A (4:17)

Well, you want it to be functional. And this may sound judgmental, but I think we've all know the type. You go to the gym and you see someone who has muscle, but it just doesn't look functional. It doesn't look fit. It's just kind of like you're nodding your head.

C (4:40)

Yeah, well, I mean, I'm nodding my head for two reasons. Because women will not train. Because they're afraid of getting bulky. And that really, you know, kind of puts them off. And they're afraid because they're afraid they're going to get bulky, and they're. They're afraid that they're going to put on too much muscle. And I would argue that has never happened. I've never seen it. You know, I've seen it with maybe one person. I've been a practicing physician since 2006. You want to know the one person that maybe has a little bit too much. Too much natural muscle? Are you ready? She's actually a dear friend of mine, and her name is Lisa Jaster. She was the one of the first three. Do you know who Lisa is? She's one of the first three females to make it through ranger selection. At 42, during her, like, early 40s, she made it through Ranger selection. She was at my house over the weekend, and she's tiny, but kind of jacked. And we, her and I were talking and joking and she said, maybe there's one person that put on too much muscle. And so you said it's all about functional muscle. And I would argue that, you know, if you're training, all muscle is functional. If you're training.

A (5:51)

In terms of the look I describe, I see that more commonly with men where they look like they're can't move to, to that point. I don't think I've ever seen it with a woman. But, but how do you think about that when you're coming up, when you're working out, when you're talking about hypertrophy, when you're working with a patient who wants functional strength? They want strength for longevity, for metabolic protection, all those things. How do you think about movement and reps and what that looks like? Cause you're, you're really, you're building for the future. You're not just building for aesthetics. Aesthetics are a byproduct of that. Yeah.

C (6:30)

And that's where the real shift, I think, has been. When I take a look back at where we've come from, this idea of this obesity epidemic, which really started in the late 70s, early 80s, and I just think about how we got it so wrong. And part of it was the hyper focus on obesity. Muscle wasn't even a conversation. Right. And rightly so, because number one, the amount of physical activity was already low. It didn't really change as we started to see obesity increase and muscle was really an afterthought. And also at the time, it wasn't till around 2000 that muscle became recognized as this metabolic organ system. And you know, and where. Why am I going a little bit off on this tangent? Because I recognize that if we make the same mistakes we did when we tried to fight obesity where it was really hyper focused on the fat tissue, then we're going to repeat this pattern as we now have this new landscape of GLP1s, which again can address obesity, but without addressing skeletal muscle. You get a skinnier, almost fatter version of yourself, the skinny fat version. And then people come off of these medications. And then now we're left with a worse problem because we've traded obesity for sarcopenia. And so your question as it relates to how do we begin to think about reps and sets and functional muscle? Well, I would say all muscle, if it is healthy, is functional. I define functional muscle as something that is, number one, metabolically healthy. Metabolically healthy means it doesn't have a Lot of fat infiltration. It doesn't have a ton of inter muscular adipose tissue. It is active. You are emptying this glycogen tank. Glycogen is glucose that's in the cell skeletal muscle tissue. Right. That is emptied routinely. So it's not, you know, I like to think about it muscle as a suitcase. If you open up your suitcase and maybe Colleen and myself, we love to overpack, we open up the suitcase and instead of packing for the four day trip, we packed for 14 trying to put all the clothes back in. And the clothes represents glucose and the, the clothes fall everywhere because there's literally nowhere for carbohydrates to be, to be disposed of. And so when I think about functional muscle, whether body composition changes or not, the simple act of doing either cardiovascular activity or weight training improves muscle health. And I think that becomes very empowering.

A (9:14)

So in terms of the metabolic benefit, one of the things I, when I, when I'm speaking to someone about this for the first time, I like to say, you know, we all like some leeway in our, in our diet and I like a good donut here and there. And the more muscle you have, the more flexibility you have in diet because muscle helps with your metabolic health. You're more metabolically flexible and it's better to have more muscle and say more fat per se than like no muscle and less fat because the muscle's that protection and gives you the opportunity to probably have a lot more flexibility in terms of food.

C (9:54)

Yeah. And we, we do see that. You know, again I still see patients and in the playbook, I did design a nutrition plan which are going to be very reflective of the upcoming dietary guideline changes, which is pretty phenomenal as we begin to really reorient ourselves to nutrition that matches muscle health. So I think a lot of the problem that we're seeing is that we have a nutrition plan that doesn't match our current muscle health. And when we think about how do we get healthier muscles? Well, you have to do resistance training. That is a non negotiable. If we don't train, we get weaker. If we don't train, we don't empty that muscle glycogen, which again this is what defines healthy muscle. If we don't train, we don't get strong, we don't stay mobile. But part of the challenge is how often, how often should we train and what about cardiovascular activity? And there's a lot of noise out there. And one way to really distill down what becomes important is our Priorities for me, for you, for people. Aging and independence matters, frankly, you know. Do you ever watch Landman? Have you ever seen Landman?

A (11:10)

No, what's Landman?

C (11:11)

Okay, so Landman. We don't watch a ton of tv, but my husband, who is really into the show, it's called Landman. And their older parent is staying with this guy, this Landman who runs oil rigs. And the scene opens with the guy was in all his clothes and he had fallen into the pool, and he couldn't get out of the pool because he didn't have enough hip and leg strength. And, you know, as I was watching this, I just thought it was so well done because we've all seen someone we love not be able to move the way that they used to. And part of agency, physical agency, is recognizing that we are all on an aging trajectory. But how we manage it now determines what path we take to the best of our predictable ability later on. And, you know, when you look at the statistics, the majority of people are not doing resistance training. If 50% of Americans are working out and most individuals are not meeting the baseline requirements of 150 minutes and two days a week of resistance training, we know the majority of people are not meeting that baseline criteria, then that becomes a real focus. And the first thing that people need to do is you do need to do resistance training. There's a million different ways to do it right. There's one way to do it wrong. You know, in the playbook, we've got rep schemes from six reps up until, you know, up to 30 reps, because it's about the stimulation. When we think about muscle health, people talk about this idea of progressive overload. I'm sure that you've, I know that you've talked about it and, and had people on your podcast talk about it. This idea of progressive overload is that you have to lift heavier to get the same stimulus for muscle. But that's not true. There's a million different ways. A million's extreme. There are many different ways to create progressive stimulus rather than just progressive overload. And that could be slowing down tempo. It could be adding more volume, it could be adding new exercises. There's again, a million different ways to change up these variables because your body doesn't know how many reps it's doing. But it does recognize that there's a stimulus that it requires to maintain this very important tissue a hundred percent.

A (13:34)

And I stay away from increasing weight significantly where I'm getting below maybe six reps, because at my age, I'm 51. I. I'm prioritizing injury prevention. And whenever I've gotten trouble in the weight room for the 30 plus years I've lifted weights, it's been when I've gone a little bit too heavy and. And like, not. And I don't have an ego in the gym either. It's just like, you know, I can, I can go a little bit more and then form. I tweak something that doesn't feel good. Played up for a couple days, maybe a week, and now I'm just over it.

C (14:01)

But how smart is that? So let's. Can we pause on that, Jason? Because again, there is this narrative that we have to lift heavier. And the reality is our tendons and our joints cannot keep pace with our muscular strength. And so when you're in your late 40s or 50s, it feels like everybody's getting injured because, again, your musculature is staying strong or getting stronger. But tendons and joints, it just, you're not as limber as you were, the tissue isn't as malleable. And so, you know, I think it becomes very dangerous with this idea of, well, we should just be lifting heavier. Because once you're injured, how long does it take you to recover from an injury?

A (14:44)

A hundred percent. And then if we're talking about Cardiovascular Health and VO2max, if you're laid up, like, VO2max, like, I've had situations where I've been laid up or traveling, and my VO2 max will start to drop, like, pretty quickly, and it's a lot harder to get that back. But a hundred percent agree. Lots of ways to get there. Volume is one of them. Go lighter, go slower, go longer, get creative. But don't just think more weight is the way to go. And heavy is not for everyone.

C (15:13)

Right? And I would say that, listen, a great way to get strong is to lift heavy, but it's the cost benefit. Again, we think about skeletal muscle from this metabolic perspective. How do you prevent the diseases of aging? How do we prevent these metabolic diseases? You have to have healthy skeletal muscle, which, again, is strong and also has mass. And then how do you use skeletal muscle for improving plumbing and vasculature? Right? And then also from that metabolic perspective, for all the things that we're talking about, how do you eat more carbohydrates if you want it, how do you become more metabolically flexible? And when you bucket muscle into those three, you know, there's mobility and strength. If you bucket it, then you can train for that. And Then training, you don't wake up and go, gosh, you know, I wonder if I should brush my teeth today.

A (16:12)

So it sounds like if I heard right, you view minimum effective dose for resistance training two days a week, approximately 150 minutes. I hear right?

C (16:22)

Yeah. And I mean, listen, the reality is that that is the guidelines. What we put in the program is a three day a week dumbbell only program for anybody. And anyone at any level of training can do it. We put together a six week resistance. We also have body weights, so we have a body weight section and then a dumbbell section. And again, this has to become non negotiable. But there's another part of training that I think that is really missed and that is this idea of arguably the only word I can think about it is prehab, or what my colleague Gerard d', Onofrio, who put together this foundational five called is. There are these movements that you can intersperse throughout the day that can improve posture and can improve breathing and can improve hip mobility. You know, there's, we think about exercise in this discreet moment because you're very busy, got two kids, you have family, you run multiple businesses, you have all these things going on. And I'm sure like most people, you see exercises in that one moment, because I do. And then I've had to train myself over time to wear and walk around with weighted vests just doing my normal routine, or take four breaks throughout the day to do hip mobility or, you know, abduction in calf raises or isometric movements. All things that are easy and don't require the same mental intensity as training, committed training. So there's the committed training piece and then there's improvement in activity that happens throughout the day.

A (18:03)

Well, what's amazing about you also is you do this with your kids and your husband as a family, and you show it on social. And it's like you're working out and the kids are doing something. And we all know the statistics. If you know, when kids have parents who work out, lead by example. Because look what I've learned with kids is sometimes they just have no interest in what comes out of my mouth, but they are interested in my actions.

C (18:27)

Yeah, I really appreciate that. And I also appreciate that you have been a lifelong athlete. You and Colleen have been lifelong athletes because your kids are very athletic. I mean, I will message Colleen and I'll say, hey, can you jump on a call? What are you up to? And she's taking the kids to some basketball something. Or you tall folk, maybe it's Volleyball, but I'm pretty sure it's basketball. I think that that's a real success and a real win. I have my daughter who is absolutely gifted. She's built like my husband. And then I have my son who.

A (19:03)

Who'S a Navy seal. I'm just gonna stop there. He's an ex Navy seal.

C (19:06)

Okay, yeah, that's, that's gifted.

A (19:08)

Like I just wanna give some context. Like, oh, he's gifted. No, he's an ex Navy like.

C (19:13)

And by the way, he's picked up ultra running. I mean it's bananas. He runs to work and back. He has a weighted backpack and he runs to work in. Runs to work and back. So he's training as a surgeon and it doesn't matter if it's pouring rain or not. And here's what he says to me. He said if my standards are dependent on the weather or something outside of myself, then I don't have standards. But anyway, I just to kind of circle back about my son, you know, it's fascinating. So, you know, enriched. Devini talks a lot about this, that we're all built with certain attributes. And I talk a lot of the first chapter of the playbook is mindset and it's how to think. Because we're not taught about that. And we all have different attributes at different levels. Some have more grit, some have more resilience. And so it's so fascinating to nurture these behaviors and just nurture these ways of thinking about things. Because right now there's this kind of landscape where we avoid doing hard things as opposed to perhaps reframing our relationship to what physical and mental challenges looks like. And my son, my son trains twice a day and he's six, he's four and he's a training session in the morning before he goes to school. He does push ups, he does squats. We just got him some new weights. And he does sprints on the Woodway treadmill. And then when he comes home he does another. Whatever he does. And then he likes to cold plunge. Can you imagine at 8:1 at night I'm like leonidas, what are you doing? He's like, mom, I gotta get my training in. I said, we cold plunging or what? And you can't say no to your 4 year old who's getting ready to go into 50 degree water because you don't want to do it. And it's really interesting in the way of it's so much easier to build good habits now then spend 40 years trying to break bad ones. And that's what we, you know, we don't make the kids train, but we want to be able to expose them and really encourage that so that they get to choose their own path forward. And it's very much a part of our daily life that's powerful.

A (21:39)

And I think if you think about the problems we have, and specifically kids right now growing up, there's an instant gratification issue. It's like, okay, we're going to order something, you know, it's delivered the next day. Or kids who are older have phones, and that's a whole nother thing. And science unequivocally says you will be a happier, more fulfilled person if you actually have to work through something or do something more difficult. Like, for example, if you're the kid who just like, you know, does sprints and just crush everyone every time and it's easy, that's not really fulfilling. But if you're the kid first time you do a sprint and like, you know, maybe your last, and then you work your tail off for a year and then you go from last to first, that is a hell of a lot more fulfilling and sets you up for a life that is probably a little bit better, where everything is easy. When something hard comes, you just fall apart, right?

C (22:38)

Yeah. And really, I think that that's so important to develop. And there's ways to develop that. And the ways in which I think are effective in developing that is adding in purposeful friction.

A (22:51)

Ooh, I love that. I love that. Purposeful friction.

C (22:54)

So it's. It's you, instead of waiting till the hard things come to you, you actually seek out hard things that fall into various buckets. There is, for example, the physical friction, which is super easy to think about what that looks like. And instead of taking the, you know, the escalator you're walking, even if it's, you know, in Vegas and it's up 100, whatever million flights of stairs. There's lots of little ways to put physical friction in, but there's also emotional friction. Deciding that you're going to call someone that you don't really want to call, have the conversation that you know that you need to have, but are avoiding, really communicate with someone that you know you're at odds with. So there's ways that you purpose and I actually outline choices. You can pick and choose your own adventure. But I think that we can't just think of friction as just physical and then quote, mental toughness. There are, there's more details that I think help. Again, what is the goal? The Goal is how do we develop stronger, more resilient humans. And we do that very intentionally.

A (24:02)

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C (24:22)

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A (24:32)

It's what we love about you in the book. It's, it's muscle as a mindset. It's not just the organ of longevity. It's building, building muscle in every sense of your life.

C (24:42)

That's absolutely right. And, and using love and using the, the lever of the physical muscle to reorient ourselves to things. I'll give you an example. Let's say you've had a really tough day and you guys have access to lots of amazing tools like meditation and breath work and all of those things. I don't know if any of that's worked for you, but it hasn't worked for me. Even the, even the physiological side, which again I use. But the reality is you put me physically in a max out effort sprint or 45 degree cold water and I promise you, I cannot think about one thing else, one other thing other than what I'm doing in that moment. And that immediately breaks the cycle. I'm using the lever of the physical to move the needle. For mental and everything else, nothing works faster.

A (25:38)

And so to build off of that, nothing works. You know, you talk about a lot of people climbing the wrong ladder and there's so many quote unquote healthy things out there that you know, go viral on social media. But, but in reality, like don't really move the needle. In your view, what are the top three biggest wastes of effort in wellness right now?

C (26:04)

Man, that is a tough one. I was like, oh, okay, I got this question.

A (26:07)

Should we expand the list the top.

C (26:09)

Part of, you know, of what we're going to do? Right. And it's interesting because I've got that list ready. The things that I think people do wrong. The number one way to defeat yourself is to be distracted. The number one way for self defeat is to be distracted. People Think obesity kills people? I would say distraction kills more people. And what do I mean by distraction? I mean you're picking up your phone during your workout, you're chasing the next fitness trend, you're following the next amazing TikTok diet. You're constantly distraction, you're constantly distracted. And when you're distracted, it allows for less accountability and less real movement forward. And that's the number one thing that people are doing wrong. And I, I, I'll find more, but that's number one for me, hands down.

A (27:02)

And what about for things that are quote unquote healthy? And so I'll use an example, seed oils. Do I try to avoid seed oils? Yes. Do they happen? Yes. But if you're avoiding seed oils like the plague, but you're not doing resistance training and you're not doing any cardiovascular health, I would say you're probably focused. It's probably a waste of effort. That's my quick example. Is there something else that, that stands out to you where it's like, oh, guys, why are we talking about this?

C (27:34)

Like, you're not going to like this answer, but there's a lot of discussion on red dyes and preservatives and all this, this, that avoiding these things. I totally agree, they're unnatural, probably unhealthy, but rather than picking out the ingredients, seed oils, red dye, blue dye, like all of these things, it's. How about we refocus on whole foods and recognize that there are ultra processed foods and it's the ultra processed food problem. And there's probably defining categories underneath ultra processed foods. For example, I think protein shakes are great. That would be considered an ultra processed food. It's not about making these global statements, but it's okay. So is sugar bad? I don't know. Probably in massive amounts. Is seed oil bad? Well, depending on the kind of oil, maybe, probably unnatural. But rather than pulling out those individual ingredients, individual messages, it's what are you eating in your entirety and how is that really affecting you? I think that that's a bigger conversation and it becomes very myopic when people are viewing it through the lens of the individual things instead of the whole food matrix.

A (28:54)

Don't major in the minors, major in the majors.

C (28:57)

That's right. Or just major in everything. But at the end of the day, there's only so much time.

A (29:04)

And so one of the things, huge priority. You talk a lot about protein. So protein first. Give us a primer again, because leucine is part of that conversation, the importance of protein, more specifically leucine Because I, I, I think that, I think we can never talk. There's still the amount of people to this day who I have to explain leucine to. And I'm like, guys, Gabrielle Lyon, let's go. Don Layman, like, come on, you gotta, gotta read the label. How much leucine is here? So I'll let you to take it away from here.

C (29:35)

Well, this is actually very timely because the food guide, the dietary guidelines, have hopefully changed as this comes out. Basically, if we think about why we need protein, if we take a step back and we think about what is the most important macronutrient by far and only essential, it is dietary protein. And people listening to this is. But, but I thought fat was essential. Yeah, but you probably need 4 grams of essential fatty acids. Very little. So if we think about why protein is important, again, we think about protein as if it's one thing. It's 20 different amino acids, nine of which are essential. And why protein really matters, from a broad perspective for aging individuals and really for everybody, is this idea of protein turnover. And protein turnover is very simply, our body regenerates itself, repairs and regenerates itself four times a year. As we age, that process becomes less efficient, I. E. As you get older, maybe you've got a little more gray hair, maybe your wound or your injuries aren't healing as fast. I mean, I'm just, like, mentioning this for a friend.

A (30:49)

Jack, that's me.

C (30:50)

This is, this is protein turnover. But when you're young, you're highly anabolic. When you're young, even the light is anabolic. I'm joking. You know, my videographer's always like, oh, God, is this lighting? Anabolic is, he's flexing in the, you know, his triceps in the mirror. I'm like, dude, you're 32. Yeah, everything's anabolic. But dietary protein, it's not the protein that we need per se. It's actually those individual amino acids. And out of these amino acids, they all do diverse things. And when we think about leucine, that's an essential amino acid, we think about threonine, that is an essential amino acid, and the list goes on. And for example, when we talk about leucine, this is the essential amino acid that's critical for triggering muscle protein synthesis. Muscle protein synthesis is exactly what it sounds like. It's this stimulation of, of muscle. So eventually, with all of the amino acids, you can put down more muscle and understand that this machinery is also what helps with muscle health. And leucine is the trigger for that. So making it one of the most important amino acids. Again, you need all of the essentials, meaning your body can't make it, but become really critical. And when we eat and target for muscle health, the rest falls into place. So threonine. Threonine is essential for mucin production in the gut. People have GI problems. The majority of threonine, which is found in high quality animal proteins, is important and allows us to be able to repair our gut lining and produce enough mucin to protect our intestinal lining. And another thing that I think is really important is methionine. Methionine is an amino acid that's really important for glutathione production. And our amount and need for methionine might triple as we age, which is interesting. And again, there's various amounts. We don't do a great job at testing all these amino acids in the way of what are the long term outcomes because it's very difficult to track people from, you know, in really high quality studies from, you know, 15 to 75, which protein and these amino acids, that's kind of what we're looking at. If we were to really think about their impact. Their impact. Dietary protein is important in the immediate right for triggering muscle and putting down muscle. But let's say a deficiency of leucine, that's not something that we would be able to tell. But over time, maybe that person isn't building muscle or maybe they're becoming sarcopenic. And I just want to put that into context that we talk about dietary protein as if it's one thing, but the reality is it's 20 different amino acids, nine of which are essential. I expect nobody to remember this and I think it's important to know that you think about high quality proteins which are animal based proteins are important to focus on because then you're getting all your essential amino acids.

A (33:58)

And if you're thinking about muscle health, which I think most people are listening this show, you need the two and a half grams of leucine to trigger muscle protein synthesis. Because if you don't, you're just eating protein, but it's not translation translating to building lean muscle. If you're a kid, different story. But if you're a grown up, you need the two and a half grams, like super critical. Animal protein is roughly like 10%. Plant proteins much lower.

C (34:21)

Yeah, yeah. So leucine's around 11%. Yeah, leucine is 11%.

A (34:27)

If you're buying a protein, just read a label, look at the back. Does it, does it list leucine number or not? But like that, that was like one takeaway. Because I don't think anyone wants to just like go to town on protein for the sake of going to town on protein. You want to make sure it counts, otherwise it's, it's a waste. And that is such a huge takeaway. That's been game changing for me. You know, you mentioned GLP1s and sarcopenia. I think that is. Well, you, this is your, your thesis. Like GLP1s are, are game changing for many people. We are seeing them, it's unfolding in real time. With that said, there's a real risk of people not prioritizing protein, not prioritizing resistance training. They lose all this weight, it's amazing. But now they're vulnerable for sarcopenia. Let's talk about that.

C (35:10)

Yeah, I think that it is. We are trading one epidemic for another and that we are completely unprepared to deal with the ramifications of what we're about to experience. Obesity. That was a real problem and is a real problem. We can all recognize that. And with the use of GLP1s, it's been extraordinary. Again, I worked during my fellowship running a weight management clinic, so that was part of my job as a fellow. We didn't have access to, to GLP1s at the time. If we did, it would have been tremendous and reduced the amount of suffering for so many people. But now it's very ubiquitous and people do have access, which I think is wonderful. However, the data supports that most people after two years do not stay on these medications. And in weight loss, it's not just weight that they're losing. They're often losing muscle and bone. Once they come off of these medications, essentially what happens is they regain weight and that weight is typically fat weight. And so now they've just accelerated aging. If you take a step back and you think about sarcopenia, which is a decrease in muscle mass and function, you're looking at, I don't know, 4% per decade. So it's not this massive, massive loss, Right? And maybe it's a little bit more, maybe it's a little bit less. But the reality is, is the, the muscle loss is not nearly, is as rapid as it has the potential to be with the use of GLP1s because of their effectiveness in losing total body weight, whether it's 14% or more, depending on the agent used. And with that, fat loss is muscle. And muscle is already so precious and so Difficult for people to maintain that. I am concerned, I am definitely concerned about what we're about to experience because I'm not sure we have the right tools to be able to protect muscle appropriately. I don't know if as individuals age if resistance training is going to be enough or are they going to have to get really smart with anabolic use with radio frequency other ways to create contractions that are potentially more robust than someone could do if they were just lifting a bicep curl.

A (37:35)

So if you're working with someone in your practice and perhaps they're taking a low dose GLP1, what's Like your, you know, if you had to generalize like what. What are the must haves in your protocol for that person?

C (37:45)

Well, the first thing is diet and lifestyle. They have to be on a great resistance training program. It's just non negotiable. It's an absolute must. And then the other part is they have to have their nutrition right. And let's say and you know there was this, this protein sparing fast a long time ago, which is not really popular now, but it was when we were. You laughed because that's. You probably remember this, this was in. I think, I don't know if Mayo was the first one that utilized it. But basically the majority of the calories came from protein. And with and the use of GLP1s, people are very. They're not hungry. They're already not hungry. As they age, we see appetites decrease. But also if you were to prioritize food, this is where shakes come in, essential amino acids come in. Using and prioritizing protein is an absolute non negotiable. And then hormones do play a role and they can augment a really good program, especially testosterone and anabolics. So I think testosterone is a real opportunity. And then finally this isn't a must have but I do think that we are going to start to see more of the attention in machines like Emsculpt and Emsculpt. I tell Brad, who owns it, I said listen, you named this terrible because it's not really a sculpting machine. It's a longevity machine because it allows for an ability for a hyper stimulation of muscle. So basically it is a machine that you put a paddle on and it provides radio frequency, high high FEM radio frequency and it stimulates skeletal muscle to contract.

A (39:28)

So you can build muscle with the machine?

C (39:29)

Yeah, you can build muscle and you can support muscle against atrophy, which I think is really critical.

A (39:37)

That's really interesting. Like I Think of people when it, when things go south, you're injured, you're laid up, something happens. You know, it's like the story or we watch it on tv. Someone's in a hospital and they're losing, they're just melting away. They're. They're sitting down on a bed. The use cases for people who are laid up with injuries, like, that's where it's tremendous. Like you physically can't go to the gym. Like, we can keep, we can keep your muscle going.

C (39:59)

I absolutely agree with that. And I think it's going to become more critical. I think that's the future is more technology because we are going to have to be able to protect skeletal muscle.

A (40:10)

I think that's game changing for people who suffer critical injuries as they get older, because that's when things start to go very south. They become immobile, they lose energy. VO2 max drops below the independence line, everything. But if you're able to keep the muscle going, like you don't lose all hope being laid up in a hospital bed.

C (40:25)

That's exactly right. And what you're talking about is the way that aging does happen, and it's called a catabolic crisis model. And the late Doug Patton Jones and my mentor, Dr. Don Layman were the ones that really coined this and started writing about it, is that people believe that aging is in this long, kind of slow trajectory. It's not. It's in moments of discrete injury or immobility or sickness psychic. So the decline is actually very rapid. So people will, I don't know, be fine, be fine and then get pneumonia. And then the dip is very dramatic. Where they're not training for a week to two weeks or they're on bed rest, they lose a tremendous amount of muscle versus someone who's young, will maybe be able to retain three times as much muscle versus someone who is older. And you know, after a week there's this accelerated loss. And so that is really how we think about aging. And ideally, how do you build and maintain as much muscle as possible, which is and must be the priority. And once you do that, you know, it's not like you can plan for when you're going to get injured, but you can prepare for it.

A (41:35)

And muscle is your insurance policy.

C (41:37)

It is. It's your most important one. And it's fascinating because you can't buy it. You know, I was thinking about this as I was bitching about my training session on Saturday. So I was a half an hour late for my training session. But my coach, Carlos At Sigma Sigma training performance, Carlos makes me get it in the entire workout, but I was half an hour late. And so it was pull ups and pushups and air dying. And there was no, I thought I was going to die. There was no rest. And I thought to myself, you know, there is this thing to strength that it's not for sale and that it's a hundred percent earned. Yeah, there are baseline capacities, how fast you can run and, you know, your baseline strength. But I just, you know, as I was trying to resolve the fact that I thought I was going to vomit and finding ways to feel good about and support what I was doing, and that was kind of one of the, one of them.

A (42:37)

So how, on that note, how do you do it all? You're a mom of two young kids, you're a wife, you're a doctor, you've got a business, a podcast, bestselling books, speaking, travel. There's a lot. How do you find time?

C (42:51)

Well, the first answer to that is I don't have time not to do it. Training is the easy part because I don't have time to get sick. And if I don't think I have time for training me, then how am I supposed to have time for getting sick? I mean, that just makes no sense. And then the other part is I'm really discerning. I'm discerning about what has my attention and where I'm going to put my energy. And that is a skill that people can develop over time because not thoughts are all relevant. And you have to be able to distill down and discern, is this a relevant thought? Is this not irrelevant thought? Is this a relevant action or an irrelevant action? And I think that as people become very discerning, it allows for the next right action. Followed by the next right action is, you know, like Jocko Call talks about discipline, you're allowed to then put your disciplines in place for ultimate freedom.

A (43:43)

So signal versus noise, so to speak. This is something I should tune into. This is something I completely need to tune out. That is, love the concept. It's something I am working on as well. Difficult.

C (43:54)

Be fast at making those decisions. Have a standard that you set and this is within your standard. And then the decisions are made very, very quickly.

A (44:05)

What's an example?

C (44:06)

For example, for me to go speak, it has to fall underneath two criteria. And that criteria is if I'm going to go speak to this community, is it going to be people that are going to take this information and then pay it forward and really move the needle Right. Because otherwise I don't want to get on a plane and leave my kids to go speak to people that could care less.

A (44:27)

Right.

C (44:28)

So number one, is this going to be mission focused? And then number two is, is this someone I care about? Is this a friend? Is this someone who I want to show up for and I will try to make that happen. And those are the two. That's the two defining moments about if I'm going to be able to do the thing or. And obviously is my schedule clear at that time? But it allows for rapid decisions. And that's just an example. Spending time scrolling on Instagram. I spend no time scrolling on Instagram. Zero.

A (45:01)

Well, the first part is amazing. We'll see you in Miami in March because I think we check the boxes, you'll come to our event and you'll bring your kids too.

C (45:08)

That's an example of how do we make decisions.

A (45:12)

And let's talk about social media for a second. I'm curious because there's so much noise and something I see in our space. Extremes play and extreme views are often controversial and not grounded in science. And I know you are grounded in science and I know you do not have extreme views. How do you reconcile that?

C (45:39)

Which part?

A (45:40)

Like thinking about h. How do I, what do I tune into? What do I tune out when I show up on social? What do I share? What do I not share? Because I think you're, I think you can also tell a lot about people's views by also what they choose not to engage in and share on social. Like am I just. Oh, this is trending. It's controversial. Let me just get in here. Whether I have a view or not. Like how do you, how do you. Because I know you're also, you're careful in a very positive way.

C (46:12)

I am because I think you know when. Well, number one, I am a trained fellowship trained physician as well as being mentored by one of the world leading experts in protein metabolism. He's my mentor. He would absolutely kill me if I didn't maintain scientific integrity. And scientific integrity is the following is understanding where the data came from and what it is and what it actually shows and be very careful as to what is said about it. And if someone could over extrapolate that or you know, just be very calculating as to what is the truth, what do we know? And honestly, what do we not know? From my perspective, what do I follow is I follow the scientists. I read a lot and I read a lot of literature, but I don't get my information from People that are not scientists. Right. So just me personally and then, and I'll give you an example. And this is actually, this was actually really interesting. I do a lot of lectures, I speak a lot. And one of the topics and one of the new concepts that I highlight in this book is this idea of carbohydrate tolerance. We talk all about protein, how much total protein we need, how much protein we need per meal, but we don't really talk about a carbohydrate tolerance, which is how many carbohydrates can someone actually dispose of if they are like the majority of the population, which is sedentary and not training. So this is what the data would support, that the average American is eating 300 grams of carbohydrates and not exercising. They're doing three glucose tolerance tests a day and someone pulled a clip from a 45 minute talk saying you can only dispose of around 40 grams of carbohydrates in a two hour period. Otherwise, you know, we have a clinical definition for this, it's diabetes. And that's actually correct. But what the people don't understand is that in the literature you can't compare. Again, this is, this is kind of nuanced, but you can't compare something called a euglycemic clamp, which is a perfect condition in a fasted state of an empty muscle of glycogen, versus what people are actually doing. And so as this video went around being viral, I could have tried to re educate these people or I can go on my podcast and I can talk about what does carbohydrate tolerance mean? How do we think about it? Because you can't argue with people that are already convinced you're wrong. They've already made up their mind about what their outcome is going to be. And so. But in real academia, it's not like that. In real academia, people know the difference between a glucose tolerance test in a clamp setting versus what people are really doing. And they would probably ask the person as opposed to a bunch of viral videos. And so that's the, the real difference. So me personally, I spend time reading and educating on my own platforms and writing books and doing things of value. I mean, I'm still publishing. We just published a peer reviewed paper on muscle mass and sexual function. We published a paper on testosterone pellet use. We're working on another trial right now on safety profiles with testosterone.

A (49:42)

So is that for men and women.

C (49:44)

Or this one is for women. It's for women.

A (49:47)

Sure, let's talk about that. Let's, let's close with that. I'm curious, what are the early findings.

C (49:52)

That there really are no negative outcomes of testosterone use? And this was pellets. They're not getting these negative side effects. So it's really showing safety. And that one is done in women. And we're working on some other trials right now, working on another study right now looking at testosterone use in women. The paper that we published in, I think it was sexual reviews and this was really targeted towards men, was healthy muscle mass. So actual mass and strength improved erectile function. And it, you know, erectile function is an indicator of healthy metabolic health. In part. Right. It's healthy vasculature and, and muscle, muscle mass and muscle strength are correlated to healthy erectile function, which is amazing. I think the first paper of its kind published like that.

A (50:49)

Wow, congratulations.

C (50:51)

Thanks. I mean, I didn't do it.

A (50:53)

What's been game changing for you recently since we last spoke and it's been about a year. Like what have you changed? Which a great ROI for you in.

C (51:02)

Terms of my focus on health, nutrition, anything, any.

A (51:07)

Anything. Like what have you changed recently where you said this is really working for me in terms of my routine?

C (51:15)

Well, I'm really working on sleep, which I'm not excited about. I hate sleeping. I hate, I just hate it. It's the worst. But I'm working on it. And I also spend a lot more time outside, so I work outside.

A (51:27)

So it's the worst. Because you struggle with sleep?

C (51:29)

No, because again there's this talk about how important it is and I get it, it's all of those things. But I am just someone who likes to do. And I don't love to sleep. It's a character and there's nothing that is just the way that it is. And unfortunately I have a partner who has to work 24 hours or 36 hour calls and it kind of feeds bad behavior. So we're going to be working on that. And it was like, oh really? Who can stay up longer? No, it's just terrible. But spending a lot more time outside because there are things called muscle clocks and I touch on it in the playbook. But muscles are also on a circadian rhythm. And whether it's a big impact or not a big impact, the time at which you train, the time at which you sleep, the amount of time you spend outside, the amount of light infiltrating in all affects metabolism. Again, is it a huge needle mover? I don't know. Probably depends on if you're a night shift. Worker or not. But understanding that there's more to muscle than just training and eating protein, that is this very complex organ system and what do we need to do to really build it as we age is very much on my mind.

A (52:41)

Well, the book is amazing. It is always a pleasure to have you. Where can people find you? Tell us more about the book, what you're up to.

C (52:50)

Well, you can find me on my website, Dr. Gabrielle Lyon. We also have a link to Strong Medical, which is the medical practice, which is telemedicine. And again, it's all about muscle, pretty much. Amazing. Dr. Lisa Hunt is our lead physician. I'm on Instagram, I'm on TikTok. I have a great podcast called the Dr. Gabrielle Lyon Show. This book is available where all books are sold. The Forever Strong Playbook. And I have to say, while we think about the idea of muscle and protein, what we're really after is a movement. We're really after calling people to a higher standard and building more resilient humans. And that's what the real mission is. But you have to have a playbook. To do that, you need a tactical field guide, and that's what this is. And a great newsletter. I think I covered everything almost.

A (53:43)

Well. Congratulations on the book. Surely another bestseller. And I'll see you in Miami in March.

C (53:48)

Thank you so much. Well, I love being able to chat with you guys. So fun, so fun. Well, thank you so much for having me. I'm so grateful.