A (2:27)

I was thinking about the obesity epidemic and, you know, it was not happening. And then in the 70s, we had this massive spike in obesity from the 70s to the 2000s. They didn't think about muscle. Instead they were focusing on the pathology of obesity and not understanding that muscle played such a huge role in it. You know, I've spent some time, a lot of time thinking about this and I realized that because physical activity didn't really decline, it was already a little bit low. It was really the increase in hyper palatable food which caused everyone to focus on calories in, calories out. And nobody discussed movement as opposed to, you know, just thought about muscle in the form of exercise only and that's it. And not like you should do more of it. Think about the quality of muscle. They didn't think about any of those things, which blows my mind because I think that we're at the precipice of a repeat of history. So from in 1977, we have this obesity epidemic. Muscle goes completely ignored from a metabolic perspective till 2000 and enter the landscape of GLP1. We are on the precipice of swapping obesity for sarcopenia.

B (3:42)

That's exactly right.

A (3:44)

If we don't pay attention, we're gonna make the same mistake.

B (3:46)

I feel like it's the pendulum swinging. Cause I think a lot of the pain that Gen Xers have is because we grew up in the 90s with Kate Moss and the Waifs and heroin chic and like thin, thin, thin, straight up and down, no curves. And so it's like we're pendulum swinging from that to obesity back to that. And we're missing this incredible opportunity that still, I mean, I'm surrounding myself with people like you. We're all talking about it, but you don't have to be too far off of the beach to be like, nobody else is actually talking about this though.

A (4:19)

Right. I realize that, but we are actually going to solve for that. And that's exactly what we're doing. Especially with your work on testosterone. And, you know, I had another thought. You ready for this next thought? This next thought was the following. A patient could go to their doctor and say, I need a medication that's going to help treat my obesity. Conversely, a patient doesn't go to a doctor or can't really go to their doctor and say, you know what? I need to treat my muscle mass. I want to be stronger. And have more healthy muscle. They're not met with the same kind of respect or interest or even bias or even judgment. The organ of adipose and the organ of skeletal muscle, they're not treated the same. One has a stigma. They both have stigmas. Why is it treated that way? So why couldn't someone go and say, you know what? I need an anabolic agent. I need testosterone.

B (5:11)

Because they'll be labeled as, like, a meathead or aesthetic. I mean, same reason why I wanna lose adipose tissue is cause I wanna look good. But no, there's actually metabolic consequences to too much adipose tissue. Where did the stereotype. You probably know this from you writing books. Like, where did the stereotype of, like, the muscly meathead come from in the first place? Do you know?

A (5:31)

I don't. And it's totally wrong, because we know. So dumb jock. You know, I was at the gym this morning, and this guy was lifting. I don't know, it must have been 350 pounds, sweating everywhere. And he's got leg veins, and his quads were as big as my head. And I thought to myself, what? Everyone who's listening to this is probably thinking, this guy's gotta be a genius. So the idea of dumb jock is totally off base. And it's. One of the primary ways that we improve our cognitive function is through training. Yes, the plumbing. So the aerobic activity, but not just the plumbing. It improves vascular health, obviously, and executive function, the ability to do numbers. Again, I did my training in geriatrics. This is all critical. And skeletal muscle is the voluntary control. It's the choice.

B (6:16)

Yeah. I mean, what's so cool about your history is that you trained studying older people in their terminal decade. Right? And it's like, that's the power that physicians have. That's the power that I have is like. Like, I see what's happening when you're 82. Like, I see your future. And for people, they don't understand that we study this, there's two groups of people that I ask questions to. If you've been married for more than 50 years, I want to know your secret. And if you're 90 or older, I want to know your secret. And everybody's, you know, everybody's got a gem that they want to. They want to share, but it's like, that's where you came from, is you're like, what if we can do this aging thing differently? Tell us more about, like, your. Aha.

A (6:56)

Yeah, There. There was no other possibility. And this was during my fellowship in Geriatrics at Wash U. So I did a combined fellowship in geriatrics and nutritional sciences after studying protein and muscle metabolism, who I'm still mentored by with Dr. Donald Layman.

B (7:12)

Go listen to every single episode. You should just, on your website, be like, these are all of the Don Layman episodes. Please. Those are gems. Every single time.

A (7:19)

He's just a genius. And when I was doing my fellowship, every fellow has a project, and my special project was looking at body composition and brain function. And this woman, you know, you just love these participants. She spent a lot of time with them. We were doing cognitive function, FMRI training. It was just a whole shebang. It was all of it, nutrition. And this one woman, she was a mom of three, and she cycled through the same 20, 30 pounds. And I imaged her brain, and her brain looked like the beginning of an Alzheimer's brain. And I was like, you got to be kidding me. This is what's in store for this woman. Meanwhile, on the weekends, I'm rounding at these nursing homes and I'm reintroducing myself to these patients. And it's just devastating just to their families and their life. I mean, it's awful. And I couldn't not see it, and I also couldn't not do anything about it. And that's really where the muscle centric medicine was born. I had this moment where they were looking at the wrong tissue. This wasn't an obesity problem. Obesity was a symptom of unhealthy muscle. Muscle's a problem, and we're still seeing that today.

B (8:27)

What I'm seeing a lot. So I started my private clinic. I have an inbody scanner and a lot of people. For people who don't know in body scanners, it'll do total weight, then muscle mass, and then fat mass. And so if the muscle is low, that's a C, right? A C shape. And then if you're balanced, it's an I shape and then D, like Gabrielle and everybody else. Those are the athletes. So I have a lot of C shaped people. What I mean by that is low muscle mass, high adipose tissue, universally. They think the way to fix this is to eat less, to get the fat down. That's the default go to. How would you help the C people become more I people?

A (9:04)

This goes along with the trend of what we have to lose. We've had a diet problem for the last 50 years, and it's really been all about what we have to lose. It's been focused on fat. That redirection has Created a lot of problems because at some point, the way to improve body composition isn't to eat less. The way to improve body composition is to address muscle health and match a diet that supports muscle health, which we don't have right now. And that's what becomes really important. It is both resistance training and dietary protein. You need both. They're both two parts of the equation. And you have to be able to make these protein decisions to protect muscle. So if you want to move from a C to an I, the way to do it is you have to train and you have to get your nutrition right. It's a non negotiable.

B (9:56)

I was making a list of all the things I want to talk with you about today and I was like, you know, we're gonna talk about creatine and grams of protein and all this stuff. And I'm like, you know what it is. And you do a very good job when you do public speaking about this mindset. Because if you think it's difficult, it will be. If you think it's hard, it will be. If you think grams of protein's too challenging, it will be like the mindset of body recomp is where I'd say most of the work has to be for people. What do you think about that?

A (10:26)

I think that that's exactly right. And you know, my first chapter of the playbook is all about mindset.

B (10:34)

Nice way to lead with it.

A (10:36)

Yep. And the reality is if you cannot be discerning, then you're not going to be able to take the next right step. You have to understand what needs to be focused on. You have to be able to be discerning, allow yourself to think the next right thought and take the next right action. And then ultimately this allows for a very disciplined life so that you get to choose.

B (10:59)

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A (12:21)

Yes. Because you're not able to connect your future self with your present. And you have to be able to create friction and watch the friction and put yourself in position. So what I would say you do, Kelly, is you, you should go and you should go into the Starbucks and you should order that 16 ounce mocha and then you should leave it there or give it to someone else.

B (12:39)

What does that do?

A (12:40)

It increases your ability to, number one, maintain your own drive and motivation. And number two, it stings a lot less the fifth time you do it.

B (12:49)

Yeah, that's for sure.

A (12:50)

It's this intentional friction.

B (12:52)

Yeah. I mean, to me it was like, you know, I haven't had alcohol in four years and it's like, it's hard in the beginning and now I'm like, God, why would I ever put that in my body? You know? And it's like you become the person who lifts the weights. You become the person who doesn't have the alcohol. Like, you have to become something different than you already are when you're looking at that C shaped body comp and realizing like, it's not as simple as just not eating.

A (13:17)

And if you don't believe that you have the time for it, how would one manage the time for illness? You don't have the time or the luxury not to. And that becomes really critical because I think a lot of your listeners, they're on hormone replacement or they're thinking about all of the things that you talk about. Yet there seems to be a disconnect between action and interest. And the way to bridge that gap is you think about what inspires you, what motivates you, and then you don't wait for the moment where you feel ready. You decide that these are the things that you're going to do and then you fall back on your own attributes and you fall back on your behaviors and you plan for your weaknesses. Over time you make massive improvements and you then set a standard that you always hit feel they like always. Yeah, because you set a standard that's within your wheelhouse. So if you're starting to work out, you don't start with a five day a week program, you start with a three day a week program. That's what I did in my playbook. The playbook is a training program for everybody. I know you have a trainer, but you should really try it.

B (14:25)

Of course I'm going to try your program. Of course I'm going to read your book.

A (14:28)

So six weeks, let's try it. Let's see how you do on a dumbbell program for six weeks. Dumbbell plus high intensity interval training for six weeks.

B (14:38)

I love it.

A (14:38)

Body changes, nutrition changes, all of it.

B (14:42)

I just saw somebody who had dropped some weight on intermittent fasting. She was giving herself an eight hour feeding window and she's under muscled and was having trouble kind of dropping the next ten pounds that she wanted to drop. And I was like, my understanding is intermittent fasting works for some people. Everybody's different, they got to figure it out. But it's hard to get the amount of protein in, in an eight hour window. So where would you take somebody who was like, hey, I had some success with intermittent fasting, but now I don't know. You know, I like that I lost some weight on it, but I, I'm like, I was starting her with. Just write down how much protein you're doing in a day because most people don't know if you don't track it.

A (15:21)

Yeah. So 100 grams is the minimum that you need. And also as your calories decrease, your protein has to increase. Protein is not a percentage of calories, period. Protein should be thought of in terms of grams, especially if you're over 40. If you're over 40, you have to protect muscle at all costs. Intermittent fasting is fine. There's no issue with it. It's not a magic bullet. It does seem to work well for some people. The idea behind intermittent fasting is it restricts the feeding window. What I would say is if you are eating in that eight to nine hour window, here is the way that I would do it. The first meal of the day should have around 50 grams of protein. It could be done through food, it could be done through a protein shake. It could be done through additional essential amino acids, which is what I use. So for example, I use Body Health's essential aminos. If I'm only going to do a 25 gram of protein breakfast. In order to bump it up, you add in essential aminos, you now have a higher protein breakfast without getting a whole bunch of extra calories or a whole bunch of extra volume. Right. So if she's not hungry, chances are as she's streamlined her eating, she's less hungry. So that 50 grams of protein in the morning, number one, will reduce her hunger because it releases GLP1 at a gram of 30 or more. The second thing is it allows her with balanced carbohydrates to maintain her blood sugar. And then with her second meal. Do I care so much about it? I don't. But it should not be skewed one way or the other. It shouldn't be like high carbohydrates. There should be protein. And then her last meal before she goes back into her overnight fast should be another 40 to 50 grams.

B (17:08)

I was talking to somebody about this, and I learned this from you and Donald Lehman is as we age, I'm gonna F it up. But basically the body needs more protein to kind of push into the machine to get it working. Caveat. If it's a well oiled machine, meaning like you have muscles that you are using, you might not need as much, but just the aging process kind of. The protein efficiency, is that the right word for it?

A (17:32)

That's right. So, so what happens?

B (17:34)

I'm like a barbarian re like resaying what you say. I'm like, you gotta like push more with the protein.

A (17:40)

Yeah girl, yeah, you got it. So what happens as we age, which is interesting, is this aging phenomenon called anabolic resistance. Anabolic resistance is skeletal muscles inefficiency of recognizing and being stimulated by protein. Protein is made up of amino acids, not just essential amino acids, but amino acids. There's 20 different amino acids. They all do various things, nine of which are essential. Of those nine, skeletal muscle is exquisitely sensitive to leucine. This is the stimulator amino acid that is necessary to stimulate an MTOR complex that then stimulates muscle protein synthesis. And the body turns over four times a year. As we age, we become less efficient at turning over protein. You know, you might see that your skin gets a little worse or your hair gets a little not so great. Well, your hair is great, but you see what I mean? So the efficiency of protein decreases. However, one can stimulate muscle, older muscle, to the same degree as younger muscle with the addition of protein. And then there's a synergistic effect when it comes to stimulating muscle with Exercise followed by protein. And this becomes important because it allows us to overcome the aging effect. And if we believe that skeletal muscle is the organ of longevity, which you and I are friends in real life, you better believe, which I know you do, then we have to reorient ourselves to a nutrition plan that supports muscle. And right now, we don't have that. Right now, we are eating too many calories, and we're highly focused on fat. And we're focused on fat, but yet 55% of our calories are coming from carbohydrates.

B (19:30)

Yep, I'm seeing a resurgence of go vegan to get your cholesterol down.

A (19:35)

Please don't.

B (19:37)

I'm seeing it. It might be in my house. It might be in my house right now with somebody visiting.

A (19:42)

Okay, now here's the deal.

B (19:45)

Tell us the deal with that.

A (19:47)

Majority of vegans are younger. It seems that the majority of them go back to their normal nutrition plan within six months.

B (19:56)

So vegan isn't sustainable for most people.

A (19:58)

For most people it's not. So if we think about the numbers, and we want to age well, 40% of women over the age of 65 are deficient in protein.

B (20:09)

Can you test that or is that just them not eating 100 grams a day?

A (20:12)

So it's based on the recommended Dietary Allowance, which is set at the minimum, which is already too low because it's frankly an irrelevant number because it's based on nitrogen balance studies, which is irrelevant because nitrogen balance doesn't have any health outcomes. If anyone knows what a nitrogen balance health outcome is, please call me, because I'm still waiting.

B (20:32)

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A (22:02)

Well, this is complicated because protein deficiency doesn't show up immediately. Protein deficiency can come in a number of forms. One would argue in part that potentially protein deficiency looks like sarcopenia. Again, we're talking about protein, but the reality is there's 20 different amino acids all do different things. Threonine for mucin production, phenylalanine for serotonin production, leucine for muscle stimulation. And we don't eat leucine and threonine and phenylalanine, we eat whole foods. And so the reality is when we see how, you know, you could do a blood test and say your albumin is low, okay, fine, but that's an acute marker, maybe over a period of time. But how I would say that someone's deficient in protein is a number of ways. Number one, you do have to track, you have to know. And number two, are they maintaining or are they losing muscle? And again, is it protein? Who knows? They could have cachexia or they could be not moving. There's a whole host of things that one could or could not do. And that's what makes it so hard. And that's why people argue so much about protein. Because if you think about takes 14 to 16 weeks to see changes, small changes in muscle on measurements like adexa. So if you're looking at the same person, you can't expect doing a 10 to 12 week study, people say, well, it didn't show any change in lean body accretion or whatever. Well, yeah, what do you expect?

B (23:30)

So if I have an inbody that's in my hallway, my trainer's like, Kelly, you jump on that thing twice a year. And I'm like, but it's in my hallway, like what's too soon? Where it's just gonna f with you psychologically. Cause it's variation that's not real.

A (23:44)

Totally up to you.

B (23:45)

Okay.

A (23:46)

So if you are an untrained individual, you will see changes in. You will see changes fast. Right? If you're untrained, you'll see it in a month. If you're a trained individual, then you won't see it. It'll take a long time.

B (24:02)

Yeah, I think that, you know, but the whole like, especially if you're trained to get that extra half a pound, to get that extra pound, like it is hard earned. Like I would like to go through a drive through and buy some muscle. That would be my preference.

A (24:17)

And also friend, why is it so much easier to gain body fat than to build muscle? And then my favorite and ladies, don't do this. My favorite excuse in the world is don't train because you're going to get too bulky.

B (24:30)

Dude. That will not die. That will not die.

A (24:33)

Oh my God, you are so funny.

B (24:36)

I love like, I love it like they, there's somebody did this on Instagram a while ago of like they're like, they take the men in the gym and the men are like we wish, we wish we could get bulky. Like they have 10 times the testosterone, way more upper body strength and they're like not getting bulky over here. Like even the dudes aren't getting like whatever bulky means, by the way.

A (24:57)

Exactly. There's. I'm still trying. Yeah, yeah, I'm still trying. And by the way, you and I are the same size. We're both still trying.

B (25:03)

I have the don't start, don't die in the winter body type of like I will put on ass fat faster. You put me on a couch and give me a big max. I will put on ass fat quickly.

A (25:13)

See, I'm the opposite. I won't. I don't even know where my ass is. It's gone on vacation forever. I have zero ass. Zero.

B (25:21)

I love. I was just at vonda rights conference in Orlando which I highly recommend to everybody and somebody was like the non medical term as fat is actually like protective healthy fat. It's the visceral fat that's inflammatory. It's like literally a different breed that shouldn't, it shouldn't be called like, they both shouldn't be called fat. Right. Because they're so different.

A (25:41)

Well, I'm going to drop a bomb. The next iteration is IMAT is intramuscular adipose tissue which is probably more relevant and drives disease and metabolic outcomes. So body fat probably in the next five years doesn't matter nearly as much. It's almost irrelevant.

B (25:59)

Like Body fat percentage is becoming the way of the bmi, Meaning it's not. Doesn't tell you enough.

A (26:06)

Yes, Got it.

B (26:07)

Because if my body fat is 30%, but it's not visceral.

A (26:12)

So here's. And I've really. This is probably the one thing that I've changed my mind on. I used to believe when I was in my fellowship that you couldn't be fit the fit fat phenotype. However, I was wrong. The reason I was wrong was because when you are moving and just exercising, whether your body composition changes or not, you're decreasing intramuscular adipose tissue, which is that marbling of that stake. And that is very empowering. You think about linemen. Linemen. And if you look at their blood, I'm picking linemen. But not everyone. But this fat fit phenotype exists. And in part, I believe that's because they have low intramuscular adipose tissue. It's the intramuscular adipose tissue that is more related to insulin resistance and diabetes and cardiovascular disease than the percent body fat. But we haven't been testing it, and it's not really available.

B (27:11)

Yeah, I was gonna say, are you gonna get a cat? Is a CAT scan an mri like to actually see it? Yeah. I think they would come up with some sort of like, muscle ultrasound impedance thing at some point that can detect.

A (27:21)

They do, but it's highly variable. So you know that they have it. It would be great. There's too much variation. Ultrasound is there. We're just not there yet at a population level. Remember, we looked at BMI not for intervention, but at a population level. And then we moved to percentage of body fat. And then we move to, well, not quite just body fat, but then there was waist, hip circumference and these other markers. Great. And then body fat is in there, and then visceral fat. But if you think about it, there's liver fat, and people are like, okay, well, what do we do with that? And then there's muscle fat. And potentially muscle fat may be even more detrimental than liver fat. Intramuscular adipose tissue over time decreases contractility, decreases strength, changes the metabolic regulation of muscle. So muscle. Most people don't realize this, but muscle at rest burns primarily fatty acids. If you overconsume carbohydrates and you flood the system with carbs or glucose, you force it to burn and dispose of carbohydrates. But at rest, muscle primarily burns fatty acids.

B (28:37)

Interesting. So. So at rest, your muscle is consuming fatty acids. If you foie gras it, it'll become a glucose sink for you. That's where the fat, the marbling comes from. Though, is the glucose sink. And the carbs?

A (28:51)

Well, yes, and there's a number of reasons as to why. Well, number one, if you over consume carbohydrates, muscle has to handle the glucose and also liver in addition. Now you've deranged metabolism. And here is going to be a shocking, not so exciting, I'm sorry, truth. But if roughly 73% of Americans are either overweight or have obesity and the majority of people are sedentary, then by definition they have unhealthy skeletal muscle. That means 40% of their body weight is probably in there, marbled. Okay? Now if the average American diet is 300 grams of carbs a day, they're doing three oral glucose tolerance tests a day. There is a derangement in metabolism if someone is sedentary. And we calculated, myself and Dr. John Layman, because we're working on a paper, we calculated and maximum disposal rate is 40 grams in a two hour period. And this is very particular. So there's the obligatory use which is red blood cells and the organ systems and skeletal muscle at rest burns very little. In fact, I calculated all these numbers. Skeletal muscle at rest is not very active. What's happening is our red blood cell which has a constant requirement of. Are you ready for this? 4 grams per hour, which is not much skeletal muscle. Guess how much glucose it uses per hour at rest. You're gonna die.

B (30:25)

Not much. Cause it uses fatty acids, 2 to 3 grams.

A (30:28)

Okay, so total fasting, sedentary, you're like, you know, you're looking at 40 grams per hour in a two hour period. So it's 20 grams per hour.

B (30:39)

Do you ever see America getting to like a low carb lifestyle like, or an earn your carbs if you exercise that day, sort of thing of like it's not meat that's the enemy. But I think most people don't know that. And to me I'm like, it's not the hamburger, it's the bun on the burger. That's what makes the hamburger bad.

A (31:03)

That's absolutely right. And the other component to that is people are overeating carbohydrates and overeating calories. That's it. You know, Our diet is 11% saturated fat. It's a carbohydrate issue. And do you know how we see this? Because we have elevated triglycerides and elevated insulin and elevated glucose. So these are diseases of, or these are indications of unhealthy muscle rather than. It's not about the symptom of obesity. So triglycerides, this is. So here's what we did. So in research and in the weight management clinic that I ran, when you reduced carbohydrates to under 140 grams a day, you, you could reduce triglycerides by 20% and that's how we figure out if people are following their nutrition plan.

B (31:48)

Ah, so triglycerides is the marker of foie gras.

A (31:52)

Well, foie gras is fat, so.

B (31:55)

Well, I think of, I think of foie gras is like force feeding. So like if you're over, if you're over carved, you're force feeding the goose. I am crude and just trying to figure it out at this point.

A (32:05)

You're hilarious. You're actually also an excellent interviewer.

B (32:10)

My podcast is six years old. It's a first grader at this point. I'm a pro.

A (32:14)

Hey, there's a lot of people that do podcasts for a long time and you're pro status. You're pro status.

B (32:21)

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A (32:38)

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A (32:59)

Uh huh.

B (32:59)

Yes. No. Every day, 10 grams. Getting hot. Creatine is getting hot for brain health.

A (33:04)

And creatine has been like the OG forever. It's great for brain. But it's interesting. More of the data is in older individuals. I would say the more convincing Data is like 65 and up but it doesn't hurt. And just because we don't have the data yet. Well anyway.

B (33:19)

Yes, yes, yes to creatine. As I said, safety profile and cost profile. It seems like if you're going to pick a non negotiable. That's a good one.

A (33:28)

Yeah. So Darren Kando, he is the expert in creatine. Darren Kando, Creatine also essential amino acids are. Ladies, you're not eating enough protein. Essential amino acids. I use body health. They're amazing. I use the packs. You and I travel a lot. I travel with the packs.

B (33:45)

So the packets travel with packets. Essential amino acids. What's the brand?

A (33:50)

Body health. Amazing. Amazing. Okay, See the other aspect. In women, it seems that omega 3 fatty acids seem to affect women. There's some pretty good data. I don't know if we know everything about it or why, but I think that that's a Great one. Omega 3 fatty acids. You can also test it in the blood.

B (34:07)

Omega index. Yep, I've just started getting that on.

A (34:10)

Some patients want that about 10. And then the other one is urolithin A. So urolithin A, if you're not on it, you should be. And that's mitopure. Timeline has an. I mean, it's the only one that I use. I use the gummies. I'm. I travel with the gummies. But basically it helps with mitophagy, which is the cleaning out of old cells, old mitochondria. So these are extra. Right. You want to have whole foods. So, number one, do you say creatine or do you say essential amino acids? I say essential amino acids because creatine is going to help if you don't have any muscle. I mean, yeah, I guess it'll help brain. So that's not true. And then essential amino acids. So as women get older, their appetites decrease with the use of GLP1s. People are not eating enough.

B (34:52)

That's true. It's a weird paradox, right? Because here we are saying people are overeating carbs. And then we sell. We say they're not eating enough, but what we mean is protein.

A (35:02)

Yes, exactly.

B (35:03)

Because I think they're like. We're like, we're eating too much, but we're not eating enough. Right? You're not eating enough of the proper things. But, dude, proteins take longer to eat.

A (35:12)

No, it does. That's why you take a shake.

B (35:13)

Yeah. Oh, I got. I love my shakes. Okay, let's talk about collagen. Because collagen will say it's 20 grams of protein on the label. And then I listen to brilliant people like you, and you're like, yeah, but they're. It's kind of crappy quality protein.

A (35:26)

Yeah, no, it's zero quality protein.

B (35:28)

It's zero quality protein. You heard it here, folks. So to me, I'm like, this is what you had told me. It was like, if you're good on your 130 grams of protein, add in your collagen. Fine, but don't use it as counting towards your 130 grams of protein.

A (35:43)

That's right. And I love collagen, so I use collagen every Day. Almost every day. I don't do anything every day. I don't even brush my teeth every day. No, I do, but collagen has a protein score of 0. Ladies. Also another thing. Low muscle mass is typically indicator of low bone density. Low muscle mass also is an indicator of poor cognitive function as muscle mass decreases. I was just looking at this because I'm giving a talk in front of, like, 9,000 doctors tomorrow, Friday. That 10% loss of lean body mass, which I'm saying lean body mass because, again, we haven't been testing muscle. 10% loss of lean body mass decreases immunity, increases risk of infection, decreases at 20%, decreasing wound healing, increased muscle weakness. Now, can you imagine you're losing 20% of lean body mass plus infiltration of fat because you're not training? Not good. It's not a good look.

B (36:42)

It's not a good look. It's really not a good look. Okay, so CGMs, continuous glucose monitors are now available over the counter, which is awesome. Stilo. And another one that begins with an L. There's two companies right now that are. You just literally go online and you can just buy your own continuous glucose monitor, which is sweet. You don't need a doctor to access that anymore. Do you recommend it? Do. Should people at least, like, when people come to your practice or you, like, slap this thing on for a month so you can start learning?

A (37:09)

Not anymore. Here are the reasons why I would have someone use a continuous glucose monitor. Reactive hypoglycemia. If someone is saying to me, I'm waking up in the middle of the night hungry, or like, I'm catching my breath and they don't have sleep apnea, again, what I have seen is reactive hypoglycemia is one thing. If they are saying they have low blood sugar, let's prove it. If you've got it and you need those cookies, let's prove it. If somebody is feeling very erratic, because when blood sugar is low, it increases catecholamines, so it increases this feeling of anxiety. Is it anxiety or do you have a rebound from low blood sugar?

B (37:49)

So you're doing it more for the low end of things than for people to understand. If they're spiking with white rice, et.

A (37:55)

Cetera, et cetera, you expect a certain glucose response. And also, we have a great dietitian on our team. Ayla Martin is. If you look at her reviews, people are obsessed with her. I've never had someone in the practice that people love more, like, ever. Except for our doctor, Lisa. Those Two. I mean, they like them better than they like me.

B (38:16)

I love that. Isn't that the best thing? So awesome. But do you, do you use it? So let's say somebody comes in and their, their fasting glucose on their Labs is like 250 or something like that. Do you have them wear one for a while so they can see, like, the behavior that results in a lower glucose?

A (38:32)

Dude, your blood sugar, your fasting blood sugar is 250. I'm treating you.

B (38:36)

Yeah, yeah.

A (38:36)

What's happening here?

B (38:38)

What's, what's happening there? Too much fo is what's happening there. Okay, so what are doctors getting wrong?

A (38:44)

The list is long and cumbersome. I mean, listen, the doctors that I know aren't getting stuff wrong because they're amazing humans like you and our friends. They are getting wrong. Number one, the anabolics. They're getting wrong the importance of muscle. They're getting wrong testosterone. They're getting wrong nutrition. People are still confused about nutrition. It's not confusing. It's not that confusing. You've got to protect muscle at all costs. Muscle is your medicine. Muscle is what is responsible for your aging trajectory. That's what it is.

B (39:17)

This is insane. What do you say to a woman? Let's say she's 53 and she's say she's a C on the embody and she's got more body fat and she's like, can women really, can we really turn this around? Like, she looks at like her 20 year old son who can just drop calories like nothing, although he's keeping track, like he's working for it. What do you say to the midlife woman who's like, is it possible for me? And I know you just interviewed Train with Jones, so I know that story. But, like, what do you say to these people who are like, meh, really, really, Dr. Lyons?

A (39:47)

I mean, I've seen it a million times. Of course it can be done. And it has to be.

B (39:52)

It has to be done.

A (39:54)

It's not an option. And you can always get stronger and it happens quickly.

B (39:59)

I was working. I'm like, I haven't. I don't practice regularly hanging from a bar. So recently I'm like, I will practice hanging from a bar. And it's very uncomfortable, but you get better pretty quick.

A (40:10)

You're also littler, you're also active. You also seem to be good at things you put your mind to. So, I mean, you and I are the same size. You're a small. You're a small human. So for you it's going to be easier.

B (40:21)

I have a much bigger ass than you.

A (40:23)

Yeah, well, everybody does.

B (40:27)

You were on stage at south by Southwest, like the day after I was on stage at south by Southwest. So that was super fun. It was like two years ago now. Two and a half years ago.

A (40:35)

Yeah. But we've seen each other since then, haven't we?

B (40:37)

Tragically, no.

A (40:38)

That's that. Well, first of all, I feel like I've seen you.

B (40:41)

I just don't. I haven't come to Texas enough.

A (40:44)

But you're actually good enough guests that maybe we could do it remote.

B (40:47)

Such an honor. Okay, but you heard south by Southwest. And it was. People were doing a Q and A and somebody asked you, how do you find enough time? And your mindset shift on that person was razor sharp because you said something like, you don't have time not to do this. Yeah. And it was just like, there's like no mamby pamby excuses here.

A (41:08)

And I think that people don't actually like that about me. And I'm sorry, there's nothing I can do about it. I definitely think that it makes me not a fan favorite, but I wouldn't be being a good doctor, nor would I be being a good friend if I told you all of the reasons.

B (41:22)

Why, like, we got here. Because we're coddled. This episode is brought to you by Peloton Break through the busiest time of year with the brand new Peloton Cross Training Tread plus. Powered by Peloton iq. With real time guidance and endless ways to move, you can personalize your workouts and train with confidence. Confidence helping you reach your goals in less time. Let yourself run, lift, sculpt, push and go. Explore the new peloton cross training tread +@1peloton.com like, did you read the book the Comfort Crisis by Michael English?

A (41:56)

You sent that to me.

B (41:57)

Did I? Yeah. Did I send. It's so good. He's just like, you not moving is killing you.

A (42:02)

But also the reality. There's one more thing beyond that is that women need to be having these conversations because all of the individuals in there were men. And it's missing the connection, the female connection, the. All of those things are somewhat missing.

B (42:17)

I think the mindset shift also that comes from being strong. Like being strong people feels effing amazing.

A (42:24)

Totally.

B (42:25)

But you have to like become the person. Right. It in itself is personal growth worth having. What are you working on for 2026? We got the book coming out end of January.

A (42:35)

Starting my next book, the playbook. January 27th. I'm very excited. It's the book that I wish that I had written the first time.

B (42:41)

I love it.

A (42:42)

It's a very personal book to me, and I am proud of it. And it has a ton of recipes and protocols. Exactly what you do. In fact, I want to challenge you to do it. You know, we'll get Rachel Rubin to do it, too. Let's. We'll get on a group text.

B (42:55)

Let's do it together.

A (42:56)

Okay, I'm down. Why do. Do I have to do it? I already do it.

B (42:59)

We're already on a group text together. Just tell us what you want.

A (43:02)

Do I have to do the pro Redo my program? I'm in a different phase of my program. I go back.

B (43:07)

Oh, no. You know, you do. You do. You. Rachel and I will start at the beginning.

A (43:09)

Okay.

B (43:10)

We'll figure this out, everybody. And then everybody can watch us.

A (43:12)

Yeah, for sure. So that is something I'm really proud of, and I don't say that lightly. I'm not a. I'm going to give myself compliments because it's just not my way. I'm working on my next book, the third book, and I'm still a practicing physician. And what else am I working on? I've got some other really exciting projects.

B (43:31)

We want the female muscle and sex paper because you did the female. You did the male muscle sex paper, which is excellent, as I have two minutes on this podcast. Last muscle is good for your sex life. She published that for men and she's working on the female one, I hear. Allegedly.

A (43:45)

Yeah, we're working on a paper. Allegedly.

B (43:49)

So many things. I'm busy changing the fda. Well, the FDA is helping.

A (43:54)

You were great on that, though. I watched it. You were fantastic. I was so proud of you. I was like, I know her. She's famous.

B (44:00)

Like, that was a good two minute talk. Nailed it.

A (44:03)

You were great.

B (44:04)

It was great. Thank you. Well, thank you for coming on my podcast and loving on me and letting me love on you and helping all.

A (44:10)

The women, and I'm waiting for you to come online.

B (44:12)

I'll come to Texas at some point.

A (44:15)

No, you won't. I'm going to have to put you on remote, which is such a waste.

B (44:18)

I like Texas. I love how big it is. My grandparents lived at the bottom of i5, i35, all the way down i35. So Texas is a little sweet to me.

A (44:29)

You can come train with me. Stay my house. I have saltwater pool. I have a saltwater pool.

B (44:34)

I love that. I have a sauna. We'll talk about that next time. All right, my love, until next time. Lift weights, be strong, get after it.

A (44:43)

Aging is inevitable.

B (44:45)

Suffering is optional.

A (44:47)

That's right.

B (44:48)

Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex Ed Masterclass members. Get the master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor but not your doctor in this format and all of my platforms and guests including on this podcast are not giving individual medical advice or practicing medicine. See in Consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.