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Episode 633
The Doctor's Farmacy

Is it Worse to Be Overfat or Under Lean?

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If we want to age as well as possible, maintain function and strength, and stay independent as we age, there is a key area of our physiology that we need to pay attention to: muscle.

Skeletal muscle is the currency of aging; it’s an essential lever in maintaining optimal metabolic health, reducing body fat, and supporting longevity. And a major piece of building and maintaining muscle is protein consumption—which is often a controversial topic in the nutrition space.

Today on The Doctor’s Farmacy, I talk with Dr. Gabrielle Lyon about the science of muscle mass, protein sources, and healthy aging and how we can all pay attention to these things in our daily lives. 

Many people are confused about how much protein they should be eating. Dr. Lyon and I break down the right amount for optimal muscle synthesis and maintenance versus what the government’s Recommended Daily Allowance suggests, and discuss what that looks like for each meal of the day. We also talk about essential amino acids and why they are such an integral part of building lean body mass.

Dr. Lyon and I talk about the best sources of protein from a muscle-centric point of view, as well as the connection between dietary protein and mTOR. I like to call mTOR a “longevity switch,” and when and what we eat are two of the many factors that influence it. 

We also talk about the research on protein to reduce hunger and cravings, the best time to eat your highest protein meal of the day, and what Dr. Lyons’ daily diet and exercise routine look like. 

This is a really interesting conversation with lots of actionable steps you can take starting today.

This episode is brought to you by BiOptimizers, Rupa Health, and InsideTracker.

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I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Here are more of the details from our interview (audio):

  1. Why muscle is key to overall health and longevity
    (5:25)
  2. How much protein should you eat vs the government’s Recommended Dietary Allowance
    (11:12)
  3. Essential amino acids, animal vs plant sources of protein, and building muscle
    (18:55)
  4. How much protein do you need to eat with each meal?
    (29:04)
  5. Research showing that dietary protein will reduce hunger and cravings
    (33:54)
  6. High-protein food sources
    (37:22)
  7. Is meat bad for your health?
    (39:38)
  8. Stimulating mTOR, our “longevity switch”
    (45:55)
  9. Muscle-centric medicine
    (54:50)
  10. Dr. Lyon’s daily diet and exercise routine
    (1:05:09)

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Gabrielle Lyon

Dr. Gabrielle Lyon is a Washington University fellowship-trained physician in Nutritional Science and Geriatrics and is board certified in Family Medicine. She is the founder of the Institute for Muscle Centric-Medicine™ and has a private practice that services the leaders, innovators, mavericks, and executives in their prospective fields. In addition, Dr. Lyon also works closely with Special Operations Military. Her goal is to change the paradigm of medicine from obesity-focused to muscle-centric and change the way we think about health and medicine with high scientific integrity.

Show Notes

  1. Check out Dr. Lyon’s podcast, The Dr. Gabrielle Lyon Show, here.

Transcript Note: Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Introduction:
Coming up on this episode of the Doctor’s Farmacy.

Dr. Gabrielle Lyon:
Those individuals that have a higher protein breakfast are much less likely to crave later on in the day and/or go to the high satiety, highly palatable foods like you had mentioned for breakfast, like the French toast and the donuts later on in the 3:00 afternoon when everyone is going for it.

Dr. Mark Hyman:
Welcome to the Doctor’s Farmacy. I’m Dr. Mark Hyman. That’s pharmacy with an F, a place for conversations that matter. And if you ever worried about maintaining your function as you get older, about avoiding the disease of aging, about living to 120 and being able to do whatever you want, this conversation is important to listen to because it’s with one of the world’s experts in muscle and which is what you need and is the currency of aging. It’s Dr. Gabrielle Lyon, a good friend. She’s a graduate of Washington University, Fellowship trained physician in nutritional science and geriatrics. She’s also the founder of the Institute for Muscle-centric Medicine.
We’re going to talk about what that is. She’s a private practice that serves leaders, innovators, mavericks. I take her advice personally. She also is really amazing in terms of her work with the military and special operations military for the special ops forces who struggle with different issues. And her goal is to change the paradigm of medicine from obesity focused medicine to muscle-centric medicine and change the way we think about health and medicine with high scientific integrity. And she’s my go-to protein and muscle person. So welcome Gabrielle.

Dr. Gabrielle Lyon:
Hi. Thanks so much for having me. It’s really fun to get to have this conversation because actually you and I have had the muscle protein conversation for close to a decade now, and that is hilarious.

Dr. Mark Hyman:
It’s true. It’s true. It’s true, it’s true. I’ve learned a lot from you. So let’s get right into it. I just finished my book called Young Forever. I finished writing it. It’s coming out in February 2023. And in researching it, I really had to dive deep into this question of protein and muscle. And it’s a highly controversial subject, believe it or not because the science is not that controversial. But it’s very controversial when it comes to nutritional circles.
Before we sort of get into the controversy, I want to just get down to the basics about why muscle is the most overlooked organ when it comes to our health. Why it’s overlooked when it comes to our metabolic health and obesity. And how it impacts everything from how we regulate our blood sugar to how well we age, and why it’s such an important organ when it comes to longevity. So talk about why it’s important to our overall health and why it’s important to longevity and why it’s been this long forgotten organ.

Dr. Gabrielle Lyon:
Yes. Skeletal muscle. And when we think about skeletal muscle, that is a muscle that we have under voluntary control. You can go and exercise, you can think about it and you can contract it. Now, skeletal muscle is the most underappreciated organ. That’s right. It is actually an organ system, despite the fact that we think about it as it relates to locomotion, as it relates to exercise. It’s so much more significant than that, even though, of course, that is of critical importance. Skeletal muscle is the organ of longevity. And I can’t wait to tell you about what I mean when I say that. It is our [inaudible 00:03:19].

Dr. Mark Hyman:
You don’t have to wait. You can get right into it.

Dr. Gabrielle Lyon:
Yeah, yeah. Here I go. So muscle, when you think about muscle, I think about it really in a few different domains. Number one, as it relates to diseases of aging that we’re seeing. And when I say diseases of aging, I’m really talking about metabolic disease and then subsequently sarcopenia. So metabolic disease for the listener, we’re really talking about Type 2 diabetes, obesity, components of cardiovascular disease, Alzheimer’s, which we talk about is Type 3 diabetes of the brain. And overall insulin resistance, which is the hot topic. And insulin resistance simply means that your body requires, and it requires more of an output of insulin from the pancreas to move glucose into the cell. Now we’re like, well, what does this have to do with muscle?

Dr. Mark Hyman:
Yeah, exactly.

Dr. Gabrielle Lyon:
And I will get to that. What if I told you that muscle is one of the primary sites for insulin resistance? If we believe that insulin resistance is at the heart of these diseases that subsequently cause Type 2 diabetes and then obesity, then really skeletal muscle’s the focal point, it’s the pinnacle, not the periphery. So from a very tangible aspect, skeletal muscle is the site for upwards of 80 some percent of glucose disposal. Meaning the carbohydrates that you eat, the primary initial site of disposal is skeletal muscle. It’s also a primary site for fatty acid oxidation. You and I were talking-

Dr. Mark Hyman:
Which is what?

Dr. Gabrielle Lyon:
Yep. You and I were talking earlier about mitochondria. We think about fatty acid oxidation as a way generating energy, as a way of utilizing fatty acids in the bloodstream, moving and generating just overall energy. So glucose disposal, fatty acid oxidation, these are really the big things that when I think about skeletal muscle, I think about the importance of them. And then as we age, as an individual’s age, we see a decrease in the capacity of skeletal muscle. It becomes, like I had mentioned… I talk about this in the range of aging, but the reality is if you are sedentary, skeletal muscle metabolism, skeletal muscle defects can begin in your 30s. These diseases that you think about as aging actually happen much earlier. And the concept that a sedentary… In the data, in a lot of the research it says healthy sedentary, there’s no such thing.

Dr. Mark Hyman:
I don’t know where it says that. I haven’t read that.

Dr. Gabrielle Lyon:
It does. You will see studies that says this is a healthy sedentary population and this is what this study has done. And the reality is the homeostatic mechanisms in our body were designed for physical activity. Our genes, the way in which we utilize nutrients, all of this was designed to piggyback off of skeletal muscle metabolism and use.

Dr. Mark Hyman:
I mean, we had to use our bodies to survive.

Dr. Gabrielle Lyon:
Way more. Way more.

Dr. Mark Hyman:
Lift stuff, run, catch stuff, kill stuff, hunt stuff, pick up stones lots, right? So that’s basically-

Dr. Gabrielle Lyon:
A lot of which we don’t do anymore. So we don’t do this anymore. And one of the primary defects, I believe, all of these issues really start to begin in skeletal muscle decades before. Decades before we start to see elevations in blood sugar, decades before we start to see issues with insulin resistance because for a period of time when we’re young, we’re able to really leverage our youth, that wave of youth, to be able to account for some of these excess carbohydrate consumption, excess calories. And these are things that we have to really, really be aware of. And as we age, the muscle has the tendency, because if we get injured over a lifespan, it does become more insulin resistant and it takes on physiological changes like anabolic resistance, which I know we’re going to talk about.

Dr. Mark Hyman:
Yeah, we’re going to talk about that. That’s an interesting one.

Dr. Gabrielle Lyon:
How muscle is a nutrient sensing organ.

Dr. Mark Hyman:
Yeah. So we’re going to get to anabolic resistance, which is basically the idea that as you get older, it’s harder to build muscle. So there’s hacks you can do to fix that problem and stay well muscle well into your late, late life, even over a hundred years old. So we’re going to talk about that. I met a guy in Sardinia named Pietro who was 95 years old. The guy was so fit. I was like, holy cow, this guy’s climbing up and down mountains herding his sheep. And I’m like this is just incredible, because you don’t see this kind of physical fitness in the average 95 year old in America. It doesn’t mean it’s not possible, but it’s really interesting.
And so one of the things I want to get into is this whole idea of protein. Somehow we gotten off track when it comes to understanding protein in this country. There’s recommendations based on dietary guidelines about how much protein we should eat. It doesn’t really talk about the kind of protein or the quality of the protein and where it comes from or what it does to your body or how it works metabolically. But it’s really a really important thing to understand the history of protein recommendations and why they really are not meeting the needs of most people today.

Dr. Gabrielle Lyon:
I think that is a really, really great place to start. And before I came on here, I pulled up a couple stats for you because I know you love stats. And well, one, I want to say that when we talk about aging, we have to think about what actually kills people. And for 65 years and older, the leading cause of death is a fall. So I’m just going to say that’s the leading cause of death and that really directly relates to skeletal muscle. Next we have to think about 50 or so percent of women over the age of 50 eat less than the RDA of protein, which is 0.8 grams per kilogram. So that’s-

Dr. Mark Hyman:
Wait, wait, wait. Stop there. 50% of women don’t eat-

Dr. Gabrielle Lyon:
Over the age of 50. It’s actually 50-

Dr. Mark Hyman:
Older than 50-

Dr. Gabrielle Lyon:
It’s actually 52%. So 52% of women over the age of 50 eat less than the RDA, which is 0.8 grams per kilogram.

Dr. Mark Hyman:
So the RDA means what? Because people think that’s all the protein they need is what the RDA says you need. But that’s not actually true.

Dr. Gabrielle Lyon:
That’s not actually true. So protein, the RDA for protein is a recommended dietary allowance. Now that is 0.8 grams per kilogram. And that number hasn’t changed by the way, since the 70s. So that means one of two things. Number one, we haven’t had any new research come out that perhaps would mean that the recommendation should or should not change or number two, protein in and of itself is really a ignored macronutrient and fat and carbohydrates have really taken over the limelight. So it’s one of two things.

Dr. Mark Hyman:
But the RDA, just basically my understanding of it is it’s basically the minimum amount you need to not get a deficiency disease. So how much vitamin C do you need to not get scurvy? 30 units. How much need to not get osteoporosis and have good mental health and immune function? Probably 4,000, right? So that may be 10 times that amount. I mean I don’t think you need 10 times the RDA of protein, but what’s at the heart of that RDA? Because I think that’s key. Because I say, oh, I have 0.8, that’s easy to get.

Dr. Gabrielle Lyon:
Right and let’s leverage that. So 0.8 grams per kilogram is really the bare minimum to prevent deficiencies. And this was based on these old school nitrogen balance studies. And it was originally for animal husbandry to figure out how much protein was needed to grow or raise an animal. So what was the cheapest way that they could do it with the highest amount of carbohydrates, the lowest amount of protein, to still have some minimal growth and turnover for that animal. So number one, it’s not an optimal number and it really is based on the bare minimums.
When they started looking at humans, they looked at 18 year old men. And this was really during war time is when a lot of the discussion really picked up. And by the way, nutritional controversies and dietary protein recommendations have been a source of contention since the 1800s. So this has been something that has been going on for quite some time. Now, I will say that the recommended dietary allowance is the bare minimum to prevent deficiencies. So what does that translate to someone who is listening? Well, as you said, for some of the other micronutrients, vitamins and minerals, let’s take vitamin C for example.
The vitamin C recommendation is 60 milligrams or so a day. That is the minimum amount to prevent deficiencies.

Dr. Mark Hyman:
Scurvy.

Dr. Gabrielle Lyon:
Scurvy, yes. So the second, Mark, gets sick, I guarantee you he’s taking a thousand milligrams.

Dr. Mark Hyman:
Or more.

Dr. Gabrielle Lyon:
You know what I mean? Maybe more, maybe less. But on the flip side, when someone is going through say a catabolic crisis or let’s say they hurt their back or you now have pneumonia or some injury or say you’re just not feeling well, the individual doesn’t think, oh, I’m going to bump up my protein because that’s going to help my body recover, it’s going to help my immune system, it’s going to help with all the tissue turnover that I need. And this is a really big important flaw of our thinking in that for every other nutrient we think about the RDA as a minimum, everything else. So when we think about 150 grams of carbohydrates or when we think about a fat, we always think in terms, and I say this in absolutes, perhaps it’s not an absolute, but it’s really thought about as a minimum for everything else except for protein. And I want to lead into something else. So there’s something called the acceptable macronutrient range. And right now that recommendation for protein is between 10 and 35%. Wait, that’s a huge range. So let’s break it down.

Dr. Mark Hyman:
10% or 35%, that’s a big-

Dr. Gabrielle Lyon:
10 to 35%. So let’s break that down for an individual. So if we have someone who’s having 1500 calories and they’re at the low range of the acceptable macronutrient range, then they’re going to get 37 grams of protein.

Dr. Mark Hyman:
That’s very low.

Dr. Gabrielle Lyon:
Right. And then they’re now meeting their need, but then if they’re at the high end of the range, 35% or so, they’re going to get 131 grams of protein.

Dr. Mark Hyman:
That’s a big range.

Dr. Gabrielle Lyon:
It’s a big range. And it creates a lot of confusion, which is where my work, I believe, is very valuable. And my job is how do we teach people to protect their skeletal muscle in a aging population? Because the reality is we all are aging and there’s very specific protein recommendations. Again, it doesn’t talk about macronutrient distribution. It doesn’t talk about how much protein you need per meal, which becomes more important as you age. It really just talks about this overall 0.8 grams per kilogram in some nebulous term.

Dr. Mark Hyman:
So just sort of summarize it, basically the idea is that these protein recommendations are old. They haven’t been updated. And they are reflective of the minimum amount most people need to not get a protein deficiency, not the optimal amount necessarily to build muscle. And it doesn’t reflect what you need at different stages of your life, which are changing and it doesn’t talk about the quality of the protein. So let’s get into talking about what matters when it comes to eating protein to build, preserve and keep your muscle healthy because that’s something that most people don’t quite understand.
They think, oh well, I think eating a low carb diet, I’ll lose weight or I’m going to have a higher fat diet, I’ll be good for keto. But what actually is going on with the protein that we truly need to build muscle? And I’ve learned a lot about this from you in terms of how much you need per meal, what the amino acids are that are relevant for building muscle, where they come from and address some of the controversies there. Because I think a lot of myths are out there around dietary protein and there’s some pretty strong opinions out there.
I mean just in terms of the kind of vegan world, there’s some very powerful movies out there that seem to be very scientific. What the Health and Game Changers that would make you believe that you should be able to get all the protein you need from plants and that actually is a better source of protein and that it works just as well. And then you could basically lift up a car and look like Arnold Schwarzenegger by eating vegetables and beans and grains. But you have an issue with that. So I’d love you to break it down for us and help us navigate some of these myths and figure out what the truth is in the sciences.

Dr. Gabrielle Lyon:
Yeah, certainly. So when we talk about protein, we’re really talking about amino acids. And for humans we’re looking at 20 different amino acids, nine of which are essential. An essential amino acid means that you must get it from the diet. You must eat it. And these amino acids are needed in different amounts. And one of those amino acids is particularly important in building muscle. And by the way, the body requires all amino acids to build muscle, not just the essential. We really need all the amino acids. And out of the essential amino acids we’re really talking about, from my perspective, are the branched-chains. And that is leucine isoleucine valine. The branched-chain amino acids simply relate to the shape, the structure, of the amino acid. And this is where protein quality, that concept of protein quality comes in.
Protein quality is not a questionable term, it’s not an emotional term, it’s strictly is hard, fast biological numbers. It’s I’m 110 pounds, I’m five foot one, these are my numbers. A protein quality is determinant on these limiting amino acids, these essential amino acids. When we think about what we consider high protein and good high quality protein, we’re really looking at, again, these leucine isoleucine and valine in these essential amino acids. And they are highest in animal sourced foods. What becomes so important… It doesn’t mean that you can’t get it from plants. You absolutely can, but I remember calculating quinoa numbers because people thought quinoa was a big deal and it came out where quinoa was really important for protein and this was a great source to get your protein. And really you’re looking at six cups of quinoa based on those essential amino acids and specifically the branched-chain would equal one small chicken breast. Because, again-

Dr. Mark Hyman:
Okay, six cups of protein-

Dr. Gabrielle Lyon:
Six cups of quinoa for one small chicken breast.

Dr. Mark Hyman:
Which is probably over a thousand calories compared to 200 calories for protein from chicken.

Dr. Gabrielle Lyon:
And it’s carbicide. So it becomes carbicide.

Dr. Mark Hyman:
Carbicide? I never heard that word. What is carbicide?

Dr. Gabrielle Lyon:
Yeah, these are very important conversations because the narrative is so loud. And by the way, I have to say the high quality proteins like red meat, the consumption is down 40% by the way. And we right now eat a 70% plant-based diet right now as is. It doesn’t mean it’s not ultra processed and processed foods. But the reality is 30% of our diet comes from animal-based products, where by the way, is where we get the most nutrients, the most iron, high quality protein. So again, when we think about protein, we have to have a discerning eye and a discerning thought in the way that plant protein simply structurally is different than animal protein. And plants make a appropriate amino acid profile for plants and animals and animal products make an appropriate amino acid profile in the appropriate amounts for animals.

Dr. Mark Hyman:
So kind of what I’ve come to understand is that if you want to build muscle, you need to eat muscle. Would you agree with that?

Dr. Gabrielle Lyon:
You do need protein to build muscle, you do need also exercise, you need resistance exercise.

Dr. Mark Hyman:
No, just back up a little bit. What I’m asking is, you can eat like a grain or a bean, which has some protein, but if you really want to build muscle, you need to eat other muscle, which is chicken, fish. I mean chicken, fish, beef, those are muscles. Those are animal muscles.

Dr. Gabrielle Lyon:
So the data would support. So Stew Phillips, who you’ve had on podcast, very fine scientist, he recently did a study and what it showed was that the strength and muscle gain was similar in younger adults as long as protein amounts were equal. Now that doesn’t mean that we’re talking whole foods, but we’re talking about leucine quality and protein amounts that are equal. So could you do it with plant-based proteins? I always try to have scientific integrity in anything that I’m talking about. Do I think that you could build muscle purely on a plant-based diet? Yes. Do I think that would be optimal? I don’t. Do I think that if you are looking for a whole food diet and we have to move beyond just the macronutrients, things like creatine, iron, zinc, carnosine, anserine, all these food matrix components. I think that-

Dr. Mark Hyman:
All those things you mentioned, by the way, are things only found in animal protein.

Dr. Gabrielle Lyon:
Correct, correct.

Dr. Mark Hyman:
Yeah. Creatine, anserine, carnotine right? carnotine is actually carne, carnivore that comes from, right?

Dr. Gabrielle Lyon:
And the next question is, why is it so divisive? You and I, Mark, have been in this space for a long time. I would say 10 years ago when we first met, I don’t even think people were arguing about this. At least not on any large scale.

Dr. Mark Hyman:
I mean, yeah, for sure. So let’s go back and unpack this a little bit because I think what you’re saying is really important. There are certain amino acids that are found in higher concentrations in animal protein that are critical for activating muscle synthesis. In order to start the process of building muscle, you need eat a certain amount. And I think what I’ve understood is about two and a half grams of leucine per meal to actually activate the switch to turn on muscle synthesis. So if you don’t eat that, it tends to turn into just a source of calories, which isn’t terrible but it’s not building muscle-

Dr. Gabrielle Lyon:
Right. That is accurate. So what you’re talking about is something called-

Dr. Mark Hyman:
And by the way what you’re saying is in order to get that much leucine you need to eat six cups of quinoa or four ounces of chicken, right?

Dr. Gabrielle Lyon:
Yes. Three ounces of chicken. Yes. It’s just not feasible if you are going to try to do it through a whole food based way in which you could do it. Could you do it through soy and other plant isolates? You can. I have concerns over plant isolates over a long period of time. Again, I have no-

Dr. Mark Hyman:
What you’re saying when you mean in English is if you’re eating processed protein powders that come from plants, from pea and soy.

Dr. Gabrielle Lyon:
Doesn’t exist in nature.

Dr. Mark Hyman:
They’re jacked up often too, right?

Dr. Gabrielle Lyon:
Yeah. They just don’t exist in nature and over the long term that concerns me. And again, I just want to say that I’m not against anyone who wants to be vegan or vegetarian. It’s completely personal choice, but you can’t say that it’s healthier for you. And when we are talking about building muscle, the key amino acid really, as you had mentioned earlier, is leucine. And leucine is that branched-chain amino acid that is high in things like whey protein and animal. So for every 30 grams or four, a little over four ounces of beef or something like that, you’ll get 30 grams of leucine, or chicken.

Dr. Mark Hyman:
30 grams of protein, not leucine.

Dr. Gabrielle Lyon:
30 grams of protein. Yes. Pardon me, 30 grams of protein, you’ll get two and a half grams of leucine, which really works as a switch, especially midlife. When you’re younger you could get away with a little bit less protein. But when you are older, I like to think of a practical application of 30 grams of dietary protein, 30 grams meaning a little over four ounces to get a robust leucine hit. So what happens with leucine? Yeah.

Dr. Mark Hyman:
So just to clarify a little bit, just before you jump into that. To clarify what you’re saying is if you want to be vegan, you can do it, but you need to supplement the amino acids either as a amino acid supplement or with protein powders that are jacked up with extra branched amino acids. That you can’t just do it with plants alone and eat the quantity of food that’s going to require you to do to actually build the muscle. Is that accurate?

Dr. Gabrielle Lyon:
It’d be very difficult. That is accurate. And it would be very difficult to eat-

Dr. Mark Hyman:
I can’t eat six cups of quinoa. I mean, I don’t know about you.

Dr. Gabrielle Lyon:
And then if we translate that over to a younger person-

Dr. Mark Hyman:
Even two cups of beans.

Dr. Gabrielle Lyon:
We do a real disservice to say younger individuals when we take away or say that animal based products are unhealthy. I think that when we think about the people that have lower appetites, like an older population, again, I’m a geriatrician by training, they’re not eating a lot. So if we say, okay, you’re not eating a lot, but I really want you to go vegan or vegetarian, but you really need to consume dietary protein to protect against sarcopenia, which is loss of muscle mass and function. And also to protect your skeletal muscle. I think we really run into problems.

Dr. Mark Hyman:
So finish what you’re saying about the amount of protein.

Dr. Gabrielle Lyon:
Amount of protein, really thinking about the overall protein content of your diet is important. Number one, if we were thinking about the hierarchy, how much are you getting in a 24 hour period? The next most important aspect of understanding dietary protein is really thinking about as a meal threshold. So protein as it relates to a meal threshold amount. And this was done-

Dr. Mark Hyman:
Which means how much you need to eat at each meal.

Dr. Gabrielle Lyon:
Exactly. And this just done-

Dr. Mark Hyman:
Trying to speak English here because I don’t think everyone’s-

Dr. Gabrielle Lyon:
Oh, come on.

Dr. Mark Hyman:
…as smart as you.

Dr. Gabrielle Lyon:
Your listeners are savvy. They know. You guys know, give me a break. How much protein you need per meal. And actually this discovery was out of Don Layman’s lab where he discovered this amino acid. Well one of his graduate students, Tracy Anthony, really, they discovered that leucine was required in a meal amount, which is an amazing contribution to science. So what does that mean for the listener? That means in order to maintain healthy skeletal muscle, you do want to create a flux. You do want to be able to turn it over, you do want to be able to stimulate this complex within the muscle called mTOR. And mTOR is mechanistic target of rapamycin that is stimulated by insulin, it’s stimulated by amino acids, it can be stimulated by exercise. And really leucine is the primary driver for stimulating mTOR. And then subsequently, assuming you have all the amino acids, you will be able to lay down new tissue, new protein, you generate new proteins.

Dr. Mark Hyman:
Yeah. You just sort of dipped into something that’s really important, which is a couple things I want to get back to. One is, how much protein do you need to eat per meal? Does it matter when you eat it? Can you eat all your daily protein requirements in one meal? Do you need to spread out through the day? And how does that work? So let’s kind of tackle that and then we’re going to come back to mTOR because that just opens up a whole can of worms about aging, longevity-

Dr. Gabrielle Lyon:
I’m excited to hear what we land on with this, because you and I have talked about this many times. How you ingest dietary protein is really dependent on a couple things. Number one, your goals, number two, your age, and number three, your activity. When I think about dietary protein, and this is what I have seen in the literature, this is what I’ve seen from, again, my longtime mentor, we collaborate and put together these protocols is the first meal of the day, whenever you have it, is the most important. Whether you’re having it at 8:00 in the morning or 11:00 or noon, the first meal after an overnight fast when you are in a “catabolic,” which means a breaking down state-

Dr. Mark Hyman:
Interesting.

Dr. Gabrielle Lyon:
… is the most important meal. That is the primary meal to get dietary protein correct, no matter what your goals are. Again, this is my opinion, and this is what we’ve seen in some of the studies and our work together, Don’s and mine work together, is that first meal of the day is most important. The reason is you’re coming off of an overnight fast, your skeletal muscle, which again, skeletal muscle is the voluntary muscle control. Are you jacked and tan? What your biceps are?
That meal and hitting a minimum of 30 grams of protein actually upward between 30 to 50 grams, which seems like a lot, but can be very valuable because not only do you optimize for muscle protein synthesis because, Mark, as you had mentioned before, it either turns on or it doesn’t. But really you want to turn it on and you probably want to max out the system. And to max out the system, you want to push that leucine number threshold up a little bit higher. So between 30 and 50 grams, that first meal of the day is most valuable. And that’s also the meal I tend to have a lower carbohydrate amount in because I really want to focus on dietary protein. Again, can you add carbohydrates? You can, if you’re training, if it’s within your macronutrients range, you totally can.

Dr. Mark Hyman:
So this totally explains why 93% of Americans are in poor metabolic health because the average breakfast in America is a disaster, right? French toast, pancakes, toast, cereal, bagels-

Dr. Gabrielle Lyon:
Sounds delicious

Dr. Mark Hyman:
… muffins. I mean the sugared coffees people have, I mean I think people are using a ton of oat milk these days and people don’t realize that oat milk is-

Dr. Gabrielle Lyon:
It’s called oat juice. It’s called-

Dr. Mark Hyman:
Oat juice?

Dr. Gabrielle Lyon:
I refuse to call almond milk almond milk, it has to be almond juice. You have to call it almond juice. It’s so ridiculous.

Dr. Mark Hyman:
And it’s so high. I mean some of them are better in terms of their carbohydrate load. But it’s like you have an oat latte, you think, oh, I’m doing something healthy, but actually you’re just taking a big load of sugar. And so I think that’s a big disaster. We don’t have typically high protein breakfast in America. You might have steak and eggs and bacon if you’re a cowboy, but it’s a pretty unusual to doing that. And eggs have gotten a bad rap, so people think, oh, I should stay away from eggs.

Dr. Gabrielle Lyon:
This is another really good point that you bring up, is that it’s also, so the dietary protein to stimulate muscle, but also the subsequent nutritive effects of the amino acids. Well, dietary protein also will decrease hunger. And there’s been an fMRI studies that will show that those individuals that have a higher protein breakfast are much less likely to crave later on in the day and/or go to the high satiety, highly palatable foods like you had mentioned for breakfast, like the french toast and the donuts later on in the 3:00 afternoon when everyone is going for it.

Dr. Mark Hyman:
So basically it helps regulate your appetite, it builds muscle, it prevents you laying down fat. I mean, if you want to be-

Dr. Gabrielle Lyon:
It helps with your metabolism just by the sheer fact of there’s a thermogenic effect of protein.

Dr. Mark Hyman:
Yeah, we didn’t talk about that.

Dr. Gabrielle Lyon:
The thermic effect of protein, really… And I’ve thought a lot about this because it’s very variable in the literature and I believe it’s variable because when people are under consuming protein, they don’t hit enough protein to stimulate muscle protein synthesis. When you hit enough protein to stimulate muscle protein synthesis, that’s where you get that real thermic effect of food where it actually takes energy.

Dr. Mark Hyman:
So this is a really important concept. So basically some foods take more energy to metabolize.

Dr. Gabrielle Lyon:
And or utilize, right?

Dr. Mark Hyman:
That’s what I mean by metabolize, so utilize. Others, you have to process protein and it actually uses more energy. I wrote about this in Ultra Metabolism almost 20 years ago and-

Dr. Gabrielle Lyon:
I cannot believe it’s been that long, but yes.

Dr. Mark Hyman:
Yeah. And that was so clear to me that if you eat protein, you actually get this thermic effect, which is kind of like a bonus. You can literally lose pounds and pounds and pounds simply by choosing more protein calories than carbohydrate calories.

Dr. Gabrielle Lyon:
And what’s really interesting is that, and this is Steven Simpson’s work, and that’s the Protein Leverage Hypothesis. And basically what he reported that was reducing protein from 18 to 13% of the diet, which is not a huge, so you’re talking just a few percentage increase-

Dr. Mark Hyman:
Decrease.

Dr. Gabrielle Lyon:
… or a few percent decrease from 18 to 13% that this can lead to a 10% increase in overall calorie consumption. The body will drive to eat dietary protein. There is a driver because we need it. Again, it’s essential. Carbohydrates are not essential. Fat, there’s some fatty acids that are essential, but protein is arguably the most important macronutrient for aging and longevity and muscle health.

Dr. Mark Hyman:
Well, so just to kind of summarize, basically quality matters. You need to have either jacked up, processed vegan protein powders to meet the needs, particularly as you age with extra leucine, which has problems in and of itself when you’re eating a processed food. And who knows what that’s going to do to us. Two, you need to make sure you have plenty of protein in the morning after your overnight fast. Three, it’s good to spread your protein out throughout the day. And four, we need more protein than we thought. Probably 1.2 to two grams per kilo. So for the average person, you say 30 to 50 grams, what is that? That’s like three, four ounces of chicken and six ounces, eight ounces.

Dr. Gabrielle Lyon:
Just about four ounces. Yeah, so for one gram or one ounce, there’s about seven grams of protein.

Dr. Mark Hyman:
So for 50 you need like seven or whatever, right?

Dr. Gabrielle Lyon:
Yeah. So seven. Yes. So exactly. And this is where, again, you can use yogurt, you can use eggs, you can use whey protein. Can you use some plant-based sources as long as you’re having a higher quality protein? You can, but again, it’s just making sure that you’re meeting that amino acid threshold and it’s just much easier to do with animal products. Could you do it from a whole food vegan diet? Probably, just the amount of food that you would consume it would require a lot of activity.

Dr. Mark Hyman:
Yeah. One of the things I’ve found very effective is I do my workout in the morning and then I use goat whey and I can get fairly high concentrations of protein using goat whey in a shake. So I tend to use this goat whey one, because I think it’s probably got less of a one casein that can be in regular goat whey, because there’s still some casein in whey and because it’s likely to be more regeneratively raised and so forth. So I think the reasons I do it, I tolerate it better. I don’t have any issues with it. If I have regular whey, sometimes I have issues with it. Do you think whey protein is a really a good hack for people?

Dr. Gabrielle Lyon:
I do.

Dr. Mark Hyman:
And they’re good as you age.

Dr. Gabrielle Lyon:
I do. And we know that there is a lot of research out there utilizing whey protein with an older individual, with older individuals. It’s interesting, I say older individuals, is that defined as 65 or above or is it perhaps-

Dr. Mark Hyman:
I’m going to be 63 since, so this older is like 90 I think.

Dr. Gabrielle Lyon:
Right. So whey protein is really good because it also has immunoglobulins. There’s other food matrix components to whey above and beyond just the macronutrients. But again, we don’t really eat for protein, we eat for those amino acids. And that’s where the guidelines have kind of gotten wrong. Because if you look at the label, you look at the back of a label and it just says protein, but it doesn’t say the amino acid profile, doesn’t say the quality of the protein. So long story short, yes, whey protein is very valuable and I think it’s a great “hack” for an individual for sure. And it’s really easy to tolerate and use. It’s a great way to get protein up.

Dr. Mark Hyman:
So I want to touch on a couple things. One thing next I want to talk about is mTOR, and then I want to talk about this controversy about meat being bad for your health. It could be good for your muscle, but is it bad for your health?

Dr. Gabrielle Lyon:
Are we still there?

Dr. Mark Hyman:
And is it bad for the environment? So I think most people believe that meat is unhealthy. And I think I see this over and over because I get asked about this all the time. And I think the general consensus out there in the public is, and I think part of this is due to very good PR campaign by-

Dr. Gabrielle Lyon:
Right. I agree with you.

Dr. Mark Hyman:
… subsets of the population who believe-

Dr. Gabrielle Lyon:
I can agree with that.

Dr. Mark Hyman:
… eating meat is bad for you and bad for the planet. So that that’s really important. Now ethically, if people have a moral issue around killing animals, I have no problem with that. And I have many Buddhist monk as patients. That’s okay. I don’t have any discussion about that. But in terms of the science around planetary health and human health, I want to get into that.
But before we do that, I want to keep on this track of aging. And like I said, I just finished my book called Young Forever and it was so clear to me that maintaining muscle mass as we age and preventing sarcopenia is so key to maintaining our metabolic health, our sexual health, our hormonal regulation, our brain health and our functionality and our ability to do whatever it is we want to do as we get older.
So the question that keeps coming up within this community is… Oh, and I see a lot of actually longevity experts, like the top scientists, talk about how you should be vegan in order to promote longevity. And it’s sort of shocking to me because they’re saying they want to do this because it induces autophagy, it doesn’t stimulate mTOR like traditional protein. Now, mTOR is this switch, I call it one of the longevity switches, it’s a nutrient sensing switch for those listening, that detects the amounts of amino acids and sugars in your blood and then responds to those. If there’s none, it actually inhibits mTOR, which then starts this process of self-cleaning called autophagy, which is essentially the idea that we’re going to live longer if we can have our recycling and cleanup crew working more often. And I agree that’s really important. But at the same time-

Dr. Gabrielle Lyon:
Which do you think is more important having muscle mass as you age?

Dr. Mark Hyman:
Well I think it’s a false argument, right? It’s a false argument.

Dr. Gabrielle Lyon:
Okay, fair enough.

Dr. Mark Hyman:
You don’t have to choose. I don’t think you have to choose. I think you can live and eat in a way that stimulates autophagy and also eat and live in a way that increases mTOR activation, develop muscle. So it’s like you need the demolition crew and you also need the construction crew. So let’s talk about that from your perspective about this sort of controversy about limiting protein and particularly animal protein in order to inhibit mTOR, which is key to aging. And it’s true when you inhibit mTOR through one of those calorie restriction or whether it’s through rapamycin or other strategies, it actually does extend life and address a lot of the disease of aging and the hallmarks of aging. So can you kind of walk us through from your perspective as a muscle-centric scientist and physician

Dr. Gabrielle Lyon:
And a Wash U trained geriatrician

Dr. Mark Hyman:
Yes. An expert in longevity and aging.

Dr. Gabrielle Lyon:
So you mentioned-

Dr. Mark Hyman:
The way, for those of you don’t know, Washington University is one of the top medical schools in the world. So you might have heard of Harvard and Stanford, but Wash U is right up there.

Dr. Gabrielle Lyon:
You mentioned longevity experts and I would say longevity experts, especially those in the public right now are very mechanistic. You may hear the conversation. So I think it’s really important that we set the stage of where the information is coming from. So longevity experts, typically rodent models, I don’t know any randomized control human trials, mechanistic data from individuals who are interested in the mechanisms of longevity. Now you show me the geriatricians and the experts in sarcopenia and the experts in muscle and aging where any of them are arguing to restrict dietary protein because of mTOR. I would say none of them would say that. And I would say that there are multiple randomized control trials that support optimal dietary protein above and beyond the RDA. In fact, there’s multiple papers. I know there’s a position paper, which I’ve sent to you, the [inaudible 00:39:10] paper, but there’s multiple other papers that will always show that individuals that have more than the RDA, 0.8 grams per kilogram, more than the RDA will have better body compositions, maintain lean muscle mass, have better blood pressure, lower metabolic syndrome, lower fasting triglycerides, all of these things.
So I think it’s really important for your listener to understand longevity expert mechanism and in the trenches, geriatricians, sarcopenia experts and muscle experts who perhaps, who perhaps have not infiltrated the space yet, so that becomes very important to understand.

Dr. Mark Hyman:
But you’re changing that.

Dr. Gabrielle Lyon:
I’m working on it, right, because I’ve seen it and I also am trained in nutritional sciences, which is again, very different when you are trained in nutritional sciences and a physician versus looking at… Doesn’t take away from these very fine career scientists, but I think that conceptually we’re really, really missing the mark. And in fact, when we think about mTOR, again, this is one mechanism. So if people are afraid of red meat, and we’ll get back to that, the question is what is the mechanism of action that “red meat” is so bad. You have to tell me can’t be TMAO for those that are interested, it’s like this-

Dr. Mark Hyman:
Oh wait before you into the meat bad for you thing.

Dr. Gabrielle Lyon:
Fine, fine.

Dr. Mark Hyman:
I want to go back to the mTOR thing.

Dr. Gabrielle Lyon:
Let’s talk about mTOR.

Dr. Mark Hyman:
We got to unpack this a little bit. It’s a Goldilocks problem. You don’t want to stimulate it all the time.

Dr. Gabrielle Lyon:
Correct.

Dr. Mark Hyman:
But you also don’t want to inhibit it all the time.

Dr. Gabrielle Lyon:
I agree.

Dr. Mark Hyman:
So how do we do it in a way that when actually gives us time for autophagy and self-cleaning, which I do think is critical for longevity and-

Dr. Gabrielle Lyon:
Well, there are other ways to do autophagy.

Dr. Mark Hyman:
Exactly. Okay, we’ll get into that. And then what is the right amount and timing of protein to stimulate mTOR to build muscle?

Dr. Gabrielle Lyon:
These are great questions. Let’s talk about mTOR mechanistic target of rapamycin, which is you called was a longevity switch and absolutely important and valuable and it is maintained within our tissues. It’s actually mTOR, mechanistic target of rapamycin, is in every tissue. It is in the brain, in the pancreas, the liver, skeletal muscle. What is so fascinating about mTOR is that it’s exquisitely sensitive to different stimuli depending on the tissue it’s in. So skeletal muscle is exquisitely sensitive to leucine and dietary protein. The pancreas and the liver are more sensitive to increased levels of insulin, which come from increased levels of calories and carbohydrates. So you’re with me so far?

Dr. Mark Hyman:
Yeah, I’m with you.

Dr. Gabrielle Lyon:
So the question becomes, if mTOR is in every part of the body, it’s been maintained forever, wouldn’t it make more sense that when we think about diseases of aging and things like cancer, which are related to obesity, 40% of cancers are related to obesity. Wouldn’t it make sense that perhaps we really focus on excess carbohydrates, excess calories, because that is, we’re looking at pancreas, liver, and all these other organs versus skeletal muscle, which is particularly sensitive to amino acids. By the way, mTOR stimulation and skeletal muscle is also sensitive to resistance exercise, which means resistance exercise stimulates mTOR. So if you believe that mTOR is bad because protein, then you have to believe exercise is bad because the pathways are the same.

Dr. Mark Hyman:
So just to kind of dumb it down for me, because I like really simple guy. I think it’s important as I begin to think about this to go, okay, wait, if I basically take time away from eating at all, right? If I make give myself 12 hours overnight, which everybody should be doing right? It’s called breakfast. Eat dinner at 6:00 and eat 6:00 in the morning, that’s 12 hours. If you eat dinner at 6:00 and eat breakfast at 8:00, that’s 14 hour fast. If you do it a 10, that’s a 16 hour fast. If you give yourself that time, it allows your body to activate these ancient longevity switches that help us to prevent longevity related disease is and addresses the hallmarks of aging. I really think that’s true. But then when you are eating, you need to actually make sure you’re eating the right amounts and types of protein to activate mTOR, right? Is that fair to say?

Dr. Gabrielle Lyon:
That is very fair to say. And also what you said as well that was really important is that you don’t want mTOR to be going on all the time. You don’t want to be eating these small meals that are high in carbohydrates. Those are things that, or even small meals throughout the day that are high in protein. You don’t want to be stimulating mTOR all day long.

Dr. Mark Hyman:
So that idea of eating five or six or seven times a day?

Dr. Gabrielle Lyon:
You don’t want to do that. I would agree with that.

Dr. Mark Hyman:
That’s snacking. Snacking is one of the worst things that ever happen to America. It’s just unbelievable. I mean, I’ve been to all the sort of longevity zones and just like nobody snacks, there’s no snack food. It’s like an American invention to sell more crap and more processed food.

Dr. Gabrielle Lyon:
So I would agree that the idea is that you stimulate this mTOR, this mechanism, whether it is for muscle protein synthesis or just by eating, because essentially you do, over discrete meals. You shouldn’t be snacking. It should be, ideally, I can appreciate individuals wanting to eat two meals a day. I think that two meals a day would be enough to maintain skeletal muscle health, assuming that you’re optimized that first meal and that last meal of the day. So you’re pushing mTOR stimulation up those two meals of the day. And then you can have a smaller meal midday if you need, but that would be perfectly adequate.

Dr. Mark Hyman:
Yeah, correct. Great. Okay, so I think we answered that question. It’s a Goldilocks problem. It’s not good or bad, it’s about how much and when. So let’s talk about health, maybe we can have great amounts of muscle, but are we going to get heart disease and cancer and diabetes and all the things that people say from potentially eating too much animal protein?

Dr. Gabrielle Lyon:
I haven’t ever seen that data. And in fact when you-

Dr. Mark Hyman:
Me neither, I’m just asking

Dr. Gabrielle Lyon:
And I think that when-

Dr. Mark Hyman:
It’s the prevailing view, right?

Dr. Gabrielle Lyon:
It is. But when you actually look at, say the risk ratio or the hazard ratio, let’s say you were to look at the risk ratio of disease and cancer or meat and cancer, they’re insignificant. So in order for something to be significant, it has to have a risk ratio above two. And none of the data supports that. It’s just not significant. And I think the things that we know that can really affect health span are smoking, obesity, a sedentary lifestyle versus something that is so nutrient dense, like dietary protein. We’ve really missed the mark. And if people are concerned about autophagy or proteostasis or mitophagy, there are other ways to do it while protecting skeletal muscle. Like you said, through exercise, through calorie restriction, these are means, or even cyclical protein restriction, these are means to perhaps augment these buzz words like autophagy.
But as we age, we have to be very careful. You are up against a lot. And the reality is you have to plan for collision with the enemy. And the enemy could be an illness, the enemy could be something that is outside of your control. So you must really optimize for skeletal muscle mass. You must do strength training. The only way to improve muscle mass health is through exercise and dietary protein.

Dr. Mark Hyman:
So basically that’s the key. You got to not just… The way I explained it to people is like if you want to make soup, you need to put all the ingredients in the pot, but then you got to turn on the heat.

Dr. Gabrielle Lyon:
Turn up the heat.

Dr. Mark Hyman:
So basically the heat is exercise. If you put all the protein in a pot and you don’t do any exercise, it may not have the benefits you want, it’ll still help to some degree. But I think the key is the timing of exercise and the kind of exercise that we’re doing. And that is really critical to muscle. So strength training, resistance training is so key. Also interval training, which is really jacking up your intensity so that you kind of stimulate your mitochondria to function better, so that’s really key.
Let’s just talk about protein quality for a minute. Not in the view of vegetable or animal protein, but even within animal protein, are they all created equal? Is a grass fed cow or a feedlot cow the same or a wild animal the same as a feedlot cow or grass fed cow? And what’s your perspective on the quality and where we get our animal protein from?

Dr. Gabrielle Lyon:
I will say that there are poor… Well, number one, we have an entire globe to feed. So the reality is we have a lot, a lot, a lot of people to feed. So I want to say that so while we’re talking about dietary protein, the quality, I acknowledge the fact that we are very lucky to have the capacity to eat high quality protein. When it comes to the majority of cattle, the most cattle is raised from small farms. It just is. The reality is the majority of cattle is from small ranch farms. And then the next question is grass fed versus or conventional feed lot raised. And I would say typically the animals go to feed lots for finishing. From a dietary perspective, am I concerned? I am not necessarily concerned from a nutrition perspective. I think the high quality protein would rank number one.
And I don’t want people who say financially struggle. I want them to eat high quality protein. So whether it’s conventional, organic, I’m okay. Again, maybe there’s a difference in omega 3s that might be variable. But again, maybe you’re not eating beef to get your omega 3s. Maybe you’ll take a supplement. The next question would be, of course, then we think about regenerative farming and how can we contribute to that? And that’s all very valuable. But I really want to have the listener in mind is that these kinds of meats are very expensive.

Dr. Mark Hyman:
For now, for now.

Dr. Gabrielle Lyon:
For now, yeah.

Dr. Mark Hyman:
Yeah. Just like my first calculator was over $100 and my first computer was $3,500 for four megabytes of a hard drive and one megabyte of RAM. So I think we’ll get there and I’m working a lot in the food system and to kind of support regen agriculture. And I think it’s going to happen, but it’s just going to take time.
So I want to get into the conversation that you’re really creating, which is why we need to shift from an obesity focused narrative about medicine, weight loss, and move to a muscle-centric version of our thinking about medicine. And it’s a very different idea than most of us were trained in. We talked about weight loss, we talked about the idea of getting fat off our body, but we don’t talk about muscle as part of this issue and it’s super important. And if you don’t address that, you basically will lose muscle as you lose weight. And then your metabolism will be slower and then you need less calories. So you get in this vicious cycle if you don’t understand how to preserve and maintain or even build muscle as you’re losing weight. So can you talk about the whole idea of muscle-centric medicine? How do you come up with it? What does it mean and how did it influence what we have to do, what we have to eat and how we have to exercise?

Dr. Gabrielle Lyon:
The concept of muscle-centric medicine really came from a combination of my undergraduate training. So I trained in human nutrition, vitamin mineral metabolism at the University of Illinois with Dr. Donald Layman, and then obviously residency. And then I did a fellowship. So I did a postdoc after I completed my residency in nutritional sciences and obesity medicine and geriatrics. So it was a combination research for two years in combination with clinical responsibilities, a medical training fellowship with geriatrics and obesity. And we were working on a study and the study was looking at the body composition and brain volume. It was looking at what were some of the brain changes that we would see with within obesity. And it was really interfacing the concept of Type 3 diabetes.
And Mark, you’ve known me for many years, I am very warm and loving person. I became very attached to some of the participants that I felt very much personally responsible for them. And there was one woman who was just an amazing woman. She was a mother of three in her, I don’t know, maybe she was her early, somewhere in her fifties. And she was the typical mom who had put herself last and her three children first and her husband first, and had struggled to lose 20 pounds her whole life. So she was going through that cycle, that exactly what you’re talking about. And she was one of multiple patients that I had seen like this. So I was also running an obesity clinic that we met once a week and we weighed everybody. It was like a whole thing.
And I imaged her brain. We did an fMRI study of her brain and her brain looked like the Alzheimer’s brain patients that I was working with. So this was obesity. And I felt at that moment I had this aha moment. I felt that we and I had failed her. I felt that we were looking and constantly trying to chase body fat and this rigamarole of always losing weight and dieting and all this stuff. And obesity wasn’t the thing that everybody had in common. It was actually low muscle mass that everybody had in common.
And I realized that she wasn’t over fat, she was under muscled. And that the origins of her problem and the perspective of her problem, and the subsequent consequence of a brain looking like Swiss cheese, which was just so devastating to see was actually a muscle issue first. And I felt very personally responsible and I began to think, how can I change this conversation? How can I never let something like that happen to another person again?

Dr. Mark Hyman:
Amazing. So most of us know, okay, we can get on the scale and figure out our weight, but we don’t necessarily have a clear view of how do we determine if we are under lean or under muscled.

Dr. Gabrielle Lyon:
Right.

Dr. Mark Hyman:
And I think most people are over fat and under lean. It’s not just being overweight. And I think the key of measurement is key on here. And how do we start to measure this?

Dr. Gabrielle Lyon:
Well, traditionally when we think about skeletal muscle mass… Well number one, unless you’re a geriatrician, you’re not really thinking about it. You’re always thinking about weight.

Dr. Mark Hyman:
I’m a family doc, I think about it.

Dr. Gabrielle Lyon:
Yeah, yeah. But yes, of course you do. But typically you don’t do the things that we think about in sarcopenia where we’re looking at how many times can you stand up from your chair, how fast can you walk? What’s your gate speed? How much can you grip?

Dr. Mark Hyman:
Grip strength, right.

Dr. Gabrielle Lyon:
When you think about it, they’re kind of like a geriatric assessment, would be in a typical geriatric assessment. But the one thing that actually we don’t typically do in geriatrics and what nobody really does is they don’t look at the ratio of appendicular lean mass. So it’s appendicular lean mass, which is the lean tissue on your body. So not your trunk but your arms.

Dr. Mark Hyman:
Your legs and your butt.

Dr. Gabrielle Lyon:
And this is one way… Right, it’s your appendage, your appendix, whatever. It’s your appendicular. You know what I’m talking about?

Dr. Mark Hyman:
Your arms and legs.

Dr. Gabrielle Lyon:
Your arms and legs. And so that is one way, and it’s not really commonly used because it’s basically, and I have the numbers. So for example, it’s a ratio of appendicular lean mass over height squared.

Dr. Mark Hyman:
Oh, boy, that’s a mouthful.

Dr. Gabrielle Lyon:
And no one really cares. And we actually were looking at this, so I have a book coming out, but that book’s not coming out until September. And we actually put models in there that we looked at the data and basically for sarcopenia, and I’ll just give you this number, is that anything less than seven kilograms per height squared is considered sarcopenia. So this is an appendicular ratio. So it’s seven kilograms per height squared for men is sarcopenic, and then less than around five and a half.

Dr. Mark Hyman:
And how do you measure the arms and leg muscle?

Dr. Gabrielle Lyon:
So, great question. So usually DEXA. DEXA, which people have access to, but it’s not as frequent, and then a CT and MRI. These things are not necessarily very easy to access. Another thing that people can do for a weight measurement or for a body composition measurement is a waist circumference. So that should be less than half your height. Yeah, waist height ratio.

Dr. Mark Hyman:
Yeah. So I think you just brought up something I think is actually widely available but not used, which is a DEXA machine. So the DEXA machine is a dual-energy X-ray absorptiometry, whatever, t’s a big mouthful, garbo, medical garbage language. Anyway, it’s a test we use all the time to test for osteoporosis in women and it’s a pretty standard test. And in the software for the machine, you can load up a measurement, a tool, that looks at your body composition and the distribution of fat. So when you get on a body composition scale, you can get a rough idea of the body composition, but you don’t get a distribution.
With the DEXA scan, you can see is it in your arms and your legs? You have a really skinny arms and legs, but a big belly or you have a lot of fat around your belly, but you still have more muscle on your arms and legs. You can actually tell much more about where the fat is, how much muscle you have, where it is and isn’t through that machine. And I think it should be basically standard of care. It should be getting a blood pressure, it should be getting a blood sugar level or a cholesterol level.

Dr. Gabrielle Lyon:
I agree. I’m hoping that it will move in that direction. And then the other-

Dr. Mark Hyman:
Because it wakes people up, it freaks them out when you say, oh my God. I remember this kid as part of this movie Fed Up that I was in about childhood obesity. I met with this kid and his family in South Carolina and we did DEXA scans on the whole family. And in normal body composition, it should be 10 to 20% body fat for a guy and maybe 20, 30% for a woman. And if you’re an athlete, it actually may be lower. So I’m like 6% body fat. You’re probably less than 20% body fat is my guess. Maybe you’re like 3%, I don’t know. And this kid was like 50% body fat and he’s like, am I going to become 100% body fat? I’m like, no, you have bones and you have some muscle.

Dr. Gabrielle Lyon:
Right.

Dr. Mark Hyman:
Yeah, and so it was a shock and it got him awake to what was happening in his body, which you often need a little kick in the pants to think differently about your health. But I’ve seen this happen to people, so I encourage people to seek it out and find somewhere to get a DEXA scan. Which is most imaging centers, most hospitals, most clinics that do this actually have it. You just have to check and see if they have that program for the body composition.

Dr. Gabrielle Lyon:
And we do that for every patient. We do that for every patient. We think it’s really valuable. So you make a really good point is how much muscle is enough? I don’t think that we know that. I think that is still a nebulous concept because muscle is very difficult. It’s not homogeneous, it’s not all the same kind of tissue, really like fat tissue. Whereas muscle has different fiber types depending on your genetics, depending on what you’ve done. So the tissue isn’t uniform much like fat tissue. So it’s more difficult to assess and look at. But eventually I think that we will move to, at least I hope, ultimately at least once a year we’ll do an MRI, probably an MRI of a body composition. And the other thing I just want to mention is you really want to be aware that there’s this concept that being overweight you carry more muscle doesn’t mean that it’s healthy muscle. Fat can infiltrate into muscle.

Dr. Mark Hyman:
I call it a rib eye steak versus a filet mignon, right?

Dr. Gabrielle Lyon:
Exactly. So that’s another aspect that becomes very difficult. And then the other thing you mentioned about being on under muscled is we have to think also about those physical performance and strength measurements. And that can be different for anyone. And not necessarily the grip strength or how long you can hang, but really determining, okay, what is your baseline squat? Can you do that? Or what is your baseline leg press? Or some kind of marker, how many pushups you can do. But also getting in line with knowing yourself and tracking yourself and seeing if there’s improvement.

Dr. Mark Hyman:
Yeah, for sure. I read a study recently that if you can do 40 pushups, your risk of heart disease was dramatically lower. Right? I couldn’t do 10 when I was 50. I could do like 75 or 80 at one go.

Dr. Gabrielle Lyon:
100. We’re going to do a push up challenge. I did a push up challenge with my friend Sean Stevenson, he beat me [inaudible 01:00:20].

Dr. Mark Hyman:
Of course as well. I mean, he’s a crazy guy.

Dr. Gabrielle Lyon:
He’s a beast.

Dr. Mark Hyman:
So I want to finish up by asking you what your daily routine looks like in terms of diet and exercise and how someone with your level of knowledge and expertise shapes their diet and their day to build muscle and have a muscle muscle-centric life.

Dr. Gabrielle Lyon:
Right. I thank you for this question. I am fast most of the morning and I’ll eat around 11:30 and that will be… I’ll eat say cottage cheese or I’ll have some 30 gram of protein meal. I’ll have cottage cheese, maybe I’ll have some Greek yogurt.

Dr. Mark Hyman:
Is it after your workout or before?

Dr. Gabrielle Lyon:
Oh yeah. So I don’t eat after I work out. I train heavy three days a week. So I train heavy three days a week and I typically do legs. I’ll do some kind of full body movement, maybe it’s kettlebell swings or pull ups, something like that. But I really focus legs heavy three days a week. I’ve been getting back into CrossFit. I’ve been going to a place called CrossFit Stealth. So I’m just waiting to hurt myself again. I think last time I… Who knows. But now that my book is done and my babies are almost two back into CrossFit and I’ll do that once a week, I’d like to kind of do some of that metabolic conditioning. So that would be a day where I would do some kind of high intensity interval training. So that’s four days a week. And then I’ll do some kind of zone two cardio training two or three days a week.

Dr. Mark Hyman:
But do you eat after you work out?

Dr. Gabrielle Lyon:
I do. I do.

Dr. Mark Hyman:
So the protein you’re talking about is after you work out.

Dr. Gabrielle Lyon:
The protein? Yes, but it’s not immediately after. So again, it’s depending on your age, it can be within a 24 hour period. I think where individuals really benefit from dietary protein after they eat is depending on if they’re older or not. Or really I think that data would support if you’re younger, as long as it’s in a 24 hour period-

Dr. Mark Hyman:
It doesn’t matter.

Dr. Gabrielle Lyon:
… then it doesn’t really matter. But as you get a little bit older, or if you are-

Dr. Mark Hyman:
What does older mean?

Dr. Gabrielle Lyon:
I know. I know.

Dr. Mark Hyman:
40, 50, 60, 70?

Dr. Gabrielle Lyon:
I don’t know. I don’t know that answer. But also I also think that there’s some room that if you’re sedentary, so if you are younger with older muscle, and I say older muscle and I say this slightly like obese muscle or or possibly impaired or having low grade chronic inflammation, I think that there would be no reason not to eat. So let’s say you have a lower anabolic response, which simply means that it’s more difficult for you to build muscle. I think if you are one of those people training hard and then potentially not stressing about having protein after. But if you can, it could be beneficial, could be beneficial. I think this is a really important concept in that if you don’t have time for the concepts that we’re talking about, so if you say you don’t have time to exercise and you don’t have time to eat dietary protein, then you better have time for sickness.

Dr. Mark Hyman:
My funny slide I often use is, would you have time to exercise an hour a day or be dead 24 hours a day?

Dr. Gabrielle Lyon:
That’s hilarious. That’s hilarious. Right?

Dr. Mark Hyman:
There is an old quote. If you don’t make time exercise, you have to make time for sickness. So I think that’s right. What’s your book called that’s coming out?

Dr. Gabrielle Lyon:
So the title might change actually it’s called-

Dr. Mark Hyman:
The Dr. Hyman Diet?

Dr. Gabrielle Lyon:
No, no. Yours is Forever Young, right?

Dr. Mark Hyman:
Young Forever.

Dr. Gabrielle Lyon:
Young Forever. So I think, so this is a working title. It may be called Forever Strong, but it’s a title in process. So Forever Strong and it will be about the Revolutionary Science of Muscle and Nutrition for Extraordinary Health.

Dr. Mark Hyman:
Coming out when?

Dr. Gabrielle Lyon:
September 2023.

Dr. Mark Hyman:
Okay. We’re going to stay tuned for that. I’ll have you back on my podcast about to talk about that.

Dr. Gabrielle Lyon:
But it goes on presale. And actually I have to call you because I have no idea what I’m doing, but it goes on presale in February. So I don’t know if the presale’s important.

Dr. Mark Hyman:
Oh cool.

Dr. Gabrielle Lyon:
Cool.

Dr. Mark Hyman:
And you have a great podcast to get, The Dr. Gabrielle Lyon Show.

Dr. Gabrielle Lyon:
I do. You’re going to be my podcast as a matter of fact.

Dr. Mark Hyman:
So you can listen to that.

Dr. Gabrielle Lyon:
You want to know what it’s called?

Dr. Mark Hyman:
The Dr. Gabrielle Lyon Show, I think it’s called that.

Dr. Gabrielle Lyon:
It is. It is. And, yes, it is. Again, you are going to be a guest to talk about your book. We’re going to talk all about this. And guess who is a physician in my practice now?

Dr. Mark Hyman:
I don’t know.

Dr. Gabrielle Lyon:
Brian Stepanenko.

Dr. Mark Hyman:
Oh, wow.

Dr. Gabrielle Lyon:
Do you remember Brian?

Dr. Mark Hyman:
Yeah.

Dr. Gabrielle Lyon:
Yep. So Brian is former military, great guy. So yeah, so if people want to be a patient of mine. They can apply on the website to be a patient. Also very active on Instagram. I have a newsletter, all the things.

Dr. Mark Hyman:
And definitely check out your website, drgabriellelyon.com. You have a free guide on your protocol, so that’s great. You can get that information. And I encourage you, if you like this podcast, to share it with everybody, your friends and family. Everybody needs more muscle. And leave a comment, how have you actually learned about what works for you in terms of losing weight, building muscle, and how has your diet changed to help you or maybe not. And we’d love to hear from you and subscribe wherever you got your podcast and we’ll see you next time on the Doctor’s Farmacy.

Outro:
Hi everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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