musculoskeletal structure to support you for that health span or that longevity and so i I think it's critical that we view physical activity and resistance type training, much like what we just talked about in terms of those exercise modalities that combine cardiovascular but resistance based training are really, really important.

32:45Are they conducting any studies at the moment to understand, you know, for people who are on these class of drugs, what you would need to do in terms of protein intake and exercise to offset that diminishing muscle? um there hasn't been studies done yet okay but i think that it's there's going to be a need for it and i think applications much like the outcomes you know people have just completed this study and there will be others done there as well that combine resistance type training but with the basis to improve muscle mass lean muscle mass improve the functionality of muscle in life specifically for women whether they're on glp1s or not i think that this is exactly the sweet spot right now that not only scientists, but I think participants within GLP-1 treatments needs to be pretty conscious of.

33:35And what about these studies coming out saying like that they reduce inflammation and they help with heart disease and dementia? And I guess those are all inflammatory things as well, right? So have you seen that in your research? I haven't in terms of the inflammatory cascades i mean i've spent you know 20 years looking at inflammatory pathways in you know in in our tissues and in our cells and what the effects of nutrition drugs and physical activity has on inflammatory pathways i think it's going to be you know really important area for sure when you have an inflammatory insult the negative side of it is it just accelerates all those declines that we we had talked about so it's important to counteract inflammation by, you know, what we consume and then also the therapies that, you know, we can adopt as well.