Transcript for:
Huberman Lab Podcast with Dr. Gabrielle Lyon on Muscle Health

welcome to the huberman Lab podcast where we discuss science and science-based tools for everyday [Music] life I'm Andrew huberman and I'm a professor of neurobiology and Opthalmology at Stanford school of medicine I'm pleased to announce that my new book which I've been working on for more than 5 years is now available for pre-sale purchase the book is entitled protocols an operating manual for the human body and within the book you can find as the suggests 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 protocols 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 in 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 Gabriel lion Dr Gabrielle lion is a medical doctor who did her clinical and research training at Washington University in St Louis she is an expert in geriatrics in nutrition in Health and Longevity and during today's episode Dr lion explains how if we are interested in our immediate and long long-term 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 Health 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 Lon 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 lifespan 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 you 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 Nei venison Maui Nei venison is the most nutrient-dense and delicious red meat available I've 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 1 gram of highquality protein per pound of body weight every day not only does that protein provide critical building blocks for things like muscle repair and synthesis but also for overall metabolism and health Maui Nei venison has an extremely high quality protein per calorie ratio so that you can get that one gram of protein per pound of body weight easily and without ingesting in excess of calories also Maui venison is absolutely delicious I love their venison steaks their ground venison I love their bone broths and I love their jerky which is extremely convenient when you're traveling those Maui Nei venison jerky sticks have 10 G of high quality protein per stick at just 55 calories while Maui Nei offers the highest quality meat available their supplies are limited responsible management of the access deer population on the island of Maui means that they will not go beyond Harvest capacity so signing up for a membership is the best way to ensure access to their highquality meat if you'd like to try Maui Nei venison you can go to mauii venison docomond to get 20% off your membership or first order again that's Maui venison / huberman 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 3 years ago as a way to understand how different foods and activities impacted my blood glucose levels and it's proven incredibly informative for me in determining what food choices I make when to eat and when to time eating relative to workouts sleep Etc indeed using levels has made it very easy for me to optimize my entire schedule and to understand where the flexibility in that schedule exists so that if I need to move a meal or I need to fast a little bit longer or if I need to work out fasted or not fasted all of that can be adjusted while maintaining energy and focus and great sleep at night if you're interested in learning more about levels and trying a CGM yourself you can go to levels. l/ huberman levels just launched a new CGM sensor that is smaller and has even better tracking than the previous version right now they're also offering an additional two free months of membership again that's levels. link l nk/ huberman to try the new sensor and two free months of membership today's episode is also brought To Us by Helix sleep Helix sleep makes mattresses in pillows that are customized to your unique sleep needs now I've spoken many times 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sleep quiz and Helix will match you to a mattress that's ideal for your unique sleep needs right now Helix is giving up to 30% off mattresses and two free pillows again that's helixsleep.com huberman to get 30% off and two 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 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 in women in 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 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 um 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 um an experience I'd love to share with you I did my fellowship in geriatrics and nut 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 of three kids and she had always yo-yo dieted we imaged 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 overfat 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 too one of the most metabolically active organs in the body you'll probably tell me that one is more active than the other which one is it muscle is actually quite frankly not very metabolically active at rest interesting for every pound of skeletal muscle it might at rest 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 um you looked at the problem through a different lens that she's under muscled how does one go from being underused to properly muscled and what is that and as I say this I realize that many of our listeners probably don't resistance train or if they do they may not want to carry a lot of muscle thinking that that would make them have to buy a new wardrobe you know certainly some of our listenership probably wants to gain more muscle but is or a new wardrobe new wardrobe is there a way to view increasing muscle mass in a way that is compatible with kind of um I don't know we call like traditional Aesthetics or um 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 todos um 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 muscled uh 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 a bone but when it comes to skeletal muscle dexa is an extrapolation so for example we use 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 use dexa dexa 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 up the conversation is 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 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 of where it is and where it's going so when we think about how we maintain the health of skeletal muscle one of the things that I 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 we're gaining and that would be for the listener dietary protein skeletal muscle is sensitive to one of the amino acids lucing and depending on the quality of the diet meaning how much Lucine 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 bioxy is this this concept called muscle protein 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 stimulates 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 is correlated but it's a separate thing Al together 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 um well the the first thing that you said is is AB absolutely something that we see is that in an individual that carries a lot a lot of muscle and say they're inactive there is a big discussion about how um heavy individuals will have more muscle mass but what 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 out a marbled steak and that's exactly what can happen to un healthy 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 um a marbled steak I think at the extreme like a wagu m um a raw wagu looks like there's as much white fat in it as there is red meat in it um and it's a very different taste and texture so that's what we're talk talking about my understanding is those cows uh don't move around much um they're somewhat sedentary compared to say a free range grass eating cow is that right yeah 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 muscle like a suitcase and an individual was say going on a trip for 4 days but chooses to eat or pack for 30 days we know these people yes I know I'm maybe 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 uh that's besides the point when an individual is overeating calories overeating 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 in the mechanisms of glucose disposal whether it's uh 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 the cells now what happens is is there becomes this stasis so if an individual is inactive and not exercising then that skeletal muscle becomes overpacked uh skeletal muscle at rest Burns primarily free fatty acids which is interesting most people think about skeletal muscle as burning carbohydrates but actually at 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 maybe let's start with the feeding or the providing of nutrients to 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 uh representation of the muscle seems Fuller as opposed to flatter um you know but these are um not specific um or these are not um 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 the the liver stores glycogen maybe 100 grams and then skeletal muscle depending on your size for example um you might store much more muscle glycogen whether it's four 500 grams compared to someone who is my size and can we do the the standard conversion of four calories per gram so if the liver is 400 gr you know we just say okay there's about 1,600 calories worth of yes of energy there so if I if I go out and I uh do some exercise and burn, 1600 calories over time does that mean that the the liver is then completely depleted so well the liver will deplete in through an overnight fast so the liver's main the liver maintains blood glucose so skeletal muscle doesn't maintain blood glucose directly the way that you would leverage uh muscle glycogen would be through exercise the way in which you would deplete muscle glycogen would be through more um 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 a day per day per day at four calories per gram at four calories per gram and is that um both simple and complex carbohydrates fibrous carbohydrates yes it would just be overall if they completely sary so just a little bit of walk getting up going to the computer to the bathroom to the car Etc but basically sedentary 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 an individual can ingest at one time that would mitigate uh 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 gram depending on how intense an individual ual exercises and that would be safely disposed of in a 2hour period I mean when you think about an oral glucose tolerance test that's a 75 gram load you assume within two 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 which they shouldn't which they shouldn't but you're going to quickly exceed that 130 G per day and even if exercising with resistance training say hard for an hour um which you know can afford somebody maybe what another couple hundred 300 grams of carbohydrates probably not that much okay uh you know I I think that if people care about body composition which um I would say everyone should because you want to have an appropriate level of body fat and healthy skeletal muscle then you wouldn't NE necessarily unless you're doing some kind of cardiovascular activity you're not using a ton of of muscle glycogen depending on how much you're training and how much glycogen is the brain using so that is a that is a good question um the brain uses um a lot of carbohydrates that would be the a primary source when they come up with the numbers of 130 it's really based on brain and then the rest of the the body can we safely say that for somebody that's thinking a lot they need more carbohydrates um you could say that then your brain yes your brain is very metabolically active interesting so we're going of 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 gram of carbohydrates you're kind of at the threshold that's a lot that's that's a lot four four calories per gram um of those carbohydrates and so let's say 200 gram of carbohydrates per day um 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 skeleton muscle right and you know if I were to say okay what are we thinking about for the listener or for the people out there they're 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 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 metabolic conditions there is evidence to support a lower carbohydrate intake I mean 130 G is you know one little micro packet of pretzels on an airplane ride you know so that that actually has probably closer to 37 grams of carbohydrates okay good not that I had a pretzel packet before or threw one at Rob on the way in but no right okay so I'm way off there um uh so they have a one of those a bagel in the morning and um they shouldn't but they uh but they do and then they have some you know pasta at dinner and so most people are probably exceeding that 130 gram by a huge margin yes they are and um there's a couple things there that it's really important that you said is that individuals when we're 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 when you say first meal and we'll talk a little bit later about intermittent fasting and you know I for instance eat my first meal at usually 11: a.m. it's just 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 it 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 and metabolic Health when we think about um that first meal I frankly don't care when you have it one also has to understand that you're coming out of an overnight fast if you are young and healthy then the timing of that first meal likely doesn't matter because you're robust your body is very efficient and capable to withstand um protein deg degradation it's 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 day if you are young and healthy the timing doesn't really matter matter and I would say when it begins to matter is when you're older when you are in your 60s fat continuing to fast may be a negative negative for muscle muscle Health 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 what we use to measure um as a marker for overall muscle Health now there's a lot of history here when we think about designing a a meal plan that first meal has between we'll 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 you and I were talking previously it releases um a handful of uh gut peptides like gluc gone like peptide one which later we'll talk about Monaro C py things that will affect appetite uh for that second meal and this there's some very interesting research out out of Heather Li's lab and basically when she put individuals younger uh adolescents on a meal of 30 to 40 grams of protein they were much less likely to choose say Donuts or something uh outside of what we consider a healthy nutrition plan later in the day or in the same meal later in the day so um is 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 there are meat proteins there are plant proteins how important is the quality of that protein this tends to be a Hot Topic and somewhat very controversial great when great for you I know great for everybody I mean controversy on this podcast is um is embraced uh 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 in a future time to adjust any uh uh stances based on the data and how we evolve as people so okay well I love that yeah um dietary protein we speak about it as if it's one thing but actually it's 20 different amino acids nine 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 branch chain amino acids Lucine being one of those so Lucine is uniquely stimulating to skeletal muscle and when you have enough Lucine 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 um that it's Health it's 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 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 ag1 for more than 10 years now so I'm delighted that they're sponsoring this podcast to be clear I don't take ag1 because they're a sponsor rather they are a sponsor because I take ag1 in fact I take ag1 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 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 over eat 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 ag1 once and often twice every day is that it ensures I get all of those vitamins minerals probiotics Etc but it also has a 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 ag1 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 ag1 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 ag1 is foundational nutrition designed to support all aspects of well-being related to mental health and physical health if you'd like to try ag1 you can go to drink a1.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 K2 again that's drink a1.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 um 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 at the end points of reduced body fat Etc as we'll get into later um one can still arrive there so just for practical purposes what are some excellent sources of quality protein for that first meal um 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 um 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 comp 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 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 are we seem to be moving more towards a plant-based diet right I mean I know there's 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 a 70% plant-based diet I'm talking about uh refined carbohydrates sugars ref oils and when we think about it so that 70% of um our diet comes from that where 30% comes 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 um one would not choose quinoa as a protein source so quinoa would six 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 have carbohydrates that ride along with them and and that just becomes important for overall metabolic control when we think about total caloric load and total carbohydrates someone could use a rice pea blend of protein for that first meal uh that would certainly be sufficient certainly if someone is um geared towards a more plant-based Di and doesn't want to consume animal proteins that's what I would use is there any evidence that combining a highquality 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 what is the benefit that we're looking for if the benefit that one is looking for is diversity then certainly because we know carboh hydrates can have fiber 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 is that when you stimulate muscle protein synthesis that will last about 2 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 RDA is 8 grams per kg8 gram of protein per kilogram of body weight which comes out body weight yes which comes out to be 37 G per pound so if someone was 115 PB 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 a deficiency is based on nitrogen balance 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 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 uh you know this is the human Lab podcast well I've I've made I've made uh numerical errors before on the podcast uh 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 um again just life and the two are very different the RDA for Lucine which is that essential amino acid meaning we cannot make it we must get it from the diet is set at 2.7 gram per day that's a trivial amount that is a trivial amount and 2.7 gram 2 total 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 9 n gam of Lucine per day and just to calibrate us n gram of Lucine 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 rough roughly yes wonderful question so there's a meal threshold for skeletal muscle health and that meal threshold is a minimum of 30 gr now that would equal a four 4 and A2 ounce steak um 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 Lucine maybe you do a 25 gram whey protein shake and that becomes important to 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 new nutrition and we gear it 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 Lucine is necessary to trigger muscle protein synthesis number one number two that aging impairs the efficiency of muscle protein synthesis I see so it's a runaway train if you start getting sarcopenia if there's obesity and other markers of Aging I realize obesity can occur at Young ages too but muscle loss then basically you're Al you're losing muscle quality AK 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 um yes and I would even say that we talk 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 lifespan there's also muscle span and muscle span is this concept that um 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 um because I know that there's parents I have two little kids so I 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 in and of itself a diseasome of inactivity then midlife we have to maintain the tissue we get a peak muscle mass in our 30s we get a peak bone mass around the same time and then that later 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 to maintain that is that when we increase our dietary protein so older individuals or individual 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 prot I say that that's true interesting and by the way skeletal muscle will mount a youthful response there's um you know this was uh the initial work was out of uh Bob Wolf's lab he's an icon in the industry of protein he's one of the can I say grandfathers now I mean that's pretty embarrassing when I think about Bob wolf and Don Layman and these guys you know I trained with Dr Donald Layman you know these initial studies that we think about and 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 um a younger individual still growing we'll just call them 10 12 years old or or my children I have a three and a four and a halfy old they will respond with 5 gr of dietary protein 10 gam of dietary protein 15 gram 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 30 to to 50 later we're going to talk about supplements but I'm very curious is there a place for supplementing Lucine and other Branch chain amino acids specifically you know I always assumed that supplementing with Branch chain amino acids was kind of the unique domain of people you know post exercise trying to build more muscle but as you're telling me all this it seems that adding Lucine in powder form to a meal seems like it would be great for muscle health is that true um I would say that we do not add Lucine alone okay because Lucine isol leucine and veine 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 Branch Chains would be if an IND idual 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 2 ounces of fish which wasn't enough to bring me up to a threshold that would be a place that I would add in Branch 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 Branch chain amino acids or just adding Amino acids would be the equivalent of putting a key into a car and trying to turn the car on but not having any additional substrate so you need the full spectrum of all the amino acids to affect skeletal muscle Health yeah well that's um 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 I love all those all those things um and I have to imagine that as you mentioned before there are other things in these quality and animal proteins like you mentioned um selenium you mentioned other perhaps essential fatty acids and other vitamins that perhaps have something to do with what the animal ingested during its life that also benefit muscle is that true it it is and the the big standout to me is creatine we know that creatine at five grams of creatine will affect skeletal muscle but 12 grams of creatine affects brain health and there's a lot of interesting research coming out on um creatine and brain health C can you remind me the rough um amounts of creatine and say you mentioned a let's just I mean I must say a 4 and a half ounce steak feels um rather poultry to me um that's probably the size of which is a huge meal to me right um right so let's say a 6 oun let's be generous a 6 oun steak or um four scrambled eggs I mean how much creatine are we talking eggs don't have much creatine right not much and um and I I was just recently looking at this the amount of creatine in a pound of steak you're going to cringe is is something like two grams so it's 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 um 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 uh a few caveats there is that that RDA that I gave you earlier is based only on high quality proteins and that being the minimum to prevent a deficiency if an indiv ual was plant-based they would require closer to 1.6 gram per kg a higher amount of total protein if it's coming from plants and that that becomes important to understand speaking of an Ideal World if you had a magic wand I do what would be the um my kids think I do I bet you do um what would be the amount of protein that you would have everybody eat what in terms of a number of grams per pound or kilogram of body weight that's actually an easy question one gram per pound ideal body weight total body weight not ideal body weight actually where you want to be if an individual is 200 lb but but would prefer to be 150 lbs then I would have them eat towards their ideal body weight there's no evidence that a higher protein diet is detrimental to Kidney Health to bone health and we use these terms Loosely like a high protein diet when we have to recognize that 8 gram per kg is a low protein diet so where did the idea come from that if you eat say 1 gram of quality protein per pound of ideal body weight that you're going to get gout you're going to have liver issues you're going to have all sorts of issues where did that idea come from uh frankly I'm not I'm not sure but the conversation around dietary protein has probably been the most controversial what why do you think that is I mean we don't we're not trying to get political here I'm just so curious some ideas but uh I I won't them but I I do feel as if um nutrition is not just Science Nutrition is complicated because it's something that people tie emotion to they tie religion to they there's um a lot that goes into dietary protein and food recommendations in general but it sounds like we can safely say that if you eat 1 gram of protein per pound of ideal body weight that you're not going to cause liver damage 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 cancer is that right well um 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 cancers that we're talking about there's many different types of cancers and there's many different causes it would be important to understand what risk factors are and a primary risk factor to many cancers is obesity the 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 I'll share with you some of the um early studies and this came out of Don Layman's lab with University of Illinois both you and L Norton both work there did you overlap there we did he what was he like no just came so let's just say 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 s Side Lane is a very he's like my brother we've known each other for 20 some years and he's a very popular guest former guest on this podcast and a very spirited guy and I I just like to say I don't know why his skin looks that good but um whatever so I love you Lane I 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 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 um a it was a 12-month study 130 overweight men and women so it was robust and basically what they did is they had um two groups one group was a food guide pyramid diet so it was 55 G of carbohydrates a RDA of protein which was 8 G per kg and 30% fat 30% fat was in both groups the second group was 40% carbohydrates this is remember the Zone diet 40 3030 yeah I liked that diet okay I mean there's EV is I mean I don't follow it anymore but you know I tried it for a little while and and it works great and there's some evidence to support that that is a great ratio for people coming off the lowfat era of the '90s the Zone diet felt like um the best thing ever because it was like oh you know you can enjoy some fats and wow your satiety is improved and um you 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 uh fats too low so the second group had a 40330 split so it was 40 gr of carbohydrates 30 gram of protein 30 gr or 30 % fat so these are all percentages yeah 40 30 40% now we didn't talk so much about the distribution but what is really important to understand is they were isocaloric so they both had the same calories the difference was the percentage of where the calories came from and how they were given um and there was actually four different arms to this so there was individuals that exercised and individuals that didn't okay so either zone diet or let's call it I hate to say this but more stand that's how it was designed standard American versus Zone diet so it was designed that way and then exercising or non- exercising for for each of the for this 12 month study um and by the way I had to to pack a bunch of meals it was not pretty and I had to do urine analysis it was terrible um but anyway this besides the point so the first group had um a protein distribution of 10 grams in the morning 15 at lunch and 45 at dinner kind of standard American Ste for din some cereal for breakfast with a little bit of milk and then for lunch like a sandwich exactly and so this mirrors what people do the other group had 45 grams of protein at that first meal six five six eggs five six eggs um 35 grams of protein at lunch and 35 grams of protein chicken breast and a salad at lunch with a little piece of toast and then at dinner how much um it was it was 35 gram all right a piece of fish and some rice and a vegetable but it was an even distribution so what you're seeing here is now these meals are meeting a loosing threshold of muscle protein synthesis now it's 100 this is collectively 130 individuals and they were they were older um 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 what did they see what did you see you participated in this yeah un yes I did and almost said un unforunately no I I won't um but what was so interesting is that those individuals everybody lost weight so the average weight loss um gosh I wish I had better handwriting but I'm a doctor and so it's pretty bad um the average weight loss was 24% greater in the high protein group so they lost 24% and you said it was isocaloric between the two groups but was it subc caloric overall I mean people were five that's a very smart yes it was 500 calories less than what they needed to maintain body weight correct okay got it so 24% more weight loss total total in the group that distributed their protein evenly in and followed the So-Cal Zone Diet 40 3030 and they lost more fat than the high carbohydrate group so the high protein group lost uh a total of 16 pounds versus the calorie controlled group lost 11 pounds of fat of fat which is great everyone's at home thinking this is wonderful isocaloric isocaloric but the the thing here is the lean body mass change so again this was done using dexa and we know dexa only looks at lean body mass you mentioned dexa earlier just very briefly is dexa how does dexa work not not not at a mechanistic level what what does it look like I go into the clinic am I floating in water am I holding I'm holding the the paddles you might be because you're Andrew hubin no no no but um you hold the paddles and it um and you're standing on something it's what's it so DEA you just lay on depending on the machine you can just lay on this machine and it's a a dual X-ray and it it um measures bone fat and then lean body mass okay that's sufficient for this conversation great so the lean body mass um lost and again this is everything other than bone and body fat so that was 34% in which group uh in the standard American diet group okay versus 26% 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 um changing protein in the morning versus having it at um two small meals and then having it at dinner and did they emphasize what we're calling high quality protein they did okay that is also very important fish eggs chicken ET yes they did so then this led to another study so then the second study was a 2 by two design and this is oh sorry sorry to interrupt in that previous study what was the effect of exercise between so we didn't they didn't do exercise sorry that was my fault we they did not do exercise they were just doing whatever that it was that they were doing um but what was so important to understand was that this set the stage for this idea that protein had a sparing effect and then following that the other studies so then there was a series of a few other studies um the second study looked at diet and exercise so this combined effect so this was one of the first studies and this was 48 women with a BMI of 33 46 years old so this is your post Perry postmenopausal woman who um was either in one of four treatment groups a low protein group low protein with exercise high protein high protein with exercise the low protein group was defined as the RDA 8 gr the high protein group was defined as 1.6 gram kg so starting to approach that one gram per pound it's about seven gram yeah so starting to get there but not quite there yeah so this was um a 16 weeks study and what they found overall was that the high protein group lost 18% 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 performed there resistance training this is the good news it didn't take much it was 5 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 air squats down dogs some Warrior poses maybe some handstand attempts so yeah are you doing handstand I've been to some yoga classes where I look to the sides of me and people are doing some pretty difficult things lanches 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 the study the the group that I just mentioned this was dietary intervention alone with exercise High Protein Plus exercise 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 self outside of anything diet in exercise has a dramatic effect those individuals that were doing 1.6 gram per kg which is 7 gram per pound of body weight plus exercise lost 46% more body weight that's substantial 60% more fat and 40% 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 were they below below main weight it was so they're eating to ideal body weight um but still 500 calories or so below their current caloric needs to maintain body weight so I've heard before that um when we eat protein a certain amount of energy is required to metabolize that protein can that be translated as you know um the caloric load of protein is not what it appears to be yes you know if let's say uh that 6 o steak I'm making this up I'll probably get the numbers badly wrong but if it's um you know um 6 ounces of steak and maybe that's a let's just say a 450 calories or 500 calories does that mean that only 400 of those calories are actually quote unquote utilized um what you're talking about is the thermic effect of food the thermic effect of feeding and that's the idea that certain macronutrients 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 5 to 10% and then for protein it could be anywhere from 20 to I've seen even studies that are at 30% wow 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 we'll 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 of 30 grams then you will see a more optimal utilization of protein and I think that 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 insid tracker insid 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 is that you get information back about metabolic factors and hormones and lipids and so forth but you don't know what to do with that information with inside tracker they make it very easy to know what to do with those numbers because they have a personalized platform that allows you to see the levels of those metabolic factors lipids hormones Etc and they give you specific directives that you can follow related to nutrition behavioral modification supplementation and more that can help you bring those numbers into the ranges that are optimal for you if you'd like to try insid tracker you can go to insid tracker.com huberman to get 10% off their new membership program insid tracker membership offers significantly reduced prices on insid tracker comprehensive blood panels again that's insid 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 a chicken breast and some vegetables I feel very saded um and unless I did some hard resistance training I'm 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 borquez who studies gut brain sensing explained to us and 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 veget vegetables or protein fruits and vegetables in the absence of starchy carbohydrates and one adds 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 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 risoto and it's just different I mean there are a few you know freaks out there that probably to ribeye Stakes but for most people a ribeye steak is like enough one ribey is enough what is going on there and and 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 a completely different experience than eating starch alone or starch in in larger volumes there now I'm going to speculate here the foods that we have access to are highly palatable and potentially we weren't necessarily designed to have access to those kinds of foods um and this kind of moves into this idea of something called the protein leverage hypothesis and the 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 um carbohydrates or risoto uh there is a component of blood sugar regulation that happens so as you go beyond that 50 gram threshold you tend to release more insulin so there's an insulinogenic 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 e eating your kids macaroni and cheese and then you just can't stop and then you probably feel very tired there's an eban 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 insulinogenic as well so dietary protein does does cause a phase one insulin release and that's pre-formed insulin in the pancreas it is a component uh for muscle protein synthesis but it is roughly 20% of the insulin response than the same amount of carbohydrates and when you eat a pro a a 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 glucon Genesis 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 can repack muscle that you've that is a good question the process is very slow so it's a 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 no there are essential fatty acids yeah there are and you know it's interesting we're talking about protein and as as I mentioned before we simplified in the way that we talk about it is 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 acid will'll just pick a brain one uh tryptophan for serotonin production or threonine for mucin production in the gut which helps the gut lining or you know take your pick phenyalanine these all of these essential amino acids do various things in the body for skeletal muscle the primary essential amino acid is Lucine 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 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 um by my read I haven't um seen her dexa results but she's probably had some muscular atrophy she does yoga she walks she Gardens um and seems to be in good health thank thank goodness my guess is she's lost some 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 um would the health of her muscle and her muscle mass change even if she does no resistance exercise I 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 ever you guys aren't doing headstands definitely not doing headstands she's actually you know she's she's very mobile and very sharp and um very vivacious um but I don't think she's doing the the more you know Advanced inversion things at yoga so let's assume that um she's doing some moderate exercise three three four times a week but not training with weights if somebody like her or a you know a younger male that has a similar pattern of behavior you know desk worker for the most part uh jogs a little bit gets on the on the Recumbent Bike or whatever it is but is not um doing resistance training increases is their quality protein intake um 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 um well the first thing is that if she is eating a sub amount of protein let's say she's eating the Rd of protein and the average woman eats around 68 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 is their body robbing their existing skeletal muscle of 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 um less efficient so the body is turning over roughly 300 grams of protein a day that's a lot of turnover a lot it is a lot of turnover 300 g of protein turnover yes and muscle only accounts for maybe 25% 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 she's not big on on um beef or chicken and listen mostly eggs and a little bit of fish and lots of vegetables and fruits but maintains again a like a healthy lean body weight and and that is wonderful so 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 Lucine 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 way with five to 10 gr to 15 gram of dietary protein because their um levels of testosterone Andor estrogen are driving protein synthesis in a way that lets them offset any dietary deficiencies 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 loosing and resistance training because the main pathway that these things go towards is is something called mtor mamalian 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 that 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 utilized gets this fat infiltration mitochondria changes protein turnover changes it becomes less efficient at sensing amino acids there's a decrease in capillary profusion 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 um um again closer to one gram per pound ideal body weight the evidence would say 1.6 gram per kg I'll never forget out when the protage study came out I can't believe I've been out of Fellowship that long but the protage 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 2.5 grams of Lucine or roughly 30 gram of protein and um 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 her 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 throughout the body so we talked about mtor which is mechanistic Target of rapamycin in skeletal muscle in the brain and the pancreas this is a um a protein complex that you just don't want stimulated all day long yeah for sake of um cancer risk yes 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 and then over time it drops off and it's remarkable how studies where emor 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 xigang he at Harvard uh Children's Hospital at Harvard Medical School but what one always observes and we've done these experiments in my lab is that when you increase mtor by any number of different you know um ways you know molecular CH canery and things like that that the cells grow enormous and the concern is always that if you increase mtor that you are going to bias any pre-existing tumors to proliferate as well is that right um I think that that yes compon yes um it is and we have to recognize that mtor stimulation is different in different parts of the body just as you mentioned and so um skeletal muscle is uniquely sensitive to contraction and it's through this biochemical process called red one and when you contract skeletal muscle it inhibits red one which then again there is this uh fast foration 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 space is that well I don't want to increase my dietary protein because some how 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 um it's interesting the mtor which in mice is mamalian Target of rapy um that word rapy might you know um prick up some people's ears there are some people out there and by the way I'm not recommending this that take rap Amy as a way to inhibit mtor in hopes of extending their lifespan uh there's some animal studies that support this there's um growing interest in this and um so much so that some people are willing to take rap ayin um by that logic rap ayin would perhaps inhibit muscle growth muscle Health that's a whole other discussion we'd have to get a TIA and a few Matt cine and a few other folks here um and maybe we will with you to to discuss that but the point being that I agree completely that we can't just say something that increases mtor in muscle is also going to increase cancer that these molecules like mtor have distinct roles in distinct tissues 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 right as well as resistance training and I don't think anyone in the longevity space would suggest that resistance training is a bad thing and yet we know it's increasing mtor so there's a little bit of a of a contradiction in that field just if one stands back from it and says well wait you want to take rapid M to block mtor but you also want to do resistance training to stimulate mtor 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 twinky diet probably look at a weight and grow age is the great equalizer you 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 is a science of uncertainty 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 skeletal muscle before you see any outward signs of obesity before you see any outward signs of um 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 uh 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 and they pay them um and these individuals were sedentary and what they but 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 inactivity now what is it less than 5,000 steps per day per day W there multiple way 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 as something innocuous and and not a big deal it is in it is a disease state so I feel like you've made an excellent case for the ingestion of sufficient amounts of quality protein each day especially starting with that first meal of the day um and just to underscore the suggestion that I heard it was aim for one gram of quality protein per pound of Target body weight so if somebody weighs 200 lb in the like to weigh 180 lbs try and get 180 gram of quality protein per day divided 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 mentor's fault he'll laugh um this 30 grams of protein three times a day I'm sure you've heard about it yeah or that you can't assimilate more than 30 grams of protein per meal let's let's um you assimilate you you assimilate all the protein that you ingest even if it's either correct 100 grams correct even if it is 100 grams skeletal muscle protein synthesis will max out probably at 55 grams again this 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 that meal includes 100 gram of quality proteins let's say whey protein do I put all of that 100 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 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 gram of protein again four calories per gram um typically um into muscle protein synthesis the rest is oxidized yes um maybe just touch on that process of oxidation what that looks 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 glucano Genesis 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 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 body wants to use different fuel sources differently um is there any selective use of one um macronutrient versus the other question that that's an excellent question um 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 loosing and that will be again uh that will probably take and last around 2 to 2 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 in the blood to stimulate tissue and there was a very interesting study it's the first study of its kind and this came out of Luke Van loon's lab and basically they looked at a a vegan diet with I think it had 40 grams of protein and then it had a omnivorous diet so it had both sources of protein um 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 meal of just the vegetables did not interesting even though it was plant-based proteins High you know um 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 um I would certainly go towards that higher end what is the case for fiber either supplementing fiber or um 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 um 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 um high fiber sources of berries and then whatever fat blueberries strawberries blackberries them I'm a big fan of berries I'm like a grizzly bear when it comes to berries I'm a driveby blueberry eater when they're there I can't help but swipe them off the the bowl or the plate um but there was something else that you mentioned that I wanted to highlight and 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 you know what we really care about is glucose disposal and insulin sensitivity this idea of insulin resistance is killing our world young people too yes yes we've seen double to Triple the rates of childhood obesity that's wild I don't think people younger than um um 25 recognize that like when I was growing up in school we there was junk food Lord knows there was junk food there was also good food and different kids from different homes ate different amounts of junk food but it was the rare individual in school who was overweight who was obese right um and you had some kids that seemed to be just kind of like born lean and and um with more muscle you had said wor were thinner with less muscle less it but it was very rare that there was uh 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 people were eating cereals people were eating candy bars they were also eating eggs and sandwiches and chicken dinners and um all sorts of stuff um so what's happened yeah like really what's happened because something is fundamentally different we we had PE class that was required we had to run we had to play volleyball um 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 yeah I will say that also two-thirds of Americans are either overweight or obese yeah it's wild I mean again one has to have been born in the 70s as I was or early ' 80s to really appreciate this tremendous shift in kind of like what you see and sure people are on phones more more sedentary it's got to be a combination of things but they're it's cultural you have a disease on of inactivity and sedentary behavior um that is frankly killing our population almost 50% of people have hypertension we have a a an 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 muscle now has sensitized within TW you know there's a 24-hour period 72-hour period where that muscle is still sensitized meaning it it consumes more nutrients it consumes more nutrients but also when you think about insulin resistance insulin moves gluc ose out of the bloodstream into cells and through the muscle there's the insulin dependent pathway through um 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 four receptors when you exercise you increase the density of glute 4 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 um I'll just 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 medic or science of any sort to look around and say okay there are a lot of people um 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 um Dr Chris Palmer from medical school yeah wonderful person former guest on this podcast very popular episode I mean it's really been championing this issue um 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 and U metabolic Health um but putting all that aside do you think that most public health officials understand that muscle contraction increases glute four expression at the level muscle which then um uh 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 um Concept in principle yeah like why aren't we hearing this I mean do they even require PE in school anymore um no I am not sure but this is a this is a problem I don't know but I would say if two-thirds of our population is either overweight or obese um 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 um well I 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 and away from disease as opposed to just muscle size because I think most people hear muscle and they think 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 it 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 to travel on an airplane and put your stuff overhead or pick up your toddler mine weighs 40 pounds or go downstairs what um Dr Peter AA has really been emphasizing that a lot of life-ending injuries life-ending injuries occur by virtue of people failing to do the Ecentric movements of that are essentially look like going down stepping down off something I've had to have this discussion with both my parents it was a little bit uncomfortable frankly because no one wants to be told Hey listen here are the things that can can potentially kill you it's don't worry so much about going upstairs make sure you hold the the railing both of 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 you I think I'm going to get these numbers a bit wrong I'm sure but I think um 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 not because of the break itself but because the inactivity that results and that's absolutely right 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 diog glycerols that build up that potentially lead to an compound insulin resistance skeletal muscle insulin resistance you then 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 crisis and a catabolic crisis 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 um 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 architecture of the body and this all makes useful sense um 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 uh so myocin have you heard of myokines uh I have but please educate us yes so amines are peptide hormones again skeletal muscles and endocrine organ that travel throughout the body the most famous one is interlan 6 you have interlan 15 interlukin 6 these affect um lipolysis they affect the utilization of glucose there's this idea of training in low glycogen state that might increase a more robust amounts of these inter lucans these myocin which great CU I love training fast which is interesting and we always think about exercise as this way to improve metabolism um it doesn't so much do that at rest but what it does is when you exercise you improve again glucose utilization but also you release these myocin it's not just the physical activity but it's also the subsequent effects and the subsequent um molecules that skeletal muscle releases I 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 wavefront of other endocrine and molecular factors that set in motion by 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 Incans that last hours and hours and even days that at least to my mind or my reader the literature are the most interesting the most benal fascinating and actually the science is relatively new it came out of uh Peterson's lab bente Pon in Copenhagen um 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 capspin B and irisin these myocin then stimulate bdnf release in the brain brain deriv neut trophy exactly which is a component of neurogenesis when we think about the plethora of activity of what skeletal muscle does it is no surprise that number one it's free to move can I just um mention something about bdnf if I may um I spent much of my earlier career working on neuroplastic brain development and bdnf brain derived neutrophic Factor gets mentioned from time to time and um as you mentioned it's involved in different neurogenesis Pathways and um 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 rein en forces the neural circuits that exist and one of the Hallmarks of Aging is a essentially a a degradation of neural circuitry right 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 of NE neurons within the brain declines with age we know that the neural circuitry suffers the speed of of neuronal transmission suffers and it's long been observed but only now um objectively substantiated that exercise can not just maintain but even improve brain function over time and so um thank you for allowing me to kind of uh expand on on what you just said I just think that um if ever there was a potent medicine for improving brain health its exercise and in particular resistance exercise I think that the case for cardiovascular exercise is probably that it maintains the the components of blood flow that are also critical for the yes and certainly no one is arguing the importance of cardiovascular activity and V2 Max 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 V2 max if you do not have healthy skeletal muscle you are not going to be able to be effective at nearly doing anything or surviving 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 can cancer CIA 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 myocin interfaces with cells of the immune system we've all heard of macras and the cytokine storm in Lucan 15 uh tnf tnf Alpha as being uh pro-inflammatory when the myocin which are also in lcan 6 and Inter Lucan 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 cyto kindes 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 gram amounts and calorie amounts and distribution and that's just wonderful and thanks also for explaining the mechanism and the incentive for doing this let's talk about resistance training um 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 could just actually walk us through your week what does it look like um it could be uh Sunday Monday Tuesday Etc or could be you know how many days a week do you resistance train of course you didn't know I don't I don't do any kind of training yeah well I know based on your Instagram what you do and um and now we we know why so I have a wonderful train uh trainer Carlos M shout out to him every Monday I decide I don't want to train and I know that of course you don't enjoy it um I do but it's usually suffering um at least Monday every morning I I know Monday morning's 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 train consistently three days a week and I can train I train pretty heavy for my size so I'm maybe 110 pounds um what I do is I do some kind of push pull hinge squat on all three of those days I do so you train your whole body I do three days a week separated by a day in between I do I do because uh essentially I'm working hard enough where I'm pretty exhausted so I came here and you asked me if I trained 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 uh it will be loaded it will be pretty heavy it gets my full body moving and then we'll pick some kind of compound movement whether it's a multi-joint movement that's exactly right a multi-joint movement through full range of motion so for instance a squat or a deadlift that's right um if somebody isn't skilled in squats or deadlifts um could they maybe hold on to a a kettle bell of appropriate weight for them and do like a kettle bell squat I'm going to give them an even better solution and this is this concept that I learned from um 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 ladies you're not going to get bulky should be Hy hypertrophy which is hard to achieve as you 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 um goblet squat or free weight squat or deadlift right I wouldn't I would have them do High Ground movements and this is where machines are really really wonderful people kind of will say well but you have to train for functional movement and functional well what is that we're training for life right we training for Life durability and uh if I may um you know anytime people say you know what's the best form of exercise how do you work out Etc I always say rule number one definitely train train but don't get hurt or avoid getting hurt I mean the moment somebody approaches exercise and 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 train your entire life if there are parents listening thinking about your kids there was a 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 Maxes but they're picking up kettle bells 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 um and then uh pretty quickly moved into all the leg press leg extension you all that stuff couldn't help myself but 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 um at night I would do sit-ups and handstand push-ups against my door you know I couldn't do a proper handstand unassisted but I'd 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 10 repetitions of that was pretty tough um but you're saying resistance training what you said um High Ground High ground contact high contact so um when you are choosing motions that an individual is unskilled to do I think Le let's frame this is that most most people think about exercise for optimization of performance but if we take that back a notch and you know I think about um my audience and they are individuals that are um 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 flear 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 like box jumps or I don't like them because I the Ecentric loading that you know it ends up being a lot of soreness and it just takes a lot of them to to generate what I'm trying to generate so that is exactly the point is an individual going to be able to generate enough Force to make it meaningful and someone would argue yes well for them that would be you know when I was a a practicing geriatrician and I was going through my fellowship we did the a number of metrics to look at strength and one of those was a sit and um 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 10 reps three you know four to five sets you pick there's many different ways that it where the final repetitions are challenging where the final and the load is enough and there's wonderful data out of mcmas University that it doesn't have to be heavyweight as long as the stimulus 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 and are you generating enough activity to create adaptation and change and so a high ground movement for someone who's listening to this and and is 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 all 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 warten 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 and those are those type two fibers those type two fibers that transition with age to more type one fibers those long lean fibers you go from bigger to Bulky to less choosing activities to maintain those fibers also these fibers are bigger this is where 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 um people could think about in terms of these High Ground movements you mentioned hack squats uh leg presses come to mind leg extension leg curls leg curls lat pull Downs with a supported back any kind of RS rows a supported row again these are mostly machine exercises that you're describing they are they are which is UN machines so cables would be considered low ground because you're kind of in space and if you think about it what takes someone out in their 40s what takes someone out of the game it's a tendon injury tendonopathy 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 tendinopathies you get the thickening of these tissues you know people will say that tendon lays down much slower that the collagen turnover is much slower but actually muscle turns over 1 to 2% per day 10 pendens uh turn over maybe 0.5 to 1.5% per day it's not that substantially slow 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 a catabol crises but close what is the total duration of a resistance training workout that the typical person uh could use I 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 um but I always leave some gas in the tank it's 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 um you splits um that's uh my case and I run well you are much much larger than me well it's it's um it's the case now that I try and hit each muscle group directly once per week and then in directly 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 workout on Friday sprinting as I love that that's wonderful I think that the um three days per week whole body workout I think would work for a lot of people just to take the complexity out of it um so is it the case that the entire workout could be um constrained to 40 to 60 Minutes absolutely 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 um you know after they go through a neural um a neurological adaptation is that they will get more um growth and potentially progress a 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 um it's it's much more challenging for us to put on size or uh even get stronger I mean yes there is a particular Cadence but our improvements might be minute and when you're thinking about designing a program the current recommendations uh for physical activity which by the way do you know 75 roughly 70 maybe it's 78% of individuals do not meet physical activity guidelines and what are those again 5,000 steps per day 150 minutes of moderate to vigorous activity with two days a week of resistance training per week yeah so 150 minutes total and two days a week of resistance plus two days a week of resistance training um so that is what 30 minutes 7 days a week of activity just to put that into perspective that is how sedentary we are 50% of Americans are not even training is that true in other countries as well um 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 in the blue 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 um piling wood um are they walking more um are they caring active okay highly active and the blue zones are a funny thing because um you know some will say well are the the records kept appropriately and and Etc there is um a lot though despite that that we can learn from the blue zones and I think again uh 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 piece 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 interesting my observation of family friend friends um that include people who are very fit into their 80s and '90s and even Beyond in a few cases are that and here these are uh generalizations based on observation I want to be clear that the people I know who are still skiing in their 80s who are sprinting in their 80s you know not as fast as they used to who are still playing tennis um 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 um at least of some sort like skiing is you know there's some resistance involved depending on the complexity of the slope ET yeah and trees so um what do you think is going on there I mean there's a rich literature 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 um John Rady 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 due to the lack of movement will just metabolize uh portions of itself so the relationship between movement and brain health um seems Seems obvious but um yeah how many folks do you see out there in their 60s 7s 80s and 90s that are now doing resistance training do we know the percentages on that um I don't and I was just recently looking at the ACSM guidelines which which is the American College of sports medicine um for activity and older individuals I am not sure the percentage of individuals that are actually doing resistance training and partially um 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 um 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 and the intensity of the training goes down I guess we could Define intensity somewhat Loosely but still fairly by saying you know repetitions in the what you know 5 to 10 maybe 12 repetition range where the final two or three repetitions are challenging um in good form right maybe even to failure in good form does that does that seem like Fair yeah and and I would think of the intensity component because the Aging literature it 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 think people would have to push themselves with not extremely heavy loads but moderately heavy for them so was surprising to me as well and especially when we worked on some 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 um or Central adiposity and one would think that you require a lot of extra uh 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 and 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 um 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 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 skeletal muscle and the reason I say this let let me take a step back is that in the literature and you will often hear people say that only strength matters Size Doesn't Matter I don't believe that to be true I believe that we haven't been able to test muscle size appropriately and when we begin to test it there's a a way and this is I I think this is being done it it came from a a gentleman named uh Dr uh William Evans and he utilizes something called a D3 creatine and it's a deuterated tagged creatine and an individual will ingest 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 in 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 in sufficient 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 any time that you ingest your protein would be adequate however if you're older and you want to take advantage of resistance training plus dietary protein than consuming within an hour or so and again that number is the 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 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 know drink a away protein drink within an hour of resistance training or eating a meal that include a chicken breast or some eggs or or steak is that is that basically what we're talking about um it is is if you are eating a lower protein diet I would take advantage of that because you increase the efficiency you lower that anabolic resistance load um yes one could do that and I say this in a way that if you are young and healthy and you are training I don't really care when you ingest your protein but if you are a um 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 a 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 V2 Max I make it a point to try and do a long hike or jog once a week for me that 60 to 90 minutes I'm not obsessive about it in the sense that sometimes I'll go out and I make it social with a weight vet or maybe 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 lasts about 12 minutes and total and thank goodness it's only that cuz I'm basically sucking for air 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 I don't even consider that exercise I just consider that movement that's wonderful now you're talking about um non- exercise activity um 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 longer you know longer than a few minutes yeah I mean when you're talking about increasing V2 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 m maintain our physicality throughout life if you have got a ton of time and uh you can do slow steady state it's wonderful alternatively there's a lot of evidence that high-intensity interval training um Martin gabala would be a wonderful guest he is really the expert in high-intensity interval training and its changes in um insulin sensitivity influence on V2 Max and this is really going all out in a matter of 20 seconds there's moderate intensity interval training high intensity interval training Sprint interval training that will increase V2 Max in a substantially less amount of time and could be safer for an individual um the other way is improving skeletal muscle mass if you improve strength and hypertrophy you will improve your V2 Max albeit not exactly in the same way but both are beneficial and both will improve V2 Max and blood pressure and triglycerides and clinical outcomes that we care about it's wonderful to think about things um kind of nebulously 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 the cut off 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 are 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 um higher blood glucose I don't know exactly why this is It's thought that maybe because the red blood cells live longer it maybe also higher blood creatinine levels we do see higher blood creatinine levels when individuals have higher muscle mass that is uh typically a call that I get U many of my patients are uh large and buff as I would say and they almost all have higher levels of creatinin that doesn't mean that your kidney function is suffering uh one thing that one would do clinically would uh get a cattin C to correct and get a corrected GFR 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 um potentially but what I have seen are higher alt and liver enzymes and we see that very frequently in individuals that train intensely and it concerns you or doesn't concern it doesn't concern me right because it's just a consequence of the training and presumably it's transient it is transient typically um and we may see changes in creatinin with uh I have a one patient she runs 100 miles oh goodness she's in her 60s she's an ultra Runner yeah in her 60s and she's strong I mean she's stronger than me it's extraordinary and you think about what are the things that she needs to do to maintain the health of her muscle mass so that she can continue for long periods 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 gram 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 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 one 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 in women uh postmenopausal women and older populations creatine for sure uh the other supplement is uthan a uthan a is a postbiotic made from the gut microbiome and there's a percentage of people that can make it and the majority of individuals cannot make it interesting urethan a is the this connection which I find fascinating it's a gut muscle connection individuals that take urethan a I happen to be one of them there are many papers out there that improves mitophagy 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 um milligram doses do you recommend so I take between 500 and a th000 of uthan a really I 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 urethan a with creatine and some whey protein and maybe uh 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 doesn't matter what's so interesting about urethan 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 elianin 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 um mind you but looking at how disruption of the gut microbiome 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 Health 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 gut Integrity the Gap Junctions seem to open whether it's the training volume and the physiological stress that can easily be measured with zulin or Cal protectin sto samples do this but doing things that actually help the gut not just the gut microbiome but the gut Integrity 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 alphal albumin and lact aerin and these immunoglobulins that can be very beneficial whey protein it's interesting we talk a lot about how processed foods are negative but the reality is is that processed foods aren't positive or negative the highly palatable processed foods that are full of sugar we can all agree Maybe those are not ideal but whey 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's 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 uh very tight for the powder otherwise you will be wearing it your child will be wearing it is a bit of a disaster but yes noted uh 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 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 um again I 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 um there is not the general recommendation is around four grams but some individuals four to 10 grams which would be definitely on the higher end certainly can uh potentially thin your blood if an individual is going for surgery two weeks prior would uh suggest not taking it but where it 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 bloodwork all the time looking at whether it's an Omega Quant or an Omega an Omega index can be very valuable but it is a very easy supplement to take and it seems to be very beneficial 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 um convenience when traveling and things of that sort but the liquid forms are so much more affordable in order to hit that two grams a day or you know in this case two to four yeah two to four grams um again this also depends on the absorption for the individual that's why it's really important to do blood work I have some patients that require closer to six grams to be able to improve their Omega 3 to six 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 collagen I love collagen mhm collagen in my coffee collagen coffee strong I love strong coffee if you've never had it it's amazing collagen it's called strong coffee it's called strong coffee it has collagen it has eleanine in it really helps with the Jitters there's some good evidence with alanine to help with anxiety but collagen is interesting collagen is a I say protein it's not really it 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 branch chain amino acids but it is high in glycine Proline and hydroxyproline which makes it very unique in structure it is also very difficult to test the effect on tendons uh collagen protein on tendons because as you can imagine one would not want a tendon biopsy right sounds painful sounds painful also biopsies are painful um 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 imagine yeah it's like taking a small Quirk of tissue out of the muscle um 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 gram maybe 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 robust so in one scoop might have 15 grams but I think there's no negative to increasing collagen and quite frankly we don't get a lot of collagen in our diet the places in which you would find collagen or the gristle and meats or broth yeah yeah that's another great way to increase it so you take it once a day I do particular time of day in the coffee in in the morning so my coffee has collagen in it before I train yes I do and I typically train fasted aside from that and then I'll add in an additional scoop you mentioned fasted Maybe we should touch on fasting for a moment um I inadvertently have been doing intermittent fasting for years meaning I was never hungry for breakfast so my first meal lands at 11:00 a.m. or so plus or minus an hour on most days there are exceptions to that last meal typically I don't know 8:00 p.m. 700 p.m. sometimes 9:00 p.m. I'm not super strict about that and it basically boils down to anywhere from 2 to four quote unquote meals per day um a lunch a dinner and then some eating in between could you first comment on that architecture of eating um but maybe first on fasting specifically I mean what are the benefits or detriments to um having a feeding window of about 8 or nine hours um 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 um more food coverage throughout the day two benefit that I find from fasting number one calorie restriction number two bowel rest many individuals have gastrointestinal challenges when they are in a Tim restricted window they are not feeding all day long great point and 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 there's a a bit of a a negative because you have to balance this muscle protein synthesis they're always going through a synthesis and a catabolism so an an anabolic process and a catabolic process as you age it becomes more difficult to regulate that process and if you add in 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 g gram 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 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 uh we all are I suppose is 2 hours before my 11:00 a.m. meal enough does it have to be 3 hours could it be 1 hour I mean you can only assimilate and then oxidize 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: eating 30 to 50 grams of protein the muscle protein synthetic response will last 2 hours however when we talked about mtor there's other initiation factors like eif4 that will maintain itself for another four to 5 hours I see therefore the second meal is really not necess necessarily a muscle protein synthetic 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 um 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 gram of protein then that middle meal the real goal for that metabolically is to get enough protein to meet that 1 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 um all other tissues again 25% 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 four meals I think would be uh 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 uh in principle this is probably getting a bit more toward the afficianados 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 casine and milk proteins might be more advantageous for muscle Health in the final meal of the day or closer to bedtime I realize this is getting into the details but I'm sure a percentage of our listeners would be curious to do that and of course um milk proteins always make me sleep so uh kind of fits you know it's really interesting I I will say that milk protein casine seems to be slower absorbing and that's because of the impact with the the gut obviously but is there anything special about casine or milk protein the answer to that would actually be no but the 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 there's uh people will say high saturated fat or 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 um or a shot of uh full fat cream and I will mention the which I love every once in a while that's a guilty pleasure a shot of full fat cream with equal part espresso I'll take it I'll take it I will mention that the Lucine content in milk protein is a little bit lower okay or um say Greek yogurt are there any sort of um cryptic Champion proteins you know I 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 um cryptic proteins out there that are particularly good for us in terms of their amino acid content that people don't think of you hear these days about Li I frankly don't like the taste I don't like liver but um 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 um I'm on the second category so no no proteins come to mind is 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 5 gram of protein per 1 ounce versus meat meat has on average seven gram seven or eight red meat has seven or eight grams of protein per 1 ounce so interesting you know that this idea that you know eating muscle can support the health of muscle it makes sense though doesn't it it makes perfect sense and and You' explained very clearly as to why that why that is um okay we set aside liver um for this conversation some people are into cricket and maybe there is sorry I apologize to the well not to the Crickets The Crickets probably thank me for for my response but I'm not judging it's just my my personal visceral response um my other people may like insect proteins but what about other organ Meats heart um I know I mean around the world you see the consumption of of lots of different organ Meats is there any evidence that that heart um is a good protein or are we I'm generally looking at skeletal muscle as the the best source of of amino acids uh Heart is also a good source of protein it's also high in CoQ10 which is 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 are all they are all good sources of protein aside from collagen which would be that protein score of zero and if somebody insists on being vegan or vegetarian um let's just say Vegan what are their best options there are rice pea blends 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 we the one thing that I would say as individual's age a a vegan diet can be very challenging need to make sure that you are getting enough B12 zinc iron things uh nutrients of concern that seem to be going down in general and we're seeing decreases of that um 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 o you hear this stuff but um what's the story with magnesium that is true there seems to be um less magnesium in the diet very easy to supplement whether the 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 uh for muscle for brain do you 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 you're going to be unlikely to be deficient in zinc zinc is interesting because you don't want to supplement zinc 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 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 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 uh 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 the side effect can be uh muscle pain myalgia muscle soreness it can deplete CoQ10 um 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 nids can well aspirin is in a category of its own but nids in particular seem to suppress skeletal muscle at certain doses hypertrophy potentially and strength the other thing is um fluo quinolones they are antibiotics that can affect collagen and tendon turnover if an individual is on a Flor quinolone there's a risk for you hear a lot about these Achilles injuries yeah which sorts of antibiotics I think um is it like cypro and things like that people can injure themselves badly you should be uh 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 uh absorption of vitamins and minerals that do have long-lasting effects what are your thought thoughts on the glp1 analoges OIC monjaro real quick anecdote I was in New York City I was walking up the U side on a Sunday recently and there was a sign outside a store I saw that that said we carry OIC and monjaro and I thought the sign would say like we have you know ginges or something and so and I thought wellow that's guy I 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 comment volume and contentiousness that I had ever observed and I thought whoa there's really something here my understanding is that these compounds um 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 ma imagine excuse 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 um 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 it got them kind of out the gate you know 20 30 lb weight loss very quickly without um intense Cravings their appetite is suppressed and many of them are now also exercising and doing other things so I don't think we want to look at this or talk about this as an either or OIC monjaro 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 uh these medications are they're it's complex the issue of obesity the challenge with glp WS and dual Agnes like mongero glp1 and gips it is a complex conversation so the opinion that I'm going to give is going to be uh 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 gp1 Agonist L OIC will an individual might get a 13% weight loss and how long it a couple month that's good question yeah it's a it's a a titration it's a monthly titration but over a period of 24 weeks um wow it it certainly depends significant um yeah it certainly depends on the individual but it's utilized and increased month by month a four weeks SP B the other aspect is the Dual agones like mno tritide 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 trans formed 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 that's 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 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 uh gastric emptying well I would say yes and that's exactly what the medication is designed to do there maybe some risk with pancreatitis there is some discussion about thyroid um cancer in rodent models 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 peptides like lp1 analoges that have existed in somewhat Niche communities for a while um so including things like in the melanite stimulating hormone community that are now sold under FDA approval um for things like low libido um things like VII um and Addie we were mentioning Addie for for women for hyposexual desire disorder right the I don't know the history of Addie but um certainly the um Alpha mocy stimulating hormone related peptides the gp1 peptides things like celin which are in the growth hormone secretagogues all were viewed for a long time as kind of Niche Community Fitness Community but now at least the glp1 analoges 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 um mainstream it just takes some time and they become mainstream through the standard channels of FDA approval um which as is the case with OIC and W so it's great to hear that you Embrace sort of both sides like 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 a a poster in the doctor's office but some of it is and you really um are at the intersection of both those um those Landscapes thank you and and this idea of OIC and um tripti these gp1s that you know we talked a lot about protein and one way that it has a satiating effect is this gp1 um stimulation and one has to recognize that these glp Agonist these G Agonist last for a week the dietary protein effect is meal to meal so eating protein increases gp1 as does in drinking yerbamate te but probably to a lesser degree and more transiently more transiently and I I think that that is just an important 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 gp1 released interesting it seems as if that that 30 to 40 or so gram amount of high quality protein is the same amount that has a meaningful impact on the release of gp1 very interesting I did not know that so 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 muscle muscle is the organ of longevity and when we think about lifespan we think about health span and then we finally think about muscle span I would argue that that is right after lifespan 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 a good-look body even though I can appreciate it's only a small amount aesthetic but leveraging the aesthetic to have healthy brain function there's this idea that Alzheimers or certain types of dementia are type three diabetes of the brain skeletal muscle is the only organ system we have voluntary control over it is the only endocrine organ system we have voluntary control over it which means we have a responsibility to leverage it we've talked about these in a lot of detail today meaning you've Ed ated 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 one gram per pound ideal body weight an individual could certainly go to7 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 importance 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 that there's evidence that carbohydrates are helpful 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 it 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 gr titrate up or down depending on your metabolic health and or activity understanding that outside of activity 50 g 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 Topline 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 body weight absolutely okay 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 10 sets how many um reps you're doing I think that there's many weight in which one could do it right the only way in which someone 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 intervals seem to have a 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 licens 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 and the way that we think about our life how does that influence what we actually do and I could give someone the perfect plan and it doesn't matter if I give an individual a perfect plan if they're not willing to execute 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 an effective 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 can 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 um I sometimes think of the non-negotiables of the week um that unless I'm suffering from a really bad cold or flu which fortunately for me is pretty rare um that I'm going to get those three resistance training sessions in I'm going to try and get as much quality sleep as I can and I'll get those card iov vascular training sessions and when you talk about setting standards is that what you're referring to um are you talking about blood work standards are you talking about um aggressively trying to maintain um blood values in a particular range are you mainly talking about behaviors I'm talking about both uh 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 for 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 becom impossible and that's why we said standards the other aspect is an individual has to understand where they fail I take care of a lot of very successful entrepreneurs and just 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 would you know this better than anyone this dopamine high at that Pinnacle seems to be a place of vulnerability whether they will skip a training session or buy 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 they're 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 um I have a 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 of vulnerability is where people seem to go off track and never regain their footing if they do not recognize that and so I I can appreciate that we're 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 um and for the record you said it and I'm going to blast it out credit to you as much as possible because I think it's so critical for persistent um engagement in the kinds of behaviors and mindsets that lead to success over time so love this standards over goals uh principle um knowing where one fails points of vulnerability um beautiful concept painful to hear because of the uh realistic nature of it and that's exactly why it's pot so thank you for that as predict and predictable human beings are predictable in 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 are long-term strategies for overall health because that wave of Youth does close 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 for Success it's just the way that it is tell me about the neutrality component this is fascinating and I 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 that 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 were at another NFL team and he say to me he goes 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 es and 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 es 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 then being able to pick themselves up from an experience or a moment become much more challenging my most successful patients I'm not talking about financially I talking about the ones that are able to maintain and contain their health are the ones that are neutral in terms of tone and affect um no in terms of experience as they go through life they celebrate some wins they don't celebrate others very consistent with some of the um theories that I and a few others in the science Community have expounded around dopamine regulation it makes a lot of sense and where 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 that cycle becomes a habit and if one can teach themselves to Be steady for example going into a big workout maybe they mitigate the anticipation of that workout they're much more likely to continue on that way and it's what is so important about it is a trainable skill it's sounds like it's a lot about energy conservation yes mental energy not just caloric energy yes very interesting and so then you can do the things that matter and then you don't fall off the bandwagon because it just seems that each time a person 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've set a standard where this is the thing that you do Friday night you set 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 or 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 as aspects that go along with ill health and that will allow them a distraction I want read something about a person who was obese who then got in shape um 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 extreme selfishness and that surprised me I thought you know you know what better thing to uh do in terms of helping one's health and helping therefore the relationships in your life by you know segmenting out a small not you know a 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 you know 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 flipped the script on this and and I should say that was over goodness that was 2016 so it's been a long while and they have maintained um good health and staying in shape they 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 their transformation in their psychology and the different aspects of their life but um is that something that you see a lot that people just feel like um get in shape or paying attention to what they eat is is somehow selfish I think that some people do not feel worthy of 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 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 Oho 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 Health span 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 and and actionable detail thank you also for the work you do for being such a Pioneer in both maintaining an active clinical life seeing patience men women people of different ages different backgrounds Etc I know you also do some work I'll just mention this um because it is important you don't just work with people who um 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 um a point to support communities that um perhaps couldn't afford the kind of support 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 we'll provide links to all of those in the show note captions of course and I just love love love what you're doing and I know as great as it's been that 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 Gabrielle line does all this while maintaining a family with uh two children a happy healthy marriage and a husband in residency a husband in residency and she's Stills that's right shout out to Baylor um and still pursuing Advanced Training in yet additional fields of medicine so um you are a Phenom and I have both tremendous admiration and respect and gratitude for you so thank you so much thank you 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 note captions if you're learning from Andor enjoying this podcast please subscribe to the podcast on YouTube apple and Spotify that's a terrific zeroc 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 mentioned at the beginning and throughout today's episode that's the best way to support this podcast if you have questions for me or comments about the podcast or topics or guests you'd like me to consider for the hubman Lab podcast please put those in the comment section on YouTube I do read all the comments if you're not already following me on social media I am huberman lab on all social media platforms so that's Instagram X formerly known as Twitter threads Facebook and Linkedin and on all those platforms I discuss science and science-based tools some of which overlap with the content of the huberman Lab podcast but much of which is distinct from the content on the hubman Lab podcast so again it's huin lab on all social media platforms if you haven't already subscribed to our neural network newsletter our neural network newsletter is a zero cost monthly newsletter that includes summaries of podcast episodes as well as protocols as brief 1 to three page PDFs that include everything from deliberate cold exposure to exercise to sleep to optimizing dopamine to sign up for the newsletter simply go to hubman lab.com go to the menu tab scroll down to 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 5 years and researching for more than three decades which is entitled protocols an 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 the discussion to be as informative and actionable as I did indeed it has 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 [Music]