Kevin: Here in the United States, more than two-thirds of all adults are overweight or obese.  And despite increasing awareness of the health risks associated with weight gain, the obesity epidemic continues to grow.  In the US alone, an estimated 45 million people go on a diet each year, and we spend an average of $33 billion annually on weight loss products.  Estimates of the cost of treating adult obesity here in the US range from 147 to 210 billion dollars each year.  And this epidemic isn’t just affecting adults, approximately 20% of children and teenagers are now classified as obese, and that percentage is climbing.  And we know that obesity increases our risk for other diseases such as heart disease, diabetes, high blood pressure, and certain types of cancers.

 

So with all of our medical advancements and scientific understanding are we not able to stop – or even slow – the prevalence of obesity?  What if obesity itself isn’t the actual problem in and of itself, but rather the symptom of a much greater problem?  What is the problem isn’t so much that we’re over fat, but that we’re under muscled?  What if we change our focus from obesity to skeletal muscle health – that is to muscle-centric medicine?

 

Hello and welcome to the Over 50 Health & Wellness how.  I’m you host Kevin English – I’m a certified personal trainer and nutrition coach and my mission is to help you get into the best shape of your life - no matter your age.  We have a great show for you today – Dr. Gabrielle Lyon is here to share her thoughts on muscle centric medicine.  But before we get to that I want to let you know that today’s show is brought to you by the Silver Edge.   The Silver Edge is my online personal training and nutrition coaching business where I help you get off the exercise and diet hamster wheel and start making permanent healthy lifestyle changes, so that you can enjoy the second half of your life with strength and confidence, and show up as the healthiest, strongest, most vital version of yourself no matter your age.  If you’re interested in learning more, send me an email at coach@silveredgeftness.com and we’ll start a conversation.  My promise to you is no hard sales pitch, no annoying incessant follow up emails, just an introductory conversation about your personal fitness goals.  OK, enough of that, let’s get on with today’s show!

 

My guest today is Dr Gabrielle Lyon.  Dr. Lyon helps motivate people of any age to reach their ideal weight and fullest health potential with the principles of muscle-centric medicine.  She received her doctorate in osteopathic medicine and did her fellowship in geriatrics where she studied obesity medicine and nutritional science.  Dr. Lyon has been published in Muscle & Fitness, Men’s Health, Women’s Health, and Harper's Bazar just to mention a few.  In today’s show Dr. Lyon breaks down the critical role of nutrition and why muscle is the organ of longevity.  In this episode she tells exactly how much protein aging people need, as well as the best sources of protein for us athletes of aging.  And the answer may surprise you.  This was a fantastic episode, and I personally took a ton of information away from this conversation.

 

Without further ado, let’s meet Dr. Lyon!

 

Gabrielle: I did a fellowship at Washington University in St. Louis in geriatrics, which is the study of individuals over the age of 65. And it was a very interesting combination of geriatrics, obesity medicine, and nutritional science.

Kevin: What drew you to that work? Why were you doing that as a fellowship?

Gabrielle: Well, because I really wanted to learn nutritional sciences. And the deal was in order for me to be able to do a nutritional science fellowship, I was going to have the opportunity to also do clinical care of geriatrics. And it was actually not something that I initially thought that I would ever do. But I will tell you this, it really shaped everything that I do today. And that is this concept of muscle centric medicine. I founded the Institute for muscle centric medicine, and it is on the concept that muscle is the largest organ in the body. It is truly the organ of longevity. And when you think about the interface of what is happening in the current situation, everybody's focusing on obesity. And that's not actually the problem. It is a symptomology of a much bigger problem, which actually stems in skeletal muscle. This is a huge paradigm shift for individuals, and also a shift mentally in terms of how we approach the problem for physicians to weekend warriors. It really changes the conversation. I believe that if we have a capacity to change the conversation, then we ultimately can change the trajectory of how individuals age.

Kevin: Yeah. So thanks for sharing that. And I think a lot of my listeners might be surprised when you say something like obesity is not our problem. It's a symptom. And I've heard you say before that our problem isn't so much that we're over-fat, but rather we're under-muscled. Before we dig into muscle centric medicine, tell us a little bit about the state of our health today, especially for aging folks. It's not a pretty picture, is it?

Gabrielle: No, it's not. And when we say aging, the reality is we're all aging, whether you're 30, 40, 50, you're aging. That is the natural cycle of human life. What is so fascinating, especially as an individual who's trained, you know, I'm a traditionally trained physician, but then thinking about obesity, which is not necessarily age related and then ultimately geriatrics, which is that aging in essence, when you think about Alzheimer's and you think about deterioration of skeletal muscle, which is sarcopenia, actually doesn't start later on in life. It has the capacity to start in your thirties. And that is very profound, when you think about what we offer individuals later on in life. So these issues really start in your thirties.

Then what we offer individuals, as it relates to training and wellness to an aging population is incredibly poor and very difficult to go back and fix things that have happened earlier on. And I'll tell you this, if an individual is weak or frail, they fall and break a hip, that is like a death sentence. We know that individuals with low muscle mass, their mortality, their morbidity rate, their ability to survive illness is substantially decreased. So I mean, you know, we've all seen it.

Kevin: Absolutely. And I think most of my listeners can relate to that. Certainly, we all probably have relatives or know people who have been in that frail state as they grow older. Now people may read statistics that say, well, as aging adults, every decade after 40, you're going to lose X percent of muscle.

What is the cause of that? And is that something that we have control of? Are there lifestyle factors as well as biological factors involved there?

Gabrielle: There's both. And this is a great question. What happens after 40? There's a decrease in hormones. Testosterone, estrogen, even progesterone. Thyroid hormone becomes bound. There's a huge hormonal milieu shift that happens. And when this happens, the body becomes quicker to lose skeletal muscle. In addition, what's so interesting is it becomes difficult to actually build muscle. And the ability for ourselves to sense nutrients decreases. So there's a few things. There's the mechanical aspect. It becomes very difficult to build muscle. Can you do it? Certainly you can, but there is a mechanical aspect that becomes challenging for individuals. The hormonal milieu has changed. And also the nutrient sensing aspects which, which is called an mTOR complex. The molecular aspect of skeletal muscle becomes less efficient at sensing protein.

Kevin: And I think that those of us over 50 that have an interest in health and wellness may have heard that as we get older, our need for protein actually goes up because we don't absorb it as well. And you're saying that we’re deficient in this nutrient sensing. Obviously those of us over 50, 60, we understand what happens hormonally, right? There's a shift, not the same as when you were in your twenties and thirties. So knowing that too, you're going to say that muscle is the organ of longevity, what’s the prescription then for us over 50 to achieve this optimal health?

Gabrielle: I love this. This is a great question. And we're going to talk about over 50 and what we should also think is that in your thirties, you should be doing the same thing.

Kevin: Right. If you land in your fifties already in a weakened state, because you've been deconditioned, sedentary, et cetera.

Gabrielle: Not even that. It's the ability which we had touched on before. The ability for skeletal muscle to sense protein decreases. We absorb the same amount of protein. We always absorb that, but the ability for the body to sense the amino acids, which are building blocks of proteins and in foods like meat and eggs and fish, the branch chain amino acids, and one branch chain amino acid in particular leucine decreases. What is very important to understand is that the protein intake must be in a bolus amount at a much higher level than you ate in your thirties. Specifically, when you are young, you can get away with 20 grams of protein per meal and still get a robust nutrient sensing and skeletal muscle response.

That actually changes with obesity and it changes with aging. You are a very fit guy. There are two ways to stimulate skeletal muscle. Nutrition and resistance training. Most people rely heavily on nutrition to maintain and keep their skeletal muscle, which means you need really in your fifties, you're looking at a 50 gram meal, 50 grams of protein per meal to really stimulate that anabolic response.

Right. Could you get away with less? Yes. And the way in which you get away with less is that you eat protein right after you work out. Now, this is information specific to aging population. This is not necessarily information that is needed in your twenties. In your twenties you're very anabolic. Does it matter if you have 30 grams of protein or you have 15?

No, not really. You're going to have a very robust anabolic response. MTOR stimulation, muscle protein synthesis downstream is going to happen as long as you're really getting calories and your basic protein. But as you age, and this is a part of the conversation, why I think we're seeing so much sarcopenia and aging and falls and, and just changes in metabolism and diabetes and obesity.

The reason is, is because no one's focused on skeletal muscle health. The conversation is very robust in the paleo sphere and people are talking about training, but it's not actually geared towards aging individuals. And we can talk a little bit about specific exercise prescriptions, because I think that that's really important and not discussed. We also have to really focus on dietary protein and how we're eating it. Cause there's a big push right now for vegan, vegetarian style proteins. It's probably the worst piece of advice that I would ever give anyone as a trained geriatrician. And it's not to say it's not a good strategy for other individuals, but it's not a good strategy for individuals who are older period.

Kevin: well, I'm glad you brought that up because I just jotted that down as my next question. Okay. So obviously we're in trouble if we roll into our fifties obese, right?

Gabrielle: Yeah, for sure.

Kevin: That's bad. And especially if we’re sedentary on top of that,

Gabrielle: Right.

Kevin: Those two things kind of go together. Okay. So we've just heard, you're going to recommend that we up our protein specifically, let's look at 50 grams of protein per meal,

Gabrielle: which is a lot,

Kevin: which is a lot, I think people might be surprised it because it is a lot.

Gabrielle: People are going to say, how many times a day do you have to eat that? And I will say your target protein goal is your ideal body weight. And that it's really important. Yeah.

Kevin: One gram per pound of ideal body weight right?

Gabrielle: Right. And this is much more important to focus on as individuals age. Because there's increasing inflammation. There's just changes in the way the body senses proteins. The hormones have decreased. The ability for muscle to recover is also decreased. There's changes in motor neurons. There's a whole variety of things that are essentially working against individuals.

Kevin: Right. And so what I hear you saying is if I sit down and I have a meal and it has 15 grams of protein, my body's just not sensing. It's not going to pick up the signals that it needs to assimilate that and do what I need to overcome. Right. Is that a good way of saying that?

Gabrielle: You absolutely will not. In fact, if you are eating, sub-threshold at say 15 grams per meal, the body isn't going to even try the process of muscle proteins sythesis. It will just count towards overall calories and overall protein, but it is not targeted for an aging individual. It's not even going to stimulate muscle protein synthesis.

Cause that is based on a leucine threshold. And leucine is one of the branch chain amino acids that is really optimized in animal-based products or whey protein. You must reach a threshold. Which is a minimum of 2.5 grams of leucine. And I don't want to get too technical for people, but understanding that in 30 grams of high-quality protein, there's roughly two and a half grams of leucine.

And that is the minimum amount needed for an older individual to stimulate muscle protein synthesis. This is probably the most important aspect of aging is to be able to get your nutrition correct. You know, your training obviously has to be on point, and training is a much more potent stimulus for muscle protein synthesis.

But if you're training hard and you're not fueling correctly, then we know what the trajectory of aging looks like.

Kevin: Okay. So you've referenced quality protein, several times you've referenced whey and animal protein. So we now know that we want to shoot for this 50 grams per meal in order to get the response that we want. And you referenced leucine a several times. What are the best sources of protein for us? What should we be eating?

Gabrielle: Beef is a great strategy. It's the original superfood.

Kevin: People might be surprised to hear that. They probably are expecting you to say salmon, first thing out of your mouth, but yeah.

Gabrielle: Salmon actually has a lower protein amount. For every one ounce of salmon, you get five grams of protein versus beef or a red meat or chicken, you get seven grams of protein per one ounce. Yeah. Salmon is absolutely fine, but remember we said, you're going to need a minimum of 30 grams of protein and more optimally, 50 grams of protein.

To do the calculation, that would be what, 8, 9 ounces? You're looking at nine ounces of salmon. That's a lot of salmon. And then of course, calories do matter. You don't want to overshoot your calories being metabolically healthy and in a correct calorie range for you as an individual is important. Calories always matter, regardless of the quality of food.

Kevin: Sure, so red meat and was topping your list, but you had mentioned that there is a lot of press right now and it seems to be kind of politicize or almost a religion around diet.

Gabrielle: You're absolutely right. You're absolutely right.

Kevin: And for those of us that aren't necessarily nutritionally savvy, we see this thing come across and we're like, oh, okay. Meat's bad for the environment, or it is bad for me, especially red meat, it’s kind of it's out of Vogue right now. Certainly in certain circles. So what you're saying though, is that these are things that we should look for and need to be incorporating into our diets.

Gabrielle: That's exactly what I'm saying. What I'm also saying is the evidence doesn't support any of the narrative that you're hearing. A recent paper came out. Someone just sent it to me and I, can send it here. And it talks about how red meat is bad for heart disease and and they tell you this whole meta analysis about how it's bad.

But if you actually look at the statistics and you look at the risk ratio, the risk ratio is clinically insignificant. The data actually doesn't support the sensationalized aspect of meat that is bad for you. I'll give you another example. People are talking a lot about meat, red meat and the environment. The majority of greenhouse gas, and this is from the EPA, the environmental protection agency, the majority of greenhouse gases from electricity, transportation and industry, roughly 80 plus percent. All of agriculture, including plants accounts for roughly 9%. Of that 9%, maybe three and a half percent is cattle. So people have to understand that what they're hearing in the media is incredibly biased as it relates to nutrition and medicine as well, which is unfortunate.

Kevin: Okay. So when we're looking at our macros, let's stay on nutrition for a minute longer, and macros for folks out there, that's going to be your protein, your carbohydrates, and your fats. I suspect we're going to have a lot of protein in there. What does the rest of our meal look like?

Gabrielle: Well, number one, obviously determining what your total gram is in a 24 hour period, breaking that down into really 30 to 50 grams of protein per meal. Next is understanding that carbohydrates have a meal threshold tolerance. What this means is if you are sedentary, 40 grams of carbohydrates or less per meal would be a great target range because it doesn't increase insulin in a way that would have negative implications in the body.

And this is just based on glucose disposal. I typically recommend, you've always got to nail that first meal correctly. And that first one, for my patient population is 50 grams of protein. Fat is to taste. Fat kind of comes along with their food. Maybe it's 10 grams, maybe it's 25 grams. Carbohydrates I keep low for that first meal.

You don't really need it. Then two other subsequent meals, they have 40 grams. You have to earn your carbs. It's 40 grams or less per meal. If an individual wants to go over 40 grams of carbohydrates per meal, they have to be exercising. And this is purely based again on that glucose disposal.

Kevin: Okay. And I, love that you say that because carbs right now, they're having a tough time, let's face it. Right. And now all of a sudden carbs are the villain.

Gabrielle: But protein always remains the villain by the way.

Kevin: Well, you're right. Protein. That's right. Protein always been the bad guy. That's a good point. But I think what happens is a lot of people lump all carbs together and a potato and a Coca-Cola are two completely different things. Right. But also you'd said something very interesting that I love. And that's that you have to earn your carbs. Can you talk a little bit about that?

Gabrielle: Sure. There's a baseline amount an individual, any individual can dispose of. Roughly 30 grams of carbohydrates will go liver. Then, you know, for liver glycogen, you'll get carbohydrates for obligatory use as it relates to your organ. The brain some skeletal will use some, that is non exercising. So that body has compartments that's, for lack of a better way of discussing it, compartments for where glucose goes. To go over a 40 gram threshold, you require exercise. You require movement. And typically any training with your heart rate, over 120 beats per minute, will earn you some extra carbohydrates. Remember we don't need carbohydrates. All the carbohydrates we need we can generate. Especially from protein. For every hundred grams of protein you eat, 60 grams gets converted to carbohydrates through a process called gluconeogenesis. This is important to understand, but if an individual likes to go or wants higher carbohydrates, you have to be training.

And that's really you know, depends on where your VO two max is. Depends on what kind of training capacity. If you're just lifting a bunch of weights, you don't need a bunch of carbohydrates, you actually don't, but if you're doing more endurance or you're doing more aerobic activity, then you can and utilize these carbohydrates better.

Kevin: I think that folks out there, especially my runner folks and my endurance folks, they live on the carbs. Right. If you're one of those folks that are doing triathlons, marathons, et cetera. There is a small subset of those folks that are burning fat for fuel, but for the majority, they're carb loading and all that good stuff. So what then, you had mentioned that muscle is the organ of longevity, and you've mentioned, I think that it's an endocrine organ.

Gabrielle: It is. It's an endocrine organ.

Kevin: Talk a little about that. I think that might surprise people, right? We think of muscle as it moves my levers, but we don't think about it as being an organ.

Gabrielle: Let's define endocrine organ. Endocrine organ is something that secretes proteins, secretes hormones that travel throughout the body. When you contract skeletal muscle, it secretes myokines. And myokines are specific to muscle tissue. For example, and there's many different kinds of myokines, but I think one myokine that your listeners may be familiar with is called BDNF, brain derived neurotropic factor.

And this is kind of like the happy hormone of why people feel great when they exercise. It is secreted by skeletal muscle. It goes to the brain, actually goes systemically, and has a lot regenerative effects on the body. What people also don't realize is something called interleukin six is also a myokine and that gets secreted.

And which people typically think of as an inflammatory cytokine is actually secreted by skeletal muscle. And simply what this means is the myokines that skeletal muscle secrete have very positive impacts on the body. It can reduce inflammation, it travels to bone and helps with bone turnover, stimulates bone. Travels to the brain, helps with mood neuro-regeneration, cognition. Travels the liver there's that helps with nutrient partitioning. There's many different factors of skeletal muscle other than just locomotion. We have glucose disposal, which we just touched upon. It's the largest site for glucose disposal. It secretes these myokines in an endocrine type fashion.

It is the site for lipid oxidation, which most people don't think about when we think about being concerned with cholesterol, overall cholesterol, skeletal muscle is the primary site where you can metabolize that. And even more importantly, it is the amino acid reservoir in the body. If an individual were to get injured or, if an individual is going to have to be off training, skeletal muscle is what's actually going to support that healing process. If perhaps they get into a bike accident or they have an injury, skeletal muscle is what's going to be responsible for providing with the amino acids. Other, you know, if an individual is not eating what they should be, if they're still very high carbohydrates.

Kevin: Thanks for sharing that. That's all very interesting. And I think a lot of people may think about muscle in a different way. Now keeping on the muscle for a minute. So let's just take a woman in her sixties who unfortunately has not been active all her life. She's been pretty sedentary. And she's now just getting into health, wellness and wants to build muscle. What does she need to do? What's her prescription?

Gabrielle: Good for her. Yes. let's talk about that. If she's largely untrained, it's going to be challenging to go to a heavier load. Progressive overload is really important for her, but it doesn't have to be heavyweights. People think, well, I have to lift heavy to get benefits.

You also can't necessarily lift weight without exertion. And What do I mean by that? An individual will need to lift to failure. Even if it's five or 10 pounds, they will need to lift to fatigability. And I like seeing all muscle groups work twice a week. And really putting in the effort. So the effort does matter and the weight, the heavy weight, is not necessary.

And Stu Phillips did a lot of research on this, but it is important to increase and put forth effort. Another way in which they could do it is they could do blood flow restriction, any of your older athletes that get injured. And, you know, I'm sure that many of those individuals are self-starters.

And what they'll do is they'll go back and they'll go to rehab and then they'll rehab themselves. I would suggest that those individuals begin also with blood flow restriction because they will allow for more growth factors and more stress factors to be able to help rejuvenate that tissue. And that's what I would do? I would start with, with resistance training.

Kevin: So resistance training, which is going to be lifting weights. we're going to start them, start somebody out that's unconditioned or de-conditioned without a whole lot of weight. We need to kind of build them slowly over time, but it still needs to have that exertion, right.

That effort and going to fatigue. Cause basically. Is what's happening? Are we breaking down this muscle and then eating this protein, this healthy protein and rebuilding it back bigger and stronger. Is that our basic idea?

Gabrielle: Yes. The body is always in this ebb and flow of an anabolic and catabolic state, and actually exercise is a catabolic state. So through exercise, you are breaking skeletal muscle and tissue down. When rebuilding happens is actually not during the training. It's at rest and has to be provided with proper nutrients.

And you think about baseline amino acids. And you also think about muscle glycogen, which could be if your individuals are adding a little bit of carbohydrates, this would arguably be the time to do it. A little bit of carbs with, I mean, you don't need a ton of carbs, but a little bit of carbs with some protein would be wonderful for individuals.

And I will say this for our hypothetical patient, having five grams of our young lady at 60, who's going through menopause, adding in five grams of creatine a day would be great for her as well as making sure her vitamin D and fish oil are on board. Those are all very helpful as she's thinking about now building muscle. It's never too late to make an effort.

And her first adaptations maybe neuromuscular adaptations. It may be balance. It may be coordination. The thought is that an individual who is untrained should be able to put on two pounds of skeletal muscle a month for a trained individual it's about half of that.

Kevin: Okay. So she can put on some considerable amount of muscle

Gabrielle: She ca, I mean I’m sure that there's an age component. Let's be realistic. You and I both know that as individuals age, it just becomes harder to put on that tissue.

Kevin: It does.

Gabrielle: And really, again, those are all the things that we're fighting against. We're fighting against hormones. We're fighting against this nutrient sensing and just the stimulation to be able to change that tissue takes time.

Kevin: Right. And I, I think we're seeing a lot more examples of healthy, strong, healthy aging out there

Gabrielle: Yes. Look at you. Look at you. You're over your what? 50. That's amazing!

Kevin: 57. Yeah. Thank you. Yeah. So that's my mission, to help shine a light that we, when people think of that 60 year old woman, they often in their mind, they're conjuring this, you know, a grandmotherly lady and she might be a little portly and but they don't picture her doing dead lifts or squats or.

Gabrielle: But they should.

Kevin: But they should. Right.

Gabrielle: Yeah.

Kevin: There's more and more of those people out there. And I think that's one of the great parts of social media is we are seeing more of this as opposed to the common narrative. You know, you walk out into a grocery store that you're not seeing very healthy people.

Gabrielle: And unfortunately, the common narrative is what you had mentioned before. It's not super fit 57 year olds. Which it could be, but it's absolutely not. You know, it's interesting. And I'll mention this, that the tissue changes. The type two tissues that we see those big bulky tissues, which I don't really have any right now, but they actually change. They diminish. The actual tissue, the skeletal muscle, actually diminishes. The fiber type changes.

Kevin: Yeah. So that's a good point. We have type one type two or slow Twitch, fast Twitch muscles. And we preferentially - am I correct in saying we lose those those type two, fast Twitch muscles, which is what we're targeting when we're targeting resistance training as opposed to, the 60 year old lady go out and take a 30 minute walk which is, unless she's very, de-conditioned, that's probably not going to build muscle. Right. And we're looking for this anabolic response, this muscle building response.

Gabrielle: Exactly to build and maintain those type two fibers.

Kevin: Right. Okay. And this is something that once she puts a little bit of muscle mass on her, she will be feeling better and looking better.

Gabrielle: She'll be more metabolically fit.

Kevin: And she'll be more metabolically fit.

Gabrielle: Her risk factors and her ability to manage glucose regulation will go up. And ultimately, if she can manage her body composition, then you think about Alzheimer's prevention. Cause Alzheimer's actually starts in your thirties. It's Insulin resistance of the brain. And insulin resistance starts in skeletal muscle, it doesn't start in fat tissue.

Kevin: You had mentioned glucose control several times. And I wanted to ask you about insulin resistance and it's role in obesity and just overall health and metabolic health.

Gabrielle: Right now everyone talks about insulin resistance and it's really this inability to manage your carbohydrates and needing to utilize insulin, which is created by the pancreas to help move glucose into tissue because glucose is toxic. And when you think about it, there's only one way to manage high levels of glucose and that's insulin. Versus you have multiple other ways to manage low levels of blood sugar.

Okay, so you can create gluconeogenesis. There's just a lot of different ways to manage low blood sugar, but there's only one way to manage high blood sugar. And that's insulin. We live in a society where a lot of processed foods and excess consumption of calories and carbohydrates are being pushed, unfortunately.

And when this happens, individuals have a hard time disposing of excess glucose, and require more insulin and become insulin resistant. Which makes logical sense. The part that people are missing is that it's not a fat tissue issue. That is now a, an observation of an inability to manage glucose and becoming insulin resistance oftentimes goes hand in hand with being overweight. But I told you earlier that 80 some percent of glucose disposal is through skeletal muscle,

Kevin: And if you don't have that skeletal muscle.

Gabrielle: So insulin resistance is a skeletal muscle issue. It starts in skeletal muscle first. Skeletal muscle is the primary site for glucose oxidation. And people must understand that one of the reasons it's so hard to treat insulin resistance is because everyone is focusing on fat tissue.

Lose fat, lose fat. Okay. Well, how is that going to improve your metabolism? It will improve your inflammatory markers, but the conversation is totally incorrect. By focusing on and improving high quality tissue skeletal muscle, you can actually mitigate some of the effects of glucose. Because it is the primary site for glucose disposal.

Kevin: I love this message because I think what I hear you saying is if I dial in my diet, focus on these high quality proteins, I add some resistance training, that symptom of obesity is going to take care of itself. Right?

Gabrielle: Yes. But if you focus, mistakenly, on just constantly thinking about losing weight. You go through periods of yo-yo dieting, you further destroy skeletal muscle which is your metabolic furnace in your sink. Then ultimately human nature becomes predictable, human health becomes predictable.

We know exactly what that end result is going to be. It is our job as healthcare providers and as professionals to really help shift that narrative. Because that narrative is outdated, but continues to be promoted. It is a skeletal muscle problem. Obesity, diabetes are all skeletal muscle problems.

Kevin: I'm thinking here, because it seems like the narrative 100% is let's tackle obesity. Obesity is a problem. And clearly it is. But if we flip that around and look at obesity as the symptom then working on increasing muscle will make us healthier and decrease those fat levels.

So you had mentioned medicine there and, and having this conversation, can you talk a little bit about osteopathic medicine versus say allopathic medicine. Let's talk a little bit about what's happening in healthcare at that 10,000 foot view here, because I think what's happening is a lot of folks will go with a chronic disease symptom and get treated for the relief of that symptom. But what I hear you saying is our responsibility as medical community is to do something other than that. So maybe spend a minute and talk about that.

Gabrielle: Yeah. I am a traditionally trained physician. I'm an osteopathic physician. I did my medical training is in medical schools as an osteopath, and what that simply means, and actually I chose osteopathic medicine because I was extremely interested in sports medicine. There is an MD path and a DO path. The DO path are licensed exactly the same as an MD.

So there are orthopedic surgeons who are osteopaths. There are, you know, you name it. The prescribing and the education is the same, with the addition as an osteopath also gets trained musculoskeletal. That is the only difference. And right now it's interchangeable. I did a MD fellowship at Washington university, so DOs and MDs, we work side by side licensing is all the same.

The aspect of that is traditionally, I will say osteopaths tend to be more holistic and looking at the whole body. And just as a philosophy, tend to be a little more preventative minded. I'm not sure if that answers your question, but that certainly is my understanding of it in my experience.

Kevin: Yeah. And I just think that in my experience, let's say I go for a checkup. Aa lot of times I'm, well, I'm much healthier than my doctor. I know that my doctor gives the prescription of, well, you should eat less and exercise more to a lot of people. People will say that. Well, yeah. But that's, that's very vague.

Right? And there's not a whole lot you can follow up with there. I get this feeling that a lot of doctors, just general practice doctors don't know what to tell their patients to eat. They don't know what to tell them how to move, whether those are younger patients or older patients.

And I just have this sense that there's this kind of prevailing culture in medicine, that's just this traditional. You come in, there's something, there's something wrong with you. I will treat that. And in acute cases, that's fine. If your leg is broken, I want the doctor to treat that. But if I'm overweight and sedentary and I've got insulin resistance and I'm pre-diabetic or type two diabetic, I don't want diabetes medicine necessarily. I want, or what I want that medicine to look like, that prescription to look like, is more like what you're talking about. Okay. I want you to make sure you're getting 50 grams of protein, every meal. I want you to go find a trainer or a gym and get under a barbell and start working out. I feel like we're a long ways away from that.

Gabrielle: I actually agree with you. Physicians, I was thinking about this the other day is that it's interesting. There's been kind of a progression of what medical care is. And right now, from my perspective, there's two ways that in which medical care is happening. And let's take acute issues like breaking a leg or going septic off the table.

There is either the algorithm treatment plan. You have a hypertension, this is your medication. This is you're going to get an ultrasound here, this, this, and this. And it's very much just a protocol based. And this is how it is. This is what you implement. This is the diagnosis. Here's the implementation. I think a long time ago, medicine was much more personalized and for individuals and I practice personalized medicine.

I spent an hour and a half with my patients or my busy CEOs, and they don't want to talk to me. I always schedule an hour for them, even if they want to talk to me for 10 minutes. I think we have to understand every person is individualized and that an individualized plan is incredibly important. That being said, physicians are not traditionally trained in nutritional science. I did seven years of professional nutrition training. So I did my undergrad and then I did a fellowship at a very well-known highly respected institution. That is not common. I think the other thing that we're really up against is the narrative in the medical community, as it relates to nutrition, is incredibly biased and it really does a disservice.

Physicians, I believe, always want to do the right thing. It doesn't mean that they are taught the right thing to do. And you know, I've seen that over and over again, as a trained geriatrician. It just takes a long time and long time for research that's being done to get to the physician. And it seems as if now we're seeing more of agenda driven medicine, as it relates to nutrition, getting to our physicians. It's an uphill struggle for sure.

Kevin: It is, it certainly is. And I think people might be surprised when they learn that their doctor doesn’t have  a vast knowledge on nutrition. Certainly he or she understands the biology of nutrition and what happens in the systems and the cells, we would hope so. Right. But in terms of what you should eat and why you should eat that way and understanding that it's going to be individual.

I think the other thing that was very surprising in that is that you said you spend an hour with your patients. I don't know. I can't think of a time I've ever spent more than five minutes with a physician.. Typically the, you know, somebody else comes in and is doing my blood pressure and taking my temperature. They leave and the doctor comes in. And now they're gone. So yeah, but maybe things are changing, and I think they are.

Gabrielle: They're changing, but an individual has to seek it out. Part of understanding and being a good physician is not just understanding the prescription. The nutrition prescription, but it's also about understanding the patient. There are very particular archetypes of patients and by understanding who the person is, who the patient is, really allows you to leverage that

individual to get exceptional results.

I've been in practice since 2006. I've been practicing medicine. You see over and over individual repeating itself. By understanding that, it gives you a good sense of how much nutrition information you are ready to give to the patient, where their weaknesses are, how do you augment and help them plan for their own weaknesses that they might not be aware of to really allow them to get the best results themselves.

Kevin: Well, thanks for sharing that and following up on that. So let's just take our 60 year old woman. She sedentary, she's decided she's going to start eating better. She's going to start exercising more. What should she look for in a physician if she wants to change a physician or, it's typically we're going to go at least get a physical every year.

What are we looking for? How can we, it sounds like you were saying maybe we as the individual need to take some responsibility for our own health.

Gabrielle: What a great question. I think that there's a couple things an individual should understand. The first thing is really word of mouth referral, I think is very important. For example, in my practice, I do no advertising. It's very important to find a well-trained physician and they should be very open and willing to tell you where they trained and they should have been in practice for a while.

10 years in practice is the minimum. And listen, that doesn't mean that there aren't great physicians that are coming out. There are many great physicians that are coming out. This is for me. So I have two types of physicians that I personally see. I see an internist who I know is very well-seasoned and is going to be able to catch something that's really critical.

It's important. Good physical exam. Highly trained is going to know what to do. They're going to be able to see that mole and say, hey, this doesn't look right. Or I just listened to your heart, we're doing EKG. You know, we're going to do follow up. Baseline, highly trained internist that you don't need them for nutrition advice.

You don't need them for how to train what supplements to take. This is purely a diagnostician. Then the other physician that you want to get on is a personalized functional medicine type physician. These are the physicians that are going to change the way you age. They are going to take care of you and your family.

They're going to know your family, when anything hits the fan, they've got your back. They are making calls to the specialist. You have a good relationship with them. They are on top of it. They're going to tell you and look at preventative type bloodwork. You know, they're going to say, Hey, do you have a significant travel history?

We're going to look at this for GI health or we're going to look at your hormones. And that is finding a good functional medicine physician needs to also be a medical physician. It is understanding that you are with a physician who is practicing within the scope of their care, right?

That means this person is either an MD or a DO. They could certainly be a naturopathic physician, but I'm not sure about the prescribing laws or what that is, but you know, again, someone who is trained in medicine. I hope that answers your question. But I think they should always have two physicians.

Kevin: Okay. And that that's very helpful. And I certainly, I will personally take that under advisement because I, I'm kind of looking around, you know, I'm very, very fortunate, blessed that I basically, at this point, only have my annual checkup, but yeah. I'm looking for somebody that's more has that holistic approach.

So thanks for sharing that. I did want to go back to the nutrition cause I feel like there's some in my audience that are going to say, hey, wait, how did you have this person on and not ask her opinion on one of the hottest things which is Keto. So I did mean to bring that up while we were talking about nutrition. I'd love to hear your take on keto because that's one of the things when people find out I'm a nutrition coach, they’re like, oh, well, what do you think about keto? And it just, it's just got a lot of traction right now. So I'd love to hear your thoughts.

Gabrielle: I think that there's a lot of different nutritional strategies that can work for people, different people. I personally don't prescribe a ketogenic style diet unless an individual has had head trauma. And I will tell you, or they have seizures, and I'll tell you why, because for me, it's always about optimizing for skeletal muscle. A high fat diet doesn't optimize for skeletal muscle.

It might work for an individual. I don't think a ketogenic diet is magic. I think it allows for calorie control and I think it allows for hunger control. That is my overarching opinion on a ketogenic diet. I don't prescribe it in less than individual is again is like one of my military operators who has had head trauma or they have seizures. Because a diet has to be sustainable. Now there's nothing wrong with a ketogenic style diet. If someone likes it and they feel that they can eat that way for an extended period of time and as a geriatrician, I am always thinking about what does it look like for skeletal muscle in an individuals thirties? And how is their nutrition plan going to support them in their forties and fifties, sixties, seventies and beyond? That is absolutely a protein forward, protein optimized diet. Hands down the literature is clear.

So it's not even up for debate. That this is going to protect skeletal muscle. And if your listeners believe with me, that skeletal muscle is the organ of longevity, and they know that the healthier the muscle is the healthier they're going to age, the more metabolically flexible they're going to be, the more capacity they're going to have for activities of daily living. Then they're also going to believe that choosing nutrition plan that is going to support skeletal muscle is absolutely going to be the key.

Kevin: Fantastic. Thanks for sharing that. I love that take on that. And the other one I want to ask you about that comes up all the time is, what about intermittent fasting?

Gabrielle: Yeah. These are great questions. And these are great questions because I get to talk about age specific experiences with this. Intermittent fasting is really great in a lot of ways. It allows bowel rest. So let's define intermittent fasting. It's really eating in an eight to nine hour window. And the rest of the time you're fasting.

My patients go from 10 to six in our eating or 11 to seven or 12 to eight. And they do really well on that. The concept of fasting is helpful in the way that it helps with circadian entrainment. People think of circadian entrainment, which are their biological rhythms in the body, as it relates to going outside and being in the sun.

But food is one of the biggest circadian regulators. By utilizing time-restricted feeding or intermittent fasting, it allows for predictability for the body. Which I think is important and also allows for that circadian entrainment. You're not eating around the clock. Let's talk about what that looks like for body composition of an older athlete or an older adult.

If someone is highly, highly, physically active and really dialed in with their protein intake, intermittent fasting for an older individual is okay. When I say older I mean fifties, sixties. Now we're getting into your seventies. Do I think people should it be intermittent fasting? I start to question this.

My dad, who is 71, very fit guy, does intermittent fasting. Have I seen his muscle mass decreased with this new strategy? I have. That is purely anecdotal. That doesn't mean there's randomized controlled trials to support that. I just think that we have to be very conscious of, can we take a recommendation in our forties and fifties and push that towards our sixties and seventies?

I think we have to be very cautious of that. Because the unintended consequences of that behavior may result in skeletal muscle loss, which we can not get back over a period of time. Therefore, if an individual is interested in intermittent fasting and is on that sixties, seventies, eighties path, perhaps they do that one to two days a week.

Kevin: Yeah, great strategy. So speaking of the muscle loss there in the end of the seventies and eighties, is it fair to say that it's easier to maintain muscle mass as organ of longevity than it is to build new muscle for that aging population, right?

Gabrielle: It is. It really is. And I would say that we've all seen this with our parents. That they really have to maintain what they have and once you start to lose it and that fiber type changes, or if they've gone through periods of obesity, fat begins to infiltrate into the muscle, just like a marbled steak.

Then the contractile nature of that tissue changes. The ability to oxidize glucose changes, the ability to oxidize fat changes. It's not as metabolically healthy tissue anymore. It's this marbled steak. And you don't want that to happen.

Kevin: So we want metabolically healthy muscle and lots of it as we age. Right? That's that is the key to aging. I mean, we can boil this down to that. It's just, now it's just a matter of strategies for supporting that for building that, for maintaining that over the longterm.

Gabrielle: I think that you're onto something. Cause you have a community where you are talking and being the example for highly trained exercising, nutrition oriented individual. That's what we need. Because it really shifts the conversation. It's just what we need.

Kevin: I’m very passionate about that. But it's a tough sell. I'll tell you it really is because you take somebody who's sedentary and obese and they feel like it's such a long way to get to be healthy. And maybe it does, maybe it doesn't depends on the person, but when you say that, okay, here's the prescription.

We're gonna, A I'm a big believer in baby steps. You don't need to do any of this overnight, but what we're going to do is we're going to change your nutrition. We're going to change your activity level. And I need you to do make these - let's face it - difficult choices every single day for the rest of your life.

That's what I'm pitching. That's what I'm selling. And for some people it's just too much of a trade off. I know a doctor, an MD doctor, who's a radiologist and he is, he's just metabolically ill. He's got all the chronic disease. He's got this big basket of medicines for each of his symptoms. He knows better. And you know, we'll get in these discussions. I'll say

Gabrielle: This is where leveraging his predictability as a human comes into making transformational change. This is, is now planning for his weaknesses.

Kevin: Yeah, and there, and I think you've talked about this also, the compression of morbidity. So you take somebody like that and he'll tell you, he said, yes, I'm going to go out this way because I don't want to do what it takes. I know what it takes to be strong and healthy. And that's so odious to me. I don't want to do that, that, and I think about it.

What that looks like, what his health span is. He's gonna live a long time because our medicine is going to keep him living a long time, most likely, but he's going to have this morbidity, it's going to stretch out for years, potentially.

Gabrielle: Right.

Kevin: Whereas that much healthier individual, we can say, okay, you've got this much longer health span. And then hopefully that morbidity cycle is much, much shorter. And I think a lot of people miss that, but yeah, it can be a tough sell to some folks.

Gabrielle: I mean, I think if an individual is living out of integrity within their own wellness, then you know, that's tough because that's a settling that is a much deeper discussion then, it’s a much deeper discussion as it relates to really having him face, those demons are. For sure.

Kevin: Yeah. Yeah. Okay. So Dr. Lyon, you've obviously put a lot of thought and a lot of time into this area of expertise here. What's next for you? What's on the horizon?

Gabrielle: I'm working on a book. Yeah. My book agent has a book. It's technically the Lyon Protocol right now. That name is going to change and it talks about all these things. It talks about muscle as the organ of longevity. It has three strategies for how to optimize body composition, whether it's build muscle, lose weight, maintain. So that's really going to be the next year. And then I'm building some online courses for the people that can't come see me as a patient. I do have a concierge medical practice in which I do everything remote now since COVID, but that is by application only. And we take roughly 50% of those individuals that apply to be a patient.

I want to be able to offer something to the 50% of the patients that we don't take. So I'm going to be building out that and then giving them zoom calls that kind of a thing. So it will be this whole ecosystem to allow me to help more people. And that's really next for this next year. It's going to be the book, any ecosystem to help other individuals.

And then of course, what I'm working on now is I have a YouTube channel, a newsletter, all of that, which is all written by me. It's highly curated information.

Kevin: Okay. Great. We’ll certainly will be looking for the book and the online offering. And I personally subscribe to your newsletter would strongly suggest folks to do that. And I can drop all of your info into the show notes here, but what's the best way for folks to connect with you.

Gabrielle: Instagram. I am very active on Instagram and I do my best to respond to all messages or I'll take those and do a YouTube video on the questions that you guys have for me. And of course, being connected on my newsletter. I'm always talking about what's next, where I'm speaking and what I will be doing.

Kevin: Right. And your websites. I think it's just www.drgabriellelyon.com. Is that right? And again, I'll drop all that into the show notes. Okay. Well, Dr. Lyon, I want to thank you so much for coming on and sharing all of your knowledge and your wisdom with us, and just really encourage you to keep up the great work. And I wish you all the best in all your future endeavors.

Gabrielle: Thank you. so much.

Kevin: OK folks, that’s our show for this week.  All of the links to the resources we discussed in this episode and more can be found at www.silveredgefitness.com/episode72.  And you can continue the conversation over there as well, I’d love to hear your thoughts and comments on today’s show.  Also, you can show our support for this show by giving me a five star review on whatever platform you listen to podcasts on, and be sure to subscribe and follow so you don’t miss any future episodes.  Speaking of future episodes, my guest next week is Dr. Stefan Zavalin and he’s going to talk to us about the dangers of sitting and how we can transform our culture of sitting by incorporating movement into our daily life.  I want to thank you so much for listening today. And until next time, stay strong.