A (2:33)

I have quite a few questions that I took a very long time to write, so forgive me, but I don't want to miss any of them. So one of the things that you do is really flip what we know about health on its head. And you basically argue that we've been asking the wrong questions about health span and longevity for decades. What do you mean by that? And what are the wrong questions and what are the right ones?

B (3:01)

You know, humans are really interesting, and once we understand something or think that we understand something, we go all in and we repeat it. And this is kind of a cognitive bias. And I would say that we've been talking about an obesity problem for the last 50, 50 years. And I would also say that if you ask the right questions, then you get to real answers. And at one point in my fellowship, I was imaging a woman's brain, and, you know, I was looking at her body composition and brain function, and her brain looked like the beginning of an Alzheimer's brain. And at that moment, I realized that it wasn't a fat problem, that we had been absolutely looking at the wrong tissue. And the underbelly of all of this was muscle, and we just have not simply addressed it. And skeletal muscle as an organ system.

A (3:49)

How are we missing something so obvious that's right in front of our face?

B (3:53)

You know, again, I think humans are funny, and part of the challenge is when you think about obesity, it's something easy to see and it affects people. But muscle is really related to being, I don't know, jacked and tan in the gym. We have not bridge the gap between skeletal muscle as an organ system and as the focal point for so many of the diseases that we see now, like diabetes, cardiovascular disease, Alzheimer's, which is type 3 diabetes of the brain. And we take for granted that it's always based on obesity, and obesity is the cause. But I would argue obesity is just one of the symptoms of unhealthy muscle. And if we can reorient ourselves to muscle as an organ system, then we can get true and lasting transformation. Because, you know, it's not about what we have to lose. Which is hilarious, because I am talking to someone who has focused a lot of their career on what we have to lose. However, as you were doing that, I would say it's always been about muscle, and that is the focal point for health and wellness. And the smarter we get about skeletal muscle, and we bridge the gap of it just being so that we look good, but really the organ of longevity, then we're going to be able to transform the world.

A (5:10)

I've always understood the importance of muscle with regard to longevity and metabolic health. Right. And not breaking a hip when you're 70 years old and Being able to pick up your grandchild when you're 80 years old, that part has always made sense. But when you start getting into things like cognitive decline and beating cancer, if you have enough muscle, this is something not just the average bear isn't making a connection on, but as we've just discussed, the vast majority of the medical community. Can you explain the connection there? Right, so I'm thinking I've got an Alzheimer's gene, I've got Parkinson's in the family. What is muscle going to have to do with that? Show me the. Connect the dots.

B (5:54)

Yes. First of all, I love that you're actually willing to have a conversation about muscle and reorient ourselves when we think about what muscle does. So skeletal muscle. Yes. We've already identified it as this organ system for being strong and being powerful and being fit. This is one small piece of which, which muscle is responsible for. But even more importantly, skeletal muscle is number one, your metabolic sink. The carbohydrates that you eat, the fuels that you ingest. When we are seeing issues with glucose, insulin, fatty acids, elevated triglycerides, we are eating mismatched to our muscle health. Muscle is the primary site for glucose disposal. At rest, healthy muscle burns fatty acids. It is an amino acid reservoir. So you had mentioned cancer. One of the things that kills people with cancer is cancer. Cachexia, rapid muscle wasting.

A (6:55)

Right. What individuals you need to outlive the treatment. I've seen you talk about like, if you have enough muscle, you can survive the process of killing the cancer.

B (7:05)

If you ask me, nothing is more important. And even if you think about your brain, roughly 30 to 40% of your brain is responsible for movement. If we do not train our muscle, then when we think about twofold, what happens to the brain? And I have seen data that those that engage in resistance training will help protect the brain from atrophy. I mean that in and of itself, but also skeletal muscle, if you do not want to have metabolic disease, you must have healthy skeletal muscle. And if Alzheimer's is type 3 diabetes of the brain, it doesn't start in the brain, it starts in the periphery. And that's muscle.

A (7:43)

Okay, so the first thing is what. I might take notes while you're talking so I don't interrupt you like I almost did. What does atrophy of the brain actually mean? Because it's not a muscle. So what does that mean? Like dead spots where you don't have blood vessels or. And when you say type 3 diabetes, can you explain to people what does that mean? What does that mean when we're talking about brain health. So first thing, what is atrophy of the brain?

B (8:08)

It means your brain shrinks. Got it. One of the early studies that I worked on was looking at the relationship between body composition and brain function. And one of the things that we saw was those that had a wider waistline had lower brain volume.

A (8:24)

Wow. Okay, okay. And the. And the mechanism for that would be circulation, or you're using the brain to move the body, or. We don't actually know. We just see it.

B (8:38)

Yeah.

A (8:39)

And it's related.

B (8:40)

There are. There's a multitude of reasons as to why I believe that to be true. And one of the things that we know is that the brain becomes insulin resistant, just like the body.

A (8:49)

Got it.

B (8:50)

And when the brain gets insulin resistance, a whole host of problems happen, similarly to what we see in the periphery. And that. So, for example, if you are insulin resistant, then you have high levels of blood glucose. If you are insulin resistant, you are dealing with a. It's almost not metabolically healthy. And this isn't the perfect way to say it, but the brain is struggling from a healthy metabolic milieu.

A (9:21)

And I got it.

B (9:22)

When. When we think about Alzheimer's, again, the brain and the body are not that different. What is good for one thing is also good for the other. So if we have insulin resistance of our periphery, we will inevitably, at some point, get insulin resistance in our brain. And when that happens, you know, you hear about all kinds of. Of things that then come into play, whether it is tau, proteins, and there's a whole host of things. And I don't think that we know exactly, because Alzheimer's is a very big. Obviously a big field, but that we know for sure is metabolic dysfunction of the periphery deeply affects the brain.

A (10:01)

Can you give me a case study, for example, of a person that you have taken from A to Z? Right. They. They aren't exercising. I'm guessing they probably are on 12 different medications. They probably have type 2 diabetes. They're probably on, you know, the statins, the whole thing. Insulin, the whole thing, whatever. Me, a real life example of somebody you've taken with this plan from start to finish. What does it look like? What can they expect? What happens?

B (10:28)

Okay, well, first of all, I think that your audience, they're very interested in health. Is that fair to say?

A (10:34)

I hope so. It's been leaning a little political in the last couple of years, but I certainly hope so. And there's unquestionably a Venn diagram where those two things intersect, which is unfortunate. But it is the way of the world. So one would say, I certainly hope so.

B (10:50)

Okay, well, we'll assume that again, health doesn't matter how you're political leaning. In order to really be able to show up, you've got to be healthy.

A (11:00)

Right.

B (11:01)

There's a number of ways to do this. But I'm going to give you an example of a patient I just had today. When she came to me, she had cholesterol over 400. She was actually eating a very high fat diet, but still exercising.

A (11:14)

And.

B (11:15)

And she was terrified of carbohydrates. Again, and this is the most easiest page. Cause I actually just came out of clinic. So this, I just saw this patient. She was terrified of carbohydrates. She was extremely restrictive and falling prey to a lot of, I think, fads out there.

A (11:34)

I have so many questions for you about that, but keep going, keep going.

B (11:38)

I could even pull up her chart if I wanted to even be more exact. But so there was a handful of things. And she was 50. So she is 50. And this is before starting hormones when I got her, before doing any of these other things. And you would look to her and you go, okay, well, you're doing everything right. You're tracking or you think that you're tracking appropriately. And when we got down to the nuts and bolts of it, her blood markers were not good. She had elevated triglycerides, elevated glucose, elevated insulin. She essentially had, quote, metabolic syndrome, which I would say is an indication of unhealthy muscle and not necessarily an indication of just obesity. We've been working together almost actually longer than six months. And I'm going to tell you what happened. First thing we did is we addressed the thing that everybody does. Everybody eats.

A (12:27)

Yep.

B (12:28)

No, right, Yep. So we had to get that right. And what was interesting is she was on this very high fat keto diet. And for her genetics, it was not a fit. High fat keto diets can be useful in many different domains, but it wasn't for her.

A (12:45)

Okay.

B (12:47)

We had to reorient her to a higher protein diet and that was closer to 1 gram per pound, her ideal body weight, which since she's been with me, she's lost over 20 pounds. She's currently 121 pounds. And we reoriented her about 120 grams of protein. We actually added in carbohydrates and we reduced her fat. Her primary macronutrient was fat. And now her blood cholesterol is normal, her glucose is normal, her insulin is normal. She's lost over 20 pounds. She's stronger and fitter than she ever has. And of course, Jillian, this is just one person.

A (13:25)

Yep.

B (13:26)

Right. There's many different ways in which someone could utilize the Playbook, and the Playbook is the book that I had wanted from the beginning. So I wrote the book that I had wanted. It doesn't matter where you start. It doesn't matter what nutrition plan you are on. And if you believe muscle is the organ of longevity, then you have to eat for it and you have to train for it, and there's a whole host of other things. But really simply, we really just modified her nutritional habits and obviously adjusted her training and worked on her mind. She's in the best place that she's ever been in.

A (14:01)

Here's where I'm at with regard to my opinion on nutrition, and I want you to correct me and be savage. I've come to the conclusion that you don't want to overeat, but if you're eating the right foods inherently, you won't do that. You want to use common sense with your food choices, which would mean eating food in its most whole and natural form. Seems like protein and fiber is pretty much a win across the board. Try to avoid ultra processed foods, and that, to me, seems like that's a winner. Now, now, am I wrong? Attack me. What are the. Hit me with the hole. Hit me with the horns here. This is what I've taken away from.

B (14:49)

Not my style, first of all. Not my style.

A (14:51)

I like it, though. It's okay. I want to do it. I want to know where I'm. I'm getting it wrong.

B (14:56)

No, no. So definitely not myself. But what I will tell you is that if we look at what people are doing, so if we look at the healthy eating index, if we were to examine what people are actually doing.

A (15:07)

Right.

B (15:07)

The majority of people are eating, you know, 98% more ultra processed foods, sugars, and junk than they should be. Right. We're totally overeating it. The majority of people, according to the data, are under eating fruits and vegetables. Right. Our number one fruit is banana. Our number one vegetable is, I guess potato would be a root vegetable. Potato in the form of potato chips are, quote, fruit or vegetable. Wherever you categorize tomato is in tomato sauce or ketchup. So the reality is where we are. Yeah, totally gross. And the number one. The number one cause of saturated fat in our diet. Do you know what it is?

A (15:52)

Gosh. Honestly, I know.

B (15:58)

We eat pizza.

A (15:59)

Yeah.

B (16:01)

You know, and I just want to. I just want to say that because the conversation is, you know, how do we decrease our protein and do all these other things? But when reality hits, the reality is we are eating junk and we are eating pizza and we are eating pastries and sandwiches. So now that we know what we're actually doing, then how do we think about what we are doing? So humans love novelty. And when I say love novelty, there has been the phentermine diet, the lucky diet, which is smoking, the grapefruit diet, the cabbage soup diet. You name it, we've had it. Humans love novelty. But if you actually look at the data, the intake of protein is roughly anywhere from 15 to 20%. It has been for as long as we've been tracking. Because humans have a biological drive, it's called the protein leverage hypothesis. To eat towards a certain amount of protein, which I think is fascinating because no matter what you are putting in front of us, at some point we will fall off the wagon. Or, or we will continue to eat processed foods to get to those amino acids.

A (17:12)

Wow.

B (17:13)

And so I say this because I think that you, you guys like a little science. And how do we.

A (17:18)

Oh, yeah, science.

B (17:20)

Well, we have to think about, okay, well, what are people actually doing? Rather than I'm going to come in here and say, listen, I've been doing this for 17 years. This is why you should listen to me. This is not the truth at all. This is not why you should listen to me. What you should do is you should go back and we should look at what the science says and what we're actually doing. So this protein leverage hypothesis is that individuals will drive towards a certain amount of protein. And as we're adding in all these processed foods, the body will continue to feed to look for this. So when what you said about protein do, should we eat unprocessed foods and increase protein? Yes. And there is a reason as to why we are driven to feed. And I got more for you as to why, but I just, I wanted to kind of lay that out there because I think it's important. Otherwise we're just going to keep chasing novelty, right?

A (18:08)

Do you think we chase novelty because we're looking for some sort of magic bullet? And I myself, I even have questions for you. I myself, I'm like, is it hrt? Is it this new slupp peptide? Is it. You know, there's some sort of something for. We think that there's this fountain of youth. And I know, focus on the big rocks, move your body, eat with common sense, sleep. But still, doc, I'm like, okay, and then can you tell me about. What do you think about those, Peptide? Like what is that?

B (18:41)

Well, hrt, we've had two real major health disasters. Well, we've had a handful of major health disasters.

A (18:47)

Okay.

B (18:48)

One was a food guide pyramid. So this was the biggest social experiment that went wrong. Right, right. Like food Guide pyramid came in, we all became obese and there's diabetes. All these issues.

A (18:59)

Yeah.

B (19:00)

Other was the conversation around hormones which whether it's the Women's Health Initiative or why testosterone replacement therapy went down and how we castrated men for like 30 years because people thought that testosterone caused prostate cancer. A handful of major mishaps, hormones and the food guys pyramid. If I were to pick the two, those are two that we really made some massive mistakes on.

A (19:30)

You know, I don't know if you're friendly with him or not or what you think of him, but Dr. Attia has said the Women's Health Initiative was one of the most bungled things in medicine and it's just devastating.

B (19:45)

Oh, totally. And yes, I was just, I was just with Peter, I did a round table, a strength episode for women and it was really focused a bit on muscle.

A (19:54)

Yeah.

B (19:55)

But yes. So the Women's Health Initiative. But this is a perfect example of how as humans we don't necessarily question and we just run with something. So the data has always been there. People just didn't ask or they didn't look and then they believe that hormone replacement therapy is been all wrong. Same thing happened with men and testosterone. You know the guy that brought testosterone replacement therapy to the modern day era, his name is Abe Morgenthaler and he is a Harvard trained urologist. And so I just going to give you this quick story, please. People don't know this but basically up until 19, I don't know, 30s, in the mid-30s, people were using hormone replacement and they were using Testosterone.

A (20:43)

In the 30s.

B (20:44)

The 30s for men and women. Yeah.

A (20:47)

Okay, hold on. Can I ask real quick? Forgive me, what form? Like, like pregnant horse urine?

B (20:53)

No idea. No idea. Okay, gotcha.

A (20:55)

We don't know, but they were doing it.

B (20:57)

I mean, somebody knows, but I personally don't.

A (20:59)

Understood. Understood. I'm with you.

B (21:00)

Okay, so. And then this one, you know, OG, I think he won a. This guy, I think he won a Nobel prize. But anyway, he said that and published that testosterone gives people prostate cancer. All the other doctors followed suit. They started castrating men, you know, literally. Literally. Literally, yes. Or their testicles. I should be professional. I'm a doctor and you can pass.

A (21:32)

On that one, dog. It's relatable. We could say ball. It's okay.

B (21:36)

So just want to, you know, we have a mutual friend in common. Danica Patrick is a very dear friend.

A (21:41)

No, you cheats. You're her doctor. I know she sings your praises. She's incredible.

B (21:46)

I was. She was like, you know, she swears a lot. And I was like, all right, well, then she's going to encourage me to swear. I do. In private. But anyway, so they started castrating men.

A (21:55)

Good God.

B (21:56)

Nobody asked the question. And so this one guy who went to Harvard, Abe Morgantaler, was like, I don't understand. I studied testosterone in lizard brains. And when you gave them testosterone, the women got hornier, the men got hornier. Like, everybody like. And these were obviously rodent models or. Or reptiles. They were animal models. But everything seemed to get better, and he couldn't connect the dots. And so he would start to see these patients that had low testosterone, and he started to give them testosterone. And his colleagues were like, you are going to kill people. You are going to be responsible for killing these people. And he just. He couldn't make sense of it. So you have this whole cohort of doctors saying that this is what happens and that you should not use testosterone because it's bad, and we know it's bad. And with so much conviction. And so what did he do? He went to the basement of Harvard and pulled out those old dusty papers, and he pulled up a study, this study that had. Nobody had bothered to go back at, that had changed the landscape for men and women of testosterone.

A (23:02)

Men and women?

B (23:04)

Ah, yeah. I mean, it was mostly men, but men and women, I mean, they seem to follow suit. And it was based on one patient with an outdated test that they no longer used because it was not dependable. They were wrong.

A (23:20)

Wow. That's insane.

B (23:23)

We're wrong.

A (23:24)

Talk to me about. With trt, so we have common sense. Don't eat ultra processed foods. We're leaning into protein. And I want to get into use. I think you said a gram per pound of body weight.

B (23:38)

Yeah.

A (23:39)

Okay, now what if I'm. What if I'm 100 pounds overweight? Then what am I doing? Am I still eating that much protein?

B (23:45)

I mean, again, we have to look at what is your goal? Where do you want to go to.

A (23:50)

Right.

B (23:50)

I see overweight. You and I both know how hard it is to get protein. Right? But, you know, from your days of, you know, being like the OG in. In the fitness space, that dietary protein is what is going to protect muscle. And by the way, I bet you when it started being so controversial about dietary protein, you were probably surprised.

A (24:10)

No, I wasn't. I was actually wrong. You know who gave me an ass whooping was Lane Norton. You know why?

B (24:16)

You know, I trained with Lane.

A (24:19)

Lane gave me such an ass kicking. And the reason that I went down that rabbit hole of we don't need that much protein, there's so many. I don't even know where to begin. First of all, what is it? The American Dietary association has like an infinitesimal amount of necessary dietary protein. There were studies that it was causing brittle bones. There were studies that it was hurting your kidneys. There were longevity. Doctors talking about how all these amino acids floating around the body that you're not using because you're not working out can be harmful and can prevent you from getting into autophagy of cleaning up dead and senescent tissue. And you don't. I actually started to take the bait on that one big time. I'd say about nine years ago. And I was. I don't want to name names, but these are PhDs. You know, when Lane was like, you're an asshole. I was like, hey, listen, you're calling me an asshole. But there's this PhD, that PhD, this MD, that MD, this one with a bit. Yeah. And, you know, he. We went through study. I'll never forget. Right? There's like three podcasts. We went study by study, and I felt exceptionally stupid. And then it was Dr. Rhonda Patrick, Dr. Peter Attia, Dr. Gabrielle Lyon, and I. I thought, like, how do we get so misled, though? Because it wasn't as though I came up with this on my own doc. This was other PhDs and other doctors saying this stuff.

B (25:46)

So here's the problem. So, by the way, Lane and I trained at the University of Illinois together. We were mentored at the same time. We are mentored. And I am still mentored and trained by his PhD advisor, who's Dr. Donald Lehman.

A (26:01)

Unbelievable. A small world.

B (26:04)

Small world. And when you think about it, there are not that many world class protein researchers. No, there's probably four. And Don Layman is, hands down one of them. So we know that leucine, which is one of the amino acids, affects skeletal muscle. He is, in a large part responsible for that and the amount of protein that we need to affect muscle health. The guy is legendary. And what Lane and I both started to see was all this misinformation, all this misinformation coming out about protein, and it's actually re emerging now. It is re emerging now we are seeing this backlash of you are eating too much protein and you should eat, you know, go more plant based. The reality is we should all eat more fruits and vegetables. The idea that a plant based diet is going to solve our problems is totally incorrect. It's just wrong. And a lot of these scientists are not trained in nutritional sciences.

A (27:06)

No, they're just not.

B (27:07)

But when you look at the data, again, when you look at the data, you know, right now we're looking at the rda which is, which, you know, they're redoing it. Hopefully we're going to see it's nothing.

A (27:19)

It's so small. It, I can't, I can't recall exactly because I've for, I've wiped the information from my brain because it's so useless and detrimental. But it was something tiny. I pull it up right now, but.

B (27:30)

I remember it being so it's 0.8 grams per kilogram. And the reality is 0.8 grams per kilogram is nothing. It's nothing. It's 0.37 grams per pound. And this was put together, I think it's by the McGovern Committee and the, I don't know, a long time ago. You can look up, maybe it was the 70s, maybe it was before that. But basically it was a staff house rider who was trained in economics at the time. He's like a 30 some year old kid, didn't know anything about nutrition and he was really very plant based like at this time. And you guys can look it up. And so someone said go write these, you know, write this up. And he wrote it up and that's what he put in there. And they put 10% saturated fat, which was genius because it allows us to weaponize our foods, by the way. So if we believe that 10% that we should only believe eating 10% saturated fat, then it wipes out nearly all animal foods from the diet as being healthy. For example, an egg. An egg has 18 saturated fat. You and I both know that an egg is high in choline fat soluble vitamins. It is a biological, a very bioavailable source of dietary protein. However, based on 10% saturated fat, this is never going to be considered a quote, healthy food.

A (28:48)

Right. It was the root of all evil. Do you mind if I, if I ask you real quick in a quick segue?

B (28:56)

Yeah.

A (28:57)

You mentioned since you brought up the egg, your, your client, your patient who was eating a ton of fat had exceptionally high cholesterol. Okay, now there's, oh my God. I have interviewed everyone from Dr. Arthur Agatston to Lane himself. All right, then you got people in the zeitgeist. I don't want to name names. They're like, don't even worry. Don't even worry about dietary cholesterol. It's not the same as serum cholesterol. Never going to be an issue. But it isn't. Correct me if I'm wrong here. It isn't necessarily the dietary cholesterol, but there is some element of. Element of a huge amount of saturated fat that can elevate cholesterol. What is your take on this? Because it's, it's so complicated. I just say go to your doctor and get a calcium score.

B (29:48)

Oh, and I would say get a clearly scan so it's hard and soft plaque and. Well, what I will tell you is two things. When calories are controlled, the chances are the saturated fat amount doesn't necessarily matter. Old. And you are not part of the maybe 20% of the population that doesn't do well on saturated fat. Right. So there is a. That means the majority of the people. And you know, there are, it's. There are variations within that percentage, but the majority of people, if calories are controlled, saturated fat, which the body makes will likely not be a problem.

A (30:26)

Right. It's when you overeat it.

B (30:29)

Right. However, if you are over consuming calories and you are over consuming calories in saturated fat, carbohydrates, processed foods, this will become a problem.

A (30:40)

That's what Agatston says. And he also says there's a genetic predisposition and certain people.

B (30:45)

There's a genetic predisposition. But we are making, you know, global recommendations. Not global. I mean, really, we make recommendations for us, but we are making blanket recommendations.

A (30:59)

Right.

B (31:00)

For the entire population. And so, you know, for our population. So how do we really begin to think about it to say that LDL cholesterol doesn't matter? I'm a physician. I don't agree with that. LDL cholesterol, in my opinion. And apob and there's a number of other markers. It matters. It would be very flippant for me to say this. This number doesn't matter. It probably matters more to some people than it does to others, which is why, you know, I think that the nutrition plan that I have put forth.

A (31:32)

Yeah.

B (31:33)

With my colleagues like Dr. Don Layman and Lane Norton, you know, he's cited in my books as well. The reality is if we are prioritizing for body composition and calories are controlled, then I don't think the evidence Supports issues with your choice, variations in diet. But you have to recognize that there are foundational protocols and you have to make protein decisions first. Protein decisions are based on age, physical activity, metabolic health, and personal decision. Once you get your protein number, then you can decide. Pick or choose. Do you want carbohydrates or do you want fat?

A (32:12)

That was my next question. So there's a. There's essentially a formula in the book that allows you to determine. Hence my, you know, initial question of, what if I'm 100 pounds overweight? Who are you? What's your goal? What are your genetics, so on and so forth. There's a way to get your personal protein prescription. I got it. That makes sense. Perfect sense.

B (32:34)

But I love that you're having all these people on, and, you know, I think that we have to get down to the basics of what is important for human health, and here's how we solve for this. Are you ready, Gillian?

A (32:46)

Yeah.

B (32:47)

If you buy my argument that muscle is irreplaceable and this is the organ of longevity, period, end of story. You will survive. Nearly all cause mortality. Nearly anything that is going to kill you, you will survive better if you have healthy muscle. If you believe that at the root of obesity, diabetes, cardiovascular disease, Alzheimer's, the list goes on, is healthy skeletal muscle. Because healthy obesity and all these diseases are in part, symptoms of dysregulated skeletal muscle. And mark my words, what's going to happen is that body fat is going to come out as an important biomarker, but not the most important. I am. You heard it here. I believe in the next five to 10 years, people are going to start recognizing intermuscular adipose tissue as the primary driver for insulin resistance and all of these other diseases. Said simply, your muscle should look like a filet, not a wagyu steak.

A (33:48)

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B (35:13)

When your muscle looks like a wagyu steak before you get gained body fat, before any of these other things. So now let's circle back to the question on does saturated fat matter? Yeah, saturated fat matters. But if we are orienting ourselves to eating for muscle health, then the decisions become very easy. Which is one reason why, why even if someone is eating a high fat diet and let's say that maintains their muscle mass. Okay, fine, so say it's muscle sparing. Let's just say they have ketones and they, they've been able to spare their muscle. To me, that is not optimal. We're not looking to not just be worse than yesterday. It's coming for. It's coming. Aging is coming for all of us. It's coming. It's like tax day.

A (35:58)

Sure is. Man, this little patch of gray hair right there that just, I'm like, really? The eyes go.

B (36:05)

I've been grinning since I was 16, so I'm. But the reality is if we orient ourselves in these conversations of be more plant based, eat high fat diet, eat carnivore like all these other conversations, great. Decide what works for you. But recognize that muscle is your priority and eating for that will determine everything else. And so then we can all fight less and agree more and take action. Because at the end of the day, I want a strong country. I am in it because I believe that we can be stronger and more resilient. Period. End of story. But there's only one way to not be that and that's to not train, to not take responsibility for your own health and wellness. And you know, no one else can do it for you. And so we've got to get these pieces right if we want to show up as the best version of ourselves. And I know it's not always easy, but humans are totally predictable. And if you can talk yourself out of it, you can totally talk yourself into it.

A (37:04)

Of course, if I'm A person that's intimidated by resistance training. In the book, do you tell me where to start? Is there a prescription for. Because like, I love Peter, but some of the crap in his book I can't do. Oh, dead hang friend two years. I'm like, oh my gosh. It's like some of it is just, he's brilliant, but he's also a bit. It's very tough for the, for the average person to take that on. Some of those things that, that he does or he says we should be able to do when you, you know, can't run a 5K, you know, you haven't been off the couch. If you're telling me, hey, listen, you know, don't eat a bunch of crap. Don't eat a bunch of processed foods. They're already like, oh my God, it's so hard. Guess what? You got to work out. We, you got to lift weights. We both know there's the pushback. And I have gone from the person that demanded so much from people to like, hey, let's get you off the couch and have a step goal. And I hate myself for it, but I don't, Doc, I'm like, I gotta like, I'm meeting them where they're at. And where they're at is way behind the eight ball. What are you telling these people that have no frickin idea, haven't lifted a weight in a gazillion years, and they go for a walk every night with a dog for 15 minutes.

B (38:24)

Okay, Jillian, here's the first thing. People have been lifting weights their entire life. Do you lift a suitcase? Do you get groceries? Do you pick up a toddler? Do you lift anything? Just because it isn't in the form of a kettlebell doesn't mean that you haven't been lifting. You know, when I talk to patients in our practice, you know, and I, and I hear these, some of these women talk and say, well, you know, Doc, I've never lifted weights. I'm like, no, that's not true. Do you ever. So you never pick up your 40 pound toddler and they're like, doc, no, I pick up my toddler all the time, all day long. The truth is, is we have been lifting weights our whole life. Maybe they don't have a structured training program, but it's all this narrative about why they can't. And, and I get it, but it's just not true. And so in the book, you can do this training program at home, it is for beginners, and you can scale it up all you need are some bands and maybe a couple dumbbells. And it is for again, beginners, people that have never lifted weights and feel very intimidated. And also movements that create getting your body ready. And I will say one more thing, friends out there, you cannot wait till you are motivated. It is not going to happen for me. I've been lifting for 30 years and I know that I'm training tomorrow. I'm already bitching about it in my mind and I just can't wait. I. So my, my trainer, Carlos Mata, he just, he'll wait for my tax. I guarantee you I'm going to be bitching about in two more hours. It's gonna happen. But it's an exercise, doesn't matter. I still am going to do it. And the less you wait for yourself to become inspired to do it. And again. And I think that in the book, I do have a mental component, because as I sat down to write this book, I was thinking, okay, there's a million different diet books out there and there's a million different training books out there, and there's books on how to recover. And by the way, I've got tons of refs recipes in this book. I have like 60 plus recipes and lots of pictures. But I sat down, I'm like, well, what, what's the disconnect? And I realized that the perfect plan, training plan, eating plan, can be as perfect as ever. But if you cannot make the mental connection, yes. Oh my gosh, never going to matter. And so in this book, I teach people how to do that because that's actually where it starts. So how to Think is the first chapter, because unless you nail that, then it's never going to happen. And again, human beings are totally predictable. And we set goals for ourselves and then we fail on these goals. But if we change our perspective and we set standards for ourselves, then we don't fail our own standards.

A (41:27)

Right, right. Of course, you know, that's been the number one problem with regard to helping people lose excess body fat and keep it off. The lose part is always easy. Yeah, you can get them there. 95% of the people that lose it, though, will put it back on. And it's because it's just not clicking. And for years. Well, what, are we gonna spend two decades in therapy, see if that works or. And all the odds are stacked against them with the misinformation and the diets and all these things at the computer all day long or sitting all day long. That is such a vital component. You're right. Is getting Your brain in a place where you're ready to commit to the basics. It's not complicated. What you're talking about is pretty simple. But no one said it was easy. Well, we gotta maintain muscle. Wanna put on muscle, Wanna maintain it, wanna eat, you know, common sense. It's not that freaking complicated. You don't have to be a PhD to understand what you're asking people. But well. Well, you gotta be a PhD to figure it out.

B (42:34)

But there's so much noise, Jillian. There is so much noise in this space that even you, a fitness professional, got completely wrapped up. And now, so I looked at some of this data and. You remember Atkins?

A (42:46)

Oh, heck yeah. Oh, my gosh. Of course. Doesn't go away, it just reskins itself.

B (42:53)

No. So this OG sold 10 million copies of his book through his career. At the peak, he had 1 in 11Americans on his diet. Okay, you ready for it? Now, sky is a world class doctor. Now you go on. Tic tac, tic tac, tick tock, same thing. I would love a tick tock. God knows I need it. And you have an influencer. Spreads information, has the same impact a legacy doctor does in the velocity at which information spreads is undeniable. And the challenge is it becomes so confusing for someone who is untrained. People do not know who to trust and what to do. And this provides, unfortunately, a level of distraction.

A (43:46)

Yes, right.

B (43:48)

So I don't have to do it if I'm totally distracted. But also people are so confused and they even now I have patients that tell me, you know, but this doctor said, don't eat red meat because that causes heart disease. And I'm like, yo, red meat consumption has been down, it's like down 40 since the 1970s. And I don't see a heart disease getting any better.

A (44:09)

Right.

B (44:11)

And you know, so, yeah, I don't, I can appreciate that it's hard, but the reality is even more now, people have to come, become extremely aware of where they are getting information. Otherwise it's gonna be a real challenge.

A (44:29)

Talk to me a little bit about peptides. So I, I mentioned this. You know, we obviously have all the weight loss peptides. And again, from what I take away is this dose is so massive, it essentially crashes people's metabolism, causes muscle wasting. I would imagine for you, that is apocalyptic. Am I wrong? And, and, and yeah, let's start with am I wrong? Let's, let's go there. So what do you think of these things then? Cause I've had my arm twisted to a place where I'm like, okay, if it's a life or death intervention, if you've tried everything, if you're morbidly obese, like, okay, okay, okay. But I would still default to a micro dose. But I mean, this is you.

B (45:14)

This is my answer. It's fine. I'm happy. We're going to disagree on something. You're going to be happy because you like bringing the heat.

A (45:20)

Okay, tell me, tell me.

B (45:22)

Okay, you like them. I believe in two things. Okay, well, number one, that people should have physical autonomy, of course, do whatever they want to do, and as long as it doesn't, quote, hurt them, that they should be able to choose number one.

A (45:40)

Of course.

B (45:40)

So if someone wants to go on a peptide, they should be able to. Number two, if we look at the data, roughly 74% of Americans are either overweight or obese. It is staggering. It is staggering. And the majority of people are not exercising. So we have a real problem. We have a real problem. Whatever we've been doing for the last 50 years or more has not worked. Just hasn't worked. So I ran a. So part of my job as a fellow was to run a weight management clinic at WashU, and I did this for two years. And we did not. You know, at the time, these drugs were only approved for type 2 diabetes. They weren't approved for weight loss.

A (46:28)

Right.

B (46:30)

These people suffered so badly that, I mean, it wasn't success. It was a lot of failures a lot of the time. When GLP1s came on the market, available now to be used for weight loss, we are seeing something so transformative for people that it's unreal. Hold on that. Which is wonderful, right? We have a major, major obesity problem. But now what's happening? If I just told you that we have a huge portion of the population is either overweight or obese and they are sedentary. And now we can treat the obese, you know, the obese part. Yet we have never addressed the foundation of what the real problem is, which is muscle. We are now trading one epidemic for another.

A (47:22)

That's what, that's. That's exactly.

B (47:25)

They are trading obesity for sarcopenic obesity. And there is no physician that is prepared to deal for that. They're not prepared to deal with that.

A (47:35)

Peter T. Has said that. He, he said that, like he wouldn't even put someone on it until he does a DEXA scan. And there was even. I can't recall because it was years ago, but I think it was with Megyn Kelly. And he gave an interview where he said he's actually seeing people's body fat percentage go up even though they're getting smaller.

B (47:53)

So the reality is. But the reality is now there's a double edged sword here. Right. So the reality is, from the data that I have seen, GLP ones, which by the way, we use in our clinic.

A (48:03)

I get it, I get it. Because would it not be a cost benefit analysis though, or, or are you titrating these things?

B (48:10)

Of course, of course.

A (48:11)

Well, see, why is no one talking about that titrated.

B (48:15)

We also have anabolic agents that are FDA approved or, you know, we'll use testosterone. We will use things to make sure that their muscle is maintained. However, what, what we have to recognize is there is not something inherently caustic to skeletal muscle from these GLP1s.

A (48:34)

Okay?

B (48:35)

Bad behaviors. And I would argue that we're going to start to see more and more data that this improves intramuscular adipose tissue, which. Jillian, that is the new biomarker. The new biomarker that we need to be paying attention to is intermuscular adipose tissue. It's the fat within the muscle. Right. You know, you've got linemen that are healthy simply by the fact that they're moving their body and moving their muscle doesn't matter if their body composition is changing or they're losing weight or not. Just the act of exercising. And I'm going, that's the act of exercising, of emptying the tank of glycogen and using the fuel and muscle. You're already becoming healthier. I believe that these GLP1s affect that intermuscular adipose tissue. So not the athlete's paradox, the, the fat that is used for fuel around the mitochondria, but the fat that is in the skeletal muscle, you know, that is deposited there because it's unhealthy, because it has nowhere to go.

A (49:33)

Got it.

B (49:34)

These GLP1s, I believe, improve and we're going to start seeing more and more data that these GLP1s can improve this intermodal, it's called imat this intramuscular adipose tissue. However, so I want to be clear, I think there's a lot of mistake. These don't affect skeletal muscle because you're using a GLP1. You're affecting skeletal muscle because you're not eating.

A (49:54)

You're not eating at all and you're not exercising. Right, Right, of course. So you're losing. Well, with any weight loss regimen, you're going to lose a certain percentage of muscle. But it seems like what would Be healthy is maximum.25% of your weight loss is lean mass. But then on these it could be. Lustig said, I think he was seeing upwards of 60% of it.

B (50:15)

Yeah. And I actually got a lot of heat on this, which is interesting. So if we think about sarcopenia, which is a decreased muscle mass and function.

A (50:21)

Yeah.

B (50:22)

Sarcopenia is about 4% per decade. 4% loss per decade.

A (50:31)

Wow. Okay.

B (50:32)

If an individual goes on a GLP run and loses, you name it, 14 of their weight loss is skeletal muscle or more, 50%. I mean it all depends on the person. Then in my mind, again, I got a lot of heat, but I'm a geriatrician by training, so we've seen sarcopenia that if sarcopenia is 4% per decade of muscle loss and people are losing double that on a GLP1 and we know that the majority of people after two years go off of them.

A (51:13)

Right.

B (51:13)

You are now left with a frail, a frail self.

A (51:20)

But see then, doc, okay, you. And I'm not sure if you're familiar with Brigham Bueller, but he does the same thing with the patients at his clinic. He'll micro dose GLP1, he'll put them on some sort of growth factor, IGF, whatever this, that the other. And he's got this Molotov cocktail with a team of geniuses that are tweaking, monitoring 24 7. How. I mean, this is not like the average bear. This is, they're getting the pen dose is insane. There's nobody like you titrating up, titrating down, putting other stuff in there to try to maintain muscle, making sure they're exercising at the same time. Hey, look at it. So, yeah, basically like I'm the average person and I'm buying the Forever Strong playbook today. Am I buying this book. And I, if I'm 50 years old, I'm starting TRT, HRT, I'm going on a Molotov cocktail. In the book do you talk about these things and make recommendations so I know if I'm, if I'm a candidate for this stuff or if so, how to talk about it with my doctor.

B (52:30)

Now, this book, if you are going to be going on these, whatever you call it, mocktail, cocktail, whatever it is, this book will have you covered. Again, I've been training for over a decade. This is the playbook that I wanted. Whether you are on a GLP1, whether you are on a hormone replacement therapy, which by the way, people are going to be really upset in five years when they've been on hormone replacement therapy and their body composition has not changed, ladies.

A (53:00)

Because they're not exercising right. If you don't exercise, it doesn't do nada.

B (53:05)

It's a combination.

A (53:07)

Right?

B (53:08)

You gotta get it right. And it's possible because the science exists. So if you're gonna pick up this playbook, which, by the way, is visual, has recipes. I mean, I'll, I'll, you know, you saw it. It's. It's awesome. I'm proud of it.

A (53:24)

As you should be.

B (53:25)

Yeah. And of course, I don't see that lightly. And if anyone knows me personally, I'm the last person to be like, I'm proud of. I'm proud of something. I'm usually like, nope, not good enough. Nope, not good enough. But this book is so easy and it's evidence based and it removes the noise. It tells, it tells you how to eat, how to move, how to think, how to recover. You know, it's, it is set to get maximum results and avoid all of the noise. So whatever on the periphery, whatever kind of distraction somebody wants to get involved with, that's fine. But you always have to come back to the fundamentals. It's, it's required. And I gotta say, listen, aging is inevitable, but the reality is strength is a responsibility.

A (54:15)

Yeah.

B (54:16)

Not a luxury.

A (54:18)

Right, Right. Of course. If I, if I was to give you. I hate these questions, so forgive me, but, but people love them. And the reason I say I hate them is because you'll see in just a moment.

B (54:32)

Oh, God.

A (54:33)

If there was one tribe. No, here's what I mean. They'll say to me, if I only get one exercise for the rest of my life, I'm like, well, that's ridiculous. If you asked a doctor to do a quadruple bypass and you gave him one tool, that patient's going to die. But if I was to make it something that could remotely make sense, if there's one health trend that you find deeply alarming, it would say avoid at all costs. Which one would that be?

B (55:02)

So this is, this is tough. So if it's one trend or top.

A (55:06)

Three, I'll give you three. Okay.

B (55:08)

I'll give you three. Oh, this is, this is hard.

A (55:13)

I know, I know. That's why I hate these. But I can't help but ask you, because I actually am inherently curious of what is sounding the alarm bell for you at a fever pitch.

B (55:26)

I think the idea that someone could eat a low protein diet, I think it is so detrimental.

A (55:35)

Yeah.

B (55:36)

And so, I mean, I had this one woman she was 74 years old. She came to see me speak and she whispered in my ear, she's like, doc, do you think it's okay if I go plant based? And I was like, well, you're 74 years old, how many calories are you eating? She's like, I'm like, you know, maybe if I, maybe I'm around a thousand calories. Like, well, do you take supplements? She's like, no, I can't swallow pills. You tell my grandma to go plant based. Yeah, I, I mean, to me this is alarming. This is alarming. And I know that this is controversial and I have nothing against, you know, I was vegetarian for a long time. I have nothing against this. But we don't understand the repercussions of our actions. And while something might work well for someone in midlife, in your 40s and 50s, that does not mean that it works for someone in their 60s and 70s.

A (56:26)

It didn't work well for me in my 30s. I was anemic. I tried it multiple times because I.

B (56:32)

Hate killing things and same.

A (56:35)

Yeah, not for health. And my dermatologist was like, your skin looks like shit, everybody. I wasn't healing properly. I was anemic, I was exhausted. Didn't work for me at 30, let alone 74.

B (56:49)

So, so I, I'm really concerned about the older population because, yeah, you know, of, of women, roughly 40 of women over the age of 65 are below the recommendation for dietary protein. And I, I just get concerned with the amount of noise out there that, you know, you can always get stronger at any age, but you know, the window of opportunity can close and so knowing the right thing to do at the right time is very important. So you asked me and here I am going on some long winded way.

A (57:19)

But no, I get it. That's a great friggin answer.

B (57:23)

I think that that's alarming. The other thing is I think our kids should train. I have a four year old who's training for the SEAL teams, which is hilarious. We do not discourage hard physical work. You know, we're not up there making him do PRs or whatever, but he wants to do push ups and jump in the cold plunge. Go right ahead.

A (57:43)

Are you good with cold plunge for kids? I've seen conflicting information like they can't regulate their body temperature and that you'll see Ronaldo put his kid in the cold plunge. My son asks me all the time. I'm like, I don't know, I mean.

B (57:54)

I, you know, they are pretty good at getting out, you Know, my kid jumps in, puts his head in, gets in there and then gets out.

A (58:04)

Okay. He seems to be living just fine.

B (58:07)

With you, but again, we're not like, all right, go, go, go. Stay in there, you know?

A (58:12)

Yeah, I get it. I understand. Of course.

B (58:15)

I think the idea that kids shouldn't lift early, that is an outdated. That's an out.

A (58:21)

Growth plate issues. Thoughts?

B (58:24)

We're out. It's out. It's false. Not. You know, kids should be training if they want to train. It should be fun and they should be training. We are not raising children. We are raising adults.

A (58:34)

Beyond body weight. You're talking about heavy weights in the gym. You're not worried? Growth plate stuff?

B (58:39)

No, I mean, again, I am not concerned. Listen, do. I mean, I'm not saying for the kids to do one rep maxes.

A (58:48)

Of course, of course. Right?

B (58:50)

I think that kids can go in there and they can be lifting weights.

A (58:55)

Yeah, I get it. Okay.

B (58:58)

I mean, I have not seen data otherwise that has made me concerned about kids going and lifting on a hypertrophy program.

A (59:06)

Oh, my God, Doc, do you realize that this was always the kind of parting like, until their growth plate closes, you want to be really careful, like heavy, lower body weights and give. Get them body weight stuff and get calisthenics and push ups and lunges and squats and time under tension. But. But don't overload them. And now there's no data. No data.

B (59:28)

I'm sure there's. I haven't seen convincing data.

A (59:31)

Oh, my God.

B (59:32)

We should not be allowing our children to lift weights. I have just. I haven't seen it. And I'm certainly open if someone can send me some data that our kids shouldn't be lifting weights. I haven't seen it. Again, I'm not talking about one rep maxes.

A (59:46)

Sure.

B (59:46)

But it should be able to go. And I think that, listen, our kids are eating Fruit Loops and whatever, and that's okay, but if my kid is doing push ups with us and sprint intervals on the treadmill and lifting this kettlebell, be like, oh, my God. Our priorities are just a little wrong. It's a little, you know, health and fitness. It's so much easier to build strong habits when these kids are young than spend 40 years trying to break old ones.

A (60:22)

Of course. Of course. Okay. Is there a third one?

B (60:27)

I hope we get to the positive ones, the things that everyone has to be doing.

A (60:30)

I'm gonna give you those, your three tops next. And then obviously I'm gonna tell them they need to buy the book. But the Three absolute. Oh, my God. Don't ever.

B (60:39)

The three are older. Listen again, there's some nuance to this. I think that if you are an older individual, I think going plant based is a terrible idea. If you are someone who doesn't supplement and has trouble swallowing like, this is not a great idea.

A (60:52)

Yeah.

B (60:53)

I've concerns. Number two, the idea that kids shouldn't be lifting weights. Beyond. Again, I'm not talking about, you know, being militant, but they.

A (61:01)

They should be exercising. Of course.

B (61:04)

Number three, The third thing that really gets under my skin. I'd like to say that sleep's important because I think it's annoying, but you got to do it. The. The third one. I think that. I think that when we. And this isn't a. This is a challenging one, so I'm going to try to express it. I think that we. When we focus on small components versus the big picture. So if we are only focusing on seed oils or we are only focusing on. You pick the, you know, kind of like the through line.

A (61:47)

Yeah.

B (61:47)

I think that this is the. The forest for the trees. I think that we have to really not focus on each individual thing, but we have to really understand what is the mission and what are we trying to get. Of course we need healthier humans. And so I think that. Again, I don't know however you want to put that, but I think focus.

A (62:05)

On the big rocks. Don't focus on. Don't focus on. I personally, I. Methyl and blue makes no sense to me as a healthy person. And maybe you disagree, but I like. It's fish. It is fish tank cleaner. Like, I. I just haven't even looked. I just can't get past that part of it. But I know people that don't exercise but will drink fish tank cleaner. I'm like, you guys have lost your fucking mind. You lost your mind.

B (62:29)

Right. So how do we reorient ourselves? Things that we have to. Right. And yeah, I think that. I think that that's really important.

A (62:39)

Okay, now the top three that you. Okay, can. I'm gonna guess, I'm gonna say, obviously get your protein prescription. That's gonna be number one. Am I right or wrong? Yep. Okay. All right. Number two, lift weights. But how often do you have, like a preference? All in the book.

B (62:56)

Yeah.

A (62:56)

Got it.

B (62:58)

Three to four days a week. And there should be a structured program. You shouldn't be going in there and winging it. I think that's really important.

A (63:05)

Yeah. Trainer logic. You don't see that, though. Nobody has a trainer logic anymore. It's Bizarre.

B (63:12)

You gotta do it. And then the third one is, you know, I think there's a component to the human spirit that we have to really put in, you know, parts in our life that really push us. And you pick a crucible, but if you don't bring one in, it's coming for you. I love that. Because the human spirit was designed to push up against hard things to grow. I think resistance is not just for muscle. I think it's for really how we are as humans. And so putting in things that you do not want to do or things that really stretch you, you should be putting those in on the regular. And I mean really stretch you. So this could be. I'll give you an example. This could be the baton death march, which is, I don't know, my husband signed up for it, or the Boston marathon or a 50 hour event, or you just pick it. But it should be something that is so challenging that it almost takes the physical aspect out because it's just so intense. And again, it could be a million different things, but something that is really a crucible event.

A (64:25)

I completely get what you're saying. And it's a tool that I always utilize with fitness to open up a door of possibility. Because it's like, I never thought I could do that, but if I could do this, I bet I could do that, that and that and that and that. And I couldn't agree with you more. That sort of strategic stress makes you more resilient, more thoughtful, more wise, more powerful, more confident and more courageous. And the mores go on and on and on. Doug, you're wonderful. Thank you so much for giving me all of your time. Are you taking patience? You have a website? Is it just the book? Like, tell everybody all about you. I'll pretend like I don't know the answer.

B (65:06)

Okay, so I again, I put all this in my book and I feel very passionate about this book. And this is the Forever Strong playbook. And get on Amazon and go to my website, Dr. Gabrielle lyon.com. i am taking patients. Our team is taking patients. And they can find that information. It's called Strong Medical, but they can find it all underneath. Everything is on our website. I have an Instagram, I have a great YouTube. Jillian, you should come on my show. We've got the number three top medical show in the country.

A (65:37)

I think I'm not qualified to be on your show, but I would love it, just asking you questions the entire time.

B (65:43)

It'll be a great time. And let's see, I think that that is that's pretty much it.

A (65:50)

I'm so glad to finally meet you and I look forward to meeting you in person. We know so many of the same people and this is long overdue. So thank you. And I'm excited to have my. I'm a terrible chef, so my son is fantastic and have him start making some of those recipes.

B (66:07)

Thank you so much for having me on.

A (66:09)

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