#234 – Why your workout isn’t working for you and what to do instead for improved metabolic health and body composition | Dr. Gabrielle Lyon & Dr. Casey Means

Diet and exercise culture tends to prioritize calorie restriction and calorie burning via cardio workouts. While fat loss is beneficial, building and maintaining healthy muscle mass is also crucial for metabolic health and longevity. Dr. Gabrielle Lyon and Dr. Casey Means discuss Lyon’s book “Forever Strong,” why strength-training should be a priority for workout routines, how muscle is the body’s metabolic currency, and why boosting protein intake aids in adding and preserving muscle mass.

Helpful links

– Gabrielle Lyon, DO: https://drgabriellelyon.com/
– Forever Strong: A New Science-Based Strategy for Aging Well by Gabrielle Lyon, DO: https://drgabriellelyon.com/forever-strong/
– Muscle-Centric Medicine: https://drgabriellelyon.com/muscle-centric-medicine/
– Dr. Gabrielle Lyon Show podcast: https://drgabriellelyon.com/podcast/
– Gabrielle Lyon, DO, on Instagram: https://www.instagram.com/drgabriellelyon/
– Gabrielle Lyon, DO, on Twitter: https://twitter.com/drgabriellelyon
– Gabrielle Lyon, DO, on YouTube: https://www.youtube.com/channel/UCWPQJeWz4pvccA3lIoZ7j1Q
– Casey Means, MD, on Instagram: https://www.instagram.com/drcaseyskitchen/
– Casey Means, MD on Twitter: https://twitter.com/DrCaseysKitchen

**2:58 — Dr. Casey Means shares her enthusiasm for Dr. Gabrielle Lyon’s book**

Gabrielle Lyon, DO, is launching her book “Forever Strong: A New Science-Based Strategy for Aging Well.” Dr. Means had the pleasure of being an early reader.

> It truly has changed my life. I read it, and as I was reading, I thought, “There are so many people I just want to give this to who are, I think, feeling stuck in their health journey.” I genuinely believe the missing piece is that they’re not focusing on muscle. And what’s so cool about muscle is that it’s a whole set of things that you put into your life rather than take out of your life. And so let’s just jump in right there because you have a very different thesis for what’s going on in our crazy metabolic disease epidemic in our country. And the central thesis of your book is that we are approaching the obesity crisis all wrong. We are so focused on fat loss, and we’re not focused on muscle gain and muscle health. So why is this shift so important and how can we start to bring a muscle centric focus into the healthcare system?
>

**8:28 — Muscle is our metabolic currency**

Having more healthy muscle mass helps with glucose regulation and contributes to overall metabolic health.

> Muscle is our metabolic currency. It is our health currency. It is the only actual currency that can’t be bought, sold, bargained for: it has to be earned. And when it relates to metabolism, it is the primary site for glucose uptake. What is glucose? Glucose comes in the forms of the carbohydrates that we eat, and we’re talking about 80% of glucose uptake goes to skeletal muscle. Skeletal muscle makes up some 40% of the human body. This is the primary site. When we are talking about metabolic dysregulation, we’re talking about elevated levels of insulin, elevated levels of glucose, elevated levels of triglycerides—all of these markers that kind of coalesce into this concept of metabolic syndrome or insulin resistance. A primary focus of this is skeletal muscle. So skeletal muscle is the metabolic sink, the primary site for glucose disposal, a primary site for fatty acid oxidation, which is really important to understand. It’s also a primary site for—and the only site for—myokine production.
>

**17:36 — According to Dr. Lyon, gaining muscle is more important than losing fat**

Muscle is more metabolically healthy than fat. And while losing excess fat is beneficial to health, we also need to prioritize maintaining and gaining muscle mass.

> Skeletal muscle is going to increase your survivability against nearly all diseases. And, in fact, the loss of skeletal muscle is likely more critical than the impact of gaining fat. So this changes the paradigm of thinking, right? Because the conversation is all about, “Well, if you gain weight, if you gain fat, this is an issue.” Clearly this is a problem, but it’s actually much more detrimental. I hesitate to say much more, but again, this is my scope of work. This is the lens at which I view things through: the loss of healthy skeletal muscle is much more dangerous than the gain of body fat—because of the metabolic implications because of the survivability going forward. And what’s amazing about this story and what’s amazing about this paradigm of thinking is that it’s something that we actually can do something about.
>

**21:31 — Muscle mass is protective against sarcopenia**

A lack of adequate skeletal muscle puts us at risk for frailty later in life. Frailty occurs because of sarcopenia, declining skeletal muscle.

> Again, we have to think about how do we put together a diet and nutrition plan where it’s not that we’re losing weight, but what we’re actually losing is fat. So for example, if you were to put someone on a hundred percent starvation diet—which obviously we wouldn’t do—but if someone were to go on a hundred percent starvation diet and lose five to six pounds a week, at least half of that would be lean tissue. This takes us back to the concept of what modalities are we going to use to optimize body composition while losing the appropriate amount of weight. When we think about weight loss just through a calorie deficit, we do nothing for mitochondrial function versus if we think about how do we lose weight while stimulating skeletal muscle—now we can impact mitochondria. We can lose fat and do something better, like improve mitochondrial function, as opposed to dietary interventions alone—which as we have seen with this huge public experiment of yo-yo dieting, ultimately people become sarcopenic or they suffer from obesogenic sarcopenia, which is the gain of fat, loss of skeletal muscle sarcopenia. For many people, they know what that is. Visually, as individuals age, they get skinnier, they get smaller. Sarcopenia is a loss of mass and function, and again, body composition is the lowest hanging fruit for all health and wellness, and it’s never too late to start, which is incredible to think about. And when we correct for body composition issues, we optimize for skeletal muscle.
>

**28:44 — Dr. Means raises the question about menopause**

The loss of estrogen that occurs when one is nearing menopause puts women at risk for metabolic health issues.

> How about with menopause? It just feels like there’s this tidal wave of people starting to realize that we are so behind on menopause care, and half the population will go through this, and doctors have no idea what to tell them. Women go off this metabolic cliff after menopause if they’re not really vigilant about it because our estrogen drops. All of a sudden women start out pacing men for obesity and diabetes and Alzheimer’s dementia—two to one with dementia.
>

**29:53 — The benefits of focusing on metabolic health in the menopause transition**

Worsening metabolic health can exacerbate some of the classic menopause symptoms, such as weight gain, hot flashes, and more.

> From a metabolic standpoint, just from a mood-enhancement standpoint, we do know that because of this influence on BDNF, that the data does support exercise to enhance mood in general. We also know that the fitter a person is going into menopause, that potentially the lower the significant experience of menopause is. There’s no reason why we wouldn’t try to be the fittest best version of ourselves going into a potentially challenging time. Now, that being said, I do think that if you are a candidate for hormone replacement, there’s a huge benefit to that. I don’t think individuals should suffer. I think that there’s a lot of good evidence to support estrogen, progesterone, and testosterone.
>

**34:26 — Dr. Lyon encourages people to reevaluate the type of exercise they are doing**

Resistance training is crucial or metabolic health and overall health

> If you have done yoga, Pilates, or walking for years, and your body composition is stayed the same, then the metabolic input that you are putting into the system is not enough for the outcome that you are looking for. And we’ve all seen that person, right? We’ve all seen that person at the gym who’s on the treadmill. They’re there six days a week doing their jogging for 45 minutes, and their body has not changed ever. If we do the same thing over and over again, as we age, it becomes more detrimental because, now as hormones shift, the ability to build, protect, and maintain muscle without the proper input decreases for those individuals. If you are listening and you are doing your cardio every day and you’re going to the gym, I would say that’s amazing. But what I’d like you to do is I’d like you to swap out three days a week of some kind of resistance training.
>

**37:04 — Dr. Lyon discusses the importance of getting enough protein**

Protein is necessary for building and protecting muscle mass, but many people don’t get enough.

> One thing we know for sure is one way to protect skeletal muscle is through increasing dietary protein. Again, you need dietary protein, and you need resistance exercise. You need those two things to support health and longevity. There’s a lot of controversy about reducing dietary protein for longevity, and my answer to that would be: “Would you rather be frail and weak and have an extremely poor quality of life—always worried if you are going to fall, break a hip, not be able to lift your groceries, or would you rather be robust and capable throughout the rest of your life?” So these are the things that we have to be very careful about when we hear this narrative about reducing dietary protein. We’re already not getting enough. We’re not getting enough to support the quality of the tissues that we need.
>

**41:04 — Dr. Lyon discusses the timing of protein intake**

Dr. Lyon recommends prioritizing protein intake at breakfast and di

> So that first meal is the most important. And then I would also say that that last meal before you’re going into an overnight fast is just as important. So you prioritize dietary protein at the first meal and the last meal, and then of course the next macronutrient you can decide whether it’s carbohydrates or fats. I would say I don’t go over a 1:1 ratio of protein to carbohydrates. I cap a non-exercising individual at maximum 50 grams of dietary carbohydrates per meal. Again, you have to figure out your carbohydrate tolerance. But I think that there can be a dysregulation of metabolism with too much glucose—and the body can dispose of around 50 grams over two hours in a sedentary individual. And then fat, you know, you’ve got to calculate how many calories you need over time, and then you can kind of put fat in there as you wish.
>

**48:48 — Dr. Lyon discusses supplementation with creatine**

Creatine helps support skeletal muscle.

> Well, it’s interesting because creatine is stored in skeletal muscle, and women actually have lower stores of creatine in the body. Creatine is very well-studied. It’s been around for decades. I do believe that if I were to pick one supplement and a woman isn’t eating a ton of calories or isn’t eating a ton of red meat, I think creatine would be it. It has impact on brain function; it has impact on energy production typically. It helps with athletic performance. There are just all kinds of things that creatine has the potential to do. I think it’s very valuable. There’s even some evidence to suggest that various amounts are needed during various times in a woman’s cycle, that potentially she needs more when she’s menstruating. Again,  I’m not totally convinced on that literature, but over time, it’s clear to me that women definitely benefit from supplementing with 5 grams of creatine a day, 3 to 5.
>

Gabrielle Lyon (00:00:06):
The one thing that all these people had in common from the nursing home to the obesity clinic wasn’t obesity in and of itself. It was the fact that they all were under muscle. It struck me that for the last 50 years, we were trying to fix the wrong problem. And of course, when I asked my colleagues and I looked into the literature, it was still all about obesity. Again, it wasn’t an obesity problem which is potentially why we weren’t getting any better at fixing it, it really was having unhealthy skeletal muscle, and that’s really where Muscle-Centric Medicine was born. And I knew that if I could get this message out to the world, that I could change the trajectory of how people age.
Ben Grynol (00:00:52):
I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health, and along the way we have conversations with thought leaders about research-backed information so you can take your health into your own hands. This is A Whole New Level.
Casey Means (00:01:21):
Hello and welcome to A Whole New Level. This is Dr. Casey Means, Co-founder and Chief Medical Officer of Levels, and I could not be more excited about this conversation today. We have Dr. Gabrielle Lyon here today, the queen of muscle. And when I started my year on January 1, 2023, my word of the year was strength. So I think I manifested meeting Dr. Lyon because literally following her, reading her book, consuming her content voraciously has been one of the biggest factors in me feeling inspired and motivated and capable to gain strength this year. So I am so grateful to this woman personally and professionally.
(00:02:05):
She is such a force. You know her from her incredible work of creating the field of Muscle-Centric Medicine, her Instagram and social channels. She has hundreds and hundreds of thousands of followers. She has a YouTube channel. She has an incredible top podcast, The Gabrielle Lyon Show, which you got to check out, and she is coming out with a book that’s going to change lives and is going to have a major impact on the obesity epidemic, but also the human thriving of people all over the world. It’s called Forever Strong: A New, Science-based Strategy for Aging Well. It comes out on October 17, 2023. Pre-order, pause the episode and literally go pre-order it now. There’s information on how to in the information below this podcast. It’s really mind-blowing and it is a totally different paradigm for approaching our chronic disease epidemic that is ravaging Americans today.
(00:02:58):
Dr. Lyon is a board-certified family medicine and fellowship-trained physician in nutritional science and geriatric. She advocates for the practical application of resistance training for health performance, aging, and disease prevention, how to use protein effectively to build muscle and be healthy, the forgotten macronutrient that we’re going to talk about today, and is just all around one of the most inspiring people I’ve ever met. So welcome to the show, Dr. Lyon.
Gabrielle Lyon (00:03:31):
Thank you so much for that absolutely beautiful introduction. I’m so grateful to be here talking to you. And by the way, you got an early copy of my book, one of the very first people to read it, so thank you so much.
Casey Means (00:03:43):
I feel so honored. It truly has changed my life. I read it and as I was reading it, I thought there are so many people I just want to give this to who are I think feeling stuck in their health journey and I genuinely believe, I think the missing piece is that they’re not focusing on muscle. And what’s so cool about muscle is that it’s a whole set of things that you put into your life rather than take out of your life. And so, let’s just jump in right there because you have a very different thesis for what’s going on in our crazy metabolic disease epidemic in our country, and the central thesis of your book is that we are approaching the obesity crisis all wrong. We are so focused on fat loss and we’re not focused on muscle gain and muscle health. So why is this shift so important and how can we start to bring a muscle-centric focus into the healthcare system?
Gabrielle Lyon (00:04:36):
Wonderful question. And the first place I’d love to start is a story about where this came from and how this happened. I did my research fellowship, so I did a clinical fellowship in geriatrics and nutritional sciences, and then I did research in obesity medicine at Wash U. And I think that we all go into medicine because we want to either alleviate suffering or really make people’s lives better. And at the time, I was working on a study and we were looking at body composition and brain function. I was working doing this clinical research and then of course my rounds as a physician was in the world, geriatric clinic, aging, nursing homes, the end of life, and really deeply depressing because there’s always a choice as to how we age.
(00:05:31):
And one study participant really changed my entire world. Her name was Betsy, she was a mom of three in her, I don’t know, mid-50s, big brown eyes, curly hair, an infectious smile. We all know somebody like that. And at the time, she had always struggled with weight and always had struggled with obesity, 20, 30 pounds, a lifetime of yo-yo dieting, you name it. As much of your listeners are probably thinking, Jenny Craig, Weight Watchers, all of the things, cycled through multiple different kinds of diets, the weight loss fad, followed the food guide pyramid to a T, and the results were devastating. At the end of it all is a really destroyed body composition, meaning a lot of body fat and very little muscle.
(00:06:28):
And at the time, we were doing brain imaging, and I imaged her brain and her brain looked like the beginning of an Alzheimer’s brain, and it was at that moment where I knew what was in store for her and I felt personally responsible. Even though I was not her direct physician and even though I hadn’t been caring for her for years, I felt responsible. I felt that the medical community had failed her.
(00:06:56):
The one thing that all these people had in common from the nursing home to the obesity clinic wasn’t obesity in and of itself, it was the fact that they all were under muscle. And it struck me. It struck me that for the last 50 years, we were trying to fix the wrong problem. And of course, when I asked my colleagues and I looked into the literature, it was still all about obesity. And again, it wasn’t an obesity problem, which is potentially why we weren’t getting any better at fixing it. It really was having unhealthy skeletal muscle and that’s really where Muscle-Centric Medicine was born. And I knew that if I could get this message out to the world, that I could change the trajectory of how people age, and that’s really what the goal of this book is.
Casey Means (00:07:45):
So amazing, and I literally in my mind’s eye can see that patient from my own training. A beautiful sweet woman or man who’s really tried, has tried to do everything right, and they are going into old age, frail, and starting to become decrepit, and have dementia, and it is so, so, so devastating. And we feel hopeless as doctors throw up a couple of meds at them and it’s just knowing exactly what’s going to happen, which is a slow and painful decline towards death, which all of us want to avoid.
(00:08:16):
I’m going to be totally honest, in my conventional medical training with ENT residency, I never once, and I’m not kidding, not once thought about muscle as a true organ, as a multidimensional organ. I thought about it maybe with sarcopenia patients when the patient was in the hospital bed for like five or six days and we’re worried about them losing muscle rapidly, so we give them a bunch of sugar-filled Ensures. That’s basically it. And so, this is why you’ve totally, totally blown my mind. I think maybe for both the doctors listening, but also the lay people listening, why should people care about muscle and what is your elevator pitch on the suite of things that muscles do that we just don’t really recognize?
Gabrielle Lyon (00:09:03):
Let’s start with what people think about muscle. Everybody thinks about kind of the jacked and tan person at the gym being super buff, and that’s what we think about muscle. We think about physical performance, but muscle is our metabolic currency. It is our health currency. It is the only actual currency that can’t be bought, sold, bargained for. It has to be earned. And when it relates to metabolism, it is the primary site for glucose uptake. What is glucose? Glucose comes in the forms of the carbohydrates that we eat and we’re talking about 80% of glucose uptake goes to skeletal muscle. Skeletal muscle makes up 40 some percent of the human body. This is the primary site. When we are talking about metabolic dysregulation, we’re talking about elevated levels of insulin, elevated levels of glucose, elevated levels of triglycerides, all of these markers that kind of coalesce into this concept of metabolic syndrome or insulin resistance, a primary focus of this is skeletal muscle.
(00:10:08):
So skeletal muscle is the metabolic sync, the primary site for glucose disposal, a primary site for fatty acid oxidation, which is really important to understand. It’s also a primary site for, and the only site for a myokine production, which is when we think about muscle as an endocrine organ, an endocrine organ, it secretes these peptides, myokines, whether it’s interleukin 6 or irisin, there’s hundreds of different myokines that are released and go and travel throughout the body that can cause an increase in BDNF, in brain-derived neurotropic factor, for neurogenesis, it helps with overall immune modulation.
(00:10:50):
Myokines can really play a role in more than 36 chronic diseases. This is really incredible and this is about what the influence of exercise has on this tissue so we can voluntarily control our skeletal muscle. When we contract skeletal muscle, whether it’s through endurance exercise or resistance training, the body releases these myokines, which is incredible. Another really important part of skeletal muscle is thinking about it as an amino acid reservoir, critical when an individual is in a highly catabolic state, whether it’s cancer or any kind of infection, the body relies on some of these amino acids. And then finally again, another really important aspect of skeletal muscle is it’s the body’s armor. If you were to fall, skeletal muscle is where you become mobile. I mean, this is tremendous, tremendous, tremendous tissue. It probably does more than anything.
Casey Means (00:11:53):
I truly can’t believe that muscle is 40% of our body mass and we just don’t think about it that way. It really comes down to physique, appearance, and strength. That’s what we think about with it, I think conventionally, but what you’re saying is that it is actually a hormone secreting organ. The myokines, again, a word I never heard in medical school, which are involved in brain protection, immune modulation. Something that blew my mind so much reading your book was that training as an ENT, which every single condition we treat basically is an inflammatory condition that you spoke about how muscle is actually an immune modulating organ. Can you speak a little bit more towards that as it pertains to our inflammatory chronic disease epidemic, also our autoimmune diseases, and how would theoretically something like muscle have to do with an inflammatory condition?
Gabrielle Lyon (00:12:47):
I deeply appreciate this question. When we hear a lot about the cytokine storm, which interleukin 6 is considered a cytokine and it can cause a cascade of inflammatory reactions, especially if it’s produced from the macrophages, cells of the immune system. That has one effect on the body. But the other effect is when interleukin 6 is produced from skeletal muscle, it actually has pleiotropic effects. It can lower inflammation over time. It can also help regulate our metabolism. Exercise helps regulate our metabolism, not just through the increase in mitochondria, but when muscle secretes myokines, specifically interleukin 6, it helps the liver with metabolism of glucose. It helps the rest of the body with the metabolism of fat. It helps direct the way in which we utilize substrates, which is so fascinating.
(00:13:42):
And then, from a anti-inflammatory effect as it relates to autoimmunity, exercise in itself is extremely effective in chronic conditions like rheumatoid arthritis, like rheumatologic diseases. Just fascinating with the way in which it helps regulate these other cytokines and that becomes phenomenally important. In fact, it is potentially more effective, I don’t want to say more effective, because some individuals need medications, but it is up there with its capacity to help regulate and lower immune responses through exercise.
Casey Means (00:14:31):
If you’ve heard me talk on other podcasts before, you know that I believe that tracking your glucose and optimizing your metabolic health is really the ultimate life hack. We know that cravings, mood instability and energy levels and weight are all tied to our blood sugar levels. And of course, all the downstream chronic diseases that are related to blood sugar are things that we can really greatly improve our chances of avoiding if we keep our blood sugar in a healthy and stable level throughout our lifetime. So I’ve been using CGM now on and off for the past four years since we started Levels and I have learned so much about my diet and my health. I’ve learned the simple swaps that keep my blood sugar stable like flax crackers instead of wheat-based crackers. I’ve learned which fruits work best for my blood sugar like I do really well with pears and apples and oranges and berries, but grapes seem to spike my blood sugar off the chart.
(00:15:27):
I’m also a notorious night owl and I’ve really learned with using Levels, if I get to bed at a reasonable hour and get good quality sleep, my blood sugar levels are so much better and that has been so motivating for me on my health journey. It’s also been helpful for me in terms of keeping my weight at a stable level much more effortlessly than it has been in the past. So you can sign up for Levels at levels.link/podcast. Now, let’s get back to this episode.
(00:16:02):
You talked about in the book how actually having better skeletal muscle more and healthier impacts survivability of basically every major chronic disease. Is that accurate? We would never conventionally associate with muscle things like heart disease or dementia. Can you speak to how having just more muscle on your body can improve our survival from many of these diseases that again, we just don’t think of as related to muscle?
Gabrielle Lyon (00:16:34):
Certainly, and some of this is controversial because when we think about skeletal muscle, we don’t have a great way of measuring it. People often think about DEXA as a way in which we directly measure skeletal muscle. It’s not, quite frankly. A DEXA is a way in which we directly measure adipose tissue and the rest is estimated. Because of this, over time, people don’t relate the amount of skeletal muscle mass to improvements, which is really important to understand. So people will say, “Well, strength is more important than mass. Strength is more important than mass.”
(00:17:08):
However, I don’t believe that that is true. And there’s some recent work by Bill Evans coming out with D3-Creatine, and I’ll definitely circle back to your question about more muscle mass being helpful because we are now starting to directly be able to measure skeletal muscle mass. It’s currently used in research, but eventually we’ll get to the general public, which is D3-Creatine. The majority of creatine is all in skeletal muscle, so it will allow us to directly measure skeletal muscle versus measuring lean mass. Lean mass is not just skeletal muscle. Lean mass in the body is everything other than adipose tissue. So it’s the organs, it’s the bone, it’s everything else. Because it is everything else, when we say lean mass, I mean what is that? Maybe 40% of that is skeletal muscle, so it’s not a direct measure.
(00:17:57):
Because of that, I think that the amount of skeletal muscle mass has been largely underplayed. So in the literature, people will say, and you will see this in the literature for the physicians out there, they will say, “Muscle mass doesn’t matter. It just matters strength.” If you were to take a step back, that doesn’t really make sense because healthy skeletal muscle mass in and of itself would improve the amount of glycogen storage, which is the storage form of carbohydrates. We know that muscle stores roughly five times more than liver glycogen because liver glycogen, liver in and of itself is smaller. We have to think of the health of skeletal muscle. So now this is where we move into more muscle mass is better. I would say more healthy skeletal muscle mass is better.
(00:18:44):
What I mean by that is individuals with obesity, there’s some evidence to support that they may carry “more muscle,” but the question is that healthy muscle or is that muscle that looks like a marbled steak? Is that skeletal muscle that has fat infiltration? And again, for the listener, athletes also store intramuscular triglycerides as a source of energy. But when an individual is sedentary or struggles with obesity or challenges with weight, the fat in the skeletal muscle, in and around the skeletal muscle creates issues. It creates low levels of inflammation. There is a decrease in flux, there’s a decrease in substrate fatty acid utilization. There’s a decrease in glycogen utilization. This stasis, this lack of flux creates low levels of systemic inflammation and that becomes a problem.
(00:19:38):
So where it is important is healthy and earned skeletal muscle is critical for mitochondrial function and actually generating more mitochondria. You can do this through endurance training. Having more healthy skeletal muscle in case of an illness, in case of again, say a cancer or a highly catabolic process, skeletal muscle is going to increase your survivability against nearly all diseases. And in fact, the loss of skeletal muscle is likely more critical than the impact of gaining fat.
(00:20:14):
So this changes the paradigm of thinking, because the conversation is all about, well, if you gain weight, if you gain fat, this is an issue. Clearly this is a problem, but it’s actually much more detrimental. I hesitate to say much more, but again, this is my scope of work. This is the lens at which I view things through the loss of healthy skeletal muscle is much more dangerous than the gain of body fat because of the metabolic implications, because of the survivability going forward. And what’s amazing about this story and what’s amazing about this paradigm of thinking is that it’s something that we actually can do something about.
Casey Means (00:20:49):
I have the privilege of talking to a lot of Levels members and prospective members. I don’t practice or see patients right now, but I get to talk to so many people who are looking for something to help them feel better. A lot of the people that we serve are women ages 35 to 65, and a lot of them are either in their fertility years or their perimenopausal, menopausal, or just after menopause. And some of the things that I hear frequently are that they are doing everything right. They feel like they’re eating healthy, they’re buying whole foods, they work out five days a week, they’re managing their stress and things, they’re still having trouble. Maybe having trouble with fertility, they’re having bad menopausal symptoms, or they’re gaining lots of weight after menopause.
(00:21:39):
So it is heartbreaking because people are trying so hard, and I ask a lot of them because of your inspiration, I ask everyone, do you resistance train? What are you lifting? What’s your relationship with muscle? And by and large, I would say people haven’t thought that much about it. They’re doing Pilates, cardio, things like that. So I guess I have two questions. One is that the weight loss comment is one that I hear every single day, multiple times a day. That’s a big part of it.
(00:22:07):
So one question I have is for someone who is trying to lose weight and really robust resistance training is not a part of their paradigm, do you feel like that is step one in the weight loss journey? It’s not like starting with thinking about all the deprivation, but actually what can you build to help on the weight loss journey? Should we be reframing everything about like, I want to lose this 20 pounds to, okay, I’m going to start by building muscle and the rest is going to take care of itself. Obviously, you might need to do a calorie deficit or things like that, but should we reframe to thinking that is step one is actually building before we lose weight? And then, I’d like to chat about some of more of the women’s health stuff, but I’m just curious if that’s a paradigm change we need to make.
Gabrielle Lyon (00:22:54):
100%. Let’s talk about weight loss. Number one, we call it weight loss, but what we’re really looking for is fat loss.
Casey Means (00:23:02):
Yes.
Gabrielle Lyon (00:23:03):
Just in the semantics of how we can have these conversations. When we talk about gastric bypass or when people talk about again, weight loss, what they really want is fat loss. When you lose weight, typically the maximum amount of fat you could lose a week depending on how much you have to lose is two pounds a week. So anything above and beyond that is typically lean tissue, which is crazy. And some of the earlier studies when Dr. Donald Layman was doing some of the earlier studies, they did a 1,500 to 1,600 calorie reduction, put people on “the food guide pyramid.” Of course, that was a universal health experiment in the United States, and 35% of the tissue was lean tissue lost.
(00:23:56):
So again, we have to think about how do we put together a diet and nutrition plan where it’s not that we’re losing “weight,” but what we’re actually losing is fat. So for example, if you were to put someone on 100% starvation diet, which obviously we wouldn’t do, but if someone were to go on 100% starvation diet and lose five to six pounds a week, I mean at least half of that would be lean tissue. This takes us back to the concept of what modalities are we going to use to optimize body composition while losing the appropriate amount of weight. When we do and think about weight loss just through a calorie deficit, we do nothing from mitochondria function, versus if we think about how do we lose weight while stimulating skeletal muscle, now we can impact mitochondria.
(00:24:50):
We can “lose fat” and do something better like improve mitochondria function as opposed to dietary interventions alone, which as we have seen with this huge public experiment of yo-yo dieting, ultimately people become sarcopenic or they suffer from obesogenic sarcopenia, which is the gain of fat, loss of skeletal muscle, sarcopenia, for many people, they know what that is visually as individuals age, they get skinnier, they get smaller. Sarcopenia is a loss of mass and function, and again, body composition is the lowest hanging fruit for all health and wellness, and it’s never too late to start, which is incredible to think about.
(00:25:35):
And when we correct for body composition issues, we optimize for skeletal muscle. And the two main ways we optimize for skeletal muscle are number one, focusing on dietary protein. And number two, focusing on exercise. Now, I put it in that order because only 24% of the population is meeting the requirements for exercise, only 24% of resistance training and cardiovascular activity, while 100% of people are eating. This is why I focus so much on dietary protein because everybody is doing it. You cannot get away from eating. If you nail that part appropriately, then the subsequent benefit for health and wellness, for longevity for the way in which you age and the quality of your weight loss, you have control over.
Casey Means (00:26:25):
That makes so much sense. It’s like we’re all eating. And one of the benefits of I think your approach to diet that you go into so much detail on the book, the book is so thorough and detailed about multiple different tracks for nutrition, it’s just amazing is that it’s not about deprivation. It’s actually about putting more of something that is delicious in and starting with adding the protein. And it honestly will crowd out other stuff in the diet, and it’s so satiating. I mean certainly, the USDA food pyramid doesn’t focus on protein. I think many of us don’t even know what it’s like to have a high protein diet and how it actually can make life easier because more satiated and more sort of stable energy. And so, it’s kind of exciting because it’s like none of it’s about really starting from a place of what do I have to take away.
(00:27:19):
So okay, so that’s fascinating about weight loss. I’d love to shift gears and talk about a little bit of the women’s health stuff because again, this is just a population that I think is being honestly so let down by the healthcare system in terms of really good information for how to age in the most healthy and symptom-free way. So could you talk about why muscle is important and let’s maybe focus on two particular phases, which is one, around the fertility years and specifically going into pregnancy, and two, perimenopause and menopause. How can really focusing on building more healthy muscle help women in these two phases?
Gabrielle Lyon (00:27:57):
Yes, absolutely. Skeletal muscle as it relates to aging for everybody is critical. And women, it is very interesting because pregnancy is a insulin-resistant state. The body has to grow another person within it, and that person, that baby needs to get nutrients. So in and of itself, pregnancy is an insulin-resistant state. One of the major complications with this is gestational diabetes. Gestational diabetes, of course there are genetic components, but there are things that people can do to safeguard themselves against gestational diabetes. And it was interesting, because obviously I have had two pregnancies. I have a little over two-year-old and a four-year-old, and one of the things that I really thought about and dove into the research about during that time was the impact of skeletal muscle on PCOS, on pregnancy. And there’s not actually a ton of information regarding skeletal muscle in pregnancy.
(00:28:58):
If people were to go and look through PubMed or Google Scholar, there’s not a ton, which is fascinating. Skeletal muscle, like we talked about before, is the primary site for glucose disposal. Exercise throughout training is something that I personally did and I did a lot of resistance exercise, and I know that we see that in terms of four levels when an individual takes a carbohydrate load and goes for a walk or does some squats or does some pushups, glucose levels will decrease. Well, the reason it’s decreasing at a particular rate and a rate that one in which you can improve upon is because you’re moving skeletal muscle. Again, the majority of glucose disposal is insulin-mediated. However, you can get away from having to leverage your own body’s insulin when you’re exercising, and this becomes really important for pregnancy. So that’s one aspect.
(00:29:50):
The other aspect of PCOS, PCOS, they say what 8 to 13% of individuals of women will have it. I mean, that’s maybe the prevalence. I think it’s probably much higher. PCOS is polycystic ovarian syndrome, clinically defined as ovulatory dysfunction, maybe androgen excess, PCOS on morphology or ultrasound, 75% of PCOS individuals will have insulin resistance and they can be lean or obese. And whether there’s a genetic defect in insulin signaling or there’s probably multiple inputs. These things are not challenges and health issues are not necessarily just one thing, there’s typically multiple parts that play into a role of an ultimate clinical outcome. However, again, when we think about insulin resistance, this all goes back to skeletal muscle. Skeletal muscle, insulin, really the primary sites of insulin-targeted tissue is skeletal muscle is adipose tissue and is liver. Last time I checked, you couldn’t do much about liver or adipose tissue, but you can do a lot about skeletal muscle.
Casey Means (00:31:08):
Amazing. And then, how about with menopause, because this just feels like there’s, I really, really feel like this tidal wave of people starting to realize we are so behind on menopause care and half the population will go through this and doctors have no idea what to tell them. And of course, women go off this metabolic cliff after menopause if they’re not really vigilant about it because our estrogen drops, and all of a sudden women start out pacing men for obesity and diabetes and Alzheimer’s dementia, two to one with dementia. And every woman I’ve talked to wants to do something about this but isn’t I think getting complete information. And so, how can muscle impact the menopause journey, the weight gain that might come, and maybe even menopausal symptoms, is there any research on that?
Gabrielle Lyon (00:31:59):
Well, exercise typically can improve everything. Exercise can improve everything. And one of the reasons exercise can improve everything, and I say this as a blanket statement, but from a clinical standpoint, no one has exercised and go, “Gosh, I feel so much worse that I got up and I went for a walk, or I got up and I did some kind of physical activity.” From a metabolic standpoint, just from a mood enhancement standpoint, we do know that because of this influence on BDNF, that the data does support exercise to enhance mood in general. We also know that the fitter a person is going into menopause, that potentially the lower the significant experience of menopause is. There’s no reason why we wouldn’t try to be the fittest best version of ourselves going into a potentially challenging time.
(00:32:51):
Now that being said, I do think that if you are a candidate for hormone replacement, there’s huge benefit to that. I don’t think individuals should suffer. I think that there’s a lot of good evidence to support estrogen, progesterone, and testosterone. While testosterone, believe it or not, is not FDA approved for women at this time. There is clear clinical indications that women lower testosterone levels, low libido, in negative impact on skeletal muscle. These are all reasons why one individual would consider supporting the body’s testosterone, all really, really critical, which is fascinating. Going into menopause, this is the time where I strongly consider women to reconsider the type of exercise they’re doing.
(00:33:39):
All exercise is good. I firmly believe that zone two cardio is wonderful for people. It helps with endurance, it helps with mitochondrial health, but there’s other ways to “skin a cat.” This could be high intensity interval training. This doesn’t have to be long. Martin Gibala has done a lot of really good work in this area. I actually interviewed him on my podcast. There’s effective ways to move the needle for people. It doesn’t have to be time-consuming. I will say that I also believe that if someone is doing exercise, it should be challenging. We have gotten very comfortable, and I think as society, there’s so much stress in other domains of life that people, unless you train yourself to actually go in and get after it in the gym, typically people will go there to try to relax or decompress.
(00:34:33):
I strongly suggest that women try to do that. Men and women try to do the decompression some other way. When you are going to the gym, I believe that perhaps three to four times a week of highly focused intentional training is critical. And it should be hard. You should be fatigued. You should go to a point of exertion. And again, in the literature, you could do high volume and lower weight or you could do heavier weight and less volume. But overall, and I cover this in my book, but overall women and men should really be thinking about how are we influencing that tissue to get a metabolic adaptation, and there’s multiple ways to do that. But again, resistance training, and that could be 10 to 20 sets per muscle group per week, and someone could decide on how to do that. Or you could think about getting a well-designed program that could be three to five days a week where you’re hitting each body part twice. Again, there’s multiple ways to do it, but what we’re looking for is a stimulus.
Casey Means (00:35:42):
That’s super helpful, practical advice. And what about for a woman who might be listening who is like, “I exercise five days a week. I do, and I’m just not seeing the results that I want.” And maybe there is no strength component to that. It’s mostly cardio or yoga or Pilates or what else is pretty common now, a lot of walking, hiking, things like that. And so, of course, all exercise is good and we should have the broad range, but do you think for most women, they should be swapping out some of their more cardio-focused or more stretching type exercises for focused intense, more resistance training. And it’s literally peeling back on some of that stuff and actually inserting maybe not doing more exercise, but actually swapping out some of their, how would you basically structure a week for someone ideally?
Gabrielle Lyon (00:36:39):
Here’s what I would say. From a practical standpoint, is what you’re doing getting you the results that you want? And if it’s not and you don’t have the body composition that you desire, perhaps the stimulus has to change. If you have done yoga, Pilates, or walking for years and your body composition has stayed the same, then the metabolic input that you are putting into the system is not enough for the outcome that you are looking for. And we’ve all seen that person, right? We’ve all seen that person at the gym who’s on the treadmill. They’re there six days a week doing their jogging for 45 minutes and their body has not changed ever. If we do the same thing over and over again, actually as we age, it becomes more detrimental, because now as hormones shift, the ability to build, protect, and maintain muscle without the proper input decreases.
(00:37:35):
For those individuals, if you are listening and you are doing your cardio every day and you’re going to the gym, I would say that’s amazing. But what I’d like you to do is I’d like you to swap out three days a week of some kind of resistance training. Now, the literature would say you could do five pounds as long as you’re going to failure. I would say perhaps you get online, look to a trainer. We actually have a whole video library by the way that we are giving people, which is amazing. But you do have to have a very well-defined and designed program to create stimulus. This is a wonderful time. And obviously, be sure not to get injured to actually stress the tissue, because what we’re looking for is a metabolic adaptation. We’re looking at stimulus, we’re looking at all ways in which we can begin to not only increase flux of skeletal muscle, but protect the muscle that we have. And if you eat and train the way you did in your twenties, it’s not going to happen.
(00:38:36):
Do you know that 40% of women over the age of 65 are below the RDA in protein? 40% of women over the age of 65 are considered deficient in protein, so we don’t even have a chance of protecting skeletal muscle. And then, the other aspect is that women on average are getting between 60 to 70 grams of protein a day. That’s not enough. If you are going through menopause, perimenopause, post menopause, this is not enough dietary protein. This is not enough to protect skeletal muscle. And really, when you’re young, this is the prime opportunity to build, but it’s never too late. It’s never too late.
(00:39:14):
However, if you begin to succumb to the challenges of nutrition dogma, which is everywhere, nutrition dogma is everywhere, it becomes very confusing. It is not evidence-based. One thing we know for sure is one way to protect skeletal muscle is through increasing dietary protein. Again, you need dietary protein and you need resistance exercise. You need those two things to support health and longevity. There’s a lot of controversy about reducing dietary protein for longevity, and my answer to that would be, would you rather be frail and weak and have an extremely poor quality of life, always worried if you are going to fall, break a hip, not be able to lift your groceries, or would you rather be robust and capable throughout the rest of your life? So these are the things that we have to be very careful about when we hear this narrative about reducing dietary protein. We’re already not getting enough. We’re not getting enough to support the quality of the tissues that we need.
Casey Means (00:40:22):
Yeah, the book is like the ultimate manifesto on exactly how much protein we need to have and when. And so, I’d love to maybe just scratch the surface here, and then obviously people should go to the book for the very specific recommendations, but you have really focused on your newsletter is about 30G’s, 30 grams of protein per meal minimum. And I love that it’s just simple and something you can remember.
Gabrielle Lyon (00:40:49):
And we’re collaborating on a recipe, aren’t we? And actually, so that is not the newsletter. By the way. That is a very special 30G’s because people were always asking us about recipes, and I know you have Casey’s kitchen. So I have a newsletter, and the newsletter typically talks about the podcast, some kind of learning resource, some kind of study that we’re reading. But the 30G’s is an actual separate newsletter that just provides recipes. And I’m hoping that you and I are going to collaborate on a recipe. Yes, a minimum of 30 grams. From a practical aspect, it’s the total protein, the total dietary protein matters, but also as we age, roughly how we think about dosing it can impact blood sugar regulation, mood, energy, all of these things and skeletal muscle influence. Again, when we think about the hierarchy of dietary protein, we think how many grams of protein per day. That’s at the core fundamentals.
(00:41:44):
There’s this hierarchy. And at baseline, one gram per pound ideal body weight. And I’m sure the listener’s going, “Oh my gosh, that’s so much. I want to be 150 pounds.” So that would be a great number to shoot for. You don’t have to have that much. I will say pregnant women should not go below 100 grams of protein. I do not recommend pregnant women or anybody to go below 100 grams of dietary protein a day. The next thing that we need to think about is how are we going to design a plan. And the first meal after you are coming out of an overnight fast is, in my opinion, the most important. It is the most well-studied, you are coming out of it overnight fasted state, skeletal muscle is primed for nutrients.
(00:42:29):
One of the things I didn’t mention about skeletal muscle is skeletal muscle is a nutrient sensing organ. It means it senses the quality of the nutrition in the diet, specifically amino acids, the essential amino acids, and even more specifically the branch chain amino acids. So when you are having a high quality protein meal, which from a practical aspect would be 30 to 50 grams, probably closer to 50 grams of dietary protein, and you can look up what that is or you can check out 30G’s, or the book obviously has a whole table at that first meal, because again, that skeletal muscle is primed for nutrition. Primed for nutrition, you have that between 30 and 50 grams of dietary protein.
(00:43:15):
You then push muscle through muscle protein synthesis, which is actually just a biomarker of the meal doing what it’s supposed to do, and you stimulate that tissue in an optimal way, and it does, it over time protects skeletal muscle. So that first meal is the most important. And then, I would also say that that last meal before you’re going into an overnight fast is just as important.
(00:43:37):
So you prioritize dietary protein on the first meal and the last meal, and then of course the next macronutrient you can decide whether it’s carbohydrates or fats, I would say I don’t go over a one-to-one ratio of protein to carbohydrates. I cap a non exercising individual at maximum 50 grams of dietary carbohydrates per meal. Again, you have to figure out your carbohydrate tolerance, but I think that there can be a dysregulation of metabolism with too much glucose and the body can dispose of around 50 grams over two hours in a sedentary individual. And then fat, you’ve got to calculate how many calories you need over time, and then you can put fat in there as you wish.
Casey Means (00:44:27):
Talked about leucine as a special amino acid in the book that really stimulates muscle protein synthesis on a molecular level and that we need a certain amount of that. And one thing I was curious about is should we be thinking about which foods we’re eating and how much actual leucine is in it and trying to get, I think it was, was it 1.7?
Gabrielle Lyon (00:44:48):
That’s a minimum. So 1.8 is around the minimum.
Casey Means (00:44:51):
To stimulate muscle proteins synthesis?
Gabrielle Lyon (00:44:53):
Yeah. You actually bring up a very, very astute point. Can we think about leucine? And the question becomes when have we ever looked at the back of a label, not a protein shake, but an actual label of food and it says the amino acid breakdown, never. It doesn’t exist. So I encourage everyone to go at home, who’s at home to look at the back of a label and it’ll say total calories, it’ll say total carbohydrates, maybe it’ll say fiber, it’ll say fats, and then it’ll say monounsaturated fats, whatever else, and then it’ll say protein.
(00:45:29):
Do you not find that fascinating? We are so behind the times on dietary protein, there are 20 different amino acids that make up protein. There are limiting amino acids. There are nine essential, these nine essential mean that the body must get them from the diet. Yet at the end of the day, when you look at the back of a label, it just says protein. These proteins, again, are made up of different amino acids in different ratios. A good rule of thumb to think about is that animal-based products are high quality proteins. This is not an emotional conversation. This is simply based on the biology and the hard biological numbers of these essential amino acids.
(00:46:09):
Leucine, isoleucine and valine are the branch chain amino acids. You primarily need leucine to stimulate skeletal muscle. It’s a requirement by skeletal muscle, again, as a nutrient sensing organ. Ideally as you age, you need more leucine because the tissue through aging, through menopause, through perimenopause becomes more “anabolically resistant,” meaning it is less sensitive to the stimulation of dietary protein. And this is where ultimately that 30 to 50 grams comes from. So it’s not just to stimulate this muscle protein synthesis, the mechanism through which would be mechanistic target of rapamycin, which for the physicians, they’ve all heard about mTOR and “the dark side of mTOR,” which I think that we have a little time to discuss, but you stimulate muscle protein synthesis via the mechanism of mechanistic target of rapamycin, and over time you begin to lay down tissue.
(00:47:11):
As we age, this mechanism, this efficiency at sensing protein becomes less. You can overcome this by exercise, increasing capillary blood flow and dietary protein, in particular the high quality dietary protein because it has higher amounts of leucine, and that could be through whey protein, that could be through eggs, beef, chicken, fish, whatever it is that you enjoy eating. It can also be done through plant-based proteins. But be advised, if you are eating a whole foods diet, the plant-based proteins often come in a matrix filled with carbohydrates. If you can metabolically tolerate that, then it’s absolutely fine.
(00:47:59):
Can you get the same stimulus with the plant-based proteins? You can, however, it requires maybe 35% more of total caloric load, for example, six cups of quinoa would equal two and a half grams of leucine. So we really have to think about how can you design a diet if you prefer to just get your protein from plant-based sources. And then again, the next layer to that is we have to think about food as a whole foods matrix. It’s not just about the macronutrient protein. There is creatine, there’s anserine, there’s taurine, there’s all kinds of other things that ride alongside with high quality proteins. I think a perfect diet would be a mix of plant products and animal products, not one or the other.
Casey Means (00:48:49):
So if I am thinking about that leucine number, which is now so stuck in my head since you’re… I’m like, okay, I’m doing all this strength training. I really, really, really want to get my best bang for the buck on like, “Oh, my God. I’m putting in the work. How do I actually get the results?” Can you sort of assume that if you’re getting the 30 to 50 grams of protein, of high quality protein in a meal that you’re probably going to get somewhere around that enough leucine or should we actually be tracking? You have a chart in your book, which is amazing, which actually shows how much leucine is in each food and per ounce or whatnot. So is a general rule of thumb that if you’re getting that 30 to 50 grams per meal that you’re going to be getting of high quality protein, that you’re going to be getting enough of the diversity of amino acids?
Gabrielle Lyon (00:49:39):
Yes, there is something called the EAA-9 coming out. It’s not out yet. It’s a proposed new system to look at the quality of protein. So that is going to be coming out. It will become very user-friendly, but that is a great way to think about things that if you hit a high quality protein 30 to 50 grams, then you will be getting enough leucine. The other important aspect of that is that each amino acid, it has diverse biological roles.
(00:50:10):
For example, leucine is really important to stimulate mTOR. Threonine is important for mucin production, which helps with the gut. There are certain amino acids that are important for neurotransmitter function, glutathione production, so all of these, there’s diverse actions of all these amino acids. And again, when we target muscle health, the rest fall into place, and that’s what becomes so interesting. So if you target skeletal muscle, you’re eating for the health of skeletal muscle, then you’ll hit the other individual nutrient requirements for these other amino acids that we don’t even talk about.
Casey Means (00:50:50):
Should we all be taking creatine? I feel like I’m hearing a lot more about creatine. I guess this is totally a self-serving question for me because I’m like, “Oh, my God. Can you just give me the answer?” And creatine and like any other supplements, you talk about omega-3s in the book, but I’m like, “Five grams, what am I supposed to do? What’s the creatine hot take?”
Gabrielle Lyon (00:51:13):
Well, it’s interesting because creatine is stored in skeletal muscle and women actually have lower stores of creatine in the body. Creatine is very well-studied. It’s been around for decades. I do believe that if I were to pick one supplement and a woman isn’t eating a ton of calories or isn’t eating a ton of red meat, I think creatine would be it. It has impact on brain function, it has impact on energy production. Typically, it helps with athletic performance. There’s just all kinds of things that creatine has the potential to do. I think it’s very valuable. There’s even some evidence to suggest that various amounts are needed during various times in a woman’s cycle that potentially she needs more when she’s menstruating. Again, I am not totally convinced on that literature, but over time it’s clear to me that women definitely benefit from supplementing with five grams of creatine a day, three to five.
Casey Means (00:52:15):
Amazing. Thank you. Now, one final question for you because I know we need to wrap up, but I think that something you hear a lot about muscle is that something that’s so sort of magical about it is that it can actually take up glucose in the absence of insulin, and I’m just wondering if you could shed light on what that really means, what is actually happening in the cell to make that happen. I think it’s always helpful to visualize the cell, and then I guess more broadly just ending with for the levels member or the person out there that has a continuous glucose monitor on and they’re really focused on getting their blood sugar drowned, how should they be thinking about what to do with their muscle to basically keep that glucose curve stable?
Gabrielle Lyon (00:52:59):
So let’s start with the idea of how is glucose taken up by the cell, and this is really a transporter issue or one of the big ways skeletal muscle takes up glucose, there’s GLUT4 transporter, which is insulin sensitive. In the brain, it’s GLUT2, and then there’s also a GLUT1 transporter that is, I believe that it is not insulin sensitive. So these are ways in which we think about how is glucose removed from the cells or removed from the bloodstream to move into the cells. I will also mention that we think about it in a very linear fashion, but in challenges with insulin resistance, it could be there’s multiple mechanisms. Is it a glycogen synthase problem? Is it a phosphorylation problem? Is it a insulin receptor problem? There’s multiple ways in which there can be impacts and influences into the system.
(00:54:03):
And this is some of DeFronzo’s earlier work. It was really a hallmark when he looked at type two diabetes and insulin resistance and the potential pathways. So I think that it’s important to understand that one, glucose is at high levels toxic to the body, and a way to move glucose out of the bloodstream into skeletal muscle is through exercise. This is amazing, this is free, this anybody could do, and it doesn’t require insulin if you are exercising. Otherwise, skeletal muscle does require insulin. Again, GLUT4 transporter is an insulin sensitive transporter, but you through leveraging, exercising skeletal muscle, can move glucose into the muscle, which is amazing. Any more questions on that? And that’s some of the earlier work from Holloszy who actually I had the privilege to meet at Washington University while he was still alive. He did some of these, the really, again, hallmark studies. Is that the answer you were looking for in terms of mechanism for people?
Casey Means (00:55:12):
Is it the muscle contraction itself that’s stimulating some intracellular pathway that’s bringing the channel, the GLUT1 or another channel to the membrane? Just was curious about what is the physical stimulus, if it’s not insulin that’s going through the whole insulin intracellular signaling cascade, how can people conceptualize what’s actually causing, is it the contraction?
Gabrielle Lyon (00:55:39):
The utilization, yes.
Casey Means (00:55:41):
Amazing. Okay. And then I guess, yeah, we can just wrap up maybe with some just your thoughts on how if someone is really focused, and so many people are now on glucose stabilization after meals during the day, keeping their fasting glucose down, there’s so much more awareness now to glucose levels. How should they be conceptualizing how to use muscle throughout the day? How resistance training plate is into this or any practical strategies for basically keeping glucose more stable during the day by leveraging muscle?
Gabrielle Lyon (00:56:12):
Well, there’s two ways that I would say individuals should really keep glucose stable during the day. Number one, get your first meal right? Get your first meal right, and it could be a one-to-one ingestion of protein to carbohydrates. When you prioritize dietary protein, the body goes through this process of utilizing protein for gluconeogenesis. So rather than having to eat carbohydrates, your body can make glucose and that is a way that is steady over time that really helps with maintaining blood sugar regulation, and that is just the input of dietary protein with the correction of carbohydrates. So that’s super easy. Everybody can do it.
(00:56:49):
The other thing is get moving. Again, exercising skeletal muscle will use glucose independent of insulin. So if you’re going to have your meal, go for a walk. I know it sounds crazy, use a walking treadmill desk. We can take phone calls outside and walking. I would also say that you have to know yourself and you have to plan for weaknesses. If you know that you are not going to exercise later on in the day, there are people that know that’s not going to happen and they’re going to tell themselves that they’re going to exercise, but you don’t do it, plan for that. Suffer a little bit, wake up a little bit earlier and do it. Again, it’s never too late to start.
(00:57:31):
I do really think implementing three to five days a week, start with three days a week of resistance training. If you do not have time, a high intensity interval training style workout, that could be, if you could put enough effort in, it could literally be seven minutes. It doesn’t have to be long periods of time. Again, we’re looking for a physiological adaptation. There’s ways in which you can influence the system.
(00:57:56):
So if you care about stabilizing blood sugar and creating and maintaining healthy skeletal muscle, prioritizing dietary protein, understanding that it will help stabilize blood sugar regulation, having healthy skeletal muscle helps with, again, think about a unhealthy muscle, think about an overstuffed suitcase. There’s no more glucose, no more glycogen that can be stored. What happens? You’re going to have increased levels of free fatty acids in the bloodstream because it can’t go anywhere. Muscle is full, liver is full, adipose tissue, where is it going to go? It’s going to go back in the bloodstream. So ways in which you can really maintain your health are leveraging skeletal muscle, which makes up about 40% of your body composition and exercising that and moving that. It doesn’t have to be complex. It just has to be effective.
Casey Means (00:58:50):
What an amazing note to end on. Thank you. Gosh, I just literally want to talk to you for 10 hours. You are so brilliant and it’s amazing, and thank God you wrote a book because you’re scaling your brilliance to so many people through a medium that fortunately people still really read health books, and so through your social media, your YouTube, your book, it’s really, you’re just so changing the world and it’s so empowering people. I have to mention, we didn’t get to this in this conversation, but your book is very heavy on mindset. And I think that, I mean, I am such a believer in the fact that mindset, it is the foundation of everything. Even just believing it’s possible to have what you want is critical to get there. If you don’t believe it’s possible, it’s probably not going to happen. All throughout the book, there’s sections about basically how to think and frame and hold yourself accountable and consider your self-worth and self-talk.
(00:59:48):
And so, that’s a really beautiful part of the book that we didn’t talk about today, but that’s a very unique aspect to this book, I think compared to a lot of other health books, especially for people out there who might be thinking like all sounds great, but I’m exhausted and I’m working two jobs and I’ve got all these barriers. This book is for you, because ultimately we got to do it and a lot of it has to do with how we think about it. So that was really just amazing. I want to just thank you for that.
Gabrielle Lyon (01:00:20):
Thank you. And that came from years of seeing patients. I can give you the best book in the world, but if you don’t understand and have a temperature of, for example, your worthiness to achieve the body that you want or being able to merge your future self with your current self and be able to leverage those decisions and also think about what the cost of not doing the thing is, I think I couldn’t just put a book out there telling you what to do. I needed to be able to take the experience of a physician and the archetype of the person of what actually makes the art of medicine and leverage that so that people can get the best out of themselves.
Casey Means (01:01:03):
Well, the book’s out October 17th. Let people know how to get the book, how to find You. I’ll turn it over to you to share with people how they can do all this.
Gabrielle Lyon (01:01:12):
Yeah. So you can go to my website, drgabriellelyon.com, and we have a ton of free gifts that we are giving away with a pre-order of the book. We spent a lot of time making these valuable and obtainable for people so they can check it out. We also are going to be having a live event in January. I’m hoping that you will come to that. That will be in Austin and there’s all kinds of things. So head on over to my website, you can pre-order the book there, and if you do it there, you’ll get tons of free stuff. You can also pre-order it on Amazon and can sign up for my newsletter, listen to my podcast, all the things. Twitter, Facebook, you name it.