Muscle is the Organ for Longevity with Dr. Gabrielle Lyon

16:45Dr. Mary Claire Haver:What does that mean?

16:46Dr. Gabrielle Lyon:I mean, muscle is muscle, right? Yeah. Yeah, muscle quality is probably -

16:50Dr. Mary Claire Haver:And we're talking skeletal muscle.

16:51Dr. Gabrielle Lyon:We are. We're not talking smooth muscle, like the muscle in the uterus. Skeletal muscle quality is probably the biggest oversight that we have in medicine right now. Because do you remember when they came out with a study saying that people that suffered with obesity had more muscle mass? Yeah, totally. And this is still repeated. It has nothing to do with the quality of the muscle, the fat that infiltrates into the muscle. So there is fat. There is fat that infiltrates underneath the fascia between muscle groups. There's fat that infiltrates into the muscle tissue, like a marbled steak. And then there's something called the athlete's paradox, which is fat in relationship to mitochondria, which is important for, say, an athlete, someone who is running a marathon.

17:34Dr. Gabrielle Lyon:But what happens is that when someone is sedentary, so there is no such thing as sedentary, healthy muscle. Muscle must move, it must contract to use those fats and those fuels. And what happens if someone is sedentary over long periods of time, not only do they become insulin resistant, which we should touch on the idea that even 18-year-olds that are in college that look perfectly healthy can have insulin resistance if they are not moving and training appropriately. But what happens is this fat that infiltrates into this tissue changes metabolic outcomes. It changes insulin resistance. Also,

18:11Dr. Mary Claire Haver:So now what was formerly PCOS, PMOS, these are muscle problems first.

18:17Dr. Gabrielle Lyon:And that becomes really critical to understand even beyond, again, strength and mobility, but as a metabolic focal point. And there's more to this because contracting muscle does a whole different thing. So this is the biggest oversight I see, and here's why. When you get a DEXA, which is the standard, it shows nothing muscle quality. The only way that we're really looking at muscle quality right now is CT or MRI. Not accessible to people. Ultrasound is a potential, but it's not common.

18:44Dr. Mary Claire Haver:So when we're trying to look for muscle quality, you're trying to see how much fat has infiltrated the muscle. Is that what you're talking about? Yes, and we are not there. The bioimpedients can't do that. We're not there, but I believe that this is a little controversial, okay? Let's do it. I do not think that body fat is an incredibly relevant biomarker. Me neither.

19:04Dr. Gabrielle Lyon:Okay. I don't think body fat percentage. I think it's genetic. I think body fat doesn't matter. I think the percentage of body fat, yes, as you get higher, it comes with comorbidities. But the quality and the amount of skeletal muscle is a much greater predictor of mortality and health outcomes. Body fat is just a sidebar. And it's the thing that we can see. And as we are seeing this increasing in treatment and exposure to what was formerly known as PCOS as a muscle, in part, part of a muscle problem, that it's the percentage of fat in skeletal muscle that is what drives insulin resistance. It's the percentage of fat that infiltrates into that tissue that drives Alzheimer's, cardiovascular disease, and these other metabolic outcomes that we have always associated with obesity.

19:48Dr. Mary Claire Haver:So if I was going to try to investigate this, a CT or MRI, what do you tell the radiologist?

19:55Dr. Gabrielle Lyon:We will get there. It's another five years out. Because the radiology people, they've been seeing this forever. Yeah. I mean, the scans have not changed, right?

20:04Dr. Mary Claire Haver:But how we interpret that.

20:05Dr. Gabrielle Lyon:It's the technology. And again, it's not so viable because body fat is very easy to measure. And there are strong correlations. But the big overwhelming miss is that we have no idea about the quality of that tissue. And that's really where it's going to go. And if we can get to the quality of tissue as routine, then I think we're going to be able to change the trajectory of the way people live.

20:26Dr. Mary Claire Haver:Are there any strength or power measurements that we can do that would approximate this?

20:31Dr. Gabrielle Lyon:That's a really good question. Muscle quality is traditionally spoken about in what you're saying based on the strength, based on metrics of get up and go, power metrics. I think that it really depends on training status. For example, if you are someone who never grew up training, I look at my mom. She has always done some kind of activity, but she has never really doubled down and focused on resistance training. So the idea that these bigger lifts, say, for example, squat, bench press, these numbers are, these are made up numbers as to what someone should reach. And that becomes important because it just puts into perspective what we need to shoot for.

21:14Dr. Gabrielle Lyon:But one more thing on muscle quality that I think is empowering for people is that regardless of body composition changes or not, you can improve muscle quality simply by doing exercise. And I'm going to say that again. Regardless if body composition changes, if someone maintains their muscle mass, maintains their fat mass just as is, the simple fact that they are doing some type of resistance or cardiovascular activity changes the quality of that muscle. In fact, it's a potent stimulus of affecting - Any movement. Any movement. And that becomes really empowering. Yeah. Because it's not chasing a scale or even...

21:55Dr. Mary Claire Haver:I mean, the data backs this up. A 30-minute walk a day for a sedentary person can decrease the risk of type 2 diabetes by 50%. And the mechanism...

22:06Dr. Gabrielle Lyon:You're not burning that many calories. You're not. And what do we think that the mechanism of action is? It's got to be muscle. It's muscle.

22:12Dr. Mary Claire Haver:Yeah.

22:13Dr. Gabrielle Lyon:And that becomes really empowering. So just the simple act of moving. But on the same hand, do we think walking is enough for staying out of a nursing home? Probably not. Probably not. And then that is where the conversation then shifts to, well, what do we have to do?

22:29Dr. Mary Claire Haver:I just saw a research graph. Literally, I was preparing for this. And it showed three trajectories to disability, right, with aging. And if you do the status quo, you most likely will lose for a prolonged period of time your ability to care for yourself. Then there's the people who walk, who maybe do some yoga, some gardening. They're active, right? But they're not resistance training. So they have a better trajectory, but they do tend to end up there. And then the only people who stayed out of disability were the people who lifted on a regular basis.

23:01Dr. Gabrielle Lyon:Isn't, you know, so I studied nutritional sciences, and you and I have talked about this at length. The idea that we have micronutrient deficiency. So we have macronutrient profiles, protein, fats, and carbohydrates, which I know that we'll talk about because the way that you eat right now, the dietary problem is a mismatch of muscle health. So we're eating a diet that is out of the range of what our muscles need and require for health. But as I was thinking about the landscape, nutritional sciences were very good and it's very easy to say, you need, Marie Claire, you need 100 grams of protein.

23:33Dr. Gabrielle Lyon:Here's why you need 100 grams of protein. Here's what's going to happen if you eat excess. Here are the micronutrients that you need. You need vitamin B12, you need zinc, you need calcium. But when it comes to movement, we are in an exercise deficiency syndrome or disease. And we have to begin to think about what do we have to add in and how do we design a macro plan? And then also the quote micronutrients of movement. And I think that we're really underserved.

24:02Dr. Mary Claire Haver:Welcome back to another MidiPause. I'm Dr. Mary Claire Haver, host of Unpaused. Let's talk about something that can be really emotional during menopause. Hair loss. Losing your hair can feel incredibly personal. For many women, hair is deeply connected to identity, confidence, femininity, and even how we recognize ourselves in the mirror. So when your hair suddenly feels thinner, your ponytail smaller, or your part wider, it can be genuinely upsetting. Almost every woman I see who is worried about her hair has been told some version of, it's just aging, or everyone loses some hair. Some have been handed a bottle of biotin and sent home.

24:45Dr. Mary Claire Haver:Almost none had the proper evaluation they actually needed. The good news is that hair loss in women over 40 is one of the most treatable conditions in midlife medicine when you have the right diagnosis and the combination of the right interventions. The reality is that hormonal changes during menopause can absolutely affect hair health. As estrogen levels decline, hair growth can slow, strands can become finer, and the hair cycle itself can shift. At the same time, changes in androgen activity can make certain types of hair thinning more noticeable for some women. But hormones aren't the only factor.

25:23Dr. Mary Claire Haver:Stress, sleep disruption, nutrient deficiencies, thyroid imbalances, and even rapid weight changes can all contribute to hair loss during this stage of life, which is why it's so important not just to dismiss it as normal aging. While hair changes in menopause are common, there may still be underlying issues worth addressing. Things like iron levels, vitamin D, thyroid function, and overall hormonal health can all play a role, and getting a full picture really matters. That's one reason MidiHealth has become such a valuable resource for women navigating midlife symptoms. Midi takes a more comprehensive approach to menopause care, connecting women with clinicians who understand how interconnected these symptoms really are.

26:07Dr. Mary Claire Haver:So instead of treating hair loss as a purely cosmetic issue, they look at the bigger picture, whether that's hormone shifts, stress, nutrition, sleep, or other health factors contributing to the problem. They also help guide women through potential treatment options and support lifestyle changes based on individual needs. And honestly, that kind of validation matters. So many women spend years feeling dismissed when they bring up symptoms like thinning hair, fatigue, or mood changes. But menopause affects your entire body, including your hair, and you deserve care that reflects that. So if your hair feels different lately, don't panic, but don't ignore it either.

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29:14Dr. Gabrielle Lyon:I believe that calories matter. Yeah. And I also think that the data supports the percentage of those calories. They also matter. And again, this can go in a million different ways. But how we think about eating for muscle health is probably the most critical as it relates to aging, menopausal transitions. because there's a way that you can eat to protect muscle health, and then there's a way that you don't. And just think about what happened with the food guide pyramid. So, you know, the food guide pyramid for – I mean, everybody has seen the food guide pyramid. Yeah, yeah, yeah. He's listening to this.

29:50Dr. Gabrielle Lyon:We all know, and it's just kind of a big disaster. But the initial guidelines, do you know where they came from, why they even –

29:57Dr. Mary Claire Haver:No idea.

29:58Dr. Gabrielle Lyon:Okay. This is going to blow your mind. The food guidelines came, I think it was around the early 90s, 80s, early 90s. And it was because they were seeing massive increase in cardiovascular disease and death. And so they attributed this to saturated fat and cholesterol in foods, right? And so these food guidelines came out. They moved to 6 to 11 servings of carbohydrates, and you should reduce your salt intake. And it has a whole beautiful list of all these things that you should reduce. Do you know how many people were smoking at the time? A huge percentage of the population. Instead of addressing smoking, they addressed nutrition.

30:40Dr. Gabrielle Lyon:But it wasn't a nutrition problem. It's a smoking problem. Wow. And since that time, smoking has gone down. It's now maybe 15 % of the population. And there's a whole bunch of things that they said, for example, reduce red meat. But red meat consumption is now, since the 70s, is down 40%. So why does that become so relevant is that we had the question wrong. We asked the wrong question. We said if people are having heart disease, dying of heart attacks, strokes, any of these other things. It must be their nutrition. It must be their nutrition. And for the last 50 years, based on this premise, we've been modeling nutrition around a false paradigm.

31:26Dr. Gabrielle Lyon:And the obesity epidemic started kind of right underneath people's noses. All of a sudden, we see an increase. Food guide pyramid comes out. There's a drastic rise in obesity, type 2 diabetes. While trying to solve for a problem, they started one. Yeah. Yeah. So while trying to solve for this problem, they started one. And that has now shaped what we see today.

31:49Dr. Mary Claire Haver:What is a myokine?

31:51Dr. Gabrielle Lyon:This is the other part of muscle that is really fascinating. Muscle is an endocrine organ. When you contract skeletal muscle, it releases hundreds of different myokines, these little peptide hormones. They affect a number of things. Yeah. They affect the brain.

32:07Dr. Mary Claire Haver:Okay.

32:07Dr. Gabrielle Lyon:How? Yes. So let's talk about why we think exercise is important. So this is the work factor. People believe that exercise is important for if we were to think about these superficial aspects. We think about increasing blood flow, helping with cardiovascular function, right? VO2 max. We also think about movement, right? Improving insulin resistance and utilizing calories.

32:33Dr. Mary Claire Haver:I think that as a doctor now, but as a young woman, I only thought about it as a way to maintain my figure. And you did a great job.

32:43Dr. Gabrielle Lyon:So calories. Right. That was it. So this is one way that we think about leveraging muscle. But the other part about muscle is the action of contracting it releases these peptide hormones. And this is a new reframe for people because the science isn't that old. So, you know, you're talking about the group in Copenhagen. She is a immunologist who's also an exercise physiologist. And she started looking at myokines, which are these peptide hormones or these proteins that are released from training muscle. Here's the thing, and there's hundreds of them. The most common is interleukin-6. Interleukin-6, someone might be like, well, isn't that a cytokine, right?

33:24Dr. Gabrielle Lyon:The cytokine storm, interleukin-6 when we're very sick. But myokines that are released from muscle have a different effect, what we call a pleiotrophic effect. What do they do? Myokines released from muscle help with lipid oxidation, help with carbohydrate metabolism beyond the exercise. So there's the exercise component of using muscle glycogen. There's the exercise component of using fatty acids. And then there's the muscle component of what the muscle releases and the interorgan crosstalk between the brain, the pancreas, the liver, as you increase in activity, whether it's strength training or endurance type activities, the amount and kind of myokines, whether it's interleukin-6 or BDNF, which you've heard of, which by the way, BDNF is released in the brain.

34:15Dr. Gabrielle Lyon:It's not people think that it's released into the blood and then crosses the blood brain barrier, but it actually doesn't. So these myokines do a number of things. And we can kind of talk about interleukin-6, which, again, is the most famous or various ones. But I think the big takeaway is the act of training produces hundreds of different myokines, all of which do different things.

34:38Dr. Mary Claire Haver:And I love it. They crosstalk to multiple organs.

34:41Dr. Gabrielle Lyon:And we only know about 5%. Wow. And the other thing that I think that we're going to get to in five years, in five years, we're going to be able to look at muscle quality. We're going to be able to look at the percentage of fat that is infiltrated into tissue. We're also going to be able to look at these work factor myokines in a meaningful way. Is your exercise effective? Like measuring levels? Yes. And again, it's not being done right now. It's being done in research. But they're so variable because obviously these what we call myokines are released from various cells, from macrophages as well.

35:13Dr. Gabrielle Lyon:which is one of the reasons why muscle is important for immune function, is it balances these inflammatory cytokines. Is there such thing as too much muscle? I've never seen it. Okay. But that's a great question. I've never seen it.

35:27Dr. Mary Claire Haver:Yeah. And you've seen a lot of muscle. I've seen a lot of muscle. I've seen the people you work out with. Talk to me about BDNF because that is something I've heard of. For our lay people listening out there.

35:38Dr. Gabrielle Lyon:BDNF is brain-derived neurotropic factor. And brain-derived neurotropic factor is what we think about as fertilizer for the brain. A large portion of the brain is designed for movement. When we stop moving, that's right, when we stop moving, we are not engaging those areas of the brain. There are a number of things that become important for healthy brain function. So as a fellow, as a geriatric fellow at WashU, one of the things that we did was run a aging and memory clinic. Why is that important? It's important because Alzheimer's is critical. Type 3 diabetes is the brain. There's a metabolic factor.

36:15Dr. Gabrielle Lyon:But exercise is something that we always tested. Movement and exercise was something that we always asked and always tested. And so your question is, what does BDNF do in the brain? And one of the things is it helps with synapses. It helps with connections. It also helps with, I would say, exercises, what helps with blood flow. and also improving peripheral insulin resistance because peripheral insulin resistance also relates to cerebral insulin resistance. Okay. And that's insulin resistance in the brain because that in itself is an organ system. If you want to think faster, you have to move faster.

36:55Dr. Gabrielle Lyon:Something called cognitive velocity. This idea of a lot of people as they age, they limit their fast movements, sprinting activities. it doesn't also have to be running. It can be on the bike. So if someone is listening to this and is like, okay, I now believe we do not have a fat problem. I believe that the under-arching organ is muscle. What do I need to do and why does it matter for muscle health? Well, number one, we know we need muscle for maintaining our nutritional status and our metabolic health. But also beyond that, beyond strength, which we'll talk about, the idea of movement and being able to be independent.

37:33Dr. Gabrielle Lyon:When you move fast, you also affect your synapses and your neurotransmitters. You think faster.

37:40Dr. Mary Claire Haver:So insulin resistance, you know, there's a lot of crosstalk on the channels about how do we measure it? How do we know, you know, and what I try to explain to my patients is this is something we can pick up a decade before diabetes and start making interventions to where you never become diabetic. But like, how do we measure this? Like, how could a patient ask her clinician, okay, am I insulin resistant? What would they ask for?

38:09Dr. Gabrielle Lyon:They would ask for the exact factors and blood markers that they would think about metabolic syndrome. Okay. Fasting insulin. I like it lower, you know, as low as we can get it. People will say, well, you know, five is the perfect range. I'm not sure what you guys look for in your clinic. People ask for - We hope for less than 5.3. Okay, 5.3. fasting glucose, fasting insulin, but also you have to look at it.

38:32Dr. Mary Claire Haver:And we do the HOMA-IR. Yep.

38:33Dr. Gabrielle Lyon:So you do HOMA-IR or triglycerides, all of which become really important. In research, we used to do euglycemic clamps. Euglycemic clamps are considered the gold standard data, but there are problems with euglycemic clamps. It is where you're tagging and measuring where insulin is going and how the liver is using it, how muscle is using it. But the problem is it's highly controlled. The meals before, the meals during, the meals after, all of that just highly controlled. Okay. So yeah, that is the way that people would measure insulin resistance early on. Okay. Whether they're using home IR or fasting insulin glucose tolerance test.

39:09Dr. Mary Claire Haver:Yeah. Well, we did that a lot in pregnancy, you know, when we were screening for gestational diabetes. So I have extensive, but in our clinic, we're doing fasting insulin, fasting glucose, and then calculating the home IR score from that and counseling around that.

39:22Dr. Gabrielle Lyon:And I think that that's, I mean, that's what we do. I will also say that when we think about insulin resistance, you had mentioned something really important, is that it can start decades before. And that is really critical to understand. You don't have to wait until your doctor says, you know, you're pre-diabetic or they're having cognitive impairment. So say your patient gets this insulin resistance diagnosis. What is your prescription? First thing that we do is you have to address nutrition. Typically, it is a mismatch. Insulin resistance is a mismatch of two things. It's a muscle problem and it's a nutrition problem.

39:56If we know that muscle makes up probably 30 % for women, that is 30 % of the tissue, if they are not training, becomes insulin resistant.

40:04Dr. Gabrielle Lyon:It can become inflamed. It creates byproducts that create inflammation in the body, which, again, ceramides, diacylglycerols, things that we're not typically measuring. But the most effective way to decrease that right now, I mean, GLP-1s may come into the conversation regarding muscle quality. For sure. Exercise. We'll get there. Movement, exercise. Okay. The other thing is once we talk more about nutrition is really balancing the nutrition. So myself and my mentor, Don Lehman, what we believe is that there is a mismatch between muscle health and our nutrition. And it's something that we call carbohydrate tolerance.

40:43Dr. Gabrielle Lyon:Carbohydrate tolerance is the amount of carbohydrates that one can eat without deranging metabolism. Okay. And we can talk about that. What is it? Yep. What is it? Do you know how much the average American eats in carbohydrates a day?

40:57Dr. Mary Claire Haver:I do not. I'll guess it's going to be bad. Let me guess something bad, like 200, 250?

41:03Dr. Gabrielle Lyon:300. Wow. 300 grams of carbohydrates a day. The RDA recommends 130 grams per day. We're eating 300, essentially three glucose tolerance tests a day. How do we metabolize?

41:16Dr. Mary Claire Haver:I think most of that is sugary drinks. It is.

41:18Dr. Gabrielle Lyon:It is. But if we think about it, if people are in alignment with what muscle does for glucose disposal, then we recognize that you must have activity. How does activity play in with glucose disposal? You're looking at anywhere between 30 to 70 grams an hour of carbohydrate utilization. So 30 grams, you would have to do some kind of maybe slow walking, right? 70 grams of carbohydrates. So as your heart rate gets higher, you're using more carbohydrates. You know this. But what happens is if we already know that roughly 75 % of people are not exercising or meeting their baseline recommendations, they are doing multiple glucose tolerance tests day after day after day.

42:01Dr. Gabrielle Lyon:You have to correct for that. And when you calculate out disposal, someone eats or drinks a sugary beverage, which they are no longer doing because they're listening to your podcast. They're not drinking diet or they're not drinking because they're not drinking your frappuccinos. But if you were, you have to calculate how much glucose, and we've done these calculations, can one dispose of in a two-hour period, right? Because an oral glucose tolerance test is, you know, you have a bolus load. 75 gram load. 75 over what? Two hours. Two hours. There's a clinical definition if your blood sugar remains elevated, which is?

42:39Dr. Gabrielle Lyon:Pre-diabetes, diabetes. Exactly. Exactly. So when we have a glucose load and we have to dispose of that over a two-hour period, you will be able to dispose of safely without causing metabolic dysregulation with insulin and glucose around 50 grams. Okay.

42:55Dr. Mary Claire Haver:With no exercise. That's right. Just eat.

42:58Dr. Gabrielle Lyon:If you eat and you are sedentary, 40 to 50 grams over a two-hour period. That means that anything above that number, you must be training. You have to earn those carbs. As you think about a diet, as people are thinking carbohydrates, which there's no bad foods, it's really how you design a diet, which we're going to talk about, is that a very practical takeaway is if you are not around exercise, 40 to 50 grams of carbohydrates is your upper threshold. But beyond that, now you're moving into, and being sedentary, now you're moving into the zone of insulin resistance or elevated levels of blood sugar or insulin.

43:38Dr. Mary Claire Haver:I've never heard it talked about that way.

43:40Dr. Gabrielle Lyon:Well, we had to do the calculations. And this is why nutritional sciences is so valuable in the context of physicians treating patients is the primary fuel source for muscle is not carbohydrates at rest. It's fatty acids. The muscle burns primarily fatty acids at rest. In order to get it to begin to utilize carbohydrates, you must do physical activity. Wow. Yeah, because when we're sleeping, you're running off of your stores. So when people say muscle is the most metabolically active organ, it's actually incorrect. It's not metabolically active. It's like two to three grams an hour. It doesn't burn a lot of carbohydrates at all.

44:19Dr. Gabrielle Lyon:The brain, the other organ system, there's obligatory use.

44:22Dr. Mary Claire Haver:It's crazy how much the brain burns.

44:24Dr. Gabrielle Lyon:Yeah. So if you're talking about, you know, if the muscle itself over a two-hour period is going to burn 20 grams of carbohydrates at rest, you know, you're not, you can't have these frappuccinos. You're just, you're setting yourself up for a major problem.

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48:52Dr. Mary Claire Haver:The American woman, I looked this up, is consuming 50, 60, 70 grams of protein per day. And I think that drops with age. And you're saying that's not enough. And the biggest question we get is how much should she be eating? How much nuance goes into that answer?

49:09Dr. Gabrielle Lyon:Well, I want to clarify and say I am not saying this. And the data is very strong in the literature as to how we make protein decisions.

49:20Dr. Mary Claire Haver:Because the FDA says that's enough.

49:22Dr. Gabrielle Lyon:And the new dietary guidelines came out. I was there. It was amazing. Don Lehman wrote the protein portion of the dietary guidelines. And those new guidelines are all reflected in the playbook. Awesome. Okay. Protein decisions. First of all, let's talk about what protein is. Protein is 20 different amino acids. These amino acids make proteins, nine of which are essential amino acids. The body cannot make them. But when you pick up a protein bar, it just says protein. Right. It doesn't specify the 20 different amino acids, all of which do various unique things in the body. For example, tryptophan for serotonin production or threonine for mucin production in the gut.

50:07Dr. Gabrielle Lyon:while we think about dietary protein as one thing, it is not. And that becomes really important because as we age, our needs for each of those amino acids change. And now your audience is like, wow, I'm so confused. We're talking about amino acids. There are nine essential dietary protein. Peptides. Peptides. I thought quinoa was protein. And here's what I will tell you, is that we make are protein decisions based on a few factors. Protein, when we think about it, dietary protein comes from plant and animal sources. Higher quality proteins, this is just based on biological numbers of the essential amino acids.

50:45Dr. Gabrielle Lyon:High quality proteins come from animal foods. Fish, eggs, beef, chicken, yogurt, dairy, you name it. Low quality proteins, again, based on the biological value and numbers of these essential amino acids are things like soy, which is the closest to an animal profile. We have things like hemp protein, pea protein. But again, the quality is different.

51:11Dr. Mary Claire Haver:Meaning how many amino acids they have.

51:13Dr. Gabrielle Lyon:How many of the essential amino acids, exactly right. And collagen protein is very low, if not devoid, in some of these branch chains. And tryptophan. So again, all of these amino acids and protein sources have different impacts. To uncomplicate it, let's put that aside for one second and say, why is protein important? Why does it matter? And how do we make those decisions? Protein decisions, dietary protein decisions, number one, people have to recognize it is the most important essential macronutrient, especially as we age. When we are young, you know my kids, They're jumping off your dock four and five years old.

51:56Dr. Gabrielle Lyon:They are highly anabolic. They can have two grams of protein and they're building, they're growing. But as we age, we're no longer growing up. We have to account for protein turnover. Protein is important because our bodies are repairing and replacing itself four times a year. We become less efficient at doing that as we age.

52:17Dr. Mary Claire Haver:So let me back up to that because I don't think a lot of people understand this. and I don't think, like I kind of knew, but it didn't, like the gravity of it didn't make sense to me until I really realized I was aging. The muscle I have today is not the muscle I'm going to have in 10 years. The bones I have today are not the bones. We're constantly breaking them down and building fresh. That's correct. And that process gets harder with aging.

52:41Dr. Gabrielle Lyon:It changes. And this process, there's protein turnover, which is this body rebuilding and repairing itself, but also the tissue itself, the muscle tissue becomes less sensitive to the signals. And you're thinking, okay, so muscle, how do I build healthy muscle? If we think about how we're building healthy muscle, we have to think about the influences. The influences are the following, mechanical tension, insulin, energy, right? Total substrate. And muscle is uniquely sensitive to amino acids, and particularly one of those amino acids called leucine, one of the essential amino acids. Now, the balance between, say, the hormone aspect, so if someone is thinking about muscle, and I'll give you a visual for this, because again, how do we take the science and we translate it so people can do something about it, is at the center of muscle, think about a complex, like it's called mTOR, which is a very popular protein kinase in the longevity space.

53:47Dr. Gabrielle Lyon:mTOR is essential for muscle protein synthesis. How do we build and maintain healthy muscle? The influences of mechanical tension, the influences of hormones, the influences of amino acids, the balance between those change. So when we are making our protein decisions, you have to pull each of those levers. If you are getting enough dietary protein, then perhaps through leucine, then you are less dependent on hormonal status. If you are young and you have high robust hormonal status, then you are less dependent on that lever of the amino acid leucine. So the balance, when you are young, you can get away, do you remember when you were in high school?

54:27Did you?

54:28Dr. Gabrielle Lyon:Got to eat everything. Like the Twinkie diet. I mean, I remember going off. Okay, off campus, and I would eat French fries. That's it. We went to this place. I had French fries for lunch. That's it. I was very fit, very active, and I was able to maintain my body weight. And then all of a sudden, the Twinkie diet with French fries, unless you're like my big jacked husband, just like, I don't know what happened. But all of a sudden, you're like, gosh, I can't lift as much. And there's kind of a little bit of redistribution, and things change. And part of this comes down to, are we evolving our diet to keep up with our aging milieu, this hormonal milieu?

55:06Dr. Gabrielle Lyon:Now, making protein decisions, and I hear this a lot because, again, I've been doing this for a long time, that it's just based on one thing and then there's one right number for everybody.

55:16Dr. Mary Claire Haver:Yeah.

55:17Dr. Gabrielle Lyon:There is not. No one should go below 100 grams of protein a day.

55:21Dr. Mary Claire Haver:Okay.

55:22Dr. Gabrielle Lyon:What's that based on? Yes. Why? This is based on one of the benefits of dietary protein is, again, that input on skeletal muscle. When you are younger, the dosing doesn't really matter. But as you age, you have to hit a threshold. Now, there's a few things here. When someone doesn't hit their threshold of 2.5 grams of leucine, which equals 30 grams of protein, which equals five and a half ounces of, say, steak or a handful of eggs or a brick of tofu. If someone wakes up in the morning and they have two eggs and then fruit and go on their day, they have not stimulated muscle. They're getting in protein.

56:11Dr. Gabrielle Lyon:But again, because muscle is aging, It is very sensitive to these inputs. You have to get this right. So when you go below 100 grams, if you were to think about it, there's a handful of metabolic properties that protein has.

56:26Dr. Mary Claire Haver:I promised you for the majority of my life I was below 100 grams.

56:29Dr. Gabrielle Lyon:This is not ideal. The only way that you would be able to make up for that is if you were highly active. Okay. However, as we think about nutrient density and the quality of our diet, protein becomes irreplaceable. And one of the things that you'll hear a lot about is this idea of satiation, of protein being one of the GLP-1, nature's GLP-1, right? It sends signals to the brain. Right, leptin, ghrelin. Leptin, ghrelin, PYY. There's other kinds of peptides, hormonal peptides that are released in the gut that affect the brain and satiety. Dietary protein does a lot more than muscle. And when you get into that between, we'll say 30 to 50 gram range, you hit that two and a half grams of leucine, you turn on the machinery, the muscle is ready to rebuild and repair itself.

57:17Dr. Gabrielle Lyon:But if you were below that number, what we've seen, and we've seen some of this data in the early 2000s at University of Illinois, I worked on some of these studies, less than 100 grams, proteins seem to lose the effect of improving insulin, improving glucose, and improving triglycerides. So basically, and we can talk about this. When I did, I did my undergraduate at the University of Illinois. I've been studying nutritional sciences since, for the last 20 years. We worked on some of the earliest studies of both postmenopausal women. I mean, again, there was a handful of those cohorts and then just regular people, right?

57:53Dr. Gabrielle Lyon:And what we did is we looked at those individuals on a food guide pyramid. They had, it was, yeah, food guide pyramid is 0.8 grams per kg. basic, the basic protein intake.

58:07Dr. Mary Claire Haver:In, you know, in imperial units, it would be roughly 60 to 70 grams of protein a day

58:13Dr. Gabrielle Lyon:for a woman. That's right. Based on that. And then we looked at a group that had 1.6 grams per kg. So the current recommendation of protein, which is 1.2 to 1.6 grams per kg. And what we saw was those individuals that were in the Food Guide Pyramid group, they were not, and calories were controlled. This is really important. You asked me at the beginning, are calories equal? Do you believe in this calories in, calories out? And I said, well, yes, but there's a few caveats. So in some of these early studies, which I will send you, the 2000, 2005.

58:43Dr. Mary Claire Haver:And we'll link them in the show notes.

58:44Dr. Gabrielle Lyon:I will link them, or I will get them to you and you will link them. They were isocaloric. They had 1 ,600, between 1 ,600 and 1 ,800 calories in both groups. One group followed the Food Guide pyramid, had the older recommendation for dietary protein, which is what women were doing, 60 to 70 grams. And then the other group had 1.6 grams, so they were at least at 100 grams of protein. And breakfast was around 50 grams, between 30 and 50 grams. Those individuals with no change in calorie, overall calorie, just the change in the macronutrients, protein was roughly 30%. They improved body composition.

59:18Dr. Gabrielle Lyon:They decreased fasting insulin. They improved blood glucose. And they improved triglycerides.

59:24Dr. Mary Claire Haver:So I actually just posted about this. I looked at a cross-section of observational studies. They went back and looked at the NHANES data, the WHI data. They followed these women in these cohorts for decades, right? And they looked at nutritional studies, thank God. They tracked their nutrition, and then they tracked frailty and their frailty scores. And there was a correlative response of how much protein women were eating and their risk of frailty. So the lower their protein intake, the more likely they were to be frail. And then they said, okay, the only way to reverse that and get them out of frailty, protein was important, but you couldn't do it without resistance training.

1:00:07Dr. Mary Claire Haver:Like just piling on protein. And then if they had an adequate diet, piling on extra protein wouldn't get them out of frailty either. They had to do the movement component.

1:00:17Dr. Gabrielle Lyon:That's absolutely true. And this goes back to your question was how do we make protein decisions? You need the stimulus and the substrate. And here's how we make protein decisions. You make protein decisions, number one, based on age. The older you are, the more protein you need. You make protein decisions based on physical activity. And it's a U-shaped curve, which is fascinating. If you are highly physically active, you know, very, very high. We're talking about athletes, people that are just marathoners. Those people need more protein. If you are sedentary, you need more protein. Wow. From the mechanistic way, when you think about you have to pull one of those levers.

1:00:57Dr. Gabrielle Lyon:So if you do not have the mechanical tension or the movement, then you depend on dietary protein. So the worst of all worlds is a sedentary aging female with a low protein diet. And then personal choice becomes the other thing. Once we have how much protein someone is going to eat, right? So it's based on age, physical activity, and personal choice. So when someone is thinking, how do I get the right amount for me? No less than 100 grams, because it also loses that thermic effect. People will say it's a thermic effect of food. To explain this is not all calories, calories from carbohydrates, calories from fats, calories from proteins, because they do different things in the body, they have different biochemical footprints.

1:01:42And in order to, and I'm sure you've heard this, it's difficult to overfeed dietary

1:01:49Dr. Gabrielle Lyon:protein. And this is, I actually really wanted to address this because I'm sure that you have physicians listening to your podcast. And I was sitting at a round table of very prominent physicians and they were saying that you should not overeat protein. And the only reason to go above the RDA, which is set at the minimum 0.8 grams, is if you are doing resistance training. And anything above the RDA, 0.8 grams, if you are not doing resistance training, turns to fat. That is not true. It is not the first pathway. The first pathway for protein is oxidation, meaning you're utilizing it, you're burning it.

1:02:27Dr. Gabrielle Lyon:The other thing is it's used for gluconeogenesis, meaning the generation of glucose. We don't have a need for carbohydrate, but we do have a need for protein. And protein is used for rebuilding, but it's also used in a process of creating more blood sugar, creating more glucose at a much slower rate. I wanted to just bring that up because that is misinformation. And you and I now, and also all physicians have access to AI. AI is not always correct, even if it is in medical databases. I'm always testing it for menopause information, and it's just not good. And this just has to be addressed because you and I both attack things for women, from different angles.

1:03:14Dr. Gabrielle Lyon:And if women don't get this nutrition piece right, and well-meaning doctors are going on here and saying, you know, what are these concerns about protein? And it says extra protein turns to fat, or it's going to create cardiovascular, like all of this stuff, this is not true. And from a biochemical aspect, that's not what happens. It's oxidized. And I just wanted to bring that up because it's, if we don't get that right, no amount of hormone replacement, no amount of training is going to overcompensate for a nutrition plan that is not done right for an aging woman. How can our listeners find you?

1:03:53They can go to my website, drgabriallion.com, also on Instagram and our YouTube, both Dr.

1:03:59Dr. Gabrielle Lyon:Gabrielle Lyon. We see patients at Strong Medical and anywhere – again, we have a podcast, which you've been on, newsletter, the whole thing.

1:04:08Dr. Mary Claire Haver:Okay, awesome. Awesome. Well, Dr. Gabrielle Lyon, thank you so much for joining us on Unpaused. You've been an incredible guest. I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. Full episodes of Unpaused are available on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Good Roommate Media and Longwave Digital.

1:04:44Dr. Mary Claire Haver:This episode was sponsored by MidiHealth, the first virtual clinic created for women by women for the treatment of menopause. Don't let anyone tell you menopause is something you have to suffer through alone. Midi can help. Visit joinmidi.com to learn more.