Welcome to the huberman Lab podcast where we discuss science and science based tools for everyday life. I major huberman and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. I'm pleased to announce that my new book which I've been working on for more than five years is now available for pre sale purchase. The book is entitled protocols and operating manual for the human body and within the book you can find as the
is Jess protocols for everything from how to improve and even optimize your sleep for increasing your motivation and focus for nutrition that is specific nutritional guidelines to follow for health and performance as well as exercise Stress Control your oral and gut microbiome both of which are critical for brain and body Health as well as protocols for creativity and much more within the Book You'll also find the scientific basis. That is the mechanisms and specific studies that substantiate these
Two calls and the book is designed to be incredibly easy to use such that if you're suffering from a particular pain point in life such as difficulty sleeping or excess stress or any number of different issues that you can go to a specific chapter and protocol and begin to resolve that issue. So my goal in writing this book is that it not only be exceptionally practical but that it also be extremely informative that is teaching you a lot about the science that underlies the protocols that can improve your mental health physical health and performance.
To order protocols go to protocols book.com. And there you will find links to any number of different vendors and you can select the one that you prefer again. That's protocols book.com. My guest for today's episode is dr. Gabrielle lion. Dr. Gabrielle line is a medical doctor who did her clinical and research training at Washington University in st. Louis. She's an expert in geriatrics in nutrition in Health and Longevity and during today's episode. Dr. Lian explains how if we are interested in our immediate and long-term
And Health Muscle is the organ that we need to pay attention to she explains how this is true for everybody men and women alike and that there are specific things that we all can and should do with our nutrition and our exercise in order to maximize the health of our muscular tissue. Now in some cases people will be interested in building more muscle, but it's important to point out that much of today's discussion is simply about improving the health of your muscular tissue and the specific ways to do that in order to support brain.
With body health and movement, of course as well as the health of every organ system in your body again, placing a focus on improving muscular tissue itself as a way to improve all the organ and tissue systems of your body, dr. Line explains the specific science and protocols that can be applied in your everyday life at the level of what you choose to eat or not eat as well as how much of certain foods to eat or avoid as well as specific training regimens most of which take very little time, but they can vastly improve
The health of your muscular tissue and therefore the health of your entire brain and body. I'm certain that by the end of today's episode. You will have a much more thorough understanding of what you can do to improve your immediate and long-term health and thereby potentially your life span all of which are based on the most modern understanding from basic research from clinical studies and from practical application in the real world before we begin I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford it is however part of my desire and
Effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is Maui Nui venison. Maui Nui venison is the most nutrient dense and delicious red-meat available spoken many times before on this and other podcast and with several expert guests on this podcast about the fact that most of us should be seeking to get about one gram of high quality protein per pound of body weight every day. Not only does
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Hubermann, today's episode is also brought To Us by levels levels is a program that lets you see how different foods and activities affect your health by giving you real time feedback on your diet using a continuous glucose monitor one of the most important factors in both your short and long-term health is your body's ability to manage glucose or what's sometimes called blood sugar to maintain energy and focus throughout the day you want to keep your blood glucose steady without big spikes or crashes. I started using levels about three years ago as a way to understand how different.
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Isis and to free pillows again, that's Helix sleep.com huberman to get 30% off and to free pillows and now for my discussion with dr. Gabrielle lion, dr. Gabrielle lion. Welcome.
Thank you so much.
So great to have you here. You have a tremendous range and depth of expertise you treat men you treat women, you know a ton about exercise physiology nutrition.
You've done work in Psychiatry, you've done work in geriatrics, you know so very much about how to get healthy and stay healthy. And today we're going to talk about all of that to kick things off. I would love to dive into your take on this unique aspect of our physiology that most people when they hear about
Think about weight training or maybe bodybuilding or have some immediate reaction to but you have a different stance on this incredible organ that we call muscle. So if you would just tell us how you look at this thing that we call muscle in men and women and kids and old people young people. How should we think about
muscle? Well, first of all muscle is the organ of longevity and we've always thought about muscle just as
you said when it comes to exercise performance mobility and strength which by the way, all of those things are important and critical for life, but there's something very unique and special to skeletal muscle. First of all, it's an organ system. It's an endocrine organ. It is responsible for a large component of glucose disposal roughly 80% of glucose disposal and we all hear about these things like cardiovascular disease type 2 diabetes obesity.
Largely many of these metabolic diseases begin in skeletal muscle decades before interesting skeletal muscle is also an amino acid Reservoir. It is the place that your body pulls from amino acids. And that is something that changes as we age this idea of protein turnover and we require healthy skeletal muscle, of course, it's the body armor that we all know and it is really responsible for how we age and by the way,
I came to this understanding through an experience. I love to share with you. I did my fellowship in geriatrics and nutritional sciences. And at the time we were looking at, you know, every fellow has to have a project lucky for us and we were looking at body composition brain function and there was one patient who I just adored she was a mom three kids and she had always yo-yo dieted we image her brain and her brain looked like the beginning of an Alzheimer's brain.
And I thought to myself and I felt very responsible thinking why was this woman who was doing everything that we told her to do she was exercising. She was eating a low-fat high-carbohydrate diet. Why was she so metabolically unhealthy?
And I realized that at the end of the day it wasn't that she was over fat. It was that she was under muscled and we spend decades and have spent decades trying to treat obesity. When really what we need to be looking at is skeletal muscle super interesting. We know that the brain is among the most metabolically active organs in the body and muscle to one of the most metabolically active organs of the body. You'll probably tell me that one is more active than the other which one is it muscles actually.
Frankly not very metabolically active arrest interesting for every pound of skeletal muscle it might arrest burn 10 calories. Primarily Burns fatty acids at rest.
Okay, I learned something new and I imagine many other people did as well. So this woman that was overweight. Yeah, you looked at the problem through a different lens that she's under muscled. How does one go from being under muscle to properly muscled and what is that? And as I say this I realized that many of our listeners
listeners probably don't resistant strain, or if they do they may not want to carry a lot of muscle thinking that that would have to buy a new wardrobe. You know, I certainly some of our listenership probably wants to gain more muscle, but
is there a new wardrobe or
Georgia? Is there a way to view?
Increasing muscle mass in a way that is compatible with kind of I don't know we go like a traditional Aesthetics or with overall health in a way that's sort of distinct from quote-unquote bodybuilding. I mean again, as soon as we talk about muscle, we think about slabs of meat added to different parts of our body and surely certain people probably want to add muscle to certain parts of their body for aesthetic reasons, but how should we think about muscle in the context of some of the tools?
Dues in terms of nutrition and exercise and we'll segue into that again. How should we conceptualize this business of being under muscled and getting to I guess what we call appropriately
muscle. I think that that's a it's a really good point this idea of being appropriately muscled. So the truth is I can't tell you how much skeletal muscle mass. You should have for Optimal Health. I don't know how much skeletal muscle mass. I should have for Optimal Health. We haven't done a good job in the literature and just as a population being able to track
Skeletal muscle and know what is optimal? We are really good at looking at body fat and we're really looking good at looking at bone. But when it comes to skeletal muscle dexa is an extrapolation. So for example, we used dexa as the gold standard and I'm going to come back to what we need to do to gain healthy skeletal muscle, but I think that there it's really important to put things into perspective and a framework for how we think about things. We traditionally used EXA.
Still looks at bone and it looks at lean tissue collectively part of lean tissue is skeletal muscle mass. It doesn't determine the health of skeletal muscle mass. It doesn't determine anything about the quality of that tissue. It purely looks at lean tissue which then we determine part of that lean tissue. Maybe it's 40% is skeletal muscle and that's important to understand as we begin to frame of the conversation as how much skeletal muscle. Should I have I have no idea but what I
Can tell you is that if I were to look at your blood work and I saw something like elevated triglycerides or elevated insulin or elevated glucose. I would begin to understand that the health of your skeletal muscle isn't where it should be. And by the way the health of skeletal muscle mass begins when we're young this idea of sarcopenia, which for The Listener or the viewer the definition of sarcopenia, by the way became a disease it wasn't even close.
Classified as a disease till 2016. Wow. Yes. Wow, which is very recent for a disease. It is a decrease in muscle mass and function.
But interestingly we don't necessarily know what one should have. So I think it's important to understand that when we're talking about the health of skeletal muscle. We're still pretty much in the infancy of understanding the trajectory of where it isn't and where it's going. So when we think about how we maintain the health of skeletal muscle one of the things that I didn't mention is that skeletal muscle is a nutrient sensing organ. It is uniquely sensitive to the quality of our diet.
The quality of our diet defined as the quality of the amino acids that were gaining and that would be for the listener dietary protein skeletal muscle is sensitive to one of the amino acids leucine and depending on the quality of the diet. Meaning how much loosing that you're getting in any given meal. Will then stimulate muscle Health not just muscle size, but muscle Health Muscle health and the way that we think about muscle health is by proxy is this this concept called muscle?
In synthesis, which we can measure and when we get a dietary protein amount, which is between 30 and 50 grams of high quality protein. It's stimulate skeletal muscle.
So I love this idea of focusing for a bit on muscle protein health because it divorces us from this conversation at least temporarily about muscle size, which of I have to imagine it's correlated, but it's a separate thing altogether. Actually I should just ask the question. Is it possible for somebody to have a lot of muscle but their muscle health is poor. Yes. Okay conversely can somebody have a moderate to low amount of muscle but their muscle quality is high or is that
Less
common. Well, the the first thing that you said is absolutely something that we see is that in an individual that carries a lot of a lot of muscle and say they're inactive there is a big discussion about how heavy individuals will have more muscle mass but we have to recognize is the health of that skeletal muscle is fat deposition can be visceral fat deposition fat around the organs and it can be also fat infiltrate into the tissue like not to gross anyone.
A marbled steak and that's exactly what can happen to unhealthy skeletal muscle which then affects its ability to contract which also affects there's a ton of mitochondria in skeletal muscle. It affects the efficiency of skeletal muscle. So yes, someone can have potentially more muscle but more unhealthy muscle interesting when you say a marbled steak. I think at the extreme of wagyu a raw wagyu looks like there's this much white fat in it as there is red meat
Eat in it and it's a very different taste and texture. So that's what we're talking about. My understanding is those cows don't move around much. They're somewhat sedentary compared to say free range grass eating cow. Is that right? Yeah. Okay. That's that's absolutely correct. Okay, so we want we want quality healthy muscle and then we can talk about muscle amount. And then the other thing that I'll say about it is part of what defines muscle health, is that flux that movement. So if you were to think about skeletal
So like a suitcase and individual was say going on a trip for four days but chooses to eat or pack for 30 days. You know these people. Yes. I know. I may be one of them. I have my suitcase here. I was only coming in for a day, but I may have packed for four days. Not sure what I was doing. But that's besides the point when an individual is over eating calories over eating carbohydrates. I had mentioned earlier that skeletal muscle one of its primary roles is glucose disposal.
And I'm sure we're going to get into mechanisms of glucose disposal whether it's insulin-dependent or insulin independent. Depending on if someone is moving or Contracting that muscle when an individual is eating food carbohydrates, it gets stored in skeletal muscle as glycogen because as we know glucose at a high level is toxic to the body so the body must move glucose out of the bloodstream into the cells. Now what happens is is there because
Comes This stasis, so if an individual is inactive and not exercising then that skeletal muscle becomes overpacked skeletal muscle at rest Burns primarily free fatty acids, which is interesting. Most people think about skeletal muscle is burning carbohydrates, but actually it rest skeletal muscle Burns fatty acids, as you can imagine when that muscle is full and you are not exercising it then the substrates have nowhere to go.
And it remains in the bloodstream and that would be a sign of unhealthy skeletal muscle which then Loops back to what you see in blood
work.
Elevated insulin elevated blood
glucose elevated free fatty acids elevated Branch chain amino acids all of these things which again as skeletal muscle as the metabolic sink have nowhere to go.
So I'm starting to get a picture where in order to have healthy muscle.
We need to think about the feeding of that muscle the providing of nutrients to that muscle that is as well as the use of that muscle. We let's start with the feeding or the providing of nutrients so that muscle you mentioned that muscle at rest. Mainly Burns fatty acids. It can store glycogen. How do we know when a muscle is full of glycogen? I mean, there's the the visual representation of the muscle seems Fuller as opposed to flatter, you know, but these are not specific
Or these are not precise terms. You know, how much carbohydrate does it take to fill all the muscle of the body with glycogen and then what sorts of things perhaps deplete that I think it's a great question. We know that when we're talking about glycogen in the liver stores glycogen, maybe 100 grams and then skeletal muscle depending on your size. For example, you might store much more muscle glycogen, whether it's for 500 grams compared to someone who is my size and can we do the the
Conversion of 4 calories per gram. So if the liver is 400 grams, you know, you just say Okay is about 1600 calories worth of yes, well energy there. So if I go out and I do some exercise and burn 1600 calories over time. Does that mean that the liver is then completely
depleted? So well, the liver will deplete in through an overnight fast. So the livers main deliver maintains blood glucose. So skeletal muscle doesn't maintain blood glucose directly the way that you would Leverage.
Muscle glycogen would be through exercise the way in which you would deplete muscle glycogen would be through more intensive exercise. And when you think about the foods and the way in which you know, your original question is how would we know how much muscle glycogen or how much we need to refuel? I typically think about it as overall activity levels. So if someone is sedentary then the current recommendation for carbohydrates would be 130 grams per day per day.
4 calories
per gram at 4 calories per gram. And is that both
simple and complex carbohydrates fibrous
carbohydrates? It would just be
over all 130 grams if they're completely sedentary. Yes. So just a little bit of walking getting up going to the computer to the bathroom to the car Etc. But basically said
interests and the average American takes in 300 grams of carbohydrates a day. So more than double and as you can imagine this can distort metabolism when we think about
glucose disposal the way in which I think about glucose disposal if an individual is sedentary is thinking about how many carbohydrates and individual can ingest at one time that would mitigate insulin response and would be able to be disposed of safely. And that number is between 40 and 50 grams of carbohydrates at a meal outside of exercise. The rest of carbohydrates would be earned through exercise and through
every hour of exercise depending on the intensity that could be between 40 to 70 grams depending on how intense and individual exercises and that would be safely disposed of
In a two hour period I mean when you think about an oral glucose tolerance test, that's a 75 gram load you assume within 2 hours that that blood sugar regulation should come back to a normal
range.
So at 40 to 50 grams of carbohydrate every two hours does that mean that if somebody were to eat 40 to 50 grams of carbohydrates every two hours they shouldn't which they shouldn't do but because it's you're going to quickly exceed that 130 grams per day and even if exercising with resistance training say hard for an hour, which get, you know can afford somebody maybe what another couple hundred 300 grams of
carbohydrates, really not that much. Okay, you know, I think
That if people care about body composition which I would say everyone should because you want to have an appropriate level of body fat and healthy skeletal muscle, then you wouldn't necessarily unless you're doing some kind of cardiovascular activity. You're not using a ton of muscle glycogen depending on how much you're training and how much glycogen is the brain using so that is it. That is a good question the brain uses.
A lot of carbohydrates that would be the primary source when they come up with the numbers of 130. It's really based on brain and then the rest of the body
can we safely say that for somebody that's thinking a lot they need more
carbohydrates. You could say that then your brain. Yes. Your brain is very metabolically
active interesting. So we're going to drawing rough estimates not knowing people's body weight not knowing their body composition, but what I'm arriving at here is you know,
If somebody does a little bit of cardiovascular training, maybe a little bit of light resistance training. I'm describing the activities of many people out there.
Maybe 250 grams of carbohydrates your kind of at the threshold of a lot. That's a lot for 4 calories per gram those carbohydrates. And so let's say 200 grams of carbohydrates per day, but that's not a ton of calories overall. So what should the remainder of the calories be made up
of so, you know, I think what we're really talking about here is how do we design a nutrition plan for people to have healthy skeletal muscle, right and you know, if I were to say, okay, what are we?
About for The Listener or for the people out there thinking, you know, I really want to have a healthy body composition and healthy skeletal muscle mass the way in which they would do. That is number one. You have to prioritize dietary protein. So we're talking about carbohydrates here, but carbohydrates shouldn't be the primary focus. Nobody has challenges getting carbohydrates in 130 grams would be a safe recommendation. If it someone is overweight or struggles with type 2 diabetes or any of these other men.
Dibala conditions there is evidence to support a lower carbohydrate intake.
I mean 130 grams is you know, one little micro packet of pretzels on an airplane ride,
you know that actually has probably closer to 37 grams of carbohydrates. Okay good. So I had a pretzel packet before or through one that robbed on the way in but no,
right? Okay, so I'm way off there so they have a one of those a bagel in the morning and
Shouldn't but they but they do and then they have some pasta dinner. And so most people are probably exceeding the 130 grams by a huge.
Margin. Yes, they are and there's a couple things there that it's really important that you said is that individuals when were thinking about designing a plan for skeletal muscle Health that first meal is most important that first meal of the day having dietary protein will set you up metabolically for the rest of the day
and we say first meal and we'll talk a little bit later about intermittent fasting.
Fasting and I for instance eat my first meal at you. She 11 a.m. It's kind of how I'm wired. I've never wanted to eat breakfast first thing. I've forced myself to eat some eggs first thing in the morning from time to time and felt fine. But do you recommend that people eat a true breakfast like within a certain number of hours of waking up for sake of muscle Health that and metabolic Health
when we think about that first meal. I frankly don't care when you have it one also has to
I understand that you're coming out of an overnight fast. If you are young and healthy than the timing of that first meal likely doesn't matter because you are robust. Your body is very efficient and capable to withstand protein degradation is degradation is able to withstand protein degradation and protein turnover, which is ultimately why we're eating so that's one reason why we're eating and we'll talk a little bit more about that that first meal of the
The day if you are young and healthy, the timing doesn't really matter and I would say when it begins to matter is when you're older when you are in your 60s that continuing to fast maybe - - for muscle muscle help that first meal of the day is important because we know that when you get between 40 and 50 grams of protein that first meal of the day you stimulate muscle protein synthesis muscle protein synthesis is by proxy.
We use to measure as a marker for overall muscle Health. Now. There's a lot of history here when we think about designing a meal plan that first meal has between will say give it between 30 to 50 grams of dietary protein that will do a number of things. Number one. It will stimulate skeletal muscle what we would consider the health of skeletal muscle. It also will affect the brain. It'll improve satiation your now we're talking previously it releases a
Handful of gut
peptides like glucagon-like peptide one, which she helped me. You will talk about those in the C'Mon. Jarro but
CK P YY things that will affect appetite for that second meal and there's some very interesting research out of Heather ladies lab and basically when she put individuals younger adolescents on a meal 30 to 40 grams of protein, they were much less likely to choose say
Oh nuts or something outside of what we would consider a healthy nutrition plan
later in the day or in the same
meal later in the day.
So
essentially augmenting their willpower. Okay, so it sounds like for young people they can
delay breakfast if they want for older people probably not but that the first meal of the day should include what you're calling dietary protein 30 to 50 grams. Yes, and maybe we should talk about the quality of that protein because I think a lot of people understand that their meat proteins there.
Our plant proteins how important is the quality of that protein?
This tends to be a Hot Topic and somewhat very controversial great when way great for you. I know
it's great for everybody. I mean controversy on this podcast is is embraced in the following way. We State what we know we State what we don't know and we are always happy to return to the conversation at a future time to adjust any stances based on the data and
How we evolved as people
so, okay. Well, I love that. Yeah dietary protein we speak about it as if it's one thing but actually it's 20 different amino acids 9 of which are essential the rest we can generate in our body and when we think about skeletal muscle we think about the essential amino acids and the essential amino acids primarily for skeletal muscle Health are the branched-chain amino acids leucine being one of those so leucine is uniquely.
Lee stimulating to skeletal muscle and when you have enough leucine it triggers muscle protein synthesis.
And when you say stimulating and muscle protein synthesis, I think a lot of people get a picture in their mind of a muscle growing but no, you're not necessarily talking about that you're talking about the organ that is muscle that its Health its metabolism being cultivated so that it can do all the hormone endocrine related things and the glucose disposal related things that we'll get into in a bit more detail later. Is that right?
Yeah, and so
When you have a breakfast of 30 to 50 grams, you appropriately stimulate muscle protein synthesis and one has to recognize that if you eat below that threshold, you do not stimulate the health of that skeletal muscle you do not stimulate muscle in a way that would be necessary for outcomes that matter and outcomes that matter are sarcopenia outcomes that matter are body composition prevention of obesity.
You must get this nutrition, right? It's the thing that 100% of people do is
eat as many of you know, I've been taking a G1 for more than 10 years now. So I'm delighted that they're sponsoring this podcast to be clear. I don't take a G1 because they're a sponsor rather. They are a sponsor because I take a G1. In fact, I take a G1 once and often twice every single day and I've done that since starting way back in 2012. There is so much conflicting information out there nowadays about what proper nutrition is, but here's what there seems to.
Be a general consensus on whether you're an omnivore or a carnivore a vegetarian or a vegan. I think it's generally agreed that you should get most of your food from unprocessed or minimally processed sources, which allows you to eat enough but not overeat get plenty of vitamins and minerals probiotics and micronutrients that we all need for physical and mental health. Now, I personally am an omnivore and I strive to get most of my food from unprocessed or minimally processed sources, but the reason I still take a G1 once and often twice every day.
Is that an insurer's I get all of those vitamins minerals probiotics Etc. But it also has adaptogens to help me cope with stress. It's basically a nutritional insurance policy meant to augment not replace quality food. So by drinking a serving of a G1 in the morning and again in the afternoon or evening, I cover all of my foundational nutritional needs and I like so many other people that take a G1 report feeling much better in a number of important ways such as energy levels digestion sleep and more. So while many supplements out there are
Really directed towards obtaining one specific outcome. A G1 is foundational nutrition designed to support all aspects of well-being related to mental health and physical health. If you'd like to try a G1 you can go to drink AG one.com huberman to claim a special offer. They'll give you five free travel packs with your order plus a year supply of vitamin D3 K to again. That's drink AG one.com huberman. It's great that we're focusing on muscle and then referring to obesity because I think so many people
Virtually everybody thinks okay reduce body fat. How do you do that? You get the calories in calories out equation in a certain direction. And by the way, I believe in the law of thermodynamics and calories in calories out. But by focusing on muscle protein synthesis and muscle Health through the ingestion of quality protein early in the day. I see that you're entering this all through it through a different Channel, but that the endpoints of reduced body fat Etc as will get into later one can still arrive there. So
For practical purposes what are some excellent sources of quality protein for that first
meal. Well now the quality of protein is defined by the amino acid composition and typically animal-based proteins have higher quality. These are hard fast biological numbers. The dietary protein in say a steak is very similar to the protein amino acid in skeletal muscle. So the quality of the proteins
Like eggs, like whey protein, like beef like poultry those compositions are similar to the human body composition. So they contain the amino acids in the appropriate ratios for skeletal muscle Health. Now plant-based proteins have a different composition and they have a composition obviously similar to plants and one can get enough of the essential amino acids if the total caloric load of that.
That protein is high enough and I think that that's important to recognize because right now the American diet is 70% plant-based and we're we seem to be moving more towards a plant-based diets that right it
is. I mean, I know they're sort of a movement toward that you hear about plant-based. But so most people are not eating steak and eggs for breakfast. We know
that well most people when I say 70% plant-based diet, I'm talking about refined carbohydrates sugars cereals.
And when we think about it, so the 70% of our diet comes from that were thirty percent come from animal-based proteins, which contain a ton of nutrients like bioavailable zinc and selenium B12, but when it comes to muscle Health one could as long as they are thinking about making sure that the overall protein load is high enough in that plant based protein. For example one would not choose.
choose quinoa
as a protein source, so quinoa would 6 cups of quinoa would equal the same as one small chicken breast when it comes to an amino acid profile. So I think one has to be aware that plant-based proteins typically of carbohydrates that ride along with them and that just becomes important for overall metabolic control when we think about total clerk load and total carbohydrates. Someone could use a rice P blend of protein for that first meal that was certainly be sufficient certainly if
Someone is geared towards a more plant-based diet and doesn't want to consume animal proteins. That's what I would use.
Is there any evidence that combining high quality protein with carbohydrate in that first meal is more or less beneficial than having the protein alone. That's a good question. I would say that we don't have evidence for that that it would be more beneficial because the question would be what is the benefit that we're looking for?
If the benefit that one is looking for is diversity than certainly because we know carbohydrates cannot fiber or phytonutrients. If you're going to combine it with berries that could certainly be advantageous but not necessary. What becomes interesting is when we think about designing a diet. Does that second meal matter and not to get too technical, but maybe I'll we could get a little technical here that when you stimulate muscle protein synthesis that
it lasts about two to three hours.
now the next thing one would think is well, I know that I need a certain amount of protein for overall muscle Health the amount of protein for overall muscle Health could be anywhere from 1 gram per pound ideal body weight to lower and when we think about how we are designing a diet we have to recognize that the current recommendations are the minimum to prevent a deficiency the way in which diets are designed now according to the rdas point eight grams per kg
Point eight grams of protein per kilogram of body weight
which comes out total body weight. Yes, which comes out to be Point 37 grams per pound. So if someone was a 115-pound female that current RDA would be 45 grams of
protein way below what we talked about earlier
and this is these are very important Concepts to understand the foundations of how we think about dietary protein the current RDA which is a minimum to prevent and deficiencies based on nitrogen balance.
The nitrogen balance and by the way, the recommendations for protein that were set in the 80s have not changed which means one of two things. We haven't had a new science come out or we just haven't recognized the importance of protein and I think that it's more likely the latter that we have not yet recognized even though there's a plethora of data and I worked on some of these earlier studies which you know, I'll share I even brought the numbers to make sure that I said them right because you know, this is the human Lab
podcast.
I've made it I've made numerical errors before on the podcast, but great that you brought the numbers. We always try and correct any errors, but great to be precise the first time so thank
you. You know when we think about how we design a diet for optimal muscle health is very different than how we design a diet for again just life and the two are very different the RDA for leucine, which is that essential amino acid meaning we cannot make it. We must get it from the diet. Is that it?
2.7 grams per
day. That's a trivial amount
that is a trivial amount and 2.7 grams .7 per day per day and one must understand that this came from nitrogen balance studies. And typically, those are young men 18 year old men.
That does not support healthy aging or anyone that is struggling with obesity or any kind of chronic illness or anything. And so then when we begin to think well, what do we actually need the evidence would support two to three times that amount closer to nine grams of leucine per day and just to calibrate us 9 grams of leucine, which again is essential amino acid. We can only get from food per day. What does that equate to in terms of the total amount of let's say egg or steak?
Protein that one would need to eat in order to ensure that just
roughly. Yes wonderful question. So there's a meal threshold for skeletal muscle health and that meal threshold is a minimum of 30 grams. Now that would equal a four four and a half ounce steak dare. I say six eggs, which is a lot of eggs at one time or a scoop of whey protein scoop of whey protein might have 18 grams of protein and two and a half grams of leucine. Maybe you do a 25 gram. Whey,
Protein shake and that becomes important understand because it is a meal threshold amount, you know, we are talking about, you know, the reason why I was so excited to come on this podcast is because I think that if we can correct our nutrition and we geared towards skeletal muscle Health, then we can change the trajectory of aging and we can stop focusing on Obesity and really focus on skeletal muscle Health, but the only way that we're going to do that is if we get this nutrition right because skeletal muscle requires.
Dietary protein. There's only two main ways that we can stimulate skeletal muscle and that is through exercise primarily resistance training and dietary protein. And so when we think about how we design a diet, if you look back at the history, we have to recognize a handful of things number one that these essential amino acids primarily leucine is necessary to trigger muscle protein synthesis. Number one number two that aging impairs the efficiency of muscle.
The first C. So it's a runaway train. If you start getting sarcopenia if there's obesity and other markers of Aging the realize obesity can occur at Young ages to but muscle loss then basically you're also you're losing muscle quality AKA protein synthesis and other things and as a consequence, it makes it harder to increase muscle quality. So you have to Short Circuit this pretty
early. Yes, and I would even say that we talked about sarcopenia as a disease of Aging but I think that there is a youthful phenotype of sarcopenia
If we Define sarcopenia as decreased muscle mass and strength that can easily affect our youth. You know, we talk about health span. We talk about life span. There's also muscle span. Hmm and muscle span is this concept that is really about the skeletal muscle Health as we age and there's three primary components to that. That's understanding that skeletal muscle Health begins very early on and we're going to talk about because I know that there's parents. I have two little kids.
I want to talk about the amount of protein necessary for children, of course, and then as we think about this muscle span, there is early on early age where you're laying down the foundation where you're hopefully training doing exercise just doing movement being sedentary is a disease state in and of itself period end of story being sedentary is not the opposite of activity being sedentary is in an in and of itself a disease arm of inactivity then midlife we have to maintain the
Ah-choo, we get Peak muscle mass in our 30s. We get a peak bone mass around the same time and then that leader half of life. We have to do everything that we can to maintain that tissue because of this decrease in efficiency of skeletal muscle. So skeletal muscle as a nutrient sensing organ can respond like youthful tissue and the way that it responds like youthful tissue from an amino acid perspective. Just thinking about how we eat too.
Pain, that is that when we increase our dietary protein so older individuals or individuals as they age require more protein to then stimulate
mtor. So does that mean instead of eating 30 grams of protein per meal minimum that people older than say 50 60 should eat 40 or 50 grams of protein if that's
true interesting. And by the way, skeletal muscle will mount a youthful response. There is a you know, this is
is the initial work was out of Bob Wolf's lab. He's an icon in the industry of protein is one of the can I say grandfather's now, I mean, that's pretty embarrassing and when I think about Bob wolf and on Layman and these guys, you know, I trained with dr. Donald Layman, you know, these initial studies that we think about it we take for granted dietary protein. We think okay. Well the Bros have always known this but we have not and
When you are younger, there is a somewhat of a linear response. Let's say a younger individual still growing. We'll just call them 10 12 years older or my children. I have a 3 and a 4 and a half year old they will respond with 5 grams of dietary protein 10 grams of dietary protein 15 grams of dietary protein versus an older individual will not respond at all.
To that. However, that response can be augmented by increasing the dietary protein at that meal. So an older individual will respond like an a younger individual.
By 30 grams of protein 3250
later. We're going to talk about supplements, but I'm very curious. Is there a place for supplementing leucine and other Branch chain amino acids specifically, you know, I always assumed that supplementing with branched-chain amino acids was kind of the unique domain of people post exercise trying to build more muscle. But as you're telling me all this, it seems that adding leucine in powder form to a meal seems like it.
Great for muscle health is that
true? I would say that we do not add leucine alone. Okay, because leucine isoleucine and valine go hand in hand. It would not be advisable to add a single amino acid. The amino acid levels are maintained in the blood by adding more of one would have effects on the other the way in which I would think about supplementing essential amino acids and or branched Chains would be if an individual.
Is choosing to have a lower protein meal. I remember when I was in residency the food choices were not very good and maybe I had two ounces of fish which wasn't enough to bring me up to a threshold that would be a place that I would add in branched chain amino acids or essential amino acids. That would bring someone's amino acid threshold up but we have to understand everything that we're doing. We should be doing with a purpose the idea of just sipping on branched-chain amino acids or just adding amino acids.
Would be the equivalent of putting a key into a car and trying to turn the car on but not having any additional substrate. So you need the full spectrum of all the amino acids to affect skeletal muscle health
and well that's reassuring to hear because I love the taste of scrambled eggs and steaks. And I also like tuna and I also like chicken and I love all those all those things and I have to imagine that as you mentioned before there are other things in these quality animal protein.
ins like you mentioned selenium you mention other perhaps essential fatty acids and other vitamins that perhaps have something to do with what the animal ingested during its life that also benefit muscle is that
true it is and the the big stand out to me is creating we know that creatine at 5 grams of creatine will affect skeletal muscle but 12 grams of creatine affects brain health, and there's a lot of
You're seeing research coming out on Creatine and brain
health. Can you remind me the rough amounts of creatine and say you mentioned a let's just I mean, I must say a four and a half ounce steak feels rather paltry to me. That's probably the size of a but yeah, it is a huge meal to me, right? So let's say 6 oz let's be generous a 6 ounce steak or for scrambled eggs. I mean how much creatine are we talking eggs? Don't have much creatine
right? Not much and
and I was just recently looking at this the amount of creatine and a pound of steak you're going to cringe is something like 2 grams says not very much. It's not very much. But when we think about eating Foods as in a food Matrix, what you're saying is absolutely true that it's interesting. We don't eat single nutrients while we think about dietary protein as a single nutrient and we think about carbohydrates. But what we really do is we eat mixed meals and when we think about that the
The quality of the protein Matters from a protein perspective. Could you get plant-based proteins and animal-based proteins and could it be equal? Yes it could so I want to be very clear to say and have a very balanced perspective that we could get all of our dietary protein from plants from plant-based sources a few caveats. There is that that are DEA that I gave you earlier is based only on high quality proteins.
And that being the minimum to prevent a deficiency if an individual was plant-based, they would require closer to 1.6 grams per kg a higher amount of total protein if it's coming from plants and that becomes important to understand
speaking in of an Ideal World if you had a magic wand, what would be the kids think I do I bet you do. What would be the
Amount of protein that you would have everybody eat. Well in terms of a number of grams per pound or kilogram
of body weight that's actually an easy question 1 gram per pound ideal body weight
total body weight
not ideal body weight actually where you want to be if an individual is 200 pounds, but but would prefer to be 150 pounds. Then I would have them eat towards their ideal body weight. There's no evidence that a higher protein diet is detrimental to kidney how
health to bone health and we use these terms Loosely like a high protein diet when we have to recognize that point eight grams per kg is a low-protein diet. So where did the idea come from that if you eat say one gram of quality protein per pound of ideal body weight that you're going to get gout you're going to have liver issues. You're going to have all sorts of issues. Where did that idea come from? Frankly? I'm not I'm not sure but the conversation around dietary protein.
Probably been the most controversial.
What do you think? That is? We don't I'm we're not trying to get political agenda so
curium ideas, but I won't share them. Okay, but I I do feel as if nutrition is not just Science Nutrition is complicated because it's something that people tie emotion to they tie religion to they there's a lot that goes into dietary protein and food recommendations and
general but it sounds like we can safely say that if you eat one gram of protein per pound of ideal body weight that you're not going to cause liver damage or get gout or increase your risk of cancer, right? My understanding is that even if it comes from red meat there's no increase in risk of cancers that right. Well, here's what I would say to that. I would say that this idea about red meat and cancer. Number one. We would have to even Define what kind of cancer is that? We're talking about. There's many different types of cancers, and there's many different causes is
Be important to understand what risk factors are and a primary risk factor too. Many cancers is obesity.
The question then becomes, how do we design a diet that mitigates obesity. The evidence is also very clear that a more protein forward diet optimizes body composition and you combine that with resistance training and you will see a tremendous amount of change. I worked on some of these early studies and I'll share with you some of the early studies in this came out of Don Lemons lab with the University of Illinois.
You and Layla Norton both work there. Yes. Did you
overlap the we did
And while he
was he like youngest came, well, wasn't that he
sat in the back of the class and I sat in the
front. Okay. All right there you heard it shots fired
and all kidding aside Lane is a very he's like my brother we've known each other for 20 some years and I'm
very popular guest former guest on this podcast in a very spirited guy and
I'd like I just like to say, I don't know why his skin looks that good but whatever so I will be Lane I've worked on yes, we do. I worked on some of these early studies and this was
These studies were some of the first studies to come out about dietary protein nutrition and resistance training, in fact to my knowledge and to I think the knowledge of many of my colleagues. This was the first study and what it was it was a it was a 12 month study 130 overweight men and women, so it was robust and basically what they did is they had two groups one group was a food guide pyramid.
Good diet. So it was 55 grams of carbohydrates a RDA of protein which was pointed grams per kg.
And 30% fat 30% fat was in both groups. The second group was 40% carbohydrates. This is remember the Zone diet 40 30
30. Yeah. I liked that diet.
Okay, I mean there's a
fish. I mean, I don't follow it anymore. But you know, I tried it for a little while and
and it works for you and there's some evidence to support that that
is a great ratio for be coming off the low-fat era of the late 90s the Zone diet felt like the best thing ever because it was like, oh, you know, you can enjoy some fats and wow you're so
Heidi is improved and get stronger. You just feel better when you're ingesting some ideally quality fats. That's my experience
anyway, and also we know that it influences hormonal status. You don't want to push fats too low. So the second group had a 40 30 30 split. So it was 40 grams of carbohydrates 30 grams of protein 30 grams are 30% fat. So these are all
percentages 43 40
percent now, right we didn't
talk so much about the distribution. But what is really important to understand is they were isochoric so they both had the same calories. The difference was the percentage of where the calories came from and how they were given and there was actually four different arms to this. So there was individuals that exercise and individuals that didn't
okay. So either zone diet or let's call it hate to say this but more about American diet how it was designed standard American versus zone diet. So it was designed that way and then exercise
You're not exercising for each of
the four this 12 month study. And by the way, I had to pack a bunch of meals. It was not pretty and how to do your analysis it was terrible. But anyway, that's besides the point. So the first group had a protein distribution of 10 grams in the morning 15 at lunch and 45 at dinner and some standard American diet that takes for dinner Zach. Yes. I'm cereal for breakfast with a little bit of milk and then for lunch like a sandwich
Act like I'm so this mirrors what people do the other group had 45 grams of protein at that first meal
six at five six
eggs, five six eggs, 35 grams of protein at lunch and 35 grams of protein
chicken breast a salad at lunch with a little piece of toast and then at dinner how
much it was. It was 35 grams. All
right piece of fish and some rice and
vegetable, but it was an even distribution. So what you're seeing here is now these meals are meeting a leucine threshold.
Of muscle protein synthesis now it's 100 and this is a collectively 130 individuals and they were they were older. I think that they were all in their 40s or Beyond
if we just compare first the groups that did not exercise two different diets. What did they see? What do you see? Have you participate in this?
Yeah. Yes. I did and he's almost I won't but what was so interesting is that those individuals everybody lost weight. So the average weight loss.
Gosh, I wish I had better handwriting but I'm a doctor and so it's pretty bad. The average weight loss was 24% greater in the high protein group. So they lost twenty four
percent. And you said it was isochoric between the two group. That's right. Was it sub caloric? Overall
me live or ingested. That's a very smart. Yes. It was 500 calories
less than what they needed to maintain body weight. Correct. Got it. So 24 percent more weight loss total told him that group that distributed their protein evenly in and follow the so-called.
Zone Diet
430 they lost more fat than the high-carbohydrate group. So the high protein group lost a total of 16 pounds versus the calorie controlled group lost 11 pounds of fat a fat, which is great. Everyone's at home thinking this is wonderful. I so caloric Isaac Clark, but the thing here is the lean body mass change. So again, this was done using dexa and we know
Oh dexa only looks at lean body mass.
You mentioned X earlier just very briefly is dexa. How does dexa work notnot at a mechanistic level? What does it look like I go into the clinic in my floating in water. Now my holding. Yeah. I'm holding the paddle you
might be because you're Andrew
humor, and I don't know but you hold the paddles and it and you're standing on say it's what's
it? So a dexa you just lay on it depending on the machine. You can just lay on this machine and it's a dual X-ray and it measures bone fat and then lie
Body mask that's the family this
conversation great. So the lean body mass loss. And again, this is everything other than bone and body fat. So that was 34% in which group in the standard American diet group versus 26 percent in the high protein group now where it gets fascinating. So what the big takeaway is is understanding that protein had a sparing effect
protein protected muscle.
More body fat loss at the same caloric amounts. Yes, same amount of deficit relative to body
weight right in this group exercise was not introduced. So this was purely the food guide pyramid changing protein in the morning versus having it at two small meals and then having it at dinner
and did they emphasize what we're calling high
quality protein did okay. That is also very
important meeting fish. Yes chicken. It's yes they did
so
And this led to another study. So then the second study was a two-by-two design and this is the
sorry sorry to interrupt in that previous study. What was the effect of exercise
between something they didn't do exercise got it? Okay, that was my fault that we did. They did not do exercise. They were just doing whatever that it was that they were doing. But what was so important understand was that this set the stage for this idea that protein had a sparing effect and then following that
That the other study so then there was a series of a few other studies the second study looked at diet and exercise. So this combined effects to this is one of the first studies in this was 48 women with a BMI of 33 46 years old. So this is your post Perry postmenopausal woman who was either in one of four treatment groups a low protein group low protein with exercise high protein high-protein with
Sighs the low protein group was defined as the RDA .8 G the high protein group was designed defined as 1.6 grams.
TJ
so starting to approach that one gram per pound. It's
about .7
G to starting to get their bow. Not quite there.
Yeah. So this was a 16 weeks study and what they found overall was that the high protein group lost 18 percent more body fat and 25% less lean mass.
Overall and 12% more total body weight. And so now we start moving into this synergistic effect of dietary protein and resistance training
and it was the type of exercise that they perform their resistance training.
This is the good news. It didn't take much it was five days a week of walking 30 minutes and two days a week of resistance training with just body weight. It was like yoga activity
so are Squad,
It's down dogs. Some Warrior poses, maybe some handstand attempts. So yeah, so know what are you doing some yoga classes where I look to the sides of me and people are doing some pretty difficult thing very impressed and shoes and things like
that. Definitely not me do not invite me life is better this way. I'm not going to those classes but 16 weeks they did a high-protein with protein and exercise those individuals. So now so the study the
The group that I just mentioned this was dietary intervention alone with exercise High Protein Plus exercise and very simple exercise. So if someone is listening to this and they're thinking what can I do to make very practical changes to massively impact my life outside of hormone replacement outside of any Super Supplement outside of anything died in exercise has a dramatic effect those individuals that were doing 1.6 grams.
As per kg which is point seven grams per pound of body weight plus exercise lost 46 percent more body weight. That's substantial 60 percent more fat.
And forty percent less fat free, Mass.
From organs, you know muscle whatever that is, you know compared to the low protein group plus exercise and was it sub caloric where they below below me once wait it was so they're eating to ideal body weight, but still 500 calories or so below their current caloric needs to maintain body weight. So I've heard before that when we protein a certain amount of energy is required to metabolize that protein can that be translated as
You know, the caloric load of protein is not what it appears to be. Yes, you know if let's say that six a mistake I'm making this up and I'll probably get the numbers badly wrong. But if it's you know, six ounces of steak and maybe that's a say of 450 calories or 500 calories. Does that mean that only 400 of those calories are actually quote unquote
utilized what you're talking about is a thermic effect of food the thermic effect of feeding, and that's the idea that certain
It's require a certain percentage of energy or the energy from those calories to be utilized for fat. It's something like 3% for carbohydrates. Maybe it's five to 10% and then for protein it could be anywhere from 20 to I've seen even studies that are 30% Well, I know but here is the thing. It's not that it's the energy that it takes. So if we were going to make it simple will say 100.
Calories from straight protein the body would net 80 calories because 20% of that energy is being used for what I would say is muscle protein synthesis. It's not the handling of nitrogen. It's none of that and there's variations in the literature and the variations come from how an individual doses protein. So the dosing depending if you've hit that minimum 30 grams, then you will see a more optimal utilization of protein and I think that that's
that's where that number comes from. It's actually the stimulation of muscle.
Because that is such an energetic process in and of itself. I'd like to take a quick break and acknowledge our sponsor inside tracker inside tracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. Now, I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term Health can only be analyzed from a quality blood test now a major problem with a lot of blood tests out there.
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Inside tracker.com huberman to get 10% off their new membership program inside tracker membership offers significantly reduced prices on inside trackers comprehensive blood panels. Again, that's inside tracker.com huberman to get 10% off slightly tangential question, but I think meaningful given the context of what we're talking about. Why is it that if I eat a plate of scrambled eggs or a steak or chicken breast and some vegetables? I feel very sated.
And unless I did some hard resistance training kind of good with that, but that if I eat any of those same foods and one piece of a baguette or one fork full of pasta that then I want a lot more pasta and I want half the loaf of bread. Why is that? Is it the blood glucose response? Is there something about carbohydrate at the level of the mouth? I mean, what is it, you know former guest on this podcast. Dr. Diego board cos who studies gut brain.
Sensing explained to us and that this is separate from the microbiome that we have receptors all along the length of our gut from our mouth out to the rectum that are sensing the amino acids and are looking for those essential amino acids, but also sensing sugar and things like that and signaling to the brain about how much more we should eat of a given food or forage for a given food and I just have to say at a psychological level subjective level. There's something so fundamentally different about eating protein and vegetables or protein fruits and vegetables.
In the absence of starchy carbohydrates and when ads starchy carbohydrates or eat starchy carbohydrates alone, and it's like it's not a runaway train, but it's almost as if like, it's never quite enough until there's a physical volume in the gut that it is like at threshold and I don't think I'm alone in this you look at the way people eat chips you look at the way people eat pasta you look at the way people eat risotto and is just different. I mean, there are few, you know freaks out there that probably two ribeye steaks, but for most people a rib-eye steak is like
Enough one rib eyes enough what is going on there? And it feel free to speculate but is it amino acid sensing? And because I think this is really important because I think as you're suggesting if I may that people prioritize protein from the first meal of the day and throughout the day.
You know, I think people are imagining well gosh what happens to my pasta? What happens to the bread what happens to all these things? And you know, they're perhaps overlooking the fact that eating protein vegetables and maybe fruit maybe a little bit of starch is just a completely different experience than eating starch alone or starch come in larger volumes
there. Now, I'm going to speculate here the foods that we have access to our highly palatable and potentially we weren't necessarily
Lee designed to have access to those kinds of foods and this kind of moves into this idea of something called the protein leverage hypothesis and the protein leverage hypothesis is that individuals will continue to eat and this is one way people explain obesity is that individuals will eat to satisfy an amino acid need now, your original question was when we eat carbohydrates or risotto. There is a component of blood sugar regulation that happened so
As you go beyond that 50 g threshold you tend to release more insulin. So there's an insolent genic effect of dietary carbohydrates, which some people will experience as lower blood sugar. We've all had that experience where you're I mean not all but, you know, eating your kids macaroni and cheese and then you just can't stop and then you probably feel very tired. There is an ebb and flow of blood sugar.
The interesting thing about dietary protein is you will hear people say I'm going to reduce my dietary protein because it's insulin a genic as well. So dietary protein does cause a phase one insulin release and that's preformed insulin in the pancreas. It is a component for muscle protein synthesis, but it is roughly 20% of the insulin response.
That and the same amount of carbohydrates and when you eat a protein meal that is robust and dietary protein your body will be able to then generate its own glucose roughly for every 100 grams of protein. Your body will generate 60 grams of glucose over a period of time through the process called gluconeogenesis. And that is one of the benefits of a higher-protein diet. You generate the glucose that you need and can that be converted into glycogen.
A 3-pack muscle that
you've that is a good question. The process is very slow. So it's a much slower process than if you were to have your bread or
risotto.
So you told us about essential amino acids, are there any essential carbohydrates know there are essential fatty acids
there are and you know, it's interesting. We're talking about protein and as I mentioned before we simplified in the way that we talk about it as if it's one thing but it's 20 different amino acids. These amino acids each have unique metabolic roles in the body. It's not interchangeable. For example the essential amino.
You know acid will just pick a brain one tryptophan for serotonin production or threonine for mucin production in the gut which helps the gut lining or you know take your pick phenylalanine these all of these essential amino acids do various things in the body for skeletal muscle the primary essential amino acid is loosing and while again it is very complex in the way that we would think about. How do we eat enough lysine or how do we eat?
Enough methionine. It's not a great way to think about it because then Things become very complex and someone is like well, what do I do? But if you eat for the needs of skeletal muscle Health everything else falls into place.
My mom is 79 years old. She's relatively Lean by my read. I haven't seen her decks of results, but he's probably had some muscular atrophy. She does yoga. She walks she Gardens and seems to be in good health thing. Thank goodness.
My guess is she's lost a muscle in the last decades. If she were to increase the amount of protein quality protein that she eats especially in that first meal of the day would the health of her muscle and her muscle mass change, even if she does no resistance exercise and I suppose she gets a little bit of resistance training from the yoga, but I haven't been to a yoga class with my mom at my guys aren't doing headstands. Definitely not doing headstands. She's actually an you know, she's she's very mobile.
oil and very sharp and very vivacious but
I don't think she's doing the the more, you know, Advanced inversion things that yoga so let's assume that she's doing some moderate exercise three three four times a week, but not training with weights. If somebody like her or you know, younger male that has a similar pattern of behavior do desk worker for the most part jogs a little bit gets on the on the Recumbent Bike or whatever it is, but is not doing resistance training increases their quality protein intake throughout the day and especially at that first meal ensuring
At least 30 and up to 50 grams of intake what changes are likely to happen. Even without resistance exercise. Well, the first thing is that if she is eating a sub amount of protein, let's see. She's eating the Rd of protein and the average woman eats around 60 grams of protein a day 40% of women over the age of 60 are deficient in protein. They're eating below the RDA and what's happening to their body. There is their body robbing their existing skeletal muscle.
Amino acids in order to supply what the brain and other organs need
in part in part. One of the things that happens with aging is the body the whole body protein turnover becomes less efficient. So the body is turning over roughly 300 grams of protein a day. That's a lot it is or not. It is a lot of
turnover 300 grams of protein of
turnover. Yes and muscle only accounts for maybe 25 percent of turnover.
An individual might eat an average female like your mom is eating probably around 68 grams of protein a day. Yeah, if I'm lucky she's not big on on beef or chicken and listen to the eggs in a little bit of fish and lots of vegetables and fruits but maintains again like a healthy lean body weight and and that is wonderful because she's balancing her lower protein intake with physical activity. Remember there are two main ways to stimulate skeletal muscle and that's through resistance training which one would argue she is doing
And or dietary protein, but when we think about muscle protein synthesis, there's really four inputs. There's resistance training. There's energy there's insulin growth hormones. And then there's leucine when you are younger. Your body is driven by more of the anabolic hormones, which is one reason why we believe that a younger individual can get away with 5 to 10 grams to 15 grams of dietary protein
because their levels of
of testosterone and or estrogen are driving protein synthesis in a way that lets them offset any dietary
deficiency. Well that their body is just highly anabolic they're growing they're growing up. They're growing when an individual like your mom who's now stopped growing the body becomes much more reliant on leucine and resistance training because the main pathway that these things go towards is something called mtor. Mammalian Target of rapamycin the influence on
Those Pathways changes as we age so the lever in which you pull changes and the importance of that lever changes. So the best thing that your mom could do to maintain skeletal muscle, so why and what happens to skeletal muscle as we age skeletal muscle if it is not contracted and utilize gets this fat infiltration mitochondria changes protein turnover changes. It becomes less efficient at sensing amino acids. There's a decrease in
reperfusion, which is why one reason why exercise is so important in order for her skeletal muscle to respond like a younger muscle what she should do is do some kind of resistance training and then add in some kind of dietary protein because when we think about the protein hierarchy the amount of protein in a 24-hour period matters the most protein hierarchy again closer to 1 gram per pound ideal body weight the evidence would say 1.6 grams per kg
I'll never forget when the probate study came out. I can't believe I've been out of Fellowship that long but the pro date study was a position paper and it talked about how the current recommendation for dietary protein is too low and that to support healthy aging you need two point five grams of leucine or roughly 30 grams of protein and you know an increase in total overall dietary protein and this was really the first position statement and that came out gosh, I think 2010
Yet we haven't changed any of the recommendations for the general population yet. So in order for your mom's muscle to respond, if you compound those two things then she will maintain with activity the health of our skeletal muscle you mentioned something else an individual shouldn't just load protein loading extra protein and not moving is not a good idea because of proteins effect on mtor.
Brought the body. So we talked about MTAR which is mechanistic Target of rapamycin in skeletal muscle in the brain and the pancreas. This is a protein complex that you just don't want stimulated all day long
for sake of cancer risk. Yes as my understanding is that mtor is very highly expressed in all cells of the body early in development and throughout growth. In fact, it's expressed in the cells. I spent my career working on the retinal cells.
As and then over time it drops off and it's remarkable how studies where mtor is replaced into cells allows them to essentially look like and behave like young cells again, even replacing some regenerative capacity. This is work of a guy named she gone he at Harvard Children's Hospital Harvard Medical School, but what one always observes and we've done these experiments in my lab is that when you increase seventh or by any number of different, you know,
Ways, you know molecular chicanery and things like that that the cells grow enormous and the concern is always that if you increase mtor that you are going to buy us any pre-existing tumors to proliferate as well. Is that right? I think that that yes component. Yes it is and we have to recognize that MTAR stimulation is different in different parts of the body just as you mentioned and so skeletal muscle is uniquely sensitive to contraction and it's
This biochemical process called red one and when you contract skeletal muscle it inhibits red one which then again there is this phosphorylation of mtor and muscle protein synthesis happens that is unique to skeletal muscle and when individuals will say this is will be a common discussion that you hear in the spaces that well. I don't want to increase my dietary protein because somehow that is going to cause cancer and that is not true. That is a very
Myopic thought process that would be the same as saying resistance training, which also stimulates mtor is going to cause
cancer right? I completely agree with you. I think it's interesting that mtor. Which in mices mammalian Target of rapamycin that were rapamycin my you know, pick up some people's ears. There are some people out there and by the way, I'm not recommending this that take rep rapamycin as a way to inhibit mtor in hopes of extending their life.
Span there's some animal studies that support this there's a growing interest in this and so much so that some people are willing to take rapamycin by that logic rapamycin would perhaps inhibit muscle growth muscle Health. That's a whole other discussion. We'd have to get a tea and a few Matt Carolina a few other folks here, and maybe we will with you to discuss that but the point being that I agree completely that we can't just say something that increases m
I'm tour in muscle is also going to increase cancer that these molecules like mtor have distinct roles in distinct issues at distinct time points throughout the lifespan. And as you mentioned ingesting quality protein can increase muscle protein synthesis by way of mtor and other Pathways which right as well as resistance training and I don't think any one in the longevity space would suggest that resistance training is a bad thing. And with that we know it's increasing mtor. So there's a little bit of a contradiction
In that field just if one stands back from it and says well wait, you're want to take rapamycin to block M2 or but you also want to do resistance training to stimulate them to our which one is
it? Yeah, and we have to recognize that the efficiency of the stimulation declines as we age and the way that we overcome that is again this idea of muscle span. How do we continue to go through life and design a diet that we know will be more dependent on dietary protein and movement as we age because the balance between the two changes when you're young you could eat the twigs.
Inky diet probably look it away and grow age is the great equalizer, you know, I trained in geriatrics and I am telling you age is the great equalizer and creating protocols and habits put into place to allow you to age. Well is everything and there is so much confusion in the nutrition space that if we can pull back and recognize. Well number one science is a is a evolving field and it's the you know, there's a science of
Certainty, but there are foundational principles that we can put into place and one of those foundational principles is skeletal muscle Health Muscle as the organ of longevity must be supported and there are very few ways in which we can do that. You know, when you think about the metabolic implications of skeletal muscle as glucose disposal unit these diseases of Aging really begin in skeletal muscle before you see any outward signs of
a city before you see any outward signs of anything that would indicate you are unhealthy. It's kind of like osteoporosis as the silent disease skeletal muscle health is also that way and in fact, there's some very pivotal work out of Yale and they looked at young healthy college students, you know as a college student you'll do anything for a couple bucks, right? They pay them and these individuals were sedentary and what they they were healthy.
Lean and what they saw was skeletal muscle insulin resistance just by being inactive.
Can you imagine as you continue and how do we Define an activity now? What is it less than 5,000 steps per day per day while I was meant multiple ways. I mean think about it. We were designed as humans to be very mobile. And so now we live in a world that what we think about as sedentary behavior is something innocuous and not a big deal. It isn't it is a disease state.
So
I feel like you've made an excellent case for the ingestion of sufficient balance of quality protein each day, especially starting with that first meal of the day and just to underscore the suggestion that I heard. It was aim for 1 gram of quality protein per pound of Target body weight. So somebody weighs 200 pounds in the like to weigh 180 pounds try and get 180 grams of quality protein per day divided.
It up into meals that include somewhere between 30 to 50 grams of protein per meal. Yes, and that first and last meal are the most important. There's a lot of information going around that an even distribution has to happen. And partially this is my mentors fault. He'll laugh this 30 grams of protein 3 times a day. I'm sure you've heard about it. Yeah. We're that you can't assimilate more than 30 grams of protein per meal. Let's let some U s-- let's drill into you assimilate all the protein that you adjust even if it's darker.
It's 100 grams. Correct? Even if it is 100 grams skeletal muscle protein synthesis will max out probably at 55 grams again, it is maybe it's 50. Maybe it's 55. The rest is oxidized. You can only incorporate so many proteins so much protein and the rest is then used as fuel or oxidized. What if I do hard resistance training in the hours before a meal and then that meal includes 100 grams of quality proteins is a whey protein do I put all of
Of that hundred grams into muscle protein synthesis, I would say I don't know if you put all 100 grams, but I would guess that it would cap out at a certain number and really the totality of evidence would suggest it's probably around 55 grams. So regardless of whether or not somebody does resistance training you can ingest about 50 grams of protein again, 4 calories per gram typically into muscle protein synthesis. The rest is oxidized. Yes, maybe just touch on that process of oxidation what that
Like yeah, it's basically
just utilizing those proteins. It's utilizing them for energy. It's not storing them it whether it goes back for gluconeogenesis or wherever it goes it is then
oxidized. Okay, and if that meal with let's say 50 grams of quality protein is combined with 50 grams of carbohydrate. They have fruit some oatmeal pasta rice Etc. Does that change the utilization of the protein at all? I know I asked this question earlier, but one could imagine that the
The body wants to use different fuel sources differently. Is there any selective use of one macronutrient versus the
other? That's an excellent question the body that amount it will be seen as a mixed meal, but the body will always choose to get rid of glucose first glucose dominates metabolism because again, it can be toxic to the body. So it must be utilized now. What is also very interesting is
That now you're talking about the speed of absorption. One of the things that we should mention is. Typically you need a substantial rise in leucine. And that will be again that will probably take and last around two to two and a half hours. So when you have a mixed meal that slows down absorption digestion, this is where the quality of the protein comes in that becomes very important because you have to reach a threshold.
Hold in the blood to stimulate tissue and there was a very interesting studies the first study of its kind and this came out of Luc van loons lab and basically they looked at a vegan diet with I think it had 40 grams of protein and then it had a never aside so it had both sources of protein and what they found was that the individuals that had the for the 40 G meal. That was a mixed meal with animal-based proteins actually stimulated muscle protein synthesis.
whereas the mixed me love, just the vegetables did not interesting even though it was
Plant-based proteins hike, you know enough protein in that meal and that likely might be because of the rate of absorption because of the fiber content and it becomes important to recognize that a higher protein meal seemed especially with the quality of the protein that if you're picking the range between 30 and 50 depending on the mixed meal amount. I would certainly go towards that higher-end.
What is the case for?
Fiber either supplementing fiber or in my case. I get fiber from fruits and vegetables mainly
fiber is extremely valuable. It's extremely valuable for the gut microbiome. It's extremely valuable for satiation fiber. If I were to design a diet, the first thing that I would pick would be dietary protein then I would think about how I'm going to parse out the rest of the carbohydrates because you earn carbohydrates through exercise. I usually choose berries high fiber sources of berries and then whatever.
I'm very strawberries blackberries. I'm a big fan of berries. I'm like a grizzly bear when it comes to Barry's. I'm a drive-by blueberry eat or when they're there. I can't help but swipe them off the the bowl or the plate but there was something else that you mentioned that I wanted to highlight in. This was if I did resistance training then could I eat 100 grams of protein and then 100 grams of carbohydrates. The amazing part about exercise is what we really care about is glucose disposal and insolence.
Sensitivity this idea of insulin resistance is killing our world young people to yes. Yes, we've seen double to Triple the rates of childhood obesity. That's wild. I don't think people younger than 25 recognize it like when I was growing up in school. We there was junk food. Lord knows there was junk food. There's also good food and different kids from different homes. They different amounts of
On food, but it was the rare individual in school who was overweight was obese and you had some kids that seem to be just kind of like born lean. And and with more muscle you had that were thinner with less muscle lesson. We it but it was very rare that there was an obese kid. You just didn't see it much and I don't recall there being a lot of restrictive eating or even discussion about nutrition, right and
And people were eating cereals people were eating candy bars. They were also eating eggs and sandwiches and chicken dinners and all sorts of stuff. So what's happened? Like really what's happened because something is fundamentally different. We had PE class that was required. We had to run we had to play volleyball we had to do those things, but it's not like we were all athletes and we'd walk to class I skateboard. I played some soccer but I wasn't an athlete per se so like what in the world
Is going on I will say that also two-thirds of Americans are either overweight or
obese. Yeah, it's wild. I mean I again one has to have been born in the 70s as I was were early 80s to really appreciate this tremendous shift in like what you see and sure people are on phones more and more sedentary. It's got to be a combination of things. But there
there's all its cultural you have a disease on of inactivity and sedentary behavior. That is frankly killing our population.
Almost 50% of people have hypertension. We have a what 40 million people on statins? I'm sure that number has changed and skeletal muscle is medicine skeletal muscle again helps with triglycerides helps with insulin glucose disposal. So where this came from you just mentioned if I exercise then can I eat whatever you're eating? Yes, but we're not talking about being irresponsible, but skeletal.
Now his sensitized within you know, there's a 24-hour period 72-hour period where that muscle is still
sensitized meaning it consumes more
nutrients. It consumes more nutrients. But also when you think about insulin resistance insulin moves glucose out of the bloodstream into cells and through the muscle, there's the insulin dependent pathway through obviously insulin, and that's whatever pi3k if you
Care if anyone cares and then there is insulin independent, which is through exercise and how glucose moves from the bloodstream into the cells is through glute for receptors. When you exercise you increase the density of glute for receptors to the surface just by doing activity. It doesn't require insulin you are able to then move glucose out of the bloodstream into cells and again insulin resistance is at the heart of so many
Of the problems that we're seeing. Do you think that
most people including the auto say it the public health officials in charge understand that the points that you just made I mean clearly one doesn't have to even have a degree in medicine or science of any sort to look around and say okay. There are a lot of people suffering from obesity and we are hearing more and more about the negative effects on brain on other aspects of mental health and physical health and the interrelatedness of
mental health and obesity. I mean, dr. Chris Palmer from high school. Yeah, wonderful person former guest on this podcast very popular episode. I mean, it's really been championing this issue as of a few Folks at Stanford and elsewhere this new field of so called metabolic Psychiatry the link between brain health mental health and metabolic Health, but putting all that aside. Do you think that most public health officials?
Stand that.
Muscle contraction increases glute for expression at the level of muscle which then grabs more nutrients from the bloodstream which then lends itself to all sorts of positive health benefits and diverts from these negative health benefits. I mean, like why isn't that on every billboard why I mean, it's such a simple Concept in principle. Yeah, like why aren't we hearing this? I mean do they even require PE in school
anymore? No, I am not sure but this is a this is a problem. I don't know.
No, but I would say if two-thirds of our population is either overweight or obese the health officials may fall into that category or at least two-thirds of them potentially.
Yeah, and I'm not blaming them. I'm just wondering I mean, I don't think well, I don't think we hear this message enough that muscle contraction is medicine. We've heard that from dr. Casey means we're hearing about it from you that muscle and muscle Health in particular. And again, I'm so grateful that we're talking about muscle health and muscle quality and muscle as a tissue that utilizes nutrients.
And can divert things towards Health in a way from disease as opposed to just muscle size because I think most people here muscle and they they eat for muscle and they just think muscle size and frankly. Most people don't want increased muscle size.
But if you train for hypertrophy, which is muscle size very difficult to get especially as you age by the way becomes much more difficult, but you will also get strength and power if an individual struggles, you know, if they fall they break a hip they have to be able to get off up off the floor you have to be able
Able to travel on an airplane and put your stuff over head or pick up your toddler mine weighs 40 pounds
or go downstairs. What? Dr. Peter it's he has really been emphasizing that a lot of Life ending injuries life-ending injuries occurred by virtue of people failing to do The Eccentric movements of that are essentially look like going down stepping down off something. Yeah that did have this discussion with both my parents. It was a little bit uncomfortable frankly because no one wants to be told Hey listen here the things that can potentially kill you. It's don't
You so much about going upstairs. Make sure you hold the railing both my parents being able bodied. I'm grateful again for that but be careful as you walk downstairs, I mean one fracture at age 79 80 the age of my parents in. I think I'm going to get these numbers a bit wrong. I'm sure but I think Peter mentions that that leads to death in a large percentage of people that break that hip or break that leg or break that wrist, even yes and the other thing that because of the break itself, but because the inactivity that
results and that's absolutely right the
the skeletal muscle inactivity causes a derangement of metabolism. The derangement of metabolism will then go on to get fatty acid infiltration fatty acids that infiltrate into skeletal muscle. Once that happens you now have a decreased flux. You're not moving muscle glycogen. You're not getting rid of these ceramides or these diacyl glycerol. Is that build up that potentially lead to and compound insulin resistance skeletal muscle insulin resistance you
Generate a low-grade inflammation that is constantly going on. If 40% of your body weight is skeletal muscle and you are not maintaining the health of skeletal muscle you are walking around with an inflammatory bag on you this decline in aging people think that we go through a linear decline in aging we don't we go through a series of catabolic crises and a catabolic
crises would be something like someone Falls breaks a hip and never regains full functioning or someone gets pneumonia is on bed rest for 5 days or a period of time this compounds upon itself these catabolic crises compound upon themselves and individuals never return to full function the thing that becomes interesting and very important. Is that when you maintain
The health of skeletal muscle low muscle mass would be early indication of osteoporosis bone attaches to muscle muscle pulls bone creates a load a stimulation that is required for for building. I mean imagine the astronauts or an individual who again is on bed rest when you are training and you are putting force and load on your body, then you're able to maintain the entirety of the
A texture of the body and this all makes useful sense, but it is underappreciated as an organ system and the other thing about skeletal muscle and depression and mood. Is that skeletal muscle and inflammation as you contract it the duration and intensity of contraction releases myokines. So my all kinds of you heard of myokines I have but please edges. Yes. So Amaya kinds are peptide hormones again skeletal muscles and endocrine organ that travel throughout
The body the most famous one is interleukin 6 you have interleukin 15 interleukin 6 these effect lipolysis. They affect the utilization of glucose. There's this idea of training in a low glycogen state that might increase a more robust amounts of these interleukins. Is that right? These my all kinds which is
because I love training fast, which is
interesting and we always think about exercise as this way to improve metabolism. It doesn't so much do that at rest. But what it does is when
When you exercise you improve again glucose utilization, but also you release these microns. It's not just the physical activity, but it's also the subsequent effects in the subsequent molecules that skeletal muscle
releases. I'm I just want to say realizing I'm interrupting Amen to that. So often people look at how many calories were burned in a given bout of resistance training and while that is perhaps interesting the wave front of other endocrine and molecular factors that set in motion.
Byron proper resistance training to me is the most interesting and important aspect meaning in the hours afterwards sure. You're going to continue to burn calories at an elevated rate, but it's all the the effects of the hormones and as you're pointing out the interleukins that last hours and hours and even days that least to my mind or my reading of the literature are the most interesting the
most beneficial meeting and actually the science is relatively new. It came out of pederson's lab. Bente Paterson & Co
Copenhagen extraordinary work. She's an she is in part an immunologist and exercise physiologist when you train and you release these myokines, they which are based on the intensity and duration of your activity release something called caps. Epson be an Irishman these myokines then stimulate bdnf release in the brain brain derived neurotrophic exactly, which is a component of neurogenesis when we think about the plethora of activity of
Skeletal muscle does it is no surprise that number one. It's free to move.
Can I just mention something about bdnf? If I may it's been much of my earlier career working on neural plasticity brain development and bdnf brain-derived neurotrophic Factor gets mentioned from time to time. And as you mentioned it's involved in different neurogenesis Pathways, and but I think one of its most interesting effects is its role in consolidating existing connections what we call synaptic
Connections in the brain and I'm so glad you mentioned this because what you're effectively saying is that doing resistance training properly sets in motion a molecular Cascade that feeds back to a molecular Cascade within the brain that reinforces the neural circuits that exist and one of the Hallmarks of Aging is a essentially a degradation of neural circuitry right now sometimes in extreme cases like Alzheimer's or other forms of dementia Parkinson's Etc, but we know that the volume of gray matter of
Of neurons within the brain declines with age. We know that the neural circuitry suffers the speed of neuronal transmission suffers and it's long been observed. But only now objectively substantiated that exercise can not just maintain but even improve brain function over time. And so thank you for allowing me to kind of expand on what you just said. I just think that if ever there was a potent medicine for improving brain health, its exercise and in particular,
The resistance exercise. I think the case for cardiovascular exercise is probably that it maintains the components of blood flow that are also critical for the blind.
Yes, and certainly no one is arguing the importance of cardiovascular activity and vo2max. We can appreciate that on the flip side of that skeletal muscle has not had its moment yet and in particular resistance training, you're not going to be able to be effective at maintaining a VO2 max. If you do not have healthy skeletal muscle you are not going to be able to be effective at nearly doing anything or sir.
Iving any kind of illness the higher the amount of skeletal muscle mass. You have the healthy skeletal muscle mass the greater your survivability against nearly any kind of disease remarkable for example cancer cachexia, which is the wasting that comes with cancer kills 20% of individuals survivability comes from the health of skeletal muscle also on that same note Contracting skeletal muscle releasing myokines interfaces with cells of the immune system. We've
all heard of macrophages and the cytokine storm interleukin 15 tnf tnf-alpha as being a pro-inflammatory when the myokines which are also interleukin 6 and interleukin 15 are released from skeletal muscle they interplay and they somewhat dampen the inflammatory effect and have a different effect on the entirety of the system.
When these quote cytokines come from skeletal muscle incredible. So as long as we are now on the topic of exercise, let's make it concrete for people. We talked earlier about nutrition and specific G amounts and calorie amount and distribution and that's just wonderful and thanks also for explain the mechanism and the incentive for doing this. Let's talk about resistance training and let's do this in a slightly different way than we did earlier. What is your program for resistance training?
And then we'll talk about what other people might consider for them and maybe the same thing. So if you just actually walk us through your week. What does it look like? It could be Sunday Monday Tuesday Etc or could be you know, how many days a week? Do you resistant strain? Of course are you know, I don't I don't do any kind of training. Yeah. Well, I know based on your Instagram you do and and now we know why so I have a wonderful train the trainer Carlos Montoya. Shout out to him every Monday I decide I don't want to train and I know that the of course you do.
Enjoy it I do but it's usually suffering at least Monday every morning. I know Monday morning going to come up and I'm going to think about all the ways in which I can get out of it. I never get out of it. I always show up. I trained consistently three days a week and I contrary I trained pretty heavy for my size. So Ima maybe 110 pounds. What I do is I do some kind of push pull hinge squat on all three of
Thank you. So you train your whole body. I do three days a week separated by a day in
between I do I do because essentially I'm working hard enough where I'm pretty exhausted so I came here and you ask me if I train this morning Friday. I'm off today. Okay, but what I do is when I start I think about well actually Carlos things about this, but I'll do some kind of sled push sled push. It will be loaded. It will be pretty heavy. It gets my full body moving and then we'll pick some kind of compound movements whether
it's a multi joint. That's exactly right a multi joint movement through full range of motion. So for instance squat or a deadlift, that's right. If somebody isn't skilled in squats or deadlifts, could they maybe hold onto a kettlebell of appropriate weight for them and do like a kettlebell squat going to give them an even better solution and this is this concept that I learned from a PhD named Pat Davidson and he talks a lot about High Ground low ground movements and a high.
Ground movement would be something where you have contact contact like a hack squat so ground you have back support leg support you are able to move in a way that fully contracts the muscle that you are focused on we see a lot of people that go to the gym and kind of just do whatever and that might be okay to maintain but the goal should always be a ladies you're not going to get bulky should be hypertrophy
which is hard to achieve.
Achieve it's hard to achieve but you must Focus because maintaining and growing skeletal muscle mass as you age. It becomes much more challenging and so choosing High Ground movements. I would not have someone who is an unskilled lifter go in and do a front loaded goblet squat
or free weight squat or deadlift, right?
I want it. I would have them do High Ground movements and this is where machines are really really wonderful people kind of
Say well, but you have to train for functional movement and functional. What is that? We're training for life you're training for Life
durability. And if I may, you know any time people say, you know, what's the best form of exercise? How do you work out at cetera? I always say rule number one definitely train, but don't get hurt or avoid getting hurt. I mean the moment somebody approaches exercising gets hurt. They're in trouble one of the best ways to get in shape for your entire life is to avoid getting
injured but still train or two.
Train your entire life. If there are parents listening thinking about your kids. There was a whole push where kids shouldn't do resistance training and shouldn't move load. I look at my kids. They might not be doing one rep max has but they're picking up kettlebells. They have. Oh,
yeah. Yeah. I was told growing up to not touch the weights until I was at least 18 at 16. I started doing you know, pull-ups push-ups sit-ups and then pretty quickly moved into all the leg, press leg extension you all that stuff.
Help myself and I would argue that outside normal play. Someone is never too young to start and frankly never
too old and body weight resistance is in many cases sufficient, right? I mean as a kid I would do at night. I would do sit-ups and handstand push-ups against my door, you know, I kind of like couldn't do it proper handstand unassisted but you know flip over and then do the handstand push-ups until my mom would yell at me about the marks on the on the door, but you know, that's that's was pretty tough right getting
Repetitions that was pretty tough, but you're saying resistance training what you said High Ground
High ground contact high contact. So when you are choosing motions that an individual is unskilled to do I think let's frame this is that most people think about exercise for optimization and performance. But if we take that back a notch and you know, I think about my audience and they are
Rules that are aside from the special operators and aside from the CEOs. They are 40 year old women that are like, hey all of a sudden I noticed that my body composition has changed, you know, I work with an amazing PhD her name is Victoria Fletcher and she has helped me bring into these pieces of how do we design and think about training protocols and training programs for the more mature individual and when you think about these high ground,
Movements if someone has not trained and they're thinking well, I don't want to fall. So I'm going to do box jumps that plyometric movement. There's a high probability of injury. Yeah. I don't Works jumps. I don't like them because I The Eccentric loading that you know, and being lost soreness and it's takes a lot of them to generate what I'm telling you just so that is exactly the point is an individual going to be able to generate enough Force to make it meaningful and someone would
You yes, well for them, that would be you know, when I was a practicing geriatrician and I was going through my fellowship. We did the number of metrics to look at strength and one of those was a sit-in stand out of a chair. So sit to stand and that would have for some people have been considered a high intensity interval.
The question becomes is that enough to mount a response over time and I would argue. No what do people need to do and that is when you train for hypertrophy, which is muscle growth and let's say that is five to ten reps three, you know, four to five sets you pick there's many different ways
that are the final repetitions are
challenging where the final and the load is enough and there's wonderful data out of McMaster University that it doesn't have to be heavy weight as long as the stimulus.
This is enough and then we take it back to what is the stimulus and the stimulus the goal should be are you moving the muscles that you are supposed to be doing an are you generating enough activity to create adaptation and change and so a high ground movement for someone who's listening to this and thinking I need skeletal muscle health. I walk Walking is wonderful, but is walking enough to maintain those type two fibers. It's not you will see a transition and we've also
Seen our aging parents. I mean, my dad is in his 70s. He's very fit. But he used to be a Collegiate wrestler. He went to Wharton he was Captain of his wrestling team.
Dad you're a lot smaller and part of the reason is the fail the failure to focus on hypertrophy in those are those type two fibers those type two fibers that transition with aged more type 1 fibers those long lean fibers you go from bigger too bulky to less choosing activities to maintain those fibers. Also these fibers are bigger this work glucose disposal goals
Choosing things like leg extension. It's not a bad thing. If you get stronger and you have stronger muscles, then you will have more power you'll be able to generate more Force. You will be much less likely to fall.
And you'll be healthier overall because of muscle health. So maybe we could just list off some of the movements that people could think about in terms of these High Ground movements. You mentioned hack squats leg presses come to
mind like extended research leg curls like curls lat pull-downs with a supported back any kind rose rose supported row again, is there mostly machine exercises that you're a star they are which is our usual Sheen's so cables would be considered low ground because you're kind of in space.
If you think about it, what takes someone out in their 40s what takes someone out of the game? It's a tendon injury.
Tendinopathy these whether it's a shoulder whether it's a hamstring whether it's a hip and part of the reason is there's muscular strength. We focus on muscular strength, but there's also tendon strength which takes time and when you get tendinopathy as you get the thickening of these tissues, you know, people will say that tendon lays down much slower that the collagen turnover is much lower but actually muscle turns over 1 to 2 percent per day.
Tendons turnover maybe point five to one point five percent per day. It's not that substantially slower these it's highly active tissue. You need blood flow. You have to treat your body with respect that if you think you can always train the way that you did when you were younger and just hit those heavy weights if you get injured and you are not allowing your tendons to keep up then overall injury over time. Again, this is what we would call maybe not.
Catabolic crises but close
what is the total duration of a resistance training workout that the typical person could use I make it a point to try and warm up over the course of about 10 to 15 minutes and then do 50 to 60 Minutes of hard work. But I always leave some gas in the tank. It's the rare. I would say 5% of my total resistance training workouts. And I also train three times a week. Although I divide my body up into different splits. That's my case.
And I run like a much larger than me. Well, it's it's the case now that I try and hit each muscle group directly once per week and then indirectly another day per week. So if legs are on Monday the in that's direct and then but the indirect leg training is actually the hit work out on Friday sprinting as I love that that's wonderful. I think that the three days per week whole body workout I think would work for a lot of people just to take the complexity out of it. So is it the case that the entire workout could be constrained to?
You 45 to 60
minutes solutely and for a new lifter, they're going to get the most gains. What we find is that an if an individual is what we would consider a beginner you will see, you know, after they go through a neural neurological adaptation is that they will get more growth and potentially progress new lifter could progress weekly. Whereas a more advanced lifter. I would say, we would be considered more advanced. We've been lifting our whole lives that
For us to make changes, it's it's much more challenging for us to put on size or even get stronger. I mean, yes, there is a particular Cadence but our improvements might be minut and when you're thinking about designing a program the current recommendations for physical activity, which by the way, do you know 75 of roughly 70 maybe it's 70% of individuals. Do not meet physical activity guidelines. And what are those again? 5,000 steps
150 minutes of moderate to vigorous activity with two days a week of resistance
training per week. So 150 minutes total
and two days a week of
residual Us in two days a week of resistance training.
So that is what there are 30 minutes seven days a week of activity just to put that into perspective that is how sedentary we are 50 percent of Americans are not even
training is that true in other countries as
well? Well,
I don't know the statistics in other countries, but far and away we have arguably the biggest Health crisis.
With our population
people always point to the blue zones, they say well and they do zones. They have like a shot of vodka every night and they're socially connected and they have a Mediterranean diet and they're not lifting weights. But is it the case that they are piling would are they walking more are they
carrying active highly active and the blue zones are a funny thing because you know, some will say well are the records kept appropriately.
And Etc, there is a lot though despite that we can learn from the blue zones and I think again the connection social socialization but also movement, you know part of the reason why we are requiring this higher protein load is because we are physically less active again. There's only two main ways to stimulate skeletal muscle resistance training and dietary protein.
Arguably the resistance training piece. The physical activity peace is more influential is much more impactful to full-body homeostasis than diet will ever be if you just eat protein and don't exercise. You will likely still lose muscle testing my observation of family friends that include people who are very fit into their 80s and 90s and even be on in a few cases are that
at
and here these are generalizations based on observation. I want to be clear that the people I know who are still skiing in their 80s who are some who are sprinting in their 80s, you know, not as fast as they used to who are still playing tennis in their 80s. So what I'm referring to here are people that are playing sports that involve Dynamic movement that involve a lot of coordination and no doubt some resistance at least of some sort like skiing is, you know, there's some
Distance involved and depending on the complexity of the tree slope Etc. Yeah and trees. So what do you think is going on there? I mean there's a rich literature says to support the fact that most of our brain volume is there to support vision and movement and that when we move less there's brain atrophy John radio at Harvard talked a lot about this even some species of animals that will spend part of their life swimming around and then they'll Nest on a rock and then the brain will actually eat itself it would do to the lack of movement will just metabolize portions of itself. So the
the relationship between movement and brain health seems Seems obvious. But yeah, how many folks do you see out there in their 60s 70s 80s and 90s that are now doing resistance training do we know the percentages? I don't and I was just recently looking at the ACSM guidelines, which is the American College of sports medicine for activity and older individuals. I am not sure the percentage of individuals.
Actually doing resistance training and partially I'd have to believe that it's less. So again, I trained as a geriatrician and one of the things that we always saw not for everybody, but for the majority of people is it wasn't the duration of the training they were still if they were active they were still active. It was the intensity that they were able to mount and so because you know, there's this interesting thing is as we age well, I mean, some of us are less intense in our training and it's
The actual intensity piece that seems to go down that when this can be addressed and what do I mean by intensity? There's a million ways in which I suppose one could Define intensity but it is pushing themselves again. Are we going to say is it how many reps how heavy but the focus in the intensity of the training goes down.
I guess we could Define intensities somewhat Loosely but still fairly by saying, you know repetitions in the
What do you know five to ten maybe twelve repetition range where the final two or three repetitions are challenging in good form right? Maybe even to failure in good form, but that seemed like Fair.
Yeah, and I would think of the intensity component because the Aging literature really doesn't seem to matter if people are lifting heavier light.
I used to believe that in order to maintain skeletal muscle mass especially as hormonal status changes decrease in testosterone decrease in estrogen decrease in progesterone that the heaviness of the load has to increase I can't the data doesn't necessarily support that I would love for that to be the case
surprising to me. I would think the price I think people would have to push themselves with not extremely heavy loads but moderately heavy for them.
So it was surprising to me as well and especially when we worked on.
I'm of those earlier studies in layman's lab. There's this change in body composition that seems to happen midlife. There's an increase in visceral body fat or Central adiposity and one would think that you require a lot of extra supplements Etc to influence that but when training and nutrition are accounted for in a very controlled way body composition changes to the positive you can lose body fat.
To increase muscle mass. It'll be very interesting to see as the literature around hormone replacement continues to evolve especially as it relates to women because we know that testosterone improves skeletal muscle mass but that isn't going to be enough if you don't have the foundation the foundation in place and I think that the other big concern is how we're measuring skeletal muscle mass.
We mentioned a little bit about dexa. The more effective way is really MRI, which doesn't seem to be achievable for many people. It's expensive and CT would be the other way to actually look at muscle quality muscle quality right now is defined purely on functional movement measurements, but that's clearly not it when we Define if you look in the literature muscle quality is really about the load and the weight and the performance not about the architecture and the infrastructure of the skeleton.
Muscle and the reason I say this let me take a step back is that in the literature and you will often hear people say that only strength matter Size Doesn't Matter.
I don't believe that to be true. I believe that we haven't been able to test muscle sized appropriately and when we begin to test it, there's a way in this is I think this is being done. It came from a gentleman named. Dr. William Evans and he utilizes something called a D3 creatine and it's a deuterated tagged creatine and an individual and just a pill creatine is largely in skeletal muscle. There may be a small amount in brain.
But for the majority of skeletal muscle is that's where creatine goes. And so this is a direct way first time ever. It's it's been validated. I think it started its utilization and maybe 2019 but when individuals are directly measuring skeletal muscle mass they find that skeletal muscle mass and strength are both important
interesting. So is there a synergistic effect of ingesting quality protein?
Fission amounts distributed throughout the day and as you mentioned especially at the first and last meal of the day and resistance training exercise on muscle health and other metrics of longevity and current health status. This is a bit of a nuanced answer if you are young and you are eating close to 1 gram per pound ideal body weight then anytime that you ingest your protein would be adequate.
However, if you're older and you want to take advantage of resistance training + dietary protein than consuming within an hour or so and again, that number is the way in which I think about it is really about that blood flow is how long that blood flow is still getting to the skeletal muscle because you're delivering nutrients. If you are older or have a chronic condition, then there would be no downside and there is evidence in the literature if
If you consume dietary protein around resistance training due to that synergistic effect, if you are eating a lower protein diet and or older got it, so would it be actionable to try and I don't drink a whey protein drink within an hour of resistance training or eating a meal that include a chicken breast or some eggs or steak is that is that basically what we're talking about it is if you are eating a lower protein diet, I would take advantage of that.
That because you increase the efficiency you lower that anabolic resistance load. Yes one could do that and I say this in a way that if you are young and healthy on your training, I don't really care when you ingest your protein.
But if you are in a group or in a group of individuals, that potentially is at risk then doing resistance training and adding in dietary protein. I would say shake is a great way to go because the absorption is quicker a meal will have a slower absorption. And again, we need to get those amino acids into the bloodstream at a certain level at a certain time.
What about cardiovascular training?
Earning vo2max. I make it a point to try and do a long hike or jog once a week for me. That's 60 to 90 minutes. I'm not obsessive about it in the sense that sometimes I'll go out and I'll make it social with a weight vest or just walk or hike sometimes I'll jog on my own one shorter run of 30 minutes or so in the middle of the week at a faster clip and then one high intensity interval training session that lasted about 12 minutes and total and thank goodness. It's only that I'm basically sucking for are at the end. That's it for me plus a bunch of walking if I can I try to walk as much as possible throughout the day.
I don't even consider that exercise. I just consider
that move. That's wonderful. Now you're talking about non-exercise activity. That is extremely valuable.
I try to Pace while I take phone calls and things of that sort as much movement as possible. What is the value of getting the heart rate elevated for some period of time long you no longer than a few
minutes. Yeah. I mean when you're talking about increasing VO2 max, I think that there's a multitude of ways to do it one.
Could do slow steady state activity, but I will say as individuals age that becomes more challenging on joints. We are thinking about how are we able to maintain our physicality throughout life if you have got a ton of time and you can do slow steady state, it's wonderful alternatively. There's a lot of evidence that high intensity interval training Martin. Kabbalah would be a wonderful guest. He is really the expert in high intensity interval training and it's
Is in insulin sensitivity influence on vo2max and this is really going all out in a matter of 20 seconds. There's modern intensity interval training high intensity interval training is Sprint interval training that will increase vo2max in a substantially less amount of time and could be safer for an individual. The other way is improving skeletal muscle mass if you improve strength and hypertrophy you will improve your video.
To Max albeit not exactly in the same way, but both are beneficial and both will improve vo2max and blood pressure and triglycerides and clinical outcomes that we care about. It's wonderful to think about things kind of nebulous Lee and then it all comes back to what do we care about as we age we care about having an appropriate blood pressure. Let's call it 120 over 80 we care about having a triglyceride level of 100 or less lower.
We care about maintaining fasting insulin levels fasting glucose levels anywhere the cutoff. They will say is between 70 to 100. These are clinical outcomes that we care about and that is what we ultimately want. However, the influence is to pull those levers to get there can be varied.
It ultimately comes with how are we going to do it and how is it going to be something that we maintain you know, there's a certain aspects about dietary protein that are interesting one of the things that I've seen clinically is that those individuals that are on our higher protein diet will seem to have higher blood glucose. I don't know exactly why this is It's thought that maybe because the red blood cells live longer
and maybe also higher blood creatinine
levels. We do see higher blood creatinine levels when individuals have higher muscle mass.
Is that is typically a call that I get many of my patients are large and buff as I would say and they almost all have higher levels of creatinine. That doesn't mean that your kidney function is suffering. One thing that one would do clinically would get a Statin see to correct and get a correct egfr to see if it's within the normal range.
Is it true that if you do a hard resistance training session and then get your blood drawn the next day that you might see higher blood creatinine
levels potentially, but what I have seen
Higher, alt and liver enzymes and we see that very frequently and individuals that train intensely and it
concerns you or doesn't come this doesn't concern me because it's just a consequence of the training and yep presumably it's
transient. It is transient typically and we may see changes in creatinine with I have a one patient. She runs a hundred miles because in her 60s, she's an ultra Runner. Yeah in her 60s and she's strong and she's stronger than me. It's extraordinary and you think about what are the things that
that she needs to do to maintain the health of her muscle mass so that she can continue for long periods of time.
So while we both agree that nutrition is one of the foundations of muscle health and health generally supplements often can have their place. We talked a little bit about creatine. I and many other people supplement with 5 to 10 grams of creatine monohydrate per day, I do that because it has benefits for muscle strength. There's some brain benefits that I'm aware of and I
I realize and now you've reinforced the idea that it's difficult to get enough creatine. Even if one is ingesting the threshold amount of 1 gram of protein per ideal body weight.
What are your thoughts on creatine monohydrate and what other supplements do you recommend for your typical client? Excuse me
patient. Yeah, certainly. So creatine monohydrate is wonderful and particularly we're seeing a lot of benefits and women postmenopausal women and older populations creatine for sure. The other supplement is your listen a your with an a is a post biotic made from the gut microbiome and there is a percentage of people that can make it and the majority of individuals cannot
Not make it interesting. You're lengthen a is this connection which I find fascinating. It's a gut muscle connection individuals that take your lithium a I happen to be one of them. There are many papers out there that it improves my table G which is the health of mitochondria the turnover of mitochondria helps with the renewal of mitochondria, but what's so fascinating is there are trials in human individuals that it increases strength and endurance.
Interesting what milligram doses do you recommend?
So I take between 500 and 1,000 of your with an a really I wish that I had actually created this or found this out truly if I could make one supplement. I know I would probably make a mix of your life and a with creatine and some whey protein and maybe a 25 milligrams of collagen and I would have my perfect supplement. Is it taken with food or without food? It doesn't matter interesting morning or night it also.
It doesn't matter. What's so interesting about your with an a is that it comes from again. It's made in the gut from the gut microbiome from things like pomegranate or walnut. It's made from something called an alleged tannin and it is really again what I think of as this gut muscle connection, which I do believe is going to be the next Frontier. So interesting. I recall a few studies that dr. Andy Galpin put on his social media. These were in mice mind you but looking at how disruption of the gut.
I am could offset some of the strength and hypertrophy increases of resistance training pointing to the fact that having a healthy gut microbiome is critical for translating resistance training into actual improvements in muscle. Yes, and one of the things that we do see is that as individuals increase their activity talking about more endurance type running. There's this very interesting inflection point there's this idea of Optimal Performance and then there is this
Kind of moment where Optimal Performance depending on the training load starts to take a toll on health and wellness. I think that we see that and with that one of the things that we always see is impaired gut lining impaired got Integrity the Gap Junctions seemed to open whether it's the training volume and the physiological stress that can easily be measured with zanya Lenore calprotectin stool samples do this but doing things that actually help the gut not just the gut microbiome, but the gut
Ready is extremely important very
interesting what other supplements and maybe we should put whey protein in here as well.
Yes whey protein it's interesting whey protein and whey protein concentrate has Alpha lacked albumin and lactoferrin and he's immunoglobulins that can be very beneficial whey protein. It's interesting. We talked a lot about how processed foods are - but the reality is that processed foods aren't positive or negative the highly palatable process.
Foods that are full of sugar we can all agree maybe those are not ideal but we protein concentrate or whey protein isolate those are both processed. However, it is a great way to get your essential amino acids, which are amino acids that you must get from the diet your body cannot make them there has been a lot of research with whey protein has very little downside and it's easily tolerated those that have challenges with lactose can use the Whey Protein Isolate,
Versus the concentrate
and it's very portable if one is traveling and things of
that sort. And if one has a child, please make sure that you use a lid of very tight for the powder. Otherwise, you will be wearing it. Your child will be wearing and is a bit of a disaster but yes
noted what about other supplements including fish oil omega-3 fatty
acids. There's a lot of research around that and I think that it's a very it's a positive it's not only a positive for brain function, but it seems to have a unique anabolic.
Effect maybe it is in you know potentially from on the ribosomes. We're not sure at least I'm not sure at this time, but there seems to be even more emerging evidence that it may even impact women differently again. I can't say that in all certainty, but nearly all of my patients are on some form of fish oil.
Is there a threshold
amount that is a wonderful question there is not the general recommendation is around four grams, but some individuals for 210 grams, which would be definitely
Only on the higher end certainly can potentially thin your blood if an individual is going for surgery two weeks prior would suggest not taking it but we're becomes very interesting. It's really the combination of Omega-3 to omega-6 and understanding there's ways in which you can test in your blood we run this blood work all the time looking at whether it's an Omega Quant or an Omega and Omega index can be very valuable, but it is a very easy supplement to take and it seems to be very beneficial for
For brain health and even muscle
health. I find it to be most affordable to take it in liquid form. Just take a tablespoon of the lemon flavored fish oil put it in a protein drink or something. Then you don't taste the fishiness and then capsules for convenience when traveling and things of that sort, but the liquid forms are so much more affordable in order to hit that to grams a day or you know, in this case to 24. Yeah 24 grams. Again. This also depends on the absorption for the
Visual that's why it's really important to do blood work. I have some patients that require closer to 6 G to be able to improve their Omega 3 to 6 ratio and it certainly is there's that Precision Nutrition where the amount for one person is not necessarily the amount for another interesting what other supplements do you take I think let me think about what other supplements that I personally take things halogen College. Love collagen.
Collagen in my coffee collagen coffee strong. I love strong coffee. If you've never had it. It's amazing collagen called strong called strong coffee. It has collagen. It has l-theanine in it really helps with the Jitters or some good evidence with l-theanine to help with anxiety. But collagen is interesting collagen is a is a protein. It's not really has a protein score of zero. It does nothing to affect skeletal muscle mass. It is devoid in tryptophan and it is very low in the branched-chain amino acids.
Ed's but it is high in glycine Proline and hydroxyproline, which makes it very unique and structure. It is also very difficult to test the effect on tendons collagen protein on tendons because as you can imagine one would not want a tendon biopsy, right? That's just painful sounds painful axles biopsies are painful. Yes, I you know, I used to do a lot of those when I was in my fellowship it was it was probably less painful for me than it was for the subjects
fudge.
Let's take it like taking a small cork of tissue out of
the castle. So collagen protein I think can be very beneficial for skin hair and nails I feel as if we just haven't gotten sensitive enough to determine its effect on tissue yet. I anticipate that higher doses above 15 grams may be of some benefit. I'm just speculating but I'm guessing that it's probably closer to 25 grams, and I know that that seems a bit
So in one scoop might have 15 grams, but I think there's no - to increase in collagen and quite frankly. We don't get a lot of collagen in our diet the places in which you would find collagen are the gristle and meats or there's a bra. Yeah. Yeah, that's another great way to increase it. So you take it once a day idea particular time of day and the coffee in the morning. So my coffee has collagen in it before I train. Yes, I do and I typically trained facet aside from that and then I'll add in and
Additional
scoop you mention fasted. Maybe we should touch on fasting for a moment. I inadvertently have been doing intermittent fasting for years meaning I was never hungry for breakfast. So I was my first meal lands at 11 a.m. Or so plus or minus an hour on most days. There are exceptions to that last meal. Typically. I don't know 8 p.m. Seven PM sometimes 9 p.m. I'm not super strict about that and
it basically boils down to anywhere from two to four quote-unquote meals per day allowing should dinner and then some eating and between could you first comment on that architecture of eating but maybe first on fasting specifically, I mean, what are the benefits or detriments to having a feeding window of about eight or nine hours regardless of where it lands in the day and then let's talk about how that might slide around or if people should
Ensure getting more food coverage throughout the
day to benefits that I find from fasting number one calorie restriction. Number two bowel rest many individuals have gastrointestinal challenges when they are in a Time restricted window. There are not feeding all day long a great Point. Those are the two benefits that I often see an individual who is older or struggling to put on muscle fasting would not be my primary go to I think that as individuals age
Age there's a bit of a negative because you have to balance this muscle protein synthesis. There are always going through synthesis and catabolism so and an anabolic process and a catabolic process as you age, it becomes more difficult to regulate that process and if you add an additional fasting go through long periods of time where let's say, you're not training you're not protecting skeletal tissue, that would be a place where I don't necessarily recommend fasting.
Some people might find it difficult to hit the 30 to 50 grams of protein per meal frequency across the day in order to reach that one gram of protein per pound of ideal body weight if they were going to add a meal or let's just say add 30 to 50 grams of protein how much time separation do they need from the other meals? So for instance if I were to take a step back and say okay, you know, I need an additional 30 to 50 gram protein intake per day in order to maintain.
The muscle I have as I age and I am aging as we all are as bows.
Is two hours before my 11:00 a.m. Meal enough or does it have to be three hours? Could it be one hour? I mean you can only assimilate and then oxidized a certain amount of protein. I mean how much time window does one need between these protein
feedings? I appreciate that question. And here's my answer to that. The first meal of the day is the meal that has been studied the remainder meals to my knowledge. There is no study that shows anything about the second or the third meal and perhaps that's because of the difficulty.
But the literature suggests that that first meal of the day whenever you're going to have it, let's say for you it's 11:00 eating 30 to 50 grams of protein the muscle protein synthesis response will last two hours. However, when we talked about mtor, there's other initiation factors, like eif for that will maintain itself for another four to five hours. I see therefore the second meal is really not necessarily a muscle protein.
Addict response. I can't say that that's supported in the literature. But where the benefit of that is is that we know that more than one meal of that robust amount of protein will likely have better outcomes on this 24-hour protein response 24-hour nitrogen balance, but that second meal would be just about getting your protein in it doesn't matter if it's you know, if you have to hit your need of say 200 grams of protein and that middle meal
will the real goal for that metabolically is to get enough protein to meet that one gram per pound ideal body weight. I see and then that final meal before you go into a fast would be what we would say would support overnight protein synthesis. I mean not necessarily support overnight protein synthesis, but in the fasted State your body pulls from muscle, it has to maintain the energy balance for all other systems in the body all other tissues again 25
Percent of protein turnover goes to skeletal muscle and the rest goes to other organ systems for you or for hypertrophy adding an additional meal would again let's say for meals I think would be if I were to design a diet in the perfect world to support hypertrophy. I would add another a fourth meal.
Well, I love to eat. So that's not a problem in principle.
This is probably getting a bit more toward the afficionados. But I've heard that certain forms of animal protein and other proteins are more beneficial at certain times of day for instance meat and eggs early in the day, maybe chicken and fish in the middle of the day and that casein and milk proteins might be more advantageous for muscle Health in the final meal of the day. We're closer to bedtime. I realized this is getting into the details, but I'm sure a percentage of our listeners would be curious to do.
That and of course no proteins always make me sleepy. So kind of
fits, you know, it's really interesting. I will say that milk protein casein seems to be slower absorbing and that's because of the impact with the gut obviously, but is there anything special about casein or milk protein the answer to that would actually be no, but the length of time that it takes for digestion absorption maybe where the benefit comes in that being said, there's some data to support High saturated fat Dairy believe it or not actually can be
Good for Health and Longevity. I know that there is a people will say high saturated fat or high fat Dairy would be negative. But I would say that there is evidence to support it being health-promoting.
Well, nothing like a piece of terrific cheese like a Parmesan or a or a shot of full fat cream
and I will mention the loose
trial of every once in a while. That's a guilty pleasure a shot of full fat cream. He with equal part espresso.
I'll take it. I'll take it. I will mention that the leucine content in milk protein is a little bit lower. Okay, or say Greek yogurt.
Are there any sort of cryptic Champion proteins? You know, I think most of us think okay steak and ground beef and maybe Venison and elk and eggs and all the obvious things chicken fish Etc. But are there any kind of cryptic proteins out there that are particularly good for us in terms of their amino acid.
Content that people don't think of you here these days about liver. I frankly don't like that. I
don't know what liver but liver has a lot of other benefits to it. So it's high in fat soluble vitamins and iron very bioavailable, but I'm not it's very difficult to eat. Yeah, I think people either love it or hate it. I'm on this second category. So no proteins come to mind. As you know is salmon, you know quality protein salmon is a quality protein is higher in fat again calorie balance does matter fish is interesting fish has five.
Grams of protein per 1 ounce versus meat has on average seven g seven or eight red meat has seven or eight grams of protein per one ounce.
So interesting, you know that this idea that you know, eating muscle can support the health of muscle. It makes sense though. Don't it makes perfect sense and you've explained very clearly as to why that why that is. Okay. We set aside liver for this conversation people are into cricket and maybe there is sorry. I apologize to the well not to the Crickets The Crickets probably thank me for my response, but I'm not judging. It's just my personal visceral response my other people made.
Insect proteins but what about other organ Meats heart? I know I mean, they're all around the world. You see the consumption of lots of different organ Meats. Is there any evidence that heart is a good protein or we generally looking at skeletal muscle as the best source of amino
acids Heart is also a good source of protein. It's also high in co Q 10 which is good for muscle Health, but many people again, we don't seem to eat that however other places
eat the full animal but they're all they're all good source of protein aside from collagen, which would be that protein score of zero.
And if somebody insist on being a vegan or vegetarian, let's just say Vegan what are their best options?
There are rice people ends of protein which are absolutely suitable. There are a lot of now fermented types of protein powders out there that seem to have the same profile as way. The one thing that I would say as individuals age.
Vegan diet can be very challenging need to make sure that you're getting enough B12 is zinc iron things nutrients of concern that seem to be going down in general. We're seeing decreases of that in the general population.
What are your thoughts on magnesium? We sometimes hear that excellent people are magnesium deficient based on depletion of the soil you hear this stuff, but what's the story with magnesium at is true there seems to be less.
cesium in the diet very easy to supplement whether the form that you use whether you use a magnesium glycinate or there's a whole host of magnesium citrate for gastrointestinal Health, whatever it is, but yes magnesium supplementation can be very beneficial for muscle for brain do support the idea of supplementing with zinc or is that something that is kind of you know, sometimes yes sometimes no, I think if you're eating a Whole Foods diet
Going to be unlikely to be deficient in zinc. Zinc is interesting because you don't want to supplement sink without copper. There is a zinc copper ratio. That is well maintained in the body supplementation with one or the other will typically deplete the other and you know as a geriatrician there's a zinc copper ratio things that we think of as kind of proxies for overall brain health not saying that the zinc copper ratio is the only thing but certainly supplementing with one or the other.
Either one would be.
Careful,
what are some things that people might be doing or taking that inadvertently disrupt muscle health and perhaps even
hypertrophy one thing that people often use is ibuprofen and ibuprofen while not inherently bad. There's some evidence to suggest that higher doses of ibuprofen can impact muscle Health whether it's hypertrophy or strength, I often think about those together, but ibuprofen use. It's also not good for the
Gastric lining again. You have to be able to absorb your nutrients to be able to become strong and healthy. The other thing is obviously Statin use some people do need statins. I'm not saying that we shouldn't but that can certainly affect muscle Health aside effect can be muscle pain. Myalgia muscle soreness. It can deplete CoQ10 is
occasional use of these things.
Okay? Yeah, of course and you know, obviously check with your doctor but things that suppress inflammation like aspirin potentially.
Or other NSAIDs can well aspirin is in a category of its own but NSAIDs in particular seem to suppress skeletal muscle it certain doses hypertrophy potentially in strength. The other thing is fluoroquinolones. They are antibiotics that can affect collagen and tendon turnover if an individual is on a fluoroquinolone. There's a risk for you hear a lot about these Achilles
injuries. Yeah, which sorts of
Oops, I think um, is it like Cipro and things like that people can injure themselves badly?
You should be certainly careful about the activity that you're doing at the time. The other thing is the proton pump inhibitors people use that for stomach acid or reflux that can affect absorption of vitamins and minerals that do have long lasting
effects. What are your thoughts on the glp-1 analogs hose em Pikmin jarrow real quick anecdote. I was
In New York City. I was walking up the Upper East Side on a Sunday recently and there was a sign outside a store not yet said we carry those empik and when jarrow and I thought the sign would say like we have you know, June cream cheese or something. And so and I thought wow this guy snapped a photo of it. I didn't think much of it at the time and then I decided to post it to my Instagram thinking that there be a few opinions and frankly. I was just curious what people would think so I said, what do you think and it was one of the largest responses in terms of
common volume and contentiousness that I'd ever observed and I thought whoa, there's really something here. My understanding is that these compounds which are becoming incredibly popular can help people lose weight, but that there's some loss of muscle maybe even some bone mass. Correct me if I'm wrong on that but I would also Imagine scuse me that some of the muscle loss can be offset by resistance training maybe even protein intake and resistance training. So what is your thought about these compounds?
Last thing I'll just give a little bit of my stance. I know a number of people that had extreme struggles losing weight. I don't know the extent to which they were doing things correctly or incorrectly with nutrition. It's not my place to probe into that but that they got on these compounds one or the other and seem to love them because they got them kind of out the gate, you know, 20 30 pound weight loss very quickly without intense Cravings. Their appetite is suppressed and many of them are now also exercising and doing other things.
Things so I don't think we want to look at this or talk about this as an either/or. It was epic man jarrow or exercise and and proper nutrition. I would imagine there's a place for both, but I'd love your
take on these. I would love to share it. These medications are there. It's complex the issue of obesity the challenge with glp ones and dual Agnes like manager. No glp-1 and Gip s it is a complex conversation. So the opinion that I'm
to give is going to be while I give my opinion. I recognize that this is certainly like you said very heated. There's a couple of ways to look at it. First of all, nothing has worked more effectively.
Other than bariatric surgery than these medications to affect obesity. So glp-1 agonists like oh zampa quill an individual might get a 13% weight loss. We how long and that's expressed. Yeah through think. It's a it's a titration. It's a monthly titration but over a period of 24 weeks. Well, it certainly depends signal. Yeah.
Certainly depends on the individual but it's utilized an increased month by month for week span.
The other aspect is the Dual Agnes like Moderno tries appetite and that will potentially cause a 22% weight loss. The challenge with obesity is real. Now. I have taken care of patients that have deeply suffered with this whether it is a component of food addiction or whether it is a component of whatever the reason we have used these in clinic and it has transformed their lives.
I would never take that away from somebody certainly it is personal choice. Now the other aspects of these the comment about skeletal muscle loss. I have seen that and again we use these medications in our practice and with a proper nutrition plan and proper resistance training. I do not see a loss of skeletal muscle mass. You have to work with a provider that can help titrate it but I think that these drugs can
Be used in a very safe Manner and you know, we see improvements in alcohol consumption in in other addictions, very interesting. There are a whole host of benefits from these medications now, I think where people get upset is they say well is this a shortcut? Can you go off of them? Do you have to regain that weight? And again, we have many patients that go off of them and have implemented great strategies for training and nutrition and we don't see weight gain.
Interesting, it all depends on a comprehensive holistic View and that becomes important to recognize there are many benefits and people will say the negatives would be slowing down gastric emptying. Well, I would say yes, and that's exactly what the medication is designed to do. There may be some risk with pancreatitis. There is some discussion about thyroid cancer in rodent models.
Rodents have a different thyroid and volume of thyroid receptors in humans. I think that potentially that is incidental. I'm sure that we'll be hearing more and more about it. These medications also are not new they have been used for over a decade and those are all important points to recognize that now it is very popular, but these medications have been around for quite some
time. It is interesting that some of the
Guides like glp-1 analogs that have existed in somewhat Niche communities for a while. So including things like in the melanocytes stimulating hormone community that are now sold under FDA approval for things like low libido things like vile EC
and ADI. We were mentioning a daddy women for hypo sexual desire disorder,
right the I don't know the history of Addie, but certainly the
alpha melanocytes stimulating hormone related peptides the GOP one peptides things like Sur mer Ellen which are in the growth hormone secreted dogs all were viewed for a long time as kind of Niche Community Fitness Community, but now at least the glp-1 analogs have made their way into I mean massive scale use which speaks to kind of a general theme of what I've observed over the last well, I'm 48 now, but let's just say 35 years, which is that many of the things that exist in Niche communities become.
Mainstream, it just takes some time and they become mainstream through the standard channels of FDA approval which as is the case with some pink and went wrong. So it's great to hear that you Embrace. So we're both sides like it a lot of what you've talked about today. I think one wouldn't necessarily find in the kind of standard tables or what's on a poster in the doctor's office. But some of it is and you really are at the intersection of both those those Landscapes.
Thank you. And and this idea of I was a wreck and
tries appetite these glp ones that you know, we talked a lot about protein and one way that it has a say shading effect is this glp-1 stimulation and one has to recognize that these glp Agnes these glp-1 agonists last for a week. The dietary protein effect is a meal to meal.
So eating protein increases glp-1 as doesn't drinking yerba mate tea, but probably to a lesser degree and we're transiently
more transiently and I think that that is just an
An interesting fact and the other fact is that the amount necessary to stimulate muscle protein synthesis. The amount for muscle health is also seen in the amount of glp-1 released interesting it seems as if that that 30 to 40 or so G amount of high quality protein is the same amount that has a meaningful impact on the release of
glp-1. Very interesting. I did not know that
So if we were to just back away from everything we've talked about.
What are the top level benefits of having healthy muscle everything? Okay,
I felt muscle is the organ of longevity and when we think about life span, we think about health span and then we finally think about muscle span. I would argue that that is right after life span the benefits of healthy muscle cannot be denied. This is better metabolic Health better blood pressure.
Better survivability better strength better Mobility better body armor should someone fall should someone get sick. Your survivability will be related to the health of skeletal muscle and especially as we think about aging if we want to have good skin or we think about wanting to have a good looking body, even though I can appreciate its only a small amount aesthetic but leveraging the aesthetic to have healthy brain.
In function, there's this idea that Alzheimer's or certain types of dementia are type 3 diabetes of the brain skeletal muscle is the only organ system. We have voluntary control over these the only endocrine organ system. We have voluntary control over which means we have a responsibility to leverage it.
We've talked about these in a lot of detail today meaning you've educated us about these in detail today, and thank you.
But perhaps you could summarize what you view as the top nutrition based tools for improving muscle Health number one dietary protein and that would be in terms of a protein hierarchy roughly 1 gram per pound ideal body weight an individual could certainly go 2.7 grams per pound ideal body weight the higher the protein the less it matters the quality whether it is a high quality protein or a lower quality protein the total protein amount matters.
That is at the base of the pyramid. The next would be the I would say the quality understanding the quality of the protein so that you know exactly how much and then certainly the distribution of how you are ingesting this protein. The dietary protein habits of someone who is eating a more protein forward diet distribution will matter less the higher it is but there is certainly some great.
Orton's depending on if you are older who you know challenging for any kind of Health and Wellness challenges. This is what I would say
and I realize it will vary depending on activity but assuming that somebody gets the one gram of quality protein per pound of ideal body weight. How should they make up? The rest of their caloric needs
the next I would say would be your choice you choose carbohydrates are fat. There's evidence that carbohydrates are
Full from a fiber perspective phytonutrients other vitamins and minerals I certainly would go there that would be my preference the amount of activity that you do certainly could use carbohydrates and then fat is very easy to get essential fatty acids. Your diet doesn't have to be too high in fat to get that but at the end of the day prioritize dietary protein, the next level would be understanding your carbohydrate threshold could start at 130 grams titrate up or down depending on your metabolic health. And or
T understanding that outside of activity 50 grams or less of carbohydrates would be a threshold to mitigate substantial insulin response. Finally that fat you can choose. However you would like to get that fat typically comes within a meal and that would be the remainders of your caloric intake
and what are your Top Line tools with respect to exercise as it relates to muscle
Health resistance training is non-negotiable.
It doesn't matter if you need to start with bodyweight. Absolutely. OK move to bands definitely moving load is valuable and non-negotiable start with two days a week. You will likely progress to three days a week if you're doing three days a week again, it all depends on the volume and intensity in which you are working under depending on whether it's five to ten sets. How many reps you're doing. I think that there is many ways in which one could do it, right? The only way in which some could do it wrong.
Is to not do it quite frankly. That would be what I would say for that and then adding in high intensity interval training. I would choose high intensity interval training over slow steady state cardio because the high-intensity interval seem to have a very impactful effect with the low amount of time that it takes
let's talk about something that might seem somewhat distant from everything else we've talked about but I actually believe is Central to all of this.
Which is mindset the psychology around health and self-directed health which of course includes communication and cooperation from license trained Physicians like yourself, you know, what's your mindset and recommended mindset around muscle health and just General Health in terms of health span and lifespan
what you're talking about here is muscle span and the way in which the cognitive processes in the way that we think about our life. How does that influence what we actually do?
Do and I could give someone the perfect plan and it doesn't matter if I give an individual perfect plan if they're not willing to execute on it. I've been a physician for 20 years believe it or not that is a long period of time and I would say a good physician is a physician that identifies patterns of diseases patterns of illness, but ineffective physician is someone who identifies patterns of people because once you identify the pattern of the person you're able to leverage that so that they
Get the best out of themselves and there's a few core fundamental principles that people have to recognize if they want to be well and that is you set standards and you don't set goals people will set a weight-loss goal or a muscle hypertrophy goal. But if you set a standard for how you operate and how you execute, you know, that regardless of how you feel you're going to get up and train, you know that this is going to be your nutrition plan you
Get up and you do it you set a standard and that standard provides a framework for
execution.
I love that. I sometimes think of the non-negotiables of the week that unless I'm suffering from a really bad cold or flu which fortunately for me is pretty rare that I'm going to get those three resistance training sessions and I'm going to try and get as much quality sleep as I can and I'll get those cardiovascular training sessions and when you talk about setting standards, is that what you're referring to? Are you talking about blood work standards? Are you talking about aggressively?
To maintain blood values in a particular range where you mainly talking about behaviors.
I'm talking about both. Yes. Should there be a standard for your blood work that you're getting? Yes, we have a very strict standard that we have in place for all our patients. However, the framework for which they execute is all about the standards that they place from themselves the you know, because ultimately what we want Here Andrew is we want people to get results and the only way they're going to get results is
if they stop chasing these goals and that might be counterintuitive to people because people will say well I'm going to set a weight-loss goal goals come and go standards remain and if you fail to do the Practical in your life the Practical become impossible and that's why we set standards. The other aspect is an individual has to understand where they fail I take care of a lot of very successful entrepreneurs and
Individuals they all know where they fail they all know their points of weakness over time. It's not understanding where you Excel because quite frankly that's the easy part the part that becomes very valuable is you know, where you fail, you know where your points of vulnerability are, you know, where you fall off track? I'll give you an example. Typically when someone is about to do something amazing they have this but you were you know this better than anyone this dopamine. Hi.
At that Pinnacle seems to be a place of vulnerability whether they will skip a training session or by another car or do whatever it is that they do eat more cake. They have an experience in their environment where they're almost at their at the Pinnacle of what they are doing that is a place of vulnerability where people will fall off health track on the same token at the moment after the big successful moment. I have a
patient who puts on a massive event in Vegas and every year I wait for the call that he's feeling depressed because his dopamine didn't go back to baseline or fall to Baseline. It went below Baseline. What becomes important to recognize is that this is another point of vulnerability at this point of vulnerability is where people seem to go off track and never regain their footing if they do not recognize that and so I can appreciate that.
Talking about mindset here because there's a level of neutrality that is necessary for overall success. Again. This is what I've seen time and time again that those that are the healthiest are able to maintain this level of neutrality.
Tell me more about level of neutrality. I'm right there with you on setting standards instead of goals and I'll say I've never thought about it in this way, but I absolutely love that and for the record you said it and I'm gonna blast it out credit to you as much as possible because I think it's so critical.
Well for persistent engagement in the kinds of behaviors and mindsets that lead to success over time. So love this standards over goals principle knowing where one fails points of vulnerability beautiful concept painful to hear because of the realistic nature of it and that's exactly why it's potent. So thank you for that as well and
predictable human beings are predictable and their behaviors and it's for example on Friday night when
Everyone tells themselves. They're not going to have that drink and that pizza and that cookie and then Friday Night comes around and they are surprised by their own humanness. And again what we're looking for our long-term strategies for overall health because that wave of Youth does clothes and while we can all continue to get better as that window compresses. It becomes much more important to be very diligent on the responsibilities to our health our nervous system so that we can continue on
On for Success. It's just the way that it is
tell me about the neutrality a
component. This is fascinating and I have a very good friend. His name is Ben Newman, and he really highlighted this for me and he works with a lot of these sports teams. And he was the first patient that helped me put together this idea of neutrality. I'll give you an example. He was flying to work with one NFL team. I think they were going to the Super Bowl something major.
And I said to him, you know, how are you doing? You just came off of your book launch and just before this you are at another NFL team and he said to me he was Gabrielle. It's just another Tuesday. It's just another Tuesday. And so this idea of neutrality is that when you can manage and mitigate your emotional Ebbs and flows for when things are at their High the excitement this isn't to celebrate or not to celebrate. But when you begin to mitigate these heh,
And flows, it's almost as if there's this level of neutrality when that happens these big moments because life is full of big moments. Yes, it's full of small moments, but it certainly is full of these big moments and it's these big moments that once we enter into if one is not neutral than being able to pick themselves up from an experience or a moment become much more challenging my most successful patient. I'm not talking about financially I'm talking about the ones that are able to maintain
And contain their health are the ones that are neutral
in terms of tone and effect
know in terms of experience as they go through life. They celebrate some wins. They don't celebrate
others very consistent with some of the theories that I and a few others in the science Community have expounded around dopamine
regulation. It makes a lot of sense and where I care about this is as a physician who takes care of people and
when they cannot manage this emotional highs and lows because as you think about it, if you walk around and you feel that everything is stressful. I mean, you've got your cortisol going then you're not sleeping and it becomes this cycle and then the cycle becomes a habit and if one can teach themselves to be study for example going into a big workout, maybe they mitigate the anticipation of that workout. They're much more likely to continue on that.
A and it's what is so important about is a trainable skill.
It sounds like it's a lot about energy conservation. Yes mental energy not just caloric
energy. Yes, very interesting. So then you can do the things that matter and then you don't fall off the bandwagon because it just seems that each time a person does it they become better at doing that? It is hard to hear. I think probably for many people but it's very predictable and if you can leverage that predictable nature, for example that Friday night that
comes along and you've told yourself that this is going to be your last beer or your last pizza then you know how to engage in it. You come up with a game plan where you set a standard word. This is the thing that you do Friday night. You said the rule and the foundation for your actions
while hearing about your stance on mindset standards goals knowing where one fails points of vulnerability and neutrality.
I have one more. Oh,
please
this one is a big one and this is a person will only ever be as healthy as they feel worthy
of tell me more
that when individuals do not feel worthy of having health and wellness. They will sabotage themselves over and over and over again and it is something really important when you sit down with a patient were you reflect on yourself? The question becomes do you feel worthy of being healthy?
Do you truly feel worthy of having the body that you desire of having that overall sense of Vitality? Because if someone doesn't they will use that as a distraction, they will sabotage themselves and they will focus on the not feeling. Well the feeling tired all of the other physical aspects that go along with ill health.
And that will allow them a
distraction.
I want to read something about a person who was obese who then got in shape and they were reporting that in their family growing up. They had a narrative around exercise that for them translated to
Exercise being a form of extremes selfishness and that surprised me. I thought you know what better thing to do in terms of helping one's health and helping their for the relationships in your life by segmenting out a small knot, you know, huge portion of one's day, but, you know an hour a day to take great care of oneself and ensure health so that you don't have to be dependent on others in a way that would be burdensome to them perhaps earlier in life than it would be in any
Other case so this seems to fit very well with what you're saying. This person obviously felt that exercise was selfish and they weren't worthy somehow of being healthy and in shape that fortunately they flip the script on this end and I should say that was over goodness. That was 2016. So it's been a long while and they have maintained good health and staying in shape. They set a standard for themselves. Isn't that amazing? It's awesome. It's awesome to see it's also been awesome to see the transformation in their psychology and the different
Aspects of their life, but is that something that you see a lot that people just feel like getting in shape or paying attention to what they eat is somehow selfish. I think that some people do not feel worthy feeling good and they will sabotage themselves until they uncover that number one. That is the message that they're sending themselves. And once they do that there is a bit of friction and we know in order to be
Be successful in any game plan that friction is required. And on the other side of friction is quite frankly freedom, but those individuals have to understand that they are worthy and really do that work. But yes time and time again. It is one of the first questions that I asked do you feel worthy of feeling good? Well, dr. Gabrielle lion.
You have given us an incredible tour of muscle and in fact an entirely New Perspective even for me on how muscle impacts our health.
as we talked about at the beginning so often when people hear about the importance of muscle, they think just building muscle and that tends to separate people into those who want to build muscle in those who don't or think that they can't or don't really understand what it's about but you've made oh so clear the fact that muscle is a critical perhaps the most critical aspect of maintaining Health and Longevity of the body of the brain of healthspan lifespan what you call muscle span really seems to Wick
Out into everything in terms of our well-being and you've given us a ton of actionable tools at the level of nutrition at the level of exercise at the level of supplementation. And thankfully also at the level of mindset. I think the tools that you shared along the lines of mindset are absolutely spectacular as are all these other recommendations. So I want to say on behalf of myself and everyone listening and or watching. Thank you for sharing all of this information with us in such clear.
An actionable detail. Thank you also for the work you do for being such a Pioneer in both maintaining an active clinical life. Seeing patients men women people of different ages different backgrounds Etc. I know you also do some work. I'll just mention this because it is important. You don't just work with people who can afford the work. You also do a lot of work with people in the military Community who perhaps who cannot afford the work so you make it a point to support communities that perhaps couldn't afford the kind of
at that they absolutely deserve so thank you for that. Thank you also for being a public educator and such an avid one and really out there on Instagram on YouTube with your own podcast with your book will provide links to all of those in the show no captions, of course and I just love love love what you're doing and I know as great as its been the there's still much more to come. So thank you for taking the time to come here today, especially with the busy Clinic the businesses and of course your family people might not realize this but dr. Go
Brielle line does all this while maintaining a family with two children happy healthy marriage a husband in residency husband and residency and she still pursuing that's right. Yeah out to Baylor and still pursuing Advanced Training in yet additional fields of medicine. So you are a Phenom and I have both tremendous admiration and respect and gratitude for you. So thank you so much so much.
Thank you for joining me for today's discussion with dr. Gabrielle lion to learn more about her work and to find links to her book Forever Strong as well as a link to her, excellent podcast and to her website which has additional resources. Please see the show no captions. If you're learning from and or enjoying this podcast, please subscribe to the podcast on YouTube apple and Spotify. That's a terrific zero cost way to support us. And in addition you can give us up to a five star review on Apple or Spotify, please also check out the sponsors.
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newsletter and enter your email and I should mention that we do not share your email with anybody. I also just want to mention once again that my new book which I've been working on for more than five years and researching for more than three decades which is entitled protocols and operating manual for the human body is now available for pre-sale by simply going to protocols book.com. And there you will find links to any number of different vendors and you can pick the one that you prefer. Thank you. Once again for joining me for today's discussion with dr. Gabrielle lion. I hope you found
and the discussion to be as informative and actionable as I did indeed. It is motivated me to make several important changes in my nutritional and exercise program, which I've implemented and am already seeing spectacular results and last but certainly not least. Thank you for your interest in science.
