Muscle Doctor Reveals: Why Building Muscle Matters More Than Losing Fat

Introduction to Proof of Practice

0:00Hi, everyone. Welcome to Proof of Practice. I'm Gabby Reese, and this show exists because we have spent our lives around athletes, scientists, trainers, and high-performing people and women, and we are astonished by how much misinformation gets handed to women about their own bodies. So we built this as a place to cut through it, real research, real experience, and more importantly, real conversations. Today's topic is one that we feel incredibly strongly about, no pun intended. We're talking about muscles specifically, why building it is one of the most important things you can do for all aspects of your health.

0:36Now, I want to be clear about something up front. This is not a conversation about aesthetics. I don't care about the shape of your arms. I care about whether you're going to be fully alive and fully functioning at 70, 80, and 90. And the research, which my colleagues here are going to walk through, is unambiguous about what makes that actually possible.

Personal Experience with Lifting

0:56I've been lifting heavy things my whole career. And listen, as a volleyball player, working mom, and now in my 50s, I can tell you that the relationship I have with my body and my muscle and what I can do with it, it's not what it just looks like. It's one of the best investments that I've had the luxury of making. But I also know I'm not the average woman. I've had access, I've had coaches, and I had a culture around me that supported physical strength. Most women in this day and age, they don't. Most women are still being told to do cardio, to lose weight, avoid heavy weights so you don't get bulky, and treat exercise as punishment for eating.

1:32That framing is not just wrong, it's doing damage. So today, we want to do something really different. I want to pull the research forward, let the scientists talk, but also get practical about what it means to build muscle. With me today are three women that I love and respect enormously.

Introduction to Dr. Gabrielle Lyon

1:48Dr. Gabrielle Lyon, she's a physician and the founder of Muscle Centric Medicine. She's probably done more for the conversation around muscle and to shift the clinical conversation from fat loss to muscle gain. Dr. Abby Smith-Ryan, who's an exercise physiologist at UNC, whose research on women's physiology and body composition is changing how we think about training. And Amber Taylor is the chief digital officer at Les Mills and invests in women's health, and is someone who thinks about this at the intersection of data and technology and lived experience.

Talking about Muscle with Patients

2:21So I'm going to start with you, Dr. Lyon, because I feel like you have dedicated I don't know how many years to really not only talking about muscle and being a cheerleader for why it's so important, not only for everyone, but specifically for women. That's been about 20 years, not that anyone's counting. I want to ask you, like, right away, how do you talk about muscle when someone comes to your clinic, to your practice?

2:52Because I think that that's a starting point for a lot of people. It's sort of this thing over there, muscle. Yeah. Well, they're self-selected, obviously. If they're coming to our clinical practice, they're already interested in muscle. But body composition, we started out this conversation, and we've had many conversations collectively about how muscle is more than aesthetics. And I will say, if aesthetics and looking good naked or in a bikini is going to get you into the door, that can be our gateway drug. I'm totally good with that. And then very quickly, we have to shift to the understanding that it's the focal point.

3:27And we are going to see more and more emerging data that now creates what is, quote, out there and bring it together to muscle as the focal point.

Muscle as a Focal Point for Health

3:36Things like PCOS, infertility, things like cardiovascular disease, Alzheimer's disease. And as physicians and in the medical community, every doctor has their own specialty. Cardiologists see things through the lens of the heart. Endocrinologists might see things through the lens of the thyroid. But there is always a unifying anchor. And one could take that as a metaphor for life. And my perspective is that is muscle.

4:08And muscle anchors the cross-connection between all of these organ systems and is the lever that we pull or influences, to say the very least, these health outcomes that we care about, like mortality, like heart disease, Alzheimer's, blood pressure, et cetera. And that is how I frame it up. And again, I just recently published a paper that was linking sexual function and muscle mass and strength. And what I imagine and hope to see is that other disciplines will begin to link this and we can move from the athletic realm, which Gabby, Amber, and Abby, you guys have been in this athletic realm for a long time, is that we slowly move this and we cross over to the medical realm.

4:54And that is at the intersection where true longevity or true health or true physical excellence exists. Gabriela, when I look at you, you're somebody who is very, very fit and even muscular. But when you, I think, and that's the thing, right? It's like a body built, like when people think about like muscle build muscle, they're thinking about body building, gym culture. And that's not what you're talking about. You had said something earlier that I really, really appreciate.

5:25And it was all about this cultural perspective. Volleyball has its own culture, track, football, but for the normal people and the people that have then stepped out of athletic performance, the closest thing to a culture that we ever got was CrossFit or, you know, you've got the marathoners. But we do not have a house of strength culture, and that doesn't exist. And that is what I hope that we are building. You know, I wrote the book Forever Strong, the Forever Strong playbook, but I didn't just write it because I thought it was fun because writing it, listen, I'm writing the third.

6:00We all know that none of that's fun. But there is a potential here that exists to have a movement, a movement of strong female stewardship beyond the self-help books of, you know, be a badass and blah, blah, blah, blah, but really a cultural shift that we're at the precipice of having. Because if we don't, in the 90s, the obesity epidemic hit, right, 1980, these guidelines, 80s, early 90s, these guidelines came out.

6:32All of a sudden, we spend the next 50 years trying to address obesity. We are at the next intersection of a new epidemic, and that epidemic is going to be sarcopenia, which is low muscle mass and function. With the use of GLP-1s and with our sedentary behavior and our lower protein diet, we are witnessing, for the first time since the obesity epidemic, the beginning of a new epidemic. And if we do not pay attention, it's going to happen right underneath our noses.

Building Muscle for Beginners

7:00Abby, so someone's listening and they go, okay, I believe you. I know you guys. I believe you. I know there's a lot of science. Maybe you can start to break down for us, what does it really look like to build muscle, whether it's through movements, we're getting killed with the protein conversation over and over, but maybe just some of the cornerstones of having muscle, gaining muscle, keeping muscle, and the things that we need to do that.

7:33I have so many thoughts, but I want to just dial into a couple of things. So first, Dr. Lyon gave us this great view of what muscle is related to. And one key thing that I think we need to dial in on is the importance of strength and function. So she mentioned all the clinical things, and coming from a physiology side, strength and function is so underrated. I'm like, no, you don't need to be strong like a bodybuilder. You need to be strong to be able to carry your kid, carry your groceries, catch a fall.

8:04And so when I think about from a physiology perspective, the function of the muscle goes in hand in hand. Like we're talking about muscle size and muscle mass, but I also bring a lens of you may not gain muscle, and maybe that's not the goal, but you also want to maintain muscle with the goal of increasing strength and function. So just put that in place because an important physiological component that we know in both men and women is really around our 30s. So the third decade is where we start to lose muscle.

8:36Now, I'm not good with that. And part of why I'm in this space is, although that's what our textbooks say, and that's what the research says, and our bodies do lose muscle, it also changes shifts from, we have type 1 and type 2 muscle fibers. So ones that are like more fatigue resistant and ones that are more powerful that might help us catch a fall, our body switches from more of those powerful muscle fibers to more of our fatigue resistant as we age.

9:08We also lose muscle as we age, but it doesn't have to be that way. And it's very clear that if you load the skeleton, you can absolutely 100% gain muscle until your end of life. Like we have data into perimenopause and even into, you know, 80s and 90-year-olds increasing muscle and strength. And so I want to say like the data is true and you do lose muscle and strength, but it doesn't have to be that way.

9:39And that's where I really want to dial in of, okay, well, what do we do then? Let's talk about, you know, about what happens, but what do we do about it? And I think that's where we can all give perspective and maybe we can come back to that. So yes, your body changes, but there's a lot that we can do for that to help maintain the size, the strength and the function of our muscle. Are there certain moves, you know, we sort of have our primary patterns of, you know, squat and push and pull and walk and all these things. Are there things that baked in if somebody said, hey, listen, I can't, and I don't really want to dedicate like so much time to this, but this matters to me.

10:17Is there, is there things that show up that you go, hey, this, you're getting the greatest return on these types of basic moves for supporting not only strong muscles, but Gabrielle Lyon will talk about even actually the, the, the quality of muscle, the importance of that. Are there things that have shown up that you go, hey, it's pretty tried and true to cross the board for a lot of people because people are different how they build muscle and react and things like that. But overall, I think that this is amazing.

Measuring Muscle Quality

10:49I just want to jump in here that we have Abby here because the reality is when we talk about muscle quality, it is a very underappreciated metric in the medical field. When you get a DEXA, you measure body fat percentage. The lean mass is bunched together and is extrapolated. So you're looking at bone and body fat directly. The rest is extrapolated information, which means that it can include organs that looks at muscle, but it doesn't look at the quality of muscle tissue and muscle is fascinating.

11:25And I used to do muscle biopsies, which is the worst when we were doing research on body composition and fat is in a few places in muscle. It's underneath the fascia, between muscle groups. There's also muscle that infiltrates in through the tissue itself, the muscle tissue itself. It looks like marbling or a clinical word for that would be myosteatotosis, fat. You know, you hear about visceral fat and then fat within the organ, like fatty liver. Just like fatty liver, there can be fatty muscle.

11:58We've all eaten it. It's called Wagyu, not to be gross or graphic, but just in case you want a visual. And then there is the athlete's paradox. There is fat that serves as fuel, which is close in proximity to mitochondria. Why is that interesting? Well, because muscle is underappreciated in terms of the quality. We talk about body fat percentage and fat is very homogeneous, meaning, you know, the morphology looks pretty much the same.

12:31If I were to take the fat out of my body, it would be very similar to whatever fat is on Abby's body. But if I were to look at the muscle tissue, it is very heterogeneous, meaning the fiber types in Abby are going to be very different to the fiber types in me, to Gabby, to Amber. And this becomes relevant because it's not something that has been identified as a, it is important to address the quality of muscle. And with increasing fat content outside of the athlete, it decreases contractility.

13:05It decreases its metabolic function. And so all of the things that we love about muscle change. And I'm going to say something that I think is going to be controversial, but it's going to be proven to be true in the next couple of years. That is the fat that in that body fat is almost an irrelevant number that right now we take body fat measures. We go to the doctor, you get your body fat percentage measured. It's probably an irrelevant marker. Obviously, if you're getting up to 40% or something like that, then you see metabolic derangement and maybe that tissue is a problem.

13:38But the fat that is in the muscle is probably more important as it relates to insulin resistance, cardiovascular disease, health outcomes, than the body fat percentage. I just want to let that land because that is something new and unusual that people might not have heard before because we've been so focused on body fat percentage. It's outdated. It's the wrong entity that we're looking at. Where this segues beautifully into Abby is in the research world, people are looking at muscle quality to find not by strength, but actual morphology of that tissue.

14:13I was just going to add to that. So it's so interesting that you say that's novel. It just shows you what a nerd I am and the day-to-day I live in is that isn't novel. We've been looking at it. I mean, I've published multiple papers on muscle quality, but really an imperative translation to clinical care. I think the hard part is how you measure it. I don't know if you guys knew this about me, but I'm a body comp nerd. I love body comp measurement and have hundreds of papers on that because people get it wrong.

14:43Like DEXA doesn't allow you to understand what's inside the muscle. It's a good overall tool. No one has access to MRI. Like it's how do we bring it to what people can use? And it goes back to what Gabby asked about, okay, well, how do we build muscle? I think one question is what are we measuring? So if you, you know, I think women and anyone is motivated. If you tell me my goal is to build muscle, I want to watch that. I want to track it. I want to understand how it's moving.

15:14And if it's not, I want to adapt. So how you measure is really important. And I would say for most people, you currently can't measure muscle quality unless you come to my lab. So come on over. But another way is to globally look at either fat-free mass or lean soft tissue, which would be from different devices. And then just measure that over time. So it's not about being right. It's about some of that tracking changes and then understanding how that moves and what are you doing to move it or maintain it.

15:47And oftentimes, not always, it does match that muscle quality if you're doing the right thing. So, you know, I think sometimes it's frustrating. And I wish more people could get measured muscle quality. But it does relate to muscle size in some respect if we're over time, if we're tracking. Can I ask a nerd question? I know that Gabby is technically hosting the podcast. But can I just jump in here with a nerd question? It's kind of like the view but different. Do you guys, you guys probably use ultrasound, right? We just finished a study that used MRI, PQCT, ultrasound, DEXA, obviously not DEXA for muscle quality.

16:26So we've tried to use all of it to try and say what's the most translatable. Okay. So my next question is, and because this has been on my mind for a very long time, is the flux is really fast, right? It's intramuscular or is it intra, there's the verbiage here is particular, there's intramuscular, the myosteatotosis flux, so the fat that we would think would be pathological. That's really, again, guys, this is my nerd question, but it seems to me as if a bout of training or in real time, you could see utilization of that fat tissue, right?

17:03So it would be very unstable to measure because it would be highly dependent on the meal or how much is already in there. Is that right? Yeah. So, like, we can change it with one exercise session. And so usually when we measure, we have very strict guidelines around fasted in the morning, no exercise, no alcohol, and still some variability. But, again, it's using that person over time to be able to detect that. Okay. That's helpful. This is me selfishly from a clinical perspective because if we could get the totality of data, then we could say, hey, if your muscle fat is at 5%, you are at risk for PMOS, you are at risk for infertility, you are at risk for osteoporosis.

17:44Because what I care about is clinical outcomes, and I think that we could really begin to define this for the population. So that would be really interesting to see what we can measure and, over time, what that looks like because it's more important than body fat percentage. A hundred percent. And we have data that shows how that relates to blood markers of insulin, even hormone changes and strength. What about people who can't afford to go and get those tests? What can they look at and what can they measure? And also, can one of you bottom line the difference between strength and muscle so people know what are they measuring and then what's the difference?

18:21I'll go with the at-home measurement. And then, so one thing I tell people, it doesn't have to be the most accurate. Like, I actually, like, there's home scales that are not very accurate. But if you measure in the morning after you've gotten to the bathroom, you know, the ones where you step on without your socks on? Those aren't very accurate, but they're pretty good at tracking changes. That doesn't mean it's actual the real change, but you can say, oh, am I going up or am I going down? Which is really important if you are doing any sort of, you know, pharmacotherapy or exercise.

18:53So, and now most gyms also have, like, a bioelectrical impedance. Again, not the most accurate, but if you are hydrated and kind of measure yourself at the same point in time, we have good data that it's good for tracking changes. So, Gabrielle, you and Abby are both very, like, you want outcomes, you want to start measuring, it's all these things. I think for, you know, let's say the person who's sort of going, this is all going over my head and I want to start today.

19:25There's something that comes up in my mind right away is if someone is slender, like, for example, Amber was a runner and then kind of added in weightlifting, I believe, later, right? So, for someone like that who's already, let's just call them thin, their goal isn't, they're not trying to deal with a body composition or weight loss or, you know, anything like that. Is there a difference between somebody who's sort of at a pretty good weight and then, like, hey, I'm going to start adding muscle versus somebody who's saying, hey, I'm also navigating, I have some extra pounds, body composition, and then I'm going to start trying to add muscle.

20:05Because everyone has heard, you know, muscle weighs more than fat and all of these things. How do you guys sort of help somebody who's starting from these two different places?

Building Muscle at Different Starting Points

20:15Well, if I'm understanding your question directly, and we have patients in our clinic like this, so we have ultramarathoners that have spent their whole life really running but are wanting to add muscle to improve metabolic outcomes. So, I have a six-year-old patient, her name is Sharon. This woman will put me to shame in the gym. She is jacked. She's an ultra, I mean, she's out there, we live in Texas, she's out there gardening. I mean, pulling weeds and chopping on trees. Anyway, she wanted to improve her running ability and didn't necessarily want to, you know, add more muscle for any aesthetic purposes, but she also wanted to improve her lipids and also her blood sugar regulations.

20:58One of the most surprising things that I saw in clinic when I finished fellowship was I would get these women that were, I don't know, 23% body fat. They were lean and they were thin and they were post-menopausal and their insulin was elevated and their blood glucose was elevated. And I couldn't figure it out. And, I mean, it's not true. I could figure it out. But it was just so shocking to me that why were these seemingly fit women having issues with blood sugar regulation outside of hormone replacement?

21:29And it was ultimately that their muscle mass was too low. They were, in essence, maybe they didn't fit the clinical definition of sarcopenia, which we can all argue until the cows come home. Is it strength? Is it mass? Is it, you know, appendicular lean mass or whatever it is? But as soon as we started putting muscle on these women and this one woman in particular, that even if her body fat was still 23%, because we just improved her muscle quality and the amount of muscle, we were able to improve her blood sugar regulation, her lipid profile, all of the things that would be issues for heart disease and Alzheimer's, cognitive function, all of these problems down the line.

22:06So, to make a long story really even longer, if you are running and training, muscle is still really important. Even if the muscle that you have is, say, a type 1 muscle fiber is healthy, we still want to add mass. And this is something that I see people argue about all the time is that mass doesn't matter. Only strength matters. Well, but if you're a woman, I totally disagree. I think that mass also matters because of a place to put glucose. There's other things beyond strength. And Abby, I'm curious as to your thoughts, beyond strength and beyond just mass, where that mass in and of itself is important for clinical outcomes.

22:46I'd love to learn more, too, about different muscles impact different things. People have been asking, do I have to do whole body? Do I just do legs? Can I just do core? Can I just do arms? And maybe we can get to that later. But I'm personally fascinated by, is there a correlation between core to back, legs to something, and working different muscles to have different improvement? Or is it just improve muscle overall? I just want to finish what I realized that I went on this long tangent about all this other stuff and then maybe didn't answer the question directly, is that we moved her from ultra running to lifting two days a week.

23:24And she is strong as AF. I don't know if we're allowed to swear if it's a family-friendly show. But she is so strong and her running times improved. She had already been training. So the amount of muscle that she was putting on is small. It wasn't newbie training gains. And also, there's other things that are really important, like total caloric intake and when it comes to putting on muscle. But she improved in all aspects because we pulled back some of her running and added some training.

23:56So I just wanted to finish out and shout out to Sharon, who I'm going to send this episode to. Abby, maybe you could dive a little deeper into that. Because I think for a lot of – I mean, certainly, you know, I have a friend, a guy friend of mine who used to joke like, oh, it's leg day. Don't you own a pair of pants? And for women, it's like we're comfortable squatting because, oh, maybe my butt will look better. And for guys, it's like, well, how much do you bench? It's all of these sort of compartmentalized types of lifting. When you're talking about approaching this, if somebody – maybe someone has a practice already that's either suggestions on things to focus on, you know, Dr. Lyon said, hey, two days a week really made a difference for her.

24:40Let's say for somebody who's saying, okay, I'm going to add this practice. Is it three days a week? Is one of those days heavy with low reps? And does – to Amber's point, does it have to be all body? What are you seeing as the really important cornerstones to help people enter into, yes, I'm going to tackle kind of building more muscle and muscle mass? So one, I want to comment quickly on this concept of normal weight, obesity, or skinny fat.

25:11We just published a paper on that specifically in women. And it speaks to what Dr. Lyon talked about, about how being small, being skinny is actually not beneficial for men and women, but particularly for women as they age, which then brings us to the question of building muscle. And I love how Dr. Lyon said, oh, yeah, we build muscle. But let me tell you, I've been trying my whole effing life to build muscle, and it's not that easy. And so, like, I really wanted to communicate that absolutely you can build muscle.

25:43You can build muscle regardless of what age, but it is not easy. And it's not like we are putting on, you know, 10 to 20 pounds of muscle. A couple pounds of muscle really moves the needle. And when you do that, it's a mix of loading the skeleton, so like some sort of load that you're not used to. It does involve nutrition. And so, you know, having adequate, not just protein, but adequate calories, or at least, you know, you can still gain muscle on a caloric deficit, but you have to be really intentional.

26:17And then it goes to Amber's question about the movements. And so if I had to reverse the order, like one, I would prioritize how you load the skeleton, and that would be with compound movements. And what I mean by that is, like, hitting movements that hit the biggest muscle groups, your legs, your glutes. When you think about upper body, it's your shoulders, your chest, your any, you know, any sort of compound movement. And then your accessory movements. Like, you know, I love to work biceps because it makes me feel strong, but that's not necessarily going to move the needle.

26:49You know, you start with your lower body, your upper body, doing a push-pull. And we can talk about some examples, but really, twice a week, if you can do whole body exercises twice a week, that is where we would start. Now, many people, based on time, might split up, oh, today is my leg day. And that's fine, as long as you then do an arm day, and then a leg day, and then an arm day. So, like, depending on what your split looks like in time, it's prioritizing those compound movements and hitting those larger muscle groups is where the needle starts to move.

27:24And then twice a week. And then there is really cool data. So, the ACSM position paper really starts to outline, like, if you want to lift heavy and progress, that's a really good way to build muscle. We know that. And that's regardless of male or female. There's new data that shows, too, it's also about volume and lifting kind of to fatigue. So, doing an exercise until you can't do another, that's another way. So, that you can – it doesn't have to necessarily be heavy, but the overall volume is there, or at least the time under tension can help with that muscle change.

28:00And so, kind of compound movements. And then I definitely will want to get your guys' input there. Do you want me to stop there? I think that nutrition piece is a differentiator.

Nutrition and Protein Intake

28:12Actually, let's talk about the nutrition. Then I have a personally, like, a selfish question about something. But, you know, I think people get overwhelmed, and they almost give up before they start about, like, how much protein – I'm probably weighing about 175. Am I going to get 175 grams? There's probably no fair chance of that. So, is there a baseline? Is it 120 grams? Like, what is sort of a baseline that seems reasonable that really would support not only building but maintaining muscle?

28:43And then I'm also curious how each of you kind of eke that in, because how many meals do you skip? You're busy. You're going. Then you try to make up for it. I learned something from Dr. Lyon, which I was so glad to hear, is that, you know, I used to hear years ago, well, you can only absorb about 35 grams at a sitting. And Dr. Lyon's like, no, you get what you get. Like, whatever you're eating, you get it. So, Abby, maybe you can just share, or Dr. Lyon, sort of, like, at least a reasonable baseline that you go, hey, build it or keep it, and then the ways that you guys are doing that.

29:21Can you add when to have it? Like, do you have the protein before or after? Yeah. Let me just give a little bit of research context, and then, Gabrielle, maybe you can jump in. So, one of the things that my lab specifically focuses on is how do we do it efficiently? So, there's ways you can get to the same goal, but if we're talking about adding protein, it's going to be better if it's in your system either before or after. Having some amino acids in the blood around your training can help not only volume, but see those adaptations.

29:54What is enough? Some interesting data that not a lot of people talk about is, like, if you're already consuming 1.6 grams per kilogram, which I would say is a good baseline, is if you want to build muscle and you're already there, then you probably need to level that up a little bit if you're someone that's already consistently consuming protein. And the other thing is timing of maybe you can consume more than 35 grams at a time, given your size, but how big are the windows in between those meals?

30:29You can start to optimize that as well. So, it's not always just more protein is better. It's also maximizing just when it's in the system, when your body's going to use it most. And so, just 1.6 grams per kilogram is where I like to start people, but it also depends on where you start. And so, you know, if you're consuming, I know many women consuming 80 grams of protein, and if you bump them up, even if they're not at 1.6, but they're at a higher level, and they've kind of, instead of 10 grams at a meal, they're up to 20, that's beneficial.

31:02So, it's sometimes those small levers, it's not, you know, I always say eating protein shouldn't be a full-time job, and I think we've made it that way. Those small changes can matter. Amber, what about you? Because I feel like you're busy, and you don't seem like somebody who would eat a ton of protein to me. I don't know why you're saying that, Gabby. No, Amber? I'm just kidding. You're just going to call her out. Yeah, well, I mean. I'm still working on it. I had one more question on the protein, too.

31:33I'll tell you what I do, because, and again, I've learned this after meeting you guys. I didn't do this before, but I put, not protein, I put collagen in my coffee every morning. I need to try a different protein to put in the coffee. I learned that also from you and from Stacey. Always have protein for breakfast, and then every meal will have some kind of a protein and a vegetable. So, lunch will be fish and veg, and dinner will be the same. Probably still not getting nearly enough. But I had another question.

32:04If you eat too much protein at the same time, does it make you poop? You mean, does it make you constipated? No, poop. Like, have you ever had four hamburgers, and then you're like, oh, shit. No, 100% not. Never had four. I mean, no. Just full stop, no.

32:24That's coming from the fat in the hamburgers, not the protein. But also, I mean, I'm not sure what to even think about that. I want to weigh in on this, because this is hilarious, the hamburger story. So, when you guys are ready, I want to weigh in on the protein. Take us to the kind of baby. I want to ask if this is a cheat code. So, through injury, I've learned to train with restrictive cuffs, blood restrictive cuffs.

32:55And then I started utilizing that as a tool also in my training. Listen, it's not comfortable. I used it to keep muscle size if my knees were sore, I could train and not have to lift as heavy and get blood flow into the area. But what I have found is that it's been a wonderful tool in my training to develop bigger muscles. And so, how do you guys feel about that? Because it seems I have personally really enjoyed it.

33:27I mean, the training itself is not comfortable, but it's been a great tool. I think there is a lot of good evidence with blood flow restriction, especially in injury. We've used it in the military operator space. People have been using it for a long time. And I believe that Abby would agree. Tell me why we can circle back to nutrition, because there's two things that I really think are important to add. I want to just say one thing quick that I think is important on the injury thing.

33:58So, we know that if you're active, you're going to be injured. It's just, it happens. Okay. But the one thing that happens is you also then change your gait or change your routine. And I think that's where resistance training and building muscle comes back to play, of where it can be really beneficial and therapeutic, whether you have access to blood flow restriction or not. But for instance, if you have a knee injury, most often building your glute and your quad can help that knee injury. And so, this building muscle is not just aesthetic and it's not just, you know, insulin and glucose.

34:33It's also so important to continue training when you're injured because it's often a better way to heal, obviously. And there's a lot of really cool data on cross, basically, if you train one limb, it helps with strength in your uninjured limb. And so, like, I guess more power to the people of like, even if you're injured, like find a way. It's going to help you become, recover faster, especially if you add the nutrition component. So, maybe, Dr. Lyon, if you want to build in that element.

35:07All amazing points. I wanted to circle back to the protein. People believe that, or they would like to believe that there's one protein number for everybody. People always say, well, how much protein do I need? And the way that we think about protein is making protein decisions. Number one, age. The older you are, the more protein you need. People are like, what? Yeah, my five and six-year-olds are totally anabolic. They're still growing.

35:37They can get an anabolic stimulus with five grams of protein. But we need protein for a number of things. We need protein for muscle protein turnover. We need protein for all the enzymes. We need protein for serotonin production and mucin production. Each of these amino acids do various things in the body. So, when we make protein decisions, if you see online, if someone listening to this or watching this, sees online, well, 100 grams of protein is the number. Well, it depends. It depends on age.

36:08It also depends on physical activity. Protein, we think about as a U-shaped curve. Why do you need more protein if you are active for recovery, repair, for utilization? But also, if you're sedentary, you need more protein. So, the worst of all worlds would be a sedentary person on a lower-protein diet because now we're not stimulating muscle either way. The third thing is, what do you prefer, right?

36:39What kind of protein do you prefer? Do you prefer plant protein? Do you prefer animal protein? The higher your protein from plant sources, the more total protein you need. If you choose more animal-based sources, potentially the less protein you need because it comes down to quality. The other thing is, in women particularly, I'm trying to think about how to say this, is we don't like to see them less than 100 grams of protein for the following reasons. It seems as though, from the research that we did, that individuals, that once they go

37:14below 100 grams of protein, it seems to lose some of its beneficial effect in the following. When carbohydrates are controlled and protein is high enough, we see lower levels of blood glucose, lower levels of insulin, and better triglyceride profiles. There's also this idea of this thermic effect of food, which we don't believe, myself, Don Lehman, don't believe it actually is from the food, but it's from the machinery of muscle. So if you lower below 100 grams, it seems as if it doesn't have that same beneficial effect,

37:48even if total calories for both groups is the same. So don't go, this is my personal and professional recommendation, we never recommend someone go below 100 grams of protein a day. I think if you tie that back into what Amber said, she has protein, I would say we need a different protein at your breakfast, but you basically have protein about 30 for breakfast, 30 for lunch, 30 for dinner. You're not at 100 grams. And so that's where, I guess, I know what I would recommend, but Dr. Lyon, what would you

38:22tell her? And the 30, 30, 30 miles, so 30 grams, three times a day actually came, originated with Doug Patton Jones and Don Lehman's work. And they, you know, the late Doug Patton Jones. So Don Lehman is my mentor of over 20 years, who Forever Strong was dedicated to him. And he said it was the biggest mistake that he had ever made. They wish that they had never done that because all of these women and all of these people are doing 30 grams three times a day.

38:52So what does that mean? It means that no meal is ever optimized. And so basically what the recommendation is for you, Amber, who probably doesn't want to eat more food, this is where essential amino acids, this is where essential amino acid use comes in. And by the way, if you can see over my shoulder, this is what I personally do every day. So you see, I have lemon-lime packs. I like lemon-lime, I like orange, but these are essential amino acids. So body health means perfect amino.

39:24They are super easy. You put in a glass, you've now increased the nutrient quality and nutrient density of your meal. So that 30 gram meal now looks like a 50 gram meal. And this is what we recommend for all people on GLP-1s, all people who are restricting food intake is the use of essential amino acids, very specifically with a lower protein meal. And for you, Amber, I would consider 30 grams a lower protein meal because we want you as active as you are to be around 50, 50 grams at that first meal and 50 grams at that last

39:59meal. And I think it's very difficult to consume that. And that's where adding essential amino acids, I think just saves the day. And I know Abby's done a lot of work on essential amino acids. And that's how we think about it. Let's put the link to that. Can I just share one more story? Because I have a question on this too. But for a while, I was doing the blood glucose monitor just to test it. I had diabetes when I was pregnant and it went away. And now I'm just curious about the data and then tracking my stress on my aura and my watch. And I found that before certain meetings, I would get really stressed out.

40:32Um, and I found that in the, in the aura data. And then I started eating beef jerky right before the meeting and my stress levels remained flat. And I talked to you guys before about going and trying to lift weights before a certain meeting too. Is there any correlation there? Eat protein before stressful events where a stressful event can be a meeting or a gym, or is that just, I know it's not just in my head because I saw the data for me personally.

41:03I can give what I think, uh, happened is we know that pro, um, so basically if you go into a stressful event or you experience stress, you do see an increase in cortisol and a subsequent decrease in blood glucose, or you'll see a spike and then a drop. One strategy is to add in dietary proteins. You're adding in these amino acids that seem to assist in stabilizing blood sugar. Um, and that would be, Abby, I'm sure has a, either agrees or has another thought, but that

41:36is what I have seen in clinical practice because we do use continuous glucose monitors often. And that is one of the things that we would see. Well, yeah, I mean, the one thing I would add is protein still stimulates insulin and people forget that. So that, I mean, I think it's providing you some fuel. I do want to come back to, so I think women are overwhelmed by getting enough protein and Gabrielle, you just kind of flipped it. In my mind, made it harder for women. You, now you say, instead of 30 grams of protein, Amber needs to have 50, or she needs to go buy

42:11these very expensive essential amino acids. I don't disagree with anything you're saying, but I'd love to talk about, there's other ways too, like what I actually would start with for Amber is like, Amber, up the quality of what you're doing at breakfast, instead of adding a collagen protein, like consider a whole food or something with that, and then add a snack and then like build first on that and then start to add in some of these other things. Like I think 30 is a good base and I would love to see the research. Like I actually love that paper because it really breaks down for people of what it looks

42:45like and a minimum threshold of like, yeah, how do you get 30 grams at breakfast versus 50 and kind of hear how we said it. And so for Amber, it's you adding one more full snack and, you know, bumping it up a little bit. And I love essential amino acids and I think they're really effective around exercise, but for someone like Amber, who's just starting, like let's try and get it through your food, eat more beef jerky, and then maybe have some amino acids before you train because you're not going to have beef jerky before you go train.

43:16So I don't know, like I love, I mean, maybe Gabby, you tell us what you do and we can see, you know, like I think it's so cool how the science evolves and how we evolve and I continue evolve. Like what I say now might be different than, you know, what I say in five years based on what the data shows. I want to start off by saying I miss the mark all the time, but I'm also probably at a place where everything's pretty efficient. So I eat real whole food. So my system's probably pretty adaptable.

43:47And I have had many of times where I take a high quality protein powder, like very high quality, and I'll actually mix a little water with it and then put a little bit of yogurt on top of it and just get it in because I know it's 25 grams or whatever I can get. And it's easy to do. I can, you know, it takes just a few minutes. It's easy to digest because I'm not eating a whole meal. And the other thing that's been really important for me is carbohydrates at night. That's the thing is I train pretty hard and also, you know, I'm, I'm 56.

44:20So for my sleep quality and for my recovery quality, one thing I'm also weirdly diligent about is, is it sweet potatoes? Is it some high quality, you know, carbohydrate with, with my protein? And what I learned from Dr. Lion a long time ago was, could I win the beginning of the day and the end of the day? This really has been something that was supportive for me where, you know, if I, if I missed a little, I could gap fill, but if I really won the beginning and the end, it seemed to make a difference.

44:50But I, I want to remind people that, you know, nobody is getting, I'm not getting my numbers right, but I'm doing a lot of the right things all the time. And so my system overall is supported. And then some days, am I dehydrated? This is a big thing, right? That leads to overeating. I don't feel as good in my workouts. So I try to be mindful of, of being hydrated. That doesn't mean drinking jugs and jugs of water. I'm really diligent about, I will put, you know, sea minerals in there, try to get a little

45:20bang for my, for my buck there. And honestly, not putting stress around any of it. That is the one thing I have learned through all of this is if I, if I make this stressful to this tool that's supposed to make, to support me now is stressful, it's not going to work. And then finally, before I actually put it back to you, Abby, one thing I want to say to people when they're starting to work with loading their body, I personally like to see women, especially learn load from below first.

45:52If it's one thing, if Dr. Lyon wants to go and get under the rack and squat rack, I actually think for women to lift from below their, their loads, because usually you're in a better position posturally as you're learning how to move your body and secure your scapula and do all these things. I like to see people learning to lift that lower body first from below their body. So whether it's a bar, kettlebells, things like that, where I think that that's safer

46:23and it's more comfortable for people as they get used to learning to load before they only put it directly on their shoulders and then their spine and is their technique right and all those things. So I, I, I just want to throw that in as somebody who sees a lot of people moving. I like them to load, especially if they starting to load heavy from below. So we just finished this six weeks of progressive high intensity resistance training in perimenopause.

High Intensity Resistance Training in Perimenopause

46:52One of the first projects that really focuses on perimenopause and we did a full body exercise and I'll go through those movements just to give some specifics. And the reason I don't disagree with, I, we would always start with lower body, but most women, like I think one of the most common things we see in perimenopause is frozen shoulder. And by doing, it's partly because most women don't lift anything overhead. And so working those muscles is really also kind of prevention.

47:22And with that, so I'll just give you quickly, they, these women did leg press and this was 70 to 80, 80% of one RM, um, six to eight repetitions. And the reason it was high intensity resistance training is it's 30 seconds in between each lift and two minutes in between each exercise so that we can get it in 25 minutes. And so again, not the most effective way, but it helps with time. So leg press, lunges, um, bench press, overhead press, bicep curls, tricep extension.

47:57Um, cause so kind of a whole body push pull. And the reason I wanted to bring this up is I was somewhat unsure about with all the anabolic resistance in, in midlife and potential loss of midlife. And, you know, now you have hormones of like, how much muscle could we actually build with very minimal nutritional intake? Um, and I was so surprised by the results, like women were gaining now, arguably we were using

48:27multiple methods to track this DEXA, one of them, PQCT. So we can, you know, we're getting in the nuance, but there was substantial increases in muscle and decreases in fat in six weeks in midlife. So check, it can be done. Body recomposition can be done and it can be done with minimal diet. I think if we modify diet, it would be even better. And so I just say that of like, I would tell most women to do more than just lower body. Uh, but I hear you on the movement. You're just saying start with lower body.

48:58No, no, no. What I'm saying is when they're starting with their lower body, because if they're, if they're pressing overhead with five pound dumbbells to start fine by me, what, but when they're learning to do those lower body lifts, I like them to lift the weight from below or assisted like a leg press app. Oh no, I'm a big advocate. And this is a long lever girl. Let me tell you, this is not, this is a long way to go. And I've had to work really, really hard to be strong in my upper body. So of course I want them to be doing all the things, but I I'm just saying in the beginning

49:29of load for the lower body, lift it from below. I gotcha. The one other thing I would add to that, that I think is a really important part of this conversation is the level of empowerment that these women felt of like, it goes back to being able to lift weights is not just about the muscle and it's not just about the function. It's also about the brain. It's about how it helps you sleep and how it, it helps you conquer whatever the F you want to conquer. And we saw that again and again. And I think that's an important differentiator for men and women.

50:02Not that it's working different, but there's more intangibles that we might see. I think lowering the barrier. I really like what Abby's saying about being empowered. It, it is true and it is a choice. And I do believe that there's only one way to do it wrong and that's just to not do it. Um, and you know, people will say, I don't have time for strength or I don't have time to train. I don't have time for all these things. I can appreciate that, but how in the hell are you going to have time for the other outcome,

50:34which is injury sickness. It just, again, the conversation has to evolve. And if we can give you guys information where you go, oh man, like I have to do it. I, I think it's, it's a reasonable request to set that standard. I also would like to say that if you, I'll, I'll use myself as an example. I do a couple of things really well. I hinge probably as good as it gets. And I have control of my, of my, my scapula, my whole complex.

51:07I am still to this day trying to squat better. I'm still working on that nuance. So I also want to encourage people, even if like it's in a warmup, if you can have somebody or be near a mirror and, and just always be trying to be conscious of moving from the correct places. One, so you can avoid injury, but also inevitably later you'll be able to lift more if you're lifting from the right places. And don't be intimidated. Like I work and train with people and I'll say, listen, you're going to be able to actually

51:38do this move better than I will. So just know that it's like a constant work in progress on some of these fundamentals, but on some of the lunges and the squats and the straight leg deadlifts. And, and I'm a big fan of, of, of snapping and driving and using the hip and kettlebell snap. And by the way, as somebody who's taught over 1500 classes, the number one, one of the number one things I see people doing wrong is a kettlebell snap because they don't want to release their head. So they don't let their hips go back.

52:08Because what I heard was besides breathing, keeping your head upright is, is one of our, our most biological, like natural tendencies. Cause maybe in nature, if our head was off kilter, we were vulnerable. So just either learning the move correctly and then, you know, getting into it cause you'll avoid injury, but also knowing that there's always room for improvement and that's okay. And that's not a reason not to do it. Cause I can tell you as somebody who's still working on things that it's, you know, there's

52:38always room, room for improvement. Um, Amber, I, you know, you, you mentioned it at the top of it and, and, and Dr. Lyon and Abby have both reinstated this. People don't understand this makes you feel within yourself. Like I'm powerful. And, and sometimes we equate so much to the physique and the body, but power is like your inside stamina of reactions, approach to things, the ability to take chances, whatever that is, endure, you know, family work and, and kind of the million things that are being thrown

53:12at people or middle age, this makes gliding into middle age much easier. And so I just want to bring that back to that point, because I think we all differently want to be and look strong, but that's actually not what we're only talking about. We're talking about being strong. So Abby, I think you can take us out of this. And, and, and also I want to remind people that if they want to dive deep into the muscle conversation, Dr. Gabrielle Lyon has already written two books on this.

53:44If you want to geek out and go deep, if you want to really understand the value and how muscle supports your whole system, there's so much information that, uh, she has spent a lot of time researching and breaking down and writing. So I encourage people to, you know, go a little deeper on their own. Hey, fun fact. Do you know what the third book is on? Actually, I think you guys do. Strong women. Yeah. Oh, I didn't know that. Yeah. Look at that. Okay. Well, with that, when does it come out?

54:16November, a year and a half. Okay. Stay tuned. Okay. All right. Well, so to close us out, uh, I just want to leave us with a couple of thoughts. So first muscle is the foundation of health. We lose it not because we age, but because we stopped challenging it. And that comes at a cost declines in strength, mood, cognition, resilience, especially in midlife. Uh, the good news is that the fix is remarkably simple. Lift weights two to three times per week, or just something.

54:49I would say focus on compound movements. If you can, you know, progressively add challenge and fuel it with enough protein. A good takeaway is when at the beginning of the day and end of the day, as a good reminder, I learned something new, I guess, shoot for 50 grams of protein per meal or a minimum of a hundred grams per day. And I'll circle that back of, even if you don't hit that, give yourself grace. These are about goals, not getting it right every single day, learning new movements, continually

55:19improving. And the goal isn't to get smaller. It's to get stronger. Strength is one of the most reliable investments you can make in your future self. And I always say, I am not training to keep up with my kids. I'm training to keep, kick their ass as long as possible and just do something. And if you need, find a partner, find a friend, find a personal trainer. We are all learning. Not every one of us gets it right every day, but we're in this together. Thanks ladies for joining us and for all of the knowledge.

55:50Thank you, Abby Smith-Ryan. Thank you, Dr. Gabrielle Lyon. Thank you. And Amber Taylor. Thank you so much. I'm Gabby Reese. Thanks everyone.

56:07Thank you. Bye. Bye.

56:16Bye.

56:29Bye. Bye. Bye. Bye. Bye.