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Child: Welcome to my Mommy’s podcast.
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Hello, and welcome to The Wellness Mama Podcast. I’m Katie from wellnessmama.com, and I am back with a return guest who I always love talking to, Dr. Gabrielle Lyon, and we are talking today about Forever Strong and her new science-based strategy for aging well through muscle-centric medicine. And she is quite a force of nature. I love her message. She’s a board-certified family medicine doctor, and she also completed a combined research and clinical fellowship in geriatrics and nutritional science at Washington University at St. Louis, so she has both medical training and nutrition training. And her work all centers around the idea of muscle-centric medicine and helping bring protein metabolism and nutrition from the bench to the bedside. I really always enjoy learning from her. We get to go deep on this topic today and the reason for her writing her new book, Forever Strong, as well as some practical strategies that can benefit you immediately. So let’s join Dr. Lyon and learn from her today. Dr. Lyon, welcome back. Thanks for being here again.
Gabrielle: Yeah, of course. Thank you so much for having me.
Katie: I’m so excited to get to chat again because I think your message is so vitally important and that you are such a needed voice in this space with so much misinformation floating around there and that you walk the walk. And also, I love following you on Instagram because you are an example of all the things that you talk about. I think you’re also just a huge inspiration to women in both your message and the way that you live your life. And, I think there’s so many directions we could go with these conversations, but to kind of jump in, I know that muscle-centric medicine and the importance of muscle in general has been a vital part of your message for a really long time. And your new book, I loved Forever Strong, really goes into the science and the how-to and why this is so important. But it seems a lot of, there’s a lot of misconceptions and that maybe conventional medicine has gotten a lot of parts of this wrong. So can you kind of walk us through the background and the basics of what we’re missing when it comes to understanding skeletal muscle and its importance for everything beyond just what happens in the gym?
Gabrielle: Yeah, absolutely. I’d love to open up with a very quick and short story. I did my fellowship in geriatrics and nutritional sciences/obesity medicine. So that means after I was fully a doctor, I went back and I did additional training. One reason was because I really wanted to learn more nutritional information despite having already trained in nutrition for five years. And the deal was I had to go back and do geriatrics, which is over the age of 65. And it really looks at towards that marginal decade, the last quarter of your life per se. We’ll just say quarter. And I did that so that I could study nutritional sciences. And I was working on the interface of brain function and body composition. So basically, we were looking at body fat percentage, and memory and aging, et cetera.
And I absolutely fell in love with one of the participants. And she was a mom of three kids in her mid-50s. And, you know, there’s always that one person in our life that just changes and gives us this aha moment. And this was a woman who did everything that she was told. She ate the food guide pyramid. She was doing her cardiovascular training. She was eating a low-fat, high-carbohydrate diet, exercising more, and eating less. And she had always struggled with her weight, 20 to 30 pounds, and lost and gained those same 20 to 30 pounds over her whole life. This fad diet, this weight loss trajectory. And I imaged her brain, and she was in her mid-50s, and her brain looked like the beginning of an Alzheimer’s brain. And man, I felt that we failed her. The medical community, the world had failed her because she was doing everything that she was told. And she had gone from Jenny Craig to Weight Watchers, et cetera.
And then I started reflecting, seeing the patients in the nursing homes and at the end of life. And what was the one thing that they all had in common? It wasn’t obesity. It was that my sickest patients all had unhealthy skeletal muscle. And at the very end of the day, we have been trying to fix an obesity epidemic for the last 50 years. We’ve been so hyper-focused on body fat and assuming that that’s the correct framework. And we’ve only gotten more obese. We’ve only gotten increasingly unhealthy. And the reason is, is because fat is just a symptom of unhealthy skeletal muscle.
To wrap it all up, we don’t have an obesity epidemic. What we have is a skeletal muscle crisis. And if we simply shift the perspective from obesity-focused to muscle-centric, we’ll be able to change the trajectory of aging. So if you were to ask me, what has the medical community gotten wrong? It would be the problem of obesity and the solution of muscle.
Katie: Yeah, like I said, I think your perspective on this is so valuable. And I’ve often said on here too, I love that you categorize excess body fat or obesity as a symptom because I think that’s a really valuable step in understanding how to resolve it. And I often say, you know, symptoms, we think of them as bad things, but very often they’re a gift and they’re a messenger and they’re our body telling us very directly something that’s going on. And if we can reframe and ask better questions, when we understand that often we can get much better answers. And I feel like that’s so prominent in all of your work that you really take that first principles approach to asking the right questions and getting better answers. And you mentioned obesity just being a symptom and that lack of healthy skeletal muscle is really the actual root of this. Can you elaborate what happens physiologically when a person doesn’t have adequate or healthy skeletal muscle?
Gabrielle: Yeah. And I want to point out, if you look into the literature and you think about these studies that come out, and they will often preface the paper and say these are, quote, healthy, sedentary individuals. And that’s an oxymoron. There is no such thing as being a healthy, sedentary person. The only way to essentially be healthy is to have healthy skeletal muscle.
What does skeletal muscle do? Number one, it’s a full organ system. It is a contracting system that when you contract skeletal muscle through exercise, it releases myokines. And just to take a pause, we often think about muscle as a performance-based metrics. Oh, I either look good in a bathing suit or I can deadlift 200 pounds. But the idea that skeletal muscle is in and of itself its own organ system, just like the cardiovascular system, just like the pulmonary system, and it acts very specifically in and as an organ system.
For example, when you exercise, which the body was designed to do, it secretes these myokines, these peptide hormones that go throughout the body that interface with the brain and the liver and pancreas and the cells of the immune system. Just to even put it in perspective, there’s a lot of autoimmune diseases. One way that is a potential treatment for autoimmune diseases is exercise. And it’s not just the exercise in and of itself where we think about body composition, but it’s what the muscles secrete. So that’s number one, which is very interesting.
Number two, it is our largest site for glucose disposal. The carbohydrates that we eat has to go somewhere. The more healthy muscle mass you have, the greater your suitcase for carbohydrates. It is the site for fatty acid oxidation. It is your amino acid reservoir. And let’s say you get pregnant and you want to have a healthy baby and you really struggle to eat. Your body will pull from body protein sources. And on that note, your best protection for having a healthy pregnancy and healthy child is to have a healthy metabolic system. And the way you’re going to leverage that is through skeletal muscle. And quite frankly, it’s the only organ system we have direct control over. We don’t have direct control over any other organ system.
Katie: That’s a great point. And I hadn’t thought about that, but we do. And which I also think about often in the conversation of the rise in metabolic-related disorders. And I know the statistics vary on what percentage of the population is suffering from some version of metabolic syndrome, or at least some of the markers of it. But I know it’s well over half now, and some sources even put it upwards of 80 or 90%. And like you said, in the beginning, this is something that is only seemingly getting worse, despite our focus on it for the last several decades. And it, you know, being studied so widely and people talking about it all the time. I think also to understand this going forward, can you break down the difference between BMI and actual body fat versus muscle composition in the body? Because I know there’s a lot of terms that float around, and I want to make sure people have a clear understanding.
Gabrielle: Yeah. So there’s a body mass index and that’s really been used, and one reason and way in which they use body mass index is it allows us to be able to study populations on large scales. Body mass index does not determine directly your body fat percentage. It is just an estimation. And most clinicians don’t use that anymore for reasons of that. For example, let’s say an individual weighs quite a bit. Let’s just take my husband, for example. He has a lot of skeletal muscle. He is a lean individual, but because of his weight, he would then classify according to his BMI as obese. So it doesn’t differentiate, doesn’t really tell us much. But again, it’s used for a whole population.
And right now, the gold standard is something called a DXA. And we’ve all heard about a DXA. The thing with a DXA, is a DXA only measures directly body fat and bone. And the rest of the measurement is lean body mass. And lean body mass includes skeletal muscle, but it includes organs and everything else. So while DXA right now is the standard, it doesn’t directly measure skeletal muscle mass. This is one reason why there is this somewhat of a division between muscle mass, the amount of muscle you have, and strength because people will often say that mass doesn’t matter. It’s just all about your strength. The reason people say that is because we have 30 years of literature that have not been directly measuring skeletal muscle mass. And once you correct for skeletal muscle mass and begin to measure it directly, people can do this with a CT or MRI or something called a D3-creatine, which is a deuterated creatine. It’s a tagged creatine. Simply, this is where 98% of the creatine in the body is. It looks at these pool turnovers, and it allows you to take a pill. And in your urine, you test, and it gives you how much skeletal muscle mass you have. It’s quite interesting. It has been validated. It’s not available to the public yet. But that is the gold standard. And again, the challenges are that it doesn’t directly measure skeletal muscle mass.
We do know, which is a very interesting point, is that we understand that greater than 30% body fat is not ideal. And this generates low-grade inflammation. Again, I believe that the body fat percentage is actually much lower to be a target. For example, women, again, and I say this cautiously because it really depends on the person, but 23 to 24% body fat would be a threshold for me. Again, depends on fertility, et cetera, all of these things. But we don’t have a number for skeletal muscle mass. We don’t actually know what our targets are. And I just want to put that into perspective while we discuss a lot about body fat percentage. Body fat percentage is something easy to assess. And on the same hand, really a part of that is a symptom of unhealthy skeletal muscle. And then if you take it one step further. We also don’t know how much muscle mass an individual should have.
Katie: That’s so interesting. And so it makes sense. And to clarify, when you’re saying that body fat percentage, that’s not BMI. That’s not saying that like 30% BMI would be the upper limit. I’ve seen that same thing play out in athletes I’ve worked with who, according to the BMI scale, would be clinically obese and they’re extremely lean, extremely at the peak of their game. So that’s obviously one small example of where that falls drastically short. But you speak so well in the book about, you talked about skeletal muscle being its own organ system. And of course, fat also in a similar way, being a metabolic input to the body and how those things interact. So to help people understand this, could you compare and contrast maybe two fictional women that both weigh 165 pounds, but one has significantly more muscle and less fat than the other one. So they would on the BMI scale be the same, but they would have all kinds of different physiological things happening based on that difference in muscle mass.
Gabrielle: Yeah, what a great question and kind of a segueway into something. If we had an individual, let’s say we had two women, they were both 165 pounds. But now one woman is, let’s say, 30%, 40% body fat, and another woman is 20% body fat. The woman that is obese by body fat percentage standards, we would see a few things in her blood. Number one, we’d also assume that this woman had issues at least a decade earlier, right? So we are thinking that changes in the dynamic of skeletal muscle, for example, what do I mean specifically, insulin resistance in skeletal muscle will begin when an individual is sedentary. And that would be before we see outward signs of body fat.
Again, why is skeletal muscle at the root of body composition? Because skeletal muscle, again, is the primary site for disposal of a lot of the foods that we eat. The proteins, we need that for skeletal muscle mass, carbohydrates, and fat. So skeletal muscle is going to be the site where we hold the most mitochondria, right? This is our energy centers.
So the woman who is a higher body fat percentage, and let’s say she is largely untrained, has not been working out. At baseline, she is likely going to have higher levels of inflammation. And one might see that in something like an hs-CRP, which is an inflammatory marker from made in the liver. We might see elevated levels of triglycerides. We might see elevated levels of fasting glucose and insulin. Let’s also say that she is 165 pounds, but not strong. Maybe her walking speed is slow versus the woman who is leaner and who is always trained. My expectation of the woman with lower body fat, I’m going to assume that she is more well-trained. She likely could eat a larger glucose meal and dispose of that and be able to maintain her body composition, her fasting insulin, her triglycerides. I’m expecting all her markers to be adequate and probably more optimal. Also, blood pressure. I expect her to have a normal blood pressure. So those are the things that we would think about. So there’s blood marker parameters, and then there’s strength parameters.
Katie: That’s so interesting. And I think it’s such an important reframe to start to think of skeletal muscle as its own system like that. And based on what you just said, would it be accurate to extrapolate that it would be healthier for rather than a person to just be thin and be a good BMI, but have very low muscle mass, but look thin? Would a person potentially who had a lot more muscle mass, but still carried a little bit of excess fat potentially be metabolically healthier, even though they looked bigger or were higher on the BMI?
Gabrielle: Another great question. Here’s how I think about it. And there’s a really great series of papers by a man named Dr. William Evans. And basically, what he showed through measuring skeletal muscle mass directly through he uses, again, this D3-creatine dilution, and looking at the importance of the accuracy in the assessments of skeletal muscle mass is that the loss of lean skeletal muscle mass is more detrimental than the gain of body fat. So the loss of skeletal muscle is more damaging to outcomes that we care about, like cardiovascular disease, than is the gain of body fat.
Now, you mentioned something, and then I’m going to tell you what I would rather be. The individual who is obese and potentially has more skeletal muscle. That is true. However, when you think about when an individual puts on body fat, they also put on visceral fat. They also put on fat within that skeletal muscle while they may have more skeletal muscle, the skeletal muscle can look like a marbled steak. So it could have intramuscular lipids. That is not ideal, and that is thought to perpetuate insulin resistance. So while that individual has more muscle, it doesn’t mean that it’s more healthy muscle.
Now, as we age, body weight does matter. And now you get into kind of a slippery slope because the individual that has muscle, but it might not be healthy muscle, has the capacity to then have healthy muscle through exercise. An individual who begins training will be able to utilize the fat within that skeletal muscle. And so one should do that as early as possible. It is never too early or too late to begin training. And I’m not just talking about endurance training. Zone 2 cardio is really having its moment right now. We have to do resistance training. You must load the tissue. And I will say that the less time you spend training, the more important that that training needs to be really aggressive. And again, I say that cautiously. But if you are not going to be spending a lot of time training, then the amount of focus and the intensity that you use training really needs to be up there. Because again, we’re looking for healthy skeletal muscle.
Katie: And I know we’re going to do a whole follow-up episode to this. You guys keep an eye out for that one that really delves deep into how to start optimizing those things and the steps that we can all take. Because like you said, skeletal muscle is within our control to shift. And when we talk about those rising rates of metabolic disease, to me, that’s actually great news because that’s something we do have the ability to control through changes we make in our diet, unlike some other factors when it comes to health.
And I’m really glad you brought up visceral fat as well because I think it’s important to understand the distinction of someone who maybe carries a little bit of excess fat in their glutes, for instance, versus someone who has a whole lot of belly fat and then metabolic differences that are happening there. And I know I recently did a DXA and had very low visceral fat, which was exciting to me. But to me, this might also be why some people say things like waist-to-hip ratio, while of course not a perfect measurement, are at least a good indicator and that there seems to be a tie to longevity there. Is this because of the visceral fat component? And is that something worth at least measuring on yourself and knowing?
Gabrielle: You nailed it. Waist-hip ratio is one indication of, it’s actually really, really easy to do and is very, very helpful in understanding where your visceral fat is in terms of where it is and what you need to do about it. Yes, absolutely. Everybody could do that at home.
Katie: And I’m curious, too, like I know you talk a lot about this in the book and give some examples, but I love your phrasing that muscle is the organ of longevity. I think when we also reframe it into the aging conversation, it also hopefully helps people to both understand and be motivated to integrate the things that you explain so well in the book. But can you go a little deeper on physiologically what happens in a beneficial way when we build more healthy skeletal muscle? And maybe also explain a little bit deeper, you mentioned if you have muscle, but you have a little bit of fat in that muscle that can actually be used to your advantage. And is this why, for instance, bodybuilders might bulk and put on a little excess fat to be able to then build more muscle?
Gabrielle: So the first, where should I start with this? So the first part of your question is, what are some of the changes when you’re training, right? What are some of the changes that happen? Let’s frame this up by what happens if you are sedentary and you’re aging? With age and sedentary behavior, skeletal muscle becomes less efficient at recognizing amino acids, recognizing dietary protein. It also can become less efficient at its response to exercise over time. In addition, aging skeletal muscle can become more insulin-resistant. So insulin is a hormone released from the pancreas. I know that you’ve spoken about this often. It moves glucose out of the bloodstream into the tissues. And as we age, again, it’s believed to be an aging process. I think it’s more inactivity type of picture. But as we age, this skeletal muscle really becomes less efficient at a lot of things.
Now, how would one counteract that? And the other really important point, because I know that we’re going to discuss protein, is that there’s protein turnover that is happening often in all areas of the body. And as we age, our body becomes less efficient at being able to manage protein turnover, the rebuild and repair of organs and tissues and muscle. Now, if we maintain a very healthy active lifestyle, then we can maintain the quality of our skeletal muscle. We can also improve and maintain the health of the skeletal muscle mitochondria. We can also, through exercise, increase blood flow, making and priming skeletal muscle to the nutrients. So essentially, we can overcome this aging phenomenon through dietary protein and resistance exercise. And what is so amazing about this idea is that we have direct control over an organ system. We literally can dose the medicine through exercise and dietary protein to protect the way in which we age. There is nothing more important than the health of skeletal muscle. Nothing.
Katie: And I’m excited for our next episode to really get into the nuance of how to do that both effectively and efficiently because I know time is a limiter for a lot of the moms listening, especially. But before we wrap up this conversation, I would also love to touch base. I know you are a mom as well. And understanding how important healthy skeletal muscle is for literally our whole lives and for anti-aging and for so many aspects of health. I’m curious if you have any tips in how you approach this with your kids from a young age to help them build a really strong foundation, even from toddler age.
Gabrielle: What a great question. I incorporate my children into everything because we know that the time to lay the foundation for healthy skeletal muscle and tendons is in youth. Once, you know, there is this growth period, and this is when they really prime the skeletal muscle that they have to take them through aging. And again, tendons as well. My kids, and I have very little children, although I only have two, I don’t have six. I have a three-year-old, almost three, he’s not three yet, almost three and four and a half. We involve them in all of our training. It doesn’t mean that they are doing max deadlifts, but we have kettlebells that they can carry as we do kettlebell walks. They can do squats. We do push-up challenges with them. We make it fun, and we incorporate this into their life too. And it’s totally doable. Again, I am a working mom of two very little children, and I still get in all my training. I don’t miss it.
Katie: Well, and in our next episode, I’m excited to delve into the specifics of how you do that. And I also just want to call out, I love that you use the word training, instead of just exercising or working out. I think like that’s also a powerful reframe and sort of like the idea of movement toward a goal versus just like, I’m going to go to the gym and do random things in some random order and get some random results. So I’m really excited to delve into that in our next episode. But before we wrap this up, huge plug for your book, because I really thoroughly enjoyed it. And I think this message is so valuable. But can you speak to where people can both find the book and find you online? Because you are also prolific in your research and your information that you’re putting out.
Gabrielle: Yeah, my book is called Forever Strong. It was a New York Times bestseller or is a New York Times bestseller. It can be found on Amazon. Wherever books are sold, you can order it. I also did my own audiobook. I spent a lot of time and energy making this book an evidence-based book. So it’s dedicated to my mentor, Dr. Donald Layman. He is one of the original protein researchers. And this book is for everybody. You don’t have to be a doctor. You cannot know anything about nutrition. And this lays the foundation for very specific pathways to take you through, whether it is weight loss, muscle building, longevity, exactly what to eat, exactly how to train. I think that you guys will love it.
And there’s also a few other exciting things that I have up my sleeve. You can find all this information on my website, which is Dr. Gabrielle Lyon. We have just launched a community, and it is the Forever Strong community because we are stronger together. And once we hold ourselves to a higher standard, not going for goals, but a standard, we require a community. And this is not about a book per se, but it really is a movement. This idea of being Forever Strong is what I hope to move the world to greater health. They can find me on my podcast, The Dr. Gabrielle Lyon Show, Instagram, X, YouTube, you name it. We have a great newsletter. We put out evidence-based information in my newsletter and our Forever Strong community. Again, I also have a full clinic. They can learn more about the clinic if they are interested in working with one of our providers.
Katie: Amazing. I will make sure all of those links are included. I’m excited to chat with you again in our next episode. But for today, thank you so much for the time. It’s truly always a joy to have a conversation with you and learn from you. And I am a tremendous fan of the work that you do. Thank you for being here.
Gabrielle: Thank you so much, Katie.
Katie: And thank you for listening. And I hope that you will join me again on the next episode of the Wellness Mama podcast.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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