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

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.240 | where we discuss science

00:00:03.660 | and science-based tools for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.260 | and I'm a professor of neurobiology and ophthalmology

00:00:13.400 | at Stanford School of Medicine.

00:00:15.420 | I'm pleased to announce that my new book,

00:00:17.620 | which I've been working on for more than five years,

00:00:20.080 | is now available for pre-sale purchase.

00:00:22.800 | The book is entitled "Protocols,

00:00:24.860 | "An Operating Manual for the Human Body."

00:00:27.360 | And within the book, you can find, as the name suggests,

00:00:30.880 | protocols for everything from how to improve

00:00:33.740 | and even optimize your sleep,

00:00:35.760 | for increasing your motivation and focus,

00:00:38.560 | for nutrition, that is specific nutritional guidelines

00:00:41.700 | to follow for health and performance,

00:00:43.600 | as well as exercise, stress control,

00:00:46.200 | your oral and gut microbiome,

00:00:47.920 | both of which are critical for brain and body health,

00:00:50.720 | as well as protocols for creativity, and much more.

00:00:54.480 | Within the book, you'll also find the scientific basis,

00:00:56.680 | that is the mechanisms and specific studies

00:00:58.960 | that substantiate these protocols.

00:01:01.040 | And the book is designed to be incredibly easy to use,

00:01:04.120 | such that if you're suffering

00:01:05.400 | from a particular pain point in life,

00:01:07.420 | such as difficulty sleeping or excess stress,

00:01:10.040 | or any number of different issues,

00:01:11.840 | that you can go to a specific chapter in protocol

00:01:14.600 | and begin to resolve that issue.

00:01:16.640 | So my goal in writing this book

00:01:17.880 | is that it not only be exceptionally practical,

00:01:20.360 | but that it also be extremely informative,

00:01:22.840 | that is teaching you a lot about the science

00:01:24.840 | that underlies the protocols that can improve

00:01:27.500 | your mental health, physical health, and performance.

00:01:30.060 | To order protocols, go to protocolsbook.com,

00:01:33.520 | and there you will find links

00:01:34.840 | to any number of different vendors,

00:01:36.160 | and you can select the one that you prefer.

00:01:38.320 | Again, that's protocolsbook.com.

00:01:40.680 | My guest for today's episode is Dr. Gabrielle Lyon.

00:01:43.920 | Dr. Gabrielle Lyon is a medical doctor

00:01:46.000 | who did her clinical and research training

00:01:47.840 | at Washington University in St. Louis.

00:01:50.280 | She's an expert in geriatrics, in nutrition,

00:01:53.120 | in health, and longevity.

00:01:54.920 | And during today's episode, Dr. Lyon explains

00:01:57.120 | how if we are interested in our immediate

00:01:59.540 | and long-term health,

00:02:01.000 | muscle is the organ that we need to pay attention to.

00:02:04.120 | She explains how this is true for everybody,

00:02:06.380 | men and women alike,

00:02:08.080 | and that there are specific things

00:02:09.400 | that we all can and should do with our nutrition

00:02:12.520 | and our exercise in order to maximize the health

00:02:15.680 | of our muscular tissue.

00:02:17.200 | Now, in some cases, people will be interested

00:02:19.200 | in building more muscle,

00:02:20.880 | but it's important to point out

00:02:21.860 | that much of today's discussion

00:02:23.440 | is simply about improving the health

00:02:25.280 | of your muscular tissue

00:02:26.520 | and the specific ways to do that

00:02:28.400 | in order to support brain health,

00:02:30.440 | body health and movement, of course,

00:02:32.520 | as well as the health of every organ system in your body.

00:02:35.400 | Again, placing a focus on improving muscular tissue itself

00:02:39.300 | as a way to improve all the organ and tissue systems

00:02:42.200 | of your body.

00:02:43.200 | Dr. Lyon explains the specific science and protocols

00:02:46.560 | that can be applied in your everyday life

00:02:48.540 | at the level of what you choose to eat or not eat,

00:02:51.400 | as well as how much of certain foods to eat or avoid,

00:02:54.920 | as well as specific training regimens,

00:02:56.880 | most of which take very little time,

00:02:58.920 | but they can vastly improve the health

00:03:00.680 | of your muscular tissue

00:03:01.720 | and therefore the health of your entire brain and body.

00:03:04.760 | I'm certain that by the end of today's episode,

00:03:06.640 | you will have a much more thorough understanding

00:03:09.120 | of what you can do to improve your immediate

00:03:11.120 | and long-term health

00:03:12.360 | and thereby potentially your lifespan,

00:03:14.920 | all of which are based on the most modern understanding

00:03:17.160 | from basic research, from clinical studies,

00:03:19.760 | and from practical application in the real world.

00:03:22.960 | Before you begin, I'd like to emphasize

00:03:24.760 | that this podcast is separate

00:03:26.200 | from my teaching and research roles at Stanford.

00:03:28.440 | It is, however, part of my desire and effort

00:03:30.360 | to bring zero cost to consumer information

00:03:32.440 | about science and science-related tools

00:03:34.640 | to the general public.

00:03:35.920 | In keeping with that theme,

00:03:37.000 | I'd like to thank the sponsors of today's podcast.

00:03:39.680 | Our first sponsor is Maui Nui Venison.

00:03:42.360 | Maui Nui Venison is the most nutrient-dense

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00:03:46.760 | I've spoken many times before on this and other podcasts

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00:03:53.900 | to get about one gram of high-quality protein

00:03:56.840 | per pound of body weight every day.

00:03:59.360 | Not only does that protein provide critical building blocks

00:04:01.860 | for things like muscle repair and synthesis,

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00:05:00.960 | Today's episode is also brought to us by Levels.

00:05:03.880 | Levels is a program that lets you see how different foods

00:05:06.480 | and activities affect your health

00:05:08.240 | by giving you real-time feedback on your diet

00:05:10.400 | using a continuous glucose monitor.

00:05:12.640 | One of the most important factors in both your short

00:05:14.720 | and long-term health is your body's ability

00:05:16.880 | to manage glucose, or what's sometimes called blood sugar.

00:05:20.040 | To maintain energy and focus throughout the day,

00:05:22.180 | you want to keep your blood glucose steady

00:05:24.200 | without big spikes or crashes.

00:05:26.580 | I started using Levels about three years ago

00:05:28.640 | as a way to understand how different foods

00:05:30.360 | and activities impacted my blood glucose levels.

00:05:33.320 | And it's proven incredibly informative for me

00:05:35.780 | in determining what food choices I make,

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00:06:32.780 | Now I've spoken many times before on this and other podcasts

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00:07:37.300 | And now for my discussion with Dr. Gabrielle Lyon.

00:07:40.580 | Dr. Gabrielle Lyon, welcome.

00:07:43.020 | - Thank you so much.

00:07:44.980 | - So great to have you here.

00:07:46.500 | You have a tremendous range and depth of expertise.

00:07:51.460 | You treat men, you treat women.

00:07:54.260 | You know a ton about exercise, physiology, nutrition.

00:07:57.920 | You've done work in psychiatry.

00:08:01.740 | You've done work in geriatrics.

00:08:03.820 | You know so very much about how to get healthy

00:08:07.860 | and stay healthy.

00:08:09.020 | And today we're gonna talk about all of that.

00:08:12.620 | To kick things off,

00:08:13.460 | I would love to dive into your take

00:08:16.380 | on this unique aspect of our physiology

00:08:20.220 | that most people, when they hear about,

00:08:22.220 | think about weight training or maybe bodybuilding

00:08:27.020 | or have some immediate reaction to,

00:08:29.780 | but you have a different stance

00:08:32.540 | on this incredible organ that we call muscle.

00:08:36.820 | So if you would just tell us

00:08:39.100 | how you look at this thing that we call muscle.

00:08:41.940 | In men, in women, in kids, in old people, young people,

00:08:45.140 | how should we think about muscle?

00:08:47.060 | - Well, first of all, muscle is the organ of longevity.

00:08:50.180 | And we've always thought about muscle,

00:08:52.380 | just as you said, when it comes to exercise,

00:08:55.140 | performance, mobility, and strength,

00:08:57.060 | which by the way,

00:08:57.900 | all of those things are important and critical for life.

00:09:02.180 | But there's something very unique

00:09:04.020 | and special to skeletal muscle.

00:09:05.660 | First of all, it's an organ system.

00:09:07.900 | It's an endocrine organ.

00:09:09.620 | It is responsible for a large component of glucose disposal,

00:09:13.860 | roughly 80% of glucose disposal.

00:09:15.980 | And we all hear about these things

00:09:17.740 | like cardiovascular disease, type 2 diabetes, obesity.

00:09:21.840 | Largely, many of these metabolic diseases

00:09:26.500 | begin in skeletal muscle, decades before.

00:09:28.860 | - Interesting.

00:09:30.060 | - Skeletal muscle is also an amino acid reservoir.

00:09:33.140 | It is the place that your body pulls from amino acids.

00:09:36.540 | And that is something that changes as we age,

00:09:40.420 | this idea of protein turnover,

00:09:42.060 | and we require healthy skeletal muscle.

00:09:43.860 | Of course, it's the body armor that we all know,

00:09:47.020 | and it is really responsible for how we age.

00:09:50.980 | And by the way, I came to this understanding

00:09:54.220 | through an experience I'd love to share with you.

00:09:57.460 | I did my fellowship in geriatrics and nutritional sciences.

00:10:00.740 | And at the time, we were looking at,

00:10:03.140 | every fellow has to have a project, lucky for us.

00:10:06.420 | And we were looking at body composition and brain function.

00:10:10.140 | And there was one patient who I just adored.

00:10:12.940 | She was a mom of three kids,

00:10:15.100 | and she had always yo-yo dieted.

00:10:17.920 | We imaged her brain,

00:10:19.180 | and her brain looked like the beginning

00:10:21.020 | of an Alzheimer's brain.

00:10:22.180 | And I thought to myself, and I felt very responsible,

00:10:27.060 | thinking, why was this woman who was doing everything

00:10:31.260 | that we told her to do, she was exercising,

00:10:34.340 | she was eating a low-fat, high-carbohydrate diet,

00:10:38.180 | why was she so metabolically unhealthy?

00:10:41.240 | And I realized that at the end of the day,

00:10:44.340 | it wasn't that she was over fat,

00:10:46.220 | it was that she was under-muscled.

00:10:48.020 | And we spend decades, and have spent decades,

00:10:51.660 | trying to treat obesity,

00:10:53.720 | when really what we need to be looking at

00:10:55.340 | is skeletal muscle.

00:10:57.420 | - Super interesting.

00:10:59.460 | We know that the brain is among

00:11:01.460 | the most metabolically active organs in the body,

00:11:04.220 | and muscle too,

00:11:05.460 | one of the most metabolically active organs in the body.

00:11:07.580 | You'll probably tell me that one is more active

00:11:09.660 | than the other.

00:11:10.500 | Which one is it?

00:11:11.320 | - Muscle's actually, quite frankly,

00:11:12.380 | not very metabolically active at rest.

00:11:14.000 | - Interesting.

00:11:14.840 | - For every pound of skeletal muscle,

00:11:16.500 | it might at rest burn 10 calories.

00:11:19.040 | Primarily burns fatty acids at rest.

00:11:22.020 | - Okay, I learned something new,

00:11:23.380 | and I imagine many other people did as well.

00:11:25.760 | So this woman that was overweight,

00:11:27.780 | you looked at the problem through a different lens,

00:11:32.100 | that she's under-muscled.

00:11:33.440 | How does one go from being under-muscled

00:11:37.200 | to properly muscled?

00:11:38.460 | And what is that?

00:11:39.660 | And as I say this,

00:11:40.560 | I realized that many of our listeners

00:11:43.020 | probably don't resistance train.

00:11:45.560 | Or if they do,

00:11:46.980 | they may not want to carry a lot of muscle,

00:11:50.060 | thinking that that would make them

00:11:52.520 | have to buy a new wardrobe.

00:11:54.220 | Certainly some of our listenership

00:11:55.420 | probably wants to gain more muscle,

00:11:56.740 | but is-

00:11:57.700 | - Or a new wardrobe, I'm sure.

00:11:58.540 | - Or a new wardrobe.

00:11:59.380 | Is there a way to view increasing muscle mass

00:12:04.280 | in a way that is compatible with kind of,

00:12:08.140 | I don't know, like traditional aesthetics

00:12:10.860 | or with overall health

00:12:13.700 | in a way that's sort of distinct

00:12:15.940 | from quote-unquote bodybuilding?

00:12:17.540 | I mean, again, as soon as we talk about muscle,

00:12:19.660 | we think about slabs of meat

00:12:21.340 | added to different parts of our body.

00:12:22.800 | And surely certain people probably want to add muscle

00:12:25.900 | to certain parts of their body for aesthetic reasons.

00:12:27.720 | But how should we think about muscle

00:12:30.040 | in the context of some of the to-dos

00:12:33.160 | in terms of nutrition and exercise?

00:12:34.640 | And we'll segue into that.

00:12:36.000 | Again, how should we conceptualize this business

00:12:38.180 | of being under-muscled and getting to,

00:12:40.680 | I guess what we call appropriately muscled?

00:12:42.720 | - I think that it's a really good point,

00:12:44.720 | this idea of being appropriately muscled.

00:12:46.520 | So the truth is I can't tell you

00:12:48.920 | how much skeletal muscle mass you should have

00:12:50.880 | for optimal health.

00:12:52.560 | I don't know how much skeletal muscle mass

00:12:54.320 | I should have for optimal health.

00:12:55.960 | We haven't done a good job in the literature

00:12:58.220 | and just as a population being able to track skeletal muscle

00:13:02.960 | and know what is optimal.

00:13:04.680 | We are really good at looking at body fat

00:13:06.920 | and we're really good at looking at bone.

00:13:09.140 | But when it comes to skeletal muscle,

00:13:11.220 | DEXA is an extrapolation.

00:13:13.400 | So for example, we use DEXA as the gold standard.

00:13:16.920 | And I'm gonna come back to what we need to do

00:13:19.320 | to gain healthy skeletal muscle.

00:13:21.520 | But I think that it's really important

00:13:23.120 | to put things into perspective

00:13:24.920 | and a framework for how we think about things.

00:13:28.160 | We traditionally use DEXA.

00:13:31.800 | DEXA looks at bone

00:13:34.040 | and it looks at lean tissue collectively.

00:13:36.680 | Part of lean tissue is skeletal muscle mass.

00:13:39.780 | It doesn't determine the health of skeletal muscle mass.

00:13:42.280 | It doesn't determine anything

00:13:43.480 | about the quality of that tissue.

00:13:45.520 | It purely looks at lean tissue,

00:13:47.720 | which then we determine part of that lean tissue,

00:13:49.960 | maybe it's 40% is skeletal muscle.

00:13:52.960 | And that's important to understand

00:13:54.680 | as we begin to frame up the conversation

00:13:57.140 | as how much skeletal muscle should I have?

00:13:59.720 | I have no idea.

00:14:01.240 | But what I can tell you

00:14:02.740 | is that if I were to look at your blood work

00:14:05.000 | and I saw something like elevated triglycerides

00:14:08.260 | or elevated insulin or elevated glucose,

00:14:12.160 | I would begin to understand

00:14:13.800 | that the health of your skeletal muscle

00:14:15.840 | isn't where it should be.

00:14:17.720 | And by the way, the health of skeletal muscle mass

00:14:20.680 | begins when we're young.

00:14:22.920 | This idea of sarcopenia,

00:14:24.320 | which for the listener or the viewer,

00:14:27.160 | the definition of sarcopenia,

00:14:29.200 | by the way, became a disease.

00:14:31.080 | It wasn't even classified as a disease till 2016.

00:14:34.280 | - Wow.

00:14:35.120 | - Yes, wow, which is very recent for a disease.

00:14:39.320 | It is a decrease in muscle mass and function.

00:14:44.080 | But interestingly, we don't necessarily know

00:14:46.600 | what one should have.

00:14:47.560 | So I think it's important to understand

00:14:49.280 | that when we're talking about the health of skeletal muscle,

00:14:51.900 | we're still pretty much in the infancy

00:14:54.000 | of understanding the trajectory

00:14:57.080 | of where it is and where it's going.

00:14:59.480 | So when we think about how we maintain

00:15:01.160 | the health of skeletal muscle,

00:15:02.480 | one of the things that I didn't mention

00:15:04.080 | is that skeletal muscle is a nutrient-sensing organ.

00:15:07.040 | It is uniquely sensitive to the quality of our diet.

00:15:12.840 | The quality of our diet defined as the quality

00:15:16.160 | of the amino acids that we're gaining.

00:15:18.480 | And that would be, for the listener, dietary protein.

00:15:21.720 | Skeletal muscle is sensitive

00:15:23.800 | to one of the amino acids, leucine.

00:15:26.120 | And depending on the quality of the diet,

00:15:28.480 | meaning how much leucine that you're getting

00:15:30.000 | in any given meal, will then stimulate muscle health.

00:15:33.680 | - Not just muscle size, but muscle health.

00:15:35.680 | - Muscle health.

00:15:36.600 | And the way that we think about muscle health is by proxy,

00:15:39.880 | is this concept called muscle protein synthesis,

00:15:43.400 | which we can measure.

00:15:44.820 | And when we get a dietary protein amount,

00:15:48.620 | which is between 30 and 50 grams of high-quality protein,

00:15:53.200 | it stimulates skeletal muscle.

00:15:54.760 | - So I love this idea of focusing for a bit

00:15:59.240 | on muscle protein health,

00:16:01.520 | because it divorces us from this conversation,

00:16:03.620 | at least temporarily, about muscle size,

00:16:06.440 | which I have to imagine is correlated,

00:16:08.800 | but it's a separate thing altogether.

00:16:10.840 | Actually, I should just ask the question,

00:16:12.120 | is it possible for somebody to have a lot of muscle,

00:16:14.900 | but their muscle health is poor?

00:16:17.320 | - Yes.

00:16:18.240 | - Okay, conversely, can somebody have a moderate

00:16:20.920 | to low amount of muscle, but their muscle quality is high,

00:16:24.480 | or is that less common?

00:16:26.040 | - Well, the first thing that you said

00:16:28.480 | is absolutely something that we see,

00:16:30.640 | is that in an individual that carries a lot of muscle

00:16:34.560 | and say they're inactive,

00:16:35.720 | there is a big discussion about how heavy individuals

00:16:40.440 | will have more muscle mass.

00:16:42.200 | But what we have to recognize

00:16:43.400 | is the health of that skeletal muscle is fat deposition

00:16:46.320 | can be visceral fat deposition, fat around the organs,

00:16:50.040 | and it can be also fat infiltrate into the tissue,

00:16:53.360 | like, not to gross anyone out, a marbled steak.

00:16:56.600 | And that's exactly what can happen

00:16:58.120 | to unhealthy skeletal muscle,

00:17:00.360 | which then affects its ability to contract,

00:17:03.060 | which also affects,

00:17:04.200 | there's a ton of mitochondria in skeletal muscle.

00:17:06.080 | It affects the efficiency of skeletal muscle.

00:17:08.680 | So yes, someone can have potentially more muscle,

00:17:11.760 | but more unhealthy muscle.

00:17:13.680 | - Interesting, when you say a marbled steak,

00:17:16.520 | I think at the extreme, like a Wagyu, a raw Wagyu,

00:17:20.760 | it looks like there's as much white fat in it

00:17:23.440 | as there is red meat in it.

00:17:25.700 | And it's a very different taste and texture.

00:17:28.320 | So that's what we're talking about.

00:17:29.560 | My understanding is those cows don't move around much.

00:17:33.520 | They're somewhat sedentary compared to say,

00:17:35.760 | a free range grass eating cow.

00:17:38.200 | Is that right? - Yeah.

00:17:39.040 | - Okay. - That's absolutely correct.

00:17:40.480 | - Okay, so we want quality, healthy muscle,

00:17:43.800 | and then we can talk about muscle amount.

00:17:46.120 | - And then the other thing that I'll say about it

00:17:47.840 | is part of what defines muscle health

00:17:51.520 | is that flux, that movement.

00:17:53.060 | So if you were to think about skeletal muscle

00:17:55.240 | like a suitcase and an individual was say,

00:17:58.680 | going on a trip for four days,

00:18:00.420 | but chooses to eat or pack for 30 days.

00:18:04.300 | - We know these people. - Yes, I know.

00:18:05.500 | I may be one of them.

00:18:06.500 | I have my suitcase here.

00:18:07.740 | I was only coming in for a day,

00:18:09.780 | but I may have packed for four days.

00:18:12.100 | Not sure what I was doing, but that's besides the point.

00:18:15.660 | When an individual is overeating calories,

00:18:18.340 | overeating carbohydrates,

00:18:20.180 | I had mentioned earlier that skeletal muscle,

00:18:22.200 | one of its primary roles is glucose disposal.

00:18:25.020 | And I'm sure we're gonna get

00:18:25.860 | in the mechanisms of glucose disposal,

00:18:27.660 | whether it's insulin dependent or insulin independent,

00:18:31.380 | depending on if someone is moving

00:18:32.780 | or contracting that muscle.

00:18:34.460 | When an individual is eating food, carbohydrates,

00:18:38.740 | it gets stored in skeletal muscle as glycogen,

00:18:42.620 | because as we know,

00:18:43.740 | glucose at a high level is toxic to the body.

00:18:46.980 | So the body must move glucose out of the bloodstream

00:18:49.880 | into the cells.

00:18:51.700 | Now, what happens is there becomes this stasis.

00:18:57.180 | So if an individual is inactive and not exercising,

00:19:01.540 | then that skeletal muscle becomes overpacked.

00:19:05.540 | Skeletal muscle at rest burns primarily free fatty acids,

00:19:08.900 | which is interesting.

00:19:09.860 | Most people think about skeletal muscle

00:19:11.620 | as burning carbohydrates,

00:19:13.340 | but actually at rest, skeletal muscle burns fatty acids.

00:19:16.460 | As you can imagine, when that muscle is full

00:19:20.100 | and you are not exercising it,

00:19:21.940 | then the substrates have nowhere to go

00:19:24.980 | and it remains in the bloodstream.

00:19:26.820 | And that would be a sign of unhealthy skeletal muscle,

00:19:29.140 | which then loops back to what you see in blood work.

00:19:32.100 | - Elevated insulin, elevated blood glucose.

00:19:35.620 | - Elevated free fatty acids,

00:19:37.060 | elevated branched chain amino acids,

00:19:39.420 | all of these things, which again,

00:19:41.740 | as skeletal muscle, as the metabolic sink,

00:19:43.580 | have nowhere to go.

00:19:45.140 | - So I'm starting to get a picture

00:19:46.620 | where in order to have healthy muscle,

00:19:49.380 | we need to think about the feeding of that muscle,

00:19:52.460 | the providing of nutrients to that muscle, that is,

00:19:55.820 | as well as the use of that muscle.

00:19:58.420 | Let's start with the feeding

00:20:00.540 | or the providing of nutrients to that muscle.

00:20:02.140 | You mentioned that muscle at rest mainly burns fatty acids.

00:20:05.380 | It can store glycogen.

00:20:06.980 | How do we know when a muscle is full of glycogen?

00:20:10.820 | I mean, there's the visual representation

00:20:13.620 | of the muscle seems fuller as opposed to flatter,

00:20:16.660 | but these are not specific

00:20:19.300 | or these are not precise terms.

00:20:23.380 | How much carbohydrate does it take

00:20:24.940 | to fill all the muscle of the body with glycogen?

00:20:27.940 | And then what sorts of things perhaps deplete that?

00:20:31.900 | - I think it's a great question.

00:20:32.900 | We know that when we're talking about glycogen,

00:20:36.020 | the liver stores glycogen, maybe a hundred grams,

00:20:38.540 | and then skeletal muscle, depending on your size,

00:20:41.060 | for example, you might store much more muscle glycogen,

00:20:45.020 | whether it's four or 500 grams

00:20:46.580 | compared to someone who is my size.

00:20:48.820 | - And can we do the standard conversion

00:20:50.580 | of four calories per gram?

00:20:51.820 | So if the liver is 400 grams,

00:20:54.020 | we just say, okay, there's about 1,600 calories worth

00:20:57.340 | of energy there.

00:20:59.340 | So if I go out and I do some exercise

00:21:02.380 | and burn 1,600 calories over time,

00:21:04.140 | does that mean that the liver is then completely depleted?

00:21:07.460 | - So, well, the liver will deplete

00:21:10.340 | through an overnight fast.

00:21:11.260 | So the liver maintains blood glucose.

00:21:13.980 | So skeletal muscle doesn't maintain blood glucose directly.

00:21:17.100 | The way that you would leverage muscle glycogen

00:21:20.620 | would be through exercise.

00:21:22.620 | The way in which you would deplete muscle glycogen

00:21:24.580 | would be through more intensive exercise.

00:21:29.060 | And when you think about the foods

00:21:31.720 | and the way in which, you know,

00:21:33.020 | your original question is how would we know

00:21:35.340 | how much muscle glycogen or how much we need to refuel?

00:21:39.060 | I typically think about it as overall activity levels.

00:21:41.620 | So if someone is sedentary,

00:21:44.220 | then the current recommendation for carbohydrates

00:21:47.180 | would be 130 grams per day.

00:21:49.780 | - At four calories per gram.

00:21:51.020 | - At four calories per gram.

00:21:52.380 | - And is that both simple and complex carbohydrates,

00:21:55.020 | fibrous carbohydrates?

00:21:55.940 | - Yes, it would just be overall.

00:21:58.020 | - 130 grams, if they're completely sedentary.

00:22:00.220 | - Yes.

00:22:01.060 | - So just a little bit of walking,

00:22:02.060 | getting up, going to the computer,

00:22:03.580 | to the bathroom, to the car, et cetera,

00:22:05.340 | but basically sedentary.

00:22:06.300 | - Yes, and the average American

00:22:08.620 | takes in 300 grams of carbohydrates a day.

00:22:11.860 | So more than double.

00:22:12.980 | And as you can imagine, this can distort metabolism.

00:22:19.180 | When we think about glucose disposal,

00:22:21.020 | the way in which I think about glucose disposal,

00:22:23.020 | if an individual is sedentary,

00:22:24.500 | is thinking about how many carbohydrates

00:22:27.980 | an individual can ingest at one time

00:22:30.900 | that would mitigate insulin response

00:22:34.060 | and would be able to be disposed of safely.

00:22:37.060 | And that number is between 40 and 50 grams

00:22:39.780 | of carbohydrates at a meal outside of exercise.

00:22:44.380 | The rest of carbohydrates would be earned through exercise.

00:22:48.700 | And through every hour of exercise,

00:22:51.180 | depending on the intensity,

00:22:53.140 | that could be between 40 to 70 grams,

00:22:56.700 | depending on how intense an individual exercises.

00:22:59.860 | And that would be safely disposed of in a two-hour period.

00:23:04.340 | I mean, when you think about an oral glucose tolerance test,

00:23:07.620 | that's a 75-gram load.

00:23:09.540 | You assume within two hours

00:23:11.620 | that that blood sugar regulation

00:23:13.300 | should come back to a normal range.

00:23:16.580 | - So at 40 to 50 grams of carbohydrate every two hours,

00:23:20.820 | does that mean that if somebody were to eat

00:23:23.420 | 40 to 50 grams of carbohydrates every two hours-

00:23:26.220 | - Which they shouldn't.

00:23:27.060 | - Which they shouldn't, right.

00:23:28.260 | But because you're gonna quickly exceed

00:23:30.180 | that 130 grams per day.

00:23:32.100 | And even if exercising with resistance training,

00:23:34.780 | say hard for an hour,

00:23:37.540 | which can afford somebody maybe, what,

00:23:40.220 | another couple hundred, 300 grams of carbohydrates?

00:23:43.460 | - Probably not that much.

00:23:44.580 | - Okay.

00:23:45.420 | So I think that if people care about body composition,

00:23:48.900 | which I would say everyone should,

00:23:51.700 | because you want to have an appropriate level of body fat

00:23:55.180 | and healthy skeletal muscle,

00:23:57.180 | then you wouldn't necessarily,

00:23:58.900 | unless you're doing some kind of cardiovascular activity,

00:24:01.980 | you're not using a ton of muscle glycogen,

00:24:04.940 | depending on how much you're training.

00:24:07.020 | - And how much glycogen is the brain using?

00:24:10.580 | - So that is a good question.

00:24:13.100 | The brain uses a lot of carbohydrates.

00:24:17.420 | That would be a primary source.

00:24:19.660 | When they come up with the numbers of 130,

00:24:22.540 | it's really based on brain and then the rest of the body.

00:24:26.300 | - Can we safely say that for somebody that's thinking a lot,

00:24:29.420 | they need more carbohydrates?

00:24:31.860 | - You could say that.

00:24:32.900 | Then your brain, yes,

00:24:33.860 | your brain is very metabolically active.

00:24:35.940 | - Interesting.

00:24:36.980 | So we're gonna drawing rough estimates,

00:24:40.740 | not knowing people's body weight,

00:24:42.620 | not knowing their body composition,

00:24:43.920 | but what I'm arriving at here is,

00:24:46.300 | if somebody does a little bit of cardiovascular training,

00:24:49.260 | maybe a little bit of light resistance training,

00:24:51.260 | I'm describing the activities of many people out there,

00:24:54.820 | maybe 250 grams of carbohydrates,

00:24:57.020 | you're kind of at the threshold.

00:24:58.500 | - That's a lot.

00:24:59.420 | - That's a lot for calories per gram of those carbohydrates.

00:25:04.060 | And so let's say 200 grams of carbohydrates per day,

00:25:07.740 | but that's not a ton of calories overall.

00:25:11.100 | So what should the remainder of the calories be made up of?

00:25:14.060 | - So, I think what we're really talking about here

00:25:16.340 | is how do we design a nutrition plan

00:25:19.140 | for people to have healthy skeletal muscle?

00:25:21.780 | And if I were to say, okay,

00:25:23.700 | what are we thinking about for the listener

00:25:26.140 | or for the people out there?

00:25:27.940 | They're thinking,

00:25:29.140 | I really wanna have a healthy body composition

00:25:32.240 | and healthy skeletal muscle mass.

00:25:34.060 | The way in which they would do that is,

00:25:36.040 | number one, you have to prioritize dietary protein.

00:25:39.180 | So we're talking about carbohydrates here,

00:25:41.220 | but carbohydrates shouldn't be the primary focus.

00:25:44.580 | Nobody has challenges getting carbohydrates in.

00:25:47.020 | 130 grams would be a safe recommendation

00:25:49.420 | if someone is overweight or struggles with type two diabetes

00:25:53.320 | or any of these other metabolic conditions,

00:25:56.060 | there is evidence to support a lower carbohydrate intake.

00:25:59.260 | - I mean, 130 grams is one little micro packet of pretzels

00:26:04.140 | on an airplane ride, you know?

00:26:06.360 | - That actually has probably closer

00:26:07.840 | to 37 grams of carbohydrates.

00:26:10.080 | - Okay, good.

00:26:10.920 | - Not that I had a pretzel packet before

00:26:12.400 | or threw one at Rob on the way in, but no.

00:26:14.640 | - Right, okay, so I'm way off there.

00:26:16.840 | So they have one of those, a bagel in the morning

00:26:23.440 | and they shouldn't, but they do.

00:26:26.360 | And then they have some pasta at dinner.

00:26:29.440 | And so most people are probably exceeding

00:26:30.840 | that 130 grams by a huge margin.

00:26:33.240 | - Yes, they are.

00:26:34.300 | And there's a couple of things there

00:26:36.880 | that it's really important that you said,

00:26:38.620 | is that individuals, when we're thinking about designing

00:26:40.780 | a plan for skeletal muscle health,

00:26:43.260 | that first meal is most important.

00:26:45.780 | That first meal of the day, having dietary protein,

00:26:48.740 | will set you up metabolically for the rest of the day.

00:26:51.380 | - And when you say first meal,

00:26:52.740 | and we'll talk a little bit later

00:26:53.840 | about intermittent fasting.

00:26:54.980 | And I, for instance, eat my first meal at usually 11 a.m.

00:26:58.660 | It's just kind of how I'm wired.

00:27:00.740 | I've never wanted to eat breakfast first thing.

00:27:02.380 | I've forced myself to eat some eggs first thing

00:27:04.320 | in the morning from time to time and it felt fine.

00:27:07.680 | But do you recommend that people eat a true breakfast,

00:27:12.040 | like within a certain number of hours of waking up

00:27:13.760 | for sake of muscle health and metabolic health?

00:27:18.600 | - When we think about that first meal,

00:27:21.560 | I frankly don't care when you have it.

00:27:23.520 | One also has to understand

00:27:25.080 | that you're coming out of an overnight fast.

00:27:27.440 | If you are young and healthy,

00:27:29.280 | then the timing of that first meal likely doesn't matter.

00:27:32.200 | Because you are robust,

00:27:34.640 | your body is very efficient and capable

00:27:38.480 | to withstand protein degradation.

00:27:43.480 | It's able to withstand protein degradation

00:27:45.980 | and protein turnover, which is ultimately why we're eating.

00:27:49.820 | So that's one reason why we're eating.

00:27:51.140 | And we'll talk a little bit more about that.

00:27:53.460 | That first meal of the day, if you are young and healthy,

00:27:57.180 | the timing doesn't really matter.

00:27:58.860 | And I would say when it begins to matter

00:28:01.460 | is when you're older.

00:28:02.740 | When you are in your 60s,

00:28:05.740 | fat continuing to fast may be a negative,

00:28:08.500 | negative for muscle health.

00:28:10.580 | That first meal of the day is important

00:28:14.180 | because we know that when you get

00:28:16.180 | between 40 and 50 grams of protein,

00:28:18.020 | that first meal of the day,

00:28:19.720 | you stimulate muscle protein synthesis.

00:28:22.180 | Muscle protein synthesis is by proxy

00:28:24.340 | what we use to measure

00:28:25.780 | as a marker for overall muscle health.

00:28:29.040 | Now there's a lot of history here

00:28:30.980 | when we think about designing a meal plan.

00:28:34.180 | That first meal has between,

00:28:36.360 | we'll say give it between 30 to 50 grams of dietary protein.

00:28:41.360 | That will do a number of things.

00:28:42.960 | Number one, it will stimulate skeletal muscle,

00:28:45.260 | what we would consider the health of skeletal muscle.

00:28:47.740 | It also will affect the brain.

00:28:49.540 | It'll improve satiation.

00:28:51.140 | You and I were talking previously.

00:28:52.780 | It releases a handful of gut peptides.

00:28:57.420 | - Like glucagon-like peptide one,

00:28:59.460 | which later we'll talk about. - GLP, yes, GLP.

00:29:01.280 | - Ozempic mongero, but yeah. - CCK, PYY,

00:29:04.100 | things that will affect appetite for that second meal.

00:29:09.100 | And there's some very interesting research

00:29:11.420 | out of Heather Leidy's lab.

00:29:12.620 | And basically, when she put individuals,

00:29:15.600 | younger adolescents, on a meal of 30 to 40 grams of protein,

00:29:20.600 | they were much less likely to choose, say, donuts

00:29:24.860 | or something outside of what we would consider

00:29:28.900 | a healthy nutrition plan.

00:29:30.620 | - Later in the day or in the same meal?

00:29:32.140 | - Later in the day.

00:29:33.180 | So it was essentially augmenting their willpower.

00:29:36.220 | - Okay, so it sounds like for young people,

00:29:37.980 | they can delay breakfast if they want.

00:29:39.580 | For older people, probably not.

00:29:40.940 | But that the first meal of the day should include

00:29:43.340 | what you're calling dietary protein, 30 to 50 grams.

00:29:46.860 | And maybe we should talk about the quality of that protein.

00:29:50.420 | Because I think a lot of people understand

00:29:52.860 | that there are meat proteins, there are plant proteins.

00:29:55.880 | How important is the quality of that protein?

00:29:59.320 | - This tends to be a hot topic

00:30:02.360 | and somewhat very controversial.

00:30:03.840 | - Great. - Great for you.

00:30:06.520 | - I know, great for everybody.

00:30:07.680 | I mean, controversy on this podcast

00:30:09.800 | is embraced in the following way.

00:30:13.280 | We state what we know, we state what we don't know,

00:30:16.400 | and we are always happy to return to the conversation

00:30:19.680 | at a future time to adjust any stances based on the data

00:30:23.960 | and how we evolve as people.

00:30:25.780 | - Okay, well, I love that.

00:30:27.700 | Dietary protein, we speak about it as if it's one thing.

00:30:31.960 | But actually, it's 20 different amino acids,

00:30:34.520 | nine of which are essential,

00:30:36.240 | the rest we can generate in our body.

00:30:38.600 | And when we think about skeletal muscle,

00:30:40.880 | we think about the essential amino acids.

00:30:43.900 | And the essential amino acids,

00:30:45.880 | primarily for skeletal muscle health,

00:30:48.200 | are the branch chain amino acids,

00:30:50.000 | leucine being one of those.

00:30:51.700 | So leucine is uniquely stimulating to skeletal muscle.

00:30:56.700 | And when you have enough leucine,

00:31:00.020 | it triggers muscle protein synthesis.

00:31:01.900 | - And when you say stimulating and muscle protein synthesis,

00:31:04.580 | I think a lot of people get a picture

00:31:05.740 | in their mind of a muscle growing.

00:31:07.580 | But you're not necessarily talking about that.

00:31:09.840 | You're talking about the organ that is muscle,

00:31:12.140 | that it's health, it's metabolism being cultivated

00:31:15.620 | so that it can do all the hormone endocrine related things

00:31:18.940 | and the glucose disposal related things

00:31:20.540 | that we'll get into in a bit more detail later.

00:31:22.200 | Is that right?

00:31:23.040 | - Yeah.

00:31:23.860 | And so when you have a breakfast of 30 to 50 grams,

00:31:27.960 | you appropriately stimulate muscle protein synthesis.

00:31:31.320 | And one has to recognize

00:31:33.120 | that if you eat below that threshold,

00:31:36.000 | you do not stimulate the health of that skeletal muscle.

00:31:38.840 | You do not stimulate muscle in a way

00:31:42.740 | that would be necessary for outcomes that matter.

00:31:45.800 | And outcomes that matter are sarcopenia.

00:31:48.200 | Outcomes that matter are body composition,

00:31:50.500 | prevention of obesity.

00:31:52.580 | You must get this nutrition right.

00:31:54.580 | It's the thing that 100% of people do is eat.

00:31:57.580 | - As many of you know,

00:31:58.420 | I've been taking AG1 for more than 10 years now.

00:32:01.320 | So I'm delighted that they're sponsoring this podcast.

00:32:03.780 | To be clear, I don't take AG1 because they're a sponsor.

00:32:06.540 | Rather, they are a sponsor because I take AG1.

00:32:09.660 | In fact, I take AG1 once and often twice every single day.

00:32:13.060 | And I've done that since starting way back in 2012.

00:32:16.540 | There is so much conflicting information out there nowadays

00:32:19.120 | about what proper nutrition is.

00:32:21.300 | But here's what there seems to be a general consensus on.

00:32:24.280 | Whether you're an omnivore, a carnivore,

00:32:26.620 | a vegetarian, or a vegan,

00:32:28.320 | I think it's generally agreed

00:32:29.500 | that you should get most of your food

00:32:31.040 | from unprocessed or minimally processed sources,

00:32:34.040 | which allows you to eat enough, but not overeat,

00:32:36.560 | get plenty of vitamins and minerals,

00:32:38.120 | probiotics, and micronutrients

00:32:40.160 | that we all need for physical and mental health.

00:32:42.580 | Now, I personally am an omnivore,

00:32:44.360 | and I strive to get most of my food

00:32:45.920 | from unprocessed or minimally processed sources.

00:32:48.720 | But the reason I still take AG1 once

00:32:50.680 | and often twice every day is that it ensures

00:32:53.280 | I get all of those vitamins, minerals, probiotics, et cetera,

00:32:57.040 | but it also has adaptogens to help me cope with stress.

00:32:59.880 | It's basically a nutritional insurance policy

00:33:02.160 | meant to augment, not replace quality food.

00:33:04.840 | So by drinking a serving of AG1 in the morning,

00:33:07.080 | and again in the afternoon or evening,

00:33:09.120 | I cover all of my foundational nutritional needs.

00:33:11.720 | And I, like so many other people that take AG1,

00:33:14.440 | report feeling much better in a number of important ways,

00:33:17.480 | such as energy levels, digestion, sleep, and more.

00:33:20.620 | So while many supplements out there

00:33:22.040 | are really directed towards obtaining one specific outcome,

00:33:25.200 | AG1 is foundational nutrition

00:33:26.940 | designed to support all aspects of wellbeing

00:33:29.120 | related to mental health and physical health.

00:33:31.640 | If you'd like to try AG1,

00:33:33.040 | you can go to drinkag1.com/huberman

00:33:36.480 | to claim a special offer.

00:33:37.920 | They'll give you five free travel packs with your order,

00:33:40.040 | plus a year supply of vitamin D3K2.

00:33:42.640 | Again, that's drinkag1.com/huberman.

00:33:46.740 | - It's great that we're focusing on muscle

00:33:48.560 | and then referring to obesity,

00:33:50.600 | because I think so many people,

00:33:52.440 | virtually everybody thinks, okay, reduce body fat.

00:33:55.640 | How do you do that?

00:33:56.560 | You get the calories in, calories out equation

00:33:59.020 | in a certain direction.

00:33:59.860 | And by the way, I believe in the law of thermodynamics

00:34:01.940 | and calories in, calories out.

00:34:03.860 | But by focusing on muscle protein synthesis

00:34:07.480 | and muscle health through the ingestion

00:34:09.080 | of quality protein early in the day,

00:34:11.860 | I see that you're entering this

00:34:13.040 | all through a different channel,

00:34:15.040 | but that the end points of reduced body fat, et cetera,

00:34:17.840 | as we'll get into later, one can still arrive there.

00:34:21.240 | So just for practical purposes,

00:34:23.760 | what are some excellent sources of quality protein

00:34:27.720 | for that first meal?

00:34:28.840 | - Well, now the quality of protein

00:34:32.320 | is defined by the amino acid composition.

00:34:35.400 | And typically animal-based proteins have higher quality.

00:34:39.040 | These are hard, fast biological numbers.

00:34:41.300 | The dietary protein in say a steak

00:34:45.800 | is very similar to the protein amino acid in skeletal muscle.

00:34:50.480 | So the quality of the proteins like eggs,

00:34:53.740 | like whey protein, like beef, like poultry,

00:34:56.900 | those compositions are similar

00:34:59.760 | to the human body composition.

00:35:01.940 | So they contain the amino acids in the appropriate ratios

00:35:05.120 | for skeletal muscle health.

00:35:07.440 | Now, plant-based proteins have a different composition

00:35:11.060 | and they have a composition obviously similar to plants.

00:35:14.740 | And one can get enough of the essential amino acids

00:35:18.400 | if the total caloric load of that protein is high enough.

00:35:23.400 | And I think that that's important to recognize

00:35:26.480 | because right now the American diet is 70% plant-based

00:35:31.480 | and we seem to be moving more towards a plant-based diet.

00:35:35.520 | - Is that right? - It is.

00:35:36.360 | - I mean, I know there's sort of a movement toward that.

00:35:37.980 | You hear about plant-based,

00:35:39.040 | but so most people are not eating steak and eggs

00:35:42.100 | for breakfast, we know that.

00:35:43.340 | - Well, most people, when I say 70% plant-based diet,

00:35:46.180 | I'm talking about refined carbohydrates, sugars,

00:35:50.540 | refined oils. - Cereals.

00:35:52.320 | - And when we think about it,

00:35:53.460 | so that 70% of our diet comes from that

00:35:58.460 | where 30% comes from animal-based proteins,

00:36:02.180 | which contain a ton of nutrients

00:36:04.140 | like bioavailable zinc and selenium, B12.

00:36:07.820 | But when it comes to muscle health,

00:36:09.860 | one could, as long as they are thinking about making sure

00:36:14.140 | that the overall protein load is high enough

00:36:17.540 | in that plant-based protein.

00:36:19.780 | For example, one would not choose quinoa as a protein source.

00:36:24.780 | So six cups of quinoa would equal the same

00:36:30.060 | as one small chicken breast

00:36:31.340 | when it comes to an amino acid profile.

00:36:32.780 | So I think one has to be aware that plant-based proteins

00:36:36.160 | typically have carbohydrates that ride along with them.

00:36:39.020 | And that just becomes important

00:36:40.560 | for overall metabolic control

00:36:42.580 | when we think about total caloric load

00:36:44.860 | and total carbohydrates.

00:36:46.640 | Someone could use a rice-pea blend of protein

00:36:49.540 | for that first meal.

00:36:51.060 | That would certainly be sufficient.

00:36:53.180 | Certainly, if someone is geared

00:36:55.900 | towards a more plant-based diet

00:36:57.300 | and doesn't want to consume animal proteins,

00:36:59.780 | that's what I would use.

00:37:00.980 | - Is there any evidence that combining

00:37:04.740 | a high-quality protein with carbohydrate

00:37:07.280 | in that first meal is more or less beneficial

00:37:10.280 | than having the protein alone?

00:37:12.560 | - That's a good question.

00:37:13.800 | I would say that we don't have evidence for that,

00:37:16.480 | that it would be more beneficial,

00:37:17.660 | because the question would be,

00:37:18.500 | what is the benefit that we're looking for?

00:37:21.240 | If the benefit that one is looking for is diversity,

00:37:25.840 | then certainly, because we know carbohydrates

00:37:27.920 | can have fiber, phytonutrients,

00:37:29.600 | if you're gonna combine it with berries,

00:37:31.380 | that could certainly be advantageous.

00:37:33.420 | But not necessary.

00:37:36.160 | What becomes interesting is when we think

00:37:37.880 | about designing a diet, does that second meal matter?

00:37:41.000 | And not to get too technical,

00:37:43.520 | but maybe we could get a little technical here,

00:37:46.240 | is that when you stimulate muscle protein synthesis,

00:37:50.000 | that will last about two to three hours.

00:37:52.360 | Now, the next thing one would think is,

00:37:55.880 | well, I know that I need a certain amount of protein

00:37:58.440 | for overall muscle health.

00:38:00.480 | The amount of protein for overall muscle health

00:38:02.400 | could be anywhere from one gram per pound

00:38:04.800 | ideal body weight to lower.

00:38:07.440 | And when we think about how we are designing a diet,

00:38:11.600 | we have to recognize that the current recommendations

00:38:14.080 | are the minimum to prevent a deficiency.

00:38:16.700 | The way in which diets are designed now,

00:38:20.080 | according to the RDA, is 0.8 grams per kg.

00:38:23.140 | - 0.8 grams of protein per kilogram of body weight.

00:38:26.560 | - Which comes out-- - Total body weight.

00:38:28.160 | - Yes, which comes out to be 0.37 grams per pound.

00:38:31.240 | So if someone was 115 pound female,

00:38:35.160 | that current RDA would be 45 grams of protein.

00:38:39.040 | - Way below what we talked about earlier.

00:38:41.160 | - Right, and these are very important concepts

00:38:44.720 | to understand the foundations

00:38:46.120 | of how we think about dietary protein.

00:38:48.580 | The current RDA, which is a minimum to prevent a deficiency,

00:38:51.720 | is based on nitrogen balance.

00:38:53.600 | Nitrogen balance, and by the way,

00:38:55.240 | the recommendations for protein

00:38:56.720 | that were set in the '80s have not changed,

00:39:00.000 | which means one of two things,

00:39:01.160 | we haven't had new science come out,

00:39:03.360 | or we just haven't recognized the importance of protein.

00:39:07.080 | And I think that it's more likely the latter,

00:39:09.640 | that we have not yet recognized,

00:39:11.640 | even though there's a plethora of data.

00:39:13.760 | And I worked on some of these earlier studies,

00:39:15.520 | which I'll share, I even brought the numbers

00:39:17.680 | to make sure that I said them right,

00:39:19.160 | because this is the Human Lab Podcast.

00:39:22.920 | - Well, I've made numerical errors before on the podcast,

00:39:27.660 | but great that you brought the numbers.

00:39:29.140 | We always try and correct any errors,

00:39:30.480 | but great to be precise the first time, so thank you.

00:39:33.400 | - When we think about how we design a diet

00:39:35.860 | for optimal muscle health is very different

00:39:38.040 | than how we design a diet for, again, just life.

00:39:42.900 | And the two are very different.

00:39:44.920 | The RDA for leucine, which is that essential amino acid,

00:39:48.640 | meaning we cannot make it, we must get it from the diet,

00:39:52.280 | is set at 2.7 grams per day.

00:39:55.200 | - That's a trivial amount.

00:39:56.960 | - That is a trivial amount, and--

00:39:58.960 | - 2.7 grams total per day. - 2.7 per day.

00:40:02.360 | And one must understand that this came

00:40:04.560 | from nitrogen balance studies,

00:40:07.320 | and typically those are young men, 18-year-old men.

00:40:11.140 | That does not support healthy aging

00:40:14.560 | or anyone that is struggling with obesity

00:40:16.400 | or any kind of chronic illness or anything.

00:40:19.800 | And so then when we begin to think,

00:40:21.800 | well, what do we actually need?

00:40:23.360 | The evidence would support two to three times that amount,

00:40:26.440 | closer to nine grams of leucine per day.

00:40:29.560 | - And just to calibrate us, nine grams of leucine,

00:40:33.520 | which again is an essential amino acid

00:40:35.200 | we can only get from food, per day,

00:40:37.420 | what does that equate to in terms of the total amount

00:40:40.660 | of, let's say, egg or steak protein

00:40:42.840 | that one would need to eat in order to ensure that?

00:40:45.200 | Just roughly. - Yes, yes.

00:40:46.660 | Wonderful question.

00:40:47.760 | So there's a meal threshold for skeletal muscle health,

00:40:50.200 | and that meal threshold is a minimum of 30 grams.

00:40:53.680 | Now, that would equal a 4 1/2-ounce steak,

00:40:58.680 | dare I say six eggs, which is a lot of eggs at one time,

00:41:01.800 | or a scoop of whey protein.

00:41:04.160 | Scoop of whey protein might have 18 grams of protein

00:41:07.680 | and 2 1/2 grams of leucine.

00:41:09.720 | Maybe you do a 25-gram whey protein shake.

00:41:13.380 | And that becomes important to understand

00:41:15.000 | because it is a meal threshold amount.

00:41:19.120 | You know, we are talking about,

00:41:21.040 | you know, the reason why I was so excited

00:41:22.280 | to come on this podcast is because I think

00:41:25.080 | that if we can correct our nutrition

00:41:28.500 | and we gear it towards skeletal muscle health,

00:41:31.000 | then we can change the trajectory of aging,

00:41:33.240 | and we can stop focusing on obesity

00:41:34.860 | and really focus on skeletal muscle health.

00:41:36.360 | But the only way that we're gonna do that

00:41:37.680 | is if we get this nutrition right,

00:41:39.660 | because skeletal muscle requires dietary protein.

00:41:43.800 | There's only two main ways

00:41:45.160 | that we can stimulate skeletal muscle,

00:41:47.200 | and that is through exercise,

00:41:48.900 | primarily resistance training, and dietary protein.

00:41:52.340 | And so when we think about how we design a diet,

00:41:55.380 | if you look back at the history,

00:41:57.100 | we have to recognize a handful of things.

00:42:00.020 | Number one, that these essential amino acids,

00:42:03.060 | primarily leucine, is necessary

00:42:05.740 | to trigger muscle protein synthesis, number one.

00:42:08.220 | Number two, that aging impairs the efficiency

00:42:11.740 | of muscle protein synthesis.

00:42:12.860 | - I see, so it's a runaway train.

00:42:14.240 | If you start getting sarcopenia,

00:42:15.740 | if there's obesity and other markers of aging,

00:42:18.400 | I realize obesity can occur at young ages too,

00:42:20.940 | but muscle loss, then basically you're losing muscle quality

00:42:25.360 | aka protein synthesis and other things.

00:42:27.700 | And as a consequence,

00:42:28.580 | it makes it harder to increase muscle quality.

00:42:31.500 | So you have to short circuit this pretty early.

00:42:34.180 | - Yes, and I would even say that we talk about sarcopenia

00:42:37.500 | as a disease of aging,

00:42:39.080 | but I think that there is a youthful phenotype of sarcopenia.

00:42:42.180 | If we define sarcopenia

00:42:43.660 | as decreased muscle mass and strength,

00:42:45.720 | that can easily affect our youth.

00:42:47.700 | You know, we talk about health span.

00:42:49.520 | We talk about lifespan.

00:42:51.060 | There's also muscle span.

00:42:52.880 | And muscle span is this concept

00:42:56.400 | that is really about the skeletal muscle health as we age.

00:43:01.400 | And there's three primary components to that.

00:43:03.820 | That's understanding that skeletal muscle health

00:43:07.140 | begins very early on.

00:43:08.740 | And we're gonna talk about,

00:43:10.460 | 'cause I know that there's parents.

00:43:11.380 | I have two little kids.

00:43:12.220 | So I wanna talk about the amount of protein

00:43:14.440 | necessary for children, of course.

00:43:16.500 | And then as we think about this muscle span,

00:43:19.260 | there is early on, early age,

00:43:21.260 | where you're laying down the foundation,

00:43:23.180 | where you're hopefully training, doing exercise,

00:43:26.120 | just doing movement.

00:43:27.700 | Being sedentary is a disease state in and of itself,

00:43:30.500 | period, end of story.

00:43:32.100 | Being sedentary is not the opposite of activity.

00:43:34.940 | Being sedentary is in and of itself

00:43:37.380 | a disease of inactivity.

00:43:39.620 | Then midlife, we have to maintain the tissue.

00:43:42.860 | We get a peak muscle mass in our 30s.

00:43:46.420 | We get a peak bone mass around the same time.

00:43:49.460 | And then that later half of life,

00:43:52.640 | we have to do everything that we can to maintain that tissue

00:43:55.340 | because of this decrease in efficiency of skeletal muscle.

00:43:58.580 | So skeletal muscle, as a nutrient-sensing organ,

00:44:01.500 | can respond like youthful tissue.

00:44:04.300 | And the way that it responds like youthful tissue

00:44:07.700 | from an amino acid perspective,

00:44:10.220 | just thinking about how we eat to maintain that,

00:44:13.340 | is that when we increase our dietary protein,

00:44:16.320 | so older individuals or individuals as they age

00:44:18.860 | require more protein to then stimulate mTOR.

00:44:22.980 | - So does that mean instead of eating 30 grams of protein

00:44:26.020 | per meal minimum, that people older than say 50, 60,

00:44:31.020 | should eat 40 or 50 grams of protein?

00:44:33.140 | - I would say that that's true.

00:44:35.180 | - Interesting.

00:44:36.060 | - And by the way,

00:44:37.580 | skeletal muscle will mount a youthful response.

00:44:40.340 | The initial work was out of Bob Wolf's lab.

00:44:45.580 | He's an icon in the industry of protein.

00:44:48.400 | He's one of the, can I say grandfathers now?

00:44:51.280 | I mean, that's pretty embarrassing.

00:44:53.240 | And when I think about Bob Wolf and Don Lehman

00:44:55.960 | and these guys, you know, I trained with Dr. Donald Lehman.

00:44:59.400 | You know, these initial studies that we think about

00:45:02.040 | and we take for granted dietary protein,

00:45:04.040 | we think, okay, well, the bros have always known this,

00:45:07.880 | but we have not.

00:45:11.600 | And when you are younger,

00:45:14.320 | there is a somewhat of a linear response.

00:45:17.400 | Let's say a younger individual, still growing,

00:45:22.120 | we'll just call them 10, 12 years old or my children.

00:45:25.680 | I have a three and a four and a half year old.

00:45:27.540 | They will respond with five grams of dietary protein,

00:45:31.560 | 10 grams of dietary protein, 15 grams of dietary protein

00:45:34.920 | versus an older individual will not respond at all to that.

00:45:42.940 | However, that response can be augmented

00:45:47.940 | by increasing the dietary protein at that meal.

00:45:51.800 | So an older individual will respond

00:45:54.240 | like a younger individual by 30 grams of protein,

00:45:59.240 | 30 to 50.

00:46:02.040 | - Later, we're going to talk about supplements,

00:46:03.840 | but I'm very curious.

00:46:05.080 | Is there a place for supplementing leucine

00:46:09.060 | and other branch chain amino acids specifically?

00:46:12.120 | You know, I always assumed that supplementing

00:46:14.280 | with branch chain amino acids was kind of the unique domain

00:46:17.400 | of people, you know, post-exercise,

00:46:19.360 | trying to build more muscle.

00:46:20.420 | But as you're telling me all this,

00:46:22.080 | it seems that adding leucine in powder form to a meal

00:46:27.080 | seems like it would be great for muscle health.

00:46:29.240 | Is that true?

00:46:30.760 | - I would say that we do not add leucine alone

00:46:33.800 | because leucine, isoleucine and valine go hand in hand.

00:46:38.580 | It would not be advisable to add a single amino acid.

00:46:42.260 | The amino acid levels are maintained in the blood.

00:46:46.420 | By adding more of one would have effects on the other.

00:46:50.700 | The way in which I would think about supplementing

00:46:53.420 | essential amino acids and or branch chains

00:46:55.920 | would be if an individual is choosing

00:46:58.560 | to have a lower protein meal.

00:47:00.340 | I remember when I was in residency,

00:47:02.300 | the food choices were not very good

00:47:03.940 | and maybe I had two ounces of fish,

00:47:06.620 | which wasn't enough to bring me up to a threshold.

00:47:08.500 | That would be a place that I would add

00:47:10.020 | in branch chain amino acids or essential amino acids.

00:47:13.620 | That would bring someone's amino acid threshold up.

00:47:17.140 | But we have to understand everything that we're doing,

00:47:20.020 | we should be doing with a purpose.

00:47:22.140 | The idea of just sipping on branch chain amino acids

00:47:25.460 | or just adding amino acids would be the equivalent

00:47:29.060 | of putting a key into a car and trying to turn the car on,

00:47:33.420 | but not having any additional substrate.

00:47:37.160 | So you need the full spectrum of all the amino acids

00:47:40.740 | to affect skeletal muscle health.

00:47:42.660 | - Yeah, well, that's reassuring to hear

00:47:45.020 | because I love the taste of scrambled eggs and steaks.

00:47:47.760 | And I also like tuna and I also like chicken

00:47:50.220 | and I love all those things.

00:47:53.140 | And I have to imagine that as you mentioned before,

00:47:54.900 | there are other things in these quality animal proteins.

00:47:58.460 | Like you mentioned selenium,

00:48:01.900 | you mentioned other perhaps essential fatty acids

00:48:05.240 | and other vitamins that perhaps have something to do

00:48:09.180 | with what the animal ingested during its life

00:48:12.320 | that also benefit muscle.

00:48:14.060 | Is that true?

00:48:15.000 | - It is.

00:48:15.840 | And the big standout to me is creatine.

00:48:18.220 | We know that creatine at five grams of creatine

00:48:21.820 | will affect skeletal muscle,

00:48:23.400 | but 12 grams of creatine affects brain health.

00:48:26.900 | And there's a lot of interesting research coming out

00:48:29.220 | on creatine and brain health.

00:48:33.540 | - Can you remind me the rough amounts of creatine

00:48:37.440 | and say, you mentioned a, let's just,

00:48:39.640 | I mean, I must say a four and a half ounce steak

00:48:41.760 | feels rather poultry to me.

00:48:44.240 | That's probably the size of it.

00:48:45.080 | - Which is a huge meal to me.

00:48:47.680 | - Right, so let's say a six ounce, let's be generous.

00:48:50.280 | A six ounce steak or four scrambled eggs.

00:48:52.940 | I mean, how much creatine are we talking?

00:48:54.640 | Eggs don't have much creatine, right?

00:48:56.120 | - Not much.

00:48:56.960 | And I was just recently looking at this,

00:49:00.040 | the amount of creatine in a pound of steak,

00:49:03.100 | you're gonna cringe, is something like two grams.

00:49:05.760 | - So it's not very much.

00:49:06.600 | - It's not very much.

00:49:07.840 | But when we think about eating foods as in a food matrix,

00:49:11.880 | what you're saying is absolutely true there.

00:49:14.080 | It's interesting, we don't eat single nutrients.

00:49:16.760 | While we think about dietary protein as a single nutrient

00:49:20.320 | and we think about carbohydrates,

00:49:21.480 | but what we really do is we eat mixed meals.

00:49:24.000 | And when we think about that,

00:49:27.160 | the quality of the protein matters.

00:49:29.120 | From a protein perspective,

00:49:31.120 | could you get plant-based proteins and animal-based proteins

00:49:33.880 | and could it be equal?

00:49:34.720 | Yes, it could.

00:49:35.560 | So I wanna be very clear to say

00:49:37.720 | and have a very balanced perspective

00:49:39.340 | that we could get all of our dietary protein

00:49:43.640 | from plants, from plant-based sources.

00:49:46.720 | A few caveats there is that that RDA

00:49:49.440 | that I gave you earlier is based only

00:49:51.160 | on high quality proteins.

00:49:53.340 | And that being the minimum to prevent a deficiency.

00:49:56.160 | If an individual was plant-based,

00:49:57.800 | they would require closer to 1.6 grams per kg,

00:50:01.760 | a higher amount of total protein if it's coming from plants.

00:50:05.400 | And that becomes important to understand.

00:50:07.640 | - Speaking of an ideal world, if you had a magic wand.

00:50:11.640 | - I do.

00:50:12.600 | - What would be the--

00:50:13.680 | - My kids think I do.

00:50:15.120 | - I bet you do.

00:50:16.400 | What would be the amount of protein

00:50:19.360 | that you would have everybody eat?

00:50:22.480 | In terms of a number of grams per pound

00:50:24.920 | or kilogram of body weight.

00:50:25.920 | - That's actually an easy question.

00:50:27.560 | One gram per pound, ideal body weight.

00:50:29.120 | - Total body weight, not lean body weight.

00:50:30.840 | - Ideal body weight, actually.

00:50:32.520 | Where you want to be.

00:50:33.920 | If an individual is 200 pounds

00:50:36.360 | but would prefer to be 150 pounds,

00:50:39.520 | then I would have them eat towards their ideal body weight.

00:50:43.240 | There's no evidence that a higher protein diet

00:50:46.520 | is detrimental to kidney health, to bone health.

00:50:49.800 | And we use these terms loosely, like a high protein diet,

00:50:52.600 | when we have to recognize that 0.8 grams per kg

00:50:56.080 | is a low protein diet.

00:50:57.760 | - So where did the idea come from

00:50:59.120 | that if you eat, say, one gram of quality protein

00:51:02.320 | per pound of ideal body weight,

00:51:04.840 | that you're gonna get gout,

00:51:07.160 | you're going to have liver issues,

00:51:09.720 | you're gonna have all sorts of issues.

00:51:11.160 | Where did that idea come from?

00:51:13.280 | - Frankly, I'm not sure.

00:51:15.160 | But the conversation around dietary protein

00:51:18.040 | has probably been the most controversial.

00:51:20.440 | - Why do you think that is?

00:51:21.480 | I mean, we're not trying to get political here.

00:51:23.440 | I'm just so curious.

00:51:24.280 | - I have some ideas, but I won't share them.

00:51:27.120 | - Okay, that's fine.

00:51:28.440 | - I do feel as if nutrition is not just science.

00:51:33.440 | Nutrition is complicated

00:51:37.200 | because it's something that people tie emotion to,

00:51:40.440 | they tie religion to,

00:51:42.160 | there's a lot that goes into dietary protein

00:51:46.000 | and food recommendations in general.

00:51:48.960 | - But it sounds like we can safely say

00:51:50.960 | that if you eat one gram of protein per pound

00:51:52.680 | of ideal body weight that you're not going

00:51:55.280 | to cause liver damage or get gout

00:51:57.240 | or increase your risk of cancer, right?

00:51:59.400 | My understanding is that even if it comes from red meat,

00:52:01.400 | there's no increase in risk of cancer, is that right?

00:52:03.680 | - Well, here's what I would say to that.

00:52:07.080 | I would say that this idea about red meat and cancer,

00:52:10.560 | number one, we would have to even define

00:52:11.960 | what kind of cancers that we're talking about.

00:52:13.520 | There's many different types of cancers

00:52:15.240 | and there's many different causes.

00:52:17.720 | It would be important to understand what risk factors are.

00:52:21.040 | And a primary risk factor to many cancers is obesity.

00:52:25.000 | The question then becomes how do we design a diet

00:52:29.600 | that mitigates obesity?

00:52:31.640 | The evidence is also very clear

00:52:33.560 | that a more protein forward diet optimizes body composition.

00:52:38.560 | And you combine that with resistance training

00:52:40.840 | and you will see a tremendous amount of change.

00:52:44.000 | I worked on some of these early studies

00:52:45.880 | and I'll share with you some of the early studies

00:52:48.960 | and this came out of Don Lehman's lab

00:52:50.800 | with the University of Illinois.

00:52:52.280 | - Both you and Layne Norton both worked there, yeah?

00:52:54.360 | - Yes.

00:52:55.200 | - Did you overlap them?

00:52:56.040 | - We did.

00:52:56.880 | - Okay, what was he like?

00:52:57.720 | No, I'm just kidding.

00:52:58.560 | - So let's just say he sat in the back of the class

00:53:00.640 | and I sat in the front.

00:53:01.480 | - Okay, all right, there, you heard it.

00:53:03.400 | Shots fired.

00:53:05.120 | - And all kidding aside, Layne, he's like my brother.

00:53:07.680 | We've known each other for 20 some years.

00:53:09.360 | - Yeah, he's a very popular guest,

00:53:11.040 | former guest on this podcast and a very spirited guy.

00:53:13.680 | - And I'd just like to say,

00:53:14.800 | I don't know why his skin looks that good,

00:53:16.320 | but whatever.

00:53:19.840 | So I worked on--

00:53:20.680 | - Love you, Layne.

00:53:21.560 | - I've worked on, yes, we do.

00:53:22.680 | I worked on some of these early studies

00:53:24.120 | and this was, these studies were some of the first studies

00:53:28.200 | to come out about dietary protein,

00:53:31.280 | nutrition and resistance training.

00:53:33.680 | In fact, to my knowledge and to, I think,

00:53:36.800 | the knowledge of many of my colleagues,

00:53:38.460 | this was the first study.

00:53:40.060 | And what it was, it was a 12-month study,

00:53:44.820 | 130 overweight men and women.

00:53:47.680 | So it was robust.

00:53:49.080 | And basically what they did is they had two groups.

00:53:52.840 | One group was a food guide pyramid diet.

00:53:56.760 | So it was 55 grams of carbohydrates,

00:53:59.400 | a RDA of protein, which was 0.8 grams per kg,

00:54:03.560 | and 30% fat.

00:54:06.640 | 30% fat was in both groups.

00:54:08.560 | The second group was 40% carbohydrates.

00:54:11.400 | This is, remember the zone diet, 40/30/30?

00:54:13.960 | - Yeah, I liked that diet.

00:54:15.320 | - Okay, I mean, there's evidence--

00:54:16.840 | - Ish, I mean, I don't follow it anymore,

00:54:18.460 | but I tried it for a little while and--

00:54:20.200 | - And it works great.

00:54:21.040 | And there's some evidence to support

00:54:22.480 | that that is a great ratio for people.

00:54:24.440 | - Coming off the low-fat era of the late '90s,

00:54:27.360 | the zone diet felt like the best thing ever

00:54:31.200 | because it was like, oh, you can enjoy some fats

00:54:33.700 | and wow, your satiety is improved and you get stronger.

00:54:37.520 | You just feel better when you're ingesting

00:54:39.200 | some ideally quality fats.

00:54:41.240 | That's my experience anyway.

00:54:42.080 | - Yes, and also we know that it influences hormonal status.

00:54:45.880 | You don't wanna push fats too low.

00:54:48.560 | So the second group had a 40/30/30 split.

00:54:51.240 | So it was 40 grams of carbohydrates,

00:54:53.560 | 30 grams of protein, 30% fat.

00:54:57.000 | So these are all percentages.

00:54:58.000 | - Yeah, 40%, right.

00:54:59.680 | - Now, we didn't talk so much about the distribution,

00:55:04.460 | but what is really important to understand

00:55:06.440 | is they were isocaloric.

00:55:07.840 | So they both had the same calories.

00:55:09.920 | The difference was the percentage

00:55:11.560 | of where the calories came from and how they were given.

00:55:14.480 | And there was actually four different arms to this.

00:55:18.480 | So there was individuals that exercised

00:55:20.820 | and individuals that didn't.

00:55:22.220 | - Okay, so either zone diet or let's call it,

00:55:24.480 | I hate to say this, but more standard American diet.

00:55:26.320 | - No, it was, and that's how it was designed.

00:55:27.840 | - Standard American versus zone diet.

00:55:29.280 | - Yes, so it was designed that way.

00:55:30.720 | - And then exercising or non-exercising for each of those.

00:55:33.760 | - For this 12-month study.

00:55:35.540 | And by the way, I had to pack a bunch of meals.

00:55:37.880 | It was not pretty, and I had to do urine analysis.

00:55:40.120 | It was terrible.

00:55:41.800 | But anyway, this is besides the point.

00:55:43.760 | So the first group had a protein distribution

00:55:48.440 | of 10 grams in the morning, 15 at lunch, and 45 at dinner.

00:55:53.440 | - And kind of standard American diet.

00:55:56.520 | - So that mirrors-- - Steak for dinner.

00:55:57.840 | - Exactly. - You have some cereal

00:55:58.820 | for breakfast with a little bit of milk,

00:56:00.320 | and then for lunch, like a sandwich.

00:56:01.520 | - Exactly, and so this mirrors what people do.

00:56:05.380 | The other group had 45 grams of protein at that first meal.

00:56:08.620 | - Five, six eggs. - Five, six eggs.

00:56:10.760 | 35 grams of protein at lunch, and 35 grams of protein

00:56:14.980 | at dinner. - So chicken breast

00:56:15.820 | in a salad at lunch with a little piece of toast,

00:56:17.740 | and then at dinner, how much?

00:56:19.380 | - It was 35 grams.

00:56:20.860 | - All right, a piece of fish and some rice and a vegetable.

00:56:23.020 | - But it was an even distribution.

00:56:24.560 | So what you're seeing here is now these meals

00:56:27.300 | are meeting a leucine threshold

00:56:29.660 | of muscle protein synthesis.

00:56:31.500 | Now it's 100, this is collectively 130 individuals,

00:56:34.980 | and they were older.

00:56:37.580 | I think that they were all in their 40s or beyond.

00:56:40.260 | - If we just compare first the groups

00:56:42.420 | that did not exercise, two different diets,

00:56:44.220 | what did they see?

00:56:45.580 | What did you see?

00:56:46.420 | You participated in this study.

00:56:48.040 | - Yes, I did.

00:56:48.880 | - You almost said, "Unfortunately."

00:56:49.700 | - I said, "Unfortunately."

00:56:50.540 | No, I won't.

00:56:52.340 | But what was so interesting is that those individuals,

00:56:56.460 | everybody lost weight.

00:56:57.540 | So the average weight loss, gosh,

00:57:00.100 | I wish I had better handwriting, but I'm a doctor,

00:57:01.780 | and so it's pretty bad.

00:57:04.420 | The average weight loss was 24% greater

00:57:08.060 | in the high protein group.

00:57:09.420 | So they lost 24%.

00:57:11.380 | - And you said it was isocaloric between the two groups.

00:57:13.420 | - That's right.

00:57:14.260 | - But was it subcaloric overall?

00:57:15.180 | - It was. - People were ingesting.

00:57:16.340 | - That's very smart.

00:57:17.300 | Yes, it was 500 calories less.

00:57:20.100 | - Than what they needed to maintain body weight.

00:57:21.820 | - Correct. - Okay, got it.

00:57:22.660 | So 24% more weight loss total.

00:57:25.220 | - Total.

00:57:26.040 | - In the group that distributed their protein evenly

00:57:28.020 | and followed the so-called zone diet, 40, 30, 30.

00:57:30.700 | They lost more fat than the high-carbohydrate group.

00:57:35.700 | So the high-protein group lost a total of 16 pounds

00:57:42.300 | versus the calorie-controlled group lost 11 pounds.

00:57:47.180 | - Of fat.

00:57:48.020 | - Of fat, which is great.

00:57:48.960 | Everyone's at home thinking this is wonderful.

00:57:51.180 | - Isocaloric.

00:57:52.020 | - Isocaloric, but the thing here

00:57:53.780 | is the lean body mass change.

00:57:55.580 | So again, this was done using DEXA,

00:57:58.500 | and we know DEXA only looks at lean body mass.

00:58:01.380 | - You mentioned DEXA earlier.

00:58:02.260 | Just very briefly, how does DEXA work?

00:58:06.260 | Not at a mechanistic level.

00:58:07.700 | What does it look like?

00:58:08.540 | I go into the clinic, am I floating in water?

00:58:10.820 | - No, you're getting scanned.

00:58:11.780 | - I'm holding the paddles.

00:58:12.620 | - Well, you might be because you're Andrew Huberman, but--

00:58:14.780 | - No, no, no, but you hold the paddles

00:58:16.620 | and you're standing outside.

00:58:18.740 | What's it do?

00:58:19.580 | - So DEXA, you just lay on, depending on the machine,

00:58:21.940 | you can just lay on this machine, and it's a dual X-ray,

00:58:24.900 | and it measures bone, fat, and then lean body mass.

00:58:29.900 | - Okay, that's sufficient for this conversation, great.

00:58:31.900 | - So the lean body mass loss,

00:58:35.340 | and again, this is everything other than bone and body fat.

00:58:39.340 | So that was 34%.

00:58:41.500 | - In which group?

00:58:42.540 | - In the standard American diet group,

00:58:45.420 | versus 26% in the high protein group.

00:58:48.460 | Now where it gets fascinating,

00:58:50.620 | so what the big takeaway is,

00:58:53.380 | is understanding that protein had a sparing effect.

00:58:57.820 | - Protein protected muscle, more body fat loss,

00:59:00.980 | at the same caloric amounts.

00:59:03.060 | - Yes.

00:59:04.100 | - Same amount of deficit relative to body weight.

00:59:06.900 | - Right, in this group, exercise was not introduced.

00:59:09.660 | So this was purely the food guide pyramid,

00:59:12.380 | changing protein in the morning,

00:59:16.100 | versus having it at two small meals,

00:59:19.980 | and then having it at dinner.

00:59:21.220 | - And did they emphasize what we're calling

00:59:22.740 | high quality protein?

00:59:23.860 | - They did.

00:59:24.700 | - Okay.

00:59:25.540 | - That is also very important.

00:59:26.360 | - Meat, fish, eggs, chicken, et cetera.

00:59:27.420 | - Yes, they did.

00:59:28.940 | So then this led to another study.

00:59:30.940 | So then the second study was a two by two design,

00:59:33.860 | and this is-

00:59:34.700 | - Oh, sorry, sorry to interrupt.

00:59:35.800 | In that previous study,

00:59:36.940 | what was the effect of exercise between the two groups?

00:59:39.460 | - They didn't do exercise.

00:59:40.300 | - Got it, okay.

00:59:41.120 | - Sorry, that was my fault.

00:59:41.960 | They did not do exercise.

00:59:43.020 | They were just doing whatever it was that they were doing.

00:59:46.980 | But what was so important to understand

00:59:50.140 | was that this set the stage for this idea

00:59:54.660 | that protein had a sparing effect.

00:59:56.900 | And then following that,

00:59:59.600 | the other study,

01:00:02.320 | so then there was a series of a few other studies.

01:00:04.780 | The second study looked at diet and exercise.

01:00:08.660 | So this combined effect.

01:00:09.860 | So this was one of the first studies,

01:00:11.220 | and this was 48 women with a BMI of 33, 46 years old.

01:00:16.380 | So this is your peri post-menopausal woman

01:00:20.220 | who was either in one of four treatment groups,

01:00:23.640 | a low protein group, low protein with exercise,

01:00:26.600 | high protein, high protein with exercise.

01:00:29.960 | The low protein group was defined as the RDA, 0.8 grams.

01:00:34.400 | The high protein group was defined as 1.6 grams, kg.

01:00:38.940 | - So starting to approach that one gram per pound.

01:00:43.060 | - It's about 0.7 grams per pound.

01:00:45.260 | - So starting to get there, but not quite there.

01:00:47.460 | - So this was a 16 weeks study.

01:00:51.780 | And what they found overall

01:00:55.060 | was that the high protein group lost 18% more body fat

01:00:59.420 | and 25% less lean mass overall,

01:01:05.260 | and 12% more total body weight.

01:01:08.260 | And so now we start moving into this synergistic effect

01:01:13.740 | of dietary protein and resistance training.

01:01:16.840 | - And it was the type of exercise

01:01:18.420 | that they perform their resistance training?

01:01:21.100 | - This is the good news.

01:01:22.480 | It didn't take much.

01:01:24.300 | It was five days a week of walking 30 minutes

01:01:27.140 | and two days a week of resistance training

01:01:29.940 | with just body weight.

01:01:31.220 | It was like yoga activity.

01:01:33.100 | - So air squats, down dogs, some warrior poses,

01:01:37.540 | maybe some handstand attempts.

01:01:39.300 | - So yeah, no one is doing handstand.

01:01:41.060 | Rob, are you doing handstands?

01:01:42.100 | No one's doing handstands.

01:01:42.940 | - I've done yoga classes where I look to the sides of me

01:01:45.620 | and people are doing some pretty difficult things.

01:01:47.340 | - Very impressive.

01:01:48.180 | - Some planches and things like that.

01:01:49.180 | - Definitely not me.

01:01:50.020 | Do not invite me.

01:01:50.900 | Life is better this way.

01:01:51.860 | I'm not going to those classes.

01:01:53.060 | But 16 weeks, they did a high protein

01:01:57.800 | with protein and exercise.

01:01:59.740 | Those individuals.

01:02:01.260 | So now, so the study, the group that I just mentioned,

01:02:06.020 | this was dietary intervention alone.

01:02:10.080 | With exercise, high protein plus exercise,

01:02:13.580 | very simple exercise.

01:02:14.780 | So if someone is listening to this and they're thinking,

01:02:17.660 | what can I do to make very practical changes

01:02:20.780 | to massively impact my life outside of hormone replacement,

01:02:24.500 | outside of any super supplement, outside of anything?

01:02:27.740 | Diet and exercise has a dramatic effect.

01:02:30.820 | Those individuals that were doing 1.6 grams per kg,

01:02:35.260 | which is 0.7 grams per pound of body weight plus exercise,

01:02:39.760 | lost 46% more body weight.

01:02:42.720 | That's substantial.

01:02:45.380 | 60% more fat and 40% less fat-free mass

01:02:50.380 | from organs, muscle, whatever that is,

01:02:57.420 | compared to the low protein group plus exercise.

01:03:01.340 | - And was it subcaloric?

01:03:02.500 | Were they below maintenance weight?

01:03:04.740 | - It was.

01:03:05.580 | - So they're eating to ideal body weight,

01:03:08.100 | but still 500 calories or so below

01:03:10.500 | their current caloric needs to maintain body weight.

01:03:13.380 | So I've heard before that when we eat protein,

01:03:17.580 | a certain amount of energy is required

01:03:19.080 | to metabolize that protein.

01:03:21.140 | Can that be translated as the caloric load of protein

01:03:25.780 | is not what it appears to be?

01:03:27.580 | - Yes.

01:03:28.420 | - Let's say that six ounce steak,

01:03:29.820 | I'm making this up,

01:03:30.660 | I'll probably get the numbers badly wrong,

01:03:31.920 | but if it's six ounces of steak,

01:03:35.800 | and maybe that's a, let's just say a 450 calories

01:03:39.680 | or 500 calories,

01:03:40.940 | does that mean that only 400 of those calories

01:03:43.960 | are actually quote unquote utilized?

01:03:46.760 | - What you're talking about is a thermic effect of food,

01:03:48.780 | the thermic effect of feeding.

01:03:49.960 | And that's the idea that certain macronutrients

01:03:53.160 | require a certain percentage of energy

01:03:56.560 | or the energy from those calories to be utilized.

01:04:01.420 | For fat, it's something like 3%.

01:04:04.200 | For carbohydrates, maybe it's 5 to 10%.

01:04:07.440 | And then for protein,

01:04:09.000 | it could be anywhere from 20 to,

01:04:11.280 | I've seen even studies that are at 30%.

01:04:13.660 | - Wow.

01:04:14.500 | - I know, but here is the thing.

01:04:16.120 | It's not that it's the energy that it takes.

01:04:19.280 | So if we were gonna make it simple,

01:04:21.240 | we'll say 100 calories from straight protein,

01:04:24.840 | the body would net 80 calories

01:04:28.160 | because 20% of that energy is being used

01:04:31.520 | for what I would say is muscle protein synthesis.

01:04:35.880 | It's not the handling of nitrogen, it's none of that.

01:04:39.280 | And there's variations in the literature

01:04:41.120 | and the variations come from how an individual doses protein.

01:04:45.280 | So the dosing, depending if you've hit that minimum 30 grams

01:04:48.480 | then you will see a more optimal utilization of protein.

01:04:51.840 | And I think that that's where that number comes from.

01:04:54.360 | It's actually the stimulation of muscle

01:04:58.960 | because that is such an energetic process in and of itself.

01:05:03.240 | - I'd like to take a quick break

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01:06:14.120 | - Slightly tangential question, but I think meaningful

01:06:17.360 | given the context of what we're talking about.

01:06:19.720 | Why is it that if I eat a plate of scrambled eggs

01:06:23.040 | or a steak or a chicken breast and some vegetables,

01:06:25.960 | I feel very sated?

01:06:28.060 | And unless I did some hard resistance training,

01:06:32.000 | I'm kind of good with that.

01:06:33.920 | But that if I eat any of those same foods

01:06:37.160 | and one piece of a baguette or one forkful of pasta,

01:06:42.160 | that then I want a lot more pasta

01:06:44.680 | and I want half the loaf of bread.

01:06:46.520 | Why is that?

01:06:47.680 | Is it the blood glucose response?

01:06:49.320 | Is there something about carbohydrate

01:06:50.840 | at the level of the mouth?

01:06:52.560 | I mean, what is it?

01:06:53.400 | You know, a former guest on this podcast,

01:06:55.640 | Dr. Diego Borges, who studies gut brain sensing,

01:06:59.320 | explained to us, and this is separate from the microbiome,

01:07:01.840 | that we have receptors all along the length

01:07:03.880 | of our gut from our mouth out to the rectum

01:07:06.960 | that are sensing the amino acids

01:07:10.220 | and are looking for those essential amino acids,

01:07:12.520 | but also sensing sugar and things like that

01:07:14.160 | and signaling to the brain about how much more we should eat

01:07:16.480 | of a given food or forage for a given food.

01:07:18.800 | And I just have to say at a psychological level,

01:07:21.320 | subjective level,

01:07:22.160 | there's something so fundamentally different

01:07:24.020 | about eating protein and vegetables

01:07:25.820 | or protein fruits and vegetables

01:07:27.480 | in the absence of starchy carbohydrates.

01:07:31.000 | And when adds starchy carbohydrates

01:07:32.840 | or eat starchy carbohydrates alone,

01:07:34.320 | and it's like, it's not a runaway train,

01:07:36.520 | but it's almost as if like it's never quite enough

01:07:39.360 | until there's a physical volume in the gut

01:07:42.080 | that is like at threshold.

01:07:43.880 | And I don't think I'm alone in this.

01:07:45.240 | You look at the way people eat chips,

01:07:46.600 | you look at the way people eat pasta,

01:07:48.360 | you look at the way people eat risotto,

01:07:50.160 | and it's just different.

01:07:51.080 | I mean, there are a few, you know,

01:07:52.440 | freaks out there that probably two ribeye steaks,

01:07:55.360 | but for most people, a ribeye steak is like enough.

01:07:59.040 | One ribeye is enough.

01:07:59.960 | What is going on there?

01:08:01.240 | And feel free to speculate, but is it amino acid sensing?

01:08:05.000 | And because I think this is really important

01:08:06.780 | because I think as you're suggesting, if I may,

01:08:10.400 | that people prioritize protein

01:08:12.800 | from the first meal of the day and throughout the day,

01:08:15.500 | you know, I think people are imagining,

01:08:17.960 | well, gosh, what happens to my pasta?

01:08:20.320 | What happens to the bread?

01:08:21.480 | What happens to all these things?

01:08:22.760 | And, you know, they're perhaps overlooking the fact

01:08:25.920 | that eating protein, vegetables, and maybe fruit,

01:08:29.200 | maybe a little bit of starch

01:08:30.480 | is just a completely different experience

01:08:33.520 | than eating starch alone or starch in larger volumes.

01:08:38.520 | - Now, I'm gonna speculate here.

01:08:41.160 | The foods that we have access to are highly palatable

01:08:44.360 | and potentially we weren't necessarily designed

01:08:46.920 | to have access to those kinds of foods.

01:08:50.040 | And this kind of moves into this idea

01:08:52.320 | of something called the protein leverage hypothesis.

01:08:55.080 | And the protein leverage hypothesis

01:08:56.600 | is that individuals will continue to eat,

01:08:58.920 | and this is one way people explain obesity,

01:09:02.480 | is that individuals will eat to satisfy an amino acid need.

01:09:07.380 | Now, your original question was,

01:09:08.980 | when we eat carbohydrates or risotto,

01:09:13.400 | there is a component of blood sugar regulation that happens.

01:09:16.040 | So as you go beyond that 50-gram threshold,

01:09:20.120 | you tend to release more insulin.

01:09:23.360 | So there's an insulogenic effect of dietary carbohydrates,

01:09:26.800 | which some people will experience as lower blood sugar.

01:09:30.080 | We've all had that experience where you're,

01:09:32.900 | I mean, not all, but eating your kid's macaroni and cheese,

01:09:37.380 | and then you just can't stop.

01:09:39.300 | And then you probably feel very tired.

01:09:41.540 | There's an ebb and flow of blood sugar.

01:09:45.620 | The interesting thing about dietary protein

01:09:48.260 | is you will hear people say,

01:09:49.960 | I'm gonna reduce my dietary protein

01:09:51.400 | because it's insulinogenic as well.

01:09:53.880 | So dietary protein does cause a phase one insulin release,

01:09:58.060 | and that's preformed insulin in the pancreas.

01:10:01.080 | It is a component for muscle protein synthesis,

01:10:05.640 | but it is roughly 20% of the insulin response

01:10:10.440 | than the same amount of carbohydrates.

01:10:15.000 | And when you eat a meal that is robust in dietary protein,

01:10:20.000 | your body will be able to then generate its own glucose.

01:10:24.760 | Roughly for every 100 grams of protein,

01:10:26.680 | your body will generate 60 grams of glucose

01:10:28.840 | over a period of time

01:10:30.240 | through the process called gluconeogenesis.

01:10:32.760 | And that is one of the benefits of a higher protein diet.

01:10:35.960 | You generate the glucose that you need.

01:10:38.760 | - And can that be converted into glycogen?

01:10:41.040 | - Yes. - Can you repack muscle

01:10:42.440 | that you've depleted? - That is a good question.

01:10:44.180 | The process is very slow, so it's a much slower process

01:10:47.800 | than if you were to have your bread or risotto.

01:10:50.200 | - So you told us about essential amino acids.

01:10:54.400 | Are there any essential carbohydrates?

01:10:56.240 | - No.

01:10:57.680 | - There are essential fatty acids.

01:10:59.160 | - Yeah, there are.

01:11:00.000 | And it's interesting, we're talking about protein.

01:11:03.520 | And as I mentioned before,

01:11:05.520 | we simplified in the way that we talk about it

01:11:08.440 | is it's one thing, but it's 20 different amino acids.

01:11:12.640 | These amino acids each have unique metabolic roles

01:11:16.700 | in the body.

01:11:17.540 | It's not interchangeable.

01:11:19.180 | For example, the essential amino acid,

01:11:21.460 | we'll just pick a brain one, tryptophan,

01:11:23.620 | for serotonin production,

01:11:25.340 | or threonine for mucin production in the gut,

01:11:27.980 | which helps the gut lining,

01:11:29.640 | or take your pick, phenylalanine.

01:11:32.300 | All of these essential amino acids

01:11:35.860 | do various things in the body.

01:11:38.540 | For skeletal muscle,

01:11:40.200 | the primary essential amino acid is leucine.

01:11:43.420 | And while, again, it is very complex

01:11:46.340 | in the way that we would think

01:11:47.340 | about how do we eat enough lysine,

01:11:49.660 | or how do we eat enough methionine,

01:11:52.860 | it's not a great way to think about it

01:11:55.420 | 'cause then things become very complex.

01:11:56.860 | And someone is like, "Well, what do I do?"

01:11:59.220 | But if you eat for the needs of skeletal muscle health,

01:12:02.020 | everything else falls into place.

01:12:04.360 | - My mom is 79 years old.

01:12:07.660 | She's relatively lean.

01:12:10.120 | By my read, I haven't seen her DEXA results,

01:12:14.600 | but she's probably had some muscular atrophy.

01:12:17.000 | She does yoga, she walks, she gardens,

01:12:19.620 | and seems to be in good health, thank goodness.

01:12:23.880 | My guess is she's lost a muscle in the last decades.

01:12:29.800 | If she were to increase the amount of protein,

01:12:32.240 | quality protein that she eats,

01:12:34.240 | especially in that first meal of the day,

01:12:37.100 | would the health of her muscle and her muscle mass change,

01:12:42.100 | even if she does no resistance exercise?

01:12:44.900 | I mean, I suppose she gets a little bit

01:12:45.900 | of resistance training from the yoga,

01:12:48.340 | but I haven't been to a yoga class with my mom, ever.

01:12:50.420 | - You guys aren't doing headstands?

01:12:51.780 | - Definitely not doing headstands.

01:12:52.980 | She's actually, you know, she's very mobile and very sharp,

01:12:56.140 | and very vivacious.

01:12:58.440 | But I don't think she's doing the more, you know,

01:13:04.060 | advanced inversion things at yoga.

01:13:06.440 | So let's assume that she's doing some moderate exercise

01:13:09.280 | three, four times a week, but not training with weights.

01:13:12.220 | If somebody like her, or, you know,

01:13:14.280 | a younger male that has a similar pattern of behavior,

01:13:16.520 | you know, desk worker for the most part,

01:13:18.400 | jogs a little bit, gets on the recumbent bike,

01:13:21.280 | or whatever it is, but is not doing resistance training,

01:13:24.760 | increases their quality protein intake throughout the day.

01:13:29.080 | And especially at that first meal,

01:13:30.520 | ensuring at least 30 and up to 50 grams of intake,

01:13:34.780 | what changes are likely to happen

01:13:36.540 | even without resistance exercise?

01:13:39.180 | - Well, the first thing is that if she is eating

01:13:41.620 | a sub amount of protein,

01:13:43.180 | let's say she's eating the RDA of protein,

01:13:45.420 | and the average woman eats around

01:13:48.900 | 68 grams of protein a day,

01:13:51.060 | 40% of women over the age of 60 are deficient in protein.

01:13:55.300 | They're eating below the RDA.

01:13:57.140 | - And what's happening to their body?

01:13:58.540 | Is their body robbing their existing skeletal muscle

01:14:01.220 | of amino acids in order to supply

01:14:03.180 | what the brain and other organs need?

01:14:04.740 | - In part, in part.

01:14:05.980 | One of the things that happens with aging is the body,

01:14:09.860 | the whole body protein turnover becomes less efficient.

01:14:14.860 | So the body is turning over

01:14:18.000 | roughly 300 grams of protein a day.

01:14:20.620 | - That's a lot of turnover. - It is a lot.

01:14:22.420 | It is a lot of turnover.

01:14:23.780 | - 300 grams of protein of turnover.

01:14:25.620 | - Yes, and muscle only accounts for maybe 25% of turnover.

01:14:30.620 | An individual might eat an average female,

01:14:34.380 | like your mom, is eating probably around

01:14:36.740 | 68 grams of protein a day.

01:14:38.580 | - Yeah, if I'm lucky, she's not big on beef or chicken.

01:14:43.100 | - And listen-- - It's mostly eggs

01:14:44.020 | and a little bit of fish and lots of vegetables and fruits,

01:14:46.440 | but maintains, again, like a healthy, lean body weight.

01:14:49.580 | - And that is wonderful 'cause she's balancing

01:14:51.700 | her lower protein intake with physical activity.

01:14:54.820 | Remember, there are two main ways

01:14:56.100 | to stimulate skeletal muscle,

01:14:57.340 | and that's through resistance training,

01:14:59.340 | which one would argue she is doing, and/or dietary protein.

01:15:03.600 | But when we think about muscle protein synthesis,

01:15:05.380 | there's really four inputs.

01:15:07.100 | There's resistance training, there's energy,

01:15:12.060 | there's insulin, growth hormones, and then there's leucine.

01:15:16.980 | When you are younger, your body is driven

01:15:18.940 | by more of the anabolic hormones,

01:15:20.860 | which is one reason why we believe

01:15:22.880 | that a younger individual can get away

01:15:25.220 | with five to 10 grams to 15 grams of dietary protein.

01:15:29.100 | - Because their levels of testosterone and/or estrogen

01:15:34.100 | are driving protein synthesis in a way

01:15:36.440 | that lets them offset any dietary deficiencies?

01:15:39.040 | - Well, that their body is just highly anabolic.

01:15:41.820 | They're growing, they're growing up, they're growing.

01:15:44.660 | When an individual like your mom, who's now stopped growing,

01:15:48.620 | the body becomes much more reliant on leucine

01:15:52.840 | and resistance training, because the main pathway

01:15:54.860 | that these things go towards is something called mTOR,

01:15:57.740 | mammalian targeted rapamycin.

01:15:59.720 | The influence on those pathways changes as we age.

01:16:03.740 | So the lever in which you pull changes,

01:16:07.440 | and the importance of that lever changes.

01:16:10.460 | So the best thing that your mom could do

01:16:12.800 | to maintain skeletal muscle, so why,

01:16:15.020 | and what happens to skeletal muscle as we age?

01:16:17.780 | Skeletal muscle, if it is not contracted and utilized,

01:16:21.360 | gets this fat infiltration, mitochondria changes,

01:16:24.680 | protein turnover changes, it becomes less efficient

01:16:27.340 | at sensing amino acids.

01:16:29.760 | There's a decrease in capillary perfusion,

01:16:32.340 | which is one reason why exercise is so important.

01:16:35.500 | In order for her skeletal muscle to respond

01:16:38.160 | like a younger muscle, what she should do

01:16:40.980 | is do some kind of resistance training,

01:16:43.540 | and then add in some kind of dietary protein.

01:16:47.300 | Because when we think about the protein hierarchy,

01:16:49.340 | the amount of protein in a 24-hour period matters the most.

01:16:53.200 | Protein hierarchy, again, closer to one gram per pound

01:16:57.240 | ideal body weight, the evidence would say 1.6 grams per kg.

01:17:01.680 | I'll never forget when the PROTAGE study came out.

01:17:04.940 | I can't believe I've been out of fellowship that long,

01:17:06.820 | but the PROTAGE study was a position paper,

01:17:09.500 | and it talked about how the current recommendation

01:17:12.380 | for dietary protein is too low,

01:17:14.380 | and that to support healthy aging,

01:17:15.980 | you need 2.5 grams of leucine,

01:17:18.500 | or roughly 30 grams of protein,

01:17:20.660 | and an increase in total overall dietary protein.

01:17:25.140 | And this was really the first position statement,

01:17:28.020 | and that came out, gosh, I think 2010.

01:17:31.220 | Yet we haven't changed any of the recommendations

01:17:33.900 | for the general population yet.

01:17:36.060 | So in order for your mom's muscle to respond,

01:17:40.380 | if you compound those two things,

01:17:43.340 | then she will maintain, with activity,

01:17:46.900 | the health of her skeletal muscle.

01:17:48.420 | You mentioned something else.

01:17:49.980 | An individual shouldn't just load protein.

01:17:52.780 | Loading extra protein and not moving is not a good idea,

01:17:57.100 | because of protein's effect on mTOR throughout the body.

01:18:02.100 | So we talked about mTOR,

01:18:03.340 | which is mechanistic target of rapamycin

01:18:05.460 | in skeletal muscle, in the brain, in the pancreas.

01:18:09.320 | This is a protein complex

01:18:13.640 | that you just don't want stimulated all day long.

01:18:15.960 | - Yeah, for sake of cancer risk?

01:18:18.400 | - Yes, yes.

01:18:19.360 | - My understanding is that mTOR is very highly expressed

01:18:23.800 | in all cells of the body,

01:18:24.760 | early in development and throughout growth.

01:18:26.320 | In fact, it's expressed in the cells

01:18:28.180 | I spent my career working on, the retinal cells,

01:18:31.520 | and then over time, it drops off.

01:18:34.720 | And it's remarkable how studies

01:18:37.320 | where mTOR is replaced into cells

01:18:39.640 | allows them to essentially look like

01:18:41.640 | and behave like young cells again,

01:18:43.680 | even replacing some regenerative capacity.

01:18:46.120 | This is work of a guy named Zhigang He

01:18:47.640 | at Children's Hospital at Harvard Medical School.

01:18:50.760 | But what one always observes,

01:18:52.760 | and we've done these experiments in my lab,

01:18:54.360 | is that when you increase mTOR

01:18:55.840 | by any number of different ways,

01:18:59.800 | molecular cannery and things like that,

01:19:01.980 | that the cells grow enormous.

01:19:04.160 | And the concern is always that if you increase mTOR,

01:19:07.120 | that you are going to bias any preexisting tumors

01:19:11.220 | to proliferate as well.

01:19:12.720 | Is that right?

01:19:14.040 | - I think that yes, it is.

01:19:18.220 | And we have to recognize that mTOR stimulation

01:19:20.680 | is different in different parts of the body,

01:19:22.840 | just as you mentioned.

01:19:23.880 | And so skeletal muscle is uniquely sensitive to contraction,

01:19:28.080 | and it's through this biochemical process called RED1.

01:19:31.080 | And when you contract skeletal muscle, it inhibits RED1,

01:19:35.680 | which then, again, there is this phosphorylation of mTOR

01:19:40.080 | and muscle protein synthesis happens.

01:19:42.800 | That is unique to skeletal muscle.

01:19:46.540 | And when individuals will say,

01:19:48.760 | this will be a common discussion that you hear in this space

01:19:51.880 | is that, well, I don't wanna increase my dietary protein

01:19:54.240 | because somehow that is gonna cause cancer.

01:19:56.620 | And that is not true.

01:19:57.760 | That is a very myopic thought process.

01:20:01.000 | That would be the same as saying resistance training,

01:20:03.880 | which also stimulates mTOR, is going to cause cancer.

01:20:06.800 | - Right, I completely agree with you.

01:20:08.200 | I think it's interesting that mTOR,

01:20:11.660 | which in mice is mammalian target of rapamycin,

01:20:16.560 | that word rapamycin might prick up some people's ears.

01:20:20.280 | There are some people out there,

01:20:21.360 | and by the way, I'm not recommending this,

01:20:23.160 | that take rapamycin as a way to inhibit mTOR

01:20:26.720 | in hopes of extending their lifespan.

01:20:29.420 | There are some animal studies that support this.

01:20:31.200 | There's growing interest in this.

01:20:32.960 | And so much so that some people

01:20:35.040 | are willing to take rapamycin.

01:20:36.600 | By that logic, a rapamycin would perhaps

01:20:41.640 | inhibit muscle growth, muscle health.

01:20:43.440 | That's a whole other discussion.

01:20:44.520 | We'd have to get Atiyah and a few,

01:20:46.200 | Matt Caberline and a few other folks here,

01:20:48.160 | and maybe we will with you to discuss that.

01:20:50.960 | But the point being that I agree completely

01:20:54.840 | that we can't just say something that increases mTOR

01:20:59.080 | in muscle is also going to increase cancer,

01:21:01.640 | that these molecules like mTOR have distinct roles

01:21:04.960 | in distinct tissues at distinct time points

01:21:07.240 | throughout the lifespan.

01:21:08.600 | And as you mentioned, ingesting quality protein

01:21:11.440 | can increase muscle protein synthesis

01:21:14.200 | by way of mTOR and other pathways,

01:21:16.960 | as well as resistance training.

01:21:18.480 | And I don't think anyone in the longevity space

01:21:22.140 | would suggest that resistance training is a bad thing,

01:21:24.640 | and yet we know it's increasing mTOR.

01:21:26.320 | So there's a little bit of a contradiction in that field,

01:21:29.440 | just if one stands back from it and says,

01:21:30.920 | "Well, wait, you want to take rapamycin to block mTOR,

01:21:33.280 | but you also want to do resistance training

01:21:34.600 | to stimulate mTOR, which one is it?"

01:21:36.960 | - Yeah, and we have to recognize that the efficiency

01:21:40.160 | of the stimulation declines as we age.

01:21:42.920 | And the way that we overcome that is, again,

01:21:45.080 | this idea of muscle span.

01:21:46.720 | How do we continue to go through life and design a diet

01:21:49.720 | that we know will be more dependent on dietary protein

01:21:53.040 | and movement as we age?

01:21:54.680 | Because the balance between the two changes.

01:21:57.160 | When you're young, you could eat the Twinkie diet,

01:21:59.280 | probably look at a weight and grow.

01:22:01.600 | Age is the great equalizer.

01:22:03.560 | You know, I trained in geriatrics,

01:22:05.040 | and I am telling you, age is the great equalizer.

01:22:08.480 | And creating protocols and habits put into place

01:22:11.920 | to allow you to age well is everything.

01:22:15.780 | And there is so much confusion in the nutrition space

01:22:18.620 | that if we can pull back and recognize,

01:22:20.880 | well, number one, science is a evolving field,

01:22:25.840 | and it's the science of uncertainty.

01:22:29.880 | But there are foundational principles

01:22:31.940 | that we can put into place.

01:22:33.520 | And one of those foundational principles

01:22:35.800 | is skeletal muscle health.

01:22:37.360 | Muscle as the organ of longevity must be supported.

01:22:40.720 | And there are very few ways in which we can do that.

01:22:45.120 | You know, when you think about the metabolic implications

01:22:48.520 | of skeletal muscle as glucose disposal unit,

01:22:51.800 | these diseases of aging really begin in skeletal muscle

01:22:55.640 | before you see any outward signs of obesity,

01:22:59.440 | before you see any outward signs

01:23:01.360 | of anything that would indicate you are unhealthy.

01:23:05.320 | It's kind of like osteoporosis is the silent disease.

01:23:08.480 | Skeletal muscle health is also that way.

01:23:10.880 | And in fact, there's some very pivotal work out of Yale,

01:23:15.120 | and they looked at young, healthy college students.

01:23:18.600 | You know, as a college student,

01:23:19.440 | you'll do anything for a couple of bucks, right?

01:23:21.240 | They pay them.

01:23:23.160 | And these individuals were sedentary,

01:23:26.560 | but they were healthy, lean.

01:23:29.040 | And what they saw was skeletal muscle insulin resistance

01:23:32.800 | just by being inactive.

01:23:34.260 | Can you imagine as you continue,

01:23:37.520 | and how do we define inactivity now?

01:23:39.600 | What is it, less than 5,000 steps?

01:23:41.800 | - Per day. - Per day.

01:23:43.200 | - Wow, I mean. - And there's multiple ways.

01:23:44.600 | I mean, think about it.

01:23:45.440 | We were designed as humans to be very mobile.

01:23:49.560 | And so now we live in a world

01:23:51.520 | that what we think about as sedentary behavior

01:23:55.280 | is something innocuous and not a big deal.

01:23:57.280 | It is a disease state.

01:23:59.260 | - So I feel like you've made an excellent case

01:24:04.420 | for the ingestion of sufficient amounts

01:24:08.040 | of quality protein each day,

01:24:09.640 | especially starting with that first meal of the day.

01:24:12.060 | And just to underscore the suggestion that I heard,

01:24:15.740 | it was aim for one gram of quality protein

01:24:20.160 | per pound of target body weight.

01:24:22.880 | So if somebody weighs 200 pounds

01:24:24.240 | and they'd like to weigh 180 pounds,

01:24:26.160 | try and get 180 grams of quality protein per day

01:24:29.400 | divided up into meals that include somewhere

01:24:32.280 | between 30 to 50 grams of protein per meal.

01:24:34.960 | - Yes, and that first and last meal are the most important.

01:24:38.640 | There's a lot of information going around

01:24:40.840 | that an even distribution has to happen.

01:24:43.400 | And partially this is my mentor's fault.

01:24:45.540 | He'll laugh.

01:24:47.160 | This 30 grams of protein three times a day,

01:24:49.040 | I'm sure you've heard about it.

01:24:50.000 | - Yeah, or that you can't assimilate

01:24:51.880 | more than 30 grams of protein per meal.

01:24:53.640 | Let's drill into that.

01:24:56.120 | - You assimilate all the protein that you ingest.

01:24:58.840 | - Even if it's 100 grams?

01:25:00.920 | - Correct, even if it is 100 grams.

01:25:02.920 | Skeletal muscle protein synthesis

01:25:04.680 | will max out probably at 55 grams.

01:25:06.880 | Again, maybe it's 50, maybe it's 55.

01:25:10.000 | The rest is oxidized.

01:25:12.060 | You can only incorporate so many proteins,

01:25:15.000 | so much protein, and the rest is then used as fuel

01:25:18.160 | or oxidized.

01:25:19.240 | - What if I do hard resistance training

01:25:21.720 | in the hours before a meal,

01:25:23.720 | and then that meal includes 100 grams of quality proteins,

01:25:27.640 | let's say whey protein,

01:25:28.520 | do I put all of that 100 grams

01:25:30.760 | into muscle protein synthesis?

01:25:33.440 | - I would say, I don't know if you put all 100 grams,

01:25:35.740 | but I would guess that it would cap out at a certain number.

01:25:39.240 | And really the totality of evidence would suggest

01:25:42.040 | it's probably around 55 grams.

01:25:43.880 | - So regardless of whether or not

01:25:45.600 | somebody does resistance training,

01:25:47.760 | you can ingest about 50 grams of protein,

01:25:49.640 | again, four calories per gram,

01:25:51.680 | typically into muscle protein synthesis,

01:25:55.160 | the rest is oxidized.

01:25:56.720 | - Yes.

01:25:57.560 | - Maybe just touch on that process of oxidation,

01:25:59.520 | what that looks like.

01:26:00.360 | - Yeah, it's basically just utilizing those proteins.

01:26:04.400 | It's utilizing them for energy.

01:26:06.200 | It's not storing them,

01:26:08.560 | whether it goes back for gluconeogenesis

01:26:10.680 | or wherever it goes, it is then oxidized.

01:26:12.800 | - Okay, and if that meal with,

01:26:14.840 | let's say 50 grams of quality protein

01:26:16.840 | is combined with 50 grams of carbohydrate,

01:26:20.760 | they have fruit, some oatmeal, pasta, rice, et cetera,

01:26:23.960 | does that change the utilization of the protein at all?

01:26:27.040 | I know I asked this question earlier,

01:26:28.360 | but one could imagine that the body

01:26:30.280 | wants to use different fuel sources differently.

01:26:33.560 | Is there any selective use of one macronutrient

01:26:37.040 | versus the other? - What a good question.

01:26:38.240 | That's an excellent question.

01:26:40.320 | The body, that amount, it will be seen as a mixed meal,

01:26:44.760 | but the body will always choose to get rid of glucose first.

01:26:49.760 | Glucose dominates metabolism,

01:26:53.720 | because again, it can be toxic to the body,

01:26:55.960 | so it must be utilized.

01:26:57.600 | Now, what is also very interesting

01:26:59.680 | is that now you're talking about the speed of absorption.

01:27:04.680 | One of the things that we should mention

01:27:07.400 | is typically you need a substantial rise in leucine,

01:27:12.880 | and that will be, again, that will probably take

01:27:17.000 | and last around two to two and a half hours.

01:27:19.840 | So when you have a mixed meal,

01:27:22.000 | that slows down absorption digestion.

01:27:24.920 | This is where the quality of the protein comes in

01:27:27.480 | that becomes very important,

01:27:28.440 | because you have to reach a threshold in the blood

01:27:31.240 | to stimulate tissue.

01:27:33.040 | And there was a very interesting study.

01:27:34.520 | It's the first study of its kind,

01:27:35.880 | and this came out of Luke Van Loon's lab.

01:27:37.840 | And basically, they looked at a vegan diet with,

01:27:41.080 | I think it had 40 grams of protein,

01:27:42.680 | and then it had a omnivorous diet,

01:27:45.000 | so it had both sources of protein.

01:27:46.840 | And what they found was that the individuals

01:27:51.360 | that had the 40-gram meal that was a mixed meal

01:27:55.560 | with animal-based proteins

01:27:57.440 | actually stimulated muscle protein synthesis,

01:27:59.880 | whereas the mixed meal of just the vegetables did not.

01:28:04.200 | - Interesting.

01:28:05.640 | - Even though it was plant-based proteins,

01:28:11.600 | enough protein in that meal,

01:28:13.040 | and that likely might be because of the rate of absorption,

01:28:17.320 | because of the fiber content,

01:28:18.640 | and it becomes important to recognize

01:28:21.480 | that a higher-protein meal seemed,

01:28:24.920 | especially with the quality of the protein,

01:28:27.120 | that if you're picking the range between 30 and 50,

01:28:29.680 | depending on the mixed meal amount,

01:28:31.860 | I would certainly go towards that higher end.

01:28:36.480 | - What is the case for fiber,

01:28:38.840 | either supplementing fiber or, in my case,

01:28:42.040 | I get fiber from fruits and vegetables mainly?

01:28:45.480 | - Fiber is extremely valuable.

01:28:47.120 | It's extremely valuable for the gut microbiome.

01:28:49.240 | It's extremely valuable for satiation.

01:28:51.380 | Fiber, if I were to design a diet,

01:28:54.120 | the first thing that I would pick would be dietary protein.

01:28:57.160 | Then I would think about how I'm going to

01:28:59.320 | parse out the rest of the carbohydrates,

01:29:01.000 | because you earn carbohydrates through exercise.

01:29:03.520 | I usually choose berries, high-fiber sources of berries,

01:29:07.540 | and then whatever fat is- - So blueberries,

01:29:08.960 | strawberries, blackberries. - Yes, all of them, yes.

01:29:10.520 | - I'm a big fan of berries.

01:29:11.840 | - All of them. - I'm like a grizzly bear

01:29:13.840 | when it comes to berries.

01:29:14.720 | I'm a drive-by blueberry eater when they're there.

01:29:16.640 | I can't help but swipe them off the bowl or the plate.

01:29:19.660 | - But there was something else that you mentioned

01:29:22.360 | that I wanted to highlight,

01:29:23.240 | and this was if I did resistance training,

01:29:26.200 | then could I eat 100 grams of protein

01:29:29.440 | and then 100 grams of carbohydrates?

01:29:31.680 | The amazing part about exercise is,

01:29:34.560 | you know, what we really care about is glucose disposal

01:29:37.360 | and insulin sensitivity.

01:29:39.220 | This idea of insulin resistance is killing our world.

01:29:44.220 | - Young people, too. - Yes, yes.

01:29:47.060 | We've seen double to triple the rates of childhood obesity.

01:29:50.980 | - That's wild.

01:29:51.820 | I don't think people younger than 25 recognize it.

01:29:56.820 | Like when I was growing up in school, there was junk food.

01:30:01.260 | Lord knows there was junk food.

01:30:02.980 | There was also good food.

01:30:04.260 | And different kids from different homes

01:30:06.760 | ate different amounts of junk food.

01:30:09.020 | But it was the rare individual in school

01:30:12.820 | who was overweight, who was obese.

01:30:15.240 | And you had some kids that seemed to be

01:30:19.120 | just kind of like born lean and with more muscle.

01:30:22.860 | You had kids that were thinner with less muscle, less lean.

01:30:26.520 | But it was very rare that there was an obese kid.

01:30:31.220 | You just didn't see it much.

01:30:32.920 | And I don't recall there being a lot of restrictive eating

01:30:35.680 | or even discussion about nutrition.

01:30:37.780 | And people were eating cereals.

01:30:39.960 | People were eating candy bars.

01:30:41.240 | They were also eating eggs and sandwiches

01:30:42.920 | and chicken dinners and all sorts of stuff.

01:30:47.380 | So what's happened?

01:30:50.160 | Really, what's happened?

01:30:51.080 | Because something is fundamentally different.

01:30:52.840 | We had PE class that was required.

01:30:55.060 | We had to run.

01:30:55.900 | We had to play volleyball.

01:30:57.060 | We had to do those things.

01:30:59.360 | But it's not like we were all athletes

01:31:01.900 | and we'd walk to class.

01:31:02.940 | I skateboard, I played some soccer,

01:31:04.240 | but I wasn't an athlete per se.

01:31:06.320 | So like what in the world is going on?

01:31:09.080 | - I will say that also 2/3 of Americans

01:31:11.180 | are either overweight or obese.

01:31:12.820 | - Yeah, it's wild.

01:31:14.000 | I mean, again, one has to have been born in the '70s

01:31:16.960 | as I was, or early '80s to really appreciate

01:31:20.680 | this tremendous shift in kind of like what you see.

01:31:24.360 | And sure, people are on phones more, more sedentary.

01:31:27.880 | It's gotta be a combination of things, but there-

01:31:30.220 | - It's cultural.

01:31:31.060 | We have a disease zone of inactivity and sedentary behavior

01:31:34.940 | that is frankly killing our population.

01:31:38.300 | Almost 50% of people have hypertension.

01:31:41.380 | We have, what, 40 million people on statins.

01:31:45.960 | I'm sure that number has changed.

01:31:47.960 | And skeletal muscle is medicine.

01:31:50.300 | Skeletal muscle, again, helps with triglycerides,

01:31:53.860 | helps with insulin, glucose disposal.

01:31:56.800 | So where this came from, you just mentioned,

01:31:59.780 | if I exercise, then can I eat whatever you're eating?

01:32:04.140 | Yes.

01:32:05.180 | But we're not talking about being irresponsible,

01:32:07.260 | but skeletal muscle now has sensitized.

01:32:09.980 | Within, you know, there's a 24-hour period,

01:32:12.140 | 72-hour period where that muscle is still sensitized.

01:32:15.460 | - Meaning it consumes more nutrients.

01:32:18.100 | - It consumes more nutrients,

01:32:19.460 | but also when you think about insulin resistance,

01:32:23.000 | insulin moves glucose out of the bloodstream into cells.

01:32:27.500 | And through the muscle,

01:32:29.260 | there's the insulin-dependent pathway

01:32:31.900 | through obviously insulin,

01:32:35.700 | and that's whatever, PI3K, if you care, if anyone cares.

01:32:39.140 | And then there is insulin-independent,

01:32:42.500 | which is through exercise.

01:32:44.340 | And how glucose moves from the bloodstream into the cells

01:32:47.400 | is through GLUT4 receptors.

01:32:49.420 | When you exercise, you increase the density

01:32:52.060 | of GLUT4 receptors to the surface just by doing activity.

01:32:56.420 | It doesn't require insulin.

01:32:58.060 | You are able to then move glucose

01:32:59.900 | out of the bloodstream into cells.

01:33:01.720 | And again, insulin resistance is at the heart

01:33:06.020 | of so many of the problems that we're seeing.

01:33:09.660 | - Do you think that most people, including the,

01:33:14.020 | I'll just say it, the public health officials in charge,

01:33:17.460 | understand that, the points that you just made?

01:33:20.220 | I mean, clearly one doesn't have to even have a degree

01:33:23.560 | in medicine or science of any sort to look around

01:33:26.100 | and say, "Okay, there are a lot of people

01:33:28.460 | "suffering from obesity."

01:33:30.260 | And we are hearing more and more

01:33:32.260 | about the negative effects on brain,

01:33:34.020 | on other aspects of mental health and physical health,

01:33:36.460 | and the interrelatedness of mental health and obesity.

01:33:39.500 | I mean, Dr. Chris Palmer from Harvard Medical School.

01:33:42.140 | - He's a good friend, yes.

01:33:42.980 | - Yeah, wonderful person, former guest on this podcast,

01:33:45.660 | very popular episode.

01:33:47.000 | I mean, it's really been championing this issue

01:33:49.820 | as of a few folks at Stanford and elsewhere,

01:33:54.060 | this new field of so-called metabolic psychiatry,

01:33:56.800 | the link between brain health, mental health,

01:33:58.520 | and metabolic health.

01:34:00.660 | But putting all that aside,

01:34:05.020 | do you think that most public health officials understand

01:34:08.960 | that muscle contraction increases glute floor expression

01:34:13.960 | at the level of muscle,

01:34:14.980 | which then grabs more nutrients from the bloodstream,

01:34:19.440 | which then lends itself

01:34:20.340 | to all sorts of positive health benefits

01:34:22.380 | and diverts from these negative health benefits?

01:34:24.620 | I mean, like, why isn't that on every billboard?

01:34:27.620 | Why?

01:34:28.460 | I mean, it's such a simple concept in principle.

01:34:31.820 | Like, why aren't we hearing this?

01:34:32.980 | I mean, do they even require PE in school anymore?

01:34:35.740 | - No, I am not sure, but this is a problem.

01:34:39.220 | I don't know, but I would say

01:34:41.060 | if 2/3 of our population is either overweight or obese,

01:34:44.780 | the health officials may fall into that category,

01:34:47.900 | or at least 2/3 of them, potentially.

01:34:49.900 | - Yeah, and I'm not blaming them.

01:34:50.940 | I'm just wondering. - Of course.

01:34:51.780 | - I mean, I don't think,

01:34:52.780 | well, I don't think we hear this message enough,

01:34:56.460 | that muscle contraction is medicine.

01:34:58.220 | We've heard that from Dr. Casey Means.

01:34:59.740 | We're hearing about it from you,

01:35:01.540 | that muscle and muscle health in particular.

01:35:04.220 | And again, I'm so grateful

01:35:05.260 | that we're talking about muscle health and muscle quality

01:35:07.400 | and muscle as a tissue that utilizes nutrients

01:35:10.100 | and can divert things towards health and away from disease,

01:35:12.940 | as opposed to just muscle size,

01:35:14.380 | because I think most people hear muscle

01:35:16.520 | and they think eat for muscle,

01:35:17.360 | and they just think muscle size.

01:35:19.260 | And frankly, most people don't want increased muscle size.

01:35:22.780 | - But if you train for hypertrophy,

01:35:25.080 | which is muscle size, very difficult to get,

01:35:27.620 | especially as you age, by the way.

01:35:29.220 | It becomes much more difficult,

01:35:31.380 | but you will also get strength and power

01:35:33.540 | if an individual struggles.

01:35:35.620 | You know, if they fall, they break a hip,

01:35:37.100 | they have to be able to get up off the floor.

01:35:39.500 | You have to be able to travel on an airplane

01:35:41.340 | and put your stuff overhead or pick up your toddler.

01:35:44.300 | Mine weighs 40 pounds.

01:35:45.900 | - Or go downstairs.

01:35:47.060 | - What Dr. Peter Attia has really been emphasizing

01:35:49.540 | that a lot of life-ending injuries,

01:35:52.260 | life-ending injuries occur by virtue of people

01:35:55.340 | failing to do the eccentric movements

01:35:58.180 | that essentially look like stepping down off something.

01:36:02.220 | I've had to have this discussion with both my parents.

01:36:04.140 | It was a little bit uncomfortable, frankly,

01:36:05.460 | because no one wants to be told,

01:36:06.620 | "Hey, listen, here are the things

01:36:07.580 | "that can potentially kill you.

01:36:09.580 | "Don't worry so much about going upstairs.

01:36:11.180 | "Make sure you hold the railing."

01:36:12.580 | Both of my parents being able-bodied,

01:36:14.020 | I'm grateful again for that.

01:36:15.100 | But be careful as you walk downstairs.

01:36:17.460 | I mean, one fracture at age 79, 80, the age of my parents,

01:36:22.340 | I think I'm gonna get these numbers a bit wrong, I'm sure.

01:36:24.900 | But I think Peter mentions that that leads to death

01:36:29.100 | in a large percentage of people that break that hip

01:36:31.820 | or break that leg or break that wrist even.

01:36:34.100 | - Yes, and the other thing that-

01:36:35.380 | - Not because of the break itself,

01:36:36.420 | but because the inactivity that results.

01:36:38.100 | - And that's absolutely right.

01:36:39.580 | The skeletal muscle inactivity

01:36:43.240 | causes a derangement of metabolism.

01:36:45.500 | The derangement of metabolism

01:36:47.220 | will then go on to get fatty acid infiltration,

01:36:50.700 | fatty acids that infiltrate into skeletal muscle.

01:36:54.260 | Once that happens, you now have a decreased flux.

01:36:56.860 | You're not moving muscle glycogen.

01:36:59.300 | You're not getting rid of these ceramides

01:37:02.420 | or these diacylglycerols that build up

01:37:04.780 | that potentially lead to and compound insulin resistance,

01:37:07.820 | skeletal muscle insulin resistance.

01:37:09.620 | You then generate a low-grade inflammation

01:37:14.300 | that is constantly going on.

01:37:15.840 | If 40% of your body weight is skeletal muscle

01:37:19.760 | and you are not maintaining the health of skeletal muscle,

01:37:23.120 | you are walking around with an inflammatory bag on you.

01:37:27.560 | This decline in aging,

01:37:31.880 | people think that we go through a linear decline in aging.

01:37:35.880 | We don't.

01:37:36.720 | We go through a series of catabolic crises.

01:37:39.120 | And a catabolic crises would be something like

01:37:41.900 | someone falls, breaks a hip,

01:37:44.960 | and never regains full functioning.

01:37:47.240 | Or someone gets pneumonia,

01:37:49.120 | is on bed rest for five days or a period of time.

01:37:51.920 | This compounds upon itself.

01:37:56.720 | These catabolic crises compound upon themselves

01:38:00.080 | and individuals never return to full function.

01:38:04.140 | The thing that becomes interesting and very important

01:38:07.580 | is that when you maintain the health of skeletal muscle,

01:38:12.240 | low muscle mass would be an early indication

01:38:14.360 | of osteoporosis.

01:38:15.680 | Bone attaches to muscle.

01:38:17.520 | Muscle pulls bone, creates a load,

01:38:21.960 | a stimulation that is required for building.

01:38:25.520 | I mean, imagine the astronauts

01:38:27.480 | or an individual who, again, is on bed rest.

01:38:30.260 | When you are training

01:38:33.720 | and you are putting force and load on your body,

01:38:36.680 | then you're able to maintain the entirety

01:38:39.320 | of the architecture of the body.

01:38:40.940 | And this all makes useful sense.

01:38:43.840 | But it is underappreciated as an organ system.

01:38:47.980 | And the other thing about skeletal muscle

01:38:49.820 | and depression and mood

01:38:51.620 | is that skeletal muscle and inflammation,

01:38:54.640 | as you contract it,

01:38:55.700 | the duration and intensity of contraction releases myokines.

01:38:59.400 | So myokines, have you heard of myokines?

01:39:02.020 | - I have, but please educate us.

01:39:03.700 | - So myokines are peptide hormones.

01:39:06.460 | Again, skeletal muscles and endocrine organ

01:39:08.680 | that travel throughout the body.

01:39:11.100 | The most famous one is interleukin-6.

01:39:12.820 | You have interleukin-15, interleukin-6.

01:39:15.420 | These affect lipolysis.

01:39:19.620 | They affect the utilization of glucose.

01:39:21.700 | There's this idea of training in a low glycogen state

01:39:24.540 | that might increase a more robust amounts

01:39:27.060 | of these interleukins.

01:39:28.060 | - Is that right?

01:39:28.900 | - These myokines, which is--

01:39:29.740 | - Great, 'cause I love training fast in the morning.

01:39:31.340 | - Which is interesting.

01:39:32.300 | And we always think about exercise

01:39:33.900 | as this way to improve metabolism.

01:39:36.200 | It doesn't so much do that at rest,

01:39:38.940 | but what it does is when you exercise,

01:39:40.900 | you improve, again, glucose utilization,

01:39:44.040 | but also you release these myokines.

01:39:45.500 | It's not just the physical activity,

01:39:47.520 | but it's also the subsequent effects

01:39:49.900 | and the subsequent molecules that skeletal muscle releases.

01:39:53.620 | - I just wanna say, realizing I'm interrupting,

01:39:57.060 | amen to that.

01:39:58.220 | So often people look at how many calories were burned

01:40:00.800 | in a given bout of resistance training,

01:40:03.380 | and while that is perhaps interesting,

01:40:05.980 | the wavefront of other endocrine and molecular factors

01:40:08.860 | that set in motion by proper resistance training,

01:40:11.940 | to me is the most interesting and important aspect.

01:40:15.760 | Meaning in the hours afterwards,

01:40:17.640 | sure, you're gonna continue to burn calories

01:40:19.620 | at an elevated rate,

01:40:20.700 | but it's all the effects of the hormones,

01:40:24.140 | and as you're pointing out, the interleukins

01:40:26.060 | that last hours and hours and even days

01:40:29.060 | that, at least to my mind or my read of the literature,

01:40:32.140 | are the most interesting, the most beneficial.

01:40:34.220 | - It's fascinating,

01:40:35.060 | and actually the science is relatively new.

01:40:36.780 | It came out of Pedersen's lab,

01:40:38.780 | Bente Pedersen in Copenhagen.

01:40:40.440 | Extraordinary work.

01:40:42.560 | She is in part an immunologist and exercise physiologist.

01:40:47.140 | When you train and you release these myokines,

01:40:50.780 | which are based on the intensity and duration

01:40:53.500 | of your activity, release something called capsepsin B

01:40:56.780 | and irisin, these myokines then stimulate BDNF release

01:41:01.620 | in the brain.

01:41:02.460 | - Brain-derived neurotrophic factor.

01:41:03.300 | - Exactly, which is a component of neurogenesis.

01:41:06.620 | When we think about the plethora of activity

01:41:09.220 | of what skeletal muscle does,

01:41:11.860 | it is no surprise that number one, it's free to move.

01:41:15.260 | - Can I just mention something about BDNF, if I may?

01:41:20.100 | I spent much of my earlier career

01:41:22.440 | working on neuroplasticity brain development,

01:41:24.140 | and BDNF, brain-derived neurotrophic factor,

01:41:26.540 | gets mentioned from time to time,

01:41:28.040 | and as you mentioned,

01:41:29.220 | it's involved in different neurogenesis pathways

01:41:31.540 | and, but I think one of its most interesting effects

01:41:34.540 | is its role in consolidating existing connections,

01:41:39.000 | what we call synaptic connections in the brain.

01:41:40.900 | And I'm so glad you mentioned this

01:41:42.080 | because what you're effectively saying

01:41:43.820 | is that doing resistance training properly

01:41:47.300 | sets in motion a molecular cascade

01:41:49.200 | that feeds back to a molecular cascade within the brain

01:41:52.700 | that reinforces the neural circuits that exist.

01:41:55.300 | And one of the hallmarks of aging

01:41:56.580 | is essentially a degradation of neural circuitry,

01:42:01.060 | sometimes in extreme cases like Alzheimer's

01:42:03.100 | or other forms of dementia, Parkinson's, et cetera.

01:42:05.500 | But we know that the volume of gray matter

01:42:09.700 | of neurons within the brain declines with age,

01:42:12.940 | we know that the neural circuitry suffers,

01:42:14.440 | the speed of neuronal transmission suffers,

01:42:17.020 | and it's long been observed,

01:42:18.740 | but only now objectively substantiated

01:42:21.620 | that exercise can not just maintain,

01:42:24.320 | but even improve brain function over time.

01:42:27.760 | And so thank you for allowing me

01:42:30.040 | to kind of expand on what you just said.

01:42:33.060 | I just think that if ever there was a potent medicine

01:42:36.380 | for improving brain health,

01:42:37.980 | it's exercise and in particular resistance exercise.

01:42:41.100 | I think that the case for cardiovascular exercise

01:42:43.100 | is probably that it maintains the components of blood flow

01:42:46.060 | that are also critical for the blood.

01:42:47.580 | - Yes, and certainly no one is arguing

01:42:49.220 | the importance of cardiovascular activity and VO2 max.

01:42:52.300 | We can appreciate that.

01:42:53.860 | On the flip side of that,

01:42:55.260 | skeletal muscle has not had its moment yet,

01:42:57.880 | and in particular resistance training.

01:43:00.060 | You're not going to be able to be effective

01:43:02.180 | at maintaining a VO2 max

01:43:03.420 | if you do not have healthy skeletal muscle.

01:43:05.580 | You are not going to be able to be effective

01:43:07.580 | at nearly doing anything or surviving any kind of illness.

01:43:12.300 | The higher the amount of skeletal muscle mass you have,

01:43:15.700 | the healthy skeletal muscle mass,

01:43:17.380 | the greater your survivability

01:43:19.060 | against nearly any kind of disease.

01:43:21.340 | - Remarkable.

01:43:22.180 | - For example, cancer cachexia,

01:43:24.180 | which is the wasting that comes with cancer,

01:43:25.980 | kills 20% of individuals.

01:43:28.200 | Survivability comes from the health of skeletal muscle.

01:43:32.720 | Also on that same note,

01:43:35.120 | contracting skeletal muscle, releasing myokines,

01:43:37.220 | interfaces with cells of the immune system.

01:43:39.440 | We've all heard of macrophages and the cytokine storm,

01:43:42.640 | interleukin-15, TNF, TNF-alpha as being pro-inflammatory.

01:43:47.640 | When the myokines,

01:43:52.080 | which are also interleukin-6 and interleukin-15,

01:43:54.920 | are released from skeletal muscle,

01:43:56.760 | they interplay and they somewhat dampen

01:43:59.860 | the inflammatory effect and have a different effect

01:44:03.080 | on the entirety of the system

01:44:05.720 | when these, quote, cytokines come from skeletal muscle.

01:44:10.400 | - Incredible.

01:44:11.480 | So as long as we are now on the topic of exercise,

01:44:14.480 | let's make it concrete for people.

01:44:16.680 | We talked earlier about nutrition

01:44:18.380 | and specific gram amounts and calorie amounts

01:44:20.340 | and distribution, and that's just wonderful.

01:44:22.240 | And thanks also for explaining the mechanism

01:44:24.760 | and the incentive for doing this.

01:44:26.200 | Let's talk about resistance training.

01:44:28.080 | And let's do this in a slightly different way

01:44:29.720 | than we did earlier.

01:44:31.120 | What is your program for resistance training?

01:44:34.480 | And then we'll talk about

01:44:36.200 | what other people might consider for them.

01:44:38.560 | And maybe the same thing.

01:44:39.480 | So if you could just actually walk us through your week,

01:44:42.000 | what does it look like?

01:44:43.400 | It could be Sunday, Monday, Tuesday, et cetera,

01:44:45.560 | or it could be how many days a week do you resistance train?

01:44:48.480 | - Of course, you know I don't do any kind of training.

01:44:51.060 | - Yeah, well, I know based on your Instagram that you do,

01:44:54.720 | and now we know why.

01:44:57.440 | - So I have a wonderful trainer, Carlos Mata,

01:45:00.000 | shout out to him.

01:45:01.120 | Every Monday, I decide I don't wanna train.

01:45:03.840 | And I know that-- - Really?

01:45:04.680 | - Of course. - You don't enjoy it?

01:45:06.000 | - I do, but it's usually suffering, at least Monday.

01:45:09.960 | Every morning, I know Monday morning's gonna come up

01:45:12.360 | and I'm gonna think about all the ways

01:45:13.680 | in which I can get out of it.

01:45:14.560 | I never get out of it, I always show up.

01:45:17.320 | I train consistently three days a week,

01:45:19.760 | and I train pretty heavy for my size.

01:45:22.560 | So I'm maybe 110 pounds.

01:45:25.020 | What I do is I do some kind of push, pull,

01:45:31.360 | hinge, squat.

01:45:34.280 | - On all three of those days? - I do.

01:45:35.960 | - So you train your whole body--

01:45:37.160 | - I do. - Three days a week,

01:45:38.520 | separated by a day in between?

01:45:40.160 | - I do, I do because essentially I'm working hard enough

01:45:43.600 | where I'm pretty exhausted.

01:45:44.960 | So I came here and you asked me if I trained this morning,

01:45:47.460 | Friday, I'm off today. - Okay.

01:45:49.400 | - But what I do is when I start, I think about,

01:45:52.000 | well, actually Carlos thinks about this,

01:45:53.720 | but I'll do some kind of sled push.

01:45:55.960 | Sled push, it will be loaded, it will be pretty heavy,

01:45:59.520 | it gets my full body moving,

01:46:01.560 | and then we'll pick some kind of compound movements,

01:46:04.560 | whether it's a-- - Multi-joint movement.

01:46:06.320 | - That's exactly right, a multi-joint movement

01:46:08.480 | through full range of motion.

01:46:09.800 | - So for instance, a squat or a deadlift?

01:46:12.320 | - That's right.

01:46:13.360 | - If somebody isn't skilled in squats or deadlifts,

01:46:16.400 | could they maybe hold onto a kettlebell

01:46:18.760 | of appropriate weight for them

01:46:19.880 | and do like a kettlebell squat?

01:46:21.200 | - I'm gonna give them an even better solution.

01:46:24.080 | And this is this concept that I learned

01:46:26.840 | from a PhD named Pat Davidson.

01:46:30.200 | And he talks a lot about high ground, low ground movements.

01:46:33.800 | And a high ground movement would be something

01:46:37.080 | where you have contact, contact like a hack squat.

01:46:40.240 | So ground, you have back support, leg support,

01:46:44.800 | you are able to move in a way that fully contracts

01:46:48.540 | the muscle that you are focused on.

01:46:50.560 | We see a lot of people that go to the gym

01:46:52.720 | and kind of just do whatever.

01:46:54.500 | And that might be okay to maintain,

01:46:57.980 | but the goal should always be,

01:47:00.280 | ladies, you're not gonna get bulky,

01:47:01.600 | should be hypertrophy.

01:47:04.080 | - Which is hard to achieve as you mentioned.

01:47:04.920 | - It is hard to achieve, but you must focus

01:47:08.200 | because maintaining and growing skeletal muscle mass

01:47:11.060 | as you age, it becomes much more challenging.

01:47:14.240 | And so choosing high ground movements.

01:47:16.320 | I would not have someone who is an unskilled lifter

01:47:19.320 | go in and do a front loaded goblet squat.

01:47:23.960 | - Or a free weight squat or deadlift, right.

01:47:25.920 | - I wouldn't, I wouldn't.

01:47:27.240 | I would have them do high ground movements.

01:47:30.120 | And this is where machines are really, really wonderful.

01:47:34.000 | People kind of will say, well, but you have to train

01:47:36.480 | for functional movement and functional.

01:47:39.040 | Well, what is that?

01:47:40.340 | We're training for life.

01:47:41.920 | You're training for life durability.

01:47:43.840 | - And if I may, anytime people say,

01:47:47.640 | what's the best form of exercise?

01:47:49.200 | How do you work out, et cetera?

01:47:50.200 | I always say rule number one, definitely train,

01:47:53.320 | but don't get hurt or avoid getting hurt.

01:47:55.800 | I mean, the moment somebody approaches exercise

01:47:58.280 | and gets hurt, they're in trouble.

01:47:59.640 | One of the best ways to get in shape for your entire life

01:48:01.680 | is to avoid getting injured, but still train.

01:48:04.440 | - Or train your entire life.

01:48:06.220 | If there are parents listening, thinking about your kids,

01:48:09.800 | there was a whole push where kids shouldn't do

01:48:12.120 | resistance training and shouldn't move load.

01:48:14.000 | I look at my kids, they might not be doing one rep maxes,

01:48:17.240 | but they're picking up kettlebells.

01:48:18.360 | They have, oh yeah.

01:48:19.640 | - Yeah, I was told growing up to not touch the weights

01:48:22.360 | until I was at least 18.

01:48:24.400 | At 16, I started doing pull-ups, push-ups, sit-ups,

01:48:29.400 | and then pretty quickly moved into all the leg press,

01:48:33.640 | leg extension, all that stuff.

01:48:34.920 | Couldn't help myself.

01:48:35.740 | - But I would argue that outside normal play,

01:48:39.560 | someone is never too young to start

01:48:42.000 | and frankly, never too old.

01:48:43.480 | - And body weight resistance is,

01:48:45.920 | in many cases, sufficient, right?

01:48:47.840 | I mean, as a kid, I would do, at night,

01:48:51.160 | I would do sit-ups and handstand push-ups against my door.

01:48:54.280 | You know, I couldn't do a proper handstand unassisted,

01:48:57.080 | but I'd flip over and then do the handstand push-ups

01:48:59.040 | until my mom would yell at me about the marks on the door.

01:49:02.080 | But you know, that was pretty tough, right?

01:49:04.440 | Getting 10 repetitions of that was pretty tough.

01:49:07.420 | But you're saying resistance training,

01:49:09.600 | what you said, high ground.

01:49:11.560 | - High ground, contact, high contact.

01:49:13.640 | So when you are choosing motions

01:49:18.040 | that an individual is unskilled to do,

01:49:19.820 | I think, let's frame this,

01:49:21.960 | is that most people think about exercise

01:49:25.220 | for optimization and performance.

01:49:27.520 | But if we take that back a notch,

01:49:30.760 | and you know, I think about my audience,

01:49:33.760 | and they are individuals that are,

01:49:36.160 | aside from the special operators and aside from the CEOs,

01:49:40.280 | they are 40-year-old women that are like,

01:49:43.120 | "Hey, all of a sudden I noticed

01:49:45.080 | "that my body composition has changed."

01:49:47.280 | You know, I work with an amazing PhD,

01:49:49.040 | her name is Victoria Fleckhar,

01:49:50.560 | and she has helped me bring into these pieces

01:49:54.400 | of how do we design and think about training protocols

01:49:58.080 | and training programs for the more mature individual.

01:50:02.320 | And when you think about these high ground movements,

01:50:05.180 | if someone has not trained,

01:50:07.440 | and they're thinking, "Well, I don't wanna fall,

01:50:09.860 | "so I'm gonna do box jumps."

01:50:11.480 | That plyometric movement,

01:50:13.320 | there's a high probability of injury.

01:50:15.460 | - Yeah, I don't like box jumps.

01:50:16.780 | - Or, no, I don't like them.

01:50:18.040 | - I don't like them because the eccentric loading that,

01:50:20.920 | you know, it ends up being a lot of soreness,

01:50:22.800 | and it just takes a lot of them

01:50:24.720 | to generate what I'm trying to generate.

01:50:26.680 | - So that is exactly the point.

01:50:29.160 | Is an individual going to be able to generate enough force

01:50:32.340 | to make it meaningful?

01:50:33.760 | And someone would argue, "Yes."

01:50:35.520 | Well, for them, that would be,

01:50:37.480 | you know, when I was a practicing geriatrician,

01:50:39.840 | and I was going through my fellowship,

01:50:41.460 | we did a number of metrics to look at strength.

01:50:45.800 | And one of those was a sit and stand out of a chair.

01:50:50.800 | So sit to stand, and that would have,

01:50:52.960 | for some people,

01:50:53.960 | have been considered a high-intensity interval.

01:50:56.260 | The question becomes,

01:50:58.420 | is that enough to mount a response over time?

01:51:01.200 | And I would argue, "No."

01:51:03.920 | What do people need to do?

01:51:06.040 | And that is when you train for hypertrophy,

01:51:08.120 | which is muscle growth,

01:51:09.780 | and let's say that is five to 10 reps,

01:51:13.800 | three, you know, four to five sets.

01:51:15.620 | You pick.

01:51:16.460 | There's many different ways that it can be done.

01:51:17.300 | - Where the final repetitions are challenging.

01:51:18.900 | - Where the load is enough.

01:51:20.380 | And there's wonderful data out of McMaster University

01:51:23.380 | that it doesn't have to be heavyweight

01:51:25.500 | as long as the stimulus is enough.

01:51:27.620 | And then we take it back to what is the stimulus?

01:51:30.600 | And the stimulus, the goal should be,

01:51:32.560 | are you moving the muscles

01:51:33.980 | that you are supposed to be doing?

01:51:35.380 | And are you generating enough activity

01:51:38.300 | to create adaptation and change?

01:51:41.040 | And so a high-ground movement

01:51:42.820 | for someone who's listening to this

01:51:44.200 | and is thinking, "I need skeletal muscle health.

01:51:47.200 | "I walk.

01:51:48.040 | "Walking is wonderful,

01:51:48.880 | "but is walking enough to maintain those type two fibers?"

01:51:52.640 | It's not.

01:51:53.740 | You will see a transition,

01:51:55.840 | and we've all seen our aging parents.

01:51:57.740 | I mean, my dad is in his 70s.

01:51:59.960 | He's very fit, but he used to be a collegiate wrestler.

01:52:02.760 | He went to Wharton.

01:52:03.600 | He was captain of his wrestling team.

01:52:05.900 | Dad, you're a lot smaller.

01:52:08.180 | And part of the reason is the failure

01:52:12.640 | to focus on hypertrophy,

01:52:14.320 | and those are those type two fibers,

01:52:16.240 | those type two fibers that transition with age

01:52:19.200 | to more type one fibers, those long, lean fibers.

01:52:21.880 | You go from bigger to bulky to less.

01:52:24.940 | Choosing activities to maintain those fibers.

01:52:27.400 | Also, these fibers are bigger.

01:52:28.720 | This is where glucose disposal goes.

01:52:31.280 | Choosing things like leg extension.

01:52:34.640 | It's not a bad thing.

01:52:36.120 | If you get stronger and you have stronger muscles,

01:52:39.460 | then you will have more power.

01:52:41.460 | You'll be able to generate more force.

01:52:43.780 | You will be much less likely to fall.

01:52:46.380 | - And you'll be healthier overall because of muscle health.

01:52:50.400 | So maybe we could just list off some of the movements

01:52:52.860 | that people could think about

01:52:55.020 | in terms of these high ground movements.

01:52:56.660 | You mentioned hack squats.

01:52:58.380 | Leg presses come to mind.

01:52:59.660 | - Leg extension. - Leg extension.

01:53:00.820 | Leg curls. - Leg curls.

01:53:02.620 | Lat pull-downs with a supported back.

01:53:04.860 | Any kind of- - Rows.

01:53:05.980 | - Rows, a supported row.

01:53:08.340 | Again-

01:53:09.180 | - These are mostly machine exercises

01:53:10.460 | that you're describing. - They are, they are,

01:53:11.980 | which is unusual. - Cables and machines.

01:53:13.660 | - So cables would be considered low ground

01:53:15.520 | because you're kind of in space.

01:53:17.220 | And if you think about it, what takes someone out,

01:53:20.100 | in their 40s, what takes someone out of the game?

01:53:22.660 | It's a tendon injury.

01:53:23.820 | Tendinopathies, whether it's a shoulder,

01:53:27.100 | whether it's a hamstring, whether it's a hip.

01:53:29.500 | And part of the reason is there's muscular strength.

01:53:32.660 | We focus on muscular strength.

01:53:34.180 | But there's also tendon strength, which takes time.

01:53:37.860 | And when you get tendinopathies,

01:53:39.800 | you get the thickening of these tissues,

01:53:41.620 | people will say that tendon lays down much slower,

01:53:46.220 | that the collagen turnover is much slower.

01:53:47.820 | But actually, muscle turns over 1% to 2% per day.

01:53:52.180 | Tendons turnover maybe 0.5% to 1.5% per day.

01:53:57.180 | It's not that substantially slower.

01:54:00.680 | It's highly active tissue.

01:54:02.580 | You need blood flow.

01:54:03.780 | You have to treat your body with respect

01:54:06.260 | that if you think you can always train the way

01:54:08.660 | that you did when you were younger

01:54:09.900 | and just hit those heavy weights,

01:54:11.900 | if you get injured,

01:54:13.500 | and you are not allowing your tendons to keep up,

01:54:16.980 | then overall injury over time,

01:54:19.960 | again, this is what we would call,

01:54:21.460 | maybe not a catabolic crises, but close.

01:54:24.860 | - What is the total duration of a resistance training workout

01:54:28.120 | that the typical person could use?

01:54:30.380 | I make it a point to try and warm up

01:54:32.740 | over the course of about 10 to 15 minutes

01:54:34.620 | and then do 50 to 60 minutes of hard work.

01:54:38.820 | But I always leave some gas in the tank.

01:54:41.300 | It's the rare,

01:54:42.860 | I would say 5% of my total resistance training workouts.

01:54:45.820 | And I also train three times a week,

01:54:47.140 | although I divide my body up into different splits.

01:54:50.960 | That's my case.

01:54:51.880 | And I run three days.

01:54:52.720 | - Well, you are much larger than me.

01:54:54.100 | - Well, it's the case now

01:54:57.320 | that I try and hit each muscle group directly once per week

01:54:59.860 | and then indirectly another day per week.

01:55:01.940 | So if legs are on Monday, that's direct.

01:55:04.500 | But the indirect leg training

01:55:05.620 | is actually the HIIT workout on Friday, sprinting.

01:55:08.600 | - I love that.

01:55:09.440 | That's wonderful.

01:55:10.260 | - I think that the three days per week whole body workout,

01:55:12.940 | I think would work for a lot of people

01:55:14.180 | just to take the complexity out of it.

01:55:16.700 | So is it the case that the entire workout

01:55:19.980 | could be constrained to 45 to 60 minutes?

01:55:23.300 | - Absolutely.

01:55:24.220 | And for a new lifter, they're gonna get the most gains.

01:55:27.060 | What we find is that if an individual

01:55:29.560 | is what we would consider a beginner,

01:55:31.880 | you will see after they go through a neurological adaptation

01:55:36.880 | is that they will get more growth

01:55:42.100 | and potentially progress.

01:55:44.180 | A new lifter could progress weekly.

01:55:46.740 | Whereas a more advanced lifter,

01:55:47.880 | I would say we would be considered more advanced.

01:55:50.020 | We've been lifting our whole lives.

01:55:51.620 | That for us to make changes,

01:55:53.820 | it's much more challenging for us to put on size

01:55:58.460 | or even get stronger.

01:56:00.620 | I mean, yes, there is a particular cadence,

01:56:02.940 | but our improvements might be minute.

01:56:06.280 | And when you're thinking about designing a program,

01:56:08.380 | the current recommendations for physical activity,

01:56:11.400 | which by the way, do you know 75, roughly 70,

01:56:14.420 | maybe it's 78% of individuals

01:56:17.020 | do not meet physical activity guidelines.

01:56:19.880 | - And what are those again?

01:56:20.940 | 5,000 steps per day?

01:56:22.180 | - 150 minutes of moderate to vigorous activity

01:56:25.140 | with two days a week of resistance training.

01:56:27.100 | - Per week?

01:56:27.940 | - Yeah.

01:56:28.760 | - So 150 minutes.

01:56:30.240 | - Total.

01:56:31.300 | And two days a week of resistance training.

01:56:32.400 | - Plus two days a week of resistance training.

01:56:34.700 | - So that is what?

01:56:37.900 | 30 minutes, seven days a week of activity.

01:56:41.660 | Just to put that into perspective,

01:56:42.940 | that is how sedentary we are.

01:56:45.060 | 50% of Americans are not even training.

01:56:47.700 | - Is that true in other countries as well?

01:56:49.800 | - Well, I don't know the statistics in other countries,

01:56:53.900 | but far and away,

01:56:56.240 | we have arguably the biggest health crisis

01:57:01.060 | with our population.

01:57:03.620 | - People always point to the blue zones.

01:57:05.340 | They say, well, in the blue zones,

01:57:07.340 | they have like a shot of vodka every night

01:57:09.560 | and they're socially connected

01:57:10.840 | and they have a Mediterranean diet

01:57:12.460 | and they're not lifting weights.

01:57:14.340 | But is it the case that they are piling wood?

01:57:17.880 | Are they walking more?

01:57:20.140 | - They're highly active.

01:57:22.100 | Highly active.

01:57:22.980 | And the blue zones are a funny thing

01:57:25.580 | because some will say,

01:57:28.740 | well, are the records kept appropriately and et cetera.

01:57:33.740 | There is a lot though,

01:57:37.420 | despite that, that we can learn from the blue zones.

01:57:39.780 | And I think again, connection, socialization,

01:57:44.620 | but also movement.

01:57:47.020 | Part of the reason why we are requiring

01:57:49.600 | this higher protein load

01:57:51.480 | is because we are physically less active.

01:57:54.460 | Again, there's only two main ways

01:57:56.180 | to stimulate skeletal muscle,

01:57:57.460 | resistance training and dietary protein.

01:58:00.660 | Arguably, the resistance training piece,

01:58:03.260 | the physical activity piece is more influential,

01:58:06.740 | is much more impactful to full body homeostasis

01:58:10.940 | than diet will ever be.

01:58:12.780 | If you just eat protein and don't exercise,

01:58:16.120 | you will likely still lose muscle.

01:58:18.620 | - Interesting.

01:58:19.580 | My observation of family friends

01:58:23.340 | that include people who are very fit

01:58:25.340 | into their 80s and 90s,

01:58:27.740 | and even beyond in a few cases,

01:58:29.820 | are that, and here,

01:58:32.140 | these are generalizations based on observation,

01:58:35.500 | I want to be clear,

01:58:36.620 | that the people I know

01:58:38.420 | who are still skiing in their 80s,

01:58:42.620 | who are sprinting in their 80s,

01:58:44.820 | not as fast as they used to,

01:58:46.660 | who are still playing tennis in their 80s.

01:58:49.460 | So what I'm referring to here

01:58:50.380 | are people that are playing sports

01:58:52.180 | that involve dynamic movement,

01:58:53.740 | that involve a lot of coordination,

01:58:55.340 | and no doubt some resistance,

01:58:57.720 | at least of some sort.

01:58:59.740 | Like skiing is, you know,

01:59:00.920 | there's some resistance involved,

01:59:02.460 | depending on the complexity

01:59:03.780 | of the slope, et cetera. - And trees, potentially.

01:59:05.340 | - Yeah, and trees.

01:59:06.180 | So what do you think is going on there?

01:59:08.060 | I mean, there's a rich literature

01:59:09.580 | to support the fact that most of our brain volume

01:59:12.460 | is there to support vision and movement,

01:59:15.020 | and that when we move less,

01:59:16.220 | there's brain atrophy.

01:59:17.420 | John Rady at Harvard talked a lot about this,

01:59:20.540 | even some species of animals

01:59:21.900 | that will spend part of their life swimming around,

01:59:23.940 | and then they'll nest on a rock,

01:59:25.100 | and then the brain will actually eat itself

01:59:27.100 | due to the lack of movement.

01:59:28.060 | It will just metabolize portions of itself.

01:59:31.020 | So the relationship between movement

01:59:32.540 | and brain health seems obvious.

01:59:36.180 | But yeah, how many folks do you see out there

01:59:40.620 | in their 60s, 70s, 80s, and 90s

01:59:45.180 | that are now doing resistance training?

01:59:46.900 | Do we know the percentages on that?

01:59:48.380 | - I don't, and I was just recently looking

01:59:50.060 | at the ACSM guidelines,

01:59:51.820 | which is the American College of Sports Medicine,

01:59:55.020 | for activity in older individuals.

01:59:57.740 | I am not sure the percentage of individuals

02:00:01.260 | that are actually doing resistance training.

02:00:03.620 | And partially, I'd have to believe that it's less.

02:00:07.100 | So again, I trained as a geriatrician,

02:00:09.700 | and one of the things that we always saw,

02:00:12.180 | not for everybody, but for the majority of people,

02:00:14.380 | is it wasn't the duration of the training.

02:00:16.740 | They were still, if they were active,

02:00:18.220 | they were still active.

02:00:19.060 | It was the intensity that they were able to mount.

02:00:22.620 | And so because, there's this interesting thing,

02:00:25.740 | is as we age, well, I mean,

02:00:28.340 | some of us are less intense in our training.

02:00:30.980 | And it's the actual intensity piece

02:00:33.740 | that seems to go down, that when this can be addressed,

02:00:37.620 | and what do I mean by intensity?

02:00:39.540 | There's a million ways in which

02:00:41.020 | I suppose one could define intensity.

02:00:43.700 | But it is pushing themselves, again,

02:00:47.460 | are we gonna say, is it how many reps, how heavy?

02:00:51.540 | But the focus and the intensity of the training goes down.

02:00:54.800 | - I guess we could define intensity somewhat loosely,

02:00:57.500 | but still fairly by saying, repetitions in the,

02:01:01.660 | what, five to 10, maybe 12 repetition range,

02:01:04.980 | where the final two or three repetitions

02:01:07.980 | are challenging in good form, right?

02:01:12.100 | Maybe even to failure in good form.

02:01:14.340 | Does that seem like fair?

02:01:16.200 | - Yeah, and I would think of the intensity component,

02:01:19.760 | because the aging literature,

02:01:21.700 | it really doesn't seem to matter

02:01:23.420 | if people are lifting heavy or light.

02:01:25.980 | I used to believe that in order to maintain

02:01:28.860 | skeletal muscle mass,

02:01:29.820 | especially as hormonal status changes,

02:01:32.580 | decrease in testosterone, decrease in estrogen,

02:01:34.740 | decrease in progesterone,

02:01:36.100 | that the heaviness of the load has to increase.

02:01:39.900 | I can't, the data doesn't necessarily support that.

02:01:42.620 | I would love for that to be the case.

02:01:44.300 | - Surprising to me.

02:01:45.140 | - It is surprising. - I would think people

02:01:46.480 | would have to push themselves with not extremely heavy loads,

02:01:49.560 | but moderately heavy for them.

02:01:51.560 | - So it was surprising to me as well.

02:01:53.640 | And especially when we worked on some of those earlier

02:01:56.400 | studies in Lehman's lab,

02:01:58.560 | there's this change in body composition

02:02:00.320 | that seems to happen midlife.

02:02:01.560 | There's an increase in visceral body fat,

02:02:04.320 | or central adiposity.

02:02:06.160 | And one would think that you require a lot of extra

02:02:13.080 | supplements, et cetera, to influence that.

02:02:15.860 | But when training and nutrition are accounted for

02:02:19.180 | in a very controlled way,

02:02:21.000 | body composition changes to the positive.

02:02:24.140 | You can lose body fat and increase muscle mass.

02:02:26.860 | It'll be very interesting to see as the literature

02:02:29.620 | around hormone replacement continues to evolve,

02:02:32.180 | especially as it relates to women,

02:02:34.500 | because we know that testosterone

02:02:35.780 | improves skeletal muscle mass.

02:02:38.460 | But that isn't going to be enough

02:02:42.320 | if you don't have the foundation in place.

02:02:46.880 | And I think that the other big concern

02:02:48.460 | is how we're measuring skeletal muscle mass.

02:02:51.440 | We mentioned a little bit about DEXA.

02:02:53.640 | The more effective way is really MRI,

02:02:56.800 | which doesn't seem to be achievable for many people.

02:03:00.200 | It's expensive, and CT would be the other way

02:03:02.600 | to actually look at muscle quality.

02:03:04.040 | Muscle quality right now is defined purely

02:03:06.280 | on functional movement measurements,

02:03:09.000 | but that's clearly not it.

02:03:10.800 | When we define, if you look in the literature,

02:03:12.680 | muscle quality is really about the load

02:03:15.920 | and the weight and the performance,

02:03:18.380 | not about the architecture and the infrastructure

02:03:20.520 | of the skeletal muscle.

02:03:22.000 | And the reason I say this, let me take a step back,

02:03:25.060 | is that in the literature,

02:03:26.580 | and you will often hear people say

02:03:28.060 | that only strength matters, size doesn't matter.

02:03:31.100 | I don't believe that to be true.

02:03:33.820 | I believe that we haven't been able

02:03:35.180 | to test muscle size appropriately.

02:03:38.640 | And when we begin to test it, there's a way,

02:03:42.540 | and this is, I think this is being done,

02:03:44.320 | it came from a gentleman named Dr. William Evans,

02:03:48.260 | and he utilizes something called a D3 creatine,

02:03:51.980 | and it's a deuterated tagged creatine.

02:03:54.220 | And an individual will ingest a pill.

02:03:56.580 | Creatine is largely in skeletal muscle.

02:03:59.860 | There may be a small amount in brain,

02:04:01.240 | but for the majority of skeletal muscle,

02:04:04.680 | that's where creatine goes.

02:04:06.320 | And so this is a direct way, first time ever.

02:04:08.840 | It's been validated.

02:04:10.280 | I think it started its utilization in maybe 2019.

02:04:14.720 | But when individuals

02:04:16.120 | are directly measuring skeletal muscle mass,

02:04:19.320 | they find that skeletal muscle mass

02:04:21.760 | and strength are both important.

02:04:24.660 | - Interesting.

02:04:25.500 | So is there a synergistic effect

02:04:27.940 | of ingesting quality protein in sufficient amounts

02:04:31.900 | distributed throughout the day,

02:04:33.500 | and as you mentioned,

02:04:34.340 | especially at the first and last meal of the day,

02:04:36.700 | and resistance training exercise on muscle health

02:04:40.340 | and other metrics of longevity and current health status?

02:04:45.100 | - This is a bit of a nuanced answer.

02:04:47.820 | If you are young and you are eating

02:04:49.900 | close to one gram per pound ideal body weight,

02:04:52.380 | then any time that you ingest your protein would be adequate.

02:04:56.740 | However, if you're older

02:04:58.980 | and you want to take advantage of resistance training

02:05:03.140 | plus dietary protein,

02:05:04.580 | then consuming within an hour or so,

02:05:07.500 | and again, that number is,

02:05:09.200 | the way in which I think about it

02:05:10.580 | is really about that blood flow,

02:05:12.160 | is how long that blood flow is still

02:05:15.380 | getting to the skeletal muscle

02:05:16.640 | because you're delivering nutrients.

02:05:18.460 | If you are older or have a chronic condition,

02:05:21.540 | then there would be no downside,

02:05:23.760 | and there is evidence in the literature,

02:05:25.840 | if you consume dietary protein around resistance training

02:05:29.340 | due to that synergistic effect,

02:05:31.820 | if you are eating a lower protein diet and/or older.

02:05:34.920 | - Got it.

02:05:36.620 | So would it be actionable to try and,

02:05:41.620 | I don't know, drink a whey protein drink

02:05:43.300 | within an hour of resistance training

02:05:45.260 | or eating a meal that include a chicken breast

02:05:47.820 | or some eggs or a steak?

02:05:49.260 | Is that basically what we're talking about?

02:05:51.400 | - It is.

02:05:52.240 | If you are eating a lower protein diet,

02:05:55.140 | I would take advantage of that

02:05:56.820 | because you increase the efficiency,

02:05:58.620 | you lower that anabolic resistance load.

02:06:01.760 | Yes, one could do that,

02:06:04.540 | and I say this in a way that

02:06:06.940 | if you are young and healthy and you are training,

02:06:09.180 | I don't really care when you ingest your protein,

02:06:12.100 | but if you are a group or in a group of individuals

02:06:17.100 | that potentially is at risk,

02:06:22.380 | then doing resistance training

02:06:24.860 | and adding in dietary protein,

02:06:27.100 | I would say a shake is a great way to go

02:06:28.740 | because the absorption is quicker.

02:06:30.820 | A meal will have a slower absorption,

02:06:33.780 | and again, we need to get those amino acids

02:06:36.060 | into the bloodstream at a certain level at a certain time.

02:06:39.860 | - What about cardiovascular training, VO2 max?

02:06:42.580 | I make it a point to try and do a long hike

02:06:44.400 | or jog once a week.

02:06:45.420 | For me, that's 60 to 90 minutes.

02:06:47.300 | I'm not obsessive about it in the sense that

02:06:49.260 | sometimes I'll go out and I make it social

02:06:51.020 | with a weight vest or maybe just walk or hike.

02:06:53.220 | Sometimes I'll jog on my own.

02:06:54.900 | One shorter run of 30 minutes or so

02:06:56.860 | in the middle of the week at a faster clip,

02:06:58.380 | and then one high-intensity interval training session

02:07:00.380 | that lasts about 12 minutes in total,

02:07:02.500 | and thank goodness it's only that

02:07:03.780 | 'cause I'm basically sucking for air at the end.

02:07:06.580 | That's it for me, plus a bunch of walking if I can.

02:07:09.220 | I try to walk as much as possible throughout the day.

02:07:11.660 | I don't even consider that exercise.

02:07:13.160 | I just consider that movement.

02:07:14.000 | - And that's wonderful.

02:07:14.820 | Now you're talking about non-exercise activity.

02:07:19.740 | That is extremely valuable.

02:07:21.660 | - Yeah, I try to pace while I take phone calls

02:07:23.460 | and things of that sort, as much movement as possible.

02:07:26.540 | What is the value of getting the heart rate elevated

02:07:30.220 | for some period of time longer than a few minutes?

02:07:34.660 | - Yeah, I mean, when you're talking about increasing VO2max,

02:07:37.280 | I think that there's a multitude of ways to do it.

02:07:40.440 | One could do slow steady-state activity,

02:07:44.040 | but I will say, as individuals age,

02:07:46.580 | that becomes more challenging on joints.

02:07:48.100 | We are thinking about how are we able

02:07:50.420 | to maintain our physicality throughout life.

02:07:54.620 | If you have got a ton of time

02:07:56.420 | and you can do slow steady-state, it's wonderful.

02:08:00.100 | Alternatively, there's a lot of evidence

02:08:02.120 | that high-intensity interval training,

02:08:04.840 | Martin Gabbala would be a wonderful guest.

02:08:06.660 | He is really the expert in high-intensity interval training

02:08:09.540 | and it's changes in insulin sensitivity,

02:08:14.540 | influence on VO2max,

02:08:17.000 | and this is really going all out in a matter of 20 seconds.

02:08:21.060 | There's moderate-intensity interval training,

02:08:22.920 | high-intensity interval training, sprint interval training.

02:08:26.160 | That will increase VO2max

02:08:27.940 | in a substantially less amount of time

02:08:30.440 | and could be safer for an individual.

02:08:32.860 | The other way is improving skeletal muscle mass.

02:08:37.840 | If you improve strength and hypertrophy,

02:08:40.020 | you will improve your VO2max,

02:08:41.940 | albeit not exactly in the same way,

02:08:44.260 | but both are beneficial and both will improve VO2max

02:08:47.320 | and blood pressure and triglycerides

02:08:49.900 | and clinical outcomes that we care about.

02:08:53.200 | It's wonderful to think about things kind of nebulously

02:08:58.200 | and then it all comes back to

02:09:01.040 | what do we care about as we age?

02:09:02.840 | We care about having an appropriate blood pressure.

02:09:05.600 | Let's call it 120 over 80.

02:09:07.480 | We care about having a triglyceride level

02:09:09.240 | of 100 or less, lower.

02:09:11.600 | We care about maintaining fasting insulin levels,

02:09:15.420 | fasting glucose levels,

02:09:17.100 | anywhere the cutoff they will say is between 70 to 100.

02:09:21.780 | These are clinical outcomes that we care about

02:09:24.660 | and that is what we ultimately want.

02:09:28.940 | However, the influence is to pull those levers to get there

02:09:33.540 | can be varied.

02:09:35.600 | It ultimately comes with how are we going to do it

02:09:39.100 | and how is it going to be something that we maintain?

02:09:41.460 | There's certain aspects about dietary protein

02:09:45.280 | that are interesting.

02:09:46.520 | One of the things that I've seen clinically

02:09:48.040 | is that those individuals that are on a higher protein diet

02:09:50.600 | will seem to have higher blood glucose.

02:09:54.160 | I don't know exactly why this is.

02:09:55.920 | It's thought that maybe because

02:09:57.000 | the red blood cells live longer.

02:09:58.480 | - And maybe also higher blood creatinine levels.

02:10:01.540 | - We do see higher blood creatinine levels

02:10:04.000 | when individuals have higher muscle mass.

02:10:06.060 | That is typically a call that I get.

02:10:08.240 | Many of my patients are large and buff, as I would say,

02:10:12.180 | and they almost all have higher levels of creatinine.

02:10:15.740 | That doesn't mean that your kidney function is suffering.

02:10:18.100 | One thing that one would do clinically

02:10:20.100 | would get a cystatin C to correct and get a corrected GFR

02:10:24.600 | to see if it's within the normal range.

02:10:26.700 | - Is it true that if you do a hard resistance training

02:10:29.020 | session and then get your blood drawn the next day

02:10:31.340 | that you might see higher blood creatinine levels?

02:10:34.340 | - Potentially, but what I have seen

02:10:35.740 | are higher ALT and liver enzymes.

02:10:37.900 | And we see that very frequently

02:10:39.220 | in individuals that train intensely.

02:10:41.420 | - And it concerns you or doesn't concern you?

02:10:43.300 | - It doesn't concern me.

02:10:44.140 | - Right, 'cause it's just a consequence of the training

02:10:45.820 | and presumably it's transient.

02:10:47.380 | - It is transient, typically.

02:10:49.260 | And we may see changes in creatinine with,

02:10:52.840 | I have one patient, she runs 100 miles.

02:10:55.680 | - Oh goodness. - She's in her 60s.

02:10:57.740 | - She's an ultra runner?

02:10:58.780 | - Yeah, in her 60s.

02:10:59.820 | And she's strong, I mean, she's stronger than me.

02:11:02.200 | It's extraordinary.

02:11:03.220 | And you think about what are the things

02:11:05.600 | that she needs to do to maintain the health

02:11:08.400 | of her muscle mass so that she can continue

02:11:10.920 | for long periods of time.

02:11:12.840 | - So while we both agree that nutrition

02:11:15.720 | is one of the foundations of muscle health

02:11:17.480 | and health generally,

02:11:19.240 | supplements often can have their place.

02:11:22.140 | We talked a little bit about creatine.

02:11:24.720 | I and many other people supplement with five to 10 grams

02:11:27.540 | of creatine monohydrate per day.

02:11:29.640 | I do that because it has benefits for muscle strength.

02:11:33.280 | There's some brain benefits that I'm aware of.

02:11:35.480 | And I realize, and now you've reinforced the idea

02:11:37.880 | that it's difficult to get enough creatine,

02:11:40.280 | even if one is ingesting the threshold amount

02:11:43.800 | of one gram of protein per ideal body weight.

02:11:47.860 | What are your thoughts on creatine monohydrate

02:11:50.800 | and what other supplements do you recommend

02:11:52.860 | for your typical client, excuse me, patient?

02:11:56.040 | - Yeah, certainly.

02:11:56.880 | So creatine monohydrate is wonderful.

02:11:59.520 | And particularly we're seeing a lot of benefits in women,

02:12:02.600 | post-menopausal women and older populations.

02:12:05.800 | Creatine, for sure.

02:12:07.920 | The other supplement is urolithin A.

02:12:10.400 | Urolithin A is a postbiotic made from the gut microbiome.

02:12:14.240 | And there's a percentage of people that can make it

02:12:16.720 | and the majority of individuals cannot make it.

02:12:19.160 | - Interesting.

02:12:20.000 | - Urolithin A is this connection, which I find fascinating.

02:12:23.000 | It's a gut muscle connection.

02:12:25.380 | Individuals that take urolithin A,

02:12:28.120 | I happen to be one of them,

02:12:29.640 | there are many papers out there that it improves mitophagy,

02:12:34.000 | which is the health of mitochondria,

02:12:37.040 | the turnover of mitochondria,

02:12:38.840 | helps with the renewal of mitochondria.

02:12:41.200 | But what's so fascinating is there are trials

02:12:43.920 | in human individuals

02:12:46.080 | that it increases strength and endurance.

02:12:48.360 | - Interesting.

02:12:49.200 | What milligram doses do you recommend?

02:12:52.320 | - So I take between 500 and 1,000 of urolithin A.

02:12:55.720 | Really, I wish that I had actually created this

02:12:58.960 | or found this out.

02:12:59.960 | Truly, if I could make one supplement-

02:13:01.560 | - That's a bold statement.

02:13:02.400 | - I know.

02:13:03.280 | I would probably make a mix of urolithin A

02:13:05.840 | with creatine and some whey protein

02:13:07.400 | and maybe 25 milligrams of collagen.

02:13:11.280 | And I would have my perfect supplement.

02:13:13.280 | - Is it taken with food or without food?

02:13:15.680 | - It doesn't matter.

02:13:16.680 | - Interesting. Morning or night?

02:13:17.920 | - It also doesn't matter.

02:13:18.840 | What's so interesting about urolithin A

02:13:20.800 | is that it comes from, again, it's made in the gut,

02:13:24.160 | from the gut microbiome,

02:13:25.120 | from things like pomegranate or walnut.

02:13:27.240 | It's made from something called an elagitannin.

02:13:29.760 | And it is really, again,

02:13:32.760 | what I think of as this gut muscle connection,

02:13:35.120 | which I do believe is going to be the next frontier.

02:13:37.680 | - So interesting.

02:13:38.520 | I recall a few studies that Dr. Andy Galpin

02:13:40.760 | put on his social media.

02:13:42.840 | These were in mice, mind you,

02:13:45.160 | but looking at how disruption of the gut microbiome

02:13:48.840 | could offset some of the strength

02:13:51.520 | and hypertrophy increases of resistance training,

02:13:54.440 | pointing to the fact that having a healthy gut microbiome

02:13:56.840 | is critical for translating resistance training

02:14:00.400 | into actual improvements in muscle health.

02:14:02.520 | - Yes. And one of the things that we do see

02:14:04.560 | is that as individuals increase their activity,

02:14:07.400 | talking about more endurance type running,

02:14:10.520 | there's this very interesting inflection point.

02:14:12.720 | There's this idea of optimal performance.

02:14:15.200 | And then there is this kind of moment

02:14:19.280 | where optimal performance, depending on the training load,

02:14:22.000 | starts to take a toll on health and wellness.

02:14:23.880 | I think that we see that.

02:14:25.480 | And with that, one of the things that we always see

02:14:27.560 | is impaired gut lining, impaired gut integrity.

02:14:30.920 | The gap junctions seem to open,

02:14:33.880 | whether it's the training volume

02:14:35.440 | and the physiological stress.

02:14:37.480 | That can easily be measured with zonulin or calprotectin.

02:14:41.360 | Stool samples do this,

02:14:42.480 | but doing things that actually help the gut,

02:14:46.080 | not just the gut microbiome,

02:14:47.320 | but the gut integrity is extremely important.

02:14:51.720 | - Very interesting.

02:14:52.560 | What other supplements?

02:14:53.840 | And maybe we should put whey protein in here as well.

02:14:57.600 | - Yes, whey protein.

02:14:59.080 | It's interesting, whey protein and whey protein concentrate

02:15:02.360 | has alpha-lactalbumin and lactoferrin

02:15:04.720 | and these immunoglobulins that can be very beneficial.

02:15:07.920 | Whey protein, it's interesting.

02:15:09.320 | We talk a lot about how processed foods are negative,

02:15:12.160 | but the reality is that processed foods

02:15:15.080 | aren't positive or negative.

02:15:16.520 | The highly palatable processed foods that are full of sugar,

02:15:19.720 | we can all agree maybe those are not ideal,

02:15:22.240 | but whey protein concentrate or whey protein isolate,

02:15:26.360 | those are both processed.

02:15:27.960 | However, it is a great way to get your essential amino acids

02:15:32.920 | which are amino acids that you must get from the diet.

02:15:35.760 | Your body cannot make them.

02:15:37.520 | There has been a lot of research with whey protein,

02:15:39.760 | has very little downside and it's easily tolerated.

02:15:42.960 | Those that have challenges with lactose

02:15:45.480 | can use the whey protein isolate versus the concentrate.

02:15:50.520 | - And it's very portable if one is traveling

02:15:52.520 | and things of that sort.

02:15:53.680 | - And if one has a child,

02:15:55.560 | please make sure that you use a lid

02:15:57.840 | of very tight for the powder.

02:16:00.200 | Otherwise you will be wearing it,

02:16:01.640 | your child will be wearing it is a bit of a disaster,

02:16:04.280 | but yes.

02:16:05.120 | - Noted.

02:16:05.960 | What about other supplements,

02:16:07.800 | including fish oil, omega-3 fatty acids?

02:16:10.360 | - There's a lot of research around that.

02:16:12.120 | And I think that it's a positive.

02:16:13.960 | It's not only a positive for brain function,

02:16:15.660 | but it seems to have a unique anabolic effect.

02:16:19.040 | Maybe it is in, you know, potentially from on the ribosomes.

02:16:23.240 | We're not sure, at least I'm not sure at this time,

02:16:25.460 | but there seems to be even more emerging evidence

02:16:28.000 | that it may even impact women differently.

02:16:30.640 | Again, I can't say that in all certainty,

02:16:32.960 | but nearly all of my patients are on some form of fish oil.

02:16:37.320 | - Is there a threshold amount?

02:16:39.440 | - That is a wonderful question.

02:16:41.140 | There is not, the general recommendation

02:16:44.580 | is around four grams,

02:16:45.800 | but some individuals four to 10 grams,

02:16:47.640 | which would be definitely on the higher end,

02:16:49.560 | certainly can potentially thin your blood.

02:16:52.920 | If an individual is going for surgery two weeks prior,

02:16:56.240 | would suggest not taking it.

02:16:58.560 | But where it becomes very interesting,

02:16:59.840 | it's really the combination of omega-3 to omega-6

02:17:03.680 | and understanding there's ways

02:17:05.080 | in which you can test in your blood.

02:17:06.320 | We run this blood work all the time,

02:17:07.640 | looking at whether it's an omega quant or an omega,

02:17:10.600 | an omega index can be very valuable,

02:17:12.400 | but it is a very easy supplement to take.

02:17:15.940 | And it seems to be very beneficial for brain health

02:17:19.000 | and even muscle health.

02:17:20.520 | - I find it to be most affordable to take it in liquid form.

02:17:24.920 | Just take a tablespoon of the lemon flavored fish oil,

02:17:28.320 | put it in a protein drink or something,

02:17:30.040 | then you don't taste the fishiness

02:17:31.760 | and then capsules for convenience when traveling

02:17:35.440 | and things of that sort.

02:17:36.440 | But the liquid forms are so much more affordable

02:17:39.480 | in order to hit that two grams a day,

02:17:41.560 | or, you know, in this case-

02:17:43.000 | - Two to four, yeah, two to four grams.

02:17:45.740 | Again, this also depends on the absorption

02:17:47.820 | for the individual.

02:17:48.660 | That's why it's really important to do blood work.

02:17:50.400 | I have some patients that require closer to six grams

02:17:54.060 | to be able to improve their omega-3 to six ratio.

02:17:58.920 | And it certainly is, there's that precision nutrition

02:18:01.860 | where the amount for one person

02:18:03.580 | is not necessarily the amount for another.

02:18:06.300 | - Interesting.

02:18:07.580 | What other supplements do you take?

02:18:09.340 | - I think, let me think about what other supplements

02:18:12.220 | that I personally take.

02:18:13.580 | Collagen, I love collagen.

02:18:15.800 | Collagen in my coffee, collagen coffee,

02:18:20.620 | I love strong coffee.

02:18:21.460 | If you've never had it, it's amazing.

02:18:23.140 | Collagen- - It's called strong coffee.

02:18:24.300 | - It's called strong coffee.

02:18:25.420 | It has collagen, it has L-theanine in it,

02:18:27.900 | really helps with the jitters.

02:18:29.260 | There's some good evidence with L-theanine

02:18:30.860 | to help with anxiety.

02:18:32.460 | But collagen is interesting.

02:18:34.020 | Collagen is a, I say protein, it's not really,

02:18:38.060 | it has a protein score of zero.

02:18:40.020 | It does nothing to affect skeletal muscle mass.

02:18:42.460 | It is devoid in tryptophan,

02:18:44.300 | and it is very low in the branch chain amino acids,

02:18:46.700 | but it is high in glycine, proline, and hydroxyproline,

02:18:51.060 | which makes it very unique in structure.

02:18:53.620 | It is also very difficult to test the effect on tendons,

02:18:58.620 | collagen protein on tendons, because as you can imagine,

02:19:02.580 | one would not want a tendon biopsy.

02:19:05.080 | - Right, sounds painful. - It sounds painful.

02:19:07.060 | - Muscle biopsies are painful.

02:19:09.140 | - Yes, you know, I used to do a lot of those

02:19:11.040 | when I was in my fellowship.

02:19:12.260 | It was probably less painful for me

02:19:14.980 | than it was for the subjects, but--

02:19:16.180 | - I can imagine, yeah, it's like taking a small quirk

02:19:18.340 | of tissue out of the muscle. - Yes.

02:19:20.040 | So collagen protein, I think, can be very beneficial

02:19:24.920 | for skin, hair, and nails.

02:19:26.660 | I feel as if we just haven't gotten sensitive enough

02:19:30.180 | to determine its effect on tissue yet.

02:19:34.300 | I anticipate that higher doses above 15 grams

02:19:39.300 | may be of some benefit.

02:19:40.620 | I'm just speculating, but I'm guessing

02:19:42.460 | that it's probably closer to 25 grams,

02:19:44.980 | and I know that that seems a bit robust,

02:19:46.620 | so in one scoop might have 15 grams,

02:19:50.660 | but I think there's no negative to increasing collagen,

02:19:54.460 | and quite frankly, we don't get a lot of collagen

02:19:56.180 | in our diet.

02:19:57.100 | The places in which you would find collagen

02:19:58.740 | are the gristle in meats, or--

02:20:00.420 | - But in broth. - Yeah.

02:20:01.940 | That's another great way to increase it.

02:20:03.580 | - So you take it once a day? - I do.

02:20:06.120 | - Particular time of day?

02:20:07.260 | In the coffee, in the morning? - I take it in the morning,

02:20:08.580 | so my coffee has collagen in it.

02:20:10.980 | Sometimes I'll add-- - Before you train?

02:20:12.380 | - Before I train, yes, I do,

02:20:13.580 | and I typically train fasted aside from that,

02:20:15.660 | and then I'll add in an additional scoop.

02:20:17.700 | - You mentioned fasted.

02:20:20.460 | Maybe we should touch on fasting for a moment.

02:20:23.560 | I inadvertently have been doing intermittent fasting

02:20:27.220 | for years, meaning I was never hungry for breakfast,

02:20:30.440 | so my first meal lands at 11 a.m. or so,

02:20:33.460 | plus or minus an hour on most days.

02:20:35.940 | There are exceptions to that.

02:20:37.500 | Last meal typically, I don't know, 8 p.m.,

02:20:42.500 | 7 p.m., sometimes 9 p.m.

02:20:44.220 | I'm not super strict about that,

02:20:46.020 | and it basically boils down to anywhere from two

02:20:50.100 | to four "meals" per day, a lunch, a dinner,

02:20:55.100 | and then some eating in between.

02:20:58.220 | Could you first comment on that architecture of eating,

02:21:02.420 | but maybe first on fasting specifically?

02:21:05.620 | I mean, what are the benefits or detriments

02:21:07.460 | to having a feeding window of about eight or nine hours,

02:21:12.460 | regardless of where it lands in the day,

02:21:13.940 | and then let's talk about how that might slide around

02:21:15.820 | or if people should ensure getting more food coverage

02:21:18.880 | throughout the day.

02:21:19.860 | - Two benefits that I find from fasting.

02:21:22.460 | Number one, calorie restriction.

02:21:24.540 | Number two, bowel rest.

02:21:26.500 | Many individuals have gastrointestinal challenges.

02:21:30.440 | When they are in a time-restricted window,

02:21:32.780 | they are not feeding all day long.

02:21:34.700 | - Great point.

02:21:35.540 | - Those are the two benefits that I often see.

02:21:37.980 | An individual who is older or struggling to put on muscle,

02:21:41.500 | fasting would not be my primary go-to.

02:21:44.740 | I think that as individuals age,

02:21:46.620 | there's a bit of a negative

02:21:49.740 | because you have to balance this muscle protein synthesis.

02:21:53.140 | They're always going through a synthesis and a catabolism,

02:21:58.460 | so an anabolic process and a catabolic process.

02:22:02.040 | As you age, it becomes more difficult

02:22:03.600 | to regulate that process,

02:22:04.840 | and if you add in additional fasting,

02:22:07.400 | go through long periods of time

02:22:08.600 | where, let's say you're not training,

02:22:10.360 | you're not protecting skeletal tissue,

02:22:12.520 | that would be a place

02:22:13.360 | where I don't necessarily recommend fasting.

02:22:15.500 | - Some people might find it difficult

02:22:18.360 | to hit the 30 to 50 grams of protein per meal frequency

02:22:23.360 | across the day in order to reach that one gram of protein

02:22:27.080 | per pound of ideal body weight.

02:22:29.140 | If they were going to add a meal,

02:22:30.700 | or let's just say add 30 to 50 grams of protein,

02:22:34.320 | how much time separation do they need from the other meals?

02:22:38.060 | So for instance, if I were to take a step back and say,

02:22:40.780 | "Okay, you know, I need an additional 30 to 50 gram

02:22:43.820 | "protein intake per day

02:22:45.460 | "in order to maintain the muscle I have as I age,"

02:22:48.640 | and I am aging, as we all are, I suppose.

02:22:51.180 | "Is two hours before my 11 a.m. meal enough?

02:22:55.620 | "Does it have to be three hours?

02:22:57.120 | "Could it be one hour?"

02:22:58.380 | I mean, you can only assimilate

02:22:59.980 | and then oxidize a certain amount of protein.

02:23:02.540 | I mean, how much time window does one need

02:23:04.540 | between these protein feedings?

02:23:06.420 | - I appreciate that question.

02:23:07.620 | And here's my answer to that.

02:23:09.060 | The first meal of the day is the meal that has been studied.

02:23:13.060 | The remainder meals, to my knowledge,

02:23:14.980 | there is no study that shows anything

02:23:18.260 | about the second or the third meal.

02:23:19.700 | And perhaps that's because of the difficulty.

02:23:22.520 | But the literature suggests that that first meal of the day,

02:23:25.640 | whenever you're gonna have it,

02:23:26.660 | let's say for you it's 11,

02:23:28.400 | eating 30 to 50 grams of protein,

02:23:30.760 | the muscle protein synthetic response will last two hours.

02:23:34.840 | However, when we talked about mTOR,

02:23:36.640 | there's other initiation factors like EIF-4.

02:23:39.600 | That will maintain itself for another four to five hours.

02:23:44.520 | - I see.

02:23:45.360 | - Therefore, the second meal

02:23:48.760 | is really not necessarily

02:23:50.920 | a muscle protein synthetic response.

02:23:53.660 | I can't say that that's supported in the literature,

02:23:55.980 | but where the benefit of that is,

02:23:57.800 | is that we know that more than one meal

02:24:02.160 | of that robust amount of protein

02:24:04.760 | will likely have better outcomes

02:24:06.480 | on this 24-hour protein response, 24-hour nitrogen balance.

02:24:11.480 | But that second meal

02:24:13.080 | would be just about getting your protein in.

02:24:15.280 | It doesn't matter if it's,

02:24:17.280 | you know, if you have to hit your need

02:24:19.600 | of say 200 grams of protein,

02:24:21.520 | then that middle meal,

02:24:22.400 | the real goal for that metabolically

02:24:25.040 | is to get enough protein

02:24:26.680 | to meet that one gram per pound ideal body weight.

02:24:29.560 | - I see.

02:24:30.400 | - And then that final meal before you go into a fast

02:24:33.760 | would be what we would say

02:24:35.880 | would support overnight protein synthesis.

02:24:38.960 | I mean, not necessarily support overnight protein synthesis,

02:24:41.280 | but in the fasted state, your body pulls from muscle.

02:24:44.720 | It has to maintain the energy balance

02:24:47.640 | for all other systems in the body.

02:24:50.160 | All other tissues, again, 25% of protein turnover

02:24:53.440 | goes to skeletal muscle

02:24:55.200 | and the rest goes to other organ systems.

02:24:57.900 | For you or for hypertrophy,

02:24:59.720 | adding an additional meal would again,

02:25:03.120 | let's say four meals I think would be,

02:25:05.480 | if I were to design a diet in the perfect world

02:25:08.380 | to support hypertrophy,

02:25:10.000 | I would add another, a fourth meal.

02:25:12.000 | - Well, I love to eat.

02:25:14.240 | So that's not a problem in principle.

02:25:17.140 | This is probably getting a bit more toward the aficionados,

02:25:22.100 | but I've heard that certain forms of animal protein

02:25:26.600 | and other proteins are more beneficial

02:25:28.600 | at certain times of day.

02:25:29.520 | For instance, meat and eggs early in the day,

02:25:32.580 | maybe chicken and fish in the middle of the day,

02:25:34.420 | and that casein and milk proteins

02:25:36.260 | might be more advantageous for muscle health

02:25:39.920 | in the final meal of the day or closer to bedtime.

02:25:42.480 | I realize this is getting into the details,

02:25:44.400 | but I'm sure a percentage of our listeners

02:25:46.520 | would be curious to do that.

02:25:47.760 | And of course, milk proteins always make me sleepy,

02:25:50.480 | so it kind of fits.

02:25:52.160 | - You know, it's really interesting.

02:25:53.360 | I will say that milk protein casein

02:25:55.520 | seems to be slower absorbing

02:25:57.320 | and that's because of the impact with the gut, obviously.

02:26:02.000 | But is there anything special about casein or milk protein?

02:26:05.580 | The answer to that would actually be no,

02:26:07.160 | but the length of time that it takes

02:26:09.320 | for digestion absorption,

02:26:10.520 | maybe where the benefit comes in,

02:26:12.320 | that being said, there's some data to support

02:26:14.480 | high saturated fat dairy, believe it or not,

02:26:16.600 | actually can be good for health and longevity.

02:26:20.080 | I know that people will say high saturated fat

02:26:23.200 | or high fat dairy would be negative,

02:26:25.360 | but I would say that there is evidence

02:26:26.880 | to support it being health promoting.

02:26:30.200 | - Well, nothing like a piece of terrific cheese,

02:26:34.200 | like a Parmesan or a shot of full fat cream.

02:26:39.200 | - And I will mention the Lucy.

02:26:41.040 | - Which I love every once in a while.

02:26:42.360 | That's a guilty pleasure,

02:26:43.400 | a shot of full fat cream with equal part espresso.

02:26:46.640 | - I'll take it, I'll take it.

02:26:49.280 | I will mention that the leucine content

02:26:51.160 | in milk protein is a little bit lower or say Greek yogurt.

02:26:56.160 | - Are there any sort of cryptic champion proteins?

02:27:01.080 | You know, I think most of us think, okay,

02:27:02.680 | steak and ground beef and maybe venison and elk and eggs

02:27:07.680 | and all the obvious things, chicken, fish, et cetera.

02:27:10.000 | But are there any kind of cryptic proteins out there

02:27:13.440 | that are particularly good for us

02:27:16.360 | in terms of their amino acid content

02:27:18.120 | that people don't think of?

02:27:19.200 | You hear these days about liver.

02:27:20.440 | I frankly don't like the taste of liver.

02:27:21.280 | - I don't like liver,

02:27:22.360 | but liver has a lot of other benefits to it.

02:27:25.640 | So it's high in fat soluble vitamins and iron,

02:27:28.720 | very bioavailable, but I'm not, it's very difficult to eat.

02:27:32.280 | - Yeah, I think people either love it or hate it.

02:27:35.200 | I'm on the second category.

02:27:37.080 | So no proteins come to mind.

02:27:39.440 | Is salmon a quality protein?

02:27:41.560 | - Salmon is a quality protein, is higher in fat.

02:27:43.640 | Again, calorie balance does matter.

02:27:45.680 | Fish is interesting.

02:27:46.520 | Fish has five grams of protein per one ounce

02:27:49.480 | versus meat has on average seven grams,

02:27:52.760 | seven or eight, red meat has seven or eight grams

02:27:54.400 | of protein per one ounce.

02:27:56.240 | - So interesting, you know, this idea that, you know,

02:27:59.700 | eating muscle can support the health of muscle.

02:28:03.760 | - It makes sense though, doesn't it?

02:28:04.600 | - Yeah, it makes perfect sense.

02:28:05.920 | And you've explained very clearly as to why that is.

02:28:09.360 | Okay, we set aside liver for this conversation.

02:28:13.160 | - Some people are into cricket and maybe there is-

02:28:16.240 | - Sorry, I apologize to the, well, not to the crickets.

02:28:18.960 | The crickets probably thanked me for my response,

02:28:21.600 | but I'm not judging.

02:28:22.800 | It's just my personal visceral response.

02:28:25.320 | Other people may like insect proteins,

02:28:28.240 | but what about other organ meats, heart?

02:28:30.480 | I know, I mean, around the world,

02:28:33.600 | you see the consumption of lots of different organ meats.

02:28:36.400 | Is there any evidence that heart is a good protein

02:28:39.880 | or are we generally looking at skeletal muscle

02:28:42.480 | as the best source of amino acids?

02:28:45.280 | - Heart is also a good source of protein.

02:28:47.720 | It's also high in CoQ10, which is good for muscle health.

02:28:51.760 | But many people, again, we don't seem to eat that.

02:28:55.240 | However, other places eat the full animal.

02:28:58.760 | But they're all good sources of protein,

02:29:00.680 | aside from collagen,

02:29:01.720 | which would be that protein score of zero.

02:29:04.240 | - And if somebody insists on being vegan or vegetarian,

02:29:08.200 | let's just say vegan, what are their best options?

02:29:12.240 | - There are rice-pea blends of protein,

02:29:14.720 | which are absolutely suitable.

02:29:16.880 | There are a lot of now fermented types

02:29:19.200 | of protein powders out there

02:29:21.320 | that seem to have the same profile as whey.

02:29:23.520 | The one thing that I would say as individuals age,

02:29:27.000 | a vegan diet can be very challenging.

02:29:29.840 | Need to make sure that you are getting enough B12,

02:29:32.320 | zinc, iron, nutrients of concern

02:29:36.360 | that seem to be going down in general.

02:29:38.440 | We're seeing decreases of that in the general population.

02:29:43.000 | - What are your thoughts on magnesium?

02:29:44.440 | We sometimes hear that-- - Yes, it can be excellent.

02:29:46.400 | - People are magnesium deficient

02:29:48.380 | based on depletion of the soil.

02:29:50.400 | You hear this stuff, but what's the story with magnesium?

02:29:53.640 | - That is true.

02:29:54.480 | There seems to be less magnesium in the diet.

02:29:58.480 | Very easy to supplement,

02:29:59.640 | whether the form that you use,

02:30:01.360 | whether you use a magnesium glycinate

02:30:04.240 | or there's a whole host of magnesium citrate

02:30:08.000 | for gastrointestinal health, whatever it is.

02:30:10.400 | But yes, magnesium supplementation

02:30:12.920 | can be very beneficial for muscle, for brain.

02:30:16.400 | - Do you support the idea of supplementing with zinc

02:30:21.040 | or is that something that is kind of,

02:30:23.160 | sometimes yes, sometimes no?

02:30:24.240 | - I think if you're eating a whole foods diet,

02:30:26.760 | you're going to be unlikely to be deficient in zinc.

02:30:29.560 | Zinc is interesting

02:30:30.400 | because you don't want to supplement zinc without copper.

02:30:32.840 | There is a zinc-copper ratio

02:30:34.480 | that is well-maintained in the body.

02:30:37.200 | Supplementation with one or the other

02:30:39.280 | will typically deplete the other.

02:30:41.160 | And as a geriatrician, there's a zinc-copper ratio,

02:30:45.520 | things that we think of as kind of proxies

02:30:48.640 | for overall brain health.

02:30:50.520 | Not saying that the zinc-copper ratio is the only thing,

02:30:53.000 | but certainly supplementing with one or the other,

02:30:57.160 | one would be careful.

02:31:00.520 | - What are some things that people might be doing

02:31:02.600 | or taking that inadvertently disrupt muscle health

02:31:07.160 | and perhaps even hypertrophy?

02:31:10.360 | - One thing that people often use is ibuprofen.

02:31:13.680 | And ibuprofen, while not inherently bad,

02:31:16.280 | there's some evidence to suggest

02:31:17.600 | that higher doses of ibuprofen can impact muscle health,

02:31:21.120 | whether it's hypertrophy or strength.

02:31:23.480 | I often think about those together,

02:31:25.640 | but ibuprofen use, it's also not good

02:31:28.480 | for the gastric lining.

02:31:30.960 | Again, you have to be able to absorb your nutrients

02:31:33.800 | to be able to become strong and healthy.

02:31:36.280 | The other thing is obviously statin use.

02:31:38.640 | Some people do need statins.

02:31:40.000 | I'm not saying that we shouldn't,

02:31:41.060 | but that can certainly affect muscle health.

02:31:42.800 | A side effect can be muscle pain, myalgia, muscle soreness.

02:31:47.160 | It can deplete CoQ10.

02:31:48.840 | - Is occasional use of these things okay?

02:31:51.880 | - Yeah, of course, and obviously check with your doctor.

02:31:54.000 | But things that suppress inflammation

02:31:56.840 | like aspirin potentially or other NSAIDs can,

02:32:01.280 | well, aspirin is in a category of its own,

02:32:03.960 | but NSAIDs in particular seem to suppress skeletal muscle

02:32:08.440 | at certain doses, hypertrophy potentially and strength.

02:32:12.300 | The other thing is fluoroquinolones.

02:32:15.880 | They are antibiotics that can affect collagen

02:32:19.760 | and tendon turnover.

02:32:21.480 | If an individual is on a fluoroquinolone,

02:32:24.020 | there's a risk for,

02:32:25.320 | you hear a lot about these Achilles injuries.

02:32:27.440 | - Yeah, which sorts of antibiotics?

02:32:29.160 | I think, is it like Cipro and things like that?

02:32:31.880 | People can injure themselves badly.

02:32:34.000 | - You should be certainly careful about the activity

02:32:36.440 | that you're doing at the time.

02:32:37.680 | The other thing is the proton pump inhibitors.

02:32:39.760 | People use that for stomach acid or reflux.

02:32:43.000 | That can affect absorption of vitamins and minerals

02:32:46.640 | that do have long-lasting effects.

02:32:49.240 | - What are your thoughts on the GLP-1 analogs,

02:32:53.560 | Ozempic, Monjaro?

02:32:55.560 | Real quick anecdote.

02:32:57.320 | I was in New York City.

02:32:59.520 | I was walking up the Upper East Side on a Sunday recently,

02:33:03.120 | and there was a sign outside a store that said,

02:33:06.320 | "We carry Ozempic and Monjaro."

02:33:08.680 | And I thought the sign would say,

02:33:10.520 | like, we have ginger lattes or something.

02:33:13.520 | And I thought, well, that's good.

02:33:14.760 | I snapped a photo of it.

02:33:15.640 | I didn't think much of it at the time.

02:33:16.820 | And then I decided to post it to my Instagram

02:33:19.320 | thinking that there'd be a few opinions.

02:33:21.560 | And frankly, I was just curious what people would think.

02:33:23.440 | So I said, "What do you think?"

02:33:25.200 | And it was one of the largest responses

02:33:27.800 | in terms of comment volume and contentiousness

02:33:30.400 | that I'd ever observed.

02:33:32.440 | And I thought, whoa, there's really something here.

02:33:34.520 | My understanding is that these compounds,

02:33:37.680 | which are becoming incredibly popular,

02:33:40.720 | can help people lose weight,

02:33:41.840 | but that there's some loss of muscle,

02:33:43.480 | maybe even some bone mass.

02:33:44.720 | Correct me if I'm wrong on that.

02:33:46.480 | But I would also imagine, excuse me,

02:33:48.600 | that some of the muscle loss

02:33:51.640 | can be offset by resistance training,

02:33:53.320 | maybe even protein intake and resistance training.

02:33:56.360 | So what is your thought about these compounds?

02:33:58.760 | Last thing, I'll just give a little bit of my stance.

02:34:02.200 | I know a number of people

02:34:03.240 | that had extreme struggles losing weight.

02:34:05.880 | I don't know the extent to which

02:34:07.960 | they were doing things correctly

02:34:09.120 | or incorrectly with nutrition.

02:34:10.680 | It's not my place to probe into that,

02:34:12.600 | but that they got on these compounds, one or the other,

02:34:15.560 | and seemed to love them

02:34:17.440 | because it got them kind of out the gate,

02:34:19.680 | 20, 30 pound weight loss very quickly

02:34:21.720 | without intense cravings, their appetite is suppressed.

02:34:25.160 | And many of them are now also exercising

02:34:27.480 | and doing other things.

02:34:28.600 | So I don't think we wanna look at this

02:34:30.400 | or talk about this as an either/or,

02:34:32.440 | ozempic, manjaro, or exercise and proper nutrition.

02:34:36.640 | I would imagine there's a place for both,

02:34:37.920 | but I'd love your take on these.

02:34:39.640 | - I would love to share it.

02:34:41.400 | These medications are...

02:34:43.800 | It's complex.

02:34:46.000 | The issue of obesity, the challenge with GLP-1s

02:34:49.680 | and dual agonists like Mongerno GLP-1 and GIPs,

02:34:54.640 | it is a complex conversation.

02:34:56.880 | So the opinion that I'm gonna give is going to be,

02:35:00.680 | while I give my opinion,

02:35:02.280 | I recognize that this is certainly,

02:35:04.520 | like you said, very heated.

02:35:06.440 | There's a couple of ways to look at it.

02:35:09.080 | First of all, nothing has worked more effectively

02:35:13.080 | other than bariatric surgery than these medications

02:35:18.640 | to affect obesity.

02:35:20.480 | So a GLP-1 agonist like ozempic will,

02:35:23.360 | an individual might get a 13% weight loss.

02:35:27.160 | - In how long?

02:35:28.080 | - That's a good question. - A couple months or so?

02:35:30.800 | - Yeah, so it's a titration.

02:35:34.680 | It's a monthly titration.

02:35:36.480 | But over a period of 24 weeks, it certainly depends.

02:35:41.320 | - Significant.

02:35:42.800 | - Yeah, it certainly depends on the individual,

02:35:44.800 | but it's utilized and increased month by month

02:35:49.000 | at a four-week span.

02:35:50.120 | The other aspect is the dual agonist

02:35:55.440 | like Mongerno trizepatide.

02:35:57.600 | And that will potentially cause a 22% weight loss.

02:36:04.160 | The challenge with obesity is real.

02:36:06.880 | Now, I have taken care of patients

02:36:08.480 | that have deeply suffered with this,

02:36:10.520 | whether it is a component of food addiction

02:36:13.120 | or whether it is a component of whatever the reason.

02:36:16.840 | We have used these in clinic

02:36:18.600 | and it has transformed their lives.

02:36:21.680 | I would never take that away from somebody.

02:36:24.680 | Certainly it is personal choice.

02:36:26.640 | Now, the other aspects of these,

02:36:28.840 | the comment about skeletal muscle loss, I have seen that.

02:36:32.480 | And again, we use these medications in our practice.

02:36:37.480 | And with a proper nutrition plan

02:36:40.480 | and proper resistance training,

02:36:42.960 | I do not see a loss of skeletal muscle mass.

02:36:45.640 | You have to work with a provider that can help titrate it.

02:36:49.200 | But I think that these drugs can be used

02:36:51.800 | in a very safe manner.

02:36:53.320 | And we see improvements in alcohol consumption,

02:36:57.520 | in other addictions.

02:36:59.440 | - Very interesting.

02:37:00.280 | - There are a whole host of benefits

02:37:02.320 | from these medications.

02:37:04.120 | Now, I think where people get upset is they say,

02:37:08.640 | "Well, is this a shortcut?

02:37:09.720 | "Can you go off of them?

02:37:11.000 | "Do you have to regain that weight?"

02:37:12.600 | And again, we have many patients that go off of them

02:37:16.000 | and have implemented great strategies

02:37:18.080 | for training and nutrition and we don't see weight gain.

02:37:21.280 | - Interesting.

02:37:22.120 | - It all depends on a comprehensive holistic view.

02:37:26.640 | And that becomes important to recognize.

02:37:28.960 | There are many benefits and people will say

02:37:32.120 | the negatives would be slowing down gastric emptying.

02:37:35.920 | Well, I would say yes,

02:37:37.320 | and that's exactly what the medication is designed to do.

02:37:40.240 | There may be some risk with pancreatitis.

02:37:42.800 | There is some discussion about thyroid cancer

02:37:46.520 | in rodent models.

02:37:48.080 | Rodents have a different thyroid

02:37:52.600 | and volume of thyroid receptors than humans.

02:37:55.080 | I think that potentially that is incidental.

02:37:57.800 | I'm sure that we'll be hearing more and more about it.

02:38:00.080 | These medications also are not new.

02:38:02.920 | They have been used for over a decade.

02:38:06.800 | And those are all important points to recognize

02:38:10.800 | that now it is very popular,

02:38:13.400 | but these medications have been around for quite some time.

02:38:16.680 | - It is interesting that some of the peptides

02:38:19.120 | like GLP-1 analogs that have existed

02:38:21.800 | in somewhat niche communities for a while,

02:38:25.440 | so including things like

02:38:26.520 | in the melanocyte-stimulating hormone community

02:38:29.520 | that are now sold under FDA approval

02:38:31.640 | for things like low libido,

02:38:35.360 | things like Vilece.

02:38:37.240 | - And Addy, we were mentioning Addy for women,

02:38:40.360 | for hyposexual desire disorder.

02:38:42.800 | - Right, I don't know the history of Addy,

02:38:45.040 | but certainly the alpha-melanocyte-stimulating

02:38:50.040 | hormone-related peptides, the GLP-1 peptides,

02:38:52.880 | things like Sermorellin,

02:38:53.880 | which are in the growth hormone secretagogues,

02:38:55.480 | all were viewed for a long time

02:38:57.080 | as kind of niche community, fitness community,

02:38:59.400 | but now at least the GLP-1 analogs

02:39:01.600 | have made their way into, I mean, massive scale use,

02:39:06.600 | which speaks to kind of a general theme

02:39:08.680 | of what I've observed over the last,

02:39:11.400 | well, I'm 48 now, but let's just say 35 years,

02:39:13.720 | which is that many of the things

02:39:15.360 | that exist in niche communities become mainstream.

02:39:19.840 | It just takes some time and they become mainstream

02:39:22.480 | through the standard channels of FDA approval,

02:39:25.160 | which as is the case with Ozempic and Mondrano.

02:39:27.760 | So it's great to hear that you embrace sort of both sides.

02:39:30.600 | Like a lot of what you've talked about today,

02:39:32.420 | I think one wouldn't necessarily find

02:39:34.520 | in the kind of standard tables

02:39:36.160 | or what's on a poster in the doctor's office,

02:39:39.240 | but some of it is,

02:39:40.240 | and you really are at the intersection

02:39:42.080 | of both those landscapes.

02:39:44.920 | - Thank you, and this idea of Ozempic

02:39:47.960 | and triseptide, these GLP-1s,

02:39:51.080 | we talked a lot about protein.

02:39:52.960 | And one way that it has a satiating effect

02:39:55.400 | is this GLP-1 stimulation.

02:39:59.640 | And one has to recognize that these GLP agonists,

02:40:02.740 | these GLP-1 agonists last for a week.

02:40:05.200 | The dietary protein effect is a meal to meal.

02:40:08.960 | - So eating protein increases GLP-1,

02:40:11.240 | as does drinking yerba mate tea,

02:40:13.280 | but probably to a lesser degree and more transiently.

02:40:15.720 | - More transiently.

02:40:16.820 | And I think that that is just an important

02:40:20.000 | and interesting fact.

02:40:21.240 | And the other fact is that the amount necessary

02:40:25.000 | to stimulate muscle protein synthesis,

02:40:26.800 | the amount for muscle health,

02:40:28.660 | is also seen in the amount of GLP-1 released.

02:40:32.880 | - Interesting.

02:40:33.720 | - It seems as if that 30 to 40 or so gram amount

02:40:38.720 | of high quality protein is the same amount

02:40:42.120 | that has a meaningful impact on the release of GLP-1.

02:40:46.040 | - Very interesting.

02:40:47.120 | I did not know that.

02:40:49.100 | So if we were to just back away

02:40:51.240 | from everything we've talked about,

02:40:53.000 | what are the top level benefits of having healthy muscle?

02:40:58.960 | - Everything.

02:41:00.280 | (both laughing)

02:41:01.280 | - Okay.

02:41:02.120 | - Muscle is the organ of longevity.

02:41:04.240 | And when we think about lifespan,

02:41:07.720 | we think about healthspan,

02:41:08.920 | and then we finally think about muscle span.

02:41:11.440 | I would argue that that is right after lifespan.

02:41:16.040 | The benefits of healthy muscle cannot be denied.

02:41:19.140 | This is better metabolic health,

02:41:22.180 | better blood pressure,

02:41:23.780 | better survivability,

02:41:25.820 | better strength,

02:41:27.020 | better mobility,

02:41:28.540 | better body armor.

02:41:30.580 | Should someone fall,

02:41:31.700 | should someone get sick,

02:41:33.220 | your survivability will be related

02:41:35.180 | to the health of skeletal muscle.

02:41:37.100 | And especially as we think about aging,

02:41:39.460 | if we wanna have good skin,

02:41:41.020 | or we think about wanting to have a good looking body,

02:41:45.820 | even though I can appreciate

02:41:47.480 | it's only a small amount aesthetic,

02:41:50.820 | but leveraging the aesthetic

02:41:52.440 | to have healthy brain function,

02:41:54.780 | there's this idea that Alzheimer's

02:41:57.960 | or certain types of dementia

02:41:59.480 | are type three diabetes of the brain.

02:42:01.280 | Skeletal muscle is the only organ system

02:42:04.880 | we have voluntary control over.

02:42:07.440 | It is the only endocrine organ system

02:42:10.400 | we have voluntary control over,

02:42:12.120 | which means we have a responsibility to leverage it.

02:42:16.120 | - We've talked about these in a lot of detail today,

02:42:18.460 | meaning you've educated us about these in detail today,

02:42:21.160 | and thank you.

02:42:22.000 | But perhaps you could summarize

02:42:24.720 | what you view as the top nutrition-based tools

02:42:27.240 | for improving muscle health.

02:42:29.640 | - Number one, dietary protein.

02:42:32.340 | And that would be in terms of a protein hierarchy,

02:42:36.740 | roughly one gram per pound ideal body weight.

02:42:39.140 | An individual could certainly go

02:42:40.660 | to 0.7 grams per pound ideal body weight.

02:42:44.500 | The higher the protein, the less it matters the quality,

02:42:47.660 | whether it is a high quality protein

02:42:49.220 | or a lower quality protein,

02:42:50.540 | the total protein amount matters.

02:42:53.140 | That is at the base of the pyramid.

02:42:55.180 | The next would be the,

02:42:57.620 | I would say the quality,

02:43:00.540 | understanding the quality of the protein

02:43:02.780 | so that you know exactly how much,

02:43:04.880 | and then certainly the distribution

02:43:07.060 | of how you are ingesting this protein.

02:43:09.780 | The dietary protein habits

02:43:13.380 | of someone who is eating a more protein-forward diet,

02:43:16.580 | distribution will matter less the higher it is,

02:43:19.660 | but there is certainly some great importance

02:43:23.180 | depending on if you are older,

02:43:25.280 | challenging for any kind of health and wellness challenges.

02:43:31.700 | This is what I would say.

02:43:33.340 | - And I realize it will vary depending on activity,

02:43:35.860 | but assuming that somebody gets the one gram

02:43:38.840 | of quality protein per pound of ideal body weight,

02:43:41.940 | how should they make up the rest of their caloric needs?

02:43:44.820 | - The next I would say would be your choice.

02:43:47.500 | You choose, carbohydrates or fat.

02:43:49.740 | There's evidence that carbohydrates are helpful

02:43:53.340 | from a fiber perspective,

02:43:55.100 | phytonutrients, other vitamins and minerals.

02:43:57.580 | I certainly would go there.

02:43:58.740 | That would be my preference.

02:43:59.700 | The amount of activity that you do

02:44:01.720 | certainly could use carbohydrates.

02:44:03.820 | And then fat.

02:44:04.980 | It is very easy to get essential fatty acids.

02:44:07.540 | Your diet doesn't have to be too high in fat to get that.

02:44:10.820 | But at the end of the day, prioritize dietary protein.

02:44:14.400 | The next level would be understanding

02:44:15.940 | your carbohydrate threshold.

02:44:17.820 | Could start at 130 grams, titrate up or down,

02:44:20.580 | depending on your metabolic health and/or activity.

02:44:23.540 | Understanding that outside of activity,

02:44:25.660 | 50 grams or less of carbohydrates would be a threshold

02:44:29.860 | to mitigate substantial insulin response.

02:44:32.780 | Finally, that fat, you can choose

02:44:34.940 | however you would like to get that fat.

02:44:36.700 | Typically comes within a meal.

02:44:38.420 | And that would be the remainders of your caloric intake.

02:44:42.740 | - And what are your top line tools

02:44:46.380 | with respect to exercise as it relates to muscle health?

02:44:50.260 | - Resistance training is non-negotiable.

02:44:52.220 | It doesn't matter if you need to start with body weight,

02:44:55.500 | absolutely okay.

02:44:56.980 | Move to bands.

02:44:58.680 | Definitely moving load is valuable and non-negotiable.

02:45:02.340 | Start with two days a week.

02:45:04.020 | You will likely progress to three days a week

02:45:05.800 | if you're doing three days a week.

02:45:07.380 | Again, it all depends on the volume and intensity

02:45:10.220 | in which you are working under,

02:45:11.820 | depending on whether it's five to 10 sets,

02:45:14.740 | how many reps you're doing.

02:45:17.280 | I think that there's many ways

02:45:19.180 | in which one could do it right.

02:45:20.700 | The only way in which someone could do it wrong

02:45:22.820 | is to not do it, quite frankly.

02:45:25.300 | That would be what I would say for that.

02:45:26.760 | And then adding in high-intensity interval training.

02:45:28.920 | I would choose high-intensity interval training

02:45:31.020 | over slow, steady-state cardio

02:45:33.300 | because the high-intensity intervals seem to have

02:45:36.740 | a very impactful effect

02:45:39.980 | with the low amount of time that it takes.

02:45:44.020 | - Let's talk about something

02:45:45.060 | that might seem somewhat distant

02:45:48.820 | from everything else we've talked about,

02:45:50.340 | but I actually believe is central to all of this,

02:45:52.940 | which is mindset.

02:45:54.900 | The psychology around health and self-directed health,

02:45:58.740 | which of course includes communication and cooperation

02:46:01.420 | from licensed trained physicians like yourself.

02:46:04.780 | You know, what's your mindset and recommended mindset

02:46:07.900 | around muscle health and just general health

02:46:10.220 | in terms of healthspan and lifespan?

02:46:12.660 | - What you're talking about here is muscle span

02:46:15.640 | and the way in which the cognitive processes

02:46:18.820 | and the way that we think about our life,

02:46:20.460 | how does that influence what we actually do?

02:46:23.660 | And I could give someone the perfect plan

02:46:26.860 | and it doesn't matter if I give an individual

02:46:29.100 | a perfect plan if they're not willing to execute on it.

02:46:32.260 | I've been a physician for 20 years, believe it or not,

02:46:34.740 | that is a long period of time.

02:46:36.480 | And I would say a good physician

02:46:38.540 | is a physician that identifies patterns of diseases,

02:46:41.580 | patterns of illness.

02:46:43.020 | But an effective physician

02:46:44.860 | is someone who identifies patterns of people.

02:46:47.780 | Because once you identify the pattern of the person,

02:46:50.580 | you're able to leverage that

02:46:52.300 | so that they can get the best out of themselves.

02:46:55.100 | And there's a few core fundamental principles

02:46:57.900 | that people have to recognize if they want to be well.

02:47:01.440 | And that is you set standards

02:47:04.340 | and you don't set goals.

02:47:06.140 | People will set a weight loss goal

02:47:08.140 | or a muscle hypertrophy goal.

02:47:10.420 | But if you set a standard for how you operate

02:47:13.080 | and how you execute,

02:47:14.800 | you know that regardless of how you feel,

02:47:17.140 | you're gonna get up and train.

02:47:18.660 | You know that this is going to be your nutrition plan.

02:47:22.620 | You get up and you do it.

02:47:23.580 | You set a standard and that standard

02:47:25.700 | provides a framework for execution.

02:47:27.840 | - I love that.

02:47:32.000 | I sometimes think of the non-negotiables of the week

02:47:35.920 | that unless I'm suffering from a really bad cold or flu,

02:47:38.680 | which fortunately for me is pretty rare,

02:47:40.680 | that I'm gonna get

02:47:42.520 | those three resistance training sessions in.

02:47:44.300 | I'm going to try and get as much quality sleep as I can

02:47:47.760 | and I'll get those cardiovascular training sessions in.

02:47:50.720 | When you talk about setting standards,

02:47:52.520 | is that what you're referring to?

02:47:54.520 | Are you talking about blood work standards?

02:47:56.080 | Are you talking about aggressively trying

02:47:59.120 | to maintain blood values in a particular range?

02:48:03.680 | Or are you mainly talking about behaviors?

02:48:06.120 | - I'm talking about both.

02:48:08.120 | Yes, should there be a standard for your blood work

02:48:10.220 | that you're getting?

02:48:11.060 | Yes, we have a very strict standard

02:48:12.980 | that we have in place for all our patients.

02:48:15.820 | However, the framework for which they execute

02:48:18.900 | is all about the standards that they place for themselves.

02:48:21.800 | 'Cause ultimately what we want here, Andrew,

02:48:24.600 | is we want people to get results.

02:48:26.280 | And the only way they're going to get results

02:48:28.600 | is if they stop chasing these goals.

02:48:31.760 | And that might be counterintuitive to people

02:48:33.760 | because people will say,

02:48:34.600 | "Well, I'm gonna set a weight loss goal."

02:48:36.440 | Goals come and go.

02:48:38.580 | Standards remain.

02:48:40.720 | And if you fail to do the practical in your life,

02:48:44.600 | the practical becomes impossible.

02:48:47.960 | And that's why we set standards.

02:48:50.200 | The other aspect is an individual

02:48:52.400 | has to understand where they fail.

02:48:55.120 | I take care of a lot of very successful entrepreneurs

02:48:58.120 | and just individuals.

02:49:00.360 | They all know where they fail.

02:49:02.480 | They all know their points of weakness.

02:49:05.380 | Over time, it's not understanding where you excel

02:49:09.280 | because quite frankly, that's the easy part.

02:49:11.820 | The part that becomes very valuable

02:49:13.520 | is you know where you fail.

02:49:14.680 | You know where your points of vulnerability are.

02:49:16.480 | You know where you fall off track.

02:49:18.000 | I'll give you an example.

02:49:19.600 | Typically, when someone is about to do something amazing,

02:49:23.460 | they have this, but you know this better than anyone,

02:49:25.680 | this dopamine high.

02:49:27.560 | At that pinnacle seems to be a place of vulnerability,

02:49:31.200 | whether they will skip a training session

02:49:33.960 | or buy another car or do whatever it is that they do,

02:49:38.720 | eat more cake.

02:49:39.980 | They have an experience in their environment

02:49:42.760 | where they're at the pinnacle of what they are doing.

02:49:45.820 | That is a place of vulnerability

02:49:47.480 | where people will fall off health track.

02:49:50.320 | On the same token, at the moment after

02:49:53.860 | the big successful moment,

02:49:56.220 | I have a patient who puts on a massive event in Vegas

02:49:59.920 | and every year I wait for the call

02:50:01.760 | that he's feeling depressed

02:50:03.680 | because his dopamine didn't go back to baseline

02:50:08.680 | or fall to baseline, it went below baseline.

02:50:11.640 | What becomes important to recognize

02:50:13.120 | is that this is another point of vulnerability.

02:50:15.520 | At this point of vulnerability

02:50:17.480 | is where people seem to go off track

02:50:22.120 | and never regain their footing

02:50:23.900 | if they do not recognize that.

02:50:26.000 | And so I can appreciate

02:50:27.160 | that we're talking about mindset here

02:50:28.500 | because there's a level of neutrality

02:50:30.760 | that is necessary for overall success.

02:50:34.140 | Again, this is what I've seen time and time again,

02:50:37.440 | that those that are the healthiest

02:50:39.040 | are able to maintain this level of neutrality.

02:50:41.440 | - Tell me more about level of neutrality.

02:50:43.120 | I'm right there with you on setting standards

02:50:45.360 | instead of goals.

02:50:46.180 | And I'll say, I've never thought about it in this way,

02:50:47.720 | but I absolutely love that.

02:50:50.080 | And for the record, you said it

02:50:52.200 | and I'm gonna blast it out credit to you

02:50:55.120 | as much as possible because I think it's so critical

02:50:57.340 | for persistent engagement in the kinds of behaviors

02:51:01.440 | and mindsets that lead to success over time.

02:51:03.840 | So love this standards over goals principle,

02:51:08.580 | knowing where one fails, points of vulnerability,

02:51:11.080 | beautiful concept, painful to hear

02:51:14.680 | because of the realistic nature of it.

02:51:17.360 | And that's exactly why it's potent.

02:51:18.880 | So thank you for that as well.

02:51:19.720 | - And predictable. - And predictable.

02:51:21.360 | - Human beings are predictable in their behaviors.

02:51:24.280 | And it's for example, on Friday night,

02:51:26.600 | when everyone tells themselves they're not gonna have

02:51:28.880 | that drink and that pizza and that cookie,

02:51:30.800 | and then Friday night comes around

02:51:33.080 | and they're surprised by their own humanness.

02:51:36.040 | And again, what we're looking for

02:51:37.480 | are long-term strategies for overall health.

02:51:40.580 | Because that wave of youth does close.

02:51:43.360 | And while we can all continue to get better,

02:51:46.040 | as that window compresses, it becomes much more important

02:51:49.160 | to be very diligent on the responsibilities

02:51:53.340 | to our health, our nervous system,

02:51:55.920 | so that we can continue on for success.

02:51:58.000 | It's just the way that it is.

02:52:00.340 | - Tell me about the neutrality component.

02:52:03.280 | - This is fascinating.

02:52:05.240 | And I have a very good friend, his name is Ben Newman,

02:52:08.200 | and he really highlighted this for me.

02:52:11.640 | And he works with a lot of these sports teams.

02:52:14.700 | And he was the first patient that helped me

02:52:17.480 | put together this idea of neutrality.

02:52:20.920 | I'll give you an example.

02:52:21.960 | He was flying to work with one NFL team,

02:52:24.600 | I think that they were going to the Super Bowl,

02:52:26.160 | something major.

02:52:27.520 | And I said to him, "How are you doing?

02:52:29.520 | "You just came off of your book launch,

02:52:31.080 | "and just before this, you were at another NFL team."

02:52:34.080 | And he says to me, he goes, "Gabrielle,

02:52:35.520 | "it's just another Tuesday.

02:52:37.580 | "It's just another Tuesday."

02:52:40.220 | And so this idea of neutrality is that

02:52:43.540 | when you can manage and mitigate your emotional ebbs

02:52:48.300 | and flows for when things are at their high,

02:52:51.940 | the excitement, this isn't to celebrate

02:52:53.620 | or not to celebrate.

02:52:55.180 | But when you begin to mitigate these ebbs and flows,

02:52:57.900 | it's almost as if there's this level of neutrality.

02:53:00.660 | When that happens, these big moments,

02:53:03.220 | because life is full of big moments.

02:53:05.420 | Yes, it's full of small moments,

02:53:07.020 | but it certainly is full of these big moments.

02:53:09.380 | And it's these big moments that once we enter into,

02:53:12.960 | if one is not neutral, then being able to pick themselves up

02:53:17.500 | from an experience or a moment

02:53:19.740 | become much more challenging.

02:53:21.400 | My most successful patients,

02:53:22.980 | I'm not talking about financially,

02:53:24.220 | I'm talking about the ones that are able to maintain

02:53:27.220 | and contain their health are the ones that are neutral.

02:53:30.840 | - In terms of tone and affect?

02:53:34.460 | - No, in terms of experience.

02:53:37.120 | As they go through life, they celebrate some wins,

02:53:39.580 | they don't celebrate others.

02:53:41.140 | - Very consistent with some of the theories

02:53:44.420 | that I and a few others in the science community

02:53:47.260 | have expounded around dopamine regulation.

02:53:49.900 | - It makes a lot of sense.

02:53:51.520 | And where I care about this is as a physician

02:53:55.580 | who takes care of people

02:53:56.900 | and when they cannot manage this emotional highs and lows,

02:54:01.900 | because as you think about it,

02:54:03.420 | if you walk around and you feel that everything is stressful,

02:54:05.460 | I mean, you've got your cortisol going,

02:54:07.240 | then you're not sleeping, and it becomes this cycle.

02:54:11.560 | And then that cycle becomes a habit.

02:54:14.060 | And if one can teach themselves to be steady,

02:54:18.500 | for example, going into a big workout,

02:54:20.420 | maybe they mitigate the anticipation of that workout.

02:54:24.900 | They're much more likely to continue on that way.

02:54:28.300 | And what is so important about it is a trainable skill.

02:54:32.340 | - Sounds like it's a lot about energy conservation.

02:54:35.440 | - Yes.

02:54:36.280 | - Mental energy, not just caloric energy.

02:54:38.020 | - Yes, yes.

02:54:38.860 | - Very interesting.

02:54:39.700 | - And so then you can do the things that matter

02:54:40.900 | and then you don't fall off the bandwagon

02:54:42.740 | because it just seems that each time a person does it,

02:54:46.560 | they become better at doing that.

02:54:47.980 | It is hard to hear, I think probably for many people,

02:54:51.160 | but it's very predictable.

02:54:52.940 | And if you can leverage that predictable nature,

02:54:55.700 | for example, that Friday night that comes along

02:54:57.660 | and you've told yourself that this is going to be

02:55:00.540 | your last beer or your last pizza,

02:55:03.740 | then you know how to engage in it.

02:55:06.140 | You come up with a game plan where you've set a standard,

02:55:08.460 | where this is the thing that you do Friday night.

02:55:10.480 | You set the rule and the foundation for your actions.

02:55:14.500 | - While hearing about your stance on mindset,

02:55:17.220 | standards, goals, knowing where one fails,

02:55:19.100 | points of vulnerability and neutrality.

02:55:22.260 | - I have one more.

02:55:23.100 | - Oh, please.

02:55:24.000 | - This one is a big one.

02:55:26.940 | And this is, a person will only ever be as healthy

02:55:30.660 | as they feel worthy of.

02:55:31.960 | - Tell me more.

02:55:34.140 | - That when individuals do not feel worthy

02:55:37.580 | of having health and wellness,

02:55:39.780 | they will sabotage themselves over and over and over again.

02:55:44.540 | And it is something really important

02:55:46.420 | when you sit down with a patient

02:55:48.060 | or you reflect on yourself.

02:55:50.720 | The question becomes, do you feel worthy of being healthy?

02:55:55.380 | Do you truly feel worthy of having the body that you desire,

02:55:59.480 | of having that overall sense of vitality?

02:56:03.160 | Because if someone doesn't,

02:56:05.700 | they will use that as a distraction.

02:56:08.560 | They will sabotage themselves

02:56:09.980 | and they will focus on the not feeling well,

02:56:14.140 | the feeling tired, all of the other physical aspects

02:56:19.140 | that go along with ill health.

02:56:21.700 | And that will allow them a distraction.

02:56:24.140 | - I once read something about a person who was obese,

02:56:29.620 | who then got in shape.

02:56:32.260 | And they were reporting that in their family growing up,

02:56:35.880 | they had a narrative around exercise

02:56:39.740 | that for them translated to exercise

02:56:43.660 | being a form of extreme selfishness.

02:56:46.740 | And that surprised me.

02:56:47.840 | I thought, what better thing to do

02:56:51.560 | in terms of helping one's health

02:56:53.420 | and helping therefore the relationships in your life

02:56:56.600 | by segmenting out a small, not a huge portion of one's day,

02:57:00.740 | but an hour a day to take great care of oneself

02:57:02.980 | and ensure health so that you don't have to be dependent

02:57:06.060 | on others in a way that would be burdensome to them,

02:57:08.920 | perhaps earlier in life than it would be in any other case.

02:57:13.700 | So this seems to fit very well with what you're saying.

02:57:17.180 | This person obviously felt that exercise was selfish

02:57:21.100 | and they weren't worthy somehow

02:57:23.100 | of being healthy and in shape.

02:57:25.380 | Fortunately, they flipped the script on this.

02:57:27.060 | And I should say that was over, goodness, that was 2016.

02:57:31.060 | So it's been a long while

02:57:32.260 | and they have maintained good health and staying in shape.

02:57:35.340 | They set a standard for themselves.

02:57:36.700 | - Isn't that amazing?

02:57:37.580 | - It's awesome.

02:57:38.400 | - It's awesome to see.

02:57:39.240 | It's also been awesome to see their transformation

02:57:40.740 | and their psychology and the different aspects of their life.

02:57:43.540 | But is that something that you see a lot,

02:57:46.120 | that people just feel like getting in shape

02:57:48.900 | or paying attention to what they eat is somehow selfish?

02:57:52.140 | - I think that some people

02:57:55.320 | do not feel worthy of feeling good.

02:57:58.780 | And they will sabotage themselves

02:58:02.180 | until they uncover that, number one,

02:58:05.100 | that is the message that they're sending themselves.

02:58:07.900 | And once they do that, there is a bit of friction.

02:58:11.140 | And we know in order to be successful in any game plan,

02:58:14.920 | that friction is required.

02:58:16.500 | And on the other side of friction is quite frankly, freedom.

02:58:20.200 | But those individuals have to understand

02:58:24.160 | that they are worthy and really do that work.

02:58:26.440 | But yes, time and time again,

02:58:28.880 | it is one of the first questions that I ask.

02:58:31.660 | Do you feel worthy of feeling good?

02:58:34.060 | - Well, Dr. Gabrielle Lyon,

02:58:36.940 | you have given us an incredible tour of muscle.

02:58:40.980 | And in fact, an entirely new perspective,

02:58:43.780 | even for me on how muscle impacts our health.

02:58:46.840 | As we talked about at the beginning,

02:58:49.340 | so often when people hear about the importance of muscle,

02:58:51.700 | they think just building muscle.

02:58:53.660 | And that tends to separate people

02:58:55.260 | into those who want to build muscle

02:58:56.660 | and those who don't or think that they can't

02:58:58.580 | or don't really understand what it's about.

02:59:00.900 | But you've made oh so clear,

02:59:03.220 | the fact that muscle is a critical,

02:59:05.200 | perhaps the most critical aspect

02:59:08.620 | of maintaining health and longevity of the body,

02:59:11.940 | of the brain, of health span, lifespan,

02:59:15.460 | what you call muscle span,

02:59:16.860 | really seems to wick out into everything

02:59:18.660 | in terms of our wellbeing.

02:59:20.060 | And you've given us a ton of actionable tools

02:59:22.720 | at the level of nutrition, at the level of exercise,

02:59:26.420 | at the level of supplementation,

02:59:28.220 | and thankfully also at the level of mindset.

02:59:31.300 | I think the tools that you shared

02:59:33.220 | along the lines of mindset are absolutely spectacular

02:59:36.640 | as are all these other recommendations.

02:59:39.320 | So I want to say on behalf of myself

02:59:41.720 | and everyone listening and or watching,

02:59:44.360 | thank you for sharing all of this information with us

02:59:46.720 | in such clear and actionable detail.

02:59:49.320 | Thank you also for the work you do,

02:59:51.060 | for being such a pioneer

02:59:52.760 | in both maintaining an active clinical life,

02:59:56.600 | seeing patients, men, women, people of different ages,

02:59:59.320 | different backgrounds, et cetera.

03:00:00.480 | I know you also do some work,

03:00:02.160 | I'll just mention this because it is important.

03:00:04.640 | You don't just work with people who can afford the work,

03:00:07.820 | you also do a lot of work

03:00:08.880 | with people in the military community

03:00:10.280 | who perhaps who cannot afford the work.

03:00:11.820 | So you make it a point to support communities

03:00:14.580 | that perhaps couldn't afford the kind of support

03:00:17.900 | that they absolutely deserve.

03:00:19.580 | So thank you for that.

03:00:21.220 | Thank you also for being a public educator

03:00:23.300 | and such an avid one and really out there on Instagram,

03:00:26.100 | on YouTube, with your own podcast, with your book.

03:00:28.940 | We'll provide links to all of those

03:00:30.380 | in the show note captions, of course.

03:00:32.420 | And I just love, love, love what you're doing.

03:00:35.060 | And I know as great as it's been,

03:00:38.140 | there's still much more to come.

03:00:39.420 | So thank you for taking the time to come here today,

03:00:41.580 | especially with the busy clinic, the businesses,

03:00:43.900 | and of course your family.

03:00:45.780 | People might not realize this,

03:00:47.280 | but Dr. Gabrielle Lyon does all this

03:00:48.860 | while maintaining a family with two children,

03:00:52.740 | a happy, healthy marriage.

03:00:54.140 | - And a husband in residency.

03:00:55.460 | - A husband in residency, and she's still pursuing.

03:00:57.100 | - Shout out to Baylor.

03:00:57.940 | - That's right, shout out to Baylor.

03:01:00.340 | And still pursuing advanced training

03:01:02.660 | in yet additional fields of medicine.

03:01:05.500 | So you are a phenom and I have both tremendous admiration

03:01:10.020 | and respect and gratitude for you.

03:01:11.700 | So thank you so much.

03:01:13.060 | - Thank you so much.

03:01:14.660 | - Thank you for joining me for today's discussion

03:01:16.520 | with Dr. Gabrielle Lyon.

03:01:18.140 | To learn more about her work

03:01:19.580 | and to find links to her book, "Forever Strong,"

03:01:22.180 | as well as a link to her excellent podcast

03:01:24.740 | and to her website, which has additional resources,

03:01:27.380 | please see the show note captions.

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03:01:31.620 | please subscribe to the podcast on YouTube,

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03:01:48.780 | If you have questions for me or comments about the podcast

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03:01:54.660 | please put those in the comment section on YouTube.

03:01:57.020 | I do read all the comments.

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03:02:01.020 | I am HubermanLab on all social media platforms.

03:02:03.940 | So that's Instagram, X, formerly known as Twitter,

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03:02:08.820 | And on all those platforms,

03:02:10.340 | I discuss science and science-based tools,

03:02:12.460 | some of which overlap with the content

03:02:13.900 | of the Huberman Lab podcast,

03:02:15.220 | but much of which is distinct from the content

03:02:17.380 | on the Huberman Lab podcast.

03:02:18.600 | So again, it's HubermanLab on all social media platforms.

03:02:22.100 | If you haven't already subscribed

03:02:23.300 | to our Neural Network newsletter,

03:02:24.860 | our Neural Network newsletter

03:02:26.740 | is a zero cost monthly newsletter

03:02:28.420 | that includes summaries of podcast episodes,

03:02:30.540 | as well as protocols as brief one to three page PDFs

03:02:33.780 | that include everything from deliberate cold exposure

03:02:36.500 | to exercise, to sleep, to optimizing dopamine.

03:02:39.420 | To sign up for the newsletter,

03:02:40.580 | simply go to HubermanLab.com, go to the menu tab,

03:02:43.500 | scroll down to newsletter and enter your email.

03:02:45.860 | And I should mention that we do not share your email

03:02:48.100 | with anybody.

03:02:49.260 | I also just want to mention once again that my new book,

03:02:52.540 | which I've been working on for more than five years

03:02:54.780 | and researching for more than three decades,

03:02:57.220 | which is entitled Protocols,

03:02:58.540 | an Operating Manual for the Human Body

03:03:00.840 | is now available for presale

03:03:02.780 | by simply going to protocolsbook.com.

03:03:05.240 | And there you will find links

03:03:06.300 | to any number of different vendors

03:03:07.820 | and you can pick the one that you prefer.

03:03:09.740 | Thank you once again for joining me for today's discussion

03:03:12.060 | with Dr. Gabrielle Lyon.

03:03:13.620 | I hope you found the discussion to be as informative

03:03:15.940 | and actionable as I did.

03:03:18.140 | Indeed, it has motivated me to make several important changes

03:03:21.220 | in my nutritional and exercise program,

03:03:23.820 | which I've implemented

03:03:24.900 | and I'm already seeing spectacular results.

03:03:27.900 | And last, but certainly not least,

03:03:30.100 | thank you for your interest in science.

03:03:32.100 | [upbeat music]

03:03:34.680 | you

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

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