Dr. Gabrielle Lyon: How to Exercise & Eat for Optimal Health & Longevity｜Huberman Lab

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everydaylife.

I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School ofMedicine.

I'm pleased to announce that my newbook, which I've been working on for more than fiveyears, is now available for presalepurchase.

The book isentitled,Protocols, an operating manual for the humanbody.

And within thebook, you canfind, as the namesuggests, protocols for everything from how to improve and even optimize yoursleep, for increasing your motivation andfocus, fornutrition, that is specific nutritional guidelines to follow for health andperformance, as well asexercise, stresscontrol, your oral and gutmicrobiome, both of which are critical for brain and bodyhealth, as well as protocols for creativity and muchmore.

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My guest for today's episode isDr.

GabrielleLyon.Dr. Gabrielle Lyon is a medical doctor who did her clinical and research training at Washington University inSt.

Louis. She is an expert ingeriatrics, innutrition, inhealth, andlongevity.

And during today'sepisode,Dr.

Lyon explains how if we are interested in our immediate and long-termhealth, muscle is the organ that we need to pay attentionto.

She explains how this is true foreverybody,men, and womenalike, and that there are specific things that we all can and should do with our nutrition and our exercise in order to maximize the health of our musculartissue.

Now, in somecases, people will be interested in building moremuscle, but it's important to point out that much of today's discussion is simply about improving the health of your musculartissue, and the specific ways to do that in order to support brainhealth, bodyhealth, andmovement, ofcourse, as well as the health of every organ system in yourbody.

Again, placing a focus on improving muscular tissue itself as a way to improve all the organ and tissue systems of yourbody.

Dr. Lyon explains the specific science and protocols that can be applied in your everyday life at the level of what you choose to eat or noteat, as well as how much of certain foods to eat oravoid, as well as specific trainingregimens, most of which take very littletime, but they can vastly improve the health of your muscular tissue and therefore the health of your entire brain andbody.

And by the end of today'sepisode, you will have a much more thorough understanding of what you can do to improve your immediate and long-termhealth, and thereby potentially yourlifespan, all of which are based on the most modern understanding from basicresearch, from clinicalstudies, and from practical application in the realworld.

Before webegin, I'd like to emphasize that this podcast is separate from my teaching and research roles atStanford.

Itis,however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the generalpublic.

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And now for my discussion withDr.

GabrielleLyon.Dr. GabrielleLyon,welcome.

Thank you somuch. So great to have youhere.

You have a tremendous range and depth ofexpertise.

You treatmen, you treatwomen.

You know a ton about exercisephysiology,nutrition.

You've done work inpsychiatry.

You've done work ingeriatrics.

You know so very much about how to get healthy and stayhealthy.

And today we're going to talk about all ofthat.

To kick thingsoff, I would love to dive into your take on this unique aspect of ourphysiology.

That most people when they hearabout, think about weight training or maybe bodybuilding or have some immediate reactionto.

But you have a different stance on this incredible organ that we callmuscle.

So if you would just tell us how you look at this thing that we callmuscle.

Inmen, inwomen, inkids, in oldpeople, youngpeople, how should we think aboutmuscle?

Well, first ofall, muscle is the organ oflongevity.

And we've always thought about muscle just as you said when it comes toexercise,performance,mobility, andstrength.

Which by theway, all of those things are important and critical forlife.

But there's something very unique and special to skeletalmuscle.

First ofall, it's an organsystem.

It's an endocrineorgan.

It is responsible for a large component of glucosedisposal.

And we're roughly80% of glucosedisposal.

And we all hear about these things like cardiovasculardisease, type 2diabetes,obesity.

Largely, many of these metabolic diseases begin in skeletal muscle decadesbefore.

Interesting. Skeletal muscle is also an amino acidreservoir.

It is the place that your body pulls from aminoacids.

And that is something that changes as weage.

And we have protein turnover and we require healthy skeletalmuscle.

Ofcourse, it's the body armor that we allknow.

And it is really responsible for how weage.

And by theway, I came to this understanding through anexperience.

I'd love to share withyou.

I did my fellowship in geriatrics and nutritionalsciences.

And at thetime, we were lookingat, youknow, every fellow has to have aproject.

Lucky forus. And we were looking at body composition brainfunction.

And there was one patient who I justadored.

She was amom, threekids, and she'd always yo-yodieted.

We image her brain and her brain looked like the beginning of an Alzheimer'sbrain.

And I thought tomyself, and I felt veryresponsible,thinking, why was this woman who was doing everything that we told her todo?

She wasexercising. She was eating a lowfat, high carbohydratediet.

Why was she so metabolicallyunhealthy?

And I realized that at the end of theday, it wasn't that she wasoverfat.

It was that she wasundermuscled.

And we spend decades and have spent decades trying to treatobesity, when really what we need to be looking at is skeletalmuscle.

Superinteresting. We know that the brain is among the most metabolically active organs in thebody.

And muscletwo, one of the most metabolically active organs in thebody.

You'll probably tell me that one is more active than theother.

Which one isit? Muscles actually quitefrankly, not very metabolically active atrest.

Interesting. For every pound of skeletalmuscle, it might at rest burn 10calories.

Primarily burns fatty acids atrest.

Okay, I learned somethingnew, and I imagine many other people did aswell.

So this woman that wasoverweight, you looked at the problem through differentlens.

That she'sundermuscled.

How does one go from being undermuscled to properlymuscled?

And what isthat? And as I saythis, I realized that many of our listeners probably don't resistancetrain.

Or if theydo, they may not want to carry a lot of muscle thinking that thatwould...

I'm gonna have to buy a newwardrobe.

Youknow, certainly some of our listenership probably wants to gain moremuscle.

Or a newwardrobe. Or a newwardrobe.

Is there a way to view increasing muscle mass in a way that is compatible with kindof...

I don'tknow, we go like traditional aesthetics or with overall health in a way that's sort of distinct from quote-unquotebodybuilding?

Imean,again, as soon as we talk aboutmuscle, we think about slabs of meat added to different parts of ourbody.

And surely certain people probably want to add muscle to certain parts of their body for aestheticreasons.

But how should we think about muscle in the context of some of the two dues in terms of nutrition andexercise?

And we'll segue intothat.

Again, how should we conceptualize this business of being undermuscled and gettingto, Iguess, what we call appropriatelymuscled?

I think that that's a really goodpoint.

This idea of being appropriatelymuscled.

So the truthis, I can't tell you how much skeletal muscle mass you should have for optimalhealth.

I don't know how much skeletal muscle mass I should have for optimalhealth.

We haven't done a good job in the literature and just as apopulation, being able to track skeletal muscle and know what isoptimal.

We are really good at looking at body fat and we're really looking good at looking atbone.

But when it comes to skeletalmuscle, dexa is anextrapolation.

So, forexample, we use dexa as the goldstandard.

And I'm going to come back to what we need to do to gain healthy skeletalmuscle.

But I think that it's really important to put things into perspective and a framework for how we think aboutthings.

We traditionally usedexa.

Dexa looks at bone and it looks at lean tissuecollectively.

Part of lean tissue is skeletal musclemass.

It doesn't determine the health of skeletal musclemass.

It doesn't determine anything about the quality of thattissue.

It purely looks at leantissue, which then we determine part of that lean tissue maybe it's40% is skeletalmuscle.

And that's important to understand as we begin to frame up the conversation as how much skeletal muscle should Ihave.

I have noidea. But what I can tell you is that if I were to look at your blood work and I saw something like elevated triglycerides or elevated insulin or elevatedglucose, I would begin to understand that the health of your skeletal muscle isn't where it shouldbe.

And by theway, the health of skeletal muscle mass begins when we'reyoung.

This idea ofsarcopenia, which for the listener or theviewer, the definition ofsarcopenia, by theway, became adisease.

It wasn't even classified as a disease till2016.

Wow.Yes,wow. Which is very recent for adisease.

It is a decrease in muscle mass andfunction.

Butinterestingly, we don't necessarily know what one shouldhave.

So I think it's important to understand that when we're talking about the health of skeletalmuscle, we're still pretty much in the infancy of understanding the trajectory of where it isn't and where it'sgoing.

So when we think about how we maintain the health of skeletalmuscle, one of the things that I didn't mention is that skeletal muscle is a nutrient sensingorgan.

It is uniquely sensitive to the quality of ourdiet.

The quality of our diet defined as the quality of the amino acids that we'regaining.

And that wouldbe, for thelistener, dietaryprotein.

Skeletal muscle is sensitive to one of the aminoacids,loosing.

And depending on the quality of thediet, meaning how much loosing that you're getting in any givenmeal, will then stimulate musclehealth.

Not just musclesize, but musclehealth.

Musclehealth. And the way that we think about muscle health is byproxy.

Is this concept called muscle proteinsynthesis, which we canmeasure.

And when we get a dietary proteinamount, which is between 30 and 50 grams of high qualityprotein, it stimulates skeletalmuscle.

So I love this idea of focusing for a bit on muscle proteinhealth, because it divorces us from thisconversation, at leasttemporarily, about musclesize, which I have to imagine iscorrelated, but it's a separate thingaltogether.

Actually, I should just ask thequestion, is it possible for somebody to have a lot ofmuscle, but their muscle health ispoor?

Yes.Okay,conversely, can somebody have a moderate to low amount ofmuscle, but their muscle quality ishigh, or is that lesscommon?

Well, the first thing that you said is absolutely something that wesee, is that in an individual that carries a lot of muscle and say they'reinactive.

There is a big discussion about how heavy individuals will have more musclemass.

But what we have to recognize is the health of that skeletal muscle isfat.

Deposition can be this realfat,deposition, fat around theorgans.

And it can be also fat infiltrate into thetissue, like not to gross anyoneout, a marbledsteak.

And that's exactly what can happen to unhealthy skeletalmuscle, which then affects its ability tocontract, which also affects a ton of mitochondria in skeletalmuscle.

It affects the efficiency of skeletalmuscle.

Soyes, someone can have potentially moremuscle, but more unhealthymuscle.

Interesting. When you say a marbledsteak, I think at theextreme, awagyu, a raw wagyu looks like there's this much white fat in it as there is red meat init.

And it's a very different taste andtexture.

So that's what we're talkingabout.

My understanding is those cows don't move aroundmuch.

They're somewhat sedentary comparedto,say, a free-range grass eatingcow.

Is thatright?Yeah.Okay.

That's absolutelycorrect.

So we want quality healthymuscle, and then we can talk about muscleamount.

And then the other thing that I'll say about it is part of what defines muscle health is thatflux, thatmovement.

So if you were to think about skeletal muscle like asuitcase, and an individualwas,say, going on a trip for fourdays, but chooses to eat or pack for 30days.

We know thesepeople.Yes, I know I'm maybe one ofthem.

I have my suitcasehere.

I was only coming in for aday, but I may have packed for fourdays.

Not sure what I wasdoing, but that's besides thepoint.

When an individual is overeatingcalories, overeatingcarbohydrates, I had mentioned earlier that skeletalmuscle, one of its primary roles is glucosedisposal.

And I'm sure we're going to get into mechanisms of glucosedisposal, whether it's insulin dependent or insulin independent depending on if someone is moving or contracting thatmuscle.

When an individual is eatingfood,carbohydrates, it gets stored in skeletal muscle asglycogen, because as we know glucose at a high level is toxic to thebody.

So the body must move glucose out of the bloodstream into thecells.

Now, what happensis, is there becomes thisstasis.

So if an individual is inactive and notexercising, then that skeletal muscle becomesoverpacked.

Skeletal muscle at rest burns primarily free fattyacids, which isinteresting.

Most people think about skeletal muscle as burningcarbohydrates, but actually at rest skeletal muscle burns fattyacids.

As you can imagine when that muscle is full and you are not exercisingit, then the substrates have nowhere togo.

And it remains in thebloodstream.

And that would be a sign of unhealthy skeletalmuscle, which then loops back to what you see in bloodwork.

Elevatedinsulin, elevated bloodglucose.

Yes. Elevated free fattyacids, elevated branchchain, aminoacids, all of thesethings, which again as skeletal muscle as the metabolicsink, have nowhere togo.

So I'm starting to get a picture where in order to have healthymuscle, we need to think about the feeding of thatmuscle, the providing of nutrients to thatmuscle.

That is as well as the use of thatmuscle.

Let's start with the feeding or the providing of nutrients to thatmuscle.

You mentioned that muscle at rest mainly burns fattyacids.

It can storeglycogen. How do we know when a muscle is full ofglycogen?

Imean, there's the visual representation of the muscle seems fuller as opposed toflatter.

But these are not specific or these are not preciseterms.

How much carbohydrate does it take to fill all the muscle of the body withglycogen?

And then what sorts of things perhaps to pleadthat?

I think it's a greatquestion.

We know that when we're talking aboutglycogen, the liver storesglycogen, maybe 100grams, and then skeletal muscle depending on yoursize, forexample, you might store much more muscleglycogen, whether it'sfour, 500 grams compared to someone who is mysize.

And can we do the standard conversion of four calories pergram?

So if the liver is 400grams, you know what we justsay?

Okay, it's about 1600 calories worth of energythere.

So if I go out and I do some exercise and burn 1600 calories overtime, does that mean that the liver is then completelydepleted?

So,well, the liver will deplete through an overnightfast.

So the liver maintains bloodglucose.

So skeletal muscle doesn't maintain blood glucosedirectly.

The way that you would leverage muscle glycogen would be throughexercise.

The way in which you would deplete muscle glycogen would be through more intensiveexercise.

And when you think about the foods and the way inwhich, youknow, your original questionis, how would we know how much muscle glycogen or how much we need torefuel?

I typically think about it as overall activitylevels.

So if someone issedentary, then the current recommendation for carbohydrates would be 130 grams perday.

At four calories pergram.

And is that both simple and complexcarbohydrates, fiberscarbohydrates?

Yes, it would just be overall 130 grams if they're completelysedentary.

Yes. So just a little bit ofwalking, gettingup, going to thecomputer, to thebathroom, to thecar,etc.

But basically said in terms ofaverage.

And average American takes in 300 grams of carbohydrates aday.

So more thandouble. And as you canimagine, this can distortmetabolism.

When we think about glucosedisposal, the way in which I think about glucosedisposal, if an individual is sedentary is thinking about how many carbohydrates an individual can ingest at one time that would mitigate insulin response and would be able to be disposed ofsafely.

And that number is between 40 and 50 grams of carbohydrates at a meal outside ofexercise.

The rest of carbohydrates would be earned throughexercise.

And through every hour of exercise depending on theintensity, that could be between 40 to 70grams, depending on how intense an individualexercises.

And that would be safely disposed of in a two hourperiod.

Imean, when you think about an oral glucose tolerancetest, that's a 75 gramload.

You assume within two hours that that blood sugar regulation should come back to a normalrange.

So at 40 to 50 grams of carbohydrate every twohours, does that mean that if somebody were to eat 40 to 50 grams of carbohydrates every twohours?

Or theyshouldn't. Which theyshouldn't.

But because you're going to quickly exceed that 130 grams perday.

And even if exercising with resistancetraining, say hard for anhour, which can afford somebody maybe what another couple hundred 300 grams ofcarbohydrates.

Probably not thatmuch.

Okay. Youknow, I think that if people care about bodycomposition, which I would say everyone should because you want to have an appropriate level of body fat and healthy skeletalmuscle, then you wouldn't necessarily unless you're doing some kind of cardiovascularactivity, you're not using a ton of muscleglycogen, depending on how much yourtraining.

And how much glycogen is the brainusing.

So that isit. That is a goodquestion.

The brain uses a lot ofcarbohydrates.

That would be a primary source when they come up with the numbers of130.

It's really based on brain and then the rest of thebody.

Can we safely say that for somebody that's thinking alot, they need morecarbohydrates?

You could saythat. Then yourbrain.

Yes, your brain is very metabolicallyactive.

Interesting. So we're going to drawing roughestimates, not knowing people's bodyweight, not knowing their bodycomposition.

But what I'm arriving at hereis, youknow, if somebody does a little bit of cardiovasculartraining, maybe a little bit of light resistancetraining, I'm describing the activities of many people outthere.

Maybe 250 grams ofcarbohydrates.

You're kind of at thethreshold.

That's alot. That's a lot for four calories per gram of thosecarbohydrates.

And so let's say 200 grams of carbohydrates perday.

But that's not a ton of caloriesoverall.

So what should the remainder of the calories be made upof?

So, youknow, I think what we're really talking about here is how do we design a nutrition plan for people to have healthy skeletalmuscle?

And, youknow, if I were tosay,okay, what are we thinking about for the listener or for the people outthere, they'rethinking, youknow, I really want to have a healthy body composition and healthy skeletal musclemass.

The way in which they would do that is numberone, you have to prioritize dietaryprotein.

So we're talking about carbohydrateshere, but carbohydrates shouldn't be the primaryfocus.

Nobody has challenges getting carbohydrates in 130 grams would be a saferecommendation.

If someone is overweight or struggles with type 2 diabetes or any of these other metabolicconditions, there is evidence to support a lower carbohydrateintake.

Imean, 130 gramsis, youknow, one little micro packet of pretzels on an airplaneride.

So that actually has probably closer to 37 grams ofcarbohydrates.

Okay,good.So. Now that I had a pretzel packet before or through when it robbed on the wayin, butno.

Right.Okay. So I'm way offthere.

So they have one of those a bagel in the morning and theyshouldn't, butthey, but theydo.

And then they havesome, youknow, pastadinner.

And so most people are probably exceeding that 130 grams by a hugemargin.

Yes, theyare. And there's a couple of things there that it's really important that you said is that individuals when we're thinking about designing a plan for skeletal musclehealth.

That first meal is mostimportant.

That first meal of theday, having dietary protein will set you up metabolically for the rest of theday.

And when you say firstmeal, we'll talk a little bit later about intermittent fasting andI, forinstance, eat my first meal at usually 11a.m.

It's just kind of how I'mwired.

I've never wanted to eat breakfast firstthing.

I've forced myself to eat some eggs first thing in the morning from time to time and it feltfine.

But do you recommend that people eat a true breakfast like within a certain number of hours of waking up for sake of muscle health and metabolichealth?

When we think about that firstmeal, I frankly don't care when you haveit.

One also has to understand that you're coming out of an overnightfast.

If you are young andhealthy, then the timing of that first meal likely doesn't matter because you arerobust.

Your body is very efficient and capable to withstand proteindegradation.

It's able to withstand protein degradation and proteinturnover, which is ultimately why we'reeating.

So that's one reason why we'reeating.

And we'll talk a little bit more aboutthat.

That first meal of theday, if you are young andhealthy, the timing doesn't reallymatter.

And I would say when it begins to matter is when you'reolder.

When you are in your60s, fat continuing to fast may be anegative, negative for muscle musclehealth.

That first meal of the day is important because we know that when you get between 40 and 50 grams ofprotein, that first meal of theday, you stimulate muscle proteinsynthesis.

Muscle protein synthesis is by proxy what we use to measure as a marker for overall musclehealth.

Now there's a lot of history here when we think about designing a mealplan.

That first meal hasbetween, we'll say give it between 30 to 50 grams of dietaryprotein.

That will do a number ofthings.

Numberone, it will stimulate skeletalmuscle, what we would consider the health of skeletalmuscle.

It also will affect thebrain.

It'll improvesatiation.

Youknow, we're talkingpreviously.

It releases a handful of gutpeptides.

Like Gukugan like peptideone, which later will talkabout.

CCTY, things that will affect appetite for that secondmeal.

And there's some very interesting research out of Heather Lydyslab.

And basically when she put individuals younger adolescents on a meal of 30 to 40 grams ofprotein, they were much less likely to choose say donuts orsomething.

Outside of what we would consider a healthy nutritionplan.

Later in the day or the samemeal.

Later in theday. So it's essentially augmenting their wellpower.

Okay, so it sounds like for young people they can delay breakfast if theywant.

For older people probablynot, but that the first meal of the day should include what you're calling dietary protein 30 to 50grams.

And maybe we should talk about the quality of that protein because I think a lot of people understand that there are meatproteins, there are plantproteins.

How important is the quality of thatprotein?

This tends to be a hot topic and somewhat verycontroversial.

Great. Great foryou. Great foreverybody.

Controversy on this podcast is embraced in the followingway.

We state what weknow, we state what we don'tknow.

And we are always happy to return to the conversation in a future time to adjustany.

Stances based on the data and how we evolve thispeople.

Okay,well, I lovethat.

Yeah. Dietaryprotein, we speak about it as if it's onething.

But actually it's 20 different aminoacids.

Nine of which areessential.

The rest we can generate in ourbody.

And when we think about skeletalmuscle, we think about the essential aminoacids.

And the essential amino acids primarily for skeletal muscle health are the branch chain aminoacids.

Lucene being one ofthose.

So, Lucene is uniquely stimulating to skeletalmuscle.

And when you have enoughLucene, it triggers muscle proteinsynthesis.

And when you say stimulating and muscle proteinsynthesis, I think a lot of people get a picture in their mind of a musclegrowing.

But you're not necessarily talking aboutthat.

You're talking about the organ that ismuscle, that it'shealth, its metabolism being cultivated so that it can do all the hormone endocrine related things and the glucose disposal related things that we'll get into in a bit more detaillater.

Is thatright?Yeah. And so when you have a breakfast of 30 to 50grams, you appropriately stimulate muscle proteinsynthesis.

And one has to recognize that if you eat below thatthreshold, you do not stimulate the health of that skeletalmuscle.

You do not stimulate muscle in a way that would be necessary for outcomes thatmatter.

And outcomes that matter aresarcopenia.

Outcomes that matter are bodycomposition, prevention ofobesity.

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It's great that we're focusing on muscle and then referring to obesity because I think so manypeople.

Virtually everybodythinks,okay, reduce bodyfat.

How do you dothat? You get the caloriesin, caloriesout, equation in a certaindirection.

And by theway, I believe in a lot of thermodynamics and caloriesin, caloriesout.

But by focusing on muscle protein synthesis and muscle health through the ingestion of quality protein early in theday, I see that you're entering this all througha, through a differentchannel.

But at the end points of reduced bodyfat, etcetera, as we'll get intolater, one can still arrivethere.

So just for practicalpurposes, what are some excellent sources of quality protein for that firstmeal?

Well, now the quality of protein is defined by the amino acidcomposition.

And typically animal-based proteins have higherquality.

These are hard fast biologicalnumbers.

The dietary proteinin,say, a steak is very similar to the protein amino acid in skeletalmuscle.

So the quality of the proteins likeeggs, like wayprotein, likebeef, likepoultry, those compositions are similar to the human bodycomposition.

So they contain the amino acids in the appropriate ratios for skeletal musclehealth.

Now, plant-based proteins have a different composition and they have a composition obviously similar toplants.

And one can get enough of the essential amino acids if the total caloric load of that protein is highenough.

And I think that that's important to recognize because right now the American diet is70%plant-based.

Andwe're, we seem to be moving more towards a plant-baseddiet.

Imean, I know there's sort of a movement towardthat.

You hear aboutplant-based.

But so most people are not eating steak and eggs forbreakfast.

Well,well, mostpeople, when I say70% plant-baseddiet, I'm talking about refinedcarbohydrates,sugars,cereal.

And when we think aboutit, so the70% of our diet comes from that where30% come from animal-basedproteins, which contain a ton of nutrients like biobailablezinc, andselenium,B12.

But when it comes to musclehealth, one could as long as they are thinking about making sure that the overall protein load is high enough in that plant-basedprotein.

Forexample, one would not choose quinoa as a proteinsource.

So quinoawould, six cups of quinoa would equal the same as one small chicken breast when it comes to amino acidprofile.

So I think one has to be aware that plant-based proteins typically have carbohydrates that ride along withthem.

And that just becomes important for overall metabolic control when we think about total chloric load and totalcarbohydrates.

Someone could use a rice pea blend of protein for that first meal that would certainly besufficient.

Certainly if someone is geared towards a more plant-based diet and doesn't want to consume animalproteins, that's what I woulduse.

Is there any evidence that combining a high-quality protein with carbohydrate in that first meal is more or less beneficial than having the proteinalone?

That's a goodquestion.

I would say that we don't have evidence forthat, that it would be more beneficial because the question would be what is the benefit that we're lookingfor?

If the benefit that one is looking for isdiversity, then certainly because we know carbohydrates cannot fiber orphytonutrients, if you're going to combine it withberries, that could certainly beadvantageous.

But notnecessary. What becomes interesting is when we think about designing adiet, does that second mealmatter?

And not to get tootechnical, but maybe we could get a little technical here is that when you stimulate muscle proteinsynthesis, that will last about two to threehours.

Now, the next thing one would thinkis,well, I know that I need a certain amount of protein for overall musclehealth.

The amount of protein for overall muscle health could be anywhere from one gram per pound ideal body weight tolower.

And when we think about how we are designing adiet, we have to recognize that the current recommendations are the minimum to prevent adeficiency.

The way in which diets are designednow, according to the RDA is.8 grams perkg.

.8 grams of protein per kilogram of bodyweight.

Which comes out total bodyweight.

Yes, which comes out to be.37 grams perpound.

So if someone was 115 poundfemale, that current RDA would be 45 grams ofprotein.

And thisis, these are very important concepts to understand the foundations of how we think about dietaryprotein.

The currentRDA, which is a minimum to prevent a deficiency is based on nitrogenbalance.

Nitrogenbalance. And by theway, the recommendations for protein that were set in the 80s have notchanged.

Which means one of two things we haven't had new science come out or we just haven't recognized the importance ofprotein.

And I think that it's more likely the latter that we have not yet recognized even though there's a plethora ofdata.

And I worked on some of these earlierstudies, which you know I'llshare, I even brought the numbers to make sure that I said them right because youknow, this is the human labpodcast.

Well, I'vemade, I've made a numerical errors before on thepodcast.

But great that you brought thenumbers.

We always try and correct anyerrors.

But great to be precise the firsttime.

So thankyou. And youknow, when we think about how we design a diet for optimal muscle health is very different than how we design a diet foragain, justlife.

And the two are verydifferent.

The RDA forleucine, which is that essential amino acid meaning we cannot makeit.

We must get it from the diet is set at 2.7 grams perday.

That's a trivialamount.

That is a trivial amount and 2.7 grams perday.

And one must understand that this came from nitrogen balancestudies.

And typically those are youngmen, 18 year oldmen.

That does not support healthy aging or anyone that is struggling with obesity or any kind of chronic illness oranything.

And so then when we begin tothink,well, what do we actuallyneed?

The evidence would support 2 to 3 times that amount closer to 9 grams of leucine perday.

And just to calibrateus, 9 grams of leucine again is essential aminoacid.

We can only get from food perday.

What is that equate to in terms of the total amount of let's say egg or steak protein that one would need to eat in order to ensure that justroughly.

Yes, wonderfulquestion.

So there's a meal threshold for skeletal muscle health and that meal threshold is a minimum of 30grams.

Now that would equal a 4 and a half ouncesteak.

Dare I say 6eggs, which is a lot of eggs at one time or a scoop of wayprotein.

Might have 18 grams of protein and 2 and a half grams ofleucine.

Maybe you do a 25 gram way proteinshake.

And that becomes important to understand because it is a meal thresholdamount.

Youknow, we are talkingabout, youknow, the reason why I was so excited to come on this podcast is because I think that if we can correct our nutrition and we gear it towards skeletal musclehealth, then we can change the trajectory ofaging.

And we can stop focusing on obesity and really focus on skeletal musclehealth.

But the only way that we're going to do that is if we get this nutritionright.

Because skeletal muscle requires dietaryprotein.

There's only two main ways that we can stimulate skeletal muscle and that is throughexercise, primarily resistance training and dietaryprotein.

And so when we think about how we design adiet, if you look back at thehistory, we have to recognize a handful ofthings.

Numberone, that these essential aminoacids, primarilyleucine, is necessary to trigger muscle proteinsynthesis.

Numberone, numbertwo, that aging impairs the efficiency of muscle proteinsynthesis.

Isee. So it's a runawaytrain.

If you start gettingsarcopenia, if there's obesity and other markers ofaging, realize obesity can occur at young agestoo.

But muscleloss, then basically you're losing musclequality,a.k.

protein synthesis and otherthings.

And as aconsequence, it makes it harder to increase musclequality.

So you have to short circuit this prettyearly.

Yes. And I would even say that we talk about sarcopenia as a disease ofaging.

But I think that there is a youthful phenotype ofsarcopenia.

If we define sarcopenia as decreased muscle mass andstrength, that can easily affect ouryouth.

Youknow, we talk about healthspan, we talk aboutlifespan, there's also musclespan.

And muscle span is this concept that is really about the skeletal muscle health as weage.

And there's three primary components to that that's understanding that skeletal muscle health begins very earlyon.

And we're going to talkabout, because I know that there'sparents, I have two littlekids.

So I want to talk about the amount of protein necessary forchildren, ofcourse.

And then as we think about this musclespan, there is early on earlyage, where you're laying down thefoundation, where you're hopefullytraining, doingexercise, just doingmovement.

Being sedentary is a disease state in and ofitself, period end ofstory.

Being sedentary is not the opposite ofactivity.

Being sedentary is in and of itself a disease on of inactivity.

Thenmidlife, we have to maintain thetissue, we get a peak muscle mass in our30s, we get a peak bone mass around the sametime.

And then that later half oflife, we have to do everything that we can to maintain that tissue because of this decrease in efficiency of skeletalmuscle.

So skeletal muscle as a nutrient sensing organ can respond like youthfultissue.

And the way that responds like youthful tissue from an amino acidperspective, just thinking about how we eat to maintain that is that when we increase our dietaryprotein, so older individuals or individuals as they age require more protein to then stimulateemitter.

So does that mean instead of eating 30 grams of protein per meal minimum that people older than say50,60, should eat 40 or 50 grams ofprotein?

I would say that that'strue.

Interesting. And by theway, skeletal muscle will mount a youthfulresponse.

The initial work was out of Bob Wolf'slab.

He's an icon in the industry ofprotein.

Can I say ground fathersnow?

Imean, that's prettyembarrassing.

And when I think about Bob Wolf and Don Laman and theseguys, I trained withDr.

DonaldLaman, these initial studies that we think about and we take for granted dietaryprotein.

Wethink,okay,well, the bros have always knownthis, but we havenot.

And when you areyounger, there is a somewhat of a linearresponse.

Let's say a younger individual stillgrowing, we'll just call them10, 12 years old or mychildren, I have a three and a four and a half yearold, they will respond with five grams of dietaryprotein, 10 grams of dietaryprotein, 15 grams of dietaryprotein, versus an older individual will not respond at all tothat.

However, that response can be augmented by increasing the dietary protein at thatmeal.

So an older individual will respond like a younger individual by 30 grams ofprotein, 30 to50.

Later, we're going to talk aboutsupplements, but I'm verycurious.

Is there a place for supplementing loose scene and other branch chain aminoacids,specifically?

Youknow, I always assumed that supplementing with branch chain amino acids was kind of the unique domain ofpeople, youknow, postexercise, trying to build moremuscle, but as you're telling me allthis, it seems that adding loose scene in powder form to a meal seems like it would be great for musclehealth.

Is thattrue? I would say that we do not add loosenalone, because loose and iso-lucine and valine go hand inhand.

It would not be advisable to add a single aminoacid.

The amino acid levels are maintained in the blood by adding more of one would have effects on theother.

The way in which I would think about supplementing essential amino acids and or branch chains would be if an individual is choosing to have a lower proteinmeal.

I remember when I was inresidency, the food choices were not verygood, and maybe I had two ounces offish, which wasn't enough to bring me up to athreshold.

That would be a place that I would add in branch chain amino acids or essential aminoacids.

That would bring someone's amino acid thresholdup, but we have to understand everything that we're doing we should be doing with apurpose.

The idea of just sipping on branch chain amino acids or just adding amino acids would be the equivalent of putting a key into a car and trying to turn the car on but not having any additionalsubstrate.

So you need the full spectrum of all the amino acids to affect skeletal musclehealth.

I'm reassuring to hear because I love the taste of scrambled eggs and steaks and also like tuna and I also like chicken and I love all thosethings.

And I have to imagine that as you mentionedbefore, there are other things in these quality animal proteins like youmentioned,salineum, you mentioned other perhaps essential fatty acids and other vitamins that perhaps have something to do with what the animal ingested during its life that also benefitmuscle.

Is thattrue? It is and the big standout to me iscreatine.

We know that creatine at five grams of creatine will affect skeletalmuscle, but 12 grams of creatine affects brainhealth.

And there's a lot of interesting research coming out on creatine and brainhealth.

Can you remind me the rough amounts of creatine andsay, you mentioneda, let'sjust, Imean, I must say a four and a half out steak feels rather poultry tome.

Which is a huge meal tome.

Right. So let's say sixounce, let's begenerous.

So six ounce steak or four scrambledeggs.

Imean, how much creatine are wetalking?

Eggs don't have muchcreatine,right?

Notmuch. And I was just recently looking atthis, the amount of creatine and a pound of steak you're going to cringe is something like twograms.

So it's not verymuch. It's not verymuch.

But when we think about eating foods as in a foodmatrix, what you're saying is absolutely truethere.

It'sinteresting. We don't eat single nutrients while we think about dietary protein as a single nutrient and we think aboutcarbohydrates.

But what we really do is we eat mixedmeals.

And when we think about that the quality of the protein matters from a proteinperspective, could you get plant based proteins and animal based proteins and could it beequal?

Yes, itcould. So I want to be very clear to say and have a very balanced perspective that we could get all of our dietary protein from plants from plant basedsources.

A few caveats there is that that RDA that I gave you earlier is based only on high qualityproteins.

And that being the minimum to prevent adeficiency, if an individual was plantbased, they would require closer to 1.6 grams perkg, a higher amount of total protein if it's coming fromplants.

And that that becomes important tounderstand.

Speaking of an idealworld, if you had a magicwand, what would bethe...

My kids think Ido. I bet youdo.

What would be the amount of protein that you would have everybodyeat?

In terms of a number of grams per pound or kilogram ofprotein?

That's actually an easyquestion.

One gram per pound ideal bodyweight.

Total bodyweight. Not ideal body weightactually.

Where you want tobe. If an individual is 200 pounds but would prefer to be 150pounds, then I would have them eat towards their ideal bodyweight.

There is no evidence that a higher protein diet is detrimental to kidneyhealth, to bonehealth.

And we use these terms loosely like a high protein diet when we have to recognize that 0.8 grams per kg is a low proteindiet.

So where did the idea come from that if you eat say 1 gram of quality protein per pound of ideal body weight that you're going to getgout, you're going to have liverissues, you're going to have all sorts ofissues.

Where did that idea comefrom?

Frankly, I'm notsure. But the conversation around dietary protein has probably been the mostcontroversial.

What do you think thatis?

Imean, we're not trying to get politicallywrong.

I do have someideas, but I won't sharethem.

But I do feel as if nutrition is not justscience.

Nutrition is complicated because it's something that people tie emotionto.

They tie religionto. There's a lot that goes into dietary protein and food recommendations ingeneral.

But it sounds like we can safely say that if you eat 1 gram of protein per pound of ideal body weight that you're not going to cause liver damage or get gout or increase your risk ofcancer.

Right. My understanding is that even if it comes from redmeat, there's no increase in risk ofcancer.

Is thatright?Well, here's what I would say tothat.

I would say that this idea about red meat andcancer.

Numberone, we would have to even define what kind of cancers that we're talkingabout.

Many different types of cancers and there's many different causes is would be important to understand what risk factors are and a primary risk factor to many cancers isobesity.

The question then becomes how do we design a diet that mitigatesobesity?

The evidence is also very clear that a more protein-forward diet optimizes bodycomposition.

And you combine that with resistance training and you will see a tremendous amount ofchange.

I worked on some of these earlystudies.

And I'll share with you some of the early studies and this came out of Don Laman's lab with University ofIllinois.

Well, you and Lane Norton both workedthere.

Yes. Did you overlapthem?

Wedid. And while hewas.

What was helike?No, justcame.

So what does hesay? He sat in the back of the glass and I sat in thefront.

Okay. Allright. There you heardit.

Shotsfired. And all kidding side lane is a very he's like mybrother.

We've known each other for 20 someyears.

He's very popularguest.

Former guest on this podcast and a very spiritedguy.

And I just like to say I don't know why his skin looks thatgood,but.

Whatever. So I love youLane.

I've worked onyes, wedo.

I worked on some of these early studies and thiswas.

These studies were some of the first studies to come out about dietaryprotein, nutrition and resistancetraining.

Infact, to my knowledge and to I think the knowledge of many of mycolleagues, this was the firststudy.

And what it was it was a it was a 12 month study 130 overweight men andwomen.

So it wasrobust. And basically what they did is they had twogroups.

One group was a food guide pyramiddiet.

So it was 55 grams ofcarbohydrates.

A RDA ofprotein, which was point eight grams perKJ.

And30% fat30% fat was in bothgroups.

The second group was40%carbohydrates.

This is remember the zone diet 40 3030.

Yeah, I liked thatdiet.

Okay. Imean, there's Imean, I don't follow itanymore, but youknow, I tried it for a while and it worksright.

And there's some evidence to support that that is a great ratio for people coming off the low fat era of the late90s.

The zone diet felt like the best thing ever because it waslike,Oh, youknow, you can enjoy some fats and wow your satiety is improved and getstronger.

You just feel better when you're ingesting some ideally qualityfats.

That's myexperience. And also we know that it influences hormonalstatus.

You don't want to push fats toolow.

So the second group had a 40 30 30split.

So it was 40 grams of carbohydrates 30 grams of protein 30 grams or30%fat.

So these are allpercentages.

Yeah, 40 3040%now,right.

We didn't talk so much about thedistribution, but what is really important to understand is they wereisocloric.

So they both had the samecalories.

The difference was the percentage of where the calories came from and how they weregiven.

And there was actually four different arms tothis.

So there was individuals that exercise and individuals thatdidn't.

Okay, so either zone diet or let's call it I hate to saythis, but more standard American that's how it was designed standard American versus zonediet.

Yes. So it was designed thatway.

And then exercising or non exercising for for each of the for this 12 monthstudy.

And by theway, I had to pack a bunch ofmeals.

It was not pretty and I had to do youranalysis.

It wasterrible. Butanyway, this is besides thepoint.

So the first group had a protein distribution of 10 grams in the morning 15 at lunch and 45 atdinner.

And kind of standardAmerican.

So that is fordinner.Yeah, some cereal for breakfast with a little bit of milk and then for lunch like asandwich.

Exactly. And so this mirrors what peopledo.

The other group had 45 grams of protein at that firstmeal.

Six at five sixeggs. 35 grams of protein at lunch and 35 grams of protein chicken breast and salad at lunch with a little piece of toast and then atdinner.

Howmuch? It was it was 35grams.

Allright, piece of fish and some rice and avegetable.

But it was an evendistribution.

So what you're seeing here is now these meals are meeting a leucine threshold of muscle proteinsynthesis.

Now it's a hundred and this is a collectively 130 individuals and they were they wereolder.

I think that they were all in their 40s orbeyond.

If we just compare first the groups that did not exercise two differentdiets.

What did theysee? What did yousee?

You participated inthis?

Yes, Idid. Andunfortunately,no, Iwon't.

But what was so interesting is that thoseindividuals, everybody lostweight.

So the average weightloss.

Gosh, I wish I had betterhandwriting, but I'm adoctor.

And so it's prettybad. The average weight loss was24% greater in the high proteingroup.

So they lost24%. And you said it was isocloric between the twogroups.

That'sright. Was it sub-caloricoverall?

Itwas. That's a verysmart.

Yes, it was 500 calories less than what they needed to maintain bodyweight.

Correct. Gotit. So24% more weight losstotal.

Total. And the group that distributed their protein evenly in and followed the so-called zonediet.

When they lost more fat than the high carbohydrategroup.

So the high protein group lost a total of 16 pounds versus the calorie controlled group lost 11pounds.

Offat. Offat, which isgreat.

Everyone's at home thinking this iswonderful.

Isocloric.Isocloric.

But the thing here is the lean body masschange.

Soagain, this was done usingDexA.

And we know DexA only looks at lean bodymass.

You mentioned DexA earlier just verybriefly.

IsDexA? How does DexAwork?

Not at a mechanisticlevel.

What does it looklike? I go into the clinic in my floating inwater.

No, you canstand. I'm holding thepaddles.

But you might be because you're under acuba.

No,no,no,no. But you hold the paddles and you'restanding.

I'll say it's what'sit?

SoDexA, you just lay on depending on themachine.

You can just lay on this machine and it's a dual X tray and it measures bone fat and then lean bodymass.

That's a fiction for thisconversation.

Great. So the lean body massloss.

Andagain, this is everything other than bone and bodyfat.

So that was34% in which group in the standard American diet group versus26% in the high proteingroup.

Now where it getsfascinating.

So what the big takeaway is is understanding that protein had a sparingeffect.

Protein protectedmuscle.

Yes. More body fatloss.

Yes. At the same caloricamounts.

Yes. Same amount of deficit relative to bodyweight.

Right. In this group exercise was notintroduced.

So this was purely the food guide pyramid changing protein in the morning versus having it at two small meals and then having it atdinner.

And did they emphasize what we're calling high qualityprotein?

Wedid. That is also veryimportant.

Meat,fish,eggs,chicken,etc.

Yes. Theydid. So then this led to anotherstudy.

So then the second study was a two by twodesign.

And this is very sorry to interrupt in that previousstudy.

What was the effect of exercisebetween?

So we did not they didn't doexercise.

That was myfault. They did not doexercise.

They were just doing whatever it was that they weredoing.

But what was so important to understand was that this set the stage for this idea that protein had a sparingeffect.

And then followingthat.

The otherstudy. So then there was a series of a few otherstudies.

The second study looked at diet andexercise.

So this combinedeffect.

So this was one of the first studies and this was 48 women with a BMI of 33 46 yearsold.

So this is your post Perry postman appausal woman who was either in one of four treatmentgroups.

A low protein group low protein with exercise high protein high protein withexercise.

The low protein group was defined as the RDA point ingrams.

The high protein group was defined as 1.6grams.

KG. So starting to approach that one gram perpound.

It's about 0.7grams.Yes, it's starting to getthere.

But not quitethere. So this was a 16 weeks study and what they found overall was that the high protein group lost18% more body fat and25% less leanmass.

Overall, and12% more total bodyweight.

And so now we start moving into this synergistic effect of dietary protein and resistancetraining.

And it was the type of exercise that they performed their resistancetraining.

This is the goodnews. It didn't takemuch.

It was five days a week of walking 30 minutes and two days a week of resistance training with just bodyweight.

It was like yogaactivity.

So airsquats, downdogs, some warriorposes, maybe some handstandattempts.

Soyeah, no one is doingit.

Do you remember you doinghandstands?

I've been some yoga classes where I look to the sides of me and people are doing some pretty difficult things and branches and things likethat.

Definitely not me do not inviteme.

Life is better thisway.

I'm not going to thoseclasses.

But 16 weeks they did a high protein with protein and exercise thoseindividuals.

So now thestudy, the group that I justmentioned, this was dietary intervention alone withexercise, high protein plusexercise, very simpleexercise.

So if someone is listening to this and they'rethinking, what can I do to make very practical changes to massively impact my life outside of hormonereplacement, outside of any supersupplement, outside ofanything.

Dieting exercise has a dramaticeffect.

Those individuals that were doing 1.6 grams perkg, which is 0.7 grams per pound of body weight plus exercise lost46% more bodyweight.

That'ssubstantial.60% more fat and40% less fat free mass fromorgans,muscle, whatever thatis.

Compared to the low protein group plusexercise.

Was itsubchloric? Were theybelow, below maintenanceweight?

Itwas. So they're eating to ideal bodyweight, but still 500 calories or sobelow.

Their current caloric needs to maintain bodyweight.

Sothis, I've heard before that when we eatprotein, a certain amount of energy is required to metabolize thatprotein.

Can that be translated as the caloric load of protein is not what it appears tobe?

Let's say that 6-ouncesteak.

I'm making thisup, I'll probably get the numbers badlywrong.

But if it's 6 ounces of steak and maybe that'sa, let's just say of 450 calories or 500calories, does that mean that only 400 of those calories are actually quote unquoteutilized?

What you're talking about is a thermic effect offood, the thermic effect offeeding.

And that's the idea that certain macronutrients require a certain percentage of energy or the energy from those calories to beutilized.

Forfat, it's something like3% forcarbohydrates, maybe it's 5 to10% and then forprotein, it could be anywhere from 20to, I've seen even studies that are30%.

Iknow, but here is thething.

It's not that it's the energy that ittakes.

So if we were going to make itsimple, we'll say 100 calories from straightprotein.

The body would net 80 calories because20% of that energy is being used for what I would say is muscle proteinsynthesis.

It's not the handling ofnitrogen, it's none ofthat.

And there's variations in the literature and the variations come from how an individual dosesprotein.

So the dosing depending if you've hit that minimum 30grams, then you will see a more optimal utilization ofprotein.

And I think that that's where that number comesfrom.

It's actually the stimulation ofmuscle.

Because that is such an energetic process in and ofitself.

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Slightly tangentialquestion, but I think meaningful given the context of what we're talkingabout.

Why is it that if I eat a plate of scrambled eggs or a steak or chicken breast and somevegetables, I feel verysated.

And unless I did some hard resistancetraining, I'm kind of good withthat.

But that if I eat any of those same foods and one piece of a baguette or one fork full of pasta that then I want a lot more pasta and I want half the loaf ofbread.

Why isthat? Is it the blood glucoseresponse?

Is there something about carbohydrate at the level of themouth?

Imean, what isit? Youknow, a former guest on thispodcast,Dr.

DiegoBorkas, who studies gut brainsensing, explained to us and that this is separate from the microbiome that we have receptors all along the length of thediet.

We've got from our mouth out to the rectum that are sensing the amino acids and are looking for those essential aminoacids, but also sensing sugar and things like that and signaling to the brain about how much more we should eat of a given food or forage for a givenfood.

And I just have to say at a psychologicallevel, subjectivelevel, there's something so fundamentally different about eating protein and vegetables or protein fruits andvegetables.

And so it's a sense of starchy carbohydrates and when it adds starchy carbohydrates or starchy carbohydrates alone and it's like it's not a runawaytrain, but it's almost as if like it's never quite enough until there's a physical volume in the gut that it is like atthreshold.

And I don't think I'm alone inthis.

You look at the way people eatchips, you look at the way people eatpasta, you look at the way people eatrisotto.

And it's justdifferent.

Imean, there are a few freaks out there that probably two rib-eyesteaks, but for most people a rib-eye steak is likeenough, one rib-eye isenough.

What is going on there and feel free tospeculate, but is it amino acidsensing?

And because I think this is really important because I think as you'resuggesting, if Imay, that people prioritize protein from the first meal of the day and throughout theday, youknow, I think people areimagining,well,gosh, what happens to mypasta?

What happens to thebread?

What happens to all thesethings?

And youknow, they're perhaps overlooking the fact that eating protein vegetables and maybefruit, maybe a little bit of starch is just a completely different experience than eating starch alone or starch in largervolumes.

Now, I'm going to speculatehere, the foods that we have access to are highlypalatable.

Andpotentially, we weren't necessarily designed to have access to those kinds offoods.

And this kind of moves into this idea of something called the protein-leveragedhypothesis.

And the protein-leveraged hypothesis is that individuals will continue toeat.

And this is one way people explainobesity, is that individuals will eat to satisfy an amino acidneed.

Now, your original questionwas, when we eat carbohydrates orrisotto, there is a component of blood sugar regulation thathappens.

So as you go beyond that 50-gramthreshold, you tend to release moreinsulin.

So there's an insulin-genic effect of dietarycarbohydrates, which some people will experience as a lower bloodsugar.

We've all had that experience whereyou're, Imean, notall, but youknow, eating your kids macaroni and cheese and then you just can'tstop.

And then you probably feel verytired.

There's an ebb and flow of bloodsugar.

The interesting thing about dietary protein is you will hear peoplesay, I'm going to reduce my dietary protein because it's insulin-genic aswell.

So dietary protein does cause a phase one insulinrelease, and that's preformed insulin in thepancreas.

It is a component for muscle proteinsynthesis, but it is roughly20% of the insulinresponse, and the same amount ofcarbohydrates.

And when you eat a meal that is robust in dietaryprotein, your body will be able to then generate its ownglucose.

Roughly for every 100 grams ofprotein, your body will generate 60 grams of glucose over a period of time through the process calledgluconeogenesis.

And that is one of the benefits of a higher proteindiet.

You generate the glucose that youneed.

And can that be converted intoglycogen?

Yes. That is a goodquestion.

The process is veryslow.

So it's a much slower process than if you were to have your bread orrisotto.

So you told us about essential aminoacids.

Are there any essentialcarbohydrates?

No. There are essential fattyacids.

Yeah, thereare. And youknow, it'sinteresting.

We're talking aboutprotein.

And as I mentionedbefore, we simplified in the way that we talk about it is onething.

But it's 20 different aminoacids.

These amino acids each have unique metabolic roles in thebody.

It's notinterchangeable.

Forexample, the essential aminoacid, I will just pick a brainone,tryptophan, for serotoninproduction, or three inine for mucin production in thegut, which helps the gutlining, or take yourpick,phenylalanine.

All of these essential amino acids do various things in thebody.

For skeletalmuscle, the primary essential amino acid islosing.

And whileagain, it is very complex in the way that we would think about how do we eat enoughlysine?

Or how do we eat enoughmethionine?

It's not a great way to think about it because then things become verycomplex.

And someone islike,well, what do Ido?

But if you eat for the needs of skeletal musclehealth, everything else falls intoplace.

My mom is 79 yearsold. She's relativelylean.

By myread, I haven't seen her dexarresults, but she's probably had some muscularatrophy.

She doesyoga. Shewalks, shegardens, and seems to be in goodhealth.

Thankgoodness. My guess is she's lost to muscle in the lastdecades.

If she were to increase the amount ofprotein, quality protein that sheeats, especially in that first meal of theday, would the health of her muscle and her muscle masschange, even if she does no resistanceexercise?

Am I supposed to get a little bit of resistance training from theyoga?

But I haven't been to a yoga class with mymom.

You guys aren't doing headstands?

She'sactually, youknow, she's very mobile and very sharp and I'm very b唔係 theaicius.

But I don't think she's doing the more advanced inversion things atyoga.

So let's assume that she's doing some moderate exercisethree,three, four times aweek, but not training withweights.

If somebody like her or a younger male that has a similar pattern ofbehavior, youknow, desk worker for the mostpart, jogs a littlebit, gets onthe, on the recumbent bike or whatever itis.

But is not doing resistancetraining, increases their quality protein intake throughout theday.

And especially at that firstmeal, ensuring at least 30 and up to 50 grams ofintake, what changes are likely to happen even without resistanceexercise?

Well, the first thing is that if she is eating a sub amount ofprotein, let's say she's eating the RD ofprotein.

And the average woman eats around 68 grams of protein aday.

40% of women over the age of 60 are deficient inprotein.

They're eating below theRDA.

And what's happening to theirbody?

Is their body robbing their existing skeletal muscle of amino acids in order to supply what the brain and other organsneed?

Inpart, inpart, one of the things that happens with aging is thebody, the whole body protein turnover becomes lessefficient.

So the body is turning over roughly 300 grams of protein aday.

That's a lot ofturnover.

It is a lot ofturnover. 300 grams of protein ofturnover.

Yes. And muscle only accounts for maybe25% ofturnover.

And individual might eat an averagefemale.

Like your mom is eating probably around 68 grams of protein aday.

Yeah, if I'mlucky. She's not big on beef orchicken.

And listen to the eggs in a little bit of fish and lots of vegetables andfruits, but maintains again a like a healthy lean bodyweight.

And that iswonderful. So she's balancing her lower protein intake with physicalactivity.

Remember, there are two main ways to stimulate skeletalmuscle.

And that's through resistancetraining, which one would argue she is doing and or dietaryprotein.

But when we think about muscle proteinsynthesis, there's really fourinputs.

There's resistancetraining.

There'senergy. There's insulin growthhormones.

And then there's a loosescene.

When you areyounger, your body is driven by more of the anabolichormones, which is one reason why we believe that a younger individual can get away with five to 10 grams to 15 grams of dietaryprotein.

Because their levels oftestosterone, indoor estrogen are driving protein synthesis in a way that lets them offset any dietarydeficiencies.

Well, that their body is just highlyanabolic.

They'regrowing. They're growingup.

They'regrowing. When an individual like yourmom, who's now stoppedgrowing, the body becomes much more reliant on losing and resistancetraining.

The main pathway that these things go towards is something calledMTOR, mammalian target ofrapamycin.

The influence on those pathways changes as weage.

So the lever in which you pullchanges.

And the importance of that leverchanges.

So the best thing that your mom could do to maintain skeletalmuscle.

So why and what happens to skeletal muscle as weage?

Skeletalmuscle, if it is not contracted andutilized, gets this fatinfiltration, mitochondriachanges, protein turnoverchanges.

It becomes less efficient at sensing aminoacids.

There's a decrease in capillaryperfusion, which is why one reason why exercise is soimportant.

In order for her skeletal muscle to respond like a youngermuscle, what she should do is do some kind of resistance training and then add in some kind of dietaryprotein.

Because when we think about the proteinhierarchy, the amount of protein in a 24-hour period matters themost.

Proteinhierarchy,again, closer to one gram per pound ideal bodyweight.

The evidence would say 1.6 grams perkg.

I'll never forget when the ProDage study cameout.

I can't believe I've been out of fellowship thatlong.

But the ProDage study was a positionpaper.

And it talked about how the current recommendation for dietary protein is toolow.

And that to support healthyaging, you need 2.5 grams of loosein or roughly 30 grams of protein and an increase in total overall dietaryprotein.

And this was really the first positionstatement.

And that cameout,gosh, I think2010.

Yet we haven't changed any of the recommendations for the general populationyet.

So in order for your mom's muscle torespond, if you compound those 2things, then she will maintain withactivity, the health of her skeletalmuscle.

You mentioned somethingelse.

An individual shouldn't just loadprotein.

Loading extra protein and not moving is not a good idea because of proteins effect on MTOR throughout thebody.

So we talked aboutMTOR, which is mechanistic target of rapamysin in skeletalmuscle, in thebrain, in thepancreas.

This is a protein complex that you just don't want stimulated all daylong.

For sake of cancerrisk.

Yes. My understanding is that MTOR is very highly expressed in all cells of thebody, early in development and throughoutgrowth.

Infact, it's expressed in the cells I spent my career workingon, the retinalcells.

And then overtime, it dropsoff.

And it's remarkable how studies where MTOR is replaced into cells allows them to essentially look like and behave like young cellsagain, even replacing some regenerativecapacity.

This is the work of a guy named Shiganki at Harvard Children's Hospital at Harvard MedicalSchool.

But what one alwaysobserves, and we've done these experiments in mylab, is that when you increase MTOR by any number of differentways, molecular cannery and things likethat, that the cells growenormous.

And the concern is always that if you increaseMTOR, that you are going to bias any pre-existing tumors to proliferate aswell.

Is thatright? I think thatyes, itis.

And we have to recognize that MTOR stimulation is different in different parts of thebody, just as youmentioned.

And so skeletal muscle is uniquely sensitive tocontraction, and it's through this biochemical process called redone.

And when you contract skeletalmuscle, it inhibits redone, which then again there is this fast-for-relation of MTOR and muscle proteins and thishappens.

That is unique to skeletalmuscle.

And when individuals willsay, this will be a common discussion that you hear in the spacesthat,well, I don't want to increase my dietary protein because somehow that is going to causecancer.

And that is nottrue. That is a very myopic thoughtprocess.

That would be the same as saying resistancetraining, which also stimulatesMTOR, is going to causecancer.

I completely agree withyou.

I think it's interesting thatMTOR, which in mice is mammalian target ofrapamycin, that where rapamycinmight, youknow, prick up some people'sears.

There are some people outthere.

And by theway, I'm not recommendingthis.

That take rapamycin as a way to inhibit MTOR in hopes of extending theirlifespan.

There are some animal studies that supportthis.

There's growing interest inthis.

And so much so that some people are willing to takerapamycin.

By thatlogic, rapamycin would perhaps inhibit musclegrowth, musclehealth.

That's a whole otherdiscussion.

We'd have to get a TIA and a few MattKiberline, a few other folkshere.

And maybe we will with you to discussthat.

But the point being that I agree completely that we can't just say something that increases MTOR in muscle is also going to increasecancer.

These molecules like MTOR have distinct roles in distincttissues, at distinct time points throughout thelifespan.

And as youmentioned, ingesting quality protein can increase muscle protein synthesis by way ofMTOR.

Which istrue. Which istrue.

Which istrue. And I don't think anyone in the longevity space would suggest that resistance training is a badthing.

And yet we know it's increasingMTOR.

So there's a little bit of a contradiction in thatfield, just if one stands back from it andsays,well,wait, you want to take rapamycin to blockMTOR, but you also want to do a resistance training to stimulateMTOR.

Which one isit?Yeah. And we have to recognize that the efficiency of the stimulation declines as weage.

And the way that we overcome thatis,again, this idea of musclespan.

How do we continue to go through life and design a diet that we know will be more dependent on dietary protein and movement as weage?

Because the balance between the twochanges.

When you'reyoung, you could eat the twinkydiet, probably look at a weight andgrow.

Age is the greatequalizer.

And I trained ingeriatrics.

And I am telling you age is the greatequalizer.

And creating protocols and habits put into place to allow you to age well iseverything.

And there is so much confusion in the nutrition space that if we can pull back andrecognize,well, numberone, science is a evolvingfield.

And it's the science ofuncertainty.

But there are foundational principles that we can put intoplace.

And one of those foundational principles is skeletal musclehealth, muscle as the organ of longevity must besupported.

And there are very few ways in which we can dothat.

Youknow, when you think about the metabolic implications of skeletal muscle as glucose disposalunit, these diseases of aging really begin in skeletal muscle before you see any outward signs ofobesity, before you see any outward signs of anything that would indicate you areunhealthy.

It's kind of like osteoporosis as the silentdisease.

Skeletal muscle health is also thatway.

And infact, there's some very pivotal work out ofYale.

And they looked at young healthy collegestudents, youknow, as a collegestudent, you'll do anything for a couple ofbucks,right?

They paythem. And these individuals were sedentary and whatthey, but they werehealthy,lean, and what they saw was skeletal muscle insulin resistance just by beinginactive.

Can you imagine as you continue and how do we define in activitynow?

What isit, less than 5,000 steps per day perday?

Imean, multipleway, Imean, think aboutit.

We were designed as humans to be verymobile.

And so now we live in a world that what we think about as sedentary behavior as something innocuous and not a bigdeal.

It is a diseasestate. So I feel like you've made an excellent case for the ingestion of sufficient amounts of quality protein eachday, especially starting with that first meal of theday.

And just to underscore the suggestion that I heard it was aim for one gram of quality protein per pound of target bodyweight.

So somebody weighs 200 pounds and they'd like to weigh 180pounds, try and get 180 grams of quality protein per day divided up into meals that includes somewhere between 30 to 50 grams of protein permeal.

Yes. And that first and last meal are the mostimportant.

There's a lot of information going around that an even distribution has tohappen.

And partially this is my mentor'sfault.

He'lllaugh. This 30 grams of protein three times aday.

I'm sure you've heard aboutit.

Yeah, or that you can't assimilate more than 30 grams of protein permeal.

Let's let's let's fill intothat.

You assimilate all the protein that youinvest.

Even if it's a hundredgrams.

Correct. Even if it is a hundred grams skeletal muscle protein synthesis will max out probably at 55 gramsagain.

It's maybe it's 50 maybe it's55.

The rest isoxidized. You can only incorporate so many protein so muchprotein.

And the rest is then uses fuel oroxidized.

What if I do hard resistance training in the hours before a meal and then that meal includes a hundred grams of qualityproteins.

Let's say wayprotein. Do I put all of that hundred grams into muscle proteinsynthesis?

I would say I don't know if you put all hundredgrams, but I would guess that it would cap out at a certainnumber.

And really the totality of evidence would suggest it's probably around 55grams.

So regardless of whether or not somebody does resistancetraining, you can ingest about 50 grams of proteinagain, four calories per gram typically into muscle proteinsynthesis.

The rest isoxidized.Yes.

Maybe just touch on that process ofoxidation.

What that lookslike.Yeah, it's basically just utilizing thoseproteins.

It's utilizing them forenergy.

It's not storingthem. Whether it goes back for gluconeogenesis or wherever itgoes, it is thenoxidized.

And if that meal with let's say 50 grams of quality protein is combined with 50 grams ofcarbohydrate, they havefruit, someoatmeal,pasta,rice,etc.

Does that change the utilization of the protein atall?

I know I asked this questionearlier, but one could imagine that the body wants to use different fuel sourcesdifferently.

Is there any selective use of one micronutrient versus theother?

That's an excellentquestion.

Thebody, thatamount, it will be seen as a mixedmeal, but the body will always choose to get rid of glucosefirst.

Glucose dominates metabolism becauseagain, it can be toxic to thebody.

So it must beutilized. Now what is also very interesting is that now you're talking about the speed ofabsorption.

One of the things that we should mention is typically you need a substantial rise inlosing.

And that will beagain, that will probably take and last around two to two and a halfhours.

So when you have a mixedmeal, that slows down absorptiondigestion.

This is where the quality of the protein comes in that becomes very important because you have to reach a threshold in the blood to stimulatetissue.

And there was a very interestingstudy.

It's the first study of itskind.

And this came out of Luke Van Lund'slab.

And basically they looked at a vegan dietwith, I think it had 40 grams ofprotein.

And then it hada, a nervousdiet.

So it had both sources ofprotein.

And what they found was that the individuals that hadthe, the 40 gram meal that was a mixed meal with animal basedproteins, actually stimulated muscle proteinsynthesis.

Whereas the mixed meal of just the vegetables didnot.

Interesting. Even though it was plant based proteinshigh, youknow, enough protein in that meal and that likely might be because of the rate of absorption because of the fibercontent.

It becomes important to recognize that a higher protein mealseemed, especially with the quality of theprotein, that if you're picking the range between 30 and 50 depending on the mixed mealamount.

I would certainly go towards that higherend.

What is the case forfiber, either supplementing fiber or in mycase, I get fiber from fruits and vegetablesmainly.

Fiber is extremelyvaluable.

It's extremely valuable for the gutmicrobiome.

It's extremely valuable forsatiation.

Fiber, if I were to design adiet, the first thing that I would pick would be dietaryprotein.

Then I would think about how I'm going to parse out the rest of the carbohydrates because you earn carbohydrates throughexercise.

I usually chooseberries, high fiber sources ofberries.

And thenwhatever. Soblueberries,strawberries,blackberries.

I'm a big fan ofberries.

I'm like a grizzly bear when it comes toberries.

I'm a drive by blueberryeater.

When they'rethere, I can't help but swipe them off the bowl or theplate.

But there was something else that you mentioned that I wanted tohighlight.

And this was if I did resistancetraining, then could I eat 100 grams of protein and then 100 grams ofcarbohydrates.

The amazing part about exercise is what we really care about is glucose disposal and insulinsensitivity.

This idea of insulin resistance is killing ourworld.

Young peopletoo.Yes.Yes.

We've seen double to triple the rates of childhoodobesity.

That'swild. I don't think people younger than 25 recognizeit.

Like when I was growing up inschool, we there was junkfood.

Lord knows there was junkfood.

There was also good food and different kids from differenthomes, a different amounts of junkfood.

But it was the rare individual in school who wasoverweight, it wasobese.

And you had some kids that seemed to be just kind of like born lean and with moremuscle, you had said we're thinner with lessmuscle,less.

But it was very rare that there was an obesekid.

You just didn't see itmuch.

And I don't recall there being a lot of restrictive eating or even discussion aboutnutrition.

And people were eatingcereals, people were eating candybars.

They were also eating eggs and sandwiches and chicken dinners and all sorts ofstuff.

So what'shappened? Like really what's happened because something is fundamentallydifferent.

We had PE class that wasrequired.

We had torun. We had to playvolleyball.

We had to do thosethings.

But it's not like we were allathletes.

And we'd walk toclass. Iskateboard.

I played somesoccer, but I wasn't an athlete persay.

So like what in the world is goingon?

I will say that also two thirds of Americans are either overweight orobese.

It'swild. Imean, I get one has to have been born in the 70s as Iwas.

Or early 80s to really appreciate this tremendous shift in like what yousee.

And sure people are on phones more moresedentary.

It's got to be a combination ofthings.

Butthey're. It'scultural.

We have a disease on inactivity and sedentary behavior that is frankly killing ourpopulation.

Almost50% of people ofhypertension.

We have a what 40 million people onstatins.

I'm sure that number haschanged.

And skeletal muscle ismedicine.

Skeletal muscle again helps with triglycerides helps with insulin glucosedisposal.

So where this came from you just mentioned if Iexercise, then can I eat whatever you'reeating?

Yes. But we're not talking about beingirresponsible, but skeletal muscle now has sensitized within20.

Youknow, there's a 24 hour period 72 hour period where that muscle is stillsensitized.

Meaning it consumes morenutrients.

It consumes morenutrients.

But also when you think about insulinresistance, insulin moves glucose out of the blood stream intocells.

And through themuscle, there's the insulin dependent pathway through obviouslyinsulin.

And that's whatever PI 3K if you care if anyonecares.

And then there is insulinindependent, which is throughexercise.

And how glucose moves from the blood stream into the cells is through glute 4receptors.

When youexercise, you increase the density of glute 4 receptors to the surface just by doingactivity.

It doesn't requireinsulin.

You are able to then move glucose out of the blood stream intocells.

Andagain, insulin resistance is at the heart of so many of the problems that we'reseeing.

I think that mostpeople, including the public health officials in charge understandthat, the points that you justmade.

Imean, clearly one doesn't have to even have a degree in medicine or science of any sort to look around andsay,okay, there are a lot of people suffering fromobesity.

And we are hearing more and more about the negative effects on brain on other aspects of mental health and physical health and the interrelatedness of mental health andobesity.

Dr. Chris Palmer from MedicalSchool.

Yeah, wonderfulperson, former guest on thispodcast, very popularepisode.

Imean, it's really been championing thisissue.

As a few folks at Stanford andelsewhere, this new field of so-called metabolicpsychiatry, the link between brainhealth, mental health and metabolichealth.

But putting all thataside, do you think that most public health officials understand that muscle contraction increases glute 4 expression at the levelmuscle, which then grabs more nutrients from the bloodstream, which then lends itself to all sorts of positive health benefits and diverts from these negative healthbenefits?

Imean, why isn't that on everybillboard?

Imean, it's such a simple concept inprinciple.

Like, why aren't we hearingthis?

Do they even require PE in schoolanymore?

No, I am notsure, but this is aproblem.

I don'tknow, but I would say if two-thirds of our population is either overweight orobese, the health officials may fall into that category or at least two-thirds of thempotentially.

Yeah, and I'm not blamingthem.

I'm justwondering, Imean, I don'tthink,well, I don't think we hear this message enough that muscle contraction ismedicine.

We've heard that fromDr.

CaseyMeans. We're hearing about it fromyou, that muscle and muscle health inparticular.

Andagain, I'm so grateful that we're talking about muscle health and muscle quality and muscle as a tissue that utilizes nutrients and can divert things towards health and away from disease as opposed to just musclesize, because I think most people hear muscle and they think eat for muscle and they just think musclesize.

Andfrankly, most people don't want increased musclesize.

But if you train forhypertrophy, which is musclesize, very difficult toget, especially as youage, by theway, it becomes much moredifficult.

But you will also get strength and power if an individualstruggles, youknow, if theyfall, they break ahead, they have to be able to get off off thefloor.

You have to be able to travel on an airplane and put your stuff overhead or pick up yourtoddler, a mine weighs 40pounds.

Or godownstairs, whatDr.

Peter Atias has really been emphasizing that a lot of life-endinginjuries, life-ending injuries occur by virtue of people failing to do the eccentric movements of that are essentially look like goingdown, stepping down offsomething.

I've had to have this discussion with both myparents.

It was a little bituncomfortable,frankly, because no one wants to betold,hey,listen, hear the things that can potentially killyou.

Don't worry so much about goingupstairs.

Make sure you hold therailing.

Both of my parents being able to bodythem.

I'm grateful again forthat.

But be careful as you walkdownstairs.

Imean, one fracture at age79,80, the age of myparents.

I think I'm going to get these numbers a bitwrong.

I'msure, but I think Peter mentions that that leads to death in a large percentage of people that break that hip or break that leg or break that wristeven.

Yes. And the other thingthat...

Not because of the breakitself, but because the inactivity thatresults.

And that's absolutelyright.

The skeletal muscle inactivity causes a derangement ofmetabolism.

The derangement of metabolism will then go on to get fatty acidinfiltration, fatty acids that infiltrate into skeletalmuscle.

Once thathappens, you now have a decreasedflux.

You're not moving muscleglycogen.

You're not getting rid of these ceramides or these diacyl glycerols that build up that potentially lead to an compound insulinresistance, skeletal muscle insulinresistance.

You then generate a low grade inflammation that is constantly goingon.

If40% of your body weight is skeletalmuscle, and you are not maintaining the health of skeletalmuscle, you are walking around with an inflammatory bag onyou.

This decline inaging, people think that we go through a linear decline inaging.

Wedon't. We go through a series of cataboliccrises.

And a catabolic crises would be something like someonefalls, breaks ahip, and never regains fullfunctioning.

Or someone getspneumonia, is on a bedrest for five days or a period oftime.

This compounds uponitself, these catabolic crises compound uponthemselves, and individuals never return to fullfunction.

The thing that becomes interesting and very important is that when you maintain the health of skeletalmuscle, low muscle mass would be early indication ofosteoporosis.

Bone attaches tomuscle.

Muscle pullsbone, creates aload, a stimulation that is required for abuilding.

Imean, imagine the astronauts or an individualwho,again, is onbedrest.

When you are training and you are putting force and load on yourbody, then you are able to maintain the entirety of the architecture of thebody.

And this all makes usefulsense.

But it is underappreciated as an organsystem.

And the other thing about skeletal muscle and depression and mood is that skeletal muscle andinflammation, as you contracted the duration and intensity of contraction releasesmyocins.

Somyocins, have you heard ofmyocins?

Ihave, but please educateus.

So myocins are peptidehormones,again, skeletal muscles and endocrineorgan, that travel throughout thebody.

The most famous one is interleukinsix.

You have interleukin15, interleukinsix.

These affect lightpolicies.

They affect the utilization ofglucose.

There is this idea of training in a low glycogen state that might increase a more robust amounts of theseinterleukins.

Is thatright? Thesemyocins, whichis, because I love training fast andlearning.

Which isinteresting. And we always think about exercise as this way to improvemetabolism.

It doesn't so much do that atrest, but what it does is when youexercise, youimprove,again, glucoseutilization, but also you release thesemyocins.

It's not just the physicalactivity, but it's also the subsequent effects and the subsequent molecules that skeletal musclereleases.

I just want to say realizing I'm interrupting to amen tothat.

So often people look at how many calories were burned in a given bout of resistancetraining.

And while that is perhapsinteresting, the wavefront of other endocrine and molecular factors that set in motion by proper resistance training to me is the most interesting and importantaspect.

And I'm just wondering in the hoursafterwards, sure you're going to continue to burn calories at an elevatedrate, but it's all the effects of thehormones.

And as you're pointing out the interleukins that last hours and hours and evendays, that leads to my mind or my read of literature are the mostinteresting.

And actually the science has relativelynew.

It came out of petersonlab, bento peterson and Copenhagen extraordinarywork.

She's in she is in part in immunologists and exercisephysiologists.

When you train and you release thesemyocins, they which are based on the intensity and duration of your activity release something called capsepsin, be anirisin.

These myocins then stimulate BDNF release in the brain brain to have aneutral.

Exactly, which is a component ofneurogenesis.

When we think about the plethora of activity of what skeletal muscledoes, it is no surprise that numberone, it's free tomove.

Can I just mention something aboutBDNF, if Imay, it's been much of my earlier career working on neuroplasticity brain development and BDNF brain derived neutrophic factor gets mentioned from time totime.

And as youmentioned, it's involved in different neurogenesispathways.

But I think one of its most interesting effects is its role in consolidating existingconnections, what we call synaptic connections in thebrain.

And I'm so glad you mentioned this because what you're effectively saying is that doing resistance training properly sets in motion a molecular cascade that feeds back to a molecular cascade within the brain that reinforces the neural circuits thatexist.

And one of the hallmarks of aging is essentially a degradation of neuralcircuitry, sometimes in extreme cases like Alzheimer's or other forms ofdementia,Parkinson's, etcetera.

But we know that the volume of gray matter of neurons within the brain declines withage, we know that the neural circuitrysuffers, the speed of normal transmissionsuffers.

And it's long beenobserved, but only now objectively substantiated that exercise can not justmaintain, but even improve brain function overtime.

And so thank you for allowing me to kind of expand on what you justsaid.

I just think that if ever there was a potent medicine for improving brainhealth, itsexercise.

And inparticular, resistanceexercise, I think the case for cardiovascular exercises probably that it maintains the components of blood flow that are also critical for theblood.

Yes, and certainly no one is arguing the importance of cardiovascular activity and VO2max.

We can appreciate that on the flip side of that skeletal muscle has not had its momentyet.

And in particular resistancetraining, you're not going to be able to be effective at maintaining a VO2 max if you do not have healthy skeletalmuscle.

You are not going to be able to be effective at nearly doing anything or surviving any kind ofillness, the higher the amount of skeletal muscle mass youhave, the healthy skeletal musclemass, the greater your survivability against nearly any kind ofdisease.

Remarkable forexample,cancer,Kekexia, which is the way scene that comes with cancer kills20% ofindividuals.

Survivability comes from the health of skeletalmuscle.

Also on that samenote, contracting skeletalmuscle, releasingmyocines, interfaces with cells of the immunesystem.

We've all heard of macrophages and the cytokinestorm, interleukin15,TNF, TNF alpha as beingpro-inflammatory.

When themyocines, which are also interleukin six and interleukin15, are released from skeletalmuscle, they interplay and they somewhat dampen the inflammatory effect and have a different effect on the entirety of thesystem.

When thesequote, cytokines come from skeletalmuscle.

Incredible. So as long as we are now on the topic ofexercise, let's make it concrete forpeople.

We talked earlier about nutrition and specific gram amounts and calorie amounts and distribution and that's justwonderful.

And thanks also for explaining the mechanism and the incentive for doingthis.

Let's talk about resistancetraining.

Let's do this in a slightly different way than we didearlier.

What is your program for resistancetraining?

And then we'll talk about what other people might consider forthem.

Maybe the samething. So if you could just actually walk us through yourweek, what does it looklike?

It could beSunday,Monday,Tuesday,etc.

Or it could be how many days a week do you resistancetrain?

Ofcourse. I don't do any kind oftraining.

I know based on yourInstagram, what you do and now we knowwhy.

So I have a wonderfultrainer, Carlos Manna shout out to him everyMonday.

I decide I don't want totrain.

And I know that of course you don't enjoyit.

Ido, but it's usuallysuffering, at leastMonday.

Everymorning, I know Monday morning is going to come up and I'm going to think about all the ways in which I can get out ofit.

I never get out ofit. I always showup.

I train consistently three days a week and I train I train pretty heavy for mysize.

So I'm maybe 110pounds.

What I do is I do some kind ofpush,pull, hand squat on all three of thosedays.

Ido. So you train your whole body three days a week separated by a day inbetween.

Ido. I do because essentially I'm working hard enough where I'm prettyexhausted.

So I came here and you asked me if I trained thismorning,Friday, I'm offtoday.

Okay. But what I do is when Istart, I thinkabout,well, actually Carlos thinks aboutthis, but I'll do some kind of sledpush.

Sledpush. It will beloaded.

It will be prettyheavy.

It gets my full body moving and then we'll pick some kind of compoundmovements, whether it's a multi jointmovement.

That's exactlyright. A multi joint movement through full range ofmotion.

So forinstance, squat or adeadlift.

That'sright. If somebody isn't skilled in squats or deadlifts, could they maybe hold on to a kettlebell of appropriate weight for them and do like a kettlebellsquat?

I'm going to give them an even bettersolution.

And this is this concept that I learned from a PhD named PatDavidson.

And he talks a lot about high ground low ground movements and a high ground movement would be something where you havecontact, contact like a hacksquat.

Soground, you have backsupport, legsupport, you are able to move in a way that fully contracts the muscle that you are focusedon.

We see a lot of people that go to the gym and kind of just dowhatever.

And that might be okay tomaintain, but the goal should always be alady.

You're not going to getbulky.

Should behypertrophy, which is hard toachieve.

It is hard toachieve, but you must focus because maintaining and growing skeletal muscle mass as youage, it becomes much morechallenging.

And so choosing high groundmovements, I would not have someone who is an unskilledlifter, go in and do a front loaded gobletsquat.

Or free weight squat ordeadlift,right?

Iwouldn't. I would have them do high groundmovements.

And this is where machines arereally, reallywonderful.

People kind of willsay,well, but you have to train for functional movement andfunctional.

Well, what isthat? We're training forlife.

You're training for lifedurability.

And if Imay, youknow, anytime peoplesay, youknow, what's the best form ofexercise?

How do you workout? I would say rule numberone, definitelytrain, but don't get hurt or avoid gettinghurt.

Imean, the moment somebody approaches exercise and getshurt, they're introuble.

One of the best ways to get in shape for your entire life is to avoid gettinginjured.

Or train your entirelife.

If there are parentslistening, thinking about yourkids, there was a whole push where kids shouldn't do resistance training and shouldn't moveload.

I look at mykids, they might not be doing one repmaxes, but they're picking upkettlebells.

Theyhave.Oh,yeah.Yeah, I was told growing up to not touch the weights until I was at least 18 at16.

I starteddoing, youknow, pullups, pushups, situps.

And then pretty quickly moved into all the leg press legextension, youknow, all that stuff couldn't helpmyself.

But I would argue that outside normalplay, someone is never too young to start and frankly never tooold.

And body weight resistanceis, in manycases,sufficient.

Right? Imean, as akid, I would do atnight, I would do sit ups and handstand push ups against mydoor.

Youknow, I couldn't do a proper handstand onassisted, but I'd flip over and then do the handstand push ups until my mom would yell at me about the marks on thedoor.

But youknow,that's, that's was pretty tough right getting 10repetitions.

That was prettytough. But you're saying resistance training what you said highground.

High groundcontact. Highcontact.

So when you are choosing motions that an individual is unskilled todo, I think let's framethis.

And the thing is that most people think about exercise for optimization andperformance.

But if we take that back a notch and youknow, I think about my audience and they are individuals thatare.

Aside from the special operators and aside from theCEOs, they are 40 year old women that arelike,hey, all of a sudden I noticed that my body composition haschanged.

An amazingPhD, her name is Victoria Fleckar and she has helped me bring into these pieces of how do we design and think about training protocols and training programs for the more matureindividual.

And when you think about these high groundmovements, if someone has not trained and they'rethinking,well, I don't want tofall.

So I'm going to do boxjumps.

That plyometricmovement, there's a high probability ofinjury.

Yeah, I don't like boxjumps.

I don't like them because I the eccentric loading that youknow, and being a lost soreness and it just takes a lot of them to generate what I'msaying.

So you just so that is exactly the point is an individual going to be able to generate enough force to make itmeaningful.

And if someone wouldargue,yes,well, forthem, that wouldbe, youknow, when I was a practicing Jerry Trishon and I was going through myfellowship, we didthe, the number of metrics to look atstrength.

And one of those was a sit in stand out of achair.

So sit to stand and that would have for some people have been considered a high intensityinterval.

And itbecomes, is that enough to mount a response overtime?

And I wouldargue,no, what do people need todo?

And that is when you train forhypertrophy, which is musclegrowth.

And let's say that is five to 10reps,three, youknow, four to fivesets, youpick, there's many different ways that the final repetitions arechallenging.

And the load is enough and there's wonderful data out of McMaster University that it doesn't have to be heavy weight as long as the stimulus isenough.

And then we take it back to what is the stimulus and thestimulus, the goal shouldbe, are you moving the muscles that you are supposed to be doing and are you generating enough activity to create adaptation andchange.

And so a high ground movement for someone who's listening to this and isthinking, I need skeletal musclehealth.

Iwalk, walking iswonderful, but is walking enough to maintain those type twofibers.

It'snot. You will see a transition and we've all seen our agingparents.

Imean, my dad is in hisseventies.

He's veryfit, but he used to be a collegiatewrestler.

And he was a captain of his wrestlingteam.

Dad, you're a lotsmaller.

And part of the reason is thefail, the failure to focus on hypertrophy and those are those type twofibers, those type two fibers that transition with age to more type onefibers, those long leanfibers, you go from bigger to bulky toless.

Choosing activities to maintain thosefibers, also these fibers arebigger, this work glucose disposalgoes.

Choosing things like legextension, it's not a badthing.

If you get stronger and you have strongermuscles, then you will have morepower.

You'll be able to generate moreforce.

You will be much less likely tofall.

And you'll be healthier overall because of musclehealth.

So maybe we could just list off some of the movements that people could think about in terms of these high groundmovements.

You mentioned hacksquats.

Leg presses come tomind.

Leg extension legcurls, legcurls, lat pull downs with a supportedback.

Any kind of rose rose supportedrow.

Again, these are mostly machine exercises thatyou're.

Theyare, which is a newwall.

So cables would be considered low ground because you're kind of inspace.

And if you think aboutit, what takes someone out in their40s, what takes someone out of thegame.

It's a tendoninjury. Tendonapathes, whether it's ashoulder, whether it's ahamstring, whether it's ahip.

And part of the reason is there's muscularstrength.

We focus on muscularstrength, but there's also tendonstrength, which takestime.

And when you get tendonapathes, you get the thickening of thesetissues, youknow, people will say that tendon lays down muchslower, that the collagen turnover is muchslower, but actually muscle turns over 1 to2% perday.

Tendons turn over maybe 0.5 to1.5% perday.

It's not that substantiallyslower.

These it's highly activetissue.

You need bloodflow. You have to treat your body with respect that if you think you can always train the way that you did when you were younger and just hit those heavyweights.

If you get injured and you are not allowing your tendons to keepup, then overall injury overtime.

Again, this is what we would call maybe not a cat aboutcrises, butclose.

What is the total duration of a resistance training workout that the typical person coulduse?

I make it a point to try and warm up over the course of about 10 to 15 minutes and then do 50 to 60 minutes of hardwork.

But I always leave some gas in thetank.

It's therare, I would say5% of my total resistance trainingworkouts.

And I also train three times aweek, although I divide my body up into differentsplits.

That's mycase. And I run a fewdays.

Well, you run much larger thanme.

Well, it's it's it's the case now that I try and hit each muscle group directly once per week and then indirectly another day perweek.

So if legs are onMonday, that's direct and then but the indirect like training is actually the hit workout on Friday sprinting as I lovethat.

That'swonderful. I think that the three days per week whole bodyworkout, I think would work for a lot of people just to take the complexity out ofit.

So is it the case that the entire workout could be constrained to 45 to 60minutes?

Absolutely. And for a newlifter, they're going to get the mostgains.

What we find is that an if an individual is what we would consider abeginner, you willsee, youknow, after they go through aneural, a neurological adaptation is that they will get more growth and potentially progress new lifter could progressweekly.

And so as a more advancedlifter, I would say we would be considered moreadvanced.

We've been lifting our whole lives that for us to makechanges.

It's it's much more challenging for us to put on size or even getstronger.

Imean,yes, there is a particularcadence, but our improvements might beminute.

So we're thinking about designing aprogram, the current recommendations for physicalactivity, which by theway, youknow, 75 roughly70, maybe it's78% of individuals do not meet physical activityguidelines.

And what are thoseagain, 5,000 steps perday, 150 minutes of moderate to vigorous activity with two days a week of resistance training perweek.

Yeah. So 150 minutestotal.

And two days a week ofresistance.

So that is what there are 30 minutes 70s a week ofactivity.

Just to put that intoperspective, that is how sedentary weare.

50% of Americans are not eventraining.

Is that true in other countries aswell?

Well, I don't know the statistics in othercountries, but far andaway, we have arguably the biggest health crisis with ourpopulation.

People always point to the bluezones.

Theysay,well, in the bluezones, they have like a shot of vodka every night and they're socially connected and they have a Mediterranean diet and they're not liftingweights.

But is it the case that they are pilingwood?

Are they walkingmore? Are they carryingactive?

They're carryingactive.

Highlyactive. And the blue zones are a funny thing because youknow, some willsay,well, are the records kept appropriately andetc.

There is a lotthough, despitethat, that we can learn from the bluezones.

And I thinkagain, theconnection,social,socialization, but alsomovement.

Youknow, part of the reason why we are requiring this higher protein load is because we are physically lessactive.

Again, there's only two main ways to stimulate skeletalmuscle, resistance training and dietaryprotein.

Arguably, the resistance trainingpiece, the physical activity piece is moreinfluential.

Is much more impactful to full body homeostasis than diet will everbe.

If you just eat protein and don'texercise, you will likely still losemuscle.

Interesting. My observation of family friends that include people who are very fit into their 80s and 90s and even beyond in a few cases arethat.

Andhere, these are generalizations based on observation I want to be clear that the people I know who are still skiing in their80s.

Who are sprinting in their80s.

Youknow, not as fast as they usedto.

Who are still playing tennis in their80s.

So what I'm referring to here are people that are playingsports, that involve dynamicmovement, that involve a lot of coordination and no doubt someresistance.

At least of some sort like skiingis, youknow, there's some resistance involved depending on the complexity of theslope.

Yeah, andtree. So what do you think is going onthere?

Imean, there's a rich literature to support the fact that most of our brain volume is there to support vision andmovement.

And that when we moveless, there's brainatrophy.

John Radi at Harvard talked a lot aboutthis, even some species of animals that will spend part of their life swimming around and then they'll nest on a rock and then the brain will actually eatitself.

And then we'll do the lack ofmovement.

We'll just metabolize portions ofitself.

So the relationship between movement and brain healthseems, seemsobvious.

But,yeah, how many folks do you see out there in their60s,70s, 80s and 90s that are now doing resistancetraining?

Do we know thepercentages?

Idon't. And I was just recently looking at the ACSMguidelines, which is the American College of SportsMedicine, for activity and olderindividuals.

I am not sure the percentage of individuals that are actually doing resistancetraining.

Butpartially, I'd have to believe that it'sless.

Soagain, I trained as a geriatrician and one of the things that we alwayssaw, not foreverybody, but for the majority ofpeople, is it wasn't the duration of thetraining.

If they wereactive, they were stillactive.

It was the intensity that they were able tomount.

And sobecause, youknow, there's this interesting thingis, as weage,well, Imean, some of us are less intense in ourtraining.

And it's the actual intensitypiece.

And that seems to go down that when this can beaddressed, and what do I mean byintensity?

There's a million ways in which I suppose one could defineintensity.

But it is pushing themselvesagain.

Are we going tosay, is it how manyreps, howheavy.

But the focus in the intensity of the training goesdown.

This we could define intensity somewhatloosely, but still fairly bysaying, youknow, repetitions inthe,well, youknow, five to10, maybe 12 repetition range where the final two or three repetitions are challenging in goodform.

Maybe even to failure in goodform.

Is that seem likefair?Yeah.

And I would think of the intensitycomponent.

Because the agingliterature, it really doesn't seem to matter if people are lifting heavierlight.

I used to believe that in order to maintain skeletal musclemass, especially as hormonal statuschanges, decrease intestosterone, decrease inestrogen, decrease inprogesterone.

That the heaviness of the load has toincrease.

Ican't, the data doesn't necessarily support that I would love for that to be the case surprising tome.

I wouldthink, I think people would have to push themselves with not extremely heavyloads, but moderately heavy forthem.

So it was surprising to me aswell.

And especially when we worked on some of those earlier studies in layman'slab, there's this change in body composition that seems to happenmidlife.

And increase in visceral body fat or central out ofposity.

And one would think that you require a lot of extrasupplements, etcetera, to influencethat.

But when training and nutrition are accounted for in a very controlledway, body composition changes to thepositive.

You can lose body fat and increase musclemass.

It'll be very interesting to see as the literature around hormone replacement continues toevolve, especially as it relates towomen, because we know that testosterone improves skeletal musclemass.

But that isn't going to be enough if you don't have thefoundation, the foundation inplace.

And I think that the other big concern is how we're measuring skeletal musclemass.

We mentioned a little bit aboutDEXA.

The more effective way is reallyMRI, which doesn't seem to be achievable for manypeople.

It's expensive and CT would be the other way to actually look at musclequality.

Muscle quality right now is defined purely on functional movementmeasurements.

But that's clearly not it when we define if you look in theliterature, muscle quality is really about the load and the weight and theperformance, not about the architecture and the infrastructure of the skeletalmuscle.

And the reason I saythis, let me take a stepback, is that in the literature and you will often hear people say that only strength matter size doesn'tmatter.

I don't believe that to betrue.

I believe that we haven't been able to test muscle sizeappropriately.

And when we begin to testit, there's a way in this is I think this is beingdone.

It came from a gentleman namedDr.

William Evans and he utilizes something called a D3creatine.

And it's a deuterated tagged creatine and an individual ingest apill.

Creatine is largely in skeletalmuscle.

There may be a small amount inbrain, but for the majority of skeletal muscle is that's where creatinegoes.

And so this is a directway.

First timeever, it's beenvalidated.

I think it started its utilization and maybe2019.

But when individuals are directly measuring skeletal musclemass, they find that skeletal muscle mass and strength are bothimportant.

Interesting. So is there a synergistic effect of ingesting quality protein in sufficient amounts distributed throughout theday.

And as youmentioned, especially at the first and last meal of the day and resistance training exercise on muscle health and other metrics of longevity and current healthstatus.

This is a bit of a nuancedanswer.

If you are young and you are eating close to one gram per pound ideal bodyweight, then any time that you ingest your protein would beadequate.

However, if you're older and you want to take advantage of resistance training plus dietaryprotein, then consuming within an hour orso.

Andagain, that number is the way in which I think about it is really about that blood flow is how long that blood flow is still getting to the skeletal muscle because you're deliveringnutrients.

If you are older or have a chroniccondition, then there would be nodownside.

And there is evidence in the literature if you consume dietary protein around resistance training due to that synergisticeffect.

If you are eating a lower protein diet and orolder.

So would it be actionable to try and drink away protein drink within an hour of resistance training or eating a meal that include chickenbraster, some eggs orsteak.

Is that basically what we're talkingabout?

Itis. If you are eating a lower proteindiet, I would take advantage of that because you increase theefficiency.

You lower that anabolic resistanceload.

Yes, one could dothat. And I say this in a way that if you are young and healthy and you aretraining, I don't really care when you ingest yourprotein.

But if you are a group or in a group of individuals that potentially is atrisk, then doing resistance training and adding in dietaryprotein, I would say a shake is a great way to go because the absorption isquicker.

The meal will have a slowerabsorption.

Andagain, we need to get those amino acids into the bloodstream at a certain level at a certaintime.

What about cardiovasculartraining, VO2max?

I make it a point to try and do a long hike or jog once a week for me that 60 to 90minutes.

I'm not obsessive about it in the sense that sometimes I'll go out and I make it social with a weight vest or just walk orhike.

Sometimes I'll jog on myown.

One shorter run of 30 minutes or so in the middle of the week at a faster clip and then one high intensity interval training session that lasts about 12 minutes and total and thank goodness it's only that I'm basically sucking for air at theend.

That's it for me plus a bunch of walking if I can I try to walk as much as possible throughout theday.

I don't even consider thatexercise.

I just consider thatmove.

That'swonderful. Now you're talking about non exerciseactivity.

That is extremelyvaluable.

I try to pace while I take phone calls and things of that sort as much movement aspossible.

What is the value of getting the heart rate elevated for some period of timelonger, youknow, longer than a fewminutes.

Yeah, Imean, when you're talking about increasing VO2max, I think that there's a multitude of ways to doit.

One could do slow steady stateactivity, but I will say as individualsage, that becomes more challenging onjoints.

We are thinking about how are we able to maintain our physicality throughoutlife.

If you have got a ton of time and you can do slow steadystate, it'swonderful.

Alternatively, there's a lot of evidence that high intensity intervaltraining.

Martin Gabala would be a wonderfulguest.

He is really the expert in high intensity interval training and its changes in insulin sensitivity influence on VO2max.

And this is really going all out in a matter of 20seconds.

There's modern intensity intervaltraining, high intensity intervaltraining, sprint intervaltraining.

That will increase VO2 max in a substantially less amount of time and could be safer for anindividual.

The other way is improving skeletal musclemass.

If you improve strength andhypertrophy, you will improve your VO2max, albeit not exactly in the sameway, but both are beneficial and both will improve VO2 max and blood pressure and triglycerides and clinical outcomes that we careabout.

It's wonderful to think about things kind of nebulously and then it all comes back to what do we care about as weage?

We care about having an appropriate bloodpressure.

Let's call it 120 over80.

We care about having a triglyceride level of 100 orless,lower.

We care about maintaining fasting insulinlevels, fasting glucoselevels, anywhere the cutoff they will say is between 70 to100.

These are clinical outcomes that we careabout.

And that is what we ultimatelywant.

However, the influence is to pull those levels to get there can bevaried.

It ultimately comes with how are we going to do it and how is it going to be something that wemaintain?

There are certain aspects about dietary protein that areinteresting.

One of the things that I've seen clinically is that those individuals that are on our higher protein diet will seem to have higher bloodglucose.

I don't know exactly why thisis.

It's thought that maybe because the red blood cells livelonger.

Maybe also higher blood creatininelevels.

We do see higher blood creatinine levels when individuals have higher musclemass.

That is typically a call that Iget.

Many of my patients are large and buff as I wouldsay.

And they almost all have higher levels ofcreatinine.

That doesn't mean that your kidney function issuffering.

One thing that one would do clinically would get a cystatincy to correct and get a corrected GFR to see if it's within the normalrange.

Is it true that if you do a hard resistance training session and then get your blood draw on the next day that you might see higher blood creatininelevels?

Potentially, but what I have seen are higher ALT and liverenzymes.

And we see that very frequently in individuals that trainintensely.

And it concerns you or doesn't concernyou?

It doesn't concernme. Because it's just a consequence of the training and presumably it'stransient.

It istransient,typically.

And we may see changes in creatinine with I have a one patient she runs 100miles.

She's in her60s. She's an ultrarunner.

Yeah, in her 60s and she is stronger thanme.

It'sextraordinary. And you think about what are the things that she needs to do to maintain the health of her muscle mass so that she can continue for long periods oftime.

So while we both agree that nutrition is one of the foundations of muscle health and healthgenerally, supplements often can have theirplace.

We talked a little bit aboutcreatine.

I and many other people supplement with 5 to 10 grams of creatine monohydrate perday.

I do that because it has benefits for musclestrength.

There's some brain benefits that I'm awareof.

And I realize and now you've reinforced the idea that it's difficult to get enoughcreatine, even if one is ingesting the threshold amount of one gram of protein per ideal bodyweight.

What are your thoughts on creatine monohydrate and what other supplements do you recommend for your typicalclient?

Excuseme,patient.Yeah,certainly.

So creatine monohydrate is wonderful and particularly we're seeing a lot of benefits inwomen, postmenopausal women and olderpopulations.

Creatine forsure. The other supplement is uralithinA.

Uralithin A is a postbiotic made from the gutmicrobiome.

And there's a percentage of people that can make it and the majority of individuals cannot makeit.

Interesting. Uralithin A is this connection which I findfascinating.

It's a gut muscleconnection.

Individuals that take uralithinA, I happen to be one ofthem, there are many papers out there that it improvesmitophagy, which is the health ofmitochondria.

The turnover of mitochondria helps with the renewal ofmitochondria.

But what's so fascinating is there are trials in human individuals that it increases strength andendurance.

Interesting. What milligram doses do yourecommend?

So I take between 500 and 1000 of uralithinA.

Really, I wish that I had actually created this or found thisout.

Truly, if I could make onesupplement, I know I would probably make a mix of uralithin A with creatine and some way protein and maybe 25 milligrams ofcollagen.

And I would have my perfectsupplement.

Is it taken with food or withoutfood?

It doesn'tmatter.Interesting.

Morning ornight? It also doesn'tmatter.

What's so interesting about uralithin A is that it comesfrom,again, it's made in the gut from the gut microbiome from things like pomegranate orwalnut.

It's made from something called anelagetanin.

And it isreally,again, what I think of as this gut muscleconnection, which I do believe is going to be the nextfrontier.

Sointeresting. I recall a few studies thatDr.

Andy Galpin put on his socialmedia.

These were inmice. Mindyou.

But looking at how disruption of the gut microbiome could offset some of the strength and hypertrophy increases of resistancetraining.

Pointing to the fact that having a healthy gut microbiome is critical for translating resistance training into actual improvements inmuscle.

Yes. And one of the things that we do see is that as individuals increase theiractivity, talking about more endurance typerunning.

There's this very interesting inflectionpoint.

There's this idea of optimalperformance.

And then there is this kind of moment where optimalperformance, depending on the trainingload, starts to take a toll on health andwellness.

I think that we seethat.

And withthat, one of the things that we always see is impaired gut lining impaired gutintegrity, the gap junctions seem toopen, whether it's the training volume and the physiologicalstress.

That can easily be measured with Zonulin or Calprotectin stool samples dothis, but doing things that actually help thegut, not just the gutmicrobiome, but the gut integrity is extremelyimportant.

Veryinteresting. What other supplements and maybe we should put way protein in here aswell?

Yes. Wayprotein. It'sinteresting.

Way protein and way protein concentrate has alfilex albumin and lactoferin in these immunoglobulins that can be verybeneficial.

Wayprotein. It'sinteresting.

We talk a lot about how processed foods arenegative, but the reality is that processed foods aren't positive ornegative.

The highly palatable processed foods that are full ofsugar.

We can all agree maybe those are notideal, but way protein concentrate or way proteinisolate.

Those are bothprocessed.

However, it is a great way to get your essential aminoacids, which are amino acids that you must get from thediet.

Your body cannot makethem.

There has been a lot of research with way protein has very little downside and it's easilytolerated.

Those that have challenges with lactose can use the way protein isolate versus theconcentrate.

And it's very portable if one is traveling and thinks thatsort.

And if one has achild, please make sure that you use a lid of very tight for thepowder.

Otherwise you will be wearingit.

Your child will be wearing it as a bit of adisaster, butyes.

So, what about other supplements including fishoil, mega-thriff fattyacids?

There's a lot of research around that and I think it's apositive.

It's not only a positive for brainfunction, but it seems to have a unique anaboliceffect.

Maybe it is in potentially from on theribosomes.

We're notsure. At least I'm not sure at thistime, but there seems to be even more emerging evidence that it may even impact womendifferently.

Again, I can't say that in allcertainty, but nearly all of my patients are on some form of fishoil.

Is there a thresholdamount?

That is a wonderfulquestion.

The general recommendation is around fourgrams, but some individuals four to tengrams, which would be definitely on the higherend.

Certainly, it can potentially thin your blood if an individual is going for surgery two weeks prior would suggest not takingit.

But where becomes veryinteresting?

It's really the combination of omega-3 to omega-6 and understanding those ways in which you can test in yourblood.

We run this blood work all thetime, looking at whether it's an omega quant or an omega index can be veryvaluable.

But it is a very easy supplement totake, and it seems to be very beneficial for brain health and even musclehealth.

I find it to be most affordable to take it in liquidform.

Just take a table spoon of the lemon flavored fishoil, put it in a protein drink orsomething.

Then you don't taste thefishiness, and then capsules for convenience when traveling and things of thatsort.

But the liquid forms are so much more affordable in order to hit that two grams a day or in thiscase.

Two tofour.Again, this also depends on the absorption for theindividual.

That's why it's really important to do bloodwork.

I have some patients that require closer to six grams to be able to improve their omega-3 to sixratio.

And it certainlyis, there's that precision nutrition where the amount for one person is not necessarily the amount foranother.

Interesting. What other supplements do youtake?

Ithink, let me think about what other supplements that I personallytake.

Collagen.Collagen. I lovecollagen.

Collagen. In mycoffee, collagencoffee.

I love strongcoffee. If you've never hadit, it'samazing.

Collagen. It's called strongcoffee.

It hascollagen. It has alveaning init.

Really helps with thejitters.

There's some good evidence with alveaning to help withanxiety.

But collagen isinteresting.

Collagen isa, I sayprotein.

It's notreally, it has a protein score ofzero.

It does nothing to affect skeletal musclemass.

It is devoid andtriptophan.

And it is very low in the branch-shaded aminoacids.

But it is high inglycine,proline, andhydroxyproline.

Which makes it very unique instructure.

It is also very difficult to test the effect ontendons.

Collagen protein ontendons, because as you canimagine, one would not want a tendonbiopsy.

Right. Soundspainful.

Muscle biopsies arepainful.

Yes. I used to do a lot of those when I was in myfellowship.

It was probably less painful for me than it was for thesubjects.

But,yeah, it's taking a small cork of tissue out of themuscle.

So collagenprotein, Ithink, can be very beneficial for skin-hairednails.

I feel as if we just haven't gotten sensitive enough to determine its effect on tissueyet.

I anticipate that higher doses above 15grams, maybe of somebenefit.

I'm justspeculating, but I'm guessing that it's probably closer to 25grams.

I know that that seems a bitrobust.

So, in onescoop, it might have 15grams.

But I think there's no negative to increasingcollagen.

And quitefrankly, we don't get a lot of collagen in ourdiet.

The places in which you would find collagen are the gristle andmeats.

Or there'sa... Abrough.

Yeah. That's another great way to increaseit.

So, you take it once aday?

Ido. A particular time ofday.

In the coffee in themorning.

So, my coffee has collagen init.

Before youtrain.Yes, Ido.

And I typically train faster to side fromthat.

And then I'll add in an additionalscoop.

You mentionedfasted. Maybe we should touch on fasting for amoment.

I inadvertently have been doing intermittent fasting foryears, meaning I was never hungry forbreakfast.

So, my first meal lands at 11a.m.

orso. Plus or minus anhour.

On mostdays, there are exceptions tothat.

Last mealtypically, I don'tknow, 8p.m.

7p.m. Sometimes 9p.m. I'm not super strict aboutthat.

And it basically boils down to anywhere from 2 to4,quote-unquote, meals perday.

Alunch, adinner, and then some eating inbetween.

Could you first comment on that architecture ofeating?

But maybe first on fastingspecifically.

Imean, what are the benefits or detriment to having a feeding window of about 8 or 9hours.

Regardless of where it lands in theday.

And then let's talk about how that might slidearound.

Or if people should ensure you're getting more food coverage throughout theday.

Two benefits that I find fromfasting.

Numberone, calorierestriction.

Numbertwo, bowelrest.

Many individuals have gastrointestinalchallenges.

When they are in a time restrictedwindow, they're not feeding all daylong.

And those are the two benefits that I oftensee.

An individual who is older or struggling to put onmuscle.

Fasting would not be my primarygo-to, Ithink, that as individualsage, there's a bit of anegative.

Because you have to balance this muscle proteinsynthesis.

They're always going through synthesis and acatabolism, so an anabolic process and a catabolicprocess.

As youage, it becomes more difficult to regulate thatprocess.

And if you add an additionalfasting, go through long periods of timewhere, let's say you're nottraining, you're not protecting skeletaltissue.

That would be a place where I don't necessarily recommendfasting.

Some people might find it difficult to hit the 30 to 50 grams of protein permeal, frequency across the day in order to reach that one gram of protein per pound of ideal bodyweight.

If they were going to add ameal, or let's just say add 30 to 50 grams ofprotein, how much time separation do they need from the othermeals?

So forinstance, if I were to take a step back andsay,okay, I need an additional 30 to 50 gram protein intake per day in order to maintain the muscle I have as Iage.

And I amaging, as we allare, Isuppose.

Is two hours before my 11a.m.

mealenough? Does it have to be threehours?

Could it be onehour? Imean, you can only assimilate and then oxidize a certain amount ofprotein.

Imean, how much time window does one need between these proteinfeedings?

I appreciate thatquestion.

And here's my answer tothat.

The first meal of the day is the meal that has beenstudied.

The remaindermeals, to myknowledge, there is no study that shows anything about the second or the thirdmeal.

And perhaps that's because of thedifficulty.

But the literature suggests that that first meal of theday, whenever you're going to haveit, let's say foryou, it's 11 eating 30 to 50 grams ofprotein.

The muscle protein synthetic response will last twohours.

However, when we talked aboutM-tore, there's other initiation factors likeEIF-4.

That will maintain itself for another four to fivehours.

Isee.Therefore, the second meal is really not necessarily a muscle protein syntheticresponse.

I can't say that that's supported in theliterature.

But where the benefit of that is is that we know that more than one meal of that robust amount of protein will likely have better outcomes on this 24-hour proteinresponse, 24-hour nitrogenbalance.

But that second meal would be just about getting your proteinin.

It doesn't matter if you have to hit your needof,say, 200 grams ofprotein, then that middlemeal, the real goal forthat,metaphorically, is to get enough protein to meet that one gram-per-pound ideal bodyweight.

And then that final meal before you go into a fast would be what we would say would support overnight proteinsynthesis.

Imean, not necessarily support overnight proteinsynthesis, but in the fastedstate, your body pulls frommuscle.

It has to maintain the energy balance for all other systems in thebody.

All othertissues,again,25% of protein turnover goes to skeletal muscle and the rest goes to other organsystems.

For you or forhypertrophy, adding an additional mealwould,again, let's say fourmeals, I think would be if I were to design a diet in the perfect world to supporthypertrophy, I would add another fourthmeal.

Well, I love toeat. So that's not a problem inprinciple.

This is probably getting a bit more toward theaficionados, but I've heard that certain forms of animal protein and other proteins are more beneficial at certain times ofday.

Forinstance, meat and eggs early in theday, maybe chicken and fish in the middle of theday, and that casing and milk proteins might be more advantageous for muscle health in the final meal of the day or closer tobedtime.

I realize this is getting into thedetails, but I'm sure a percentage of our listeners would be curious to dothat.

And ofcourse, no proteins always make mesleepy, so it kind offits.

Youknow, it's reallyinteresting.

I will say that milk protein casing seems to be slowerabsorbing, and that's because of the impact with thegut,obviously.

But is there anything special about casing or milkprotein?

The answer to that would actually beno, but the length of time that it takes for digestionabsorption, maybe where the benefit comesin.

That beingsaid, there's some data to support high saturated fatdairy, believe it ornot, actually can be good for health andlongevity.

I know that there's people will say high saturated fat or high fat dairy would benegative, but I would say that there is evidence to support it being healthpromoting.

Well, nothing like a piece of terrificcheese, like a parmesan or a shot of full fatcream.

And I will mention the loosecream.

Which I love every once in awhile.

That's a guiltypleasure.

A shot of full fat cream that eat with equal partespresso.

I'll takeit. I'll takeit.

I will mention that the leucine content in milk protein is a little bit lower or say Greekyogurt.

Are there any sort of cryptic championproteins?

I think most of us think steak and ground beef and maybe venison and elk and eggs and all the obviousthings,chicken,fish,etc.

But are there any cryptic proteins out there that are particularly good for us in terms of their amino acid content that people don't thinkof?

You hear these days aboutliver.

I frankly don't like the touch ofliver.

I don't likeliver, but liver has a lot of other benefits toit.

So it's high in fat soluble vitamins and iron verybioavailable, but I'mnot.

It's very difficult toeat.

Yeah, I think people either love it or hateit.

I'm on this secondcategory.

So no proteins come to mind as youknow, salmon qualityprotein.

Salmon is a quality protein is higher infat.

Again, calorie balance doesmatter.

Fish isinteresting. Fish has five grams of protein per one ounce versus meat has an average of sevengrams, seven or eight red meat has seven or eight grams of protein per oneounce.

Sointeresting, youknow, that this idea that eating muscle can support the health ofmuscle.

It makes sensethough, doesn'tit?

Yeah, it makes perfectsense.

And you explain very clearly as to why thatis.

Okay, we set aside liver for thisconversation.

Some people are into cricket and maybe thereis.

Sorry, I apologize to thewell, not thecrickets.

The crickets probably thank me for myresponse, but I'm notjudging.

It's just my personal visceralresponse.

My other people may like insectproteins, but what about other organmeats?

Heart. Iknow, Imean, they're all around theworld.

You see the consumption of lots of different organmeats.

Is there any evidence that that heart is a goodprotein?

Or we generally looking at skeletal muscle as the best source of aminoacids?

Heart is also a good source ofprotein.

It's also high in co-Q10, which is good for musclehealth.

But manypeople,again, we don't seem to eatthat.

However, other places eat the fullanimal.

But they're all good sources ofprotein, aside fromcollagen, which would be that protein score ofzero.

And if somebody insists on being vegan orvegetarian, let's just sayvegan, what are their bestoptions?

There are rice peblins ofprotein, which are absolutelysuitable.

There are a lot of now fermented types of protein powders out there that seem to have the same profile asway.

The one thing that I would say as individualsage, a vegan diet can be verychallenging.

Need to make sure that you're getting enoughB12, theZinc,iron,things, nutrients of concern that seem to be going down ingeneral.

We're seeing decreases of that in the generalpopulation.

What are your thoughts onmagnesium?

We sometimes hearthat.

Yes,excellent. People are magnesium deficient based on depletion of thesoil.

You hear thisstuff. But what's the story withmagnesium?

That istrue. There seems to be less magnesium in thediet.

Very easy to supplement whether the form that youuse, whether you use a magnesiumglycinate, or there's a whole host of magnesium citrate for gastrointestinalhealth, whatever itis.

Butyes, magnesium supplementation can be very beneficial formuscle, forbrain.

Do you support the idea of supplementing withzinc?

Or is that something that is sometimesyes, sometimesnot?

I think if you're eating a Whole Foodsdiet, you're going to be unlikely to be deficient inzinc.

Zinc is interesting because you don't want to supplement zinc withoutcopper.

There is a zinc copper ratio that is well maintained in thebody.

Supplementation with one or the other will typically deplete theother.

And as ageriatrician, there's a zinc copperratio.

Things that we think of as proxies for overall brainhealth.

Not saying that the zinc copper ratio is the onlything, but certainly supplementing with one or the other one would becareful.

What are some things that people might be doing or taking that inadvertently disrupt muscle health and perhaps evenhypertrophy?

One thing that people often use isibuprofen.

Andibuprofen, while not inherentlybad, there are some evidence to suggest that higher doses of ibuprofen can impact musclehealth, whether it's hypertrophy orstrength.

I often think about thosetogether, but ibuprofen use is also not good for the gastriclining.

Again, you have to be able to absorb your nutrients to be able to become strong andhealthy.

The other thing is obviously statinuse.

Some people do needstatins.

I'm not saying that weshouldn't, but that can certainly affect musclehealth.

The side effect can be musclepain,myalgia, musclesoreness.

It can depletecoq10. Is the occasional use of these thingsokay?

Yeah, ofcourse, and obviously check with yourdoctor, but things that suppress inflammation likeaspirin,potentially, or other NSADScan,well, aspirin is in a category of itsown, but NSADS in particular seem to suppress skeletal muscle at certaindoses,hypertrophy,potentially, andstrength.

The other thing is fluoroquineloans.

They are antibiotics that can affect collagen and tendonturnover.

If an individual is on a fluoroquineloan, there's a riskfor, you hear a lot about these Achillesinjuries.

Yeah, which sorts ofantibiotics?

Ithink, is it like sippro and things likethat?

People can injure themselvesbadly.

You should be certainly careful about the activity that you're doing at thetime.

The other thing is the proton pumpinhibitors.

People use that for stomach acid orreflux.

That can affect absorption of vitamins and minerals that do you have long lastingeffects?

What are your thoughts on the GLP1analogs,ozempic,monjaro, real quickanecdote?

I was in New YorkCity. I was walking up the debris side on a Sundayrecently, and there was a sign outside a store that said we carry ozempic andmonjaro.

I thought the sign would say we have gene quantays orsomething.

Ithought,wow, this guy snapped a photo ofit.

I didn't think much of it at thetime.

Then I decided to post it to myInstagram, thinking that there be a fewopinions.

Frankly, I was just curious what people wouldthink.

Isaid, what do youthink?

It was one of the largest responses in terms of comment volume and contentiousness that I'd everobserved.

Ithought,whoa, there's really somethinghere.

My understanding is that thesecompounds, which are becoming incrediblypopular, can help people loseweight, but that there's some loss ofmuscle, maybe even some bonemass.

I don't know if I'm wrong onthat, but I would alsoimagine, excuseme, that some of the muscle loss can be offset by resistancetraining, maybe even protein intake and resistancetraining.

So what is your thought about thesecompounds?

The last thing I'll just give a little bit of mystance.

I know a number of people that had extreme struggles losingweight.

I don't know the extent to which they were doing things correctly or incorrectly withnutrition.

It's not my place to probe intothat, but that they got on these compounds one or the other and seem to love them because they got them kind of out thegate, youknow,20, 30 pound weight loss very quickly without intensecravings, their appetite issuppressed.

And many of them are now also exercising and doing otherthings.

So I don't think we want to look at this or talk about this as an either orozemic, mongaro or exercise and propernutrition.

I would imagine there's a place forboth, but I'd love your take onthese.

I would love to shareit.

These medicationsare,they're, it'scomplex.

The issue ofobesity, the challenge with GLP ones and dual agnus likeMonderno, GLP one andGIPs.

It is a complexconversation.

So the opinion that I'm going to give is going to be while I give myopinion, I recognize that this is certainly like you said veryheated.

There's a couple of ways to look atit.

First ofall, nothing has worked moreeffectively.

Other than bariatric surgery than these medications to affectobesity.

So GLP oneagnus, Lycosemic will an individual might get a13% weightloss.

We know how longit. That's a goodquestion.

Yeah, it's a it's atitration.

It's a monthlytitration, but over a period of 24weeks.

It certainlydepends. It certainly depends on theindividual, but it's utilized and increased month by month at four weeksspan.

The other aspect is the dual agnus likeMonderno,Tresepatide.

And that will potentially cause a22% weightloss.

The challenge with obesity isreal.

Now I have taken care of patients that have deeply suffered withthis, whether it is a component of food addiction or whether it is a component of whatever the reason we have used these in clinic and it has transformed theirlives.

I would never take that away fromsomebody.

Certainly it is personalchoice.

Now the other aspects ofthese, the comment about skeletal muscleloss, I've seenthat.

Andagain, we use these medications in ourpractice.

And with a proper nutrition plan and proper resistancetraining, I do not see a loss of skeletal musclemass.

You have to work with a provider that can help titrateit, but I think that these drugs can be used in a very safemanner.

And youknow, we see improvements in alcohol consumption in otheraddictions.

Veryinteresting. There are a whole host of benefits from thesemedications.

Now, I think where people get upset is theysay,well, is this ashortcut?

Can you go off ofthem? Do you have to regain thatweight?

Andagain, we have many patients that go off of them and have implemented great strategies for training andnutrition.

And we don't see weightgain.

Interesting. It all depends on a comprehensive holisticview.

And that becomes important torecognize.

There are manybenefits.

And people will say the negatives would be slowing down gastricemptying.

Well, I would sayyes. And that's exactly what the medication is designed todo.

There may be some risk withpancreatitis.

There is some discussion about thyroid cancer in rodentmodels.

Rodents have a different thyroid and volume of thyroid receptors andhumans.

I think that potentially that isincidental.

I'm sure that we'll be hearing more and more aboutit.

These medications also are notnew.

They have been used for over adecade.

And those are all important points to recognize that now it is verypopular.

But these medications have been around for quite sometime.

It is interesting that some of the peptides like GLP1 analogs that have existed in somewhat niche communities for awhile.

And we are seeing things like in the melanocytes stimulating hormone community that are now sold under FDA approval for things like lowlibido, things likeVilecee.

AndAdi, we were mentioning Adi for women for hyposexual desireddisorder.

We don't know the history ofAdi, but certainly the alpha melanocytes stimulating hormone relatedpeptides, the GLP1peptides, things likesermeraline, which are in the growthhormone.

So,Cretagogs, all we're viewed for a long time as nichecommunity, fitnesscommunity.

But now at least the GLP1 analogs have made their way into massive scaleuse, which speaks to a general theme of what I've observed over thelast,well, I'm 48now.

But let's just say 35years, which is that many of the things that exist in niche communities becomemainstream.

It just takes sometime.

And they become mainstream through the standard channels of FDAapproval, which as is the case withozempicumondraw.

So it's great to hear that you embrace sort of bothsides.

Like a lot of what you've talked abouttoday, I think one wouldn't necessarily find in the kind of standard tables or what's on a poster in the doctor'soffice.

But some of itis. And you really are the intersection of both thoselandscapes.

Thankyou. And this idea of ozempic and tries to appetite theseGLP1s, we talked a lot aboutprotein.

And one way that it has a satiating effect is this GLP1stimulation.

And one has to recognize that these GLPagonists, these GLP1 agonists last for aweek.

The dietary protein effect is a meal tomeal.

So eating protein increasesGLP1, as does drinking yourbomote.

But it's probably to a lesser degree and moretransiently.

Moretransiently. And I think that that is just an important and interestingfact.

And the other fact is that the amount necessary to stimulate muscle proteinsynthesis, the amount for muscle health is also seen in the amount of GLP1released.

It seems as if that that 30 to 40 or so gram amount of high quality protein is the same amount that has a meaningful impact on the release ofGLP1.

Veryinteresting. I did not knowthat.

So if we were to just back away from everything we've talkedabout, what are the top level benefits of having healthymuscle?

Everything.Okay. My muscle is the organ oflongevity.

And when we think aboutlifespan, we think about healthspan.

And then we finally think about musclespan.

I would argue that that is right afterlifespan.

The benefits of healthy muscle cannot bedenied.

This is better metabolichealth, better bloodpressure, bettersurvivability, betterstrength, bettermobility, better bodyarmor.

Should someonefall, should someone getsick, your survivability will be related to the health of skeletalmuscle.

And especially as we think aboutaging, if we want to have good skin or we think about wanting to have a good lookingbody, even though I can appreciate it's only a small amountaesthetic, but leveraging the aesthetic to have healthy brainfunction.

There's this idea that Alzheimer's or certain types of dementia are type 3 diabetes of thebrain.

Skeletal muscle is the only organ system we have voluntary controlover.

It is the only endocrine organ system we have voluntary controlover.

Which means we have a responsibility to leverageit.

We have talked about these in a lot of detailtoday, meaning you have educated us about these in detailtoday.

And thankyou. But perhaps you could summarize what you view as the top nutrition based tools for improving musclehealth.

And that would be in terms of a proteinhierarchy, roughly 1 gram per pound ideal bodyweight, an individual could certainly go to 0.7 grams per pound ideal bodyweight.

The higher theprotein, the less it matters thequality, whether it is a high quality protein or a lower qualityprotein, the total protein amountmatters.

That is at the base of thepyramid.

The next would be the I would say the quality understanding the quality of the protein so that you know exactly howmuch.

And then certainly the distribution of how you are ingesting thisprotein, the dietary protein habits of someone who is eating a more protein forward diet distribution will matter less the higher itis, but there is certainly some great importance depending on if you areolder, who you know challenging for any kind of health and wellnesschallenges.

This is what I wouldsay.

And I realize it will vary depending onactivity, but assuming that somebody gets the 1 gram of quality protein per pound of ideal bodyweight, how should they make up the rest of their colorneeds.

And next I would say would be yourchoice.

You choose carbohydrates orfat.

There is evidence that carbohydrates are helpful from a fiberperspective,phytonutrients, other vitamins andminerals.

I certainly would gothere.

That would be mypreference, the amount of activity that you do certainly could usecarbohydrates.

And then fat is very easy to get essential fattyacids.

And if you have a diet that doesn't have to be too high in fat to getthat, but at the end of theday, prioritized dietaryprotein.

The next level would be understanding your carbohydrate threshold could start at 130grams, or down depending on your metabolic health and oractivity, understanding that outside ofactivity, 50 grams or less of carbohydrates would be a threshold to mitigate substantial insulinresponse.

Finally, that fat you can choose however you would like to get that fat typically comes with anamyel.

And that would be the remainder of your caloricintake.

And then you can share your top line tools with respect to exercise as it relates to muscle health resistance training isnonnegotiable.

It doesn't matter if you need to start with bodyweight, absolutelyOK, move tobands.

Definitely moving load is valuable and nonnegotiable start with two days aweek.

If you're doing three days aweek,again, it all depends on the volume and intensity in which you are working under depending on whether it's five to 10sets, how many reps you'redoing, I think that there's many ways in which one could do itright.

The only way in which someone could do it wrong is to not do it quitefrankly.

That would be what I would say forthat.

And then adding in high intensity intervaltraining, I would choose high intensity interval training over slow steady statecardio.

Because the high intensity interval seemed to have a very impactful effect with the low amount of time that ittakes.

Let's talk about something that might seem somewhat distant from everything else we've talkedabout, but I actually believe is central to all ofthis, which ismindset.

The psychology around health and self directedhealth, which of course includes communication and cooperation from licensed trained physicians likeyourself.

What's your mindset and recommended mindset around muscle health and just general health in terms of health span andlifespan.

What you're talking about here is muscle span and the way in which the cognitive processes and the way that we think about ourlife, how does that influence what we actuallydo.

And I could give someone the perfect plan and it doesn't matter if I give an individual a perfect plan if they're not willing to execute onit.

I've been a physician for 20years, believe it ornot, that is a long period oftime.

And I would say a good physician is a physician that identifies patterns ofdiseases, patterns ofillness.

But an effective physician is someone who identifies patterns of people because once you identify the pattern of theperson, you're able to leverage that so that they can get the best out ofthemselves.

And there's a few core fundamental principles that people have to recognize if they want to bewell.

And that is you set standards and you don't setgoals.

People will set a weight loss goal or a muscle hypertrophygoal.

But if you set a standard for how you operate and how youexecute, you know that regardless of how youfeel, you're going to get up andtrain.

You know that this is going to be your nutritionplan.

You get up and you doit. You set a standard and that standard provides a framework forexecution.

I lovethat. I sometimes think of the non-negotiables of the week that unless I'm suffering from a really bad cold orflu, which fortunately for me is prettyrare.

That I'm going to get those three resistance training sessions and I'm going to try and get as much quality sleep as Ican.

And I'll get those cardiovascular trainingsessions.

And when you talk about settingstandards, is that what you're referringto?

Are you talking about blood workstandards?

Are you talking about aggressively trying to maintain blood values in a particularrange?

Or you mainly talking aboutbehaviors?

I'm talking aboutboth.

Yes. Should there be a standard for your blood work that you'regetting?

Yes. We have a very strict standard that we have in place for all ourpatients.

However, the framework for which they execute is all about the standards that they place fromthemselves.

Youknow, because ultimately what we wanthere,Andrew, is we want people to getresults.

And the only way they're going to get results is if they stop chasing thesegoals.

And that might be counterintuitive to people because people willsay,well, I'm going to set a weight lossgoal.

Goals come andgo. Standardsremain.

And if you fail to do the practical in yourlife, the practical becomeimpossible.

And that's why we setstandards.

The other aspect is an individual has to understand where theyfail.

I take care of a lot of very successful entrepreneurs and justindividuals.

They all know where theyfail.

They all know their points ofweakness.

Overtime, it's not understanding where you excelbecause, quitefrankly, that's the easypart.

The part that becomes very valuable is you know where youfail.

You know where your points of vulnerabilityare.

You know where you fall offtrack.

I'll give you anexample.

Typically, when someone is about to do somethingamazing, they havethis, but youwould, you know this better thananyone.

This dopaminehigh. At that pinnacle seems to be a place ofvulnerability.

Whether they will skip a training session or buy another car or do whatever it is that they do eat morecake, they have an experience in their environment where they're almost at the pinnacle of what they aredoing.

And that is a place of vulnerability where people will fall off healthtrack.

On the same token at the moment after the big successfulmoment, I have a patient who puts on a massive event inVegas.

And every year I wait for the call that he's feelingdepressed.

Because his dopamine didn't go back to baseline or fall tobaseline.

It went belowbaseline.

And what is important to recognize is that this is another point ofvulnerability.

At this point of vulnerability is where people seem to go off track and never regain their footing if they do not recognizethat.

And so I can appreciate that we're talking about mindset here because there's a level of neutrality that is necessary for overallsuccess.

Again, this is what I've seen time and time again that those that are the healthiest are able to maintain this level ofneutrality.

Tell me more about level ofneutrality.

I'm right there with you on setting standards instead ofgoals.

And I'll say I've never thought about it in thisway, but I absolutely lovethat.

And for therecord, you said it and I'm going to blast it out credit to you as much as possible because I think it's so critical for persistent engagement in the kinds of behaviors and mindsets that lead to success overtime.

So love this standards over goals principle knowing where one fails points ofvulnerability.

Beautiful concept painful to hear because of the realistic nature of it and that's exactly why it'spotent.

So thank you for that aswell.

And predictable and predictable human beings are predictable in theirbehaviors.

And it's for example on Friday night when everyone tells themselves they're not going to have that drink and that pizza and thatcookie.

And then Friday night comes around and they are surprised by their ownhumanness.

Andagain, what we're looking for are long term strategies for overall health because that wave of youth doesclose.

And while we can all continue to get better as that windowcompresses, it becomes much more important to be very diligent on the responsibilities to ourhealth, our nervous system so that we can continue on forsuccess.

It's just the way that itis.

Tell me about the neutralitycomponent.

This is fascinating and I have a very goodfriend.

His name is Ben Newman and he really highlighted this for me and he works with a lot of these sports teams and he was the first patient that helped me put together this idea ofneutrality.

I'll give you anexample.

He was flying to work with one NFLteam.

I think that they were going to the SuperBowl, somethingmajor.

And I said tohim, youknow, how are youdoing?

You just came off of your book launch and just before this you read another NFLteam.

And he said tome, hegoes,Gabrielle, it's just anotherTuesday.

It's just anotherTuesday.

And so this idea of neutrality is that when you can manage and mitigate your emotional ebbs and flows for when things are at theirhigh, theexcitement, this isn't to celebrate or not tocelebrate.

But when you begin to mitigate these ebbs andflows, it's almost as if there's this level ofneutrality.

When thathappens, these big moments because life is full of bigmoments.

Yes, it's full of smallmoments, but it certainly is full of these bigmoments.

And it's these big moments that once we enterinto, if one is notneutral, then being able to pick themselves up from an experience or a moment become much morechallenging.

My most successfulpatients, I'm not talking aboutfinancially, I'm talking about the ones that are able to maintain and contain their health are the ones that areneutral.

In terms of tone andaffect.

No, in terms ofexperience.

As they go throughlife, they celebrate somewins, they don't celebrateothers.

Very consistent with some of the theories that I and a few others in the science community have expounded around dopamineregulation.

It makes a lot ofsense. And where I care about this is as a physician who takes care ofpeople.

And when they cannot manage this emotional highs and lows because as you think aboutit, if you walk around and you feel that everything isstressful, Imean, you've got your court is allgoing, then you're notsleeping.

And then it becomes this cycle and then that cycle becomes ahabit.

And if one can teach themselves to besteady, forexample, going into a bigworkout.

Maybe they mitigate the anticipation of thatworkout.

They're much more likely to continue on thatway.

And it's what is so important about is a trainableskill.

A lot about energyconservation, mentalenergy, not just caloricenergy.

Veryinteresting. And so then you can do the things that matter and then you don't fall off the bandwagon because it just seems that each time a person doesit, they become better at doingthat.

It is hard tohear, I think probably for manypeople, but it's verypredictable.

And if you can leverage that predictablenature, forexample, that Friday night that comes along and you've told yourself that this is going to be your last beer or your lastpizza.

Then you know how to engage init.

You come up with a game plan where you've set a standard where this is the thing that you do Fridaynight, you set the rule and the foundation for youractions.

While hearing about your stance on mindset standardsgoals, knowing where one fails points of vulnerability andneutrality.

I have onemore.Oh,please.

This one is a bigone. And this is a person will only ever be as healthy as they feel worthyof.

Tell me more that when individuals do not feel worthy of having health andwellness, they will sabotage themselves over and over and overagain.

And it is something really important when you sit down with a patient or you reflect onyourself.

The questionbecomes, do you feel worthy of beinghealthy?

Do you truly feel worthy of having the body that you desire of having that overall sense of vitality because if someonedoesn't, they will use that as adistraction.

They will sabotage themselves and they will focus on the not feelingwell, the feelingtired, all of the other physical aspects that go along with illhealth.

And that will allow them adistraction.

I once read something about a person who wasobese, who then got inshape.

And they were reporting that in their family growingup, they had a narrative around exercise that for them translated to exercise being a form of extremeselfishness.

And that surprisedme. Ithought, youknow, what better thing to do in terms of helping one's health andhelping,therefore, the relationships in your life by segmenting out asmall,not, youknow, a huge portion of one'sday,but, youknow, an hour a day to take great care of oneself and ensure health so that you don't have to be dependent on others in a way that would be burdensome tothem.

Perhaps earlier in life than it would be in any othercase.

So this seems to fit very well with what you'resaying.

This person obviously felt that exercise was selfish and they weren't worthy somehow of being healthy and inshape.

Fortunately, they flipped the script on this and I should say that was overgoodness.

That was2016. So it's been a long while and they have maintained good health and staying inshape.

They set a standard forthemselves.

Isn't thatamazing? It'sawesome.

It's awesome tosee. It's also been awesome to see their transformation in their psychology and the different aspects of theirlife.

But is that something that you see a lot that people just feel like getting in shape or paying attention to what they eat is somehowselfish?

I think that some people do not feel worthy of feeling good and they will sabotage themselves until they uncover that numberone, that is the message that they're sendingthemselves.

And once they dothat, there is a bit of friction and we know in order to be successful in any game plan that friction is required and on the other side of friction is quite franklyfreedom.

But those individuals have to understand that they are worthy and really do thatwork.

Butyes, time and timeagain, it is one of the first questions that Iasked.

Do you feel worthy of feelinggood?

Well,Dr. GabrielleLion, you have given us an incredible tour of muscle and in fact an entirely newperspective, even for me on how muscle impacts ourhealth.

As we talked about at the beginning so often when people hear about the importance ofmuscle, they think just building muscle and that tends to separate people into those who want to build muscle and those who don't or think that they can't or don't really understand what it'sabout.

But you've made oh soclear.

The fact that muscle is a critical perhaps the most critical aspect of maintaining health and longevity of the body of the brain of health span life span what you call muscle span really seems to wick out into everything in terms of our well being and you've given us a ton of actionable tools at the level of nutrition at the level of exercise at the level of supplementation and thankfully also at the level ofmindset.

I think the tools that you shared along the lines of mindset are absolutely spectacular as are all these otherrecommendations.

So I want to say on behalf of myself and everyone listening andwatching.

Thank you for sharing all of this information with us in such clear and actionabledetail.

Thank you also for the work you do for being such a pioneer in both maintaining an active clinicallife, seeingpatients,men,women, people of differentages, different backgroundsetc.

I know you also do somework.

I'll just mention this because it isimportant.

You don't just work with people who can afford thework.

You also do a lot of work with people in the military community who perhaps who cannot afford thework.

So you make it a point to support communities that perhaps couldn't afford the kind of support that they absolutelydeserve.

So thank you forthat. Thank you also for being a public educator and such an avid one and really out there on Instagram on YouTube with your own podcast with yourbook.

We'll provide links to all of those in the show no captions ofcourse.

And I justlove,love, love what you're doing and I know as great as it's been that there's still much more tocome.

So thank you for taking the time to come heretoday, especially with the busyclinic, the businesses and of course yourfamily.

People might not realizethis, butDr.

Gabrielle line does all this while maintaining a family with twochildren,happy, healthy marriage and a husband in residency and she's stillpursuing.

And that'sright. Shout out to Baylor and still pursuing advanced training in yet additional fields ofmedicine.

So you are a phenom and I have both tremendous admiration and respect and gratitude foryou.

So thank you somuch. Thank you somuch.

Thank you for joining me for today's discussion withDr.

Gabrielle Lyon to learn more about her work and to find links to her book forever strong as well as a link to her excellent podcast and to her website which has additionalresources.

Please see the show nocaptions.

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So to HubermanLab.com, go to the menutab, scroll down to newsletter and enter youremail.

And I should mention that we do not share your email withanybody.

I also just want to mention once again that my newbook, which I've been working on for more than five years and researching for more than threedecades, which is entitled protocols and operating manual for the humanbody, is now available for presale by simply going to protocolsbook.com.

And there you will find links to any number of different vendors and you can pick the one that youprefer.

And onceagain, for joining me for today's discussion withDr.

GabrielLyon, I hope you found the discussion to be as informative and actionable as Idid.

Indeed, it has motivated me to make several important changes in my nutritional and exerciseprogram, which I've implemented and I'm already seeing spectacularresults.

[근육: 장수의 핵심 기관 - 가브리엘 라이언 박사와의 대담]-[Dr. Gabrielle Lyon: How to Exercise & Eat for Optimal Health & Longevity]

📋 Summary

근육: 단순한 신체 조직을 넘어선 '장수의 기관'

1. 근육의 대사적 역할과 '근육 부족(Undermuscled)'의 위험성

2. 근육 단백질 합성과 영양 전략

3. 근육 건강을 위한 운동 프로토콜

4. 마인드셋: 목표가 아닌 '표준'을 세워라

🎯Key Sentences

📝Key Phrases

📖 Transcript