In this episode, I’m speaking with Dr. Gabrielle Lyon, founder of the Institute for Muscle-Centric Medicine®, about her new book, Forever Strong.
I believe Dr. Lyon’s message is so crucial that I bought her book for myself and my parents—this episode is a must-listen!
Table of Contents
In this podcast, Dr. Lyon and I discuss:
- The completely overlooked driver of cardiovascular disease, cancer, Alzheimer’s, and the epidemic of chronic illnesses…and it’s a factor you can change TODAY
- Why worrying about fat gain is the wrong place to put your attention, and what to focus on instead
- ‘“Calories in-calories out” and the real truth behind this hotly debated topic—plus, a deep dive into the macronutrient that can make or break body composition
- An evidence-based option for the over 40 million people on statin drugs…could cholesterol and triglycerides be managed without the risk of statin side effects?
- Why the “obesity epidemic” is completely inaccurate, and a new way to view obesity that will actually make a difference in people’s live
- Why most seniors lose up to 75% of their mitochondrial capacity…and how you can avoid being part of that statistic
Listen or download on iTunes
Listen outside iTunes
Ari Whitten: Dr. Lyon, my friend, welcome back, I think for the at least third time, if not fourth time. It’s always a pleasure to talk to you.
Dr. Lyon: I’m so happy to see you. This is really fun and I appreciate you interviewing me for this big week that’s happening. Thanks.
Ari: How does it feel to be a superstar in New York City with a giant billboard, I think in Times Square with your name, your book on it? How does it feel?
Dr. Lyon: What it feels like is that the mission matters. For me, this book is not about any single one individual. It really isn’t. You’ve known me for years now. This book is a mission to change the narrative of medicine, health, and longevity. That is why I am so excited. If we can push this message to the mainstream, we’ll begin to have different conversations, not just within a regular person, but really also in the medical community. I couldn’t be happier about that.
Ari: I agree with you 100%. I want to tell you, this is not often that I do this, but your team offered to rush me a copy, to FedEx me a copy of your book in preparation for this interview. I declined it and instead I bought your book myself.
Dr. Lyon: Thank you.
Ari: I also bought 20 more copies for my friends and family.
Dr. Lyon: Too bad.
Ari: This is the highest endorsement I can possibly give to any book of someone who’s an author in the health space. I bought a copy of your book for my parents.
Dr. Lyon: Amazing! I’m so thrilled!
Ari: That’s how much I think of your book, and that should tell everybody listening to this podcast, before we even get into this, and they’re going to see us as we have this discussion. Everybody listening before we even start this discussion should go to Amazon, or Barnes & Noble, or wherever you buy books from and get a copy of this book. It is that good. I give my strongest possible endorsement of it for everybody to get this book. It is simply a necessity to live a good life and live a long life. You have to go get it. Do it now. Don’t even wait. If you need convincing, we’re going to have this conversation anyway.
Dr. Lyon: I love that. I appreciate it that you see the importance of the work. It’s called Forever Strong because for the last 50 plus years, we’ve been talking about the obesity epidemic, the cardiovascular heart disease epidemic, the cancer, Alzheimer’s. You put in whatever it is that you want, the aging, the sarcopenia epidemic. In reality, at the end of the day, the root because of the majority of these metabolic challenges is skeletal muscle health, and that is where we need to focus our energy.
Why skeletal muscle is the most important tissue in your body
Ari: Let’s start with that. In this book, you’ve made the case that skeletal muscle is vastly more important than most people, than modern medicine has until now realized, and functional medicine also. This applies also to not just conventional medicine, but also the natural health sphere. You call it the “organ of longevity”. Give us the big picture, the high level overview, and we’re going to dig into the specifics, but what’s the high level overview of why muscle is the organ of longevity?
Dr. Lyon: Skeletal muscle makes up 40% of the body by mass, weight. It is the largest endocrine organ system in the body. It’s actually an organ system. Now, let’s think about what does skeletal muscle do? The first thing that all your listeners are going to think about or your viewers is exercise. They’re going to think about performance, and sprinters, and maybe weightlifters, and the skinny tanks, and the fake tans, but skeletal muscle is so much more than that.
It is the focal point for healthy aging and longevity that begins very young. Skeletal muscle does a number of things that it is extremely underappreciated for. Number one, and probably most obvious, is that it’s your metabolic sink, meaning it’s the place where you dispose of glucose. Glucose is from the carbohydrates that you eat. When your blood levels of glucose get high, hopefully, your pancreas, which releases insulin, insulin is a peptide hormone that will move blood glucose out of the bloodstream into the cells, starts in skeletal muscle. That is the primary point where insulin acts based on weight.
What else does it do? Skeletal muscle at rest actually burns free fatty acids. People are worried about triglycerides and cholesterol, fatty acids. Skeletal muscle is a primary site for this. Really important to understand. The other underappreciated aspect of this is when you have unhealthy skeletal muscle. What do we think about when we think about unhealthy skeletal muscle? From a visual perspective, it’s the idea of your muscle looking like a marbled steak versus a fillet.
How does skeletal muscle become unhealthy? Skeletal muscle is like a suitcase. When you open the suitcase, and you are going on a trip for four days, but you pack for 30, and if those clothes are the substrates that they are the foods that you’re eating have nowhere to go, it remains in the bloodstream, or it spills back out into the bloodstream. Ultimately, skeletal muscle provides a location for places for these macronutrients to go. That is one place. That is one obvious, obvious piece to health and longevity.
I will mention that the loss of skeletal muscle is more critical than the gain of body fat. The current paradigm talks about gaining of body fat and how it increases inflammation. All of that is true. Low levels of inflammation can lead to a multitude of risk factors. Where does that start? That starts in skeletal muscle first. Obesity is the second step. Weight gain is the second step. Fat infiltration into the skeletal muscle is the second step. That’s one aspect.
Another aspect of skeletal muscle is the organ of longevity is that it is your body’s armor. When you imagine aging, many people think about it as a potentially slow decline. It doesn’t have to happen and probably none of your listeners are thinking it’s going to happen, which is amazing. It’s actually not a slow decline. Typically what happens during aging is there’s a catabolic crisis, a series of catabolic crises.
For example, if someone gets sick and they go on bed rest for a week, if someone breaks a hip and they’re on bed rest, if they get pneumonia, if they get anything, where you are laying in bed, this is what we call a catabolic crisis. When an individual is young, their ability to respond and go back up to baseline from a muscle health perspective, meaning muscle mass and strength, is robust. Hormones are high. People are typically very physically active.
As an individual ages and is not as active as they once were, they never get back up to baseline. Every catabolic crisis that happens creates a very significant decline in overall health. If you believe that skeletal muscle is the organ of longevity, and I’ve highlighted that it is the place for glucose disposal, it is a primary site for insulin resistance and fatty acid oxidation, that when you lose that tissue, you have subsequent issues and you are predisposed to diabetes, obesity, cardiovascular disease, Alzheimer’s disease, these diseases that are rooted in metabolic dysfunction. I can go on and on. There’s more that skeletal muscle is responsible for. I’ll wrap up with two, maybe three.
The other thing is when you contract skeletal muscle, it releases myokines. Skeletal muscle is an endocrine organ. There are 600 plus myokines that travel throughout the body and do various things. The most famous myokine is interleukin-6. Interleukin-6 is released from exercising skeletal muscle in the relationship of the intensity and duration of exercise. What does it do? It lowers inflammation. It dampens the inflammation that could be released from macrophages when they release interleukin-15 or interleukin-6. It also releases BDNF, which is brain-derived neurotrophic factor, and a handful of other myokines.
Now, I’m going to blow your mind really quickly. It’s not just the exercise from a calorie perspective, from a muscle health perspective, from getting the flux out, so you need flux for skeletal muscle to be healthy. The other underappreciated fact about skeletal muscle is exercising skeletal muscle releases these myokines. If you are sedentary, you do not get the benefit of these myokines.
What happens when you carry around too much body fat?
Ari: Thank you. Beautiful overview, lots to dig in here. Let’s start with the idea that it’s not being over fat that’s the problem, it’s the idea that being under-muscled is the problem.
There’s been so many experts for so long telling us we have too much body fat. You’re shifting this paradigm and saying it’s not just too much body fat, and actually, in your case, you’re saying it’s mostly being under-muscled. Explain why, explain the scientific basis for that claim.
Dr. Lyon: Right now, again, we talk about obesity. Clearly, we know that a certain percentage of body fat has metabolic implications. When an individual is over 30% body fat, we may see elevated levels of insulin. We may see elevated levels, not always, but potentially we see elevated levels of glucose, elevated levels of insulin, elevated levels of triglyceride. The question becomes, how did an individual get to 30% body fat?
If we believe the mechanics of glucose disposal, and we believe that when you eat that you have to get rid of substrates and you have to store them or metabolize them, the primary site for utilization is skeletal muscle. Everything else, after skeletal muscle gets its first pass becomes a downstream issue. The other interesting aspect is that we know from aging studies, when individuals lose skeletal muscle, that these changes in blood levels of, again, triglycerides, these are really the hallmark markers of unhealthy skeletal muscle, not surprising, the markers that people point to as issues with obesity.
Now, I still see patients in the clinic, you can be a thinner person and not have a ton of body fat and be metabolically unhealthy. The reason for that, again, isn’t the body fat issue, it’s the fact that they don’t have enough healthy skeletal muscle to store glucose, to burn fatty acids, et cetera. That’s really the framework for thinking about it. The other issue is that we’ve been measuring body fat. We get a DEXA. A DEXA looks at body fat and bone density. Everything else is extrapolated. We have not been directly looking at skeletal muscle.
Ari: Can I play devil’s advocate for a second?
Dr. Lyon: Yes.
Ari: How can we explain people like world’s strongest men who have lots of muscle or powerlifters, people who have lots of muscle but still have lots of fat?
Dr. Lyon: I think that that’s a really good question. I’ve thought about it a lot. I would have to see their blood work. There is something to be said for certain phenotypes of bodies that potentially some individuals will never have a leaner frame, but because they are so healthy from an exercise perspective, again, we’re talking about power lifters and et cetera, we’d have to actually take a look at their blood work to see are they able to balance the amount of calories that they’re eating and what are they actually looking at. It’s very hard to say that a powerlifter would be a healthier individual.
Why and how calories matter
Ari: How do we mesh this paradigm of being under-muscled and its role in body fat gain with the calories in, calories out idea? What do you think of calories in, calories out as this sort of the explanation? I know lots of the evidence-based fitness community basically says, “Hey, this is calories in, calories out.” We have lots of science to prove that this is true. There are alternative people out there that have been– Gary Taubes and lots of people saying, “No, calories is not what’s going on. Really, it’s hormones and specifically insulin.”
I know that you’re obviously in the camp that says calories obviously matter. We have lots of evidence to show that. Do you think it’s just as simple as calories in, calories out or is there more nuance and complexity to it?
Dr. Lyon: Certainly, I believe that calories in, calories out matter. I also believe that the answer is probably somewhere in the middle. I can share with you one of the earlier studies that I worked on and this was out of Don Lehman’s lab. He looked at two groups of individuals, each eating 1600 calories. One group followed the food guide pyramid and these were postmenopausal women, not on hormone replacement. They followed the food guide pyramid where it was 50-some percent carbohydrates.
The other group was a higher protein diet. They doubled the RDA of protein. For the listener, the RDA of protein is 0.8 grams per kilogram or 0.37 grams per pound. That’s actually what the group that was given the food guide pyramid, they followed that. They followed the current recommendation of 0.8 grams per kg plus a 50% carbohydrate diet that was calorie restricted, so 1600 calories and the rest was fat
The other group had a higher protein diet, so they doubled the RDA. They had 1.6 grams per kg. Their first meal of the day had around 40 grams of dietary protein and the carbohydrates were around 30% of the diet. It was somewhat of a zone-looking diet. What they found was on calorie restriction, the individuals that didn’t exercise and were on the high-carbohydrate diet lost six times more lean mass. They all lost weight, but the majority of the weight, it was six times more lean body mass. Lean body mass is muscle, it can be bone, it’s anything other than fat tissue, which is striking.
The other group that was given dietary protein saw a sparing effect of the tissue, so they were able to maintain a large amount of lean body mass. When exercise was added to that, in totality, the group that had the high-protein group with five days a week of walking and two days a week of stretching lost only 6% of lean tissue. Calories were controlled for. This begs the question, does calories in, calories out matter? Clearly, but the effect of the quality of weight loss will depend on the macronutrient intake and distribution as well as the resistance training component or the exercise component. Clearly, from what I described, it was a very low level of exercise and movement.
Ari: It’s amazing, actually, that just walking and stretching could have that level of muscle preservation effect.
Dr. Lyon: I know.
How muscle health affects metabolic health
Ari: Another aspect of muscle and metabolic health, how does it relate to metabolic syndrome, blood lipid profiles, LDL, and risk of atherosclerosis? Does muscle as an organ and longevity tie into that story of our risk of heart disease?
Dr. Lyon: Totally. In fact, I will just highlight this, that the last time I checked, there were 40 million people on statins, by the way. I would like people to hear that. When you think about skeletal muscle health, there is a large amount of literature out there that when you have healthy skeletal muscle, when you preserve lean body tissue and you target skeletal muscle, skeletal muscle at rest burns free fatty acids, burns fatty acids, it burns triglycerides.
When you have healthy skeletal muscle, when you exercise skeletal muscle, you will see nearly an immediate impact on both triglycerides and HDL. Again, it’s a cumulative effect, but it is somewhat immediate. Over time, exercising skeletal muscle, by the way, also does not require insulin. When you think about metabolic syndrome, you think about elevated levels of triglycerides, high blood pressure, increase in glucose, increase in insulin, all of which can be corrected with skeletal muscle, with the primary focus on skeletal muscle, as well as when you do a plan that you attempt to address body composition by purely restricting calories, you do nothing for your mitochondrial health.
I know you talk about mitochondria a lot. Skeletal muscle houses a ton of mitochondria. When you leverage exercise with caloric reduction and prioritizing dietary protein, not only do you have a sparing effect, but you make your mitochondria more efficient. That becomes really critical to understand that a lot of these metabolic issues, not only can be corrected with healthy skeletal muscle through resistance training and appropriately feeding it, but also at a root cause level. When you have sedentary, healthy skeletal muscle, again, just based on the weight of it, the pathology when it becomes pathologic, and again, the way that you think about that is skeletal muscle should be trained and it should look like a fillet.
Over time, if you are sedentary and you are overeating, there’s nowhere to put carbohydrates, you are not creating flux, again, it is this movement of substrates, you have to deplete glycogen, you do that through exercise, when you do not do this, you see skeletal muscle insulin resistance begin to happen, which again makes insulin less effective. You require more. You’ll see higher levels of blood glucose. Over time, that can be very damaging. Yes, skeletal muscle is a first-line treatment, and I believe a vital sign that we’re not measuring.
What research on statins actually tells us
Ari: You may not know the answer to this, but you mentioned statins. I did a bit of a deep dive in the literature on statins and the distinction between absolute risk reduction versus relative risk reduction. This is as you know status quo, modus operandi way that pharmaceutical companies generally will overstate and over-represent the magnitude of the effect of a particular pharmaceutical by talking about relative risk reduction versus absolute risk reduction.
For example, just for listeners, I know this obviously, Dr. Lyon, but if someone told you that the risk of something bad happening to you was 1 in 10,000, or let’s say 2 in 10,000, but if you took a drug, it’s 1 in 10,000, the absolute risk reduction is meaningless there. You still have the most minuscule risk possible, but they could say, “Well, it was 1 versus 2, therefore it was a 95% or 100% reduction in risk relative to not having this drug.” That distortion happens all the time.
Dr. Lyon: All the time.
Ari: They will take statins, basically, the absolute risk reduction is something around 1%. Sometimes I’ve seen it as 1.3% or 0.8%. Then all these claims talking about 35%, 43%. The trick of what they’re doing there is relative risk reduction instead of presenting absolute risk reduction. It’s been shown in studies that people in the general public overestimate the magnitude of the effect size of statins in reducing the risk of cardiovascular disease by over 100 times. In other words, to use their methodology, they overestimate the efficacy by over 10,000%. That’s obviously intentional. It’s because they’re great marketers. They know how to market this to the general public to make them perceive that it’s so effective.
I’m curious, given that, if you can quantify the difference, the magnitude of effect of statins in reducing your risk of heart attacks versus exercise.
Dr. Lyon: You are bringing up a very important point that individuals do not recognize or talk about. I couldn’t tell you that exact number. I haven’t looked at the data of a statin versus exercise. One thing is for sure, you will have market improvements in nearly– There’s nothing more powerful than exercise because of the implications that it has on a whole body of homeostasis. There is not one medication that does everything exercise does. I think that that’s critical to understand.
The other thing about a statin, I just want to mention this because for the listener, if they’re thinking, oh, my doctor put me on a statin, we were the last country to change the cholesterol recommendation guidelines, by the way. We changed the cholesterol. We finally took the cholesterol out of the guidelines. There was a period of time where it was recommended to only have 300 milligrams of cholesterol or less a day. We were the last country to finally take it out and we took it out in 2015.
Dr. Lyon: Part of that reason is because we also have the highest statin use.
How obesity increases the risk of cancer
Ari: I want to switch to cancer. How does body composition tie into cancer and other diseases?
Dr. Lyon: Obesity is a risk factor. Obesity is a risk factor for many different cancers. Cancer is obviously a multifactorial challenge. There’s many different causes, and the pathology can be great, but there’s a few things to think about. High levels of body fat can be estrogen producing, create also low-grade inflammation. Systemically, it allows things to go awry. It also can push up inflammatory markers like hsCRP, like sed rate, you name it. That is not good. There is a strong risk factor associated with obesity over time from cancer and it’s preventable.
The other thing is exercise. When you train, you release these myokines. One myokine is called decorin. That is one of the myokines that is thought to be tumor suppressive, which is fascinating.
The other thing that is important to understand is that one of the things that kills patients with cancer is cancer cachexia, and that is a catabolic state that causes muscle wasting. An individual will not be able to survive as their skeletal muscle wastes.
The problem with only focusing on losing weight
Ari: Why is losing weight not a good focus?
Dr. Lyon: We’ve been trying to do that for the last 50 years. We have literally been focused on weight loss for easily the past five decades. My question is, have we gotten any better at it? We have 40% of adults are either overweight or obese. We are not getting better. We are getting sicker. Again, when we think about a problem and we frame the problem correctly, it would stand to reason that we get an answer that is effective. If we don’t get an answer that is effective, then potentially we have to take a step back and ask ourselves, are we framing the problem appropriately? Are we asking the right question?
That’s really where muscle-centric medicine was born is that I realized my sickest patients, it wasn’t an obesity problem. It was a skeletal muscle problem. The conversation and the languaging and the vocabulary has all been about what we have to lose when it should be about what we have to gain if we want to make positive momentum. I appreciate there is an evidence-based component to nutrition and training.
You know me very well. You know I am evidence-based. I did a fellowship at WashU in nutritional sciences and geriatrics. I did my undergraduate in nutritional sciences as well. I will say that I can provide someone with the most amazing plan that exists, but if the mental framework is not in line to execute off of that, then that person will not be successful. Yes, from a medical perspective, we need to focus on skeletal muscle health because it really is rooted in strength, capacity. I’ve never had a patient say, “Wow, I regret being strong. I regret being capable. It’s made my health worse.” I’ve never heard that.
The other thing that skeletal muscle offers when we focus on what we have to gain is the person one has to become to obtain this metabolic currency. It’s metabolic currency. It’s not currency that you can buy, that you can sell, that you can trade for. It has to be earned. You become a more resilient, more capable version of yourself. The same cannot be said if you are constantly focused on what you have to lose.
Ari: There’s a classic experience that a huge portion of people who are overweight, who have tried to lose weight, have gone through, which is, of course, the cliche of you lose it, you gain it back, you lose it, you gain it back, the yo-yo thing. Do you think, especially given what we talked about a few minutes ago related to calories in, calories out, and the nuances you gave as far as how different calories behave depending on the other aspects of a person’s behavior that are not just calories in, calories out, do you think that muscle ties into that story of why a person would be prone to regaining their weight?
Dr. Lyon: Ask it in a different way so I can give you the answer. I’m not sure I understand the question exactly.
Ari: This experience of yo-yo dieting, somebody loses weight, they go on a diet, they lose a bunch of weight, and then we know that a large portion of people gain it back.
Dr. Lyon: Yes, the recidivism rate is, geez, at least 90% [unintelligibl]
Ari: Yes, exactly. What I’m asking is, does skeletal muscle tie into that story? Meaning-
Dr. Lyon: Yes.
Ari: -are people who build their skeletal muscle, or who exercise their skeletal muscle less prone to recidivism than people who are more sedentary, for example?
Dr. Lyon: Absolutely. We have seen that. We’ve had a huge human experiment. Individuals that go through yo-yo dieting, what we ultimately see– Again, yo-yo dieting is we focus a lot on weight loss. We don’t focus a lot on the quality of the weight loss. You lose both, potentially, depending on how you do weight loss, you will lose both fat, lean tissue, bone, organ, as well as skeletal muscle if you don’t do it appropriately. Weight loss, there are very specific ways to leverage weight loss for longevity, and that is to protect skeletal muscle. When you go through periods–
I don’t know, have I ever told you the story of one of the participants? I’m sure that I have, of one of the studies that I worked on where muscle-centric medicine–
Ari: I don’t think you have.
Dr. Lyon: Let me share this with you because this was the root of where muscle-centric medicine came from. I developed this in 2015. There was an aha moment that changed everything for me. To provide you with a lens at which I was viewing things, I had mentioned before that I did my undergraduate in human nutrition. I studied under one of the world-leading protein experts, Don Lehman, where he discovered the connection between leucine muscle protein synthesis as a nutrient threshold, this gram of protein that causes subsequent muscle protein synthesis.
This came out of his lab. The information that we take for granted that is out there to and in the public, and things that we repeat over and over again, actually, he made a huge contribution in the science space. That was the framework that I began my journey. Fast forward to medical school, fast forward to two residencies, and then back in fellowship where I was doing geriatric fellowship, seeing patients 65 and up during the day in the nursing homes, palliative care, end of life, running a memory and aging clinic. That was part of what a fellow’s job was.
Then in the mornings, I was doing obesity medicine research and nutritional science. Then in the evenings, we were doing fMRI studies, and clamp data, and cognitive testing. I fell in love with one of these participants and she was a mom of three kids, just big boisterous energy. She always put herself last. She did exactly what the medical community had recommended. She exercised more, she ate less, and she’d been struggling with the same 20 pounds for say, 20 years.
I imaged her brain and her brain looked like the beginning of an Alzheimer’s brain. I realized that we failed her, that the medical community had failed her, that I had failed her. That she wasn’t told an appropriate recommendation for how to lose weight, how to maintain skeletal muscle. She had done WeightWatchers and Jenny Craig. These are low-protein diets that are processed foods. She wasn’t told to resistance train. She is an example of what you’re talking about. She never was able to recover her metabolism. Again, it wasn’t too late for her, but up until that point, she had been doing, “everything right”.
The end result of the current dogma of eat less, exercise more, it is all about calories isn’t totally correct. It’s all about protein and muscle health, and then it’s about weight loss.
Do muscles burn more calories than fat?
Ari: There is a myth out there that, when I was a personal trainer many years ago, we used to teach people that for each pound of muscle that you have on your body, it burns an extra 50 calories per day. If you were to gain 10 pounds of muscle, you burn an extra 500 calories a day. Since then, there’s been research that has tested that and shown that it’s not that. It’s more 7 to 13. You could round it off to 10.
Dr. Lyon: Disappointing, right?
Ari: Right, super disappointing. Yes, especially because gaining 10 pounds of muscle is not that easy, unless you’re a big person and you’re new to training. It’s 10 calories at rest per day per pound of muscle. Even if you were to gain 10 pounds of muscle, it’s in the neighborhood of, 100 extra calories per day, it’s not that meaningful. That’s the story of how this has been talked about in the past. It’s this calories in, calories out model. Here’s how many extra calories you were to burn at rest if you add this much muscle mass.
What you’re saying is, “No, there’s all these layers in addition to that.” Can you talk about, help people understand this story of why it’s more than calories and how that affects your body composition?
Dr. Lyon: Absolutely. I only highlighted that and I talked about that in Forever Strong because I think it’s important to highlight some of the myths because often when we hear something repeated over and over again, whether it’s accurate or not, we believe it to be true. If we are going to have a clear, transparent conversation, the goals and endpoints that we are searching for need to be tightened up. We need to have a conversation of what I believe to be very meaningful. It is amazing to put on muscle. Is it your most metabolically active organ system? No. Does it weigh a lot? Does it contribute? Yes. but collectively, all your organs contribute. The brain, which is a lot smaller, contributes somewhat 25% of resting energy metabolism. Muscle overall is not a huge contributor to resting energy metabolism. It’s not that active at rest. It primarily burns free fatty acids. The magic about muscle is different. The magic of muscle is when you train it, you make your mitochondria more efficient. When you train it, you expend energy, calories. When you train it, you release these myokines. Depending on the kind of activity that you do, there is somewhat of a metabolic revving up over time. There’s all these other aspects that become more meaningful than thinking about sedentary skeletal muscle, which quite frankly, as you pointed out, is not that impressive. Training and having skeletal muscle becomes your body’s armor.
The other aspect about skeletal muscle is this thermic effect of food or thermic effect of feeding. Calories all require a certain amount of calories from the macronutrient. Carbohydrate, fat, and protein take different amount of energy to metabolize. For example, fat, if you eat 100 grams of fat, it might take, I don’t know, 3% of that calories to even metabolize that. It’s not much. You’re getting the majority of fat. Carbohydrates could be anywhere upwards from 10%, maybe a little bit higher. If you eat 100 calories of carbohydrates, you might see 90% of that. Not super efficient.
Dietary protein, if you eat 100 grams of dietary protein, the literature indicate anywhere from– could be upwards of 30-some percent. I like to think about it as 20% to 25%. If you’re eating 100 calories of protein, you might only “see 80 calories.” It takes more energy. When you are bolusing protein appropriately and you trigger some of these metabolic processes like muscle protein synthesis, that’s deeply energy expensive. The more muscle mass you have, the more muscle protein synthesis you have, and potentially the higher thermic effect of feeding will be.
Skeletal muscle and mitochondrial health
Ari: Excellent. Let’s talk about the mitochondrial piece. Obviously, it ties into energy in a big way.
Dr. Lyon: [unintelligible] Love it.
Ari: There is no more potent medicine for improving your mitochondrial health and improving your mitochondrial size and number, which is a big thing that I find people in the functional medicine space really, for the most part, generally don’t get, and certainly, conventional medicine doesn’t talk about it at all. We talk about mitochondrial dysfunction a lot in functional medicine. Generally, the prescription for mitochondrial dysfunction is you give supplement protocols with B vitamins and vitamin and mineral cofactors magnesium and alpha-lipoic acid and CoQ10 and things like that.
It’s framed in a way as sort of, “We have these mitochondria, and they’re just dysfunctioning, they need these nutrients and cofactors. Okay, now they’re functioning again.” The story of the size, the robustness of the mitochondrial network and mitochondrial biogenesis and how many-
Dr. Lyon: Volume, yes.
Ari: -mitochondria are there is largely a story dictated by hormetic stress and exercise in particular. Talk to me about that side of the story.
Dr. Lyon: I think that you framed it beautifully, and it is a missing piece. I would say the training piece and the nutrition piece are key when it comes to health that many people are missing, including with our friends in functional medicine and certainly conventional medicine. Mitochondria health is when it becomes dysfunctional is one of the hallmarks of aging. There’s a wonderful paper that was originally published in 2013 that covers the hallmarks of aging. When you look at the hallmarks of aging, you see mitochondria dysfunction. Again, as you had mentioned, mitochondria are these little organelles that are responsible for energy production for humans.
When we think about skeletal muscle, we really think about these Type 1 fibers, and these Type 1 fibers are very– they’re small in a cross-sectional area, and they are very mitochondrial dense, metabolically active, and can be trained. They are trained through endurance-type activities. This becomes critical for the health of
mitochondria because you do need to train them, and you want to improve mitophagy. Mitophagy sounds a lot like autophagy, which is the cleaning out of old mitochondria. This becomes important when we think about aging. I would say the biggest impact that we can have here is through training skeletal muscle. Yes, that’s pretty much what I think about that.
Ari: Yes. There are studies where they’ve shown a few things I’ll mention here just to add to what you’re saying. The average 70-year-old has lost 75% of their mitochondrial capacity, skeletal muscle mitochondrial capacity.
Dr. Lyons: That’s interesting. I love that.
Ari: It’s been shown that lifelong exercisers don’t lose 75% of their mitochondrial capacity. They have the same capacity as young adults do. There are studies where they’ve specifically taken older adults who have lost a lot of their mitochondrial capacity, put them on an 8-week or 12-week exercise program and shown 50%, 70% increases, massive increases in just two or three months of training. There’s no supplement and no drug that can do that.
Dr. Lyons: It is pretty profound. Improvements can always be seen, which is– What is so fascinating is that it doesn’t matter if you are in your 80s. 75, 80, it’s never too late. You do see improvements in mitochondrial health. Absolutely.
How to structure the optimal training?
Ari: Let’s talk about training. How does one structure optimal training? You’ve mentioned resistance exercise. You just mentioned endurance exercise and the slow twitch muscle fibers. How do we put these pieces together? What is an optimal training program for longevity and skeletal muscle health actually look like?
Dr. Lyons: The first thing that I’d love to point out is the earlier that you start, the better. The earlier that you start with your skeletal muscle mass reserve, just like bone density, the better. That means there’s a lot of myths out there that children cannot have structured training or even play training, but that’s not true. Starting early is key. If you are not young listening to this podcast, which I don’t expect you to be four or five listening to this podcast, think about your children. They should be moving. They should be very active. You begin to build the skeletal muscle mass reserve when you are younger and you are still growing.
When I say younger, depending on when you stop growing, 18, 15, 17, 18. Typically by 30, you’re done growing. This is prime time muscle building. Then even 30s, 40s, you’re still absolutely, again, always able to build skeletal muscle. This is a long-winded way of saying, put as much emphasis on hypertrophy training. Again, this is my opinion, put as much emphasis on hypertrophy training as you can when you are younger. If there’s college students listening to this or younger adults, do it now.
Ari: Just say what hypertrophy is for most people who haven’t heard that term.
Dr. Lyons: What you’re really looking for is an adaptation. You’re looking to increase cross-sectional size. You’re looking to increase the size of your skeletal muscle. Why do you want to do that? Again, healthy skeletal muscle is this primary site for metabolism, and it is your body armor. If you get injured, the body will pull from these amino acids. Again, it’s growth. That’s what you’re looking for. Difference in strength.
Ari: Just speak to the women who will inevitably be concerned with becoming too big and bulky.
Dr. Lyons: Never. How tall am I? How tall am I, Ari?
Ari: What are you? 5’6″? 5’5″?
Dr. Lyons: 5’1″-
Ari: Are you really?
Dr. Lyons: -with a big attitude.
Ari: Maybe I’ve seen you in high heels.
Dr. Lyons: Yes, big attitude.
Ari: I have a thing where I never notice people’s height for some reason. I don’t know why.
Dr. Lyons: Well, I appreciate that. I joke because I’m 5’1″, 110 pounds, and I have been training very hard and heavy my whole life. I, again, am 110 pounds, and I eat a lot of protein. I eat 1 gram per pound, ideal body weight. It is nearly impossible to become bulky. I often wonder, is that a distraction because women often are very uncomfortable lifting weights? When you go to the gym, you often see them on the cardio machine. You do not see them in the weight room pounding out reps or doing deadlifts or squats. I believe that that’s changing, but as of right now, traditional ways of training seem to be more cardiovascular.
We did talk about how important that is from a heart health and mitochondrial aspect, but again, when we’re talking about health and longevity, we have to focus on resistance training. We discussed these Type 1 fibers, which are the smaller cross-sectional
areas that you can train them up during endurance, and then these Type 2 fibers that are fast-twitch, and they’re bulky. As individuals age and lose hormone status and become less active, there is a loss of these Type 2 fibers. Maintaining these Type 2 fibers are critical. They are critical for force production. They are critical for strength. When you age, you want to be as mobile and as capable as possible. That is why strength training three days a week– That’s where I would start, and I cover all of this in my book. I actually could never be a fitness influencer, Ari, because I shot 80 to 100 videos of how to do proper exercises with weights, with bands, with body weight. I definitely cannot be–
Ari: You were sick of it by the end of it?
Dr. Lyons: How do people do this? It’s very difficult.
Ari: [chuckles] I did it years ago as well.
Dr. Lyons: Resistance training is very well established from this interventional aspect of maintaining the health of skeletal muscle. Non-negotiable, three days a week, 10 sets. Let’s talk about does it have to be heavy or can it be light?
Ari: Can I say one thing before we go there?
Dr. Lyons: Yes, please.
Ari: In all my years of training–
Dr. Lyons: Just how many? At least 20 years, right?
Ari: No, as far as physical training, I started when I was 13. I just turned 40, so-
Dr. Lyons: Congratulations.
Ari: -27 years of training. In all my years of being a trainer and working with clients, there was only one girl that I ever saw who had a problem of getting too muscular, and she was a genetic freak. She was of South Pacific Islander descent. She was naturally just very, very thick, like broad shoulders. She had tree trunks for legs. I trained her for a couple years, and she actually got– She would grow muscle so fast. I was like, “Man, I wish I could grow muscle like you. I’m-
Dr. Lyons: Unusual.
Ari: -really jealous that you have the problem of growing too much muscle. You’re the only female I’ve ever seen in my life who has that problem.”
Dr. Lyons: The only female ever?
Dr. Lyons: Chances are [inaudible]–
Dr. Lyons: -individual is not that. Ladies, do not worry about this. Your biggest beauty investment is going to be training your skeletal muscle. You’re not training it– The truth is you’re not training it to look good. That’s a side effect of it, but you’re training it for the potential of cancer protection, for neuro protection, for a metabolic protection. You are training to be there for your family, and that’s what you have to understand.
Do you have to lift heavy versus light? I’m going to give you what the science says. The science says that as long as you are going to a certain amount of volume and fatigue, that you could lift light and do 50 reps of a lighter weight. Here’s what I will tell you. You can start there, but I eventually want– You can start with body weight. You can start with sitting down and standing up, depending on where you are in the spectrum of your activity. I will say that you will then progress from body weight to bands. I cover all this in the book.
Then I want you lifting weights, and here’s why I want you lifting weights. You are not lifting weights to be better at exercising. You are lifting weights to be better at life. I want you to be able to do a kettlebell carry because how much do your groceries weigh? I want you to be able to hold something up overhead, a kettlebell and walk overhead or a weight and walk overhead. I want you to practice for real life. Practicing for real life means developing the physical capacity before you need it, and that is a very critical aspect in this conversation of longevity.
While the science could show, can you get hypertrophy? Yes. Do you also need to train in multiple planes of motion to be able to twist and grab something and pick something up? Yes. You need to be able to move weights in space.
The optimal quantity of protein in your diet
Ari: I had a bunch of questions on my list to talk about my nutrition, but we’re not going to have time to dig into that. Maybe, briefly, we talk about eating protein because I know that’s so critical to the plan. How much protein should people be eating? Maybe you can speak to the fact that certain vegan diet proponents, vegetarian diet proponents sort of have the opposite argument and will say, “Most people are already eating too much protein. They’re already eating more than they need. We only need this
much. Most people are eating way too much meat.” You’re really saying the opposite, so how do you-
Dr. Lyons: Evidence doesn’t support that.
Ari: -deal with that? How do you help people make sense of those conflicting recommendations, and how much protein should people be eating?
Dr. Lyons: I spent two years writing this book, two kids later, and this book, Forever Strong, covers all of this in detail with evidence-based, high-quality data. That’s really important to point out. What we know is that as individuals age– First of all, let’s say this concept of we’re eating too much protein. We’re eating “too much protein” from the framework of the RDA. The RDA is the minimum to prevent a deficiency based on nitrogen balance studies.
Nitrogen balance studies were originally done in agriculture and for feedlots for raising cattle and other agricultural animals. What they did is they looked at nitrogen balance to understand the minimum amount of protein to support life with higher carbohydrates to cheapen the feed. How can we feed animals with the minimum amount of protein, the maximum amount of carbohydrates to allow them to maintain growth with it being a cheap way to do it? That is where these studies come from, and it is the baseline recommendation to prevent deficiencies. If you just want to survive, then yes, we’re eating the RDA, which is 0.37 grams per pound.
I weigh 115 pounds, let’s say, and if the recommendation is 0.37 grams per day, that gives me 45 grams of protein a day. That is the minimum to prevent protein deficiency. The optimal range, which there is a large body of evidence of high-quality studies, support double the RDA, which is 0.7 to 1 gram per pound ideal body weight. This improves body composition. This protects skeletal muscle through aging. Protein is the only macronutrient need that changes throughout our life. You can get away with the same amount of fat and the same amount of carbohydrates, but you cannot get away with the same amount of protein as you did when you were younger.
We talk about protein as if it’s a generic thing, as if it’s one thing. Dietary protein is made up of 20 different amino acids, 9 of which are essential, and we must get them from the diet. Those nine essential amino acids are individual nutrients. They are not interchangeable. Protein is so much more than this generic protein recommendation. They are not interchangeable. You need it to support muscle protein synthesis, which is a indicator of skeletal muscle health, somewhat of a biomarker.
It’s also important to be able to support protein turnover throughout the body. The liver, the organs, the cells are always going through turnover. We turnover around 300 grams of protein a day. We don’t eat that much. Can you imagine if you are just getting the minimum, then the other nutrients, for example, these amino acids that you must get from the diet, like threonine– Threonine is an essential amino acid where 75% of threonine goes to mucin production for gut lining. There’s phenylalanine that is important for dopamine production. There’s tryptophan for serotonin production, leucine for muscle protein synthesis.
When you are eating a lower protein diet, the body does not have enough nor does it prioritize these things. It will only prioritize protein turnover to be able to maintain tissue. Therefore, the integrity of your body and your health diminish.
Ari: Can you talk a bit about peptides? There’s a few different ways that you could go with that discussion. Obviously, the peptides that are part of myokines– Some of the myokines are peptides. There’s a lot of talk of peptides, like injectable peptides of various kinds.
What I’m referring to here is peptides that are from the diet, from the proteins we’re consuming in the diet, because it used to be framed like the proteins that we consume in our diet are all broken down into constituent amino acids. It doesn’t really matter what source you’re getting it from. Now there seems to be an emerging new body of knowledge around that certain proteins are not broken down into individual amino acids but are retained as dipeptides, tripeptides, and things like that, and seem to have bioactive functions. Can you talk a bit about that?
Dr. Lyons: Yes, certainly. It’s a really good point. This goes to the complexity of food and where whole food becomes very important and how we begin to think about food as it is in a food matrix, not just macronutrients. This is going to be the next wave of nutritional science. I absolutely believe that.
The di- and tripeptides that you’re referring to, one group of those would be through collagen. Collagen doesn’t actually stimulate skeletal muscle at all, but the benefits of collagen may have a role in gut health, skin, and again, potentially tendons. That would be one group of peptides. The other group we can think about is immunoglobulins. This comes from whole whey protein concentrate. These are things like alpha lactalbumin, lactoferrin, and they help with the immune system. These are some of the components that are found in mother’s milk.
Skeletal muscle and sarcopenia
Ari: Absolutely. Last thing that I want to talk to you about is– Actually, maybe two more things. One is we’ve talked a lot about the metabolic aspects of skeletal muscle. Can you talk about the physical aspect of it in terms of physical frailty and how that ties into sarcopenia?
Dr. Lyon: Absolutely. You’re not going to believe this. You probably know this because you’re so well-read, but sarcopenia was actually given an ICD-10, which is an international classification of disease in– Are you ready for this? Ari, do you know when? You’re going to flip.
Ari: I don’t know, no.
Dr. Lyon: 2016.
Dr. Lyon: Ari’s saying wow because it should have been recognized as a disease, I don’t know, 25 years ago. Sarcopenia is what we visibly know as our parents or loved ones get older. It’s a loss of muscle mass, again, change in fiber types or loss of fiber types and also function. That is really strength, walking ability, force production. Sarcopenia, they say, is at the rate of 1% loss of skeletal muscle per decade over the age of 50. Frankly, I believe that it begins earlier. It mirrors the timeframe of when heart disease begins in your thirties if you are not physically active.
Sarcopenia, this loss of muscle mass and function, and this health of skeletal muscle, I think changes much earlier than we recognize. We’re going to begin to recognize that more as we get more advanced at measuring and looking at skeletal muscle, which is coming. In the next five years, the entire body of literature is going to change to support some of these concepts, I believe, when we move to a deuterated creatine.
Ari: Can I add something?
Dr. Lyon: Yes.
Ari: Just a personal anecdote to your point. When I was younger, I did soccer and martial arts as my predominant sports. In more recent years, it shifted to just surfing was my main sport, surfing and weight training. I stopped doing any sport that involved running or something like martial arts where you’re moving your body ballistically and very quickly.
I recently started playing tennis about a year and a half ago, and I realized that 10 years of only doing surfing and weight training and not doing any land-based sport caused massive amounts of atrophy in the fast-twitch muscle fibers of my legs. I felt like my body had lost all of its explosiveness and speed and power. That’s somebody in their thirties. To your point, there’s absolutely– If you don’t use it, you lose it. It’s happening way earlier than your sixties or seventies.
Dr. Lyon: The one thing that we can recognize, and there’s some data out of Galveston, that an individual who is young will go on bedrest and they’ll lose 2 pounds of muscle in the first five days. The challenge is when you’re younger, people who don’t know you’re very strong, is that you’re able to get back up to “speed.” No pun intended. You’re able to get back to where you need to go.
An older individual, because of the potentially lagging proteostasis or the dysfunctional mitochondria, there’s a whole host of reasons as to why it’s typically called a catabolic crisis. This was coined by Doug Paddon-Jones. The aging trajectory that change, it becomes much more difficult to come up after baseline. That is what we have to protect against.
Ari: Yes. Even for me, it’s taken me over a year of training to get-
Dr. Lyon: It’s crazy.
Ari: –back to something approximating what I was at in my early twenties as far as my speed
and power and explosiveness. I’m still not there. It’s been a year and a half, but I’m getting close now. It’s taken a year and a half of training so far. The last thing I want you to touch on before we wrap up is growth mindset. There was a section in your book that I really like where you talk about growth mindset. You wrote in the book, “Pairing a growth mindset with internal discipline is crucial.” You also said, “It’s time to recognize that having an easy life is a delusion laced with unmet dreams and complacency.” Talk to me why we shouldn’t necessarily desire an easy life and why internal discipline and a growth mindset are so important.
Dr. Lyon: First of all, this is a little bit of tough love. The reason there’s a little bit of tough love in this book is because it took me a really long time to get over the amount of death that I saw as a physician. Maybe some physicians are more robust than I am, but day after day of seeing individuals really struggling physically or at the end of life became very difficult for me. I sat with them a lot, and I talked to them, and I listened to the things that they regretted doing and the way in which the last handful of years went for them. I don’t want anyone to experience that. I don’t want them to have regrets.
People spend a lifetime trying to look for an easy way out or struggling with the self-worthiness of having a strong physical body because they don’t feel worthy. An individual will only go as high as their health worthiness is. I’ve seen this over and over and over again. We shouldn’t frame our life looking for a stress-free life. We should understand that challenges are not negative and that challenges generate and cultivate capacity. That capacity is a privilege.
There is a narrative, again, I’ve mentioned to you before, that when we hear something enough, we believe it. It doesn’t mean it’s true. We hear over and over again how bad stress is, how stress is going to kill us and make our hair fall out and be gray, et cetera. What if that’s not true?
We have one word to define stress, and that includes the death of a loved one, my son peed on the wall, I spilled hot coffee over everything, I lost my job, or I have to go to the DMV with paperwork. We only have one word to describe a billion different things. Within that one word, we’ve also only really been taught about fight or flight versus tend and befriend or the courage response, other more facilitating responses to stress that really create a depth to capacity.
That’s what we have to understand, that I’ve never seen a stress-free life make massive impact. At the end of the day, people want to leave a legacy, whether it’s an outward legacy or an inward legacy or just a legacy of being to friends and loved ones. You cannot do that if you’re constantly trying to step away from stress. You have to embrace it and reframe it and understand that it is a privilege.
Ari: Beautifully said, my friend. A lot of what you said there is directly subjects of the book I’m writing right now, my next book. To wrap up, tell people why they should go get this book right now.
Dr. Lyon: This book is the first book of its kind called Forever Strong, and it will change the face of medicine, but more importantly, it will change the trajectory of your life and the people that you love. It’s never too late. The other thing is this is a message and a mission that I cannot spread alone. I need your help. I need your support, and together we can make the world stronger.
Ari: I’m here to help you, my friend. I’m on board. Like I said, I gave you the highest endorsement possible by buying copies of this for my parents, my friends, my family.
Dr. Lyon: Thank you so much.
Ari: Thank you so much for coming on the show. As always, I enjoyed it tremendously. Thank you so much for writing this book. I absolutely love it. To everybody listening, do not hesitate. Go on Amazon, go get yourself a copy of this book. I make no money when you go on Amazon and buy this. I’m telling you for your own benefit, this is a critical piece of the longevity and disease prevention and energy story. Go get it. Start implementing this right away. Dr. Lyon, thank you so much. I look forward very much to our next conversation.
Dr. Lyon: Thank you, my friend. Thank you.
00:00 – Intro
00:53 – Guest Intro
04:35 – Why skeletal muscle is the most important tissue in your body
11:25 – What happens when you carry around too much body fat?
14:53 – Why and how calories matter*
18:36 – How muscle health affects metabolic health
21:40 – What research on statins actually tells us
25:30 – How obesity increases the risk of cancer
26:55 – The problem with only focusing on losing weight
34:38 – Do muscles burn more calories than fat?
39:22 – Skeletal muscle and mitochondrial health
43:15 – How to structure the optimal training?
51:05 – The optimal quantity of protein in your diet
57:38 – Skeletal muscle and sarcopenia