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the body thrives under activity
and whether you take a human whether you
take an animal if you essentially
domesticate them and they are not
training they will lose muscle you can
only pull one lever so if you you have
two levers you have diet and you have
muscle mass
which would you have somebody pull for
longevity you can have an amazing diet
but you have very little muscle mass you
don't do a lot of exercising or you're
like my swimmer friend and you have in
just incredible output you're exerting
yourself tremendously you've a great
amount of lean body mass we all know
what swimmers look like they look
fantastic um
but your diet is a twinkie diet like you
called it which of those two levers is
going to be more
impactful okay so i'm going to tell you
what the research shows and then i'm
going to tell you my personal experience
so the research would say hey if you had
to prioritize one over the other
prioritize resistance training
okay
that being said in clinical practice i
have absolutely never seen that work
if they prioritize dietary protein and
they get that first meal right
by lunch they feel better i'm not asking
them to wait four weeks you nail that
first meal by the second meal you feel
better you want to deal with body
composition you want to deal with
optimal aging you want to overcome this
concept of anabolic resistance which we
can talk about
the only and most effective now again
this is my personal opinion based on
seeing hundreds and i've been at the
bedside of hundreds of dying people
geriatrics is no joke
and if i could pull the lever and go
back in time what would i tell them
you know i would say you've got to do
both but when you're young you have more
flexibility
and you can out train
a bad diet but as soon as those hormones
begin to change
if you have low quality protein and by
the way protein is utilized in a dose
response so it's a a meal dosage it's
really a 30 to 50 gram
meal dosing so that's
between four and you know five to six
ounces of protein per meal
and if you go under under that you are
below what's called this leucine
threshold and i i want to make this very
palatable for people so
basically there's essential amino acids
and out of these essential amino acids
that's really what determines the
quality of a person's diet and the
quality of protein so when they are sub
threshold of one particular amino acid
which is leucine if you eat food that is
sub threshold to that two and a half
grams of leucine
you will be skinny fat you will never
activate the proper mechanisms to turn
over muscle protein synthesis
and this is a huge problem in our
society you know there's nutrient
sensors in the body
so hitting that particular amino acid
load which is really four to six ounces
easy and it's easy for people to anchor
their meals in you know four to six
ounces of protein and then you stimulate
your muscle tissue
which we know is an endocrine organ
let's talk about that if you're not
trying to bodybuild if you're not trying
to get bigger
so i'm thinking i know somebody love her
to death she's amazing but her diet is
ridiculous but she's skinny her whole
family's skinny it's crazy and so i've
always said i guarantee if you look at
her biomarkers she's going to be skinny
fat she's going to be probably
pre-diabetic judging by how she eats
it's you know pure insanity because i
want to differentiate between busting
your ass in the gym and what you're
going to get from that and then just
like hey even if you don't care about
the gym even if you don't buy into that
uh there's just a quality of tissue
issue and if you think of it as an organ
it's like saying the quality of the
tissue of your liver or your kidneys
it's like this [ __ ] matters so if people
could do one thing
and leave this conversation with nothing
else other than muscle is the organ of
longevity and eat high quality protein
animal protein and plant protein are
totally different and if you have a diet
of plant protein it is very hard to
sustain and calorically devastating
because you need between 25 and 40
percent more so it's like six cups of
quinoa for one small chicken breast if
you really wanted to think about the
amino acids necessary to stimulate that
tissue and listen that's not the only
way to do it could we add in branched
chain amino acids to lower quality
protein absolutely but why would you do
that when we have
you know cattle or ruminants that have
that we've been consuming for two and a
half million years and have the capacity
to take low quality plant nutrition and
produce high quality
nutrition with that is nutrient dense
and highly bioavailable for humans so i
understand i've heard you say the same
thing like i understand people have they
may have a um a moral desire to eat
plant-based food and i get that due to
somebody who's absolutely i just love
animals and i long for the day where we
can lab grow meat and that there was
never an animal i'm involved in that
process but i'm also
just selfish enough to say i'm going to
protect my health
you know when you look at obviously
sustainable farming and things like that
i'm all for it i couldn't be more behind
that
but
wanting to understand sort of at a
mechanistic cellular level what's
happening and i don't care what the
answer is vegan vegetarian animal a mix
thereof
i just want to understand like at a
cellular level what's happening um and
to
get that i think understanding the
what branch chain amino acids are
why they matter and how the profiles
differ from plants to meat i think would
be really helpful yeah i i couldn't
agree with you more so really the
quality of our diet
and this is globally the quality of our
diet is largely dependent on protein so
there's 20 amino acids
and nine of those are essential
of those essential amino acids and
essential meaning i i cannot produce it
in my body
exactly
so the key branch chain amino acids and
when you think about branched chain it's
just a structure right it's just a
nomenclature
you've got leucine isoleucine and baling
and out of those three which by the way
should all be consumed together because
everything in life has its own balance
of those three amino acids leucine is
the most relevant for protecting the
organ of longevity and on a cellular
level having the right amount at one
time dosed appropriately which is where
that two and a half grams that's from
the that's just from research you know
it's really truthfully it's between 1.8
to 2.5 grams of leucine which the
majority of people are not going to go
hmm how much leucine is in my food right
it's not on the back of a label which
just goes to show you how protein has
been the black sheep of the
macronutrient family for decades when
you look at a label all it simply says
is protein but understanding on a
cellular level that really
eating protein at a meal centric dosing
meaning you at one time you're not
drinking protein shakes over a course of
two hours but at one meal at a boldest
amount you are getting between 30 and 50
grams of protein which would translate
to
between four and six ounces of high
quality protein would reach that leucine
threshold so once you reach that leucine
threshold you trigger this
this complex called mtor
mtor is the mechanistic target of
rapamycin which then is actually a
nutrient sensor
anything below that the body's like i
don't care i'm not going to put on
muscle or i don't care i'm not going to
really stimulate this very expensive
elaborate process for the body
it doesn't care
so that's where you get skinny fat
because you're grazing all day at this
low threshold meal especially important
in aging because you don't have that
flexibility
and when i say aging i'm talking about
40s
you know you've got to stay on top of it
but once you reach that threshold of
arguably two and a half grams of leucine
which you could have a two ounces of
fish and then a scoop of branched chain
and get up that leucine level but
mechanistically you need that branch
chain that essential amino acid to then
trigger the rest of what needs to happen
for muscle protein synthesis and listen
the way that they measure muscle protein
synthesis
it's not like you eat it and then you're
laying down protein it truly i mean
that's not an accurate assessment right
i would be
not being truthful if i said that but it
really is a period of time over a period
of time as you continue to do with
anything correct
optimized habits
you then can protect your tissue
and protecting tissue is everything
you know and it's very dangerous because
when people do weight loss
you know you lose some fat but you also
lose tissue
and now we're in a situation where we're
not outside and we're not doing
resistance training
and we're not actually moving that
endocrine organ
so you know it becomes much more
difficult to maintain and recoup that
tissue and the tissue is just one aspect
it's truly the metabolic aspects
you know of the of muscle and if you
want to prevent diabetes
heart disease
alzheimer's cardiovascular you know
cardiovascular disease that whole
spectrum
tissue you know muscle tissue will do
that for you and then you put on high
quality protein
you're gonna keep inflammation low
you're gonna keep calories in check
you're gonna up regulate your
thermo-effective feeding these are all
really important you're gonna do you're
gonna have lower blood pressure because
some of the amino acids one in
particular helps lower blood pressure
i mean this is amazing stuff it's a
muscle-centric approach to wellness and
the paradigm is totally wrong
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hero of your own life peace out
when i started working out you can
actually feel just the difference in in
a lot of things you can feel the
difference in mobility and strength and
just overall well-being um and then some
of the data in terms of how people
bounce back from long-term chronic
illness i know in the cancer community
one of the the things they look at is
when muscle mass gets too low they're
just like they're they're one illness
away from demise and same thing with old
people it's like hey you might be able
to survive the flu if you've got enough
muscle to see you through um but if not
then you could really be in trouble so
it's interesting to hear that broken
down i want to go back to what you were
saying about that first meal
which i think you're quite careful not
to necessarily refer to it as breakfast
but your first meal um getting getting
that right um i'd love to hear what
right is like in the real world am i
eating eggs am i eating chicken breast
am i eating quinoa like what am i eating
you are not eating
so if you get that first meal right if
your meal is bolus with protein you do a
few things number one you stimulate your
muscle tissue which is arguably the most
important organ right but number two
there and there's really good data that
it actually helps with satiation
and blood sugar regulation so you are
not going to be chasing 90 minutes later
your
blood sugar you are not going to be
obsessed in your mind and not able to
focus because you want to eat or you
feel like you have to take a nap yeah i
encourage people to try to overeat
steamed chicken breast it's like good
luck like you will tap out long before
you get obese that is for sure um so
what are give me some ideal protein
sources am i eating is it chicken breast
is it red meat
so we eat a lot of beef in our family
beef bison eggs uh we are not a low fat
family so you know for breakfast for us
might be half a pound of bison each with
a little bit of olive oil and maybe some
avocado but we're low carb for that
first meal we tend to do carb back
loading or if we're going to have
carbohydrates use carbohydrates around a
meal now my husband is a seal so they
you know they kind of like
go crazy and train and then eat and
train that's navy seal for anybody
wondering
no arguably he's probably an animal but
it's okay um so
that's how we but the first meal is
always the same why do you do carbs
later in the day that's interesting
because you've been up and you've been
utilizing your tissue so you depleted
your muscle glycogen essentially
i mean listen
the data would show in a 24-hour period
so i want to be very careful to say this
is my experience because the data will
say well in a 24 hour period how much
carbohydrates are you utilizing and i
would say it's much easier to backload
your carbohydrates or utilize them
around training
perhaps post-workout so i do believe
that training low glycogen state is very
beneficial do you work out fasted or do
you have your first meal
i do so i work out fasted and do you
have a
strategy behind why you do that
so i think the training low i like my
body to become very proficient and
and efficient on its own
i like to be able to make all the
glucose i need
right and because my diet is high in
protein
there is what happens is it goes through
gluconeogenesis so truly for every 100
grams of protein that i eat my body
generates 60 grams of carbohydrates
itself so i am not reliant on quinoa for
breakfast or carbohydrates my body
becomes so good at making and generating
its own
that it allows me to eat any
carbohydrates in
you know truthfully i don't need a bunch
of carbs it when i work them in
it would be you know possibly if we had
a really busy day we have a little
infant
you know and we have no child care so
we're just kind of
you know busy and we're training and you
know if i've gone for
a lot of training that day and i'm
running around chasing her i might have
you know and it's meal specific so
there's a carbohydrate threshold which
is how i like to think about
carbohydrates i might have
you know 20 grams of some kind of
carbohydrate
in the evening and and truly the carbs
that i love and everybody says this are
green leafy you know vegetables but i
really like things like cilantro and
chives things that maybe have more
medicinal purposes
and that's really what we use
so
so herbs is medicine which one's what
effect
i am certainly not an expert on herbs
but i will tell you one of the things
that we use is
this isn't an herb but i'm just very
strategic so like in the morning i'll
use something called sun up green coffee
and it's it's this one company that i
just really love and i have no
connection to them but they have a
product that i think nobody knows about
that everybody should and it's raw green
coffee so it looks like tea i don't make
it i get it clear like that
it look it tastes like tea
and it really and it has a high amount
of polyphenols
which i know that there's a lot of
debate in but i believe in polyphenols
and what does what do the polyphenols do
for you
so they're antioxidant they have
numerous effects anti-cancer activity
and i will tell you that i am able to
maintain my body composition
by doing these very strategic things and
just being very conscientious
of utilizing
simple tools
that i have found incredibly helpful
like for example
um jalapenos
using raw jalapenos with capsaicin you
know the whole goal is optimizing body
composition
and you utilize these in an you know
over a period of time in enough amounts
and the body generates its own effect
and listen this is totally subjective
you do have to control for calories
but there are things that we just as
scientists or as practitioners
physicians don't necessarily understand
but i can tell you that it works so i
use chlorogenic acid in the morning i've
never heard of that what is it that's
the green coffee that's why i use the
green color fluorogenic acid
yeah has high amounts of chlorogenic
acid you're going to try those syllables
put together before chlorogenic acid
okay it's a compound that helps with
fatty acid metabolism
very interesting okay so we have our
green coffee um and then uh what else
are we doing in terms of um
herbs
a lot of cilantro
and they you know there's some believe
and through what mechanism i don't know
but very detoxifying
you know a lot of individuals with quote
heavy metals will utilize a cilantro
based kind of compound
cilantro parsley chives
garlic people are like i'm not coming
your house that's all right
but it would be interesting because i
think that that's the you know i think
we're all looking for ways
to
optimize longevity at the not just at
the end of life so it doesn't really
matter if you live to a hundred versus
105 or 95 to 100 if the last five years
suck right so how do we live
a way that
surpasses what we've seen for longevity
but the quality
of our life is together and that's the
question is not the length right so it's
not quantity of life it truly is quality
towards the end so really i'm starting
to experiment with these things as it
relates to longevity
and quality
really fast give people a bit of a
breakdown on your background in
geriatrics one i don't know that
everybody knows what geriatrics is um
and then two i know you spend a lot of
time in palliative care so what that is
and sort of the it's giving you sort of
a tough edge and no [ __ ] approach to
this that i really respect so first what
is geriatrics and palliative care and
what have you learned from it yeah and
i'm going to tell you where
muscle-centric medicine came from there
was a turning point moment that was
during my fellowship um so geriatrics is
really
it's taking care of aging and it's over
the it's 65 and older and that's what's
considered geriatrics and then
palliative care is the end of life so
you
are really at the end of your life
whether it's a month or so
and and that's really transitioning to
the other side whatever that other side
is
so when i did my fellowship at washu it
was a two-year fellowship and part of
the deal was i was going to get to do
nutritional sciences so i've trained
seven years in nutritional sciences but
the deal
the deal is
in order to do clinical research so i
did two years of clinical research
part of the way that it worked was as a
physician i also had to have clinical
duties
part of those clinical duties the
agreement was right there's always a
give and take um the agreement was i got
to do obesity medicine and run a weight
loss clinic and
and image people's brains and be part of
you glycemic clamps and do all this
really rad stuff
but in order for me to do that
i had to take care of people in nursing
homes
at the end of life
in the hospital
and geriatrics and i'm sure everybody
many people have had aging parents it is
not i mean
diseases of aging are heart crushing
bone
sucking like it is
so harsh
and that's why i feel so passionate
about this message because i've actually
done the work and sat at the bedside
of these people
you know and at the end at that moment
in time you can look back and you know
people have a lot of regrets and i will
never forget and muscle-centric medicine
came from a very specific moment
part of the research i was doing is i
was imaging people's brains it was obese
brains
incredible women around
you know late 40s early 50s
and i have to change the name of this
woman so we'll call her sarah and sarah
was the nicest woman and she had three
kids she'd been overweight her whole
life
and i'd sit with her you know we did
24-hour euglycemic clamps sit with her
and you really get to know these people
you see them at multiple points in the
study and uh
one of the parts of the study was
imaging her brain
just to see what her brain looked like
and
when
we imaged her brain she had a lot of
like flattening of her matter
and it came from midlife obesity and we
knew that within you know really 10
years down the line
she's going to have
alzheimer's
what is the rapping of the matter what
is that so the gray matter right so that
the brains the the wider the waistline
the lower the brain volume
so alzheimer's there meant there are
many multiple different aspects of
alzheimer's but alzheimer's is type 3
diabetes of the brain
it's a metabolic illness
that can be
prevented just like diabetes just like
cardiovascular disease just like
hypertension and listen i i want to say
this with a little bit of reserve
because there are genetic components
however
lifestyle choices mid-life having access
to the right information changes the
trajectory of aging
i was so heartbroken when we reviewed
her fmri study i was heartbroken because
all she told me was you know i've
emotionally eaten my whole life i have
three children i'm a stay-at-home mom
and i put everybody first
and her habits were so deeply ingrained
and she was obese her muscle tissue
wasn't there
she literally in the next decade was
going to have alzheimer's and she had no
idea what she's in store for or what her
family was in store for and at that
moment i knew that chasing body fat was
the wrong thing to do
it was all about muscle as this
metabolic organ
and if she had turned her attention
protected
because it controls body composition
it's metabolically the the bigger the
waistline the smaller the brain why yeah
what mechanistically is happening
because it is very inflammatory so there
is insulin receptors in the brain
you know it can affect the bru the
blood-brain barrier
insulin resistance in the body and
insulin resistance in the brain
and
one of the other things and we'll talk
about muscle but the
the the protein component affects
satiety so that overeating that
emotional eating
your body is going to feed until it gets
the protein that it needs
and that's something super interesting
looking at cravings from that
perspective yeah and it's actually
called the protein protein leverage
hypothesis
and this is well maintained throughout
species where they will feed so you'll
continue to eat and overeat and overeat
if you're eating a low protein diet
until you reach that protein need
for these satiety mechanisms to shut
itself up
very troubling
so now give me
what does muscle do
that
interrupts that
why is it anti-inflammatory like if we
look at what i just laid out is how we
get too much insulin into the system
what's muscles rolling
so muscle is the largest site for
glucose disposal
glucose in and of itself is cytotoxic
it is
really critical to get glucose out of
the bloodstream and take it up
one of the ways the largest site
for disposal is actually muscle tissue
the more muscle you have the more
metabolically healthy it is the more
that it's actually utilizing nutrients
appropriately
the more carbohydrate flexibility you
actually have
so it's in and of itself protective
and we talked about when you when you
contract it by
secreting myokines
it is anti-inflammatory so fat is the
nemesis of muscle talk to me about what
the muscles are secreting um this isn't
uh interleukin 6 i'm familiar with only
because of what's going on with
coronavirus so that sort of cytokine
storms and stuff is that's become more
um
people are talking about it more but the
other stuff like what you just said
which i i couldn't even tell you what
you just said um
what's that called again and why is it
anti-inflammatory so the interleukin-6
is really the big one that's what muscle
is famous for but when you think about
muscle tissue as it relates to
inflammation and obesity and really
protecting sarah the story that i told
you
if she had been able to get her tissue
under control just mechanistically from
getting her protein intake up
right and making sure that that tissue
was emptied
but because she was largely inactive and
you know there's this this concept where
when the muscle is full everything
starts feeling back into the tissue or
it just can't get in
so basically you have an increase
remember there was this whole big
discussion about branched chain branch
chain amino acids cause diabetes because
everyone with elevated glucose also had
elevated branched chain amino acids i've
never heard that before tell me more
there was some research that had come
out where people had mistakenly
said well those with elevated levels of
branched chain amino acids it correlates
to high level you know it correlates to
diabetes and amino acids in the
bloodstream
correct and actually that's absolutely
true but not for the reason people think
the reason it was true is because
branched chain amino acids are utilized
by the muscle
but there's let me guess so
this is that back up mechanism right so
the branch chain amino acids should be
going into the muscle but they're full
what are they full with they're full of
glucose no
full of glucose they're full of fat
they're just full they can't accept any
more substrate because they're not being
used exactly now we're on to some now
we're on to it so these diseases of
obesity these diseases of being over fat
they're not diseases of being over fat
they are diseases of impaired muscle
so if you fix
that muscle tissue
and that's through lifestyle keeping
inflammation low keeping calories in
check and truly we are domesticated as a
planet can we define fix
so when we say fix because if you had
stopped shy of the word fixed i would
have said add more muscle which is where
i always expect you to go um is this a
a game of quantity and quality
primarily quality
these are great questions and i
i don't think anybody knows the answer
and here's why
because muscle is the most under
appreciated organ
we have percentages of body fat that we
know are not great
but we don't know i don't know what
percent muscle mass you should be
you don't know what percent muscle mass
i should be
and this is
so important to understand because if we
really truly want to help obesity
alzheimer's cardiovascular disease
it's really about optimizing muscle
tissue and nobody knows that answer
i would say from a professional opinion
quality and quantity matter of course
i'm not talking about in the extremes of
you know a bodybuilder in the olympia
although that's incredibly healthy
tissue right oh can i tell you a secret
here's something i would love to know
how does muscle mass correlate with um
surviving coronavirus
i thought about that kind of early on
and i thought
i do wonder
well if you think about it
the higher the muscle mass the better
the protection against all-cause
mortality and morbid
just in general crazy people need to let
that one sink in across all cause
mortality
i agree so listen if someone goes and
they're on an event
or they're aging i mean what are the
things that are going to be most
important
muscle tissue
you want to survive you've got to be
able to support your system
yeah man it's crazy muscle muscle muscle
so now let's talk about how do we get
some muscle so obviously we need to eat
we need to get our leucine levels right
we need to
eat a certain amount of protein which i
think you said roughly one gram per lean
body mass
that's the recommended amount i actually
that's what is would be considered in
the literature one gram per pound lean
muscle mass and i would say that's a
great starting point
i would say it should be
one gram per pound ideal body weight
okay
so the lean muscle mass is very very
plus a little bit of fat you're saying
yeah sure whatever you want as long as
the calories park me i'm 180 pounds
grams of protein 180
yes sir okay and then you know what's
your caloric target we would you know i
would probably break up your
protein meals and 50 grams or so could
you go over yeah
would you have much metabolic benefit no
so 50 grams of protein per meal so seven
times you know six would be 32 grams so
i mean brother you're gonna be eating a
lot
or if you didn't want to do that you
would have a lower dose of protein and
then how to add in your brown chain
amino acids
so that's one strategy and then you
asked about fat so fat is more you know
for men i like to keep them a minimum of
80 grams for hormone production so i
would say a minimum of 80 grams of fat
but again this is all based on calories
and carbohydrates
take it or leave it and i'll tell you
what is more important is also as you
age and we all become more mature i hate
to admit that i'm aging but we are
is that you actually have to get that
meal threshold right so you would be
doing yourself a service
by getting 50 grams of protein
per meal because you're going to get a
robust
response for muscle protein synthesis
and anabolic resistance mechanistically
the body becomes
kind of
immune or desensitized to amino acids
so you require more amino acids at one
time
to get the sensing more robust and
especially in aging like in geriatric
population you need that sensing
mechanism to be very robust and that's
where your amino acids come in and
getting that you know amount per meal
correct so you overcome this anabolic
resistance
and to lead into resistance exercise
right that is essential
and um there's a lot of questions or
someone you know if someone is aging
there's some great work out there from
mcmaster university and they say you
know they've shown that it's not the
heavy weight it's the two fatigue
ability and exhaustion that's
interesting it is interesting that they
would get the same benefit because for a
long time i said go out and work as hard
as you possibly can until you want to
quit at least twice or throw up
and that may not be
the the
that may not be a overarching
recommendation so really having a
well-designed trained program
you know planned out program is
essential and you'll respond quicker if
you're under trained or d trained right
and then the more advanced you get the
less gains you're gonna make but
resistance training is key i've heard it
said and this makes a lot of sense to me
that um
food are signaling molecules
and that's what i heard you just say
which is a nutrient sensing organ right
so the muscle is listening for the
signal of the food that i eat to say ah
cool there is adequate amounts of
protein available to me right now and
that turns something on yes
exactly
um
and that would be the branched chain
amino acids
as we age the ability for that skeletal
muscle to sense that
decreases okay sorry and i know i'm
derailing this a little bit here um but
now going back to incomplete proteins
like are found in because one of the
things you take the most heat for
is you know saying some of the protein
that you're going to get in vegetable
matter isn't going to be as complete so
which what you just said would predict
which is that if the muscle is looking
it's sensing that signal
and the signal comes in the form of
branch chain amino acids right and the
branch chain amino acids from the
vegetable matter keep me in some sub
threshold where it doesn't click over
into this
that it's not you know we use protein as
a blanket term but it's complex
you're looking at 20 different amino
acids it's not the
protein that we need essentially it's
the amino acid requirements that we have
and skeletal muscle has very specific
amino acid requirements
to do the turnover do what is necessary
and to do turnover to be able to
maintain its structure to be able to put
on
new muscle to be able to maintain its
health
this comes in the form of branch-chain
amino acids
as we age the sensing mechanism
of one of one of the branch chain amino
acids which we've talked about before is
leucine that sensing mechanism decreases
the way in which we which ultimately
leads a less efficient turnover
leads to
subsequent sarcopenia
decrease in muscle function muscle
strength muscle mass as we age
by optimizing for protein intake you
know specifically high quality protein
then just like you said
high quality protein is typically what
we think about animal based proteins
does it just have to be animal based
proteins no but these are hard fast
in the literature high quality protein
is defined by amino acid content
it's not a negotiable nebulous concept
these are hard fast biological numbers
and each protein has very specific roles
in the body
and specifically as we age and if you're
thinking about
famine and fasting
specifically as we age the branch chain
amino acids in particular leucine is
required by skeletal muscle to begin
that process
as we age this concept of anabolic
resistance
meaning there's a decrease in efficiency
the body becomes you know what's
happening at the cellular level well
yeah
there's a
decreased
sensing of mtor okay and mtor
which i understand vaguely enough to be
dangerous is uh basically what has to
happen for us to grow yes it's
mechanistic target of rapamycin there's
m21 m2 and it's in all cells it's in all
cells
it's a will it happen differentially in
different cells it does and it's
stimulated by different things in
different cells and then muscle like
what i'm going to tell you
can't wait
in muscle it's exquisitely sensitive to
leucine
in areas like pancreas or liver it's
exquisitely sensitive to energy extra
calories
it's sensitive to insulin regardless of
macronutrient well arguably it would be
more sensitive to insulin and glucose in
say the liver or the pancreas
but skeletal muscle is exquisitely
sensitive to amino acids that sensing
mechanism decreases as we age so then
this brings me to this concept of
longevity which is very hot right now
people talk about longevity and there's
this conversation of decreasing protein
intake because that's going to help
long-term fair hypothesis i have no idea
it's because of this stimulation of mtor
so they're worried about cancer yeah
they're worried about cancer but if you
were worried about cancer
and by the way mtor is signaled by
exercise in skeletal muscle as well
so
it's not an mtor issue in
muscle
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i'll see you on the inside but i i just
want to stay on this longevity topic of
individuals saying you should reduce
your dietary protein because of
longevity which that's probably the
worst piece of advice i could ever give
someone
let's define longevity
what does that mean
is it living from to 95
or is it living to
95 and a half
and the question is
do you want to be mobile and healthy or
do you want to be frail and sarcopenic
if we believe in the hypothesis of
anabolic resistance which arguably we
should this is well documented in the
literature you look at my mentor's work
dr donald layman or stu phillips any of
these guys van loon
you know this is a well documented
phenomenon
that as we age our capacity to
generate heal
keep muscle goes down
so i just told you about the sensing
mechanism and that we actually require
more dietary protein
really we require high quality protein
because we require that amino acid
stimulus
so if you now further reduce
dietary protein
from aging individuals and aging can
start in your 30s
how are you going to then stimulate
tissue
you have to be very careful about how
you want to age and this concept of
longevity longevity for a c elegans or a
fruit fly
doesn't take into account the complexity
as a human human agent is that where
they're drawing that from yes these are
not human studies
you're not looking at randomized
controlled trials you're not looking at
good high quality data
to support a reduction in dietary
protein and as a trained geriatrician no
geriatrician says hey study of old
people yes you need to reduce your
dietary protein we know that
skeletal muscle protects against disease
it protects against morbidity it
protects against mortality muscle is an
organ system it's an endocrine organ
system when you contract it it secretes
myokines these myokines you know the the
most studied myokine is interleukin-6
goes throughout the body it affects bone
it affects liver it affects nutrient
partitioning what group do we put
interleukin-6 is that considered um
immune response it so in
it is an immune response when it's
released from macrophages it is a
myokine when it's released from this
you and i talked about this last time i
don't i still don't have money
so this is this is actually a newer
science and this really comes from the
work of patterson and she has
essentially paved the way she's an
immunologist and internal medicine
and what a myokine is it's a protein
released from contracting skeletal
muscle
and when we are deconditioned and when
we are not training
you don't secrete interleukin
2 once it's in the bloodstream well it
does there's there's thousands of them
which is interesting of different kinds
of myocain interleukin 6 decorin irisin
there's
thousands
again this is new emerging science and
arguably what we should be studying i'm
starting to look at blood levels
post-exercise in my patients
right and this just goes back to a
broken obesity model which we know
you're not over fat we know everyone is
under muscled right when we were talking
about the general population
you know typically people don't have
a good solid foundation foundational
muscular base we they don't and this
idea that we would further reduce
dietary protein is going to have a much
more negative effect and here's another
question do you think there are problems
with so because i'm trying to get to
muscle obviously hugely important i
couldn't agree more with that just that
makes so much sense to me
the question is
what and maybe it doesn't even matter
but which is more important the the
muscle of the fat so for instance there
is somebody in my life who is
lovely lovely human
they're really [ __ ] strong like
really strong but they're also morbidly
obese
and so what is the muscle going to
protect them enough from the obesity and
the story i've always told myself is
that
because he has such a massive surplus of
calories and so much of it is insulin
secreting that he's in a growth phase
all the time mtor is just kicking off
like crazy but he's also eating too many
calories
the muscle can only do so much
so there is a point at which the muscle
just can't carry the burden of your dog
yeah you know i and when i think about
insulin i think about
when i think about carbohydrates i think
about it in a meal threshold not in this
24 hour period but
carbohydrates are okay you just got to
make sure that you are not over
extending yourself in terms of a meal
per meal basis
let's say someone has really really
healthy muscle
but they're over consuming calories
they're not gonna have a chance
there has to be some
you know there has to be some balance
but these issues starting skeletal
muscle first and i think that that's
very misunderstood everybody's focusing
on adiposity everybody's focusing on
insulin resistance and if you care about
root causes you have to care about
skeletal muscle
so that's where
it feels like it's maybe complicated so
um
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if if this guy who has a ton of muscle
can still end up having the problem it
feels like muscle is necessary but not
sufficient you have to both have muscle
and a diet that isn't overwhelming your
system yes it is necessary but not
sufficient i love the way you put that
and wouldn't it be great to see this guy
lose some fat adipose tissue
and i think that that would make a lot
of sense you say that he has a lot of
muscle
but what individuals that we see when we
see mris or we see cat scans there's fat
infiltration into skeletal muscle
skeletal muscle becomes marbled
you know there's no free launch or no
free pass
if you struggle with obesity it's not
just limited to visceral fat it does get
into the organ it does get into skeletal
muscle this ultimately affects this
cycle it ultimately affects your ability
to
manage you know
glucose it affects your ability to
manage substrates it affects the health
of the muscle you know we talked a
little bit about myokines and you know
the big the biggest most famous myokine
is interleukin-6 and when you contract
skeletal muscle it actually
does this whole body crosstalk where it
can lower some inflammation
throughout the whole body right so
exercise is in and of itself i don't
want to say anti-inflammatory because
oftentimes the process of exercise does
create
free radicals you know there's this you
know these these concepts like you said
are very complex yeah it's not just this
way in that way and i think that we try
to oversimplify it but to the best of
our ability there are some fundamental
things that are important to understand
and that is we have to address skeletal
muscle you must get your muscle and
while i
understand that it makes people afraid
it doesn't mean that it's true
fear can be validated but it doesn't
have to be true
that's a really we could derail this
entire episode around that
sentence but this is what's happening is
that we're not having transparent
conversations
and this is really what i'm fighting
because of dogma it's because of dogma
it is now i've been i've been in this
space for 20 years
10 years ago this was not a conversation
the sort of ethical thing animal cruelty
ethical kind of a conversation bad for
the planet it wasn't it wasn't that way
and what's happening is that at the very
heart is this anti-animal
dogma
and there's nothing wrong with not
wanting to eat animals and there's
nothing wrong with not wanting to harm
animals okay i can appreciate that
but what's happened now is there's not
transparency around it so this whole
conversation then goes to well
how can we get people to stop utilizing
animal products
well we're going to scare them we're
going to generate so much fear we're
going to put out fake
educational documentaries we're gonna
completely obliterate i think they're
wrong or sinister
it's sinister it's it's totally
conscious
the people at the top it's totally
conscious and then what's happening is
then it's getting into
um you know it's then training
physicians and then it's affecting
influencers that are then going ahead
and talking about longevity and reducing
protein and they believe they're saying
the right thing they're not they believe
they're saying the right thing for the
body or for the planet for the body but
they're not understanding that
at the very heart of that is is actually
coming from an anti-animal narrative
and what's happening is there's no
transparency in the data
and
our expectation is now to lower
the quality of evidence to be able to
say well no plant and animal protein are
the same
no they're not
the last 20 years this has not been a
conversation at the level of
branched-chain amino acids or any amino
acid and there's this whole argument
about it now it's so now then it's the
longevity piece reduce protein because
it's going to affect your longevity
longevity defined as what
six months and also have if that were
the case let's say that plant uh based
proteins actually did make you live for
an extra six months
that's what kind of muscle mass would
you have would it would it yeah but if
if it seems to me that if it actually
makes you live six months longer that's
worth talking about
but but we don't know that to be the
case right
i mean like i said a fruit fly isn't the
same and you know i've taken care of
people more than i can count at end of
life that last six months is
brutal so are you saying that what i'm
trying to understand because the analogy
you always use is that what it gives you
six more months if it does i think we
have to talk about that but is your
hypothesis that that data is flawed
you're looking at the wrong animals in
humans it's about the quality it's about
the quality of life okay
and
at the end are you conceding that like
maybe it doesn't it's possible that you
live longer it's possible i mean
i'm not even going to argue that who
cares about that well it's possible you
know i'm never gonna say okay well you
know these are things that are highly
complex is it possible maybe
but let's say let's say okay that's
possible
towards the end of life you want to be
mobile you don't want to have a broken
hip and be spend the last six months in
a nursing home bedridden or you don't
want to spend your time in an
alzheimer's ward
these things are related to skeletal
muscle
alzheimer's as well there's a metabolic
component to alzheimer's it's type 3
diabetes of the brain if you care about
alzheimer's you have to care about blood
fast connect muscle to
metabolic disease for me exactly what's
going on okay skeletal muscle is your
primary site for glucose disposal and i
use the term disposal to get it out of
the bloodstream anything to get out of
the bloodstream
so right so when you think about
skeletal muscle you have to think about
glucose utilization
or disposable
you have to think about
fatty acid oxidation
skeletal muscle
healthy muscle
stabilizing blood glucose which you've
seen so i don't get too much insulin
secreted so i don't get insulin and
that's more of a dietary thing right so
when you
have too high of a glucose load you're
going to get a subsequent insulin
response
right that that is what happens
so
skeletal muscle for all these ways in
which it can help dispose of nutrients
is really what we're thinking about when
you think about metabolic syndrome
ultimately it is a
intake issue
and i think that you meaning i could
control it through my diet you could but
you still want to have healthy skeletal
muscle for all the other things
no doubt and it gives me a lot more
flexibility in my diet gives you
flexibility gives you you know there's
mitochondria gives you a lot of
positives
okay so now coming back to the longevity
piece we've got people and um i'll be
generous and say they really really have
amazing intentions they want to protect
animals they want to protect the planet
so then let's just
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animal protection is different than
planet protection
and i think that we just have to be
really clear
animal protection is animal protection
all the other lines of narrative really
go back to animal protection because the
data doesn't support that you know it's
just that these cows are now killing the
environment right that's not true
you know if we look at the us it's
greenhouse gas is industry
transportation and electricity 50 of our
fruits are flown in
25 of our vegetables are flown it
so that it can't be so convoluted it has
to be i think
there just has to be transparent
conversations when you talk about
longevity i think we have to define
longevity we have to have these health
conversations of what are the endpoints
that we're going to be looking at
and when you say define longevity
i think
your debate is
maybe longevity isn't the right question
it's quality of life that's the right
question i and i agree with i yes
and i you know i was thinking before i
was coming here you know what is a
different
word that we can use because people talk
about longevity which is just the span
of life you know and then there's terms
thrown around like health span
i think
it really is about quality of life and
it can't necessarily be and a big part
uh and i agree with this but uh so if
i'm putting inappropriate words in my
mouth just tell me but a big part of
quality of life for you is really
strength
yeah
of course and we know that to be true
not just my personality of course i
think a lot of people d