 This is mind pup, right? Today's episode, we brought back one of our favorite guests, Dr. Gabrielle Lyon. Now she is at the forefront of what is called muscle centric medicine. In other words, we're not over fat, we're under muscled. In today's episode, we talk all about muscle and how important it is for health, how important it is for your metabolism and the difference between healthy and unhealthy muscle. Believe it or not, a pound of muscle is not just a pound of muscle. It's quite different from one person to the next, depending on their health. She talks about all this and more in today's episode. Now you can find her on Instagram, oh, excuse me, you can go to her website, drgabryllion.com. So it's G-A-B-R-I-E-L-L-E-L-Y-O-N.com. She's got great offers on there, but also she's hosting a Forever Strong Summit on January 14th in Austin, Texas. You gotta go check that out. All right, guys, new program launched. So I'm gonna give one away for free. It's MAPS 40 Plus, brand new MAPS program. Here's how you can enter to win. When we post this video here on YouTube in that first 24 hour period, comment underneath this video. Leave a comment, subscribe to this channel, turn on notifications, and then we'll let you know if you end up winning and you'll get free access to this brand new program. Now everyone else, if you're interested, first off, it is not a beginner program. This is a great program for fitness fanatics who are 40 or over. Okay, it's designed with special considerations for the things that challenge those of us in that age group. Brand new program, and if you sign up now, you get $80 off plus two free e-books. So if you're interested, just click on the link at the top of the description below. All right, back to the show. Dr. Lion, welcome back to the show. I'm so happy to see you guys. Your show always crushes on our podcast. People love what you have to say, what you do. We love it. I wanted to get into, I wanna start this by talking about sick versus healthy muscle. Ever since talking to you, I've made posts about this and talked about this. Your example of the ribeye versus the filet, like that was a great visual, but can we go into more depth? Because lean body mass, we think is lean body mass, right? So bone, organ, muscle, fat mass is fat mass. What's the difference between five pounds of not healthy muscle and five pounds of healthy muscle? It's a great question, but before I answer that, I just wanted to say thank you to you guys because I do not think my book or the platform that I have would be nearly is successful without you guys. Thank you so much. Appreciate that. Thank you so much for your support. When you started eating the royalties, did you say? After I send my five-year-old to your house. The question, what is healthy muscle versus unhealthy muscle is a very important one. And it's something that is not routinely looked at, which is when we think about it is a huge flaw, right? We look at adipose tissue, we think about adiposity, but we don't think about the health of skeletal muscle. And when I think of healthy skeletal muscle, as I would hope that everybody does, you think about it as a filet. It's a little bit different because there's something called this athlete's paradox. There's intramuscular fat, which is fat after the fascia around the muscle between muscle groups. And then there's intra with an A, intramuscular fat. And that could be what you would say would be healthier, fat versus non-healthy fat. So let me explain that. So intramuscular fat is something that both obese or individuals that potentially have type 2 diabetes, et cetera, would have, it's fat within the muscle fibers. And the athlete's paradox is that athletes, a lot of endurance athletes also have intramuscular fat because they use it for energy. Is it for readily available fuel? Yes. And did their body adapt that way because of the intense training and potential lack of- Yes, probably, yes, probably, yes. But the reason I say that is because, when you think about that picture of a filet, you would imagine that that filet doesn't have any intramuscular fat. But the athlete paradox, there is a continuous flux. So it's not fat necessarily that just stays there and builds up over time, but it's energy that's utilized. So it's a difference between fat that's sitting there versus fat that's being deposited, used, deposited. Yes. You said endurance athletes. Is this not seen in strength athletes? Is it different? From what I've seen in the literature, it's just not as well studied. Okay, so we don't know. The majority, and maybe there is more and more information, but typically when we think about fat within the intramuscular fat, a lot of it is based on endurance. Okay. And I will also say that when you think about unhealthy fat, this marbled rib eye, is that we see that there is an inverse relationship. So you are thinking about two groups of people. So one group is healthy, highly active, insulin sensitive, and they also have fat within their skeletal muscle. And then the other group would be less insulin sensitive, so insulin resistant, more obese, maybe type two diabetes. Those individuals will have higher amounts of intramuscular fat, and it is inversely related to insulin sensitivity. So for example, your skeletal muscle will be less likely to utilize glucose than another type of healthy tissue. So it's the fat in the muscle in the context of these other metrics when I look at that determinant. Do they study the fat that's within this muscle to see if there's a different fatty acid composition if we're dealing with anything like brown fat versus white fat? Is there a difference? Another great question, and really the person I would point to would be, his name is Brett Goodpasture, and he is really the guy, because there's all different kinds of fatty acids and fats, whether it's ceramides or diacylglycerol, there's all different kinds. And I think if you were to say, what makes a skeletal muscle unhealthy, you would get a million different answers. So I think the overarching theme would be, is this muscle static? Are you not utilizing it? Is it weak? Is it not strong? And what are the other components that have now infiltrated it? So for example, through advanced aging, we see increase in connective tissue, a decrease in ratio of skeletal muscle to fat, we see sarcopenia, obesogenic sarcopenia. So really in the context of the human and the activity of the human and the age. I think this just highlights how complex the human body is, right? You can't just look at one thing and say, well, here's what we're seeing. It's almost like analogy would be, my back is sore, okay, do you do anything? No, I do nothing. I sit down all day long. Versus my back is sore, well, what do you do? Well, I exercise a lot and I run a lot and I do some hard labor. And so it's a different problem. One would be very bad when the other one, not necessarily so bad. Yeah, and I think again, as we progress in this concept of muscle centric medicine, it's gonna become more into the forefront of how do we identify healthy skeletal muscle? You know, what are the metrics that we look for? How do we look at it as a vital sign? So it's not just the amount, but also the quality, the thickness. And I think that that's really where things will advance too. It seems like the move would be to get, first get this tested so you have an idea of where your baseline is. And I imagine like many other things, there's gonna be a massive wide range in individual variants, to athlete, to person. And so probably the most important thing would be like, okay, let's figure this out, what my ratios are, where I'm at, and then where I go from there maybe. Is it okay? Yeah, I definitely think that that's the direction that we're going. So when we look at where we are now, people use DEXA or InBody. Do you have a preference of any of those? I was gonna ask you. I'm gonna say something cheeky, and then I'm gonna say what I really think. So I'm gonna say neither, because I don't think either are great when it comes to looking at the health of skeletal muscle, and then all the providers and the PhDs are gonna go, well, you know, that's stupid because that's what we have. And I'll say, yeah, you're right. That's totally what we have in an ideal world. I think we are gonna start looking at skeletal muscle directly. The test to do that is called a D3 creatine test, because creatine is what is in skeletal muscle. It is not available to the public yet. It's heavily used in research. I would love to see that become available to the provider. And that's not looking at excretion of like how the kidneys are filtering it or like current tests. And what's the D3 stand for? So it's a deuterated creatine, and it's a tagged creatine. So basically they've developed this way of being able to identify how much skeletal muscle mass somebody has. So it's just looking at skeletal muscle. It's been validated in babies, you know, adults, older adults. And again, the researchers that did this is named as William Evans and Hellerstein is the other guy. And that is amazing. If we can begin to use that, I think it could be the same as checking blood pressure. Wow, wow, that powerful. Okay, so when I, back in the day, when I used to think of muscle versus fat, I would think, okay, muscle, it influences hormones, there's receptors, it puts out certain signals. Fat just sits on your body. That's not necessarily true either, right? Cause fat also has some hormone on its own, has some kind of hormonal influences. So what are the differences between fat and its influence on your hormones versus muscle and its influences? Yeah, I really like that question. One of the things that I didn't mention about inter-muscular fat, the fat around muscle and fascia, is that the more fat that you have, it is inflammatory. And it does create cytokines. And these cytokines create systemic inflammation. That is very well-established, low-grade inflammation. That is a problem. The counterbalance to that is healthy skeletal muscle. Contracting healthy skeletal muscle produces counter-regulatory myokines. And that, I think, really helps buffer. So if an individual, just go with me here. So if an individual is struggling with obesity or an individual is struggling with excess amount of body fat, contracting skeletal muscle can help balance and buffer that those low levels of inflammation, even if you haven't completely rid yourself of, say, excess subcutaneous fat. And I think that that's an important point because it's not just about long-term goals, it's about executing in the short term. You know what this reminds me of, or points to, is we've looked at fat now for so long. We now know there's brown fat, there's white fat, there's, if a woman stores body fat around her hips and thighs, there's more omega-3 fatty acids and they're probably better for the brain of the baby that she may be carrying verses around her belly and visceral body fat, very bad, other types of body fat, not as bad. We know very little about muscle, we just know muscle. You have it? Or you don't, and there's no difference. Of course, of course there's a difference between healthy versus unhealthy muscle and then it's influenced on hormones. Okay, so you said, if you got body fat, a lot of it puts out cytokines. Muscle puts out myokines, which kind of offset that and buffer the inflammatory effect. Okay, so I'm gonna paint a scenario to you very oversimplified. I know you're a doctor and you're gonna hate this, but I'm gonna put it to you anyway. Guy comes in, needs to lose 35 pounds. 35 pounds overweight. They wanna improve their blood markers. They wanna become healthier. Do you make them lose body fat first or do you make them build muscle first? I mean, so 35 pounds overweight, he's gonna have much, I think the benefits of focusing on skeletal muscle are gonna always outweigh the benefits of focusing on adipose tissue because when you create healthy muscle, you really improve your metabolism and the efficiency of utilization. So I would focus on skeletal muscle. So adding to that, does that ever change? Thank God, that's what we do. I know, we're in alignment, good, right answer. So does that ever, because I feel like that's, and we talk about this that that would be, that's no matter what someone's trying to lose and they come in, they say, Adam, I'm 100 pounds, 10 pounds, it doesn't matter. I always focus on building muscle first, right? And building the metabolism. Is there ever a case where it's, you wouldn't do that? I think the case where you wouldn't do that is if the proportion of body fat is so high, let's say it's, let's say it's an emergency, they have to, you know, again, this is just hypothetical, what if they're 600 pounds and you have to get the weight off because they have to go to surgery, then I would focus on, you know, losing that body fat. And that would be protein sparing modified fast that they used to use for situations like that. Yeah, it's emergency. I see clients like that, they used to manage a gym and we had an obesity clinic and people will come in with, you know, these are gastric bypass candidates and it was emergency like for a lot of these people. Some of them could barely walk into the gym and it was like, okay, where do I get some weight off? But I would always try and get them stronger just because it improved their mobility. You just brought something that reminds me of an old story. You know what's crazy is that I actually had people, I had two different people that tried to hire me back in the days to actually put weight on so they could qualify. So they could qualify. Yeah, did you know that? Yeah. You know that you can be too light to qualify? Yes. I had the same thing. I got to gain weight right now. Never forget that person sitting down with me and saying, oh yeah, I'm looking to get a gastric bypass and but I need to add another like 10 pounds of fat. Can you help me get fatter so I can get a gastric bypass. Talking about the health benefits of muscle, one of the more anabolic hormones both male and female bodies testosterone. I mean, insulin can be anabolic growth hormone to an extent and the interplay between all the other hormones, but testosterone is pretty anabolic. Like it's pro muscle tissue in both men and women. Why is it so demonized? Why are we so afraid of testosterone when somebody has low testosterone to put them? Is it purely because it's a performance enhancing drug or it's been put in that category? Is it dangerous? We got to be careful when we use it because you can overdose on it. What's the deal? Let's take a look at where the medical system has been. The medical system in and of itself is not set up for optimization period end of story. You broke your leg, let's fix it. You have an infection, let's fix that. You have diabetes, here's some drugs. We don't say what about if you have low muscle mass, unhealthy skeletal muscle mass, what are we going to do to prevent aging? I just think the way in which we have intellectualized medicine as a whole is backwards. Because of that, it's set up where things that would potentially help with longevity and help with aging are thought of as, oh my gosh, why are we doing that? And I think that that's the same thing with testosterone. I mean, I've mentioned this before, testosterone is not FDA approved in women. How is that possible? Yeah, you guys have it. Yeah, it's the most abundant hormone that we have. How is that possible? I'm hoping that that changes because we recognize that testosterone, I'm not talking about super physiological levels. Yeah, we're not talking about bodybuilders competing on stage. No, and by the way, they continue to lower the standard of what testosterone is. So if the minimum testosterone a handful of years ago, the numbers was maybe it's 350, now it could be 200. I mean, it's not quite 200, but do you see what I mean? So they keep lowering the standard of what we will tolerate as low. Wow, now is this because, because I know for the last five or six decades, I don't know if this is true in women, but I know we've seen this infertility in women, but we've seen testosterone levels dropping in men pretty consistently probably for the last five or six decades. Is that why they're changing the standard? Because the average keeps going, I mean, I read a study that showed something like, like a 60 year old man in 1980 has like the testosterone of like a 20 something year old today or something crazy like that. Yeah, I think that that is one reason why they are lowering it. Because if you lower it, then you're now within normal range, we don't need to treat it. Maybe it's also because testosterone is cheap. It's not a very expensive hormone to buy. I don't know exactly why, but what I can tell you is that patients do much better with more optimal levels of testosterone. And the other aspect of what we're seeing is that, there's been a lot of conversation about how it's bad for heart, it's bad for your heart, how it's bad for the prostate disease, et cetera. And they're not finding that. They are finding that it is very protective in many different domains of health and wellness for an individual. Well, I think it's disingenuous because what we're doing, we're not comparing apples to apples. So we're not looking at comparing, let's say men with suboptimal or low testosterone to men with optimal. They're looking at men that abuse testosterone and say, oh, there you go. See, it causes heart problems. It causes left ventricular hypertrophy. It causes, but these guys are taking 10 times the dose that you would take to be in a normal, a lot of lines of their other lifestyle choices too. And also when you think about, let's take thyroid replacement. Thyroid replacement is super common, no one blinks an eye. I think in the next 10 years, that's gonna happen for hormone replacement. If you are not on hormone replacement, people are gonna be like, oh, it's gonna be the equivalent of, oh, you have low thyroid, why are you not taking thyroid? Why aren't you taking that? I agree. I think, but it's gonna take 10 years. Yeah. You know what's interesting to me, when I learned this not that long ago, if you took a person and gave them 10 times their normal amount of testosterone, they might get some side effects, but they would be okay. You can't do that with almost any other hormone. If you did that with insulin, they'd die. If you did that with thyroid, they'd probably die. If you did that with estrogen, they'd be a raging bitch. Yeah. I'm kidding. I'm kidding. I'm kidding. So although testosterone can do that in some people too. But yeah, so it is interesting that it's gotten this kind of negative, like what's going on. And again, it points all to, I think maybe not knowing the real health benefits of muscle, muscle being relegated to, well, this is what keeps you mobile, but not what keeps you healthy and what contributes to longevity. It's all about keeping fat away. Yeah. And I think the dichotomy between muscle and sport. So really, skeletal muscle has not been thought of as the pinnacle of health and wellness. It's always been thought about as sport. So with sport, people think about performance enhancing drugs and testosterone, but it shouldn't be that way. It's more important in my opinion than even thinking about fat. Yeah. And if we were to close the gap of the conversation that muscle is really the pinnacle of everything. It is the pinnacle of how you're gonna be able to show up. I've never had a patient say to me, you know, I really regret being strong. I mean, that was a huge mistake. And you'll never hear that. Mm-hmm. But if we begin to kind of close the gap of what muscle really is and then begin to think about what are the things that we can do to enhance skeletal muscle health, then testosterone wouldn't be so much of a black sheep. Versus, oh, there's obesity medication. People aren't like, oh my gosh, you're taking medication for obesity. The other thing is the connection between muscle and cognitive health. I mean, obviously your brain controls muscle, moves it, contracts it, there's proprioception that's involved, which involves the brain as well. There's the insulin sensitivity aspect that muscle contributes to, which we know. It's probably a major player in dementia and Alzheimer's. Maybe if we help make that connection, because when you think of healthy brain, there's that old myth of the meathead. Oh, he's an idiot, he's built, he just works out or they're stupid. And then there's the brainiac who's really skinny, doesn't have any muscle. But that's couldn't be further from the truth. Yeah, actually, I never thought about that. That's a really good point. So I did my fellowship in geriatrics in nutritional sciences and geriatrics, which means a huge part of that was looking at memory and aging and body composition. Geriatrician is someone who studies an individual over the age of 65 and at WashU, where I was, there are specialists in Alzheimer's, Alzheimer's dementia. There's vascular dementia, there's Alzheimer's dementia, there's Lewy body dementia, all different kinds. But when you think about preventable causes of dementia or cognitive impairment, you have to think about the metabolic implications. The brain is an organ, just like the pancreas and the liver. And when you are metabolically unhealthy, when you have excess body fat, when you have higher levels of glucose, you are more, and you are more insulin resistant, these things all over time affect the brain. And when you train, exercise of course, does a multitude of things. There's probably nothing more impactful than training. Diet is probably not even as impactful as exercise. For longevity. Yeah, I've seen the studies on that, it's crazy. I mean, it's exercise. When you think about exercise, you think about contracting skeletal muscle. Contracting skeletal muscle releases these myokines. One of these myokines is BDNF that impacts the brain for neurogenesis, cognition, we all know that. Of course, endorphins everybody talks about. Then there is, again, that implication of metabolic correction of exercising skeletal muscle utilizes glucose without the need of insulin becomes very important, especially when you think about brain health, because brain is very, it is very affected by body composition over time. So the wider the waistline, the lower the brain volume. And I know that that's a very robust statement to make, but you'll see in the literature that the better your body composition, the lower your body fat, the better your brain function. Now, what's interesting about what you're saying, because so many thoughts flying through my head. So you said training is more important for longevity than diet. We've placed more of a focus on diet because when it comes to the scale moving down. Yeah. Diet will do that faster than just exercise. In fact, you can exercise and not lose a pound. You could obviously cut your calories and lose a pound. And because we've tied body fat to everything, then that is more of an important thing. The other thing too is I've seen this data and I would love to confirm it with you. Obviously, if you're super overweight, you see increased rates of mortality or whatever. The underweight, people who are very underweight probably have worse outcomes or just as bad. They do. So what is that showing? I think part of that, well, especially as you age. So one of the things as a geriatrician, surprisingly they do not recommend that you lose weight. Depending on, obviously this also depends on how overweight you are because if you were to get injured or you were to get sick, the body has to readily use stores of energy. And so that is why, I believe. And then also, but on the same hand, you're not gonna be able to survive without skeletal muscle. So when you think about cancer catechia, which is this highly catabolic state, the thing that kills you is the loss of muscle. Again, so yeah, underweight is a- Yeah, because underweight means not enough fat, but also means not enough muscle. I don't know anybody with a lot of muscle who's underweight, further height or whatever, What's the minimal dose to positively impact somebody who's like concerned about this? Like we got someone who's listening that has a grandma, grandpa, or even a parent that's aging that hasn't exercised at all. What would you like, what does the literature say about like if you at least do this weight training wise, it makes this big of an impact? Yeah, it's really fascinating at how malleable skeletal muscle is and how dynamic it is. There's literature in 85 year olds that they can improve muscle mass and strength from very limited activity. It could be from sitting to standing. That's what I did. I trained people in the age group for years and they would come see me once a week and Dr. Lyon, I would do maybe 20 to 30 minutes of exercise with them. And the rest of the time was like talking and resting and you know, whatever. So we would get through maybe a grand total of six sets of some very like, okay, what you just said, sitting down, standing up, that was like a foundational exercise. But that was probably high intensity training for them. Oh yeah, and they would get, I mean, their health would improve dramatically in a very short period of time. And they thought, oh, I didn't know I could get stronger. And you know, there's evidence. We worked on some of these earlier studies, the early 2000s where they looked at two groups of women and this was at the University of Illinois, two groups of women and one group had the food guide pyramid and I'm gonna get to the exercise piece. They ate the food guide pyramid, which is a total disaster, right? We know that like, what is? Paid for by big food. Terrible, terrible disaster. And then the other group had a double the RDA protein and they, and both were isocloric, but I wanna get to the exercise component. And what they found when they looked at the synergistic effect of exercise of dietary protein and exercise, they did three days a week of stretching. So that was the exercise intervention. So it was really limited. It was three days a week of yoga and then, you know, some walking. They were able to maintain their muscle mass and they were able to maintain their muscle mass even on a lower protein diet. And I'm not advocating a lower protein diet, but it was the point is, is that the influence of exercise, even some basic movements. So if someone is listening here and they're not doing anything, number one, don't do the food guide pyramid, right? That's like a bad idea in general. But if you are eating not an ideal diet, just by doing three days a week of exercise, which can include yoga, you'll have an impact. It's more than what they're doing. You also, you said something that we try and communicate all the time, which I think is so important is when Sal said the getting up and down, he said, yeah, that was probably like high intensity training. It's so important that if you're a coach and trainer that you understand that like meeting them where they're at, yoga could be a lot for somebody who's never done anything or not moving. And so sometimes I think as trainers, at least I was guilty of this as a young trainer is thinking like, oh, we got to be in here for an hour and you need at least three to four days a week. And I need people to listen. It's like, man, I'm taking somebody who's 50-something years old, never lifted weights in their life before. It's like, man, just getting this person to come in here and practice these movements is huge. Dr. Lian, one of my clients was she had a walker and one of her exercises was letting go of the walker and just trying to stand as tall as she could. And we would timer for 10 seconds at first. I love it. And it was a strength training exercise for her. And I think a big message here is how do we get people to start early? Like really early. We all have kids. How do we get them to start early? So then it doesn't become a habit or a situation that they have to change. I don't want, and I can appreciate people coming in in their fifties have never done anything but I want to get to the point where, we have a bunch of trainers in the room now and we're all relatively fit. I mean, you guys are fit. I'm relatively fit. But that we think about how do we become responsible for our fellow human? Because at the rate that we're going, we're going to hit a tipping point where the normal is going to be overweight or obese. We're getting close. But just the normal population. And so then the question becomes, there's going to be just huge division. There's going to be a group of people that are fit and then a group of people that are not. And not exercising. And how do we get the other individuals who don't quite understand the influence to get on board? Yeah, the political implications of that are huge because it's already like this, by the way, when you pay your health insurance and you're healthy, you're subsidizing for the unhealthy people. So when you have 60% or 70% of the population, that's obese and sick. That means the other 30% are going to support that 70% with the costs of trying to keep them alive and all of their health issues. You mentioned the food pyramid. Why is that so bad? I mean, that was the biggest social experiment I think that we had. So the food pyramid was really when everything changed and the food pyramid was a diet that was 45% carbohydrates and the base was grains and carbs and protein was maybe 10% and fats. It was a social experiment. And what does it cost the whole family? Do you think there was, was there good intention behind it or do you think that that was completely manipulated by like the food industry and so like that? Like what's your theory on that? Like did we go into it thinking, because you say experiment, like, oh, we think this is a good idea or do you think it was manipulated or played with? I think a lot of it is not based on health. A lot of the initiatives and a lot of the information that we have received for decades is not solely based on evidence-based information. That's so ironic though, because you're giving health advice but it's not based on health. It's challenging because for example, when you think about the food guide pyramid and you think about these protein recommendations that haven't been updated since the 70s, where did they come from? And really, is it because they established that this is the amount of carbohydrates? Was there really evidence for that? There was a seven, was it called the seven country study dog? Who was the doctor that did that? Yeah, Ansel Keys. There you go. He took out two countries that didn't fit that criteria. I mean, there's a lot of, and it's interesting when you look back at the history, it's never been about the science only. It's been about policy. It's been about, you know, there's a religious aspect to it. There is an emotional aspect to it and it's really damaged our society and it's really damaged going forward. There's a big push or narrative that's out there that is trying to push the average person into a plant-based or vegan diet, almost and sometimes directly, but usually kind of insinuating that the protein's not good, animal protein's not good, it's not healthy. What do you think would happen if the average person just said, I'm gonna go plant-based, I'm gonna not eat meat, eggs and milk? Well, right now 70% of our diets are already plant-based. We're pretty fat and pretty unhealthy. If we are gonna further reduce that or rather increase that plant-based number, what's gonna happen? We're not gonna go in a better direction. Right now we're 30% animal products, 70% plant-based products. If we listen to the narrative, and that's from NHANES data, so that's the largest data set that we have. So if we were to take a step back and then actually execute on those recommendations, I mean, it's going to be another disaster. Like the same thing with cholesterol. So there was that whole period of time that we should reduce, I don't remember if it was in the 60s. It was, maybe it was a little bit later, but Time Magazine came out with this article where it had like butter in the frowning face or something like that. Or maybe it was eggs in the frowning face where there was this recommendation that we should reduce our cholesterol to 300 milligrams of cholesterol a day. And everyone, all heart disease was gonna go away. They did that, nothing happened. And I think that actually heart disease went up and they ended up taking out cholesterol guidelines 2015. So people did exactly what they were told to do and nothing happened. The food guy pyramid, people did exactly what they were supposed to do, everybody got fat. There's that cover right there, eggs and bacon. Collesterol and they were wrong. They were totally wrong. Super right. I almost feel like this direction towards vegan and away from animal products is even scarier. Oh, it is, it is. I mean, I think that's worse than just trying to avoid fat or avoid cholesterol. Like going all plant-based for the majority, I think where Sal was alluding to is people already that eat the average diet have a really hard time hitting the adequate amount of protein they need to sustain muscle mass on their body. Well, we're not doing it. We're not doing it. And think about it this way. So that the recommendation at 0.8 grams per kg is 0.37 grams per pound. So if you're a hundred and if you're a 115 pound female, that's 45 grams of dietary protein a day. Now these numbers were developed, the RDA was developed on high quality protein. So the RDA is developed on high quality animal-based proteins. The recommendation of 0.8 grams per kilogram came from young men to maintain nitrogen balance, which in and of itself is not a health outcome. So now if we believe, and do you believe that the RDA is enough? No. No. The RDA is the minimum to prevent deficiencies. The RDA is based on animal-based proteins. If we then go plant-based and we further reduce our dietary protein, you tell me what's gonna happen. Hold on, let me illustrate this so people understand just how insane this is, okay? It's already hard to get protein from plant-based sources. Now I know people will see those pictures of this many beans or whatever. You go ahead and try it. Try it. A hundred grams of protein from non-animal sources. No one's gonna hang out with you. No, it's gonna be terrible. And now you're talking about protein quality as well, and studies are very clear on this. Unless your protein, it takes super high. When I say super high, like I weigh 205 pounds, I'm consuming 200 grams of protein. Unless your protein takes super high, and there's lots of studies that show this, that animal protein versus plant protein, one gram of animal protein is equivalent to like one and a half grams of plant protein. So not only is it hard to get the protein from the plant sources, but you also need more of it to do the same work. So we're literally gonna make it impossible for most people, unless they supplement like crazy. Wait, but wait. So we're talking about protein as a generic concept, and I agree with you. Now, how are you gonna get iron, your bioavailable iron? How are you gonna get creatine? How are you gonna get B12? So if we've just focused on dietary protein and go more plant-based, could we get enough? Yeah, but what about everything else? What are we going to do to the other physiological needs? Well, we could just... Yeah, you have a prediction based off of that. Like, okay, let's say, because it is feeling like it's going this direction, that we're pushing this, and more and more people are going plant-based. Are there things that you, knowing what you know already, like we're gonna see an increase in this? We're all the symptoms of being deficient. Yeah, we love... All right, here's what's gonna happen. Here's what's gonna happen. Well, you know, it's very interesting. A lot of the younger people are the influence that are arguing for plant-based. 20s, maybe early 30s. Again, as a geriatrician, you don't see geriatricians to say to anybody go more plant-based. Like, that's terrible medical practice, terrible advice. We are going to see rates of osteoporosis, of sarcopenia, because we are going to, because we, everyone in this room, we are going to change the narrative, and people are gonna start to test muscle mass directly. We are going to see an exponential level of low muscle mass. We are going to see osteoporosis like we've never seen it before. We are going to see injury, fractures, and falls like we've never seen. I'll add to that. You're gonna see higher rates of depression, and anxiety, and mental illness as well, which are all directly connected to... I mentioned B12 deficiency. You mentioned iron deficiency, both of which can make you feel more depressed and or more anxious. You didn't talk about vitamin D deficiency, which is also gonna be more common, which definitely is connected to depression and anxiety. By the way, if people look this up, look it up. Look at the rates of mental illness and the ones that I talked about, and people who are plant-based versus people who have an omnivore diet. And you're not even comparing like a healthy omnivore diet. You're just looking at the general unhealthy population, and you see that the rates are much higher. But we can always give them enziolytics and antidepressants. And the other aspect is that we have beef consumption that is down, dairy consumption is down, but all of the high-quality foods, they're lower than they've ever been before, and ultra-processed foods are higher. And then if you look at other countries, the other countries would think it's crazy to say, you know, yeah, get rid of, go more plant-based. It is a luxury that we can even have this conversation. But yeah, so back to your point, what is gonna happen if we go more plant-based? Well, again, the RDA is the minimum to prevent deficiencies. It's based on animal-based products. Now we're gonna further reduce that. What's gonna happen? Okay, so cholesterol, they were wrong about that, consuming cholesterol. They actually, FDA actually says it's no longer a nutrient of concern. So they even said this themselves. What about sodium? Sodium is, you know, bad for you, causes high blood pressure, avoid it. Everybody gotta go low-sodium diet. There's products out there that are all low-sodium. Have we been misled with sodium as well? I actually, I believe so. I'm obviously not a sodium expert, but I believe that we have been misled. It is an essential nutrient. And I think that if you look back at the history, that sodium is something that animals always search for. Whether there's salt licks or whatever it is, it's very difficult to get into the diet. The other aspect of it is that when you think about high-sodium diet or high-salt diet, will there be some individuals that are sensitive to sodium? It's probably maybe 20% of the population. And the majority of people are not going to be affected by sodium, and it's essential. Could we also be looking at a correlation? I think if you took 1,000 everyday people, just regular people, so no controls, and you just took out the people or identified the people consuming the most sodium, there's probably a correlation between that and heavily processed foods or fast food. Because I think that's what we're probably dealing with. Because you eat a whole food diet and you salt the hell out of your food. It's not that much salt. Again, I think that we have been really misled about sodium. Is it really a sodium issue or is it a processed food issue? Is it the lack of potassium? Is it the lack of other things? Staying on the diet topic, fasting, I remember that became kind of big here in the space. People were touting, it was so great. We were cringing every time we saw people say fast to lose fat, not necessarily a good idea. Here's something I notice as a trainer and a coach. All of us notice this as well. Even the fasting zealots who think it's so great, it seems like women have oftentimes a more negative, if they do have a negative effects from fasting, they seem to be more, for lack of a better term, sensitive to the potential negative effects of fasting. Is that true? Is there a difference between men and women how they react to fasting and what about fasting in general? Let's talk about fasting in general. I don't necessarily believe that there's a magic to fasting. I think that it ultimately comes down to calorie control. The question is, why are you fasting? I don't think there's anything wrong with fasting. I think that is it for bowel rest? Is it for everyone uses the magic term autophagy? How long would someone have to fast for it? I think that there's multiple ways to get an end result. But fasting definitely allows for calorie control, definitely allows for a gut reset. It can definitely help some aspects of circadian alignment depending on when you're eating versus when you're fasting. Does it affect men and women differently? I think that there's a lot of influence of hormones that we don't, that they're so variable for women in particular that we don't know. And that I was talking to our mutual friend, Lane Norton, we were just texting the other day and I was saying, what are your thoughts on the hormonal aspects of fasting or exercise, etc. And he, I think him and I were very much in alignment. There's so much variability. There's just so much variability. I think that we're very behind when it comes to looking at female physiology, just in general. That being said, if a woman's body perceives that she is under too much stress, and I'm using kind of nebulous terms because I think that this kind of relates to fertility. That if a woman's body perceives that she is under too much stress and let's say, again, I say this cautiously that cortisol is elevated over time or she becomes amenorrhoic because of perceived stress and you add fasting into that, I think that that can be a negative, rather than eating earlier on and allowing the body to kind of settle. Is there a low body fat kind of factor to that with women especially? Yeah, it depends on the woman. It really depends on the woman. Again, obviously, you want to make sure that she is having a regular menstrual cycle and that she is ovulating. Should we say 20% is ideal for getting pregnant? I don't know if we can say that. It's certainly very individual. Do you, when you just mentioned a woman's cycle, is that a really good indicator to a woman that she's healthy versus not? I would say so. Yeah, because I use that quite a bit as a trainer. Like if I had a female athlete, if she lost her period, I knew we were going too hard or she was dieting too much. I knew right away. And I think that that's a really good perspective. Yeah. Unfortunately, it's accepted in the female sporting world. I know. Oh, you lose your period. I know. And in military, same with women in the military, if they're training really hard, it's the first thing that goes. I mentioned hormonal fluctuations. Now, I know as a man, they say, if you get your testosterone levels checked, do it in the morning. That's when it's highest. So it's the most accurate reading of your high levels. But our hormones are pretty stable month in and month out compared to a woman's cycle where she gets these really kind of, you know, in comparison radical changes. How do you test the woman's hormones then? Because she could be at any moment, any time in a cycle. Yeah. Do you? You should be able to tell. For the most part, you should be able to tell based on looking at everything. And then you have ranges for that time. Estrogens, progesterone, testosterone. Yes. You should be able to tell. Okay. And in ratios of estrogen and progesterone, what are we looking for during the, what is it, what is that you're looking at when you look at those? So I used to look at those. I don't look at them anymore. Why? I just, I feel like you have to really, again, because the cycles are so variable and people are so variable, it depends on, it ultimately goes to how the woman is feeling. I think when you're early on in your medical practice, you're testing everything. You're testing everything. You're testing everything. You're testing everything all the time. And then over years of clinical practice, you'll, you'll hear a woman and she'll be saying, listen, I'm having a lot of anxiety. I can't sleep. X, Y and Z. And you might look at her blood level of progesterone, which is typically low anyway, but you know that she needs it. And you know that there isn't going to be a downside. And with her levels of estrogen, you know, from a clinical perspective, if a woman is still menstruating, you're not really going to give her estrogen. So I don't look at those ratios anymore. I know it's crazy, but That brings up a really interesting question because all fair, we are talking, we're comparing like how Western medicine does things compared to like how you do things with patients. And I mean, we should know better too. This is how we were as trainers, like how much we were by the book when we first started and then how much we threw out the book. Exactly. Later on. So I would love, Exactly what happens. It is. It's like, you need to know that stuff. It's very important. Then you realize like, okay, now none of this matters. But it's like, okay, but, and this is probably why there's this like, this belief or, and I wouldn't say belief because that even insinuates that it's not true. You talk to a lot of women and they say a lot of women have this complaint about going to the doctor. They gaslight me. They ignore me. They don't hear about how I feel. They look at my lab. They tell me I'm fine. Right. Tell me I'm crazy. And what you're saying is that's why, because you're just looking at the numbers and not listening to what she's saying. So what are, so take us through. I'd love to hear some like questions that where you're at in your career now compared to where you, when you first started, right? Yeah. Like what's different that you ask now and like what are like huge clues for you that maybe you wouldn't have asked or even seen about? Yeah. So the first thing that I do in my practice is you got to figure out who the person is. There are archetypes of people and when you figure out who the person is, you'll get a, it'll be a whole different perspective of what you're going to hear. Okay, explain that. I'll give you an example. So the, I take care of a lot of females and a lot of guys and a lot of men that are very successful, very driven type A individuals. And the first thing that I'll say is like how are you doing? And every single one of them, I'm great. Good. That's the answer always. I'm great. And so I already know, right? I already know. And so the next question I'm going to ask is, so the last time you had a big sale, a big launch, a big thing, whatever it is, how did you feel afterwards? And the guy that says, no, I was neutral. It was good. It's just what I do. His answers are going to be so much different than the entrepreneur that says, I crash and burn a doc. I crash and burn every single time. Interesting. So that's an example of, so now I know that the entrepreneur, so the entrepreneur typically that has gone in, they're very neutral, even though, you know, like some of the entrepreneurs are traveling to different countries all the time, like all over the place. Yeah. Huge book launch and just totally stable right after. Yeah. You know, like just totally capable. And then the other entrepreneur, and I'll give you an example, because where they are in their career is totally different. The other entrepreneur does this huge event in Vegas every year. And every year I wait for the call about how shitty he's going to feel afterwards, how he's going to be off his diet and he's going to be not training. And so that's, so when I get a perspective of who the person is. So for example, the guy that is neutral going in, I know that he's going to be very steady and stable. I can ask him what he ate three weeks ago on a Wednesday and he'll probably know because he's consistent. He is probably very tight on his vices. He will probably execute on his blood work. He probably will not want a ton of contact, but he'll want me to be on top of all of his stuff. Interesting. And that's one type. And then the other type that is having these massive ebbs and flows, probably he's going to be bad at getting his blood work done. He's probably going to micromanage or overthink every kind of treatment, whether it's testosterone replacement, etc. And also going to be very detached from how he truly feels. So this is cool because we have coaches and trainers in here today that are listening to this and we kind of talk a little bit about this. Now that you've learned this, like you can read these different archetypes. Do you fork? Like you're meeting, you're already, in your head, you're like, okay, I know who this is. Totally. Do you forecast it for them? Yeah. Oh, yeah. You're going to be like this. You're going to tell me that. Gets their buy-in. Oh, it's so good. And then they trust you. Yes. And then it is a relationship where they feel understood. I think that one reason why I have personally been successful as a physician is I understand who's in front of me. I can relate to them. Yeah. And I get them. I get where they're coming from. Yeah. And a physician should get the person. It's not about the labs. Yeah, yeah. It's not about, you know, as a physician you should be good at diagnosing an illness. That's your job. What are the pros and cons of each of those archetypes? Like you said some of the things that they're going to be good or bad at, but what are some of the other things that each one is challenged? Oh, yeah. And there are different. I'm sure. There are multiple different archetypes, but I think for your listener, you know, there's like the reluctant patient who has been everywhere and has tried everything, but they're jumping around from thing to thing. And there's all kinds of things. Yeah, yeah. So the pro patient, like the person who's able to be neutral, right? And that's just an example of you. You tell me your habits and I'll be able to tell you where you are in your career. I'm telling you, you tell me your habits. I don't even need to know what you do. And I will tell you what level you are in in your career. Oh, that's cool. So the good thing about kind of that CEO type is that you know you have to get someone else on board. You know, you need to get their assistant on board, their wife on board. Half the time, I don't even deal with that guy. I just go right to the wife. I'm so guilty. Hey, I was going to say, I was going to say, hey, Katrina did it. I don't get his blood work done. I don't even fucking go, I don't even want to hear you. I don't even... I don't even want to hear you. I group text with the wife like, hey, did this motherfucker get this shit done or not? Like just bypass them completely. Those guys, extremely successful. I hope she's going to make me feel okay about it though right now. Extremely successful. As long as they have someone in their corner. Very handsome. Come on, Katrina. Show up here at this time to get this done. You know, like they will try to cancel the appointment. They will try to move it. It is standard. This is weird. It is standard, right? You have to have, if they're supposed to be on this medication or this supplement, it has to already be sent for three months. A renewal has to come up. They will move. They will do this. If they need blood work, you better have someone sent to their house. So that's... They do that? Yes. So we are very skilled at dealing with these patients. We are skilled. I don't even send you just like, you don't even have to know, just do the thing. That's so awesome. The other type of patient who is kind of a more of a rookie entrepreneur or a rookie individual, those guys are more challenging. They will put off a lot of these tasks. They will put off, you have to be on top of them at all times. Do you think that's because they're at the place in their career where they haven't figured out that they might need that assistant or they need that person? They still think they can handle everything when they're falling short. And also, they fail to recognize that there's this kind of interchange that happens, right? That they think that they can outrun their physical health. And you can't. So for all the trainers listening, listening you guys behind me or if you're listening to this, as high as you are going to go is solely based on your physical health and wellness. And you cannot outrun that. That's your limiting factor. It's your limiting factor, it's you. Always. And the people at the top, they know that. They just know it. And so they are not trying to, and yes, there is a grind, right? We all grind in the beginning. But then all of a sudden there comes to a point where we're like, okay, if I keep grinding this, there's this predictable, I'm going to go high and burn out. Go high and burn. How are you going to do that? You know what you're highlighting right now? Just broadly is the difference between like concierge medicine or private medicine versus working with your insurance companies and those. I mean, you said you got to know the person, right? But the current system really almost makes it impossible. Impossible. And here's why it's so important. Like I'll use one of the most medically treated for lack of better terms conditions that we have is pain. Pain is one of the most treated over the counter and prescription wise. People will use medications for pain. You can't really separate your perception or the physiological what's happening with the pain and how you perceive it or your relationship. You can't separate the two. We know people who are depressed who get out, get out of depression. If some pain goes away, some people respond to pain medicine differently. Other pain seems to be phantom. We don't know what the hell's going on. It's a very strong psychological component. Yes. But without working with the person, that's just one thing. Energy is another one. There's definitely physiological things happening. This is why people don't like their doctors. This is why they go in and they go, it's so funny when you say your doctor, you have to hide behind something. So what's the big difference? How long do you spend with a patient? A concierge or what would that look like versus like typically I go to the doctor and it looks like... Well, first of all, this is, I'm going to say this for the provider. If you are at a place, there has to be a good match between the provider and the patient. There is, it has to be a team. So for example, if you come into my practice, you're interviewed because it has to be a good match for both people. So my initial visit is an hour and a half. Wow. An hour and a half with the patient. Yeah, typically you go to the doctor. You don't even get 15 minute visits and only three of it's with the doctor. Yeah, that's hilarious. It is, that's all you get. So you should have, in your life, you should have a good accountant, a good partner and a good doctor. I like that. Because you got to be able to call on those people at any point in time. Yeah, and you know what's interesting about this, because people look at the math and they say, oh my God, it's so expensive. They say this also about exercising, paying for a gym, eating right, whatever. But it's really expensive to be unhealthy. Yes. Also time consuming. People are like, I don't have time for this concierge doctor. I don't have time for an hour and a half for a visitor. You think you're going to have time for sickness? If you don't have time for health? You're definitely wrong. What are some of your biggest, I guess, pet peeves with the current system in terms of testing and not testing? What are some of the big issues you have with some of the ways that they operate? I think that it's very algorithmic. They really look at the basics, and you're not going to catch anything with the basics. You'll catch big stuff, but you're not going to catch the stuff, like the precursors before things. For example, when you go to a doctor and you look at a lipid panel, they don't necessarily measure APOB. APOB is really important for cardiovascular disease. When you go to the doctor, they might measure a fasting glucose level, but they don't necessarily measure a fasting insulin. Just very small things like that when you get your thyroid panel done. Typically, if a physician doesn't do, they just do a screening test for TSH. They don't do free T3, free T4 antibodies. Do you think we over-prescribe? Yes. I guess I get it. Yes, we have 40 million people on statins. I'll be more specific. Do you think we're over-prescribing antidepressants and anxiolytics, especially to women, and they're feeling those symptoms because of hormone imbalances, nutrition deficiencies, and the fact that they're not active, and we're just like, here, take this. I will say there is this misconception that physicians are paid to prescribe. That has not been my experience. That's not been my experience. I have not seen that in clinical practice. But again, we have to think where does this education come from? Where is this unifying education come from? So the people at the top educate physicians to then execute on this thing because physicians want to do the right thing. I know you guys have a coaching program where you're training up other coaches, and so the question becomes, where is this top-down approach? So if a physician was taught to do something different and maybe deploy a different treatment modality, then they could have probably better impact. They're working with the tools they were given. They're working with the tools. If you tell a contractor to build this house and you only give him a screwdriver and saw, he's going to do what he can with it. And unfortunately, I remember I watched a lecture from Obesity Medicine, which is so funny that there's an Obesity Medicine division, and it talked all about this plant-based diet and about how bad red meat was, and obviously this physician talking wasn't a nutrition expert. They had ulterior motives, I suppose, but then that was the message that was portrayed to all the other physicians. And so then they believe that and they deploy that information. And again, so it becomes really challenging. Do you think people should stop seeing their doctor if their doctor's obese? Ooh, ooh, that's a spicy question. What I will say is that it's important to find a provider that models what an individual believes to be as the importance of health and wellness. So that's how I will... So I will answer the question by, yes, that was good, that I believe that you have to feel as if the person is doing what they're telling you to do, and they are doing it themselves. Yeah, I think that's important for anybody who's helping someone. Would you go to a trainer that was overweight? I mean, unless they've been losing weight for a while and they're on that journey, I mean, it's hard, right? Because you don't believe in what you preach. No, I tease you like dodging like Neo there, but I do think that you bring up a good point because I would consider a trainer if there was something specific that I was looking for that I thought that person, that provider... They had a very specific skill or something. Maybe they were just brilliant at teaching biomechanics and I know that I'm not good at it and I can get that from them. And also we should clarify, so I wouldn't care if my neurosurgeon was obese or not. Right. So I suppose it just depends on... What you're trying to... What is it that you're... But I get what you're saying, though. It's like when you're trying to get someone to adhere to changing their lifestyle, one of the biggest roadblocks... This is anybody, by the way. You go to a spiritual leader, you go to whatever. When they look like a hypocrite, you don't want to listen to them because they're telling you to make all these hard lifestyle changes and the first way that you're going to discredit them when you hit a roadblock is to be like, you don't do that. Why would I listen to you? We do that to our parents when we're kids. Yeah, I was just thinking that. Yeah. How do you feel about the GLP-1 agonist? So this is blowing up right now. These are exploding. Yes. They're all over the place to the point where... I actually talked about this on the show. Major snack food manufacturers are meeting together to try to figure out this problem because people are going to eat less of their foods. Losing customers. They're trying to figure this out. I love it. They have used physiology and pharmacology to outsmart the bad guys. Yeah. So what do you think about that? Are they... How effective are they? Do you use them with your practice? Oh, okay. So we are talking about... There's GLP-1 agonist, which that would be the semaglutide, what gobi everyone's talking about, ozempic. Yeah. And then there's trizepitide, which is going to be the next really hot topic if it hasn't been already in Mungerna. These medications are Incritins and GLP and GIP are both produced in the body. And I will say, I think they're incredibly effective. I think they are safe and very effective. We have not seen... And by the way, the GLP-1 agonist, they have been around for a long time. I think that they first came out 2009. Okay. So that's over 20 years. They've been around for a very long time. And I think that they have very good safety side-effect profile. People will say, what about the black box warning with this thyroid cancer? And that was... I think it's an incidental finding. And also the rodent models. There's a... The GLP, the receptors are highly concentrated in thyroid for rodents, not for humans. Oh, okay. So I think that it has kind of misguided some of the information. What do I think about them? I think they're incredibly effective. And for a GLP-1 agonist, you might lose 13% body fat. For trizepatide or monjernal, you could lose 22%. Wow. Now, let's take it a step further. What is the risk of... What are the outcomes that we're looking for? What are we trying to protect people from? Obesity. Yeah. When an individual is very obese, lots of things go wrong. You get fatty liver disease. You can get scarring. You can get cirrhosis. You can get all... Like the list goes on. Atherosclerosis, hypertension, et cetera. So these medications, if we know, for example, someone loses 10% of their body weight, could reverse fatty liver disease. These medications provide people a way to do that. I mean... What about the muscle loss that we see? Is that just a result of the fact they're not... They're just eating less or not eating protein. I have not been able to find a mechanism of action. And I, in fact, think with trizepatide, I think it's going to improve... So trizepatide or monjernal, I believe that we're going to see improves insulin sensitivity and skeletal muscle. Which should be muscle preserving. Yes. So I think that the information out there right now is that they just haven't looked at skeletal muscle. I think that it is a benefit. I think that eventually they are going to use it in very low doses as a prevention and not as a treatment for obesity or type 2 diabetes. Wow. So as a trainer, I just... I could guarantee this would happen. You take the average person who does an exercise, just have them eat less, they're going to lose muscle, too. That's just how the body metabolically adapts. But I'd rather have them lose weight. Yeah, yeah. I mean, the burden on society, the burden on their family, the burden on the healthcare system if they are overweight and obese and cannot regulate food intake. Right, right. But what I'm saying is, you have them strength train and, you know, monitor their protein intake and you offset that. Not only do you offset it, they probably build muscle. Yeah. And I can't speak to this too intelligently, but I was looking at GLP and GIP and I believe that they increase during exercise. They do. Okay. Yeah, Dr. Sieg told us that. He was an expert on that. Yeah. You know what's interesting, too? There's reports of people smoking less, drinking less. That was what I was going to ask. I see that all the time. That's what's fascinating to me. Wait, what do you mean you see that all the time? I see that all the time. So we prescribe these medications in my practice. So what happens? I just, these, I believe it's like a reward pathway. I don't know exactly why it's working, but what we see is that those that have binge eating disorder or have any kind of addiction, it really seems to mitigate. Across the board. Across the board. It doesn't matter what it is. That is so weird. That's so weird. There was something about the inflammation in the brain, too. Yes. Yes. It affects, there are these receptors in the brain. Yes. And so that contributing to making better decisions as well, like when you're in a better state mentally. And I'm going to go out on a limb by saying this, and part of me in my mind is saying, oh, don't say this, but then I should definitely say it. Is that I think that when we think about optimization, what we're going to see is probably a combination of not the GLP1 agnes, but the tri-zepotide, the dual agnes with hormone replacement. People are going to feel amazing. Yeah, I bet. And again, we operate in this environment that is unnatural. What I'm not saying that we're in an unnatural environment like we are living in the sticks, my dad lives in Ecuador, the jungle, whatever. I'm not talking about that. I'm talking about an environment where we have constant stimulation, constant phones, constant food, and our drinks and our Celsius, like all this stuff. I think that the component of the tri-zepotide actually will help, I don't know if it's like refocus, but it definitely eliminates the noise of the wanting. Which in a world where, let's just talk about food for a second. Like on my phone right now in 10 minutes, I could have whatever flavor or food experience I want. That's right. Brought in here right now while we're podcasting. The only thing you can't get is a great hotel. Sorry. So what you're saying is a GLP1 agonist could totally help Justin with his Pokemon obsession. The tri-zepotide, it's the dual agonist that I think is really the winner here, the tri-zepotide. It's going to increase, what here's what they're going to find? We know that it increases fat and weight loss, but I think they're going to find positive effects on skeletal muscle. And the thing is, here's the crazy thing about humans is when they hear repetition over time, they believe it to be true. Right. So in the social media space is you're hearing, oh my gosh, and again, I'm going back and forth from a GLP versus a dual agonist, a GIP, but we're hearing over and over again about how some agonotide is bad. And these GLP1 agonists are bad and these incretin hormones are bad. It doesn't mean it's true. That's what we're hearing. You know what we're saying right now? We've talked about this on the show. I'm going to keep saying it too because so that people can say, oh, mind pump said this. We are in the propaganda war and what you have now for the first time, which you've never had before, they actually work together forever, is big pharma and big food. Usually big pharma works with big food and they would love a drug that lets you eat more garbage and lose weight, but instead they found a drug or substance or peptide that makes you eat less. So now big food's like, oops, let's do the propaganda war. So I'm seeing articles where it's like, whoa, this is weird, like I never saw, never thought I'd see this. So wait, what kind of thing are you seeing? Oh, they're meeting together. That was the big one. Like you have these heads of these companies, they're sitting down, they're saying, holy cow, people are going to eat less of our products. How do we maneuver and position ourselves? Imagine the billions of dollars that are going to be lost if snack foods and like the Nestle's and the people that like this and you know, 20% or 10% of the population eats 10% less snack food. That's billions of dollars. That's billions of dollars that companies are going to lose. Also, we just saw this recently, peptides, you could get them from a compound pharmacy, doctor can, you know, and you're fine. All of a sudden, FDA is like, hey, we got to make, we got to stop doing this everybody. And it's, I 100% think it's a GLP one agonist because they're blockbusters. And if you get it from a compound, so semi-glutide is the generic name for the peptide. We Govee or Ozempic is the, is the brand name one. They're the exact same compound. One is expensive and bought from big pharma. Another one's made it a compounding pharmacy. Of course they're going to want to shut those down. So. Yeah, they're actually, they've tried to shut down a lot of just the peptides in general, which is interesting. And again, is it because, you know, as a physician, I think about it from, you know, kind of two perspectives. I wouldn't want to give anything to anybody that I didn't know was done correctly. Sure. Was, you know, was it done in a sterile environment? And there are definitely certain regulations from big pharma. Compounding pharmacies that are private. They have different regulations from what I believe. And there's all, there's just a lot more variability. Okay. That being said, the overarching question is, should these things be available at a lower cost? Yeah. I mean, that's insane. So, yeah. Do you work with other peptides too, besides those? Oh, yeah. We work with a ton. What are your favorites? It depends. I mean, like BPC 157, whether it's oral, but it's been around for a really long time. You know, whether it is oral or injectable, depending on what the need is, we see a lot for, if an individual had, like for example, has come back from overseas and has had a lot of GI distress, which we see a lot of infection. Whether it's parasitic infection, et cetera, gastritis, whatever. The oral BPC seems to work wonders. Obviously you have to address and identify the pathogen, but once that is treated, it can be very helpful. And then again, BPC 157 from an injectable standpoint, depending if an individual is a responder or not. I had mood improvements from BPC injectable. You did. How weird is that? Yeah. I still take it every day. I also take it now with thymus and beta, which I just started that, so I'll let you know what the predictors on that. Yeah, so it's a very interesting space. Is that the most exciting thing right now that we're seeing in medicine in general right now? Is like the, I mean, availability of these peptides, I mean, that you think is most exciting? They've been around for a long time. I think what's most exciting is the triseptide and kind of the, I think that that's really exciting. Yeah. The triseptide, because that's newer, now available. What was the name of what Dr. Kahn was saying they're doing now where you could like inject something and then it works almost like a, like you only have to do it one time. Oh, that's the wrong thing. That's the fulvastatin. Yeah. The fulvastatin, yeah. Oh, I know who you're talking about, Dr. Kahn. He's friends with Jordan Shallow, who I love. I love that guy. One of my favorite people. Yeah. I know exactly gene therapy. Yeah, yes. They've been cased in like an E. coli. Yeah. A carrier and then do you see stem cell being more accessible, like in terms of treatments for that, for the average person? It's interesting because these things that they're talking about now, we've used them for a long time. Yeah. The providers that I know, they've been doing all this stuff for a really long time. So it's not necessarily new for us. Is it just becoming more accessible? I think so. Yeah. It isn't legal, right? Yeah, I don't, I mean, right now I still hear people going to Costa Rica to do it. To go back to muscle, earlier you were talking about ultrasound. Yes. Machine specific. Do you use the same ultrasound or is it a specific ultrasound? What do you look at? So it's the programming. So basically what we're talking about is what are ways to look at skeletal muscle health that can be utilized by a provider. So right now, depending on the provider, you can use ultrasound and look at thickness and muscle, aspects of muscle health. But I think that, so we are going to be opening up a brick and mortar clinic. I know everyone's going to cringe. In Long Island, Colleen Johnson, my head PA, Colleen, is going to really be heading off that initiative. And what we're going to be starting to do is working to collect data on looking at, it's called muscle sound. So we're going to be looking at skeletal muscle under ultrasound and it will be able to tell us, it's basically what they use right now in the ICU to look at nutrition status, whether it's sarcopenia or catechia. Oh, okay. But it'll be able to show how much muscle glycogen. What? Yeah. You can tell how much muscle glycogen. So this is so non-invasive. Is it like the one you get? Exactly. Where you just put a little gel and wow. And I do think, again, but we all know that the skill of the ultrasound, the person doing the ultrasound varies, but that is where things are going. So in my ideal world, what we're going to look at is we're going to have ultrasound where we're looking at skeletal muscle health. We are using a deuterated creatine to see how much muscle and we will still use dexapher body fat percentage. Not for the lean body mass. Do you, what muscle do you typically, I mean, is it standardized? Is it always the same muscle as the vasis lateralis? Or like, what muscle are you typically looking at with this? Well, I mean, we haven't implemented it yet because this is newer, I mean, is it newer technology? It's been around for a while, but just for the way in which we would utilize it, I think that the biceps are always frequently done. But then again, vasis lateralis as well. Yeah, just close to the surface. We'll see, yeah. I'd be so curious with this long-term data. Like, is there any studies? I'll let you know. Yeah, let me know. Yeah, for sure. Two, in terms of like the aging process and like over time, like where say the person doesn't like change a whole lot of their behaviors and you can see an actual drop-off or like when, if it's not really that substantial of a drop-off, if they're like consistent like in terms of them being able to have more muscle potential or, you know, when that, is there anything like that right now? No, but I, I think there's another perspective to what you're saying about that's really important is the literature that we look at for muscle protein synthesis is, you know, I think it's incremental the way in which we can detect change over time. So for example, you know, if we think about aging population and we think about dietary protein and we think about resistance training and how that affects the physiology of muscle protein synthesis. So right now we're talking about the actual fibers, we're talking about the actual tissue. And now we're talking about a physiologic response. So there's the physiology and then kind of the infrastructure. And I think that the change, we don't have a great way of measuring incremental changes over time. Yeah, because we can just look at, okay, muscle protein synthesis means we're synthesizing protein. Right. But you can't, you're not right now looking at a muscle, you gained 0.1 grand. I think that it's going to be, I think that there are challenges with those types of things. So if we think about muscle health as a whole, we think about the strength aspect, the strength mobility, which is all the stuff you guys do phenomenally well, which I do think should be included in a general assessment of any human being. A patient comes to the office, we know how much they squat, we know how much they deadlift, we know how fast they can run a mile. Like all of these things, I think that that would be incredible if that was the standard of care. So that's the capacity, right? Like what is the capacity of the tissue? And then the muscle protein synthetic response, the actual incorporation of amino acids, how does that look? We don't really, I think that the changes over time are, they're probably pretty subtle and challenging to look at. And then the imaging aspect of what does that tissue look like? And that's kind of how I think about that. And then of course you add in the blood work. What is the level of glucose after a meal that the disposal is happening? How much can the skeletal muscle dispose of glucose? So there's kind of the whole picture. So just to sum it up, what I'm saying is the strength, the actual performance of the tissue, what the tissue looks like under ultrasound or MRI or CT, which we're not going to do, obviously CT because that's too much radiation. And then how is it responding to the influence of meals? What is the health of that tissue? Very cool. Such valuable data. That's kind of what I think about. I want to go all the way back to where we were when we were talking about the archetypes of your patients, because I'm fascinated in that because I think there's a lot of parallels in what you do with what we do. Tell them why he's awesome. That's not what I'm searching for. And also in my book, I have a training archetype. I bet you guys have seen this. Oh yeah. This is so interesting to me. And again, because we have trainers that we're talking to and we have here today, I'm always looking for tactical things that I can take away, that I can give these people. So when you think of those archetypes you were describing to me, what are some general things or tips that you've learned like you give that? Okay. Let me give you the training archetype. So I cover this in my book. Okay. So in my book, and by the way I talk about Don Saladino, who we know. Yeah, I love him. So there's a couple training archetypes. So the really successful CEO is going to be a performer. Meaning, well, I mean depends because like I think about Beatrice Cooley and he can get the job done no matter where he is. But some CEOs or the archetype is the performer. That you put them to train by themselves, they're going to be a shit show. Like it's never going to go well. Do you know what I mean? Like they're not going to do it. They'll, they've got the time scheduled, but they're going to be training solo. No one's around and you're telling, okay, go do it's Monday. It's bench day. Do this. They're not going to have a great training session because this group of individuals, the performer will always do better being witnessed. Doesn't mean that they need someone yelling over them, but they need to go into the gym where there's other people around and that is a performer through and through. Don't need to talk to them. They don't, you don't, they don't want you to talk to them. They don't want you to recognize them, but they need to around because they are so competitive that they need to be witnessed. Fuck off dude. Fuck it. They are so competitive. This is so interesting to me though because if you go way back to old conversations we've had on here, shut up. One of the biggest debates we used to have was like training at home or training. And I'm like, I have this like, I don't know what it is, but going to the gym. It's a performer. And also the gym can't be empty. There has to be people. That's why I suck in this gym, but I need to go to like a gym gym. So that is a performer through and through. They need to be witnessed. Do not talk to them, but the busier the gym, the more distraction in the gym the better they're going to do. The better they're going to do. You know this person. If you are a coach and you are trying to get your really successful patient and you're going to tell you like they don't have time. You tell them, okay, really? How was it the last time you trained in your home gym? And so you get on them and they've got to go to a gym. The busier the gym, the better. They will turn it on. Awesome. The solo, there's a solo, the solo artist or whatever. Those guys don't fucking talk to them. They'll get it done no matter what. Like they're going to train at home. It doesn't matter. Give them, they'll play the music super loud. Have a full playground. Bet you would sell. Oh yeah. Full playground. Turn on the music. Don't disturb them. They'll get it done. They love it. And then there's like the chameleon where basically they don't care if it's internal, external motivation. They don't care where they are. They'll do it. You guys want to do a Zumba class? They got it. It's fun. They'll show up. They'll show up. Anytime, anywhere. Yeah, they'll show up anytime, anywhere. They will totally train. Anytime, anywhere. They will show up to train. You name it. They don't even have to be good at it, but you know, they kind of are like, yeah, let's go. This is such good information though for coaches and trainers. Because I mean, that's when you're trying to hold somebody accountable or motivate them or guide them through their health and fitness journey and you're constantly telling them, oh yeah, it's okay. You can train at home, but yet they've never proven themselves they can consistently do that. I would much rather, work out anywhere, but I would much rather work out by myself with no one else around. Yeah, and so that's the time for you where you're thinking about things, where you're processing things, getting out your anger, whatever it is. That's your time. Yeah, it's when I cry. It's real therapy. Iron therapy. Awesome. Well, this is always awesome. How's your book sales go? You're on a best seller list. You're destroying it. How's it going? I just found out yesterday I actually hit the list in Canada. Wow, nice. So number six in Canada. It's in 11 this morning. Vietnam just bought it. Yes. So it's in 11 countries now. Wow. Thank you for doing this because we were talking earlier and we were talking about, you know, why there's this misconception around strength training. I don't think this was on air, you know, how it like, why people view strength training this way, especially women, whatever, and I was talking about pop culture and the history of it. You know, there was a running revolution that started in the late 70s because of a book. It was combined, of course, with a popular movie. It was the complete book of running, hit the shelves right around the time. Rocky came out and everybody started running. I think that you are really helping the next revolution, which is going to be around strength training, around building muscle. I really do. Under muscle. And gyms are changing. I don't know if you knew this, but big box gyms when they're building them are changing their footprints. They're taking space away from cardio and group classes and moving it towards weights. So we may be at the very beginning of this new, very positive trend that will finally have a massive impact or enough of an impact to reverse this terrible trend that we've been on. And I want to thank you for being a big part of that. Huge part of that. You need a medical professional because I'm just a trainer, right? And a strong female voice. That's what people always ask from us. You guys need a woman there to come in and say this. We'll just keep bringing you back. We almost made Justin transition because he was like, this will help us get the message out. He was up for it. He actually was. He'd be hot. Yeah. Anyway, thank you so much for coming on the show. We really appreciate what you're doing and just keep doing it. You're helping so many people. Dr. Lyon. Thank you so much for having me and your guys' support means the world. So thanks. You got it.