The Strong MD | Episode 7

Muscle Matters: Dr. Gabrielle Lyon on Revolutionizing Health

In the episode, Dr. Jaime Seeman interviews Dr. Gabrielle Lyon, a board-certified family physician with expertise in nutritional sciences and geriatrics. Dr. Lyon, who runs a concierge medical practice and a media and publishing company, emphasizes the critical role of skeletal muscle in overall health and metabolism. She introduces the concept of muscle-centric medicine, explaining how maintaining and building muscle mass is crucial for preventing diseases related to aging. Dr. Lyon argues that we are not over-fat but under-muscled, and the health of our skeletal muscle significantly impacts our metabolic health. She highlights the inadequacy of current medical education in preventive care and nutrition, suggesting that more emphasis should be placed on these areas for both doctors and patients.

Dr. Lyon also discusses her book “Forever Strong,” which presents a science-based strategy for aging and emphasizes the importance of high-quality protein intake for maintaining healthy muscle tissue. She differentiates between animal and plant proteins, stressing the superiority of animal proteins in terms of essential amino acids and their impact on muscle health. Dr. Lyon suggests aiming for 1 gram of protein per pound of ideal body weight, emphasizing that this is not considered a high protein diet but rather an optimized intake for maintaining muscle. She encourages listeners, especially medical professionals, to lead by example in their own health practices, underscoring the importance of staying physically active and eating well to improve patient care and personal well-being.

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Dr. Gabrielle Lyon is an accomplished family physician and bestselling author

Dr. Jaime Seeman: Dr. Gabrielle Lyon is an accomplished board certified family physician and a distinguished New York Times bestselling author lauded for her latest work called Forever Strong, a new science based strategy for aging. Well, Dr. Lyon’s rich background encompasses a dual research and clinical fellowship in geriatrics and nutritional sciences at, Washington University, complemented by her undergraduate training in nutritional sciences at the University of Illinois. As an authority in the practical application of protein types and levels for health, performance, aging and disease prevention, she is highly sought after as an educator. Enjoy today’s episode. Dr. Gabrielle Lyon, welcome.

Dr. Gabrielle Lyon is a board certified family medicine physician

Dr. Gabrielle Lyon: What’s up, friend?

Dr. Jaime Seeman: I know you are an incredibly busy woman. You are doing so many amazing things right now, but for our listeners, can you give them just a little bit of your background? And I really want you to tell these people why you ever became a doctor, and if you still love it to this day.

Dr. Gabrielle Lyon: Yeah. so, hi, my name is Dr. Gabrielle Lyon, and I am board certified in family medicine. And I’m also fellowship trained in nutritional sciences and geriatrics at Washington University. I did a combined fellowship, which was both research based and in clinical care. Right now, I run a concierge medical practice as well as a media and publishing company. And I’m a mom of two very little children.

Dr. Jaime Seeman: Yes. And you’re also married to somebody that’s in medicine.

Dr. Gabrielle Lyon: Yeah. My husband is in a second career as a surgical resident, so he is at Baylor in urology. He’s in a second career easily working 100 hours a week.

Dr. Jaime Seeman: tell me how you guys make that work. We’ve had somebody on the podcast, a relationship expert, talking about the personality types and how to make things work, but I’m always fascinated. I’m not married to somebody that’s in medicine, and that works really well for us. But are you passing in the night? Like, how do you even make this work?

Dr. Gabrielle Lyon: It’s interesting. I think that if it was anybody else, it probably wouldn’t. So my husband is very uniquely positioned to be able to interface with all of the things that are happening in my life. And his, he was a former seal for ten years, a seal medic. So I think that if it were anyone else, it probably wouldn’t work. And I know that is kind of dark and potentially not, something that you could put tangible properties behind. But he understands the same. We have the same standards, we have the same work ethic. He would likely. And actually, he pushes me more than I would ever push him. I’ll give you an example. I just wrote a book called Forever strong. It was an instant New York Times bestseller. It took me two years to write. I had two children during that time. And he said to me, if I really cared about getting it done, I would probably wake up earlier. I would wake up with him at four and execute on the book. So that is an example versus potentially someone else who would say, no, just go back to bed, it’s okay, you can relax. I think that there is just a standard of execution that, is very helpful. And I would say the other thing is the balance of emotion. He is very sturdy and non emotional. Doesn’t complain. Again, this is unique to potentially, his training doesn’t really have a narrative and things aren’t really that big of a deal.

Dr. Jaime Seeman: Yeah, I mean, who doesn’t want a Navy Seal to be their neurology?

Dr. Gabrielle Lyon: Exactly.

Dr. Jaime Seeman: He’s equipped with skills, and life transitions. I, was actually talking to another, seal person recently, and they were talking about these life transitions and how you got to be prepared. Right, like, for the next thing. And I hear you talking about that, basically how he prepared you for this book and this launch, and you’ve done an amazing thing there.

Dr. Lyon says you take care of yourself as a physician and in life

But I think one of the things, Dr. Lyon, that you and Shane do really well is you take care of yourself. And I think that that allows you to perform as a physician and in life. So, can you tell us a little bit about just your lifestyle? How do you train? You both obviously work a lot of hours.

Dr. Gabrielle Lyon: Yeah, that’s actually very true. and I’ll speak to him first, just because we’re on the topic of him and he’s not going to listen to this podcast, although he should. he is training, for the New York, I’m sorry, the Boston marathon. This will be his second year running the Boston marathon. He gets up around 334 and will train before going into round. He doesn’t miss it. He will also train, for example, if he’s on a 24 hours call, he will either train the next day or he’ll just make up for it. He does not miss the execution of that, regardless of how tired he is. It’s just a standard that he sets. for me, I will also train regardless of how I’m feeling. I will try to get my training done in the morning, typically. Again, I have two little kids, so I will bring them with me to the gym and they will train with us either at the gym or at home. And, we really impress upon them that physical activity is a standard. It is not an exception to the rule. It is not something that happens once in a while it’s, hey, mommy’s going to do push ups. You can either jump on my back or you can do your own. we’re going to do pull ups. We’re going to do x, y and z. My son, who’s two and a half, loves the rower. And I think it becomes very critical to realize that the habits that you have and then instill as a way of life into your children, it becomes much easier to set them up for a successful life. I’m not talking about monetary success. I am talking about habitual success versus being sedentary, eating a bunch of junk, and then having to reverse those behaviors decades later when they’re in their forty s and they’re in their 50s. so that’s how we do it. And you had mentioned self care first. Yeah, we get it done. We definitely get it done. And I will say that I think people use their kids as an excuse that, oh, I have to take my child to practice. I’ll facetime you and you’ll be at practice with the kids. I guarantee you got your training in. so you cannot use your children as an excuse. Yes, you can take them to the park and. Yes, you can go to the park and yes, you can do pull ups. Yes, you can do pull ups on the tree. Yes, you can do it, period.

Tell us about your nutrition. How do you and Shane eat to take care of yourselves

Dr. Jaime Seeman: Okay, so I know that you train and you don’t miss it and you eat well, and I want to talk about your nutrition, but can you talk a little bit about your life structure? What tasks do you hire out in your life that are not worth your time and energy?

Dr. Gabrielle Lyon: Everything I can.

Dr. Jaime Seeman: I know you’re amazing, but I know you.

Dr. Gabrielle Lyon: No, I’m not. I am really not.

Dr. Jaime Seeman: Your own underwear? Come on.

Dr. Gabrielle Lyon: I am really not amazing. I hire out cooking and cleaning. I hire out everything I can. Everything. I don’t hang something on the wall, I hire it out. I always tease you when I see you doing housework. like, stuff that will require a hammer, nail or a drill, I hire it out.

Dr. Jaime Seeman: These are things that bring me joy.

Dr. Gabrielle Lyon: No hard pass, anything that requires opening a box and looking at directions. I will hire out everything. I do not cook. I don’t cook.

Dr. Jaime Seeman: But let’s talk about nutrition. So somebody’s cooking for you, but they’re obviously not making you, ah, donuts. And, about. Tell us about your nutrition. How do you and Shane eat to take care of yourselves, to be high performers?

Dr. Gabrielle Lyon: well, we definitely eat high quality foods. We don’t eat a lot of, packaged foods. We, high quality proteins, lean meats. We love piedmontes. We’ll, at any point in time, have cooked, ah, piedmontes. Steak cut up, ready to go. So we prepare for our weaknesses. We prepare that we’re tired, that we’re working, that we’re traveling. I prepare food when I’m traveling. I bring it. The food that I have with me doesn’t need a, fridge. Same thing if you are on call, if you are a resident, if you are a med student. I have all of these life attributes and skills that I do now. I did when I was a resident, when I was a medical student. and again, you can pack beef jerky. You can pack cans of chicken, even tuna, if you’ll eat that. It’s a little high in mercury. Doesn’t taste that good. packets of rice. I know, perhaps Jamie or some other people are not on the high carb. We’re having the high carb summit, a high carb plan, but I certainly do eat a substantial amount of carbs. I pack those, they’re clean. Whether it’s fruit, whether it’s rice, it all is packed, but the foods are prepared. So, at any point in time, we have made foods. and if for some reason we don’t, we’ll have foods like greek yogurt or hard boiled eggs. Beef sticks.

Dr. Jaime Seeman: Right? Like real whole foods. I wish I knew back in residency what I know now, but I love the food services where it’s just like, you just got to heat it up or just eat it straight out of the bowl. I mean, I’ve eaten things cold because that’s just what I had to do. But, I love it because I think the time it takes for you to grocery shop and then prepare it and then cook it and then clean up when you work at the pace that you do, I think that, it also takes out, what I like to call decision fatigue, because when I get decision fatigue, I’m more likely to start making poor decisions, and it’s just out of. I mean, that’s what happens as humans. Like, we can only do so many tasks in our mind, and when it comes to nutrition, I don’t want that to be the thing that I fail on.

Talk to our listeners about where are their blind spots in their medical education

And I love how you talk a lot, about preparing for your blind spots. So I want to shift that conversation of nutrition for somebody that is going through their medical education, or maybe they’re a doctor that’s been in practice for many years, and they’re realizing now that they don’t know a lot about. I mean, we tell people all the time that lifestyle is the number one treatment. But are physicians really armed with the correct knowledge and information for people? So, talk to our listeners about where are their blind spots in their medical education when it comes to lifestyle.

Dr. Gabrielle Lyon: So I want to come at this from two perspectives. The first perspective is physicians are trained, and trained appropriately in algorithmic medicine. If, for example, Jamie has to deliver a baby, there are certain protocols and standards set in place that she has to make sure that she checks off. If someone comes to me because they need treatment for their diabetes or their hypertension or, they need a diagnosis of hemochromatosis, let’s just make it up, whatever it is. We can all agree that there are certain standards of care that we must meet, and maybe diabetes and hypertension are bad examples. But, the overarching theme that I am trying to paint the picture of is that you go to up to date and you will see the algorithms. That is good medicine, that is solid for treatment, for what we have that is appropriate for a physician. A physician will spend a minimum of four years in medical school and, three years in residency. So that is seven years of a basic education to be able to do the basics, and then a fellowship in whatever it is that they are trained in. We’ve already been, so that’s seven, eight, nine years. So that’s nine years of training to be good at the foundation that’s appropriate. Where the blind spots are, first you must determine, are you practicing algorithmic medicine, which I think that we all do, or are you practicing lifestyle medicine? And I think that there is. In order to be good at both things. It’s a lot to ask for every physician to become an expert in both things, and I don’t think that that’s a fair ask. I think that where there is a potential blind spot and potential opportunity will be the nutrition piece. and I think that all physicians listening, or medical students, you will all agree, you will all see that you are not trained in prevention, but that’s not what you’re supposed to be trained in the avenue to understand those blind spots. Understanding you are not trained in preventative care, and understanding you are not trained in physical training. physical proudness or nutritional sciences will be determining if that is something that will become a large part of your practice, if, in fact, it will become a part of your practice. I do believe that there’s two things that you can do. number one, and no one is going to like to hear this, but if you are early enough in your practice, going back and doing a fellowship, or if you are a resident, go and do a fellowship. Do a fellowship in nutritional sciences, you will become exceptional. Period. End of story. If this is something that you know you deeply want to incorporate, and it becomes a talking point. So for me, I did seven years of nutritional science training. That is a long time. And I also trained under world leading experts. They were not average. They were not mediocre. These guys are the top of the top at their field. And if you see that as a pathway to go forward, then choose the lab and choose the mentors that are doing that. I can’t stress that enough. It was very difficult to go back and do a fellowship, or I didn’t go back. I continued, it was very difficult to do a fellowship, but, it will arm you with an education and a framework of thinking about something that you will be able to create new protocols that then can be instituted within medical, communities because you have the credentials. The credentials matter, especially in medicine. So that’s number one. Number two, if this is a personal, interest and something that just wants to be incorporated into practice, then you do not have to go back to do a fellowship, but find other practitioners that are offering mentorship or, for example, I say this cautiously. Functional medicine, a four m. Again, those are not huge nutrition pieces, but, there are physicians that will offer mentorship.

Dr. Jaime Seeman: They’re more prevention focused.

Dr. Gabrielle Lyon: Yeah, they’re more prevention. They’re certainly not. I’m trying to think, what would I recommend, someone to do to go back to really gain nutritional science, information. yeah, find a mentor. Find a mentor that is, ah, someone that is evidence based and that you trust. So you trust their intellectual integrity. Hopefully I answered that.

Dr. Jaime Seeman: No, you totally did. And this is a little bit of a can of worms question, but, I mean, you left traditional medical practice, you run a concierge practice, which is different than most western.

Dr. Gabrielle Lyon: I never actually went into traditional.

Dr. Jaime Seeman: So from, from like a really broad overview, knowing what’s happening in America, the amount of metabolic disease we have, and we’re going to dive into your particular approach to obesity, that fat is not the problem. do you think doctors should be trained? If we could just totally tear down the building and rebuild it. Should doctors be trained in preventative lifestyle medicine?

Dr. Gabrielle Lyon: Oh, yeah. I think at least having some structure, to nutritional sciences and some basic structure. The problem is, for example, when I went to go lecture at obesity medicine, they don’t vet the. And I’m not saying this anything against for you guys who are interested in obesity medicine. It’s a wonderful organization, but, the reason I ended up going to speak there, so I did, an hour long talk. And then q a is because I saw, physicians that were non nutrition experts go on there, talk about a vegan diet, how that is important for heart health and for aging. And then I saw them just do a whole anti red meat segment. and I felt so responsible because I knew that the nutrition aspect, that was getting to the physicians, the physicians weren’t trained to be able to critically evaluate the data. In order to be really good at nutrition, it requires a lifetime of learning, truly. And, I knew that I had to balance the conversation. Trust me, I didn’t want to go and lecture to obesity medicine again. I have two little kids and I have multiple businesses that I run. But it was a responsibility. And so I caution that your original question was, should we be trained in this? And I would say yes. I would also say there is a danger to narrative, driven training. So let’s say I say yes to that answer, and then obesity medicine offers a vegan vegetarian. This is best for longevity, which the science was given by non nutritional experts interpreting epidemiology data, giving bad information. And then the physicians from the top down will go, red meat is bad for cholesterol, or we should go plant based, which all of those things are. Nothing further from the truth.

Dr. Jaime Seeman: Right.

Dr. Gabrielle Lyon: So it’s a challenge. So I think that if it were to be that way, we would have to have a board of advisors that were, trained in the information that is being given out.

Dr. Jaime Seeman: Yeah. Unfortunately, there’s politics and money in medicine as a business and a lot of vested interests that aren’t necessarily people’s health, which is unfortunate. but I don’t want to talk about that.

The health of skeletal muscle determines nearly the health of all metabolism

So I kind of alluded to the fact that you believe that obesity is not a fat problem. So tell our listeners what it is and what the solution is.

Dr. Gabrielle Lyon: Yeah. so I had this aha moment when I was doing my fellowship in geriatrics and nutritional sciences. These were really long hours. I was up at four. I was doing fat and muscle biopsies because we were working on a project m. there was a metabolic ward unit. So obviously, I was a physician at this particular lab. And so I worked on many projects. But my personal project was I was looking at, body composition and brain function. And these are, extremely expensive studies to do. There are multiple arms to the study. There’s cardiovascular testing, there’s insulin clamps, et cetera. And, it was a weight loss study and looking at the patient population. So, in the morning and in the evenings, I would do obesity medicine research. In the morning, I would do the muscle and fat biopsy. In the evening, we would do fMRI testing and or cognitive testing, stroop test, just a whole host of cognitive tests. And we would gather the data. It would go to, the physiologist, the neurophysiologist, to determine what the numbers were, the metrics. And I absolutely fell in love with one of these participants, and she’s a participant, so it’s not as if I’m her direct doctor. Just fell in love with her mom of three. Always put herself last, never, took care of herself. Yoyo dieted for 30 years, lost and gained the same 20 pounds. She did everything that the medical community told her. Follow the food by guide pyramid, do more cardiovascular activity, eat less. And when we imaged her brain, her brain looked like the beginning of an Alzheimer’s brain. M and I felt that we failed her, that I failed her, that the medical community had failed her. She had followed the food guide pyramid. She hadn’t been doing resistance training. Nobody had talked to her about protein. She had not protected her skeletal muscle, and her cognitive performance was poor. Her metabolic markers were poor, and her brain looked like the beginning of an Alzheimer’s brain, which, when I was going to see patients in clinic, in these cognitive clinics, and then in the nursing home and in the dementia ward, in the dementia unit of a nursing home, it’s devastating. And I realized that that was her future. And, that the one thing that all of these patients had in common wasn’t that they were over fat. It wasn’t a fat issue. It was a skeletal muscle issue, and that we are not over fat. We are under muscled. And it is muscle that is at the root of these diseases of aging, and that if you have healthy skeletal muscle, then you are not going to see again. And I’m saying this in absolutes. We are all physicians here. It is not in absolutes. There are genetic causes. There are certain things that happen. But from an overarching perspective, the health of skeletal muscle determines nearly the health of all metabolism from a cardiovascular standpoint. insulin resistance, diabetes, dysfunctional skeletal muscle happens decades before, decades before we even see changes in blood markers. and so my medicine, I coined and created what’s something called muscle centric medicine. We will be offering that to other practitioners. We finished the first, section of modules. But it is extremely robust. and it’s really thinking about skeletal muscle as the core and collecting data and treating not obesity, treating not hypertension, treating not x, y and z, but treating skeletal muscle.

Dr. Jaime Seeman: give us a little appetizer of this course for somebody listening that’s in training. That’s like, wow. I sat through endocrinology class and they didn’t tell me that skeletal muscle was a treatment for metabolic disease. Give us just kind of like, how does skeletal muscle really improve metabolic disease?

Dr. Gabrielle Lyon: Yeah, well, skeletal muscle, and I think we can all agree, individuals think about it as a, performance based organ. And it is, it’s important for power, force, hypertrophy. All things that, have an aesthetic appeal or a functional appeal, but that’s one component of skeletal muscle. Skeletal muscle is really our metabolic currency. It’s currency we can’t buy, we can’t sell, we can’t trade for it, we can’t botox it. I mean, I guess you can botox skeletal muscle, but, what you cannot do is, what you must do is you have to earn this. You have to earn this tissue. It is very, plastic. You can add to this endocrine organ. It is important for a number of things, including glucose disposal. It is a non insulin dependent glucose disposal organ. when you are exercising right, you do not require insulin, because of the transporters to move glucose out of the bloodstream into skeletal muscle. So that’s very important. Skeletal muscle is the primary site for fatty acid oxidation at rest. skeletal muscle. And by the way, people think that skeletal muscle is very metabolically active. It’s not. It is, not at rest, extremely metabolically active. It has a low burn of fatty acid metabolism. But as you train skeletal muscle, you, of course, increase energy expenditure, but you also increase glycogen utilization. Healthy skeletal muscle has a flux to it. Unhealthy skeletal muscle looks like a marbled steak over time. And, for those individuals who are very astute, there is something called the athletes paradox, in which they do have formed lipid droplets, triglycerides that they use for energy. But as a whole, skeletal muscle is, by mass, 40%. it’s interesting, I keep going back to, how can that be possible? Is it really 40%? I think that there’s probably variability, but we do not test skeletal muscle mass directly. I think that there’s one physician who routinely does mris. I think it’s Sean, what was his name? Sean O’Mara. Ah, routinely, tests by mris on every patient. But that, is not the norm. It is extremely expensive for patients. So, we do not have a way in which we directly measure skeletal muscle. Dexa requires a 10% or so change before you pick up skeletal muscle, changes, which is interesting, meaning, that is not very sensitive, and you can make incremental changes, but again, it is not often picked up. So, skeletal muscle, we really have to think about it. Is there a dose response? Are we seeing changes in, fasting glucose, fasting insulin? An oral glucose tolerance test is a wonderful test. I think that eventually we will get to the point where we are measuring skeletal muscle directly by deuterated creatine. It is something that will happen, I believe, in the next five years. but at the end of the day, this course really, provides the framework for the history.

I think it’s really important to understand skeletal muscle, the pathophysiology

I think it’s really important to understand skeletal muscle, the pathophysiology of it from a medical standpoint, not a training standpoint. So we look at it from a fuel utilization and from a medical standpoint, and its direct relationship to, for example, pcos or obesity or rheumatoid arthritis, the ways in which skeletal muscle interface. and then we make our best estimates.

Dr. Jaime Seeman: I mean, that’s what your first example was like, m brain health. If you told somebody, oh, you don’t want to get dementia, you got to get stronger and grow your muscle. I feel like people would be like, what? The fact that, and the muscles.

Dr. Gabrielle Lyon: Talk to each other, and it’s really interesting because it’s not a big enough driver. everybody knows they should eat well and exercise.

So the question becomes, how do we, including physicians, hold ourselves to high standards

So the question becomes, how do we, including physicians, by the way, you guys, you have to hold yourself to the highest standard possible. It is your responsibility as a physician to be the. I won’t swear, the fittest effing physician that you can. Otherwise, you’re leaving it on the table. You are leaving the inspiration to the patient on the table. If you are not showing up, being, the example, then you’re not being a good physician. Quite frankly, you might be good at diagnosing and treating diseases. And I’m not trying to, be difficult or hard on you, but if we hold ourselves to the same standards that we are asking our patients to, it’s not like, do as I say. Don’t do as I do. No, do as I say, because you’re doing what I’m doing, and I’m telling you, if I can do it, you can do it.

Dr. Jaime Seeman: Well, there’s a reason we invited you to the strong md, podcast.

Dr. Gabrielle Lyon: Yeah, that’s right.

There are certain medications that affect skeletal muscle as well as metabolism

I want to mention something else. also in the muscle centric medicine course, we do talk about medication influence on skeletal muscle. I think that that’s important and underrepresented in the conversation. there are certain medications that affect skeletal muscle that are not commonly, thought of, as well as metabolism.

Dr. Jaime Seeman: So important. Okay. So, since muscle is so important, and there’s dangers in treating obesity with just weight loss, because if we’re losing lean body mass, that’s a huge problem when a patient loses 100 pounds, and some of that is lean body mass. So how do we, and maybe break it up at certain parts of our life? If I’m a 23 year old med student or I’m a 45 year old middle aged mom trying to be a doctor, what strategies should I be using to maintain healthy muscle tissue?

Dr. Gabrielle Lyon: Yeah, great question. quite frankly, I’m going to say this, and I’m going to say this cautiously. It’s super easy. So I worked on some of the very early studies where they were looking at protein intervention and resistance training in the early two thousand s. And I did this out of Don layman’s lab. And in order to have Healthy skeletal m muscle. Number one, how do we define healthy skeletal muscle? We define healthy skeletal muscle with really two major modalities, and that is physical strength, whether it is leg press, leg extension, some kind of attribute of strength, measure of strength. And number two, triglyceride levels, insulin and fasting blood glucose. I mean, those are really the three main measures we’re not measuring. Creatinine. What are the metabolic measures, and maybe an oral glucose tolerance test. Now, early on, in the early days, back in the old days, we looked at two groups, and one followed the food guide pyramid, which had 0.8 grams of kilogram per pound, of protein, or 0.8 grams/kg of, body weight protein. And then, so they followed the food guy pyramid. It was, I don’t know, 50% carbohydrates. And then the other group followed a 40 30 diet. So 40% carbohydrates, 30% protein, 30% fat. They were isocaloric, meaning they both had the same amount of calories. The only thing that were different was the macronutrients. the macronutrients had 1.6 grams per kg, so double the RDA. And, that was in the zone type group. And the exercise that they did. Are you ready? Was two. And Don really doesn’t, like when I talk about this it was two days a week of yoga and then walking. It was something so basic. Those individuals that had the exercise intervention, they all retained lean tissue. They had a very minimal amount of lean tissue loss. I think it was 6%, which is nothing compared to. I believe the number was 33% at the high carbohydrate, no exercise group. Wow, crazy. High carbohydrate, no exercise group. Again, I have to go back, and this was the early 2000s, so I have to really refresh, my memory. I could certainly pull it up here. so the minimum to prevent decline as you age is not drastic, but the goal is we are not preventing decline. We are building a reserve. The minimum to prevent deficiencies would be following the 150 minutes. I don’t even know where they came up with that very basic recommendation, 150 minutes a week. but the reality is you don’t have to go to the gym, and I’m cautiously saying this because I want to be intellectually honest, is that, the data would support, it’s a very minimal amount of movement to protect skeletal muscle to two days a week of yoga. Now, I am not recommending that to anybody. I am recommending that to someone who is, I’m not recommending that to anybody. What I will say is, if you are younger, you have the, hormonal aspect on your know, I often think about Jamie. I text her about this. I don’t know what to make of the female, hormones and the protections of joints and ligaments and how it influences training as we age. I’m still curious about it. I don’t know if I have landed on either way, but I will say from experience and from taking care of patients, for over a decade, that when you are young, this is the time to really push yourself. You can push yourself in a way where it seems as if individuals are much less likely to get injured, whether it is.

Dr. Jaime Seeman: Right.

Dr. Gabrielle Lyon: and this is the time to be gaining your skill set, skills of things that perhaps you wouldn’t be doing later on. I’m not saying that you wouldn’t always be doing a clean or a snatch, but you might not. If you are just getting into the gym and your first workout in your 40s is Crossfit might not be ideal, but if you are in your twenty s and you know that you can move and have resiliency, perhaps crossfit, explosive movements, things that if you can foreshadow you may not be doing early on, I think is extraordinarily valuable. and then really putting in the time. It’s much easier to maintain than it is to have a body composition reveal, right? I’ve been training for years. I’ve been training for decades. Same with my husband. Training for decades. When you train, when you have foresight and you train for a lifetime, yes. There is a component of muscle memory. you improve myonuclei, you improve the health of satellite cells, you improve the health of the architecture of the skeletal muscle, that when you go through periods of disuse, which inevitably know. Jamie’s a very dear friend. I think I got Covid twice. I, couldn’t even cancel on her one time. And there are times where you are not going to be able to move. You are going to be so sick that, you are going to want to be able to recover. Right. And that recovery will be dependent on the amount of mass that you have developed. Do you know, there’s some data coming out that in, the first seven days of being put on bed rest, which we write scripts to put, we put in orders to put someone on.

Dr. Jaime Seeman: Bed rest, you break a leg, you get Covid, you get cancer.

Dr. Gabrielle Lyon: Two pounds of skeletal muscle from your legs in a week.

Dr. Jaime Seeman: That’s crazy.

Dr. Gabrielle Lyon: Two pounds. Two pounds in a week, whether you are young or old, you’ll lose two pounds. You’ll have a weak grace period if you’re consuming enough leucine, enough protein. But after that week, if you are not moving, you will lose, ah, a drastically large amount of skeletal muscle. so if you start from low levels of skeletal muscle, and people say, well, what is the optimal level of skeletal muscle? We don’t know. We have an appendicular skeletal, ah, mass, index. I created one. I put it in my book. We use some korean data. We use some data based on athletes and based on aging. We did the best that we could, but we don’t really have a standard. I mean, basically the standard is, based on sarcopenic numbers. Could you say you want it 75% in the 75th percentile? Okay. But again, it’s so variable that, it is difficult to know what the ideal skeletal muscle mass would be for any individual. But I did try to put it, as best to the knowledge that we have, in the book.

For young med students in residency, these things are non negotiable

Dr. Jaime Seeman: Anyway, it was just yesterday I saw some recent data. I don’t know if it was Brad Schoenfeld or somebody that shared it, but basically showing in natural bodybuilding athletes. So these are people not using testosterone and all these different things, that it took them 20 years of training to basically hit their peak so I think what you’re saying is so important, like building the skill set when you’re young. And honestly, when you start to incorporate these things, I feel like over time, it’s easier for them to become non negotiables. Like when you haven’t done this for 20 years and then you’re suddenly trying to put these new things into your schedule, and then you don’t like it and you don’t find joy in it, then it’s just easy to say, well, then I’m just not going to do that again. And I think, for the young people listening while you’re in med school, figure out how to make these things non negotiable while you’re in residency, these things are non negotiable. And that just becomes part of. It’s just what you do. It’s just how you work. It’s just how your engine runs.

Dr. Gabrielle Lyon: Yeah. Let me give you an example and listen. It’s hard, man. My husband’s working 100 plus hours a week. It is tough. When I was on call, I didn’t care. People were like, oh, you’re so weird. I brought my food and I brought a jump rope, and I would jog up and down the stairs. I didn’t care. I think I’m a weirdo.

Dr. Jaime Seeman: People find me in the staircase all the time.

Dr. Gabrielle Lyon: If you can find a way, put an electron your headphones and rock and roll. Know that when you’re on call, you’re overnight and you’re going to see the peanut butter and jelly sandwiches. Plan for your weaknesses. Do not put that in your mouth. You are likely, as a resident, you are likely going to go to your vice, whether it’s shopping, whether it’s, who knows, drinking on the weekends or eating whatever, those graham crackers and all of that stuff, because you’re hungry and you didn’t plan for it and you’re up 24 hours. Don’t fall for it. Do not fall for that. Plan, for it. Bring something else. Put it in the resident call room. Med students, you know, you’re on rotation. Some days you’re going to be on surgery. Get in there. you have an opportunity to show up in a capacity that you will be proud of, truly proud of.

Dr. Jaime Seeman: I love that.

Animal and plant protein are not equal, people. What is the difference between this

let’s go back to protein for just a minute because there is a lot of noise in social media and in medical education about protein. And you kind of highlighted that. You went to this obesity medicine conference and they’re trashing red meat when it comes to skeletal muscle. As the most important component of human metabolism, essentially. Talk to us about protein sources, animal and plant. Yes. There’s this minimum requirement that you believe in. What is the difference between this? Just give us what people really need to understand here.

Dr. Gabrielle Lyon: Okay, you guys have to get my book. If you are a physician, please read my book. Just read chapter four and the protein chapter, please. I think it would be really helpful. Animal and plant protein are not equal, people. They’re not. And this is based on the amino acid profiles. There are 20 different amino acids, nine of which are essential. We frankly eat for those nine essential. When you have different foods. In these, what we would consider an ounce equivalents, for example, 1oz of peanut butter. in the current recommendations, in the my plate, in the governmental structure, they will say 1oz of peanut butter is equal to 1oz of beef. That is not equal. It would be eight tablespoons of peanut butter to equal 1oz equivalent of red meat or chicken, or some kind of protein source. We are not just looking at protein as a generic concept. We are looking at protein as an amino acid, mosaic amino acids. Yeah. These individuals, amino acid acids, the major limiting amino, acids are methionine, leucine and lysine for food ingestion. And they are limiting in various capacities. When you eat high quality protein for skeletal muscle, you reach your leucine threshold. I know I don’t really have a ton of time to go into all of this, but, leucine is necessary to trigger muscle protein synthesis. You need it in a minimum of 30 grams to initiate that process, that aging process. The other aspect is that also food is a food matrix. You can clearly see that a rice pea blend shake is different than a piece of salmon. A rice pea blend shake or a cup of broccoli is going to be different than a piece of red meat. We are looking at creatine, ancirine, carnitine, taurine, all of these, low molecular weight molecules that impact positively aging. What about b? Twelve zinc, selenium. There’s physiological roles that these nutrients are required from. And as you lower your amount of protein in the overall diet, the majority of that has to come from animal based products. Now, we don’t see overt deficiencies immediately, but one could argue as we age, we do see deficiencies and that, is, exposed in low muscle mass, in obesity, in metabolic dysfunction. so the idea of going more plant based, our current nutritional strategies are 70% plant based. The information that you’re hearing about that, red meat is bad for cholesterol, and eggs are bad for cholesterol. They took, cholesterol out of dietary cholesterol out of the guidelines in 2015. and just sticking to protein for a moment, these are not equal. We do not have a good way of expressing this to the public right now. If you look at the back of a protein bar or the back of a label, you will only see protein rather than if you look at fat, you’ll see monounsaturated, you’ll see trans fats, you’ll see saturated fats. If you look at carbohydrates, you’ll see sugars, you’ll see fiber, but you just look at protein. And that generic number is not the same from a biological equivalent. And that becomes critical to understand. We currently don’t have a great way of doing it. They will be coming out with something called an EA nine, which will eventually morph into a scoring system of three, a Ea three, which will be methionine, leucine and lysine. And it will give a potentially zero to 100 score and will be able to be labeled. We are not there yet. And protein is the most complex macronutrient because of not just these individual amino acids, which do biologically different things. For example, threeanine is a precursor for mucin production, phenylalanine for dopamine production. Each of these, amino acids are required in particular amounts to be able to optimize use in a body. so without going into a long biochemical conversation, or at least a worsening biochemical conversation, the ultimate understanding is that plant and animal protein are not equal from a food matrix perspective. There was a recent paper by van Loun that highlighted this nicely. Plant protein is not bad. It is high in carbohydrates. It is low in some of these fat solubles and some of these other, essential nutrients. When you are young, you can get away with a more plant based diet as you age. I think it is a terrible idea. And, yeah, you’ll have to stop me. Otherwise, I’ll just keep going.

Dr. Jaime Seeman: Yeah, this will be fascinating when it comes out, because from my perspective as an OBGyn, what I really care about is these women who are in their reproductive years, and they’re literally about to grow a human, right? I mean, it’s one thing if you want to experiment and try weird, crazy things when you’re an individual, but when you’re talking about growing another human, the building blocks that are essential for human life are really important to me. So this is why I want to open up this conversation. So what you’re saying with this new scoring system, the ea nine, ea three, is that animal proteins essentially will rank higher than.

Dr. Gabrielle Lyon: Yeah, and that’s been a huge issue. Is that, in the dyads or pdcas, they’re not usable numbers. So these are ways in which, they have truncated or scored protein usability. Again, it’s not determined by the overall scope of amino acids. It really needs to be determined by the limiting amino acids. and so, yes, they will evolve that scoring system.

When you are thinking about your diet, how much protein should you eat

Dr. Jaime Seeman: Okay, so let’s go back to real world applicable advice for the people listening right now. Protein is important. Nutrient dense animal foods are important. When you are thinking about your diet, how much protein, there’s a middle aged mom just like me listening right now. How much protein should she try to eat per day?

Dr. Gabrielle Lyon: A great starting point to think about is 1 gram per pound ideal body weight. You can titrate up or titrate down.

Dr. Jaime Seeman: So 150 pound woman, 150 grams.

Dr. Gabrielle Lyon: Is that where you want to be? Are you at your ideal weight? Are you good with it?

Dr. Jaime Seeman: Yeah. Want to stay there?

Dr. Gabrielle Lyon: Yeah. I am a five foot, 1250.

Dr. Jaime Seeman: Pound woman who wants to weigh 175 pounds.

Dr. Gabrielle Lyon: So then you would target 175 pounds, 175 grams of protein. You also don’t need 150 grams of protein. That would be at the higher end because at some point you have to figure out where your calories coming from. So if Jamie wanted to stay at 150 pounds, she could do 1.2 grams per kg of protein. she doesn’t have to go up to 150 grams of protein. She has to ask herself, do I do better on fats? Do I do better on carbohydrates? I’ve been to her house. There’s not one gosh darn carbohydrate in there. I’m like scrounging in the pantry looking for something. It’s the worst. I tell her I’m not coming back to her house if I don’t have carbohydrates. So, if her goal is to stay at her, current weight, then there’s no harm in having high quality protein. And at that level, 1 gram per pound ideal body weight, that’s actually not a high protein diet. If we were to really look at the definition, a low, a minimal protein diet would be 0.8 grams per kg. If you were to double that, then an optimized or moderate more moderate protein diet would be double that at 1.6 per kg. The dietary reference intakes go all the way up to 2.5 grams per kg. So her getting 150 grams of high, quality protein would not be considered a, quote, high protein diet. And I do think that semantics are important because we hear a lot of terms thrown around and it becomes very confusing. And in medicine, if I say this patient is hypertensive, this patient has stage one hypertension. You know exactly what I’m talking about. But if I say high protein diet, you could be picking your nose going, is that 75 grams of protein? Where are we? So I do think that, understanding that we must have definitions becomes important.

Dr. Jaime Seeman: Yeah. Or saying that this patient’s under muscled, what does that mean?

Dr. Gabrielle Lyon: Yeah. The only way we would do that is put them in a sarcopenic category.

Dr. Jaime Seeman: Ah.

Dr. Gabrielle Lyon: Appendicular lean mass index. It’s tricky. It’s tricky.

Dr. Jaime Seeman: Okay. All right. So our listeners are going to start eating high quality animal proteins. They’re going to start training. There’s a mindset involved with all of this, which I know you do very well, and your husband does, too.

Tell people about your book forever strong and where they can find it

But tell people about your book forever strong and where they can find it. Yeah.

Dr. Gabrielle Lyon: So my book forever strong, hit the New York Times bestseller list twice in the first six weeks, which is pretty extraordinary for a first time book. I did not do that alone. I had the support of my friends. and people can get it on Amazon or wherever books are sold. They can also go onto my website and join our community. We’re going to be launching a community. I don’t know when this podcast comes out, but we also have an in person event, January 13 and 14th. I am still trying to convince Jamie to come. Not an ideal time. I can appreciate that. It’s in Austin. We have a podcast called the Dr. Gabrielle Lyon Show. I have a newsletter in which I do always put a research article or two and break it down with the big takeaways, the areas of improvement. I’m on Instagram, et cetera. I don’t know if I missed anything.

Dr. Jaime Seeman: Yeah, you guys need to go follow her on Instagram. She has great information. I love what you’re doing, Dr. Lyon. And your book is for patients. It’s for doctors, it’s for everybody. All the people.

Dr. Gabrielle Lyon: It’s for everybody. So it’s written for the lay public. there’s pages and pages and pages of references. The original book, which is one reason it took two years to write, was very scientific. And the editor came back and said, no, we need this to be able to be.

Dr. Jaime Seeman: Like. So an Obgyn could understand it. Is that what you mean?

Dr. Gabrielle Lyon: Yeah, that’s exactly what my husband would say. Yep.

Dr. Jaime Seeman: Well, this was so lovely, Dr. Lyon, thank you for your time, your knowledge, your expertise, and really, honestly, thank you for leading by example for other physicians. And there’s going to be a, ah, young Jamie or Gabrielle that’s listening to this and, it could completely change the trajectory of their career.

Dr. Gabrielle Lyon: And if you’re out there, hit me up. We are always hiring.

Dr. Jaime Seeman: I love it.

Dr. Gabrielle Lyon shares tips on how to treat patients better

All right, thanks, everybody.

Dr. Gabrielle Lyon: Bye.

Dr. Jaime Seeman: Thank you for listening to today’s episode with Dr. Gabrielle Lyon. She is an incredible source of information and she really leads by example. I know you guys took so many pearls, tips and tricks not only in how you can treat patients better, but how you can live your own life better. When we truly optimize ourselves as healers, we take care of people in a different way. So please share this episode with your friends, family and patients. And of first, always, like, subscribe and comment for us. We appreciate you.