Building Muscle in Menopause: Protein, Creatine and Strength Training with Dr. Gabrielle Lyon

23:57Dr. Gabrielle Lyon:She knows that she needs 100 grams of protein. If she chooses to be vegan or vegetarian, this is where we use essential amino acids. Okay. As an absolute non-negotiable in that first meal. All right. What are the – or what is essential amino acids? So essential amino acids, there's nine. And if you are going to eat, for example, two eggs, if you're going to eat two eggs, you're going to get 12 grams of protein. We've already discussed that as you age, that's not going to be enough to stimulate muscle. What you are going to do is you are going to augment that with a scoop of essential amino acids so that your body recognizes that as 30 grams of protein.

24:35Dr. Gabrielle Lyon:and it's going to start the machinery. For us, we use, I only work with one company with essential amino acids and that's body health. We use essential aminos with those two eggs, one packet or two packet raises that protein quality now to then stimulate muscle. So if a woman doesn't want to eat between 30 to 50 grams of protein, but still wants to maintain her muscle and maintain her lean tissue, i.e. bone and everything else that's important, you have to get those numbers right. And I'm sure you've got other questions as to how. So that is one way, a vegan or vegetarian, which it's really important that they get that right.

25:19Dr. Gabrielle Lyon:Okay. Well, walk us through, what does a 50-gram breakfast look like? Well, there's 50 grams of protein breakfast. You want to know what I had this morning? Yep. Okay. I had two screaming kids. One drew blood to the other, but it's fine. I had two eggs. I had some cottage cheese. Two eggs is 12 grams. A small serving of cottage cheese. And I did a pack of essential aminos in orange. That was it. That raised my quality up to 50 grams of protein. That's not a ton of food. On a Saturday or Sunday, I might have six eggs, which people are like, oh, but that's so much. You could also have Greek yogurt.

26:02Dr. Gabrielle Lyon:I know, I think that you eat a lot of yogurt. Yeah, I make a shake three days a week, four days a week. You make a shake. You make a protein shake. Yeah. Your protein shake, without overcomplicating it, it could be 20 grams. You use whey protein, right? Yeah, I use whey. I have also put Greek yogurt in it, so three-quarter cups. So you're hitting it. Yeah, so it's about 40 grams of complete protein. And then I do add some collagen, but not counting that as my protein. Because we know collagen has a protein score of zero. Yeah. But the whey protein with the Greek yogurt, that's perfect. That is a high-quality breakfast.

26:35Dr. Gabrielle Lyon:Do you hear people having pushback on, what does that look like? It's too much. And if it's too much food? I mean, it takes me a couple hours to get it down. Like half of it's still in the fridge. So you can't do that. You can't do that. But if you don't have it at one time, the leucine level, the amino acids in the blood will never reach peak. So you have to have that shake at once. Okay. Okay. I just have to drink it faster. What would a 50-gram dinner look like? My favorite is lean steak. Lean steak and vegetables. Plate. One-third of your plate should be lean proteins. One-third of your plates can be some kind of fibrous carb.

27:12Dr. Gabrielle Lyon:And one-third of your plate can be starchy carb. Okay. Very simple. Red meat gets a really bad rap for aging women and a lot of women feel that it's unhealthy for them. I would say it is very healthy and almost 50 % of the fat in red meat is olive oil. It's monounsaturated fat. Wow. So are you pro shakes or anti shakes? I'm pro shake. Okay. They are so convenient. For me, it's like I can hit – because I put extra fiber in it, you know, add in. I have my berries. So, like, I can hit so many of my overall nutrition goals. And it's convenient. I know exactly what it tastes like. I don't have to measure anymore.

27:52Like, if I can get that down, I am, like, halfway home, you know, for my nutrition goals. I would agree. It's delicious.

28:00Dr. Gabrielle Lyon:And it's easy. Yeah. We're busy. It's easy. Someone's – you know, my kids are screaming. The other ones, you know, like, why are you drawing on the wall? But you have to get that right because, again, if we're talking about health outcomes that matter, we want to have good metabolic health like, again, glucose, insulin, triglycerides. They all have to be in check. There's another thing that I think is really important that is critical to understand as we think about designing a diet. The dietary guidelines that have been set have had 10 % saturated fat since the smoking days. It's never changed.

28:35Dr. Gabrielle Lyon:When we think about 10 % saturated fat, it allows us to either knowing or unknowingly demonize all animal products. Eggs, steak, everything, those foods will almost never be considered a healthy food. Even if an egg has a gram of saturated fat and a donut has more saturated fat than an 85 % lean hamburger. Okay? Yeah. We have to shift away from thinking about foods as a number like this component of the food, only saturated fat. Right. And even protein, but really thinking about the whole food matrix. Because if we demonize saturated fat, then you see people push towards more plant-based foods.

29:24Dr. Gabrielle Lyon:And plant-based foods are important, but they're not important at the expense of high-quality proteins and foods that are all nutrient dense. So the best of both worlds is really a combination of the two. And I just wanted to say that because the dietary guidelines we have to ask, are these guidelines to inform the public or are they meant for medical interventions? And where is reducing saturated fat potentially helpful? Well, if you are someone that has a high LDL level, what percentage of people have an LDL cholesterol above 160? It's like 6 % of people, 6%. So we created dietary guidelines that are potentially going to address LDL cholesterol.

30:05Dr. Gabrielle Lyon:How is that going to help someone who already has healthy LDL cholesterol numbers? Does that make sense? Yeah, no, totally. We're designing something for such a small percentage of the population where it would lead to less healthy behaviors for the majority. But they are now designing or being forced to design diets that then have to fall within that umbrella. And then the other thing for carbohydrates. You know, when I think about how do we know if your carbohydrates are in check, that's a triglyceride question. If your triglycerides are elevated, then you should reduce your carbohydrates. So this now moves us into personalized nutrition.

30:45Dr. Gabrielle Lyon:If someone is like, I did the Forever Strong playbook. My triglycerides are elevated. What do I need to do? Well, then you would reduce your carbohydrates. Then you would reduce your carbohydrates below 130 grams or below 140 grams. And we've seen that in the data. We'll see a 20 % reduction in triglyceride levels. And so we just have to ask ourselves, are we utilizing dietary patterns and guidelines as medical interventions? And if we are, then they have to be specified as medical interventions, or are we using it for optimal health? I love that. I mean... You know, I love that because we do the same thing in our clinic.

31:24You know, we have generalized guidelines. But then I get to look at a very extensive lab panel and look at the patient and be like, okay, for your nutrition, for your needs, for your – maybe you don't. Your vitamin D levels are great. You're getting plenty. You know, we don't need to supplement this. But your triglycerides are elevated. You've got insulin resistance. Now we need to, like, target your nutritional goals to meet your health goals. Right.

31:48Dr. Gabrielle Lyon:And then that is how we then move into the era of personalized nutrition. Okay. Let's talk about women specifically because there's just so little data for us. But most of the muscle and longevity research has been done on men. Am I correct in that statement? You are. What changes when you apply this to your female patients, to women? Specifically to like our listening population, which are usually somewhere perimenopause, menopause, postmenopause. So 40 plus. Yeah. There's a few things. So, number one, what we see is with a good resistance training program and calories controlled with higher protein, regardless if they are on hormone replacement therapy or not, which is really shocking because in my mind, I'm thinking we're going to replace people's hormones and their body composition is going to change.

32:37Dr. Gabrielle Lyon:We don't always see that, right? And it's not a – We don't see it in clinic either unless they do the work. And this is really important. It's a tool, but it's not everything. And it's a tool that isn't going to work if you do not have the fundamental principles in check. And so I tell patients hormone therapy will not keep you out of a nursing home. It will not. It will not. The biggest needle mover is resistance training. And people will say, well, what about zone two? Zone two is great. You've got different fiber types, type one, type two, type, you know, there's a hybrid type. People say, well, it's different in men and women.

33:12Dr. Gabrielle Lyon:And is that true? it's probably more dependent on your training because that's the realities that we have agency. So resistance training two days a week will be critical. Dietary protein is critical if you want to build muscle and maintain muscle. One of the things that we do see is that women, sometimes what becomes really important is that they have to increase their stimulus. So there's this idea of progressive overload. We don't believe that it doesn't just always have to be heavier. You can change. So you can change the stimulus. It can be heavier. It can also be a different exercise. It can be a different exercise.

33:53Dr. Gabrielle Lyon:It can be a change in tempo. It can be a change in

33:59Dr. Gabrielle Lyon:speed, exercise. There are so many levers that you can change. It doesn't just have to be heavier. and that is you can change volume there are a handful of other things that you can change beyond just going heavier and heavier the weight and so progressive overload should now be termed progressive stimulus i love that that makes me feel better because i you know i i'm human i get injured we travel i'll you know and then i'm like oh and i'll go back and look and i'm like i'm not gaining you know i'm my my weights are not increasing that much definitely i'm stronger than when I started or can lift heavier.

34:35But I'm like, I think I'm plateauing a little bit just because life gets in the way. But like I could switch it up, change it, do something different and still get enough stimulus.

34:46Dr. Gabrielle Lyon:You can. And again, we have to help. If there are all these narratives that create our limitations and that there's one way to do something, then it creates a lot of limitations within the person, within the listener who is saying exactly the same thing that you're saying. Do I love lifting heavy weights? I do. Do I get injured? Yeah. I decided that I should be doing clean and, you know, cleans at 100 pounds. I'm 100 and, I mean, I'm a small person. I couldn't move my left shoulder. I'm like out of the gym for a week now. I know you had hamstring surgery. Okay. So, I mean, from hamstring to shoulder, you name it.

35:21Dr. Gabrielle Lyon:But the real key is, and there is a lot of information in this space that, you know, what is the impact of estrogen and muscle? What is the impact? Yeah. Walk me through. What do we know? What do we know about a woman goes through the menopause transition? What happens to her muscle? I'm going to tell you my personal perspective. I think there's a lot of mechanistic data. I don't think that the mechanistic data is translating over to women yet that we can say in clinical practice. And here's what I will tell you. That does the menopause transition change body distribution of fat because of the change in estrogen and the change in testosterone?

35:59Dr. Gabrielle Lyon:you and I have seen it. Every cohort shows it. Okay. Now, what does that mean for the quality of skeletal muscle? We see mechanistic data that there are estrogen receptors on skeletal muscle, but if someone is taking estrogen, it doesn't mean that they're building more muscle. If someone is suppressing their hormonal status or estrogen on birth control, are we seeing that it's changing their musculature? We're not. I mean, there might be outliers, but what I believe that it comes down to. I mean, again, this is my perspective. I want to be fair. I don't think that we're there with the data. Right.

36:34Dr. Gabrielle Lyon:We need biopsies throughout the transition, thousands of people. I think that there is probably an influence, which we know, right? To what extent if someone is training and is highly physically active, I'm not sure if it's relevant. Would I want to believe something else? I do. Is it possible? Is it plausible? Yes. Have we proven it yet? Maybe not yet. All that to say, I think that the jury is still out. But what I will say is during the aging process, as hormones decline for both men and women... So testosterone declines in both. For both men and women, we do see changes in body composition.

37:18Dr. Gabrielle Lyon:But is it because of that, or is it because of the activity? And I just think we have to be really fair. it could be one, the other, or both. So I decided to start testosterone three years ago, maybe. And I didn't meet the qualifications for HSDD, though I have seen an uptick in that area, and I'm super happy with it. And I would feel sad if that went away. But I didn't like have distress with, you know, frequency or whatever. But I'm a naturally very thin person and I'd been lifting and I knew the studies had shown that women who naturally had higher testosterone levels as they aged, you know, when they looked at quartiles, the women with the highest testosterone levels had more muscle mass.

38:06And I was like, well, if I supplement a little bit, maybe that'll help in my efforts to hold on and grow some muscle for my aging process. And one of the side benefits was, you know, an increase in libido, which was amazing. So was I ridiculous to think that or to use that? You know, because we don't have studies. We're not looking at that data. You know, other than just looking at what woman happens to naturally, by luck or whatever, have a higher testosterone level. You know, what quartile does she land in at 50, 60, 70? And what's her muscle mass? I believe that, obviously, I believe in hormone replacement.

38:43Dr. Gabrielle Lyon:And you guys call it in the menopause group. Oh, God. Yeah. Yeah, PET. PET, progesterone, estrogen, testosterone. I have seen the benefits in my clinical practice. I believe in it. Did it improve muscle mass for you, testosterone? I don't know. It's hard to measure. It's hard to measure. We don't measure muscle mass. I'm eating protein. I'm lifting weights. And I'm growing muscle. So I don't have, it's my N of one. Right. You know? I think that it's possible if you're doing all the other things right. And again, we see great benefits for the reasons that you mentioned, sex drive, libido, maybe energy, for all of the other things.

39:27You also have to recognize that muscle mass changes are really hard to detect.

39:33Dr. Gabrielle Lyon:And one of the things that you will see in the literature is, for example, protein doesn't matter because if you're not doing resistance training, you're not going to see a change in muscle. muscle is very difficult to detect. I mean, in 10 years, you might see an 8 % change. How much is that per year? 1 %? A 1 % change in muscle mass per year? Again, because I think it's the quality of that tissue that we're not addressing. It's, again, this big gaping hole. Will testosterone help it? I mean, hopefully. But also the levels that women are getting are different than the more robust dosing of men.

40:17Dr. Gabrielle Lyon:For sure. But also we know testosterone is important for so much more. There's a lot of debate right now. Is there really? Oh, and in my world, you probably don't see a lot of it. So there's researchers who have studied testosterone, like really smart, good researchers who are coming out very strongly saying, and they're very academic minded, I don't think they actually see patients, that we're overselling testosterone. Like, we need to hold back. Don't be talking about brain or mood or cognition. Like, testosterone has no place in this conversation. Or we don't have enough data, so we shouldn't be talking about this.

40:53But we know about androgen deprivation therapy, don't we? We know a lot about men, you know. And, yeah, when we block estrogen androgen receptors, what happens? We see changes in brain function, all kinds of things. So, you know, I think there's some gatekeeping of data. I think that a lot of people want to control the narrative. And I just know clinically in my patient population, I'm seeing very positive results in multiple organ systems.

41:21Dr. Gabrielle Lyon:Yeah, we are too. And that is the challenge of academic medicine and research. Oftentimes, unless you're like the guys at Baylor, like our friend Moha Kera, who are doing the research and seeing patients, You have one group that are PhDs that are looking at what is the hardcore data. And then while hardcore data is important, we might not just be there yet in the randomized control trial saying that testosterone for women, say vaginally, will improve sex drive for X, Y, and Z or any of these other things. But I think that we're going to get there. And I think in the next 10 years, if someone goes to their physician and they're caring about aging and they're not on hormone replacement, that that physician is going to be out of date.

42:10Dr. Gabrielle Lyon:Yeah. And it needs to be a part of the conversation. Well, also, which kind of segues nicely into GLP-1s. We talked about the beginning of the obesity epidemic. Food guide pyramid happened. The late 80s, early 90s. All of a sudden, people became obese with diabetes, but they were trying to address heart disease, and then they increased heart disease and metabolic syndrome underneath the umbrella of trying to correct for cardiovascular disease. Remember, this was just a whole big human experiment mistake. We are at that precipice again. With GLP-1s. We are. Yeah. We are. and what I... What do you think we're doing wrong?

42:56What do you think we're getting wrong? Okay.

42:59Dr. Gabrielle Lyon:My prediction, and I really hope that I'm wrong, in the next 10 years, we are going to see an accelerated rate of sarcopenic obesity, sarcopenia and osteoporosis that no one is ready to manage. Is there a way to safely give a GLP-1 without that risk? We do in our clinic. So do we. And we manage nutrition and resistance training and lower dosing of these medications. It doesn't have to be very high doses. I think it's a double-edged sword. The data, I believe, that is coming out and will continue to come out improves muscle quality, lowering the fat within the muscle. I think there's some data to support that it improves strength and a whole host of promises, but that could be because healthy muscle is stronger muscle as opposed to connective tissue and fat.

43:51Dr. Gabrielle Lyon:Infiltrating. infiltrating underneath the fascia, around muscle groups, within the muscle tissue itself, within the muscle bellies. There's various places for it. But I think GLP-1s are improving that. We're going to see more data lowering inflammation. However, if someone goes on a GLP-1, and by the way, they don't magically cause muscle loss. They track in line with when an individual loses weight, we see it's the same percentage. It's not something magical. But the problem is if individuals are abusing GLP-1s, not training, seeing the celebrity sphere become very skinny, sarcopenic, I believe that we're going to have an epidemic of sarcopenia that we defined as an aging change in muscle accelerated years earlier right underneath our noses.

44:47Dr. Gabrielle Lyon:How are you monitoring body composition in your clinic? Well, like I mentioned before, we don't have great ways of measuring skeletal muscle because MRI is not feasible for most people. But we use bioimpedance and we use a DEXA and we always measure and keep strength metrics. Oh, wow. How do you do that? We're not doing that. We just report. I mean, we usually are in contact with their trainers. And whatever it is that their programs are and their lifts, are they evolving? Where are they from a strength standpoint? So you are 100 % of your patients are doing strength training. Yes, they are. So you're not coming to me.

45:23Dr. Gabrielle Lyon:Yeah. Okay. Because nothing moves the needle more than exercise. And we were talking about the fat that infiltrates into the tissue. The fat that infiltrates into that tissue, the most effective way to get rid of that is not diet. It's movement. You have to get a flex. If you think about your muscle like a pond, when a pond is stagnant, it gets bugs and all kinds of things. Muscle is the same. Even if you then revert to a healthy eating behavior, if your muscle is full, muscle glycogen, fatty acids, and you're not leveraging this turnover through activity, then your muscle doesn't – I mean, it will improve, obviously, because the quality of your diet improves.

46:06Dr. Gabrielle Lyon:But the most effective way to improve that muscle quality is through movement. All right. So let's talk about the training prescription, which is I love. So you have two books. Let's talk about this real quick. So I love the playbook. You know, what's the difference between the two books? This is, this book has pictures. This book is written for now who people don't want all the heavy science. The heavy science is all in forever strong. But this is how to do, what to do. So. And you know what? We're going to do a challenge, and maybe you will pop on the challenge and talk about your own— Lots of recipes in here.

46:42Dr. Gabrielle Lyon:Yes, and protocols. Okay. And it tells you exactly how to design a diet to support muscle health. So that's why this is how. That's right. Okay. Protein without resistance does not build muscle. It does not, but— Resistance without protein doesn't build muscle. Right. You need both. Okay. But both are valuable without the other. Meaning if you must consume calories, you still need beyond building muscle, again, skin repair, hormones, brain function, precursors, methionine for glutathione production, the Manchester antioxidant. But yes. Okay, sis, give me the scoop. What have you been up to? Living my best life.

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51:02Dr. Gabrielle Lyon:This hurts my heart a little bit because all activity is good activity. Yes. And I believe we should hold people to a higher standard if they want to age well. Okay. When individuals age, again, we touched on these fiber types. When our parents age and we've watched them age, they become thinner and more frail. Typically, there is a transition of fiber types to those bigger, bulkier fiber types to the more thin, what we would consider more endurance. Muscle fibers. Muscle fibers. The only way to protect those muscle fibers to maintain that size is to do resistance training. There's no other way.

51:39Dr. Gabrielle Lyon:Is Pilates great? Pilates is great. Is it going to be enough stimulus? If Pilates was the end-all, and Pilates is great, and people get very offended, but if Pilates was going to build the most amount of muscle, then you would think the Navy SEALs and the football players, that's all they would be doing. They wouldn't be at the weight room. They would be doing Pilates. And I would say it's a great place to start, and it's a great adjunct, and it's very hard. And I would like people to lift weights. resistance. Again, it's lifting up against something that is heavy, right? That's hard for you. And women will say, I have never lifted weights.

52:18Dr. Gabrielle Lyon:Is it too late? And you know what I will say? It's never too late. I will say, lady, you have been lifting weights your entire life. Whether you have kids, my kids are 40, 50 pounds. Whether you have groceries, you have been lifting weights your entire life, you are so much less fragile than you think you are. So if you are mature, the one thing I would say is there's a lot of discussion around power and force production. I think that muddies the water. You know, talk to me, talk to the woman who's listening, who's 50, and she's the first woman in her entire bloodline who is going to try to do this.

52:58And she's never lifted in her life. Where does she start?

53:01Dr. Gabrielle Lyon:She, well, number one, she's amazing. And there's a ton of, typically she's not ready to go to a gym. She's like, I'm embarrassed. I don't want to go to the gym. It's overwhelming. It's overwhelming. I said, you know what? We're going to start with either body weight or we're going to start with bands. And you are going to recognize that everything that we start is always hard at first. and then after she feels comfortable she will then progress to machines she doesn't have to do free weights she doesn't have to do complex movements and then she's going to say to me doc i don't have time and you know what i'm going to say to her if you don't have time for strength how are you gonna have time for sickness and then she's gonna go oh yeah okay i thought about that then she didn't go to the gym and we're gonna start her with machines there's a low injury rate with machines because there's not a ton of variability.

53:51Dr. Gabrielle Lyon:You're not getting under a barbell, doing a squat. You're not doing broad jumps. You're not doing any of those things. And then eventually, you maybe progress with a trainer or someone online to begin to see how to explore different movements because I'm going to give you another prediction. The first prediction is we're going to talk about muscle in totality. When we think about muscle, we think about body parts, biceps, back, legs, improving insulin resistance, improving strength. Once we move a little further, what I believe is next is the movement patterns. So it's now no longer thinking, again, this is not for the beginner, but this is for the people that have been following you and have been doing what you're doing.

54:36Dr. Gabrielle Lyon:It's now we have to begin to think about how are we moving? What are the patterns that we are moving in? I think that that's the next thing rather than bicep curls and leg extensions, which is perfect. And you will be perfectly healthy if you always do that. But when we think about injury prevention over time, we have to begin to think about what are the patterns and how we're moving. Okay. How about the woman who's been doing cardio her whole life? And she's fit by, you know, our usual definition of fitness. She's running. She's spinning. She's in great cardiovascular shape. But she's still losing muscle.

55:12first thing i would say these are my runners yes you know my competitive runners they are

55:16Dr. Gabrielle Lyon:very frustrated by this um i have a patient her name is sharon she's 60 when i inherited her as a patient she was running ultras she's running 50 to 100 miles and um she wanted to be able to run for the rest of her life instead of having her run more we pulled off two days a week of running and added in compound movements and weights and sled pulls. And she's 60. This woman puts me to shame in the gym. Shame. And you know what? She's gotten faster and stronger because she's diversified her program. Awesome. What does heavy enough mean for women our age? Yeah. You know, I was chatting with your team and there was the Lift More trial.

56:02Dr. Gabrielle Lyon:Lift More, yeah. Yeah. And basically the Lift More trial. 80 % of max. Exactly. I don't think that people really understand their one rep max. I think it's unrealistic. So one rep max for our listeners is the heaviest you can lift and do one repetition, one bicep curl before you cannot do a second one. So that's your max. Right. Most people are not testing that out or doing that. But basically what this showed, it was this, like you said, 85 % of one rep max and heavy enough meant two to three reps of a set should be very, very challenging. Mm-hmm. What we also see, and this says twice weekly, 30 minutes, but what we also see is that the volume is just about the stimulus.

56:42Dr. Gabrielle Lyon:And there's a million different ways to get to the stimulus. Should you be challenging yourself? Does it have to be heavy? It doesn't have to be heavy as long as the volume is there. You just have to fail, right? It just depends. Is that 25 reps or is that 10 reps? And I understand that this is very contentious in the exercise space, but we are not talking about elite athletes. And it is unfair that we take our perception and the data of elite athletes and sport performance and we push that onto our general population. It's unfair and it's not right. You know, there's all this talk about zone two training.

57:20Dr. Gabrielle Lyon:Well, zone two is different for you than it is for me, than it is for my husband who runs 100 miles. So what she needs to do is she needs to get enough stimulus where things are challenging to improve. As doctors, we're thinking about health outcomes. What are the health outcomes? I want you to have lower blood pressure. I want you to have better metabolic control. I want you to be able to live long and well and be able to stay independent. I don't need you to do a one rep max and risk injuring your back or be an idiot like myself doing cleans, clean and jerks. I mean, what am I doing? Because it's fun?

58:00Dr. Gabrielle Lyon:Okay, well, I have to be a little more disciplined in that because then you're out for a week. Yeah. Again, this is the long game. Yeah. I'm like in my mind when I'm in the gym and my gym's in my garage. I've been there. Convenience. I've been there, yes. I am thinking about that BDNF. I'm like, whenever I'm like getting tired or frustrated or like this is taking so long or whatever, I'm like, no, no, no. You're making those important, you know, messengers in your brain that are going to decrease your risk of dementia. And at the end of every workout, I'm like, one last day in the nursing home.

58:31Oh, I love that.

58:33Dr. Gabrielle Lyon:I mean, that's very positive reinforcement. Yeah. Like, I'm down here to, this is my nursing home prevention program. You know, this is, this might sound a little negative because nobody wins the war, right? Yeah, we all die. We all die. But not today, and we can win the battle. And it's just not today. I just want to decrease the time that I lose my independence. I know I'm going to lose my independence one day. You might not. Maybe not. But the trajectory of the women in my family who beat cancer, who run the cancer gauntlet and make it past 70, okay, is not great. It is over a decade of loss of independence and requiring others to care for you in your daily needs.

59:15My mom's in it right now, both frailty and dementia. So that's my motivation. And I want the science to say, okay, there's no promises in life, but how can I stack the cards in my favor? And I just was never taught and learned in med school that I have more control over this than I ever imagined. And it has everything to do with what I put on my plate and how I move my body. It's all your agency.

59:45Dr. Gabrielle Lyon:It's your choice. And that's really important. That muscle and strength is a choice. Weakness is a different choice. You know? What do you think the longevity movement is getting wrong for women? In the longevity space, the idea of stimulating mTOR is a problem and that those that suppress mTOR, which mTOR is in every cell, it's for muscle protein synthesis. It's, you know, it's apparent in all things. It's kind of this growth. It's a switch. It's a switch. And one of the things that they were saying is that when you are fasted or you are calorie restricted, mTOR levels are low, which is true, and PK is up.

1:00:31Dr. Gabrielle Lyon:but one of the things is mTORC1 is one complex, and that's the building complex, and then there's mTORC2, which is another complex, and they kind of ride along the same lines, right? Nothing in the body is completely separate. You and I would agree with this. And there's this big headline that when you inhibit mTOR, you extend life, and that's kind of the premise as to where it comes from, And I will say what it doesn't tell you is that when you chronically suppress mTOR, which again, there's a ton of problems with even the framework of this, is you also affect glucose. You become glucose intolerant.

1:01:15Dr. Gabrielle Lyon:You change your lipid profile. There's all these whole hosts of other problems with it. So it's not just muscle. Insulin resistance, weakened immune system. A lot of the data in the longevity space is... We clinical. Right. So it's rodents. And here's the thing that people will say, well, mice are not people. The rodents used are obese model rodents. They're not, quote, normal human subjects. They are feeding all day, 24 hours. They are, in essence, a diseased model. So that's one part. And by the way, mice don't die from the same things we do. They don't die of dementia? No. So mice in these landmark studies of longevity, they die mostly of lymphoma and connective tissue tumors.

1:02:07Dr. Gabrielle Lyon:They don't get atherosclerosis. They don't get Alzheimer's. And without getting too technical, this is really in the scope of rapamycin. I'm sure you've heard of it, of course. Talking about it. But basically, they did this analysis. Again, this is a landmark study. 2013 found that rapamycin barely touched the markers of aging in those mice. But what it did, it was explained by suppressing those specific cancers that kill lab mice. I've read the two biggest longevity books that have come out in the last five-ish years, but I don't want to name names. I'm going to be offended. I've also read yours and Vonda's.

1:02:51us. And so what do you think those blockbusters got wrong about women?

1:02:57Dr. Gabrielle Lyon:I mean, well, first of all, the whole premise that mTOR suppression is going to help with longevity, they've never worked in a nursing home. mTOR is necessary. This idea that we're going to suppress this one pathway, and that that is what's going to make us live longer is foolish. It is the same pathway that is stimulated with resistance training. By default, if you believed that suppressing mTOR was going to extend lifespan, then you would also have to believe that resistance training is going to decrease lifespan. And just the core fundamental arguments are wrong. And ideally, it would just be better if someone says, okay, I made a mistake, and perhaps I'm looking at this wrong, but that is, I mean, that is one of the biggest, biggest problems.

1:03:50Dr. Gabrielle Lyon:And then when the data was analyzed, there was a big 2014 study that talked about lowering dietary protein, but it was very self-selected data. And when they expanded the full data set, it actually showed that those with lower protein intakes died earlier. Yeah. So what are your top five, top three, you know, things you want a woman to take away from this conversation? Like what would be, what are things she can change in her life right now that will change the trajectory of how she's going to age? Yeah. The most important thing is that she's strong. Okay. I don't care how you get there. I don't care if it's carrying your children around the house and doing pushups in between, but you do not have time to waste.

1:04:34Dr. Gabrielle Lyon:You must get strong and you will not get bulky. the greater risk is becoming frail becoming bulky is not a real risk it's like going to medical school and going god i don't want to go to medical school because i might get too smart it's never going to happen yeah neither is getting bulky right how many women do we know that are too bulky because they've been lifting it's just not it's a it's a inherited scientific belief just like you should wait an hour before you go swimming after eating a meal that killed me as a kid. I think our parents made that up just to give themselves a break. The idea that women are going to lift and become too bulky is in line with that.

1:05:10Dr. Gabrielle Lyon:So they have to do that. They have to eat their dietary protein. High quality protein, fine. If you want to choose plant-based, that is your prerogative. You should be then utilizing essential amino acids if that is going to be the deal and how you are going to do it. But high quality protein and nutrient density are everything and doing it over the long haul. And the third is, again, this could be, is it going to be hormones? Is it going to be sleep? I think the third thing is knowing what you stand for. And when you know what you stand for and you have standards, then everything else allows you to make a good decision and be very discerning.

1:05:46So what do you mean by that? I mean that with our evolving landscape,

1:05:51Dr. Gabrielle Lyon:there's so much information. People have access to other people more than ever before, it is noisy. And if you don't know what you stand for, and if you don't know what your standards are, then you will go off course and you will fall for anything. And as a geriatrician, I saw people at the end of their life, and there was nothing more profound than regret. Not cancer, not Alzheimer's. It was the regret at the things that they didn't do or the chances that they didn't take. And that's why the third thing has nothing to do with protein or muscle. I think that, you know, and why I'm writing the third book, my third book on strong women, is I think women become whatever they've been told to become.

1:06:39Dr. Gabrielle Lyon:And I don't want that for my daughter. I don't want that for your daughter. We can get rid of the labels and you can be relentless and you can be ambitious and you Be kind and you can be all the things. I feel like in clinic, I'm often writing a prescription for a patient to put herself first. To really focus on her. To be, and she thinks she's selfish because she's not putting everyone else's needs. That's like the oldest story tale that needs to stop. Right? It's like the self-sacrificing of your people. Like I don't have time. I'm like, you don't have time not to do it. And we. Who's going to take care of you?

1:07:16Dr. Gabrielle Lyon:I agree. I agree. And that starts with being able to unwind that way of thinking because it's not useful, it's dangerous, and it creates a setup for the downfall of families. It's not selfish to be doing the things that you put the standards for that you would want your children to do. Okay. How can our listeners find you? They can go to my website, drgabriallion.com. Also on Instagram and our YouTube, both Dr. Gabrielle Lyon. We see patients at Strong Medical and anywhere. Again, we have a podcast, which you've been on, newsletter, the whole thing. Okay, awesome. Well, Dr. Gabrielle Lyon, thank you so much for joining us on Unpause.

1:08:01You've been an incredible guest, and I can't wait to share this with our listeners. Thank you for having me. you can find full episodes of unpaused on youtube at dr mary claire also you can find me on instagram at dr mary claire and get honest and accurate information on health fitness and navigating midlife at the pausedlife.com unpaused is presented by odyssey in conjunction with good roommate media and long wave digital from athletic stuff like a full court pickup game Swish! Two athletic-ish stuff, like a half-mile stroll. Get those steps in! Head to Sierra or Sierra.com for the brands you want at the prices that let you do it all.

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