Why Aging Is Not a Fat Problem — A Muscle-Centric Approach to Longevity

Why do we have obesity? Why don't we just get to that? And I think that obesity is in part a symptom of unhealthy muscle. It has nothing to do with body fat. It has everything to do with intramuscular adipose tissue. So I think that that's the real driver of disease. have to prioritize muscle first. Period end of story. Yes, uh you know obviously you need fiber, obviously you need polyphena.

get that muscle piece right because that is your central command. So even Perimenopause, menopause, redistribution of fat, you should be able to still go through body reconciliation. With just diet alone, can it redistribute? Yes. The answer to that is yes. Thanks to our Diamond Level sponsors.

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Hi everybody, welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine. And of course, today is no exception. I am here with the fabulous Dr. Gabrielle. She is one of the most forward-thinking, science-rooted voices in the conversation around aging, strength, and resilience. She's challenging long-held beliefs about muscle, protein, and aging. Muscle said.

approach which puts skeletal muscle at the center of health span and vitality. You know her of course from her bestselling book Forever Strong, and now she's back with the Forever Strong. playbook, which she told me is the book she actually wanted to write first. This is the practical how-to guide that dives into how to think, how to eat, move, recover for lasting strength.

It's grounded in science, it's grounded in her clinical experience, and it's a no-nonsense philosophy. Do the hard thing, it's how we build resilience. We had a fabulous conversation, and I'm sure you're going to. First of all, uh Dr. Lyons, Gabrielle, I'm just absolutely thrilled to have you here. I wanna say that you were at the Vibrant Summit. I saw you speak and you know you tore it up.

You've kind of yeah, I just wanna thank you for bringing your energy, your dynamism, your message to functional medicine, to the broader community, to the world, to women. I really want to thank you for it because it's so It's it's very science focused, it's very sci it's very science forward, but it's also it's dynamic, it's important. I mean you've really

gotten a lot of people thinking and probably perhaps more importantly actually moving. So bravo you. And thank you. Yeah, I really appreciate that. Um so I wanna tell you a funny story about you.

Um you know Dr. Liz Lipsky, right? Yes, of course. So that's my godmother. And when I started, and for the listener or the viewer, Liz is one of the OG. She is this is the the group before Mark Hyman and and and others and that's my godmother. So I've been hearing about you for I don't know, ten years plus. Amaz isn't that so that's amazing. Wow. Well, she's a badass. I mean, what a what a woman to have as an influence in your world.

Pretty pretty extraordinary, truly. Well and I was gonna ask you a little bit about that. So how how wonderful and yeah, thanks for thanks for bringing you into the game here. Um how did you How did you find your your space? I mean you're you you've published science, you've conducted research, you're a physician by training, you have a clinical practice. And you're obviously a lifter. I mean you're and you're like, how did you fuse? How did you find

Yeah. Um, so again, my godmother is Liz Lipskey. So by the time I graduated high school early and I moved in with her, and I started learning about nutrition. She was seeing patients. We were living on Kauai. It was amazing. And I became extremely fascinated with nutritional sciences. And then after that, I knew that that's what I was.

did my undergraduate in nutritional sciences and happened to fall into the under the mentorship of one of the OGs of protein metabolism, who is Dr. Donald Layman in that. has been an extraordinary relationship and mentorship. So that's kind of the science perspective. Then I went on, and you know, there's more details to that. But obviously after I finished residency, Don said to me, if you want to make the impact that I know that you can, you have to go back and do a fellow.

So I uh then did a fellowship at Wash U in Nutritional Sciences and Geriatrics. And here we are. Wow. And concurrent concurrent to really diving into protein science, you obviously appreciated it and in terms of building muscle. Like where is where does that get in? So I've been training my whole F my dad was a collegiate athlete. He was captain of his wrestling team. Physical activity is something that you know I have been doing my entire life.

And you know, I think about that a lot because of the obesity epidemic for kids right now. And uh I think it's much easier to recognize that we're raising adults, we're not raising kids and training early and often is actually how I grew up and I just became obsessed with it and um you know, as an organ system appreciated beyond just the looks and aesthetic.

Yes. Well, you've changed people's minds. I mean, Bob Browntree was talking to me about you and you of course know Bob because, you know, he's he's an OG as well, along with Liz. you know, just just a an important an important member of the functional medicine community. He really changed his mind in thinking about muscle as an endocrine, as an endocrine organ. Like he just really you know, it was a big aha for him, and so he's gone on to shape his level.

Uh with an appre it I it is pretty cool. That's that's amazing. So that that's the goal, right? Um

Once and I think as clinicians, once we hear something, then we can reorient ourselves to things because science is always evolving. But what becomes so fascinating, and I've thought about this a lot, because I will tell you, I think that we've gotten obesity wrong as well. Um and I can explain more about what what that looks like. You know, as clinicians, we are trained to think in algorithms and identify problems and systems and patterns, and we become very good at that.

alternatively, we become very bad at thinking outside the box. So with understanding skeletal muscle and people now adopting it as an organ system and endocrine system, I think that we'll be able to really move the needle and Yeah, I I think that that's where we're going. That's the future. I uh it's just again, you you I thought you tore it up at the Vibrant Summit and it was fun, interesting, motivating, and enlightening.

to appreciate it, to appreciate muscle. You know, not just for being able to move us fast. I was well, I can I continue to compete. I I was serious about it when I was in in university. Um And just that was hilarious. My lecture was hilarious. Just kidding. That's so fun. That's funny.

Oh my god. Um I'm like, was it? Shoot. No. It was yeah, I mean you d I mean you wanna make your point, you know, you make your point. You you hit it home. Um All right, so you brought up let's just let's let's just circle back to I've got a ton of questions for you, but why do we have obesity wrong? Um again, I think that obesity is in part a symptom of unhealthy muscles.

And we're looking at body fat percentages as that meaningful marker. And just from a clinician standpoint, I was interviewing one of the world leading experts on my Who is an MD PhD in and practices? And her specialty is PCOS. She has done two of the eight trials out there on PCOS. And GLP1s. And I was interviewing her, and I and I said to her, you know, like Melanie, what is the body fat percentage that is the cutoff for those that?

end up getting pregnant for those that don't. Because there has to be some kind of cutoff. If we are recognizing that body fat percentage, you know, is it 30%? Is it 25%? And she said, Gabrielle, it has nothing to do with body fat percentage. It has everything to do with intramuscular adaptation. And it's the fat within the muscle that really determines these metabolic outcomes.

And it got me thinking that we measure body fat percentage, I think in part because it's easy to measure, and we've been doing it for so long, you know, with ADEXA and lean body mass. We extrapolate that information with ADEXA. We don't actually look at the quality of skeletal muscle. It's very hard.

changes at from one, you know, as an individual. So for me, whether I gain a pound of muscle or lose a quarter pound or whatever it is, those small changes, it's very difficult to then be able Um and I think that at the end of the day, body fat percentage is an important biomarker, but it's gonna become relatively uh Secondary important compared to percentage of body, percentage of fat within that muscle. I think that that's the real, the real driver of. ハルウェイ

Are there surrogate mark how what are the surrogate markers? MRIs. So there's a D3 uh creatine, so it's a tagged creatine, which uh again there's not an ease of use so Bill Evans out of UCLA is is you know he's doing these studies it's not available yet for clinical use but MRIs again in Japan everyone's getting MRIs here. we aren't really getting them routinely. There is gonna be some evolution with that, but uh M R I or C T. Which again we're not

measuring these things routinely. It's so much easier to do a bioimpedance or a DEXA, which the bioimpedance is is great. It's what we have. But it doesn't actually look at the fat infiltrated into the tissue. So for example, there's been a lot of discussion about: well, a person can have obesity but still have muscle. Yes, but we know nothing about the quality of that tissue. Well, it seems like it seems to me that if somebody is obese but has reasonably decent, you know, metabolic biomarking.

And you know, sugar, maybe they have a continuous glucose monitor, you know, some of the, you know, maybe we can look at a lipid panel, et cetera. Some of our some of our standard and um markers. We might have some insight. We might be able to draw some conclusions. I think that's exactly right.

And what you're referring to is metabolic syndrome. And for the listener, I know that you have a ton of clinicians who listen: metabolic syndrome, elevated triglyceride, elevated insulin, elevated glucose, elevated blood pressure, and obesity or waistline circumference. People contribute the medical community contributes this to a lens of body fat percentage. So that's what the issue is. But I don't that's not accurate. I think that what we're looking at is the health of skeletal.

Because from a biochemical perspective when you have unhealthy skeletal muscle, where does the glucose go? So it starts with muscle first as the primary. You know, then of course the liver has to deal with it. But We are eating for a mismatch of our muscle health. And I think that when we look at metabolic syndrome, metabolic syndrome, and those biomarkers, that is an indication of unhealthy skeletal muscle. Right, right. And likely fatty infiltration. What about like

non alcoholic fatty liver disease, which is pandemic. I mean, this would this be secondary? I mean, would one already have It's a great question. I don't I we don't know that answer. It's a great question and I imagine in my mind that uh again, I don't have data, but I've been thinking a lot about this because we're writing a paper on carbohydrate tolerance right now. Thanks to our Diamond Level sponsor.

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To learn more and become a registered Dutch provider, visit Dutchtest.com. Is it muscle or liver that becomes pathologic first? It's probably liver. In overt pathology, testable pathology, because if you think about skeletal muscle, if someone is overeating carbohydrates. And the glucose disposal is about forty grams per two hour period for a sep for a sedentary individual.

The human body can dispose of around 40 grams if they are sedentary. I'm not talking about the athletic population. I am talking about in reality, because the reality is the majority of people are sedentary with obesity. Um so once the carboh and the average carbohydrate consumption is three hundred grams per per day. So it's three glucose tolerance tests.

When we think about that, if the so the first stop for glucose disposal is skeletal muscle. And if someone does not have muscle that is able to then receive glycogen or not enough skeletal muscle, then the liver has to be. So probably again, we don't know, but I'm guessing fatty liver comes first from a morphological changing standpoint, but it's li it's skeletal muscle.

inability to manage the current nutritional intake. I have to say that I am surprised sometimes at, you know, who in my practice has fatty liver. You know, certainly at a glance they don't present as somebody who would, or even their metabolic markers. may not really strongly suggest that I'm going to find it. But to link it to muscle and to this idea that you're positing makes a lot of sense.

So I propose, and actually I'm I'm working on this, is that it would be great to image liver and muscle. Mm-hmm. And and that's actually one of the things that I'm working on because I I'm guessing that the liver becomes deranged.

tissue wise first, but again, we already have derangement in skeletal or skeletal muscle is the primary organ system that But it's harder to pick up. It's probably it's probably harder it's harder to detect. Well because Because this is what's so amazing about intramuscular adequate tissue is whether body fat percentage changes or whether someone builds muscle or not, the simple act of doing physical activity decreases intramuscular adequate tissue. And because we have to get up and walk.

And do these things, I'm guessing that there is the there's more of a capacity for flux than say the load. Mm-hmm. And that's why. And again, we're really far behind in recognizing skeletal muscle. We recognize it from a performance standpoint, and we've done a great job at that, but from a metabolism medical standpoint. Skeletal muscle is the most underappreciated.

And it it's extends beyond that. I mean, even when we think about medications, we don't talk about the impact of medications typically on skeletal muscle, but also and to and then I'll sh I'll be quiet. Now this is really interesting actually. Yeah. Or have less obesity if you want to be PC. And a f a patient could not go to their doctor and say, I want a medication that's going to make me have bigger, healthier How does that make any sense?

So we don't stigmatize the fact that someone could go and say, I want a medication that's gonna help me lose fat. But if someone goes to their doctor and say, ask for an anabolic agent, The doctor's like, I'm not giving you anabolic agents. So do you see where there is a a complete disconnect in our framework for thinking about things? Yeah, I see that. Yeah. Yeah. Well, you're you're changing the conversation.

I wanted to just I'll get back to you on that. Um Uh we de and we have to make time to talk about your book because I it I I really I I like I like how you're approaching it and how you're motivating. people. So it's we we we i people if you're listening obviously get the playbook. You already have Forever Strong on your bookshelf. physician or you know, just a a regular person listening to this pod podcast with the playbook.

Is super inspirational in bringing it forward. But before we go there, before we go into that's the book that I originally wanted to write. The first one was the manifesto and the science behind it. But this playbook is the book that I had originally wanted to write. And, you know, as physicians, we we don't usually go, okay, well, we're proud of something or this was awesome.

This playbook is awesome. I mean, it tells you exactly what to do, how to do it, but also how to think about it and reframe. I mean, there isn't this disconnect. It's not just do this, but you have to really get into the psyche of pushing one's capacity. I I think that's really important. And recovering and Working and being with your mental gain, like not even necessarily work working out, but being present. Like you bring in a meditation element that

surprising to me and immediately engaging. As I was reading it, I was paying attention to my really like the things that, you know, just bring me center. And I was also thinking,'cause I was preparing for our podcast, how I I I did not expect to be in a meditative space preparing for our conversation. But it it's so important. Same here. But if our real mission

You know, uh Kara, I've I I'm sure you're in alignment with this. The real mission is to build stronger, more resilient humans. Yeah. If the entry point needs to be muscle. And protein or whatever it is, great. But the overarching mission is something much more. Beautiful. Nice. Yeah. Yeah. It's an all-hands-on deck mission. And so if your entry point is, you know, the science of muscle, that

I'm with ya. That's very cool. I just wanted to get back to the con to the to what you mentioned about MRI possibly being able to capture um uh intravuscular adipose and um You know, people are getting I have patients are coming to me with full body MRIs all the time these days, and you can order you can get them, you know, direct to consumer for relatively cheap, um, but I don't think they're going to be giving us that data. Is that correct? I mean you ha you you would need to

It's this is a really good point. So let's let's frame this up. People are getting preventative MR. Which we recommend. Uh, again, I know that there's a lot of questions around it. Are we opening up a can of worms? Okay, fine. But the chances are that we can find and prevent something catastrophic is also there. So I think that these uh MRI scans are a very

The next question is: what can we learn from them? And with particular software, we are with particular software and larger data sets, we'll begin to look at intramuscular adaptation. I think we still have to understand, you know, what does that mean? Again, because of the flux. I think the gold standard, and again, I I don't know where this will fully be able to go, but it's actually to look at

skeletal muscle under MRI while exercising to probably see. But I you know, that's Or with like a glucose load or something. Yes. You know, this is where I I actually think ideally it will go. But for the interim, getting an MRI, you know, finding there is some software that's beginning to emerge that can look at it because people are interested in muscle. But again, it has to really be the intramuscular adipose tissue. Which I think becomes valuable from a clinician.

Because it also will move the conversation away from body fat percentage to, okay, so your intramuscular adipose tissue is at five percent. Where we really want it for your body habitus is two percent. When we decrease your intramuscular adipose tissue by this say ick, you know, one percent, then we see um a handful, you know, because it's outcomes that we're we're on. that that these outcomes become better. So that's that's where I think um the same way that we're looking at uh fatty liver.

Super. Ultrasound, yes. But again, um those results will be operator dependent, and we are not routinely doing vastis lateralis ultrasound. Over time, as they link this and to your point, kind of marry it to, you know, tons of good imaging and AI technology, you know, and massive data sets. we'll be able to see what easier, more reliable markers can be good surrogates. And I mean, I think the puzzle will come together in such a way that we can

you know, that that that we can infer um more readily. And I also think I'm gonna say uh another layer to this is that intramuscular adipose tissue affects contractile function. weaker over time. We become weaker over time. And I I think that that, you know, we always think about s we oh don't always, but when we think about sarcopenia, we think about decreased muscle mass and function. And there's a number of reasons as to why it is believed that these things happen.

I think that there are under-appreciated aspects to sarcopenia, one being increase in intramuscular adipose tissue, and also I think that there's potentially impart an autoimmune component part to the health of skeletal You know, we talk a lot about thyroid and um uh Hashimoto. I I think that there is also an autoimmune component to skeletal muscle that we are not necessarily testing.

And how and what Just unbind that a little bit. Because just um interviewing immunologists and beginning to think about beyond what is traditionally thought of in the Again, we will see, but this is what I expect. You know, why wouldn't we attack skeletal muscle? You know, I mean we've there are many, many auto antibodies that we've But why exactly? Why are we not even asking these questions if we recognize that skeletal muscle is so critical as an organ system? So how can we begin to catch?

Mm-hmm. So maybe in somebody who's got who would you be flagged for actual a uh uh autoimmune pathogenic process happening? Somebody for whom sarcopenia has kicked in rather rapidly or has a history of autoimmune?

Um, it's a really good question. I don't have a clinical answer, but it is always on my mind because you know, there's again, it's just so fun talking to another clinician because You know, we think about the input of exercise and why doesn't exercise stimulus respond, why do people not respond the same way to various exercises? This is one reason why I think. I think that there are more complex processes that go on in skeletal muscle than we recognize. I don't think it's as simple as

do resistance training and then you will get this result. I think that again, it is an organ system and that we have to treat it like such and also evaluate it. And it's interconnected to the rest of the body. I mean, it makes me, you know, I just I'm always grateful for being a functional a functional medicine provider because I would, you know, I have an idea. Like if I do suspect this, you know, you brought it to my attention. And so of course immediately

thinking about it through my clinical framework and we can work on diet. We can work on a I mean there's a whole foundation Suite of interventions we use. And I believe even to layer on that when we think about treatments, I think treatments are going to be include low-dose GLP ones, anabolic agents, also radio frequency or supra physiological.

that we use external machines for. Like, you know, when you think about the astronauts or, you know, there's radio frequency that can be applied to skeletal muscle. I I think that that No, I think that's where we're going. Well, that's that's really that's very interesting. Is there a gap in your health and longevity strategy? MitoQ mitocinol is an advanced antioxidant that targets the inner mitochondrial membrane, reducing reactive oxygen species by 48%.

This patented compound is backed by 30 years of research and 25 clinical trials by Harvard, Yale, and Oxford. MidoQ supports mitochondrial and cardiovascular health, metabolism, and DNA stability. Learn more at mitoq dot com slash doctor Kara. That's M-IT-O-Q dot com slash D-R Kara. Let's see. Let me let me think. I just I I guess let's leap over to talking about

Protein. And so everything, I just all the clinicians listening, they're stoked. Everybody's taking lots of notes, or they're gonna you can go and every all of this will be on we have show notes. The full transcript is available and we'll be linking to, you know, all of Gabriel's science, et cetera. So you can always go there and get it. Um so we've got this awesome starting point we've built, but now I want to move over to talking about protein and muscle mass.

quantity and like I there's there are a handful of questions I was pondering as I was getting ready and for our our talk and you know your ad about recommending about a gram of of protein to per pound body weight these days, maybe with a little wiggle room in there to go a little bit lower. And I was wondering like That's hard to that for me that can be hard to hit on a daily basis, on an in and out daily basis.

Especially because I, you know, I wrote that book back there, Younger You, and I advocate for these massive quantities. know, polyphenol dense foods and I I I I ended up blogging on toggling between hitting your targets and then hitting younger you targets. So on days that I'm lifting I can go hard, hard, hard protein. lean more into the polyphenol conversation. When are the younger you, how much protein or how much polyphenol?

or does younger you We are doing we're looking at about seven to ten cups of colorful green and colorful veg and fruit per day. Seven to ten cups plus the but the protein the protein quantity in the original book is is lower than I would recommend today, except that I put all sorts of qualifiers. If you're lifting, you need to go higher, if you're pregnant You're all dirty you need.

Um, but it's a good chunk of food. It can be up to, you know, maybe eleven, up to eleven, uh up to eleven cups. Plus we're layering in, you know, good fats. Um Yeah. So between all of that it ends up being a a decent chunk of food, which for me I found worked if I talked. But I wanted to ask you, so that brought a thought, so you can comment on that in a minute, but it brought a thought to me around um identify individualizing.

So for example, my doctor uses an inbody in her office and wants me, I started working with her and I was about at it at about eighty-eight percent. Um uh at the eighty eighth percentile for for my age range for muscle mass and she needs she was like you need to be up above ninety and now I'm at I am happy to say and I know in bod you can c the reliability of inbody is is is is debatable on it. Well I'm up above I'm at the upper limits of detection. So greater than

ninety nine. Like a they they don't quantify. Which is fabulous. I'm really excited to be there. But it made me it uh it made me think well actually A that I wanted your opinion on it. So I'm glad that you think that it's useful and and we've got measures over time. Obviously it's not gonna be picking up muscle quality, et cetera, but I can tell that, you know, I've got good energy and movement.

the world doing stuff. So I I I I think I have reasonably decent quality. But the but the question I have for you is around how much d would that suggest that I'm consuming adequate protein because I have adequate mutt muscle by that measure. It's a really good question. And here so to frame it up is how do we think about protein? We think about protein in the form of You know, like whole food.

But how do we make protein decisions? And and first of all, you know, you you kind of looped back this uh point is that how do we stimulate muscle? So before we even talk about protein, how do we stimulate? You stimulate muscle by two meanings. Dietary protein because of the amino acid leucine and training, resistance training. So this is

you know, what we think about as the primary inputs for muscle protein synthesis, which is somewhat of a proxy to muscle health. And Now, as we age, muscle becomes less efficient, and this is called anabolic. So the question becomes how do we make protein decisions to be able to both maintain and build The first one is age. The second one is physical activity.

The third one is metabolic health, meaning, you know, do you have elevated triglycerides, insulin, glucose? And then the fourth one is personal choice. And so for someone like you, there is a U-shaped curve. And that's actually what I put in the playbook. I really simplify the idea of how do we understand dietary protein. The older you are, the more sedentary you are, the more protein you need.

Because if you relate to the idea that there are two ways to stimulate muscle, and as we get older, it becomes more anabolically resistant, then one of those two levers has to be pulled. So the older you are, the more sedentary you are, the more

Now, the more there's this U-shape curve. So then as you become more physically active, you need a little bit less. You can get away with a little bit less, like 0.7 grams per But as you become more of an elite athlete, then that's where you'll go higher in dietary protein because you know your body is gonna require it for a

repair and maybe you know if you're doing some endurance sports you'll be using some of those amino acids for um fuel and you know from my perspective for you you are pulling the level of physical So because of that, you're probably at the bottom of the curve where you're not having to go as high as one gram per pound target body weight.

And that's what I'm lifting and working. I mean that's how people really need to begin to think about how do they make protein. And then to your next point is um There is personal feeling. So if someone I personally think uh polyphenols and fruits and vegetables are extremely important. I'm not a very high fat person. I think that you'll get all the fats that you need from the foods that you eat. The body requires about four grams of food.

Fatty acids, that's not that much compared to the essential need for protein. And then we know that there's no essential carbohydrate need. So, you know, as we make these decisions, protein is the first decision. And then after you make that, you get to choose whether it's carbohydrates or whether it's fat. For someone like you you're so active.

If you look at the literature, you can earn your carbohydrates, which for whatever reason that becomes very triggering for people, with physical activity that is over, say 120 beats per minute. You can earn between forty and say seventy grams of carbs per hour. Well and that's actually a good thing'cause you wanna I mean if you're if you're gonna do an event, you're thinking about glycogen and all of that. So we so we wanna do it. But before we I wanna just pull go back to

The protein. So yes, so we're pulling both of these levers. I'm pulling the physical activity lever. So that might drop my that could drop my protein requirement. So I can see that my muscle is where it needs to be by that measure, by the in-body measure, which is awesome. But if I decide to up my game, which I want to, I actually want to go back into competitive cycling and it and its criterion. I'm I need my legs to have a lot of muscle.

it is the style of racing that I'm engaging in. I'm I will need to increase my protein game again, you're suggesting. And I'm just curious, like how do I how will I know that? Like what will be the signs, the measures, Um, well, there's no measure that you're gonna see in your blood, but potentially soreness, fatigue, recovery. Um, there's no perfect way to figure it out, but

Definitely for you, I would hit one gram per pound of target body weight. And then you could even consider using essential amino acids. So where essential amino acid use comes in is in a predicament like this. Say you want to get a lot of polyphenols, you don't want to fill your plate with too much protein. So if you have a lower protein meal at say two ounces of meat, so that's 14 grams of protein.

That's not enough to stimulate muscle protein synthesis, and also that's really too low to be super valuable. But adding in essential amino acids would complete that picture and signal to the body that it's more. More robots. And that's and and is that primarily because leucine's in the mix there? Well you need all that's a really great question. Um so leucine is like the key to a car that you turn on. But then you need gas or all the other essentials.

Yeah, you have to you you require all of them to do anything Generally speaking, for the entry level conversation, and I know we're getting we're getting pretty Pretty specific here, pretty down the rabbit hole. You would say thirty grams per meal. Thirty to fifty and that number comes from a very specific target. So thirty to fifty grams of protein. So thirty is the bare minimum for anyone listening to this, unless you're twenty.

So if you're over the age of twenty-five, then you should have the minimum you would have at your first and last meal would be thirty. For me, I have anywhere between forty and Now why is that? Well, because it stimulates skeletal muscle. So if you are below a certain threshold, muscle is not stimulated. So this idea of a bodybuilder diet of, I don't know, twenty grams of protein five times a day is not a good strategy. And you know they did those studies.

And uh the those studies are primarily done in older women. It was a group uh R N L, uh they're a French group. And basically what they looked at is one group had a bolus of protein, I think it was fifty grams or more, and then smaller protein. And then the other group had a bunch of small protein feedings, but both protein amounts were the same, and they saw more lean mass retention with the protein group that had the bulk.

So again, even if protein is the same, it's how you distribute it, especially if you are training and especially if you are more mature. So that So we want to bang out a bunch. Yeah, go ahead. Yeah, so that thirty grams is a minimum threshold. So for someone like you, Carol, who's very physically active, that's too low for you from my perspective. You want to hit that first meal. of the day when you are catabolic with a a more robust meal. Right.

The rest doesn't really matter. It's what you consume in a 24 hour period. But again, if we are talking about protecting body composition as we eat. If we are talking about anabolic resistance, because there's physiological changes that happen to skeletal muscle, then we have to account So eating and training like you did when you're in your twenties, it just it doesn't work as well if the goal is uh long-term health.

They did this research you said in older women. This this group did I mean so let's talk about that because sorely neglected group that's incredibly interesting. So when we're talking about, you know, let's just talk about perimenopause, you know, menopause, post-menopause, like let's talk about this. Um That's fascinating that they did that. So for I mean, it sounds like for you, based on the read on this, and we'll link to it again in the show notes.

that's when we really need to be moving our protein up in a meaningful way, but not just scattered. Again, scattered. So protein doesn't matter regardless of sex. So basically men and women, the skeletal muscles It's the same. And you know, I worked on some of these earlier studies. So basically, uh, so we looked at postmenopausal women, we looked at pre-menopausal women, the muscle responds the same, it's this triggering. Um but again

you know, when are the moments it's c it's something called must be Yeah. So the anabolic resistance is an age is is this triggering effect. It becomes blunt. And you have to push it harder. Yes. And the way the muscle itself. Yes, and the way you do that is either um training or food. Right. Or obviously both, ideally. Obviously both. Well, just going back to thinking about women, thinking about Harry menopause. There is

a pesky fat redibi r redistribution that happens. There is. You know, it's interesting because when I was early in my career working with women, going through this genera this this journey and speaking about it, I was as sensitive as I could possibly be without actually having experience. But you know, recently I noticed like I I Wow, I actually have that. You know, this is something that I have now and I have

And I will certainly get abdominal adi adiposity, like at a drop of a hat. I can turn it around pretty darn quickly too, but there's a phenomenon that's happening in my body as my hormones change. There's definitely a phenomena that's happening. That didn't happen when I was younger. And I am moving and I'm eating well, like I'm doing what's right, and there's this phenomenon.

And I'm an HRT. And I I just like so just in light of the science and just you know your background, what what do you say to that? And how do you work? Yeah, I mean you should be able so yes, there is this redistribution of body fat that happens as um, you know, we do see that as testosterone changes, as hormones change.

However, with appropriate nutrition and training, there should be no reason why you cannot achieve body composition goals. Um, again, and we've looked at this and Don Lehman has looked at this in women without. So that's even probably more of a challenging group. But um

Yes, it can it absolutely can be done. The question is is the stimulus enough? So is the training protocol enough? Are you training in the right way? Are you building muscle in the right way? And you know, that those are the kinds that yes you're up against physiology and we know that you can't outgrind your biology. However, you can make extraordinary changes if

Nutrition is right. Now, nutrition from my perspective is different than the traditional functional medicine nutrition. You know, which is, you know, we've all seen what the, I mean I haven't seen what it looks like recently, but it's you have to prioritize muscle first. Period end of story. Yes, uh you know obviously you need fiber, obviously you need polyphenols, but you have to get that muscle piece right because that is your central life.

Um, so even with perimenopause, menopause, redistribution of fat, you should be able to still do and go through body recomposition. And the way that's done is really getting extremely clear and figuring out what does your actual total caloric load look like. How much protein? How much activity? What is your training like? All of those things become really important. And then of course.

There's pharmacological measures. People are using GLP1s at microdosing. That can also be very helpful. There's a whole host of But with just dieting alone, can it redistribute? Yes. The answer to that is yes. And you I mean and i i it it's sufficiently outlined in the playbook, like if somebody okay and and and

Awesome. Again. Well, I would say I think that you should go on the game the the program and then in two months you tell me. Yeah. You know, because the tricky part with you is you're doing an endurance sport. So well I do lift as well, though I'm I am a committed I'm doing I but but yes, I'm doing actually talk about that. I mean I I I will always like I've been a cyclist my whole adult life. It's incredibly essential for my mental well being. In fact It's as important.

my s my my mental and psychic well being as it is for my physical well being. But I've always mixed it with with lifting as well because I was more of a sp a sprinter, you know, and my legs are my legs are big and sort of reflect that body habitus and um There's all there's so much dialogue around, you know, doing cardio and you can do resistance in a cardio manner and

But I mean I'm not gonna change what I'm t I mean I I I will fine-tune it and tweak it, but I'm still just committed to it for soul-based reasons,'cause it makes me happy. But what I mean what what what are your thoughts?

In terms of carbohydrate consumption? No, c I'm sorry, cardio and resistance. So like clearly I'm engaging in cardio because I'm I'm a cyclist, but and I'm also if you want to change body compensation. And listen, why is aerobic training good? It's good for plumbing, it's good for vasculature, it's good for cardiovascular health. Because skeletal muscle is an endocrine organ, when you engage in aerobic activity, it affects cognitive function. The faster you move, the faster you think.

You know, there are certain pathways in the brain that become affected. And also, when you contract skeletal muscle, it also, you know, releases myokines that then cross the blood-brain barrier. So there's all these benefits to cardiovascular action. But I will say, That action doesn't maintain your type two muscle fibers, which are the bigger bulky fibers.

We you're maintaining your type one fibers, which is great, but through aging, you see people seem to do that anyway. So, yes, the aerobic part is really important, but you have to add some typeover. For sure. Okay. I'm with you on that. I'm curious what you do for aerobic. Do you just blend it into your well I do the stuff actually I put in in my playbook. I do high intensity interval on Fridays.

And then one day. So basically, my schedule is I train four days a week, and then I might sprinkle on some pathetic cardio for. For you know, listen, my husband runs fifty miles. So when I say cardio, I'm doing I don't know, thirty five minutes, nothing So I train four days a week and I lift on the heavier side, but I've done all types of lifting. You know, you don't just have to lift heavy. It's all about the intensity and the progressive stimulus.

So basically um four days a week for me, then one of those days is a high intensity. So I add in high intensity with load. Um and then once every two weeks. You know, I haven't been doing a sprint interval training lately, but that's, you know, above 85% of VO2 max. That's like really intense. But uh, you know, I add in one high-intensity interval. And then I might add in some zone tier. I do at least one day of zone.

But I'm up fidgeting, I wear a weighted vest, I move all the time. If kids uh kids I I I do push ups in the airport, in the bathroom, anywhere I watch. Awesome. Um so I'm always moving. I just don't focus on that training section. Session, I think there's so there is evidence for Vilpa, which is vigorous intermittent activity. Vigorous intermittent physical Vilpa, yeah, activity. And that's doing short bursts of training. Thanks to our Diamond Level sponsor.

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Um So just going back to the Lucene conversation, I was in a lab for my for for a chunk of my postdoc period, and we always Um considered the potential for high branch chain intake as you know disrupting. you know, the um aromatic amines from being able to cross the blood brain barrier. Tyrosine, phenylalanine, etc., and potentially tweaking neurotransmitters such as serotonin.

Any now that like it's super clear to me, both just in the literature experientially, myself, my patients, that that exercise and a and a dietary pattern that supports muscle mass doesn't Usher in depression at all. antithesis to depression. It it improves mood. But what do you what are your thoughts around that? You know, competing

Yeah. So there is now is a I actually looked into this um a lot. So this is uh Windstrom's work. There's blood brain barrier, tryptophan, these other aromatic amino acids. The data isn't isn't so clear yet and again, uh, I know that they've been working on these types of things for a very long time. Um Yeah, so I would say that the data isn't there, but the individual amino acids, things like phenylalanine as precursors for neurotransmitters, there is data to support that.

I don't think that we know how to design a diet that then influences those amino acids in the brain. I just, you know, I feel like the work kind of petered out because you know, well, for reasons I'm not sure, but um there is supposed to be this ratio. Um but yeah, I I just don't think it's panned out yet. Right, right. And I and I have to say I haven't seen it I haven't seen a bear out clinic. You know, it hasn't been it hasn't moved the needle when I'm working with somebody.

Um okay I think it's very interesting. So basically what I'm hearing you say is that would there be a clinical indication, say, for more phenyl? Yes. Um You know, or tyrosine. Uh we just haven't seen that. And I've looked because I was tweaking how you ingest them. Yeah. Um and I've I've looked into it. Handful of years ago because I thought for sure that it would make a difference. See if I can find out who it is, but it's just we're not there yet.

All right. And I don't think we're gonna get there from um a gut uh a gut brain access. I just I I don't think so. Um I we I've got a couple more questions. I've got actually I wanna I I wanna touch on your book and some of the wonderment. Fabulous content in it. Um

But two other things. I wanna ask you about kids'cause I know you're a mom. You're a mom of of of kiddos who look like they're similar in age to my own daughter. I so I'm thinking about her athletics and her dietary pattern um and want your thoughts on that. Um Yeah, I did y I want your thought. Let me just say there's one other qu so And I wanna know a I was uh being trained by a a actually a really great trainer who always advised. He said, you know, kids start specializing way too soon.

in a in an in an athletic event and they don't mix it up enough and so I'm cu okay. I'm curious so so all of those athletics, resistance training, dietary pattern for kids. So we see a lot of burnout with kids because they start specializing in athletic very early. So for example, if they're doing baseball They're always doing baseball. It's baseball practice at this time. You know, this is the off season. I think, and again, I'm not an expert in this.

Particular area, but I do believe we are specializing too early. And people that are smarter than me have come on my podcast to discuss this very fat. I think it was. Joel Jameson that was talking about kids sports and Jordan Shallow, who's also in the playbook. We are specializing too early. From a lifting perspective and a protein perspective, children are very anabolic. When I say children, I'm talking about prior to pure.

Prior to puberty, there isn't this anabolic threshold. So, and again, we don't study children. We're not doing muscle biopsies on children, but five to ten grams of protein in a serving is likely anabolic. versus five to ten grams for someone who is, you know, past puberty is not it's probably not anabolic at five grams or ten grams of dietary protein. But when you are young, you are'cause you're still growing.

So it's really I speculate that it's after the growth phase closes where you're no longer growing up or no longer um in that active growth process that you really switch to that um Threshold effects? In addition, um from a dietary protein perspective, I would say that there's still wiggle room. Like, for example, your niece is still very young. She probably doesn't even need nearly as much of an adult recommendation for protein. Um, again, I think that

It's a very tricky space because we don't have data in that kind of age group. But what where they do have data, which is interesting, and this is out of um, is it whose lab is it? I I can't remember off the top of my head, but Anyway, it was looking at having thirty grams of protein for per at breakfast for these adolescents. And what they saw was especially girls.

What they saw is when they had thirty grams of protein, they were much less likely to engage in um eating behaviors that would include like high carbohydrate snacks and they were less hungry overall and they were less likely to grab the thing that was under. Well that does make sense. I mean protein is extremely satiating. That's cool. It seems a little paranoid. Okay, we'll we'll track that down. So she looks at um adolescent uh kids.

And uh what's so interesting is that that 30 gram mark is also um the same amount that will cause a secretion of GLP. GLP one. So when we're growing, you know, you would think you need extra protein, but in fact you're just gonna really use that protein wildly efficiently. You don't have to sort of push That threshold. Okay, very cool.

Well listen, Dr. Lyons, it has just been fabulous to talk to you. I've l we we we just ran the gamut. I is there anything else you want to add? We'll link to your book again, we'll just link to all your science. Um, no, but I am still publishing. So I we recently published a paper on uh muscle mass and strength and sexual function.

Uh an erectile function. So that's kind of cool. And uh other than that, I have a podcast called the Dr. Gabrielle Lion Show. I have an active medical practice called Strong Medical. You can find all these links on my website. Yeah, and we'll link to them in the show notes. We'll link over to your website in the show notes. That's great. I did well the paper the paper will be there, folks. All right. Thanks so much. Thank you.

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