Episode 54 | Oct 12, 2023

The Power of Muscle-Centric Medicine, with Dr. Gabrielle Lyon

Explore the transformative power of muscle-centric medicine. Dr. Gabrielle Lyon, the author of “Forever Strong,” delves into the crucial role of skeletal muscle as a vital endocrine organ and its profound influence on other facets of our well-being, particularly as we age. Discover why skeletal muscle is the key to longevity and more than mere physical strength. Dr. Sandi and Dr. Lyon unravel the significance of muscle, the effectiveness of weight training, and the pivotal role of protein.

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Episode Transcript

Dr. Sandi: Welcome, I am just so excited to bring to you today Dr. Gabrielle Lyon. She is a friend. I have known her for years and been so inspired by her. And now she has a book out that is called “Forever Strong.” And I just think this is transformational. It is really representing a paradigm shift. So, what was your motivation for writing this book? How did it come about?

Dr. Lyon: Well, as any book, this has been years in the making, decades actually, but specifically why now? Why forever strong now is because we are all aging, and we’ve been talking about this obesity epidemic for, I don’t know, the last 50 years. We have not gotten any better treating it. In fact, 70% or more percent of the adult population is either overweight or obese, so we’re failing people.

And instead of the question of being overfat, which is where really the thinking lies, I wanted to provide a solution, a solution that I saw in clinical practice and just the horizon of patients as it relates to what they have in common. It wasn’t an obesity issue. It really was a muscle health issue.

So, I wrote this book because there’s a huge need. And by following the protocols and understanding this paradigm shift of actually understanding that muscle, skeletal muscle specifically is the organ of longevity, people can change the trajectory of the way in which they age. They can change their patients’ lives, their clients’ lives, their own personal life. And frankly, it’s needed right now.

Dr. Sandi: So needed. And you have the credentials to be an authority figure in this area. So, can you talk a little bit about your background? You’re involved in gerontology and just have impeccable credentials.

Dr. Lyon: Yes, I really appreciate that, and I really appreciate you highlighting that. I did my undergraduate in human nutrition, vitamin, mineral metabolism, and I studied under one of the world leading protein experts who has now mentored me 20 years later. And in fact, this book is dedicated to him, and his name is Dr. Donald Layman. He’s well-published, and he has put the science behind much of what we take for granted. So, this idea of protein dosing, especially as an individual is aging, he did the science out of his lab, which is incredible.

So, then when I went to medical school, I obviously went to medical school, and then I did two years of psychiatry. I was very interested in the way that people used their mindset and brain function. And then I did three years of family medicine. And then I went back, and I did a fellowship in nutritional sciences and geriatrics at Washington University in St. Louis.

Dr. Sandi: And you’ve always been very observant about the research and what is good research and perhaps not so good. And you’ve got this program, Muscle-Centric Medicine, which is what the book is about. Can you describe what that is? Because we don’t think of muscle first. And you have written here that it’s often the hidden cause of a lot of debilitating chronic medical conditions.

Dr. Lyon: Isn’t that crazy? This idea that muscle is on the periphery of health and wellness. And when we think about muscle, typically right now it is about aesthetics or strength and power for athletic performance, but skeletal muscle is so much more than that. Skeletal muscle is the largest endocrine organ system in the body. Can you believe that? Nobody thinks about that. It is an endocrine organ. It is the primary site for glucose disposal, which is carbohydrates, and I think a lot of your listeners, and coaches, and providers will know that, but skeletal muscle does a lot of other things.

So, it is the site for the amino acid reservoir in your body. If you get sick, if you break a hip, if something happens, your body requires the building blocks that exist within skeletal muscle. It secretes myokines, and myokines are peptides that travel throughout the body that impact bone health, brain function. Also, these myokines are also immune modulators. They can help with autoimmune disease, just all kinds of magic that muscle does.

But here’s what else people don’t realize. We think about obesity as a starting point for disease. Obesity is a very complex set of issues, whether it’s mitochondria, whether it’s insulin. I mean, it could be a number of things, but at the end of the day, I believe that the majority of the issues related to obesity, that obesity is symptomology of impaired skeletal muscle. So, obesity is in part a symptom of unhealthy skeletal muscle for many of the reasons that I had mentioned before.

One of the other things that is very underappreciated is that when skeletal muscle is sedentary, there is evidence to support that someone could be a lean and otherwise healthy sedentary individual that shows insulin resistance starting at 18 because they are not utilizing skeletal muscle. And some of this original work came out of Kitt Petersen’s lab at Yale, and there’s been numerous other data points since that time, understanding that skeletal muscle is a primary deficit. There are issues in skeletal muscle first before there’s type 2 diabetes, before there’s insulin resistance. Then you can leverage this organ system to correct for those things, and that’s mind blowing, right.

Dr. Sandi: Wow, absolutely.

Dr. Lyon: Right? Skeletal muscle [crosstalk 00:06:24] of obesity yet all we’re talking about is obesity. What about skeletal muscle health? And what does that mean? You know, as a provider or as a health coach, you should be taking a very detailed history on skeletal muscle health. And by the way, I actually am going to be launching a provider course. So, that’s going to be great for everybody.

Dr. Sandi: Fantastic.

Dr. Lyon: But more importantly, when you’re taking a detailed history of an individual and just talking to them. Find out their muscle health history. How active were they as a child? What kind of sports did they play? Had they ever gone through periods where they either broke a bone and were on bed rest? What was the health of their parents? Not everybody asks, “Were your parents obese or not?” But they don’t ask how active were your parents. Do you know if your mother was active while you trained?

Understanding the muscle history because muscle does… You know, there’s this idea of muscle memory, and part of that is neurologic, but the reality is, when you train skeletal muscle young and you get a good history, you can see that these people will be primed to recover and primed to have healthy skeletal muscle. And that’s not to say that, if you didn’t work out when you were younger, that you can’t be healthy. It’s never too late. But, again, when you are getting to know somebody understanding, what are the modalities of exercise they like? What is the archetype of the person? Do they like to train hard or do they feel uncomfortable picking up weights? Will they start with Pilates? Will they start with yoga? But really getting a sense of their training, it has to be discussed.

Dr. Sandi: That is so important, and it’s important for the health coaches who are listening to take that muscle history, that strength history, and then use this book as a resource. There was a quote that I love, and that is by highlighting muscle, focus on what you have to gain rather than what you have to lose. And we’re so focused on what we have to lose, what’s not working, and it has a lot of parallels to the positive psychology movement, which is focusing on… We focus on strengths as opposed to deficits and what’s wrong with you.

But for so many people, especially women of a certain age, it’s all about losing—losing weight, losing fat. I was with a friend who was at 74—she’s my contemporary—is embarking on a diet to…she wants to lose 10 pounds. And I was talking to her about this very thing about muscle, and it’s just such a hard concept to get across. And we’re so focused on fat and measuring body fat percentage as opposed to skeletal muscle. Can you comment on that?

Dr. Lyon: Yeah, what you’re saying is absolutely correct. And I will mention that by focusing on what we have to lose, it becomes very damaging. It becomes very damaging in the actions required to get that outcome. If you focus on what you have to lose, then individuals will go through their lifetime yo-yo dieting. And every time you yo-yo diet, you destroy skeletal muscle because you don’t just lose fat. And when we define yo-yo dieting, it’s typically caloric restriction.

Changing weight based on calorie restriction alone is not ideal, right? You have to have higher dietary protein, and you have to have resistance training. The idea of leveraging a calorie deficit alone to be longstanding weight loss, you’ll lose weight, but you will also lose muscle tissue. So, that is a terrible idea.

I would love for individuals to shift their focus on what they have to gain. If you focus on muscle health, then the subsequent health desires and outcomes happen. And, no, we don’t typically and routinely test skeletal muscle mass. And in fact, we’re so far behind the times, that we don’t know an optimal amount of muscle mass. We don’t know. And there are some complexities. We have some guesses. I’ve included those in the book based on really good data where someone should be, where their skeletal muscle mass should be. And one of the reasons why we don’t typically measure skeletal muscle mass, which I believe that we will begin to, is number one, we don’t have access to great tools. So, DEXA is really a body fat measure. The rest of the lean tissue is all extrapolated. And included in that lean mass is muscle, but all lean mass is not muscle, and that becomes very interesting.

And then the other component to that is, could we use CT or MRI to measure skeletal muscle? We could but that’s not really doable for people. But there will be a time where we can use something called a D3‐creatine test where we will be able to directly measure skeletal muscle mass. And by the way, I think that when that happens, and it is in the literature now, it’s typically used in research, Dr. William Evans has written quite a few papers on it that are really well done. Once we start to measure skeletal muscle directly, people are going to see an entire change in the conversation. It is going to pivot everything, because right now people will say the amount of muscle you have doesn’t matter. They’ll say it’s just about strength. But the reality is the amount of muscle you have, and the help of that, and the strength of that matters. So, that is going to be a change in the data that we’re going to see and the change in the way that information is presented.

Dr. Sandi: Wow, that will be a wonderful advancement. But for now, I have one of those body scales, and I measure… They may not be as accurate as we would like, but at least it’s one marker. And I am 73, and I got to tell you, I am gaining muscle mass. I can feel it. It is just because I lift heavy, but I find so many women, in particular, as you mentioned earlier, that was me doing yoga every day, doing Pilates. I still do those, but lifting the little pink weights aren’t going to cut it.

So, how do you help women to not fear being in the weight room? Because I’ve taken videos like, “Here’s the cardio room, and that was me on the treadmill 5 miles years ago,” and that was it. That was my workout. And I really shunned anything that had to do with building muscle. Occasionally, I would go on some machines, but it was very sporadic. And now I’m just religiously five days a week as hard as I possibly can. But for people and for our coaches listening, how can they provide some good evidence, education, and tell people to get it, that, yeah, this is really important for their longevity and for their well-being?

Dr. Lyon: Yeah. The most important non-negotiable exercise would be resistance training, and that is the things that you do. I see all your videos. You’re doing weights. That is non-negotiable. And it is so critical because it doesn’t get easier. Gaining skeletal muscle does not get easier, and there’s a few reasons as to why this is. Protein is always turning over. The efficiency of protein utilization can go down as we age. Just the ability for us to regenerate goes down.

But the way to mitigate decline is through resistance training. And there’s a natural change in fiber types. You know, we’ve all seen our parents, kind of, lose size, right? That’s a change in fiber type, but it doesn’t have to be that way. Here’s what I would say. I would start from a psychological perspective and say the human spirit thrives on challenge, thrives on challenge and thrives on discomfort. And I guarantee you people have done harder things. And while intimidating as it is, once… Everything new is intimidating until you do it. You gain confidence because you prove to yourself you have the capacity to do it.

Number one, they’ve done harder things. You’ll translate that over. Number two, resistance training will protect people in a multitude of ways. If they were to fall, people that fall and break a hip, it is devastating the secondary outcomes. And it’s not just that if they fall, break a hip, and then they get out of the hospital, it’s the amount of muscle that you lose while you’re on bedrest or the amount of muscle that you lose when you are inactive. Why is this so critical?

Skeletal muscle is your metabolic sink. So, when you lose skeletal muscle, you lose your site for where you utilize glucose, right? So, you will start seeing higher levels of blood glucose. You will start to see higher levels of insulin, potentially higher levels of triglycerides. All these things can kind of begin to go wrong.

What’s so critical to understand is that, when you do resistance training, that you can use substrates, meaning carbohydrates, without the use of insulin, which is amazing. Exercising skeletal muscle uses glucose without insulin, so that becomes really, really important. And the other part is that people often complain of not feeling a lot of energy. A ton of mitochondria, which is the powerhouse of the cell, exists in skeletal muscle. It is the pinnacle of health and wellness. That’s what I would say. And I would also say, if you are uncomfortable lifting heavy, you don’t have to lift heavy, but you do have to go to fatigue. You do have to put enough effort in. And the evidence would support that…

So, personally, I like to lift heavy, I like to see people lift heavy because I think it does a few things. Yes, it stimulates muscle, and it challenges the tissue. It creates a metabolic stress. It also challenges the mind. When we become complacent in anything that we are doing, that complacency is a very slow decline, and that becomes really, really important. But for the listener who may be more mature and saying, “Well, I don’t want to lift heavy weights. I might get hurt,” then you can do lighter weights as long as you are creating enough stimulus over time. And that can easily be two to three days a week to start. I love the idea that you were lifting five days a week. Again, what is your goal? Is your goal hypertrophy growing or is your goal maintenance? And you target it there, but it’s the most critical aspect.

Dr. Sandi: Absolutely, it is so important. And for health coaches, you can really coach people in this area, help them just to start, start where you are, start with…you know, do one rep, and then you’ll progress, and you’ll get stronger. And to feel powerful is just wonderful.

I was at a reunion, my 54th high school reunion. We were outside, and we were taking a picture. And so some of us had to sit cross-legged on the… I was always the short one, so I’m on the bottom. And, again, there was a whole group of women who were there, and I was the only one who could get up off the ground. Everyone else needed support to get up, so it’s very, very depressing.

Another area that I know you’re passionate about is protein, and you talk a lot about this in the book. Why do we need protein? Why is it so important? And why can’t you get it on a plant-based diet? I was a vegan for years. I was so unhealthy. A vegan with no resistance training.

Dr. Lyon: And you feel so much better now.

Dr. Sandi: Night and day.

Dr. Lyon: Protein is a very interesting macronutrient. We say protein as if it’s one thing, but protein is comprised of 20 different amino acids, nine of which are essential, meaning you have to get them from the diet, and they’re not all equally essential. So, these nine amino acids that we must get from the diet are needed in varying degrees. And I’ll explain to the listener what that means. The other aspect about amino acids is they all have dual roles. It’s not just about building tissue, but, for example, threonine is the precursor for mucin in the gut. So, when you think about gut health, you think about that amino acid. Arginine is a precursor for nitric oxide. So, when you think about high blood pressure, there’s some evidence to support that those, when they are low in arginine, when you have a diet that is more well-rounded and has more arginine, the blood pressure improves.

So, these amino acids all have dual roles, and they’re all metabolized differently. As it relates to dietary protein and muscle health, there is a branch-chain amino acid called leucine. Leucine is an essential amino acid that you must get from the diet. And again, the need for that is higher than say some of the other essential amino acids just by nature of what it does. So, this brings us into this concept of dietary protein. And, again, dietary protein for whatever reason has gotten exponentially more controversial. Right, Sandy? It wasn’t like that probably 10 years ago. With the rise of social media, so has the rise of this controversy around dietary protein.

Here is why it is so important. Dietary protein, the numbers are currently set at, which is 0.8 grams per kilogram, is the minimum to prevent deficiencies. And we don’t think about kilograms, but it’s 0.37 grams per pound body weight. So, if there is a 115-pound woman, their recommended dietary allowance for protein would be 45 grams of protein. That is devastating to aging muscle, okay? Devastating to aging muscles. And in fact, protein recommendation at 0.8 grams per kg was set into motion in 1968, which means one of two things. Number one, we haven’t had any new science advances since 1968 regarding dietary protein or, number two, it just hasn’t been thought of as a primary macronutrient of concern. I am here to tell you it is a primary macronutrient of concern, and it is the most important macronutrient as it relates to aging. Why? Because muscle health is everything as it relates to aging well.

Now, what I currently recommend, and one more thing about the 0.8 grams per kg, that was set for high-quality proteins. That was not set for plant-based proteins. High-quality proteins include beef, chicken, eggs, whey, dairy, anything that is an animal product. That minimum requirement was based on animal-based products. It was not based on plant proteins. If an individual were to eat a plant-based diet and just thinking about the macronutrient protein and they’re eating whole foods, they may need to consume 35 percent more protein, depending on what it is.

Let’s take that a step further. What does that look like in food? Well, you could choose a soy product if you wanted. There was this huge push about quinoa being a good protein source, and it would take six cups of quinoa, six cups of quinoa, and 1,000 calories to equal one small chicken breast. This is not metabolically favorable, right? This is going to be devastating unless you are some kind of amazing athlete, but the other side to dietary protein is that it’s not just protein, it’s a food matrix. And the lower your protein intake, the higher the percentage must come from animal-based products.

It was a French study, but it wasn’t a randomized controlled trial. It was more of a proof of concept, and it showed that in order to meet the other physiological needs, that 50 percent of your diet needs to come from animal-based products as it relates to protein. What are some of these other physiological needs? Well, there’s other nutrients like the B vitamins, iron, zinc, selenium, creatine, and serine, taurine, all these other molecules, low-molecular weight molecules that ride alongside these high-quality proteins. So, again, it’s not just, could you design a diet that has x number of protein from a plant-based protein perspective? You can, but what about all the other physiological needs of the body? And the average woman, 65 and up, 40 percent of them are deficient in protein. They’re not meeting the RDA protein.

Dr. Sandi: Well, you’ve just described all of my friends, my contemporaries. They are not eating enough protein. Their typical day might be they’ll do Pilates or yoga, they’ll walk, and then they’ll have a salad for lunch with maybe a few strips of chicken or a tiny, tiny piece of salmon, like real tiny but nowhere near what is required. And I was having this conversation with a friend the other day, and so she said, “Well, maybe I’ll consider more protein.” So, she went to a vitamin store and they said, “No, no, no, they’re going to hurt your kidneys.” And she had been working with a trainer and the trainer said the same thing, “No, too much protein. You’ll have kidney problems.” Can you comment on that myth?

Dr. Lyon: I mean, so there’s been multiple meta-analyses that have come out that have really dispelled that myth. It’s kind of like the cholesterol story, which they took cholesterol out of the dietary guidelines in 2015. This idea that we should reduce our dietary cholesterol was, again, taken out of the dietary guidelines.

Dr. Sandi: Now, you have been advocating… And you were so helpful. We had a conversation about what I was doing, and I was buying into the intermittent fasting and not eating until 12 or 1. And since that conversation with you, I have now gone back to three meals and sometimes having more protein as another meal. And I know you’ve been talking about this on social media, and then that kind of goes against what is the fad now or that you go long, long periods of time between eating, and you intermittent fast.

Dr. Lyon: One of the things that we have to ask ourselves is, what is the goal? What is the goal of what we are doing? Is the goal of fasting for what purpose? Is it for longevity? Is it for X, Y, and Z slotted in? And then the next question is, is this the best path forward? If you are more mature, the most important thing that you are ever going to do is to protect skeletal muscle. That is the most important thing to do. Is fasting counterproductive to that? Likely yes. It is. It is not ideal as it relates to a more mature individual. Number one, their total calories are already low. After you’re in an overnight fast and then now extending further a fasting window, you’re catabolic. Your muscle tissue is beginning to turn over. You’re just in a catabolic state.

A much better strategy would be making sure that first meal of the day is very robust in protein, and that could be 40 to 50 grams. And then you can have a second meal. But, again, it all depends on what your total protein goals are, but if you are more mature and you are… When I say more mature, just older than, gosh, it could be 40, 45. But definitely if you’re getting into your 60s and beyond, total protein matters. I recommend one gram per pound ideal body weight. You could easily get 0.7 to 1 gram per pound ideal body weight. You don’t have to know your ideal body weight. Pick a weight that you felt comfortable at. And then how you prioritize protein, there’s a few ways to do it. But, again, if you are more mature, then making sure that the first meal of the day is optimized for dietary protein, and the last meal of the day is optimized for dietary protein. And then if you want to put a middle meal in, that is great. If you want to build muscle, you could have a fourth meal. There are many different strategies to do it, but that is one strategy I recommend.

Dr. Sandi: That is such sound advice, and health coaches don’t give advice. They don’t develop meal plans for people. And so what I love is that… And they also are client-centered. So, if somebody comes in who is a vegan, they’re not going to say, “Nope, you’ve got to eat animal food.” That would not be the coach approach. They can provide references to something like your book where somebody could, if they’re open just a little bit to rethinking and it comes about by focusing on what they want their health for, what matters most to them in the future, what they want to be strong for. So, often there can be that very impactful and aha moment where they make that decision to change. And I love that you’ve got recipes and meal plans, so it really is all laid out. What do you hope to accomplish? What would be a real win for the success of this book?

Dr. Lyon: Oh, I know that we can change the conversation, and I cannot change the conversation alone. I need the support of you, which you’ve so graciously given me over the years, and I need the support of other health coaches and professionals and the listener or the viewer, if this goes to be viewed. The real win is changing the conversation to one of strength and to what we have to gain and who we become in the process of doing it and also to provide really good evidence-based information that has high scientific integrity. And that’s what this book does. So, that is my goal.

Dr. Sandi: And it does it very well. It’s readable, and it is something that I believe our coaches can really work with their clients to follow this because it is evidence-based. And we have so many people suffering right now. So, I’m your biggest fan. I’m walking [crosstalk 00:30:00].

Dr. Lyon: You’re embodiment [crosstalk 00:30:01].

Dr. Sandi I mean, I just I had my three-egg omelet, and I had my whey protein shake.

Dr. Lyon: You embody where this is going. You embody this message. And it’s been transformative for you, and so that is the hope.

Dr. Sandi: I remember those raw vegan days. I couldn’t even walk up the stairs. I was so exhausted. So, Gabrielle, where can people find you? You have an awesome social media presence.

Dr. Lyon: Well, number one, you can find me on my website Dr. Gabrielle Lyon, and there is incentives to get the book early—free exercise libraries, all kinds of things. I’m very active on Instagram, Twitter, now TikTok embarrassingly. Also I have a very large health and wellness podcast, and that’s called the Dr. Gabrielle Lyon Show with amazing experts or those with real-life experiences. And a great newsletter and a YouTube, all the things. So, thank you so much for having me.

Dr. Sandi: I love your podcast. I listen to it all the time. So, again, the book is “Forever Strong,” a new science-based strategy for aging well, and isn’t that what we all want? Thank you, Dr. Gabrielle Lyon. Love you.

Dr. Lyon: I love you, friend.