314: Is A High Protein Diet SAFE? (Or Bad For Skin Problems?) w/ Dr. Gabrielle Lyon

Jennifer Fugo (00:07.768)

Dr. Lyon, thank you so much for joining us back on the show.

Dr. Lyon (00:11.242)

Thank you for having me.

Jennifer Fugo (00:13.242)

I am super excited to have you back today because we are going to talk about your brand new book. I honestly, like I've read a lot of books from a lot of guests and I felt not only like your book was extremely practical, but it was something that for some reason is right now controversial. And I don't think it should be. And I also don't, I don't see muscle and the recommendations of muscle mass and really working on your muscular strength as one of the most crucial pieces that's being recommended by different practitioners and medical professionals. You talk about in Forever Strong, and for those of you, I actually have a copy of the book and it was fantastic. You talk about how it improves your quality of life.

It provides this reservoir of amino acids, if you become really ill and you need to tap into that. It also plays this crucial role, which you discuss in depth about balancing blood glucose. But all we focus on is meds, like take make sure to take your cholesterol medication. Don't miss your blood pressure medication like it's all about medication. So as a physician, what can you share with us that led you to this conclusion that we're looking at the wrong things, we're focusing on the wrong things?

Dr. Lyon (01:37.338)

Yeah, thank you so much for that question. It really was through practical experience. And I was doing my fellowship at WashU in St. Louis, Washington University in St. Louis, and I was doing my fellowship in geriatrics and nutritional sciences. And there is always this conversation about obesity and how we need to fix obesity. And I realized, I became very attached to one participant in this study in particular. And I realized that the common thread wasn't that they all had obesity. The common thread was that they all had unhealthy muscle. Low body tone, unhealthy muscle, and perhaps one of the reasons that we were struggling so much to actually fix obesity is because that we were looking at it from a wrong perspective. We had to really begin to shift the paradigm of thinking to be able to actually move the needle for people. And…That's where this concept of muscle-centric medicine came from. It was through need. And then of course, when I go and I speak with other colleagues and, you know, as a fellow, you ask, okay, well, why are we doing it this way? And oftentimes the answer is, well, because we've always done it this way. And just because we've always done something one way doesn't necessarily mean that is the most effective and practical way. So that is where the importance of skeletal muscle came from and understanding that there really is this kind of continuum.

Jennifer Fugo (03:01.952)

And I know that number one, you back up a lot of the information that you share with research, but there's that clinical piece that you have that I think is a there's a certain level of insight that you get from that when you're just looking at numbers, you don't see it in real time. And it sounds like watching this happen in real time, you know, as you said, somebody and these individuals in studies watching what's going on with their muscle tissue. You also mentioned in the book about this marbling effect that happens to the muscle. So would that be a part of this sort of unhealthy presentation?

Dr. Lyon (03:35.934)

It is, it is. And the challenging part about muscle is we don't routinely image it. We look at it through DECSA, but we're not doing CTs or MRIs of skeletal muscle. So we're not actually looking at the tissue. We tend to be looking at it indirectly. We're extrapolating the amount of skeletal muscle. It shows us nothing about the quality of tissue, but very obvious when you look at a steak, you know that there's marbling and fat in the steak. And the same thing happens to human tissue. And if we fail to understand this, then we are not going to make the impact on our health and we are simply going to abide by the rules of just take more medication. And as I was going through this clinic, I actually was so lucky to have nutritional science training as a physician. I know that the common joke is physicians know nothing about nutrition and there's all this kind of statements that go into that, but I actually was trained in nutritional sciences by a world leading expert in protein metabolism.

Skeletal muscle makes up protein, right? Protein is skeletal muscle. So I was fortunate enough to really be able to understand some of the nuances of protein metabolism and why this becomes so critical and why there's never been a book written like this before is that it contains the research, the bench research to the bedside of an actual person of what do we need to do? Not just some… out there kind of this is what the research shows, but what do we practically have to execute to be able to get the results that we want? And I think that that's a really, really important aspect of the book.

Jennifer Fugo (05:17.672)

And you also point out that sarcopenia is actually a bigger concern than we even realize and can start earlier in life because most people think it's like an old person's problem, but that's not true.

Dr. Lyon (05:28.658)

I know, I know. Actually, you know, I was looking at the book again and I was thinking, you know, I say that sarcopenia starts in your 30s. Let's first define what sarcopenia is. It's a decrease in muscle mass and function. So the overarching term is decreased muscle mass and function. We've all seen a sarcopenic individual. We've seen those older individuals get really skinny, lose kind of their bulky muscles. There's a change in fiber type. It is not uncommon. The thing that becomes so important as it relates to sarcopenia is that we always think about it as an aging disease. It's not. It is not an aging disease. These changes in skeletal muscle can happen decades before. The rates that they say sarcopenia happens are for every decade, there's a loss between three and 8% of muscle mass. I actually think it's much higher than that. So three to 8% is almost 1% per year. I actually, however, believe that it's much higher than that.

Jennifer Fugo (06:25.508)

That's a lot.

Dr. Lyon (06:26.942)

And here's why I think it's higher, because we've never directly been measuring skeletal muscle mass. We've only been measuring fat tissue and then estimating lean mass, which includes blood, which includes bone, which includes organ. So we are at the precipice of a new frontier of medicine that is really going to define amino acids as individual nutrients, as well as muscle as this organ of longevity. We are right at the precipice.

Jennifer Fugo (06:54.54)

I mean, that's exciting because there's so much that muscle can do. You stated a couple of things, like for one, that as you increase muscle mass, you can actually increase the mitochondria or those little power plants in the tissue. Is that correct? So you, you're not stuck with a static number of them.

Dr. Lyon (07:13.358)

Correct. Right. There is mitochondrial biogenesis that happens. And the way in which you improve mitochondrial biogenesis is through exercise, through training.

Jennifer Fugo (07:21.957)

And what would adding mitochondria do to benefit? Is it just a benefit to the muscles or do we have benefit energy?

Dr. Lyon (07:27.714)

Energy, ATP, fat oxidation, energy utilization. The body is a machine. It is a currency. This is the way in which we generate energy. We become more metabolically flexible. Issues, you know, you do need healthy mitochondria. All these diseases of aging that we think about, they stem from muscle, in my opinion, as well as muscle mitochondria.

Jennifer Fugo (07:51.872)

And so something like the idea about glucose uptake. So I was telling my husband the other day, I'm like, hey, you know, one thing that can help you regulate muscles, and this is something that I was taught in grad school was that when you work larger muscle groups like the legs, it does help pull more glucose, the glucose from the bloodstream into the muscles. But when I was reading your book, what was really fascinating was that, and I don't know if that stat is entirely correct, but there's a more actual sustained impact that the muscles have and exercise specifically has on the muscles in terms of regulating glucose uptake. Can you talk a little bit about that?

Dr. Lyon (08:35.902)

Yeah, oftentimes when we think about glucose regulation, 70% of glucose regulation is through skeletal muscle. So glucose disposal, the carbohydrates you eat, the majority of that is disposed in skeletal muscle. Now, the thing is, is glucose regulation, the homeostasis of glucose regulation is really key for disease prevention. And the reason is, is because elevated levels of blood glucose now kick into insulin, insulin resistance, all these things become a major, major problem.

What is so fascinating is exercise is an incredibly potent stimulus on the whole body mechanism, the whole homeostatic mechanism of the human. In fact, it's much more powerful than anything else that we have. Truly, the impact that exercise has is second to none. However, only 24% of adults are meeting the threshold for physical activity. Whereas 24% of individuals are meeting the threshold for the recommended amount of moderate to intense exercise plus resistance training.

Jennifer Fugo (09:42.028)

And what would those be just out of curiosity? Because I hear a lot of stats and then I'm like, but what? What does that look like practically? Okay. And so do you consider cardio as part of this or that's completely separate?

Dr. Lyon (09:47.254)

150 minutes, 150 minutes and two days of resistance exercise. Most people are not meeting that.

Dr. Lyon (09:58.018)

Yeah, 150 minutes of moderate to vigorous activity. Yes, but the majority of individuals, think about it, the majority of individuals aren't even meeting that. In fact, Jennifer, you could go your entire life and never exercise a day in your life. However, the other component of healthy skeletal muscle, healthy mitochondria is exercise. I'm sorry, is food. 100% of individuals eat.

Jennifer Fugo (10:22.072)

That is true. We do eat.

Dr. Lyon (10:25.807)

You have to get that piece right. So when you exercise, you stimulate glucose uptake without insulin. And that's pretty amazing. You eat something, you can go for a walk afterwards, you eat something, you can do some squats, you can actually use and leverage skeletal muscle to move glucose, blood sugar out of the blood and into skeletal muscle without insulin. And this can have a lasting effect. Again, it does compound upon each other. It's not that you exercise once and then there's long lasting benefits. But what's so fascinating is there is short term and more moderate term impact. It is not just you exercise once, the exercise activity is over, your benefit is over. That's not actually what happens is more dynamic than that.

Jennifer Fugo (11:19.076)

Well. I want to transition over to protein because I feel like I feel like your entire platform is somehow controversial, but yet it shouldn't be it's so confusing the world we live in today. But I, you know, there's all these myths around protein. So when I'm trying to encourage clients to increase protein intake, and I work with hundreds of clients a year because of a group program that I run, and one of the exercises I have them track protein intake for three days and consistently I would argue probably about 80 to 90% of people are well below where they should be and they are shocked because they thought they were consuming enough and yet when I say listen it has all of these potential benefits I hear, “Well I heard it's really bad for your kidneys it's inflammatory it's going to increase blood glucose it's bad for osteoporosis and can contribute to that…” In your clinical experience, do you think that there's any truth to these fears? Or if not, what is a more honest and balanced view of protein intake?

Dr. Lyon (12:30.638)

It's not even my opinion. The science doesn't support a lot of those myths and there's been multiple meta-analysis that really highlight the importance of dietary protein. For example, let's kind of go through some of them. So you said protein is bad for the kidneys. There have been multiple meta-analyses, which is a collection of studies, typically well-done studies of high quality that have shown if anything in healthy kidneys, it improves filtration rate.

So that part is not true. The other big discussion about high protein is high protein in bone. I'm a geriatrician by training, and we do a journal review, and there was one journal in particular where it looked at the quartiles of bone density and protein intake. Those with the highest protein intake had the highest bone density. Bone is made from protein. So it's not that… Protein is bad for bone. We should have a diet that is balanced where there are fruits and vegetables, where there is potassium and other minerals coming in, components like that, but protein in and of itself is what the building blocks of bone is made of.

The other major myth is that, I don't know, protein is bad for heart disease. That's not true. There was a collection of studies out of Annals of Internal Medicine, that, you know, which is the VP of journals that talked about the risk of eating red meat and heart disease, those, you know, and the things that ride alongside that. And there was low quality evidence. The list goes on and on. Agriculture is another that's false, which people really love to talk about. We cannot eat our way out of climate change if I just need to say it bluntly.

But I think the bigger conversation is what happens when we begin to shift to extremes. So one of the reasons why I wrote this book and why this book is so important and why we have to be a unified front is that in the media, there's this push to go plant-based and there is this push that we need to decrease our dietary protein intake and nothing is further from the truth.

And so what's going to happen is the information that comes out of influencers unknowingly misleads people. And when people are young, there's a lot more flexibility, but as people get older, the unintended consequences of this become devastating. So personally become devastating for people. And then the next layer of that is what does it do to our children? And what does it do to those in nursing homes? And then what does that do in the military? Because when you talk about having a meatless Monday… like my daughter is three and a half, she remembers everything I say. If I begin to teach her at three and a half that meat is bad and she should have a meatless Monday, those deep-rooted morality conversations about how you can utilize food to become a better person really is going to unravel our society over time. It's been used that way for a very long time.

Food has been used as ammunition and it seems to drive people apart. But the bigger conversation is what happens with these cultural influences and what are the clinical outcomes that happen. And right now we already have a plant-based diet. We have a 70% plant-based diet. 30% of our foods come from animal-based products. Of those animal-based products come the majority of our nutrients and our nutrient-dense high-quality food. So if we do not begin to look at the science and understand that it is about the incorporation of both not in either end of the extreme. If we do not recognize that, there are going to be epidemics of sarcopenia and obesity and osteoporosis like we've never seen. I believe it's going to be exponentially worse.

Jennifer Fugo (16:38.084)

I personally at 43 right now have a very hard time watching influencers who are in their 20s advise everyone to go on what I, I mean I watch them promote these recipes that are extremely high starch with almost no protein. I cannot eat that way. I will not feel well. And it is concerning that it's promoted as healthful as completely healthy without any consequence. When the reality is, if you don't understand research, as you have experienced in your career, and seen what you've seen clinically, you're right. This is a warning that you can't undo, depending on how far you get down that road. Some of it can be really difficult to undo, if at all, by the time it gets so bad. And I wanted to ask too about being in that perimenopausal stage of life. Maybe this is a somewhat selfish question, but I do have a lot of listeners and clients around my age and I feel like, at least I found protein-focused meals, seem to meet my needs. I feel a lot more focused, strong, less blood sugar imbalance, less cravings, more satiated. It seems to work better for me. And so what do you tell women who are that mid to late 30s to early 50s, is this a general timeframe where we could benefit from a higher protein intake?

Dr. Lyon (16:45.059)

Yes. Absolutely. And just anecdotally, you have that experience. And I know that we were talking before offline that you're going to be doing this experiment for yourself. And I would say, again, I ran a weight management clinic. I've been seeing patients since 2006. And again, being trained by one of the world leading protein experts, he did some of these earlier studies. So the things that we are taking for granted, that we assume everyone already knows about protein and how to dose it, these are things that he discovered out of his lab. And I worked on some of those earlier studies when I was in undergrad, it was crazy. And the women that we focused on were perimenopausal women. And one of the things that those studies showed, which were incredible, they were isocaloric. So some of the earlier studies that Don Lehman did, they were isocaloric, meaning that both groups of calories were equal with just changing the breakfast and the overall macronutrient of protein. So making, so they did one that was the food guide pyramid and one that was purely the 40, 30, 40% carbohydrates, 30% protein, 30% fat. Just by changing the ratios of protein, they lost more body fat. I think that they lost 8% more body fat. They maintained lean muscle mass. They improved triglycerides. They lowered blood pressure. All of these things happened while the two groups were equal.

The two groups of calories were equal, but one was corrected for protein and the other wasn't. And this was around perimenopause. What also is very interesting, and I struggle with this, and Don and I have laughed about it because I believe that when hormones change, body composition seems to change. He said, absolutely not. Over the years of doing the research, that if an individual's protein is high enough, their carbohydrates are monitored, and they are training, there is absolutely, there does not have to be a change in body composition. And I have actually seen that within clinical practice over the years. That if individuals are training hard enough, and what does that mean? That means adding some kind of high intensity interval training, one to twice a week, probably more like twice a week interval training. It can be 20 minutes. It doesn't have to be an all out sprint interval training. And that's not necessarily 20 minutes of work. That's 10 minutes of work in a 20 minute, you know… 10, you know, one minute on one minute off, however you want to do it. Three days a week of resistance training, of actually, you know, they'll say, okay, well it's 10 to 20 reps per muscle group. You can say all those things, but the reality is you have to work with a trainer. You don't have to. You have to work with a trainer. You have to get a program and you have to be able to measure your numbers and figure out what you're doing. And then optimizing for dietary protein.

In the book, there's different tracks. So for example, Jen, if you're happy with your body composition, I tell you exactly how to maximize dietary protein for that. If you are metabolically compromised, so a lot of the perimenopausal menopausal women, they won't want to do the track for weight management. And it's three meals a day. It's an even distribution tells you exactly how to do it. And we have seen this over time work.

Jennifer Fugo (21:21.26)

And I will say that as I was reading through, I was like, so just, most people on Instagram already know this. I've had a lot of back injuries. I've had, in the last two years, COVID was not kind to me. The back started problems, couldn't exercise for long periods of time. And so I would say that I'm in a place where… and being perimenopause, it is harder to lose weight. I will say that. But I did find your way of calculating macros to be helpful and really insightful, and you recommended starting with protein, which I was like, okay, so everything revolves around this, and then we go to carbs, then we go to fat. Why did you find clinically that was the helpful kind of way to go?

Dr. Lyon (22:07.47)

It's the most important. It doesn't matter. Your needs for protein are steady. They are going to change. You have to get that right. When you're younger, you're not really counting calories, but as you age, if you do not nail dietary protein, what are you going to do? Right? That is an essential macronutrient, but it is essential for aging, which unfortunately, or fortunately, we are all doing. We all have the privilege to age. When you calculate calories, you know, just there's ways you can go on and get a formulation, but you have to nail your dietary protein. Dietary protein improves satiation. It improves muscle mass. It manages blood sugar. Of course, if carbohydrates are controlled, it has the potential to lower blood sugar. I mean, sorry, blood pressure because of the amino acids in it. There's, you know, one of the amino acids, arginine, is a precursor for nitric oxide. So again, there's all these different reasons. The essential need for carbohydrate, you don't have one. The amount of dietary fat, really you just need to cover your essential fatty acids, which doesn't take much, but dietary protein, this is an essential macronutrient with essential amino acids. You need these. And if you mess that up, then it's going to be very difficult to have any kind of optimal health. It's just, it is the most foundational principle that you have to nail.

Jennifer Fugo (23:37.76)

And it was something that rings true throughout your entire book. And one thing that I sort of want to circle back to in regards to injury, because we do have individuals who are coming back from injuries or maybe are living chronically with pain and whatnot. You work with veterans, and I'm sure some of them have sustained some pretty serious injuries in their line of work and whatnot. Do you have any words or insight, words of wisdom or insight that you can impart from seeing those who excel at a very high level? For those who are just like, oh, I'm just not seeing results, I don't feel well, like we have all of this junk in our heads, maybe even fear of getting hurt again. And your book focuses, by the way, and I say this with real admiration, so much mindset in this book that I honestly have not seen in other books, because it's not a mindset book, and yet it is. So what do you see that these individuals are doing differently when they're coming back from an injury or they've sustained maybe an injury that is going to be a long-term game changer? How did they approach it differently than say somebody like myself?

Dr. Lyon (24:58.374)

Okay, well first let me tell you a little bit about the population that I serve. So a portion of our practice are elite war fighters, either active duty or former Navy COs, Green Berets, Rangers. They are those that have performed at the pinnacle. So that's a portion of practice. The other group of individuals are, it's really not a demographic, it's a mindset. There are people that are coming here that want to get the best. We take care of moms and CEOs and entrepreneurs. You know, the whole gamut, but the one thing that they have in common is they want the best version of themselves. Now you mentioned veterans there in yes, I will tell you this. The time in which this archetype of a person really struck me was when I was sitting in my New York office and I had a veteran who's active duty at the time 20 year Navy SEAL. This guy has been a SEAL for 20 years. He was a breacher. For the listener who doesn't know what a breacher is, someone who goes in blows up doors. They are the muscle of the SEAL teams. And he had never been hurt, deployed multiple times. He was a career Navy SEAL. Was home in the US on his motorcycle, going five miles an hour. A 17 year old girl texting and driving totally takes him out. He lost his leg.

And he's sitting in my office. And, you know, here I am thinking, oh man, this guy must be like totally destroyed. I cannot believe this experience. He's this and that. And I went on and on with my own narrative. And I leaned in and I asked him, he's, you know, typical team guy, outfits, got his hat on, the flannels, the Solomons. He looks like a tree trunk, Texan, like Texan farm boy. And I leaned in and I said, you know… “Brian, how are you doing? He looks at me and he's like, well doc, I'm having some limb pain,” because he had lost his leg. He's having some phantom limb pain. And I go, I just say, take a deep breath. And I lean in and I'm like, “No Brian, come on. How are you doing?” And he looks at me like I had just asked him for a box of tampons.

He looks at me like I am absolutely crazy. And he said, “what do you mean how I'm doing? I just told you.” I said, no. You know, no, Brian. Here you are. You've been an AVCO for 20 years. You've lost your leg. And I am going down his story. And he looks at me and he goes, Doc, what are you talking about? That was six months ago.

What? Right? Most of us haven't even gotten over something that happened six years ago. This guy had moved on. He had no narrative. It wasn't, and then by the way, with his permission, I called my husband who's also a SEAL. And with Brian's permission, I said, oh, you know, Shane or Brian was in the office today and he was like, oh yeah, I heard. How's he doing? I was like, you know, I told him the whole story, how I saw him and how he leaned in. I leaned in and I hear dead silence on the phone. And my husband goes, yeah, honey, what are you talking about? That was six months ago. Why are you, like, what are you even talking about? So it was at that moment that I realized that those become, those individuals that become assets in their life and in other people's lives and to themselves have no narrative. They have a neutral mind. There is not a story about what is happening. They are neutral.

That is it. It's not about pushing things away. It's this happened, we move on, we are adaptable and we execute. And I know that is hard to hear and for some people probably impossible, but I can give you the best guide in the world. I could say, read this book. Nothing is like this. And it's gonna tell you how to eat your protein, why you should do it, X, Y, and Z. But if we don't get this currency right, none of this matters. And that's the reality.

Jennifer Fugo (29:18.416)

Yeah, yeah, the mindset piece is so prominent all throughout every single chapter, it opens with the mindset of the growth mindset as well. It's just so, so prevalent. And I had one last question for you, which I thought was might be you're probably the right person to ask and we don't need to go down the whole road of all of the pros and cons of it. But if somebody is struggling to lose weight, right, they're struggling to exercise, but they're watching all the news about all of these medications now that in some regards some people do view as maybe a quick fix. Do you feel like this plan that you've put together in Forever Strong would be a better starting point for someone instead of just jumping onto some sort of medication to help them in shifting their body?

Dr. Lyon (30:09.11)

This, the Forever Strong program could be used for both. It could be used in combination with the GLP-1 agonist. In fact, if anything, we use it in clinical practice and it absolutely protects their body composition.

Jennifer Fugo (30:23.428)

That's awesome.

Dr. Lyon (30:23.854)

This program is evidence-based. It protects body composition. And could someone not use medication and still lose weight and maintain muscle mass? Absolutely. I will say, though, as a practicing physician, the treatment has to match the severity of the challenge. That if you have been trying to lose weight, again, you can't just take a medication and not have your nutrition dialed in. You will destroy your body composition. Again, we've seen that. There's also no mechanism of action of at this time known why, how a GLP-1 agonist would negatively affect skeletal muscle. So it's not that the GLP-1, you know, part of the conversation is, oh, it's, you know, destroying skeletal muscle. That's not true. The fact is, is that individuals are taking in less food, less energy, and less protein. So here's what I would say. If you are choosing to use a medication, you should be following a Forever Strong program because you should absolutely be and know how to increase your protein intake. Whether you're on a medication or not, this will do all the things that you need it to do. If you choose not to be on a medication, then this will also help you either lose weight, help with longevity in a way that allows you to be capable and have your activities of daily living. All of the things, regulate the biomarkers in your blood, all of those things. So… Surprisingly, I am not actually anti-medication at all, but I am in combination.

Jennifer Fugo (31:55.854)

It's refreshing because a lot of folks in the functional, more integrative space are very, meds are toxic, meds are bad for you. And I think it's always interesting to find and talk to people who are like.

Dr. Lyon (32:04.971)

Not at all.

Jennifer Fugo (32:10.796)

It depends. Depends on the circumstance. Depends what's right for you. But I am so excited for your book. I hope that everyone goes out to get this. And I think it's worthwhile just as a starting point. I wish I had this 10 years ago. I wish that I had understood this 10 years ago. I am really excited to put some of this into practice. It's something that I got really jazzed about when I was writing out all my numbers this weekend and everything. So I will definitely be reporting back. But thank you so much for joining us. And I'm going to make sure to put not only our other episode that you were on the Healthy Skin Show before into the show notes, but every way that everybody can reach you and the book is available everywhere, correct?

Dr. Lyon (32:58.542)

From pre-order and actually for a limited time only, we're doing a lot of pre-order type goodies. There's one that we haven't released yet, which is going to be amazing. It's going to be a workout program. But there's a whole bunch of stuff right now that if people go and pre-order. And again, I can't get this message out there alone. And this is not about me. This is about how are we stronger together as a community? What needs to be done to course correct where we're going? And this is really a mission for all of us because whatever anyone is doing, they're going to be stronger and better off with a healthier body composition and more muscle and more resilient. So there's that.

Jennifer Fugo (33:36.4)

Well, thank you so much for joining us.

Dr. Lyon (33:38.401)

Yeah!