Elizabeth Stein 00:00 Hi, everyone. I'm Elizabeth Stein, founder, and CEO of Purely Elizabeth. And this is Live Purely with Elizabeth, featuring candid conversations about how to thrive on your wellness journey.

This week's guest is Dr. Gabrielle Lyon, board certified family physician leading a disruption in modern medicine, one that focuses on the largest organ in the body, skeletal muscle, to support longevity and fight back against the threat of obesity, heart disease and diabetes. She has a background that includes a combined research and clinical fellowship in geriatrics, nutritional sciences at Washington University, and undergraduate training in Nutritional Sciences at the University of Illinois. She's a subject matter expert and educator in the practical application of protein types, and the levels for health, performance, aging and disease prevention. Dr. Lyon’s new book Forever Strong: A New, Science-Based Strategy for Aging Well is out now. In this episode, dr. Lyons discusses the significance of muscle for overall health and longevity. She explains the role of skeletal muscle and preventing metabolic dysfunctions and regulating the immune system. We talked about the importance of protein intake in the diet, how much we should be consuming for optimal health, along with tips for meal planning. She also explains the impact of protein intake on muscle growth, the comparison between plant based and animal based proteins and the role of resistance trading and promoting muscle growth and overall health. This is an absolute must listen episode. I've been following this high protein strength training approach for the last year and must say that I feel my absolute best. Keep listening to learn more.

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Dr. Gabi Lyon, welcome to the podcast. It is such a pleasure to have you on today. I'm such a huge fan.

Gabrielle Lyon 02:48 Thank you. Thank you so much for having me.

Elizabeth Stein 02:50 Yeah, so I can't wait to pick your brain. I myself have been on a muscle-building journey this past year. I feel like I have been very health-conscious my whole life. But it wasn't till about a year ago that I learned more about the importance of muscle and protein. And I have to say it's been an incredible journey. I haven't felt this good and so long. And when I look back out, the amount of protein I was consuming, it's probably a third of what I'm consuming now. So I can't wait for you to educate our community. I've been trying to help educate those in my circle, but your expertise is going to go a lot longer of a way. So let's start with what led you into studying the muscle and your background.

Gabrielle Lyon 03:37 First of all, thank you so much for having me. I have a bit of an interesting background. My godmother was in the group before the Mark Hyman era. So before functional medicine and root cause thinking there was a group of providers that knew that they had to call this kind of medicine and this philosophy, something. It just so happened that my godmother was one of those people. She has a PhD in Nutritional Sciences. I moved in with her when I was 17. From 17 to now, I haven't changed. I haven't changed my interest in nutritional science. I have not changed my interest in skeletal muscle. I mean, of course, those things have evolved. But from a foundational aspect, it has always been Nutritional Sciences.

Elizabeth Stein 04:25 And what was her background? How did she get into that so ahead of its time, it sounds like?

Gabrielle Lyon 04:31 I think that that was the era of thinking about more of the hippie kind of a thing. And what happened was as some individuals went into nutrition and food is medicine, there was a whole big juicing craze, all of the components to that and she just decided to put an education behind it.

Elizabeth Stein 04:55 Well, you're so lucky that you had that influence in your life and you started studying this way. And ultimately, what did that teach you? When was the big aha for you?

Gabrielle Lyon 05:07 So I did my undergraduate in human nutrition, and vitamin-mineral metabolism at the University of Illinois, with Dr. Donald Layman, who is a world-class expert in protein metabolism. And largely much of the information that we talk about now is based on some of his earlier work, which is quite fascinating when we think about how we stand on the shoulders of giants, all of which is important and relevant. And from that information and learning, I decided that I wanted to go to medical school, because I wanted to be able to layer in just not nutritional sciences, but also the capacity to help people from a medical aspect. Whether it was medication or even surgical interventions, I was very interested in being able to take Western medicine and implement it in a way in case there was a crisis, quite frankly. I was very interested in surgery early on. And by the time I finished medical school, I hated it. I was extremely disillusioned with how we practiced, how physicians were trained, and the way that it was deeply pathological. It was all about pathophysiology and what happens when things go wrong, not information on how to make it right, or what one could do. After that, I decided to do a residency kicking and screaming and became very interested in the brain. And I did two years of psychiatry residency, found as one could imagine, it just wasn't for me, switched to Family Medicine, which family medicine is relatively all-encompassing for children, and adults. By the time I finished that, five years later, two years of psychiatry, and three of family medicine, I realized that I had to go back and do something more. And that's when I went back and I did a fellowship in Nutritional Sciences, and geriatrics/obesity medicine. And it was there that I had the biggest aha moment of my career. I was seeing patients during the day in nursing homes, hospital wards, and at the end of life, in palliative care. It was very challenging, and it faced me with my mortality. I fell in love with one of the participants because early mornings, and in the evenings, I was doing obesity medicine research, part of a fellow’s job is that you get to do a project. And my project was on the back end of another project. It was Washington University in St. Louis, out of a very famous individual lab, that was running a lot of metabolism-type research. And I was looking at brain function and body composition. And this idea that insulin resistance begins in the brain. And I fell in love with one of the participants. She was a mom in her mid-50s, postmenopausal, and she had done what the medical community had told her to do, which was eat less and exercise more. She had done all of those things, and in the process, destroyed her skeletal muscle and damaged her brain. And her brain looked like the beginning of an Alzheimer's brain. It was at that moment that I realized that the sickest patients had one thing in common. That the thread that woven them all together was not this obesity epidemic. That the thread that wove them together was this concept of being under-muscled. They weren't over-fat, but they were under-muscled. And that is where muscle-centric medicine came from.

Elizabeth Stein 08:38 Wow. All right, so let's dive into that. Certainly, we all know that muscle is important from a physical standpoint. We can look at the physical side of it and say it helps us to build muscle and or look nice and have a toned physique. But what you found out in muscle-centric medicine is that the importance of muscle is so much more than the physical, and the importance of overall health and longevity. So what does that muscle do for us? Why is it so important?

Gabrielle Lyon 09:11 Skeletal muscle is exactly what you pointed out is above and beyond looking in a bikini. It is the origin of the disease. It is the origin of health in humans, but it's also the origin of many of the Western diseases that we're seeing, including insulin resistance, diabetes, obesity, cardiovascular disease, and any disease that is related to metabolic dysfunction. And when I talk about metabolic dysfunction, I'm talking about a few factors. I'm talking about elevated levels of insulin, elevated levels of glucose, and elevated levels of triglycerides. The primary site for fuel utilization in the body is skeletal muscle. Skeletal muscle makes up 40% of the body weight. This is the target that one needs to prioritize. So number one skeletal muscle is the metabolic currency. Number two, it is the site of amino acid reserve. If an individual were to get injured, they pull from a skeletal muscle in any event of a catabolic crisis. This is the place that your body goes to utilize these amino acids, which are building blocks for everything in anything that you see that has a structure. That is why it is so important that individuals maintain the health of their skeletal muscles because it's not an if. It truly is a wind thing. When are we going to need skeletal muscle, we're going to need it when we get sick. Because we are finding ourselves in a highly or more highly inflammatory state, you're going to need it when you're on bed rest, you're going to need it when you've had an injury, you're going to need it for a whole host of reasons. And that's where having healthy skeletal muscle will buffer that. That's the second reason. The third reason is that it is an endocrine organ system. And when you contract skeletal muscle, you secrete myokines. Myokines are peptides/hormones that travel throughout the body and are unique to skeletal muscle, from both the lace in which it is of origin, meaning it comes from contracting skeletal muscle, to how it interfaces with the body, it can help regulate the immune system.

Elizabeth Stein 11:35 So many important things that to this day, that conversation hasn't been there at all. And so I think it's so incredible the work that you're doing to bring this to the forefront. Because for so long, as I said at the beginning, as I've said, I've been someone who's been into holistic health for the last 20 years and focused on my health, but protein and muscle haven't been part of that conversation. And so getting that to more people is so critical at this time when we're in a state of obesity and health at an ultimate worst in our society. It's interesting, I had been wearing Levels for a while and then stopped. And I was wearing it before my protein intake. And just this past week decided to put it back on to say, what happens now that I'm consuming so much more protein in my diet? And as you were saying about our insulin levels, it's incredible to see that before when I would have half a cup of rice, I would get that spike, and now consuming so much more protein, you don't get those spikes. So that's just one example of the benefits that it has in the body.

Gabrielle Lyon 12:48 Yeah, dietary protein is interesting, it does cause a phase one insulin release, meaning there is an initial release of insulin, which happens from some of the glucogenic amino acids. However, it is not as significant if you were to equate it with a carbohydrate of the same dose. The other thing is those that who eat a higher protein diet typically maintain blood glucose through this process of gluconeogenesis.

Elizabeth Stein 13:19 So we know that muscle is so important. And there are two big ways that we can help to increase the muscle in the body.

Gabrielle Lyon 13:29 There are two ways to maintain the health of skeletal muscle, certainly.

Elizabeth Stein 13:34 So if you can dive into what are those two big ways?

Gabrielle Lyon 13:39 The two big ways are number one, training. Training is critical. That means the input, or the outcome of metabolic adaptation, which is the goal, is probably the biggest bang for your buck. Number two is dietary protein. Dietary protein is required to help recover, and to help build skeletal muscle. And again, there are only two ways to address the health of skeletal muscle. And it's not just about the hypertrophy effect, it is about creating flux. It's about exercising, there is no such thing as a healthy skeletal muscle.

Elizabeth Stein 14:19 Okay, so let's start with protein and with the basics. How much should we be getting in a day? Let's start there. Because I think that conversation in and of itself is hard for people to wrap their heads around. I was home for the holidays, trying to tell my dad how much he needed to eat. And it was like so overwhelming. So how much do we need and some tips around how we get that in a day? Yeah.

Gabrielle Lyon 14:46 the idea of how much we need, we know that the minimum to prevent a deficiency which is certainly not optimal for health is 0.37 grams per pound of body weight. Again, this is the minimum to prevent a deficiency. This does not take us through aging. This does not take us through injury. It doesn't take us through often body composition as we train. Quite simply, what it does is it just prevents a deficiency.

Elizabeth Stein 15:12 And maybe that's just touch on that for a second for people to clear up. When they say, I've heard the RDA say this. Like, why is that maybe not the best suggestion, and how dated that is?

Gabrielle Lyon 15:25 The RDA has not changed since easily the 80s. It was based on nitrogen balance studies. Nitrogen balance studies are or were a way, it still is, a way to look at the idea of what is the minimal amount of protein needed for growth. And it was done on 18-year-old men, which doesn't translate to, again women, women in their 30s and their 40s, pre-menopausal, postmenopausal. An 18-year-old male based on a nitrogen balance study does very little for any kind of health outcome for someone like us, or anybody other than an 18-year-old male. Then I will also pose the question that when we're sick, people will take more vitamin C. The RDA for vitamin C is 60 milligrams. There is nobody that says, “Well, I'm not feeling well. I'm just going to take the RDA.” It doesn't happen. People will take 100, 200, 300 milligrams of vitamin C double, triple, quadruple the RDA. However, when people are sick, they never think, wow, I'm not feeling well, I'm going to take more protein. We haven't thought about these things. It's quietly underappreciated as to how we have been positioned to think about dietary protein. All of the data supports double the RDA for more optimal aging. Individuals when given the RDA, doubling the RDA at 1.6 grams per kilogram, individuals retain lean tissue, lose body fat, and blood markers are calorie controlled, they all do better. The minimum to prevent deficiencies should not be thought of as optimal. Doubling the RDA should not also be thought about as a high protein diet, doubling the RDA would be considered a more optimal protein diet. One would say that anything one gram or higher could potentially be a higher protein diet. My recommendation is one gram per pound for ideal body weight. I think that that is defensible. I also think that there is some flexibility. An individual could eat 0.7 grams per kilogram. For example, if you are a 115-pound female, and you do the calculation at the RDA, it's 45 grams of protein that's not enough. If you were to double that, it would be around 90 grams of protein. Now you're talking about a more reasonable amount. I don't recommend anyone go below 90 grams of dietary protein. But that would be a more reasonable amount. And then, of course, is there any harm in going higher? Well, the dietary reference intakes go all the way up to 2.5 grams per kilogram.

Elizabeth Stein 18:20 Yeah, I was definitely in the camp of eating 45 grams of protein.

Gabrielle Lyon 18:25 It’s crazy. Now, your body composition has changed since altering that.

Elizabeth Stein 18:33 Yeah, it has changed dramatically for the better. Let's take someone who's 150 pounds, therefore they should be eating roughly 150 grams of protein. How do you recommend getting that in the day? Because there was the conversation like, how do I eat that? And for some people, especially some older people who are doing intermittent fasting, and then they're like, how do I fit all that protein in this time? Any tips around that?

Gabrielle Lyon 19:03 I think the first thing one has to think about is a few things, there is a slight bit of nuance to this. And number one, total dietary protein intake is most important. If we were to build a hierarchy, we'd say that total dietary protein is important. If an individual is 150 pounds, anywhere from 150 grams of protein could certainly be a little bit lower, but that is still appropriate. But if you want it to go somewhere in what I would consider a higher-end amount, 150 grams is reasonable. When I think about 150 grams of protein, the next question is, how old is the person? And if the person is older, is that going to be the next question? I'm going to say let's make it even easier. How many times a day do you prefer to eat? And typically, I recommend everybody eat at least twice a day. I do not recommend one meal a day.

Elizabeth Stein 20:05 That’d be impossible.

Gabrielle Lyon 20:07 Well, it's not. There was a really big fan for a while, which is OMAD. I think that again, there are nuances to it. The question becomes, number one, why are you eating? Are you eating to stimulate skeletal muscle? We know that dietary protein stimulates skeletal muscle through this mechanism of mTOR signaling when we are thinking about what is relevant for us and not thinking about mechanistic data, but thinking about how we design a diet that is going to support longevity. How do we define what is important to us? Typically, many people believe it's body composition. And I would agree with that. Because again, metabolic regulation is a key piece. It truly is a cornerstone. The first meal, when you wake up from an overnight fast, is critical. Your body is primed for nutrients. This is the time we have to hit between 30 and 50 grams of protein. What that does is it stimulates muscle, and triggers this responsiveness. It is going to set you up for mitigating hunger. Why do people fall off their diet? They have challenges with hunger. Why do they fall off their diet? They fall off their diet because they can't regulate their blood sugar. And they're driven to eat or they're driven by cravings. When we have a robust amount of amino acids at that first meal of the day which is in dietary protein, a few things happen. Number one, we're not hungry. And number two, we can stimulate skeletal muscle and allow our body to generate its glucose you can have some carbohydrates. But it triggers the body in a way where it becomes more metabolically efficient. So nail that first meal, there's no excuse. 30 to 50 grams, it could be a scoop of whey protein, a scoop, and a half to two scoops of whey protein. And then the second most important meal is the second meal before you go to bed. So that last meal of the day. The middleman, we don't care so much about. So two meals where you optimize for dietary protein between 30 to 50 grams would be ideal to start. And even you said yourself that you would start with 45 grams of protein. Now there is some challenge to that because if you are beating below your threshold, meaning below that 30 to 50-gram mark, you don't stimulate muscle the same way.

Elizabeth Stein 22:48 Now I just saw how much muscle I gained this morning. So I'm getting my protein.

Gabrielle Lyon 22:52 And how much muscle gain?

Elizabeth Stein 22:54 I had gained 1.6 pounds two months ago.

Gabrielle Lyon 23:00 That's incredible.

Elizabeth Stein 23:01 Feeling good about it. So as far as protein is concerned, we have our amount, and breakfast and dinner are super important. What are some of your favorite sources you mentioned first on whey protein? I'm curious, it’s not just protein powder, because that's certainly an easy way or easier way for some people to get it in their diet. Is that your favorite do you have any recommendations?

Gabrielle Lyon 23:23 It depends on the lifestyle of an individual. Protein shakes are wonderful. I think that that's valuable. The other thing that I always recommend people to do is to prepare in advance. We prepare for the week, we make a bunch of lean steaks, we make a turkey for Tatas, and we make chicken shawarma, it's all made and cut up. Because we know that we're going to be hungry, we know that we're going to interface with all of these things. When you plan, you will keep your program. Again, you could make hard-boiled eggs and leave the hard-boiled eggs in the fridge. It doesn't have to be complicated to be efficient and effective.

Elizabeth Stein 24:08 Absolutely. So from a plant protein versus animal protein perspective, they're certainly not identical. So what does that look like when it comes to their effect on building muscle? And if you could talk a little bit about those differences.

Gabrielle Lyon 24:27 According to the literature, especially if you're a young, healthy male, doing a lot of activity and getting a fair amount of protein close to 1.6 grams per kilogram, the data supports that there's no difference in terms of skeletal muscle gain. Stuart Phillips out of McMaster University has published some of these studies. So I think it is important to recognize that as long as the dietary protein is high enough, we can still stimulate skeletal muscle, and you can still build and maintain skeletal muscle. Now the question becomes, how does that work with an aging population? How does that work for the other physiological needs that are not met by plant-based proteins? For example, bioavailable iron, zinc, selenium, creatine, and serine. How do we account for these things? In the short term, we know that plant proteins can be adequate to help build muscle and maintain muscle. What does that look like for an aging individual? And how does one develop in their 50s, 60s, and 70s, when they potentially are eating these foods over a long period, with lower bioavailable nutrients, and the carbohydrates that run along with plant-based proteins, if an individual doesn't want to rely on solely processed foods. This is where the challenge becomes, again, where are you at? And why are you eating purely plant-based? And there's the short-term impact and then the long-term recognition of how do we want to age.

Elizabeth Stein 26:08 So how about the fact that plant proteins aren't complete proteins necessarily? How does that factor into our protein intake and affect building muscle?

Gabrielle Lyon 26:21 Certain proteins are adequate, for example, soy proteins. But the challenge becomes getting enough of the protein to bring up those amino acids to an appropriate level. We've all heard of rice and beans to get a complete protein. It's not that all plant proteins are incomplete, it's that they are of lower quality. quality meaning the amino acids needed by the body and the bioavailability of the amount of protein. For example, if you look at the back of a label, and you look at the back of the protein, and the amount of protein that it says on the back of the label is 30 grams of protein. That doesn't mean that there are 30 grams of bioavailable protein, the amount that the body would “see”, I say that cautiously, it's probably 15 grams of protein. Versus if you look at the back of a label from an animal-based product, and it says 30 grams of protein, it has 30 grams of bioavailable protein. So we have to recognize that it's not just the protein quality or quantity that is a better way. It's not just about the protein quantity. It is also about the quality absorbability and digestibility.

Elizabeth Stein 27:36 So is there anything for people to look out for or good rules of thumb when they're looking at those plant-based proteins?

Gabrielle Lyon 27:46 One can assume that a plant-based, protein is nearly always a lower-quality protein. There are rice peatlands, you can look at the back of the amino acid profiles. But that is a bit complicated and not necessarily user-friendly for the average person. One way to think about it is that animal-based products are of higher quality, this is not an emotional decision. This is not an opinion, this is just based on hard, fast biological numbers. And then on the flip side, if you are ingesting, and you prefer plant-based proteins, how you would tackle that would you would you would eat anywhere from 35% more total calories of that protein. Again, if you care about calories, it's not necessarily metabolically effective or efficient for where you want to go. So, that's how I would think about it. But the biggest question is, understanding what your values are, and how you think about designing a diet. I think the best way is both plant and animal because they do different things. They have different benefits.

Elizabeth Stein 28:50 So I know we're all unique. And just to your exact point that it depends on what you're looking for, what your goals are, what your ethics are all of those things. But still, we'd love to hear what's a typical day of your protein intake. What does that look like?

Gabrielle Lyon 29:06 I'm tiny. I'm actually around 109, 110 pounds, 5’1”. And my protein intake is around 110 grams of protein. This morning, I had breakfast with my kids. I had egg and Turkey, had around 45 grams of protein, had a little bit of spinach, had a little bit of mushrooms in there, had some coffee with a shot of espresso. Then took my kid to the physician because I think that she fractured one of her metacarpals, it's the whole thing. That's kind of how it rolls. That's where I've started and I haven't had anything else yet. It's 11:30. Today was a little bit of an odd day because we had to go to the doctor, but I hit my target meal and I'll eat again in another hour. Once I'm done, I'll have one more meal. I'll sit down and have a meal with my family. And that will be tonight. I already know what it's going to be because I’ve already prepped and planned. And we use certified Piedmontese. I don't know if you've ever had that meat, but it's amazing. And if you guys love that, you can message me. I'll give you a discount code. I don't have any financial relationship with them. I'll tell you what it is. But it's GLYON. And I think it's like 20% off. Again, I have no financial relationship with them. I just love their product so much that I got the code for my patients so that they can have it. I know exactly what we're eating for dinner. And I'm really big into shishito peppers or green beans, something like that, and have some rice. Yes, I eat rice, not the devil. It's okay. Today is an off day from training. I won't be too carbohydrate-heavy today, because I'm not gonna have a training day. Maybe some outside time, maybe some yoga with the family, ice bath, call it a day.

Elizabeth Stein 31:00 Sounds lovely. Sounds perfect.

Gabrielle Lyon 31:03 That's it. So that's what today will be in terms of food. The last meal is planned. That will get me right off the bat, I'm thinking around 100 grams, and then I'll have something in between which will bring me up to that total protein intake.

Elizabeth Stein 31:19 You just mentioned carbs and curious just to hear your point of view on carbs and fat. Certainly, the conversation started. We know that muscle is so much more than just physique. But there are certainly a lot of people who are also interested in the muscle impact on our physique. So curious to hear your point of view on carbs, fats, and all of that good stuff.

Gabrielle Lyon 31:44 I am certainly not anti-carbohydrate. The current American eats 300 grams of carbohydrates today. The current Recommended Dietary Allowance is 130. You can adjust higher or lower depending on your metabolic health. I have about 110 grams of carbs a day, maybe sometimes higher, depending on my training. The carbs that you eat are important. It truly is about total calories. The carbohydrates that we choose, we tend to choose fibrous carbs. But again, we will eat rice and my family will have sweet potato. We have no issue with carbohydrates. We do eat fruit too. Again, fruit is fructose, and fructose is not utilized by skeletal muscle. So if you are eating fruit before or after a workout.3333t, that's not ideal certainly, because that's fructose. Your skeletal muscle doesn't use that. But the more healthy skeletal muscle mass you have, the more mitochondria you're going to house and the more carbohydrates technically you will burn. And again, how do you begin to think about carbohydrates? One rule of thumb is I don't go above 50 grams per meal outside of exercise, because then you will stimulate a robust insulin response and not as not a positive. We don't want continual ebbs and flows of insulin.

Elizabeth Stein 33:09 And how about from a fat perspective?

Gabrielle Lyon 33:13 It depends. The way I think about fat is from a total calorie perspective. If your total calories are in check, and you have your protein where you want it, you can determine what you're going to have for fat or carbohydrates. Totally up to you.

Elizabeth Stein 33:26 Interchangeable.

Gabrielle Lyon 33:29 For me, I do much better on carbohydrates than I do on fat.

Elizabeth Stein 33:33 So as we said, no one size fits all. It's personal. So whatever works best for you. And you can feel that. As you think about bringing this conversation into the forefront of the world today, what have we gotten wrong? And why has this conversation not been part of the dialogue on the importance of muscle?

Gabrielle Lyon 33:57 The primary dialogue, again, it's beautifully in line with standard medicine, and standard medicine is disease treatment, not prevention. And when we talk about disease treatment, then we have to talk about obesity, because that is the external driver of the things that we see versus the symptomology that obesity is which is unhealthy skeletal muscle, we have to appreciate how the system is set up is not a root cause approach. That is where muscle-centric medicine comes from this idea that skeletal muscle is at the root of things like insulin resistance, obesity, cardiovascular disease as a driver of unhealthy metabolism, and even Alzheimer's disease. The root of all of these things is an efficient and effective metabolism that allows for the primary blood markers that we're looking at to be within an optimal range. The way that we are going to do that and leverage that is through the health of skeletal muscle. Period. End of story. And that, quite frankly, is where disease begins. By the time you've gotten to the place where you have elevated levels of triglycerides, elevated levels of insulin, elevated levels of glucose, you have gone very far off track, and you either have, number one, low skeletal muscle mass, or number two, unhealthy skeletal muscle mass.

Elizabeth Stein 35:23 Certainly, your new book is going to help bring this conversation to the forefront for people. And there are so many great tools in there for people to look at from your recipes and plans. So the other big part of it is on strength training that you talked about in the book. So, let's touch on that. And what does that look like, what's an ideal strength training program? How much time and energy should we be focused on to see those results in growing that skeletal muscle mass?

Gabrielle Lyon 35:54 The first thing that you have to think about is, number one, resistance training is non-negotiable. So it is well established, that it is an effective intervention for sarcopenia. It is an effective intervention to enhance muscular health, strength, adaptation, size, and endurance. We know that resistance training, which is moving something against force, is a key to this. And then the next thing that we have to understand is, what is the goal? The goal isn't to do this specific program with this amount of weight and call it a day. The goal that we are looking for is an adaptation. We are doing this repetition, this load, we are doing this activity to gain better health and to become better and more capable in life. That could be 3, 4, or 5 days a week, depending on how you break it up. A great starting place is three days a week of resistance training, could do 10 sets per muscle group. Again, these are very broad recommendations. I cover this all in the book. But the goal is, again, you're going to put in the effort, you are going to train each muscle group twice a week, again to start. And if you're a non-trained individual, you will begin to see benefits more quickly. The key is also consistency. People will always mention something about that. But three days a week is a great place to start. Because resistance training is non-negotiable. But you cannot go in there and be on your phone and be distracted. That is not what we're looking for. We're looking for the creation of a stimulus and response.

Elizabeth Stein 37:41 In other words, it needs to be hard. You can't be lifting five pounds, for some people, a five-pound weight could be challenging at the beginning, but that perceived exertion, right?

Gabrielle Lyon 37:53 Right. Perceived exertion. That's a really good point. And then the other part of this is, you're correct, it does have to be something that is creating a bit of stimulus where you are getting tired, and potentially you cannot do anymore. There are multiple ways to get a stimulus, whether you are someone who is just going to lift a five-pound weight and then doing it for 20, 25, or 30 repetitions that could be one way, as long as the volume is there to create the stimulus. But the other component to this is doing something that you're going to see results from which is can you continue to do? How long is it going to take you to burn out on a lower amount of weight? Do you want to train for two hours a day or want to get it in there for 45 minutes and focus on the stimulus and hopefully the compensatory adaptation? And then the next thing that I think about is adding in some kind of high-intensity interval training. There's a lot of discussion around VO2 max, it is important. It is correlated to longevity, the better your VO2 max is, one way in which people train their VO2 max is slow, steady state “zone 2” training. You don't have to do it like that. I'm a mom with two very little children and a husband who is in a surgical residency. I do not have hours a week to dedicate to zone 2 training. So instead, 20% of my training is high-intensity interval training. It's not that much. I might go for a total of 10 minutes of work two times a week. So, it's a total of 20 minutes of high-intensity interval training. It’s doable.

Elizabeth Stein 39:45 Seems doable. So what is the best way, in your opinion to test our bodies for the amount of skeletal muscle that we have? And is there a rule of thumb of what that number percentage should be?

Gabrielle Lyon 40:03 It's quite challenging. We can't say that we know the optimal number of skeletal muscle mass for any individual. There are charts, of course, that look at appendicular lean mass. Quite frankly, I'm not impressed with these things. There is information that talks about if you're sarcopenic. But we don't even measure skeletal muscle mass directly routinely. DEXA doesn't measure skeletal muscle mass directly. DEXA measures bone, and certainly volume or blood, and then lean tissue and adipose tissue. But it doesn't directly measure skeletal muscle mass. It is an extrapolation. That's a challenge because it's such an important organ system, it also doesn't measure the quality of the tissue. Eventually, we will go to a place where we are measuring something called d3 creatine which is a deuterated creatine. It's a tagged creatine, we'll be able to directly look at skeletal muscle mass. We're not there yet. For the general population, a DEXA or an InBody will do at this time. But it's not what I would consider to be ideal because it takes about a 10% change in muscle mass to register on a DEXA. The change might not be that drastic for people. They might be having incremental changes. There are challenges with these things. I'm sure everybody would love a perfect answer. And unfortunately, we're not there yet. But eventually, we certainly will be. But if someone knows their appendicular lean mass, a low lean mass would be considered less than 19.75 kilograms for men and less than 15 kilograms for women. But most people are not looking at their appendicular lean mass.

Elizabeth Stein 41:58 Well, hopefully, there's some sort of a scale that comes out that makes it a lot easier for people to be able to look at that.

Gabrielle Lyon 42:05 There certainly all right now, but again, they're not accurate. A CT or MRI would be great. You don't want to do a CT all the time because of radiation exposure. MRIs are expensive.

Elizabeth Stein 42:17 What do you think are some of the biggest misconceptions when it comes to strength training?

Gabrielle Lyon 42:26 Number one, you're gonna get bulky. The number one thing I hear from women is they're gonna get bulky. And then I always remind them of the strong women numbers and strong women numbers how much does your toddler weigh? How much does your dog weigh? How often are you picking them up? Your dog weighs 40 pounds. Your biceps or not busting out of your sweater because you've been picking your dog up and down. How much do your groceries weigh? It just doesn't happen. Yeah. How much does your suitcase weigh when you're going to put it overhead? 40 pounds, you can't go over 50 Because then you get charged or whatever it is. So yes, number one is the bulky aspect of resistance training, I don't wanna look like a man. The other thing is, that I'm already getting too much protein. It's also another thing that I hear. And then thirdly, the pushback I get from exercise is the bulky. The pushback I get from nutrition is red meat, high-quality proteins are killing the planet or it's bad for the heart. And these things are not true. These are total caloric issues. If you are concerned about saturated fat, you may be one of those individuals who potentially has a reason to be concerned. But it typically is in the light of an overconsumption of calories. It's not inherently a high-quality protein issue.

Elizabeth Stein 43:47 So going back to your first misconception that you're gonna get bulky, and the reality is that it's pretty hard to put on muscle mass. And to my earlier point about my 1.6 pounds, everybody's different, but what is some a number that people could expect over a year question?

Gabrielle Lyon 44:12 It depends if someone is trained or untrained. Typically, women can put on half the amount of muscle that a man can put on. Again, it is totally variable. But if someone is untrained, you might easily be able to put on a pound of muscle a month. But again, it depends. Could you put on two pounds of muscle a month? Maybe? You seem that you did. But again, it depends on where you are with your training. It depends on where you are with your protein, or are you under the muscle to begin with? The more advanced you are in training, the more difficult it is to put on skeletal muscle mass. But as a rule of thumb, I hate to say that they could put on one to two pounds, but it could be true. It truly depends on the individual and their body type, their stimulus response, their training, and their recovery.

Elizabeth Stein 45:09 So as you mentioned, recovery makes me think just to have supplements, and curious to hear what supplements, if any, you recommend that you do for yourself or that you recommend for your clients and community.

Gabrielle Lyon 45:26 I have a handful of supplements I love. Number one, I wish I had invented this supplement myself, and it's called Mitopure. And it's urolithin A. Have you heard of it?

Elizabeth Stein 45:36 I haven't taken it. But I've heard of it.

Gabrielle Lyon 45:38 I wish that I had invented it, discovered it, and patented it myself because this is a post-biotic that has been shown to improve muscular strength and endurance. And it's so fascinating because it does highlight this gut-muscle connection. I wish I had done that. And we take anywhere between 500 to 1000 milligrams a day.

Elizabeth Stein 45:59 Okay. Gonna start taking that.

Gabrielle Lyon 46:02 One of my favorites. But that is something that I always recommend and wish I had invented. The other thing is vitamin D, people are typically deficient in vitamin D. I use liposomal vitamin D, just because of absorption seems to be better. Everyone should be checking their levels. There's no reason in this day and age that you don't know. And then a good fish oil.

Elizabeth Stein 46:21 And how much vitamin D do you take? Because again, the RDA is pretty low.

Gabrielle Lyon 46:25  It depends on what your levels are. I like to see individuals’ blood between 60 and 80 when you check your levels, so you would titrate to get there. And then for a comprehensive EPA, DHA fish oil, 2 to 4 grams, if you were going to be crazy with it. But 2 grams is adequate. 2 grams of EPA would be certainly sufficient. And then you could take 1.5 grams of DHA, just find a good Omega vitamin and you can also do an Omega index to see where you are. And then do I like creatine? I do. If you don't eat a lot of red meat, I just restarted taking it. And right now, I am also taking a ketone. It's awesome. It's audacious Audacious Nutrition. But I cycle through these things. So my standards are Mitopure, vitamin D, and fish oil. I'm always taking notes. I would love to throw in a magnesium. I loved throwing zinc. But again, those three are my foundations. And then depending on what my blood work shows, I will add in or take away and cycle through creatine, and magnesium. I should be taking a calcium supplement, calcium vitamin D K2 supplement. So, I just cycle through.

Elizabeth Stein 47:46 I have to try that, Mitopure.

Gabrielle Lyon 47:50 Amazing. Again, I wish that I had come up with it myself.

Elizabeth Stein 47:56 How does muscle affect our sleep? Is there a connection there?

Gabrielle Lyon 48:02 No, probably not directly. One could think about ways in which we could correlate muscle health to sleep. But I think that the biggest driver of good sleep is how in circadian alignment you are. There certainly are muscle clocks, not an expert in those. A muscle clock would be a kind of activity, the natural rhythm of the tissue. I can't say for certain that it would affect sleep. But again, we could also say, what happens with blood sugar regulation? One of the things that I see in my menopausal patients, is that they have low muscle mass and high visceral fat. Their sleep is affected by not being able to regulate their blood sugar.

Elizabeth Stein 48:51 So it ends up perhaps really low and ends up fixing your sleep, at the end of the day when you build your muscle because you're strength training and you're having protein and you're fixing the diet.

Gabrielle Lyon 49:01 Potentially. I would say that on the flip side if you don't sleep, it is more difficult to maintain the health of your skeletal muscle. Versus if you train and maintain the health of your skeletal muscle, do you affect sleep? Well, maybe you affect blood sugar regulation, and that can affect sleep. But I think that the flip side is probably more significant if you're not getting enough sleep, what that is, and how that impacts muscle health.

Elizabeth Stein 49:31 Alright, one last question before we jump into some rapid-fire Q&A. How quickly do you lose your muscle? Let’s say you’ve taken the month off.

Gabrielle Lyon 49:42 If you are on bedrest which is 0 activity, you can lose two pounds of skeletal muscle mass from your legs both younger and older.

Elizabeth Stein 49:50 How quickly? In a week?

Gabrielle Lyon 49:54 Seven days. So muscle mass, you'll lose strength first and then you'll potentially lose mass. If you are out walking around, and your protein is adequate, you will be able to maintain it. If you are physically active and potentially just doing even two days a week of yoga, we have seen in earlier studies that you will be able to maintain that tissue. You certainly won't grow, but you're not going to lose. If you are completely inactive, that is a rapid loss of tissue.

Elizabeth Stein 50:29 That's good to know. All right, we're gonna move into some rapid-fire Q&A. Three things that you are currently loving.

Gabrielle Lyon 50:42 My kids mostly. I am taking a deep dive into hormones, female hormones, and the effect on skeletal muscle, and spending more time thinking. We're building a community. So we built a community that we're going to launch on January 13. And I'm excited about the community, they will be able to come on we'll do Q&A, and I'll have guest experts because the community is everything. We rise together.

Elizabeth Stein 51:10 Love that. Favorite words to live by.

Gabrielle Lyon 51:14 Dedication, discipline, focus.

Elizabeth Stein 51:19 Favorite productivity hack.

Gabrielle Lyon 51:21N o phones, no nothing. And I will say also being aware of the impulse of discomfort and surfing that urge.

Elizabeth Stein 51:31 Love that. A favorite book or podcast for growth.

Gabrielle Lyon 51:37 I love doing my podcast because I listen and learn from other people. I have a book club with one of my best friends Emily Frisella and it is called Freedom Reads. We read a book a month. We're currently reading Indestructible.

Elizabeth Stein 51:55 Is that a community book club?

Gabrielle Lyon 51:58 Yes. It's less than $20 a month. We open it a few times a year.

Elizabeth Stein 52:05 Where can everyone find the podcast?

Gabrielle Lyon 52:09 For the book loving go to freedomread.com. For my podcasts, you can go to Apple, or Spotify, or go to my website, drgabriellelyon.com. And then the community will be there too. That's what I'm excited about. How cool will it be to have a community where we already have 6,000 or 7,000 people in a free community and now we're gonna close it and move it to a different kind of community? It's gonna be awesome. It's of course gonna work out.

Elizabeth Stein 52:36 So exciting. Congratulations. And lastly, what is your number one non-negotiable to thrive on your wellness journey?

Gabrielle Lyon 52:45 Training, resistance training.

Elizabeth Stein 52:47 Love that. Well, in closing, you mentioned community but anything else that's next for you, and what's happening?

Gabrielle Lyon 52:55 The Forever Strong community of course, and we will be offering some free programs. All of this can be found on my website. I have a great newsletter that is also free. I provide a ton of free content because the goal is how we change the narrative and bring health and wellness forward.

Elizabeth Stein 53:16 Love it. Well, Dr. Gaby Lyon, thank you so much for being on the podcast. Thank you for bringing this conversation to the forefront. It's so important. It's been so impactful in my life and hope so many other people have it be impactful in their life. Thank you for being here.

Gabrielle Lyon 53:30 Thank you so much for having me.

Elizabeth Stein 53:38 Thanks so much for joining me on Live Purely with Elizabeth. I hope you feel inspired to thrive on your wellness journey. If you enjoyed today's episode, don't forget to rate, subscribe, and review. You can follow us on Instagram @purely_elizabeth to catch up on all the latest. See you next Wednesday on the podcast.