Building Muscle in Menopause: Protein, Creatine and Strength Training with Dr. Gabrielle Lyon

In this episode of unPAUSED, Dr. Mary Claire Haver continues her conversation with Dr. Gabrielle Lyon, board-certified family physician, founder of the Institute for Muscle-Centric Medicine, and bestselling author of Forever Strong — this time with the practical roadmap for building muscle in your 40s, 50s, 60s and beyond. Dr. Lyon explains why your first meal of the day matters most and why 30–50 grams of protein at that meal can change your body composition on its own. She breaks down anabolic resistance — why the diet and training that worked at 20 stops working at 58 — and the research showing it's reversible: women over 60 got no muscle response from 15 grams of protein, but at 30 grams responded just like 20-year-olds. They get specific: what a 50-gram breakfast looks like, why two eggs won't stimulate aging muscle, how essential amino acids and creatine fill the gap, why the protein RDA is a floor rather than a target, the truth about red meat and saturated fat, the honest state of the evidence on hormones and muscle, and Dr. Lyon's warning about GLP-1 medications and accelerated sarcopenia. Plus: why progressive overload should really be progressive stimulus, where a woman who has never lifted should start, and why getting bulky isn't the risk — becoming frail is. Guest links: Dr. Gabrielle Lyon (Website) https://drgabriellelyon.com/ Dr. Gabrielle Lyon (Instagram) https://www.instagram.com/drgabriellelyon/ Dr. Gabrielle Lyon (YouTube) https://www.youtube.com/drgabriellelyon Books: "Forever Strong," by Dr. Gabrielle Lyon https://www.amazon.com/dp/B0C4VSDWQ2 "The Forever Strong PLAYBOOK," by Dr. Gabrielle Lyon https://www.amazon.com/dp/B0FL32CJ81 "The New Perimenopause," by Dr. Mary Claire Haver https://thepauselife.com/pages/the-new-perimenopause-book "The New Menopause," by Dr. Mary Claire Haver https://www.amazon.com/dp/B0CKBZ4K1Z For full show notes, please visit: [BIT. LY http://BIT. LY LINK] Never miss an episode—sign up for The 'Pause Life Newsletter: https://thepauselife.com/pages/newsletter Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, the unPAUSED podcast, and The 'Pause Life are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mary Claire Haver?

  In part one of my conversation with Dr. Gabrielle Lyon, a board certified family medicine physician and founder of the Institute for Muscle Centric Medicine, we challenged decades of conventional wisdom about women's health. We talked about why skeletal muscle is the foundation of healthy aging, why so many women are dramatically under consuming protein, and why building and preserving muscle must be at the center of every conversation about longevity. Now it's time to get practical. In this episode, Dr. Lyon breaks down exactly how much protein women really need. She explains why anabolic resistance changes the equation after midlife, and how resistance training, hormone therapy, and even GLP-1 medications

• 0:44Dr. Mary Claire Haver?

  fit into the picture. She also gets into when you should be eating protein throughout the day, and why sleep matters just as much as the workout itself. We also tackle one of the biggest questions I hear from women every day, which is how you actually build and keep muscle in your 40s, 50s, 60s, and beyond. Part one explained why muscle matters, and this conversation gives you the roadmap for protecting it. I'm Dr. Mary Claire Haver, a board certified obstetrician and gynecologist, and certified menopause practitioner and adjunct professor at the University of Texas Medical Branch. Welcome to UnPaused, where we cut through the silence and talk about what it really takes for women to thrive in the second half of life.

• 1:27Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone, and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. So, I hear a lot about when we should eat protein. You talked about 30 to 50 grams. Like, is the amount per day more important than when per day? And is there a wrong time to eat protein, or a right time to eat protein?

• 2:01Speaker 01

  From a practical standpoint, that first meal, when you're coming out of an overnight fast, is important.

• 2:06Dr. Mary Claire Haver?

  Okay.

• 2:07Speaker 01

  It doesn't matter when that is, but you are in a catabolic state. Catabolic state is when you're in a breakdown state. You're not feeding overnight. We were meant to eat in discreet time periods, unlike rodents, who are, you know, 24 hours ad limited feeding, nocturnal beings. But humans, we are meant to eat in discreet meals. So that first meal of the day, when you're coming out of an overnight fast, is really important. Doesn't matter when you eat it, doesn't have to be eight in the morning, or six in the morning, doesn't have to be before training or after training. But getting that first meal right at 30 to 50 grams, and closer probably to 50, to stimulate mTOR, which is in skeletal

• 2:47Speaker 01

  muscle, is going to be critical. If the listener or viewer only did that one thing, that is enough, just based on those early 2000 studies, and they've been replicated. So now we have a large body of evidence. This will change body composition, if they do nothing else.

• 3:02Dr. Mary Claire Haver?

  Amazing.

• 3:03Speaker 01

  And there's more to address there. First meal is really important. Also, before you go to sleep, the last meal of the day. And not necessarily an hour before you go to sleep, but that last meal of the day is also really important. So you're bookending both days.

• 3:18Dr. Mary Claire Haver?

  Should.

• 3:19Speaker 01

  Or both times, once a day.

• 3:21Dr. Mary Claire Haver?

  Well, and we talked a little bit about protein timing around training.

• 3:24Speaker 01

  Yeah.

• 3:25Dr. Mary Claire Haver?

  So you're saying, just get the protein in?

• 3:27Speaker 01

  I mean, there's a little nuance here. Again, all studies, to my knowledge, are done with that first meal of the day, because it's easier to have a, kind of a clean slate from a measuring perspective. But if you are eating a higher protein diet, closer to 1.2 to 1.6, if you are plant-based, you have to be at the higher end, 1.6, then protein timing doesn't matter, as long as the totality of protein you're getting in.

• 3:50Dr. Mary Claire Haver?

  Okay.

• 3:51Speaker 01

  That being said, still, we have great data that that first meal, at 30 to 50 grams of protein, affects satiety, affects body composition, again, for outcomes that we care about.

• 4:03Dr. Mary Claire Haver?

  Okay.

• 4:04Speaker 01

  And that becomes really important.

• 4:05Dr. Mary Claire Haver?

  How important is sleep?

• 4:06Speaker 01

  I mean, unfortunately, it's very important. But it's hard for a lot of women to do. The recovery and the training, you know, when I was in residency, and I'm sure you experienced the same thing, is that you were on call, and you didn't sleep. Blood sugar regulation, I put on a continuous glucose monitor one time. It was the worst decision I made. Right? Because the days that I didn't sleep, I saw my-

• 4:28Dr. Mary Claire Haver?

  It's horrible.

• 4:29Speaker 01

  My blood sugar was terrible. And, you know, we're recognizing that sleep is very important for also recovery.

• 4:34Dr. Mary Claire Haver?

  And is it true that's when we grow muscle?

• 4:36Speaker 01

  It is.

• 4:37Dr. Mary Claire Haver?

  Okay.

• 4:38Speaker 01

  It's in part of it, yep, during recovery. Also, the glial cells in the brain flush, the lymphatic system, you know, one of the, which is why I think it's a major design flaw. Because when you have little kids, my kids still sleep in my bed. I cannot get them out of my bed. I have not had a good night's sleep. The only time I have a good night's sleep is when I'm traveling. But, you know, we are designed to sleep, and one of the things is having awareness as to your own habits. So I don't know about you, but once I miss a sleep window, I'm up. Does that happen to you?

• 5:08Dr. Mary Claire Haver?

  Oh, yeah. Yeah.

• 5:10Speaker 01

  So you, if you miss, if I miss by 9:30 and I didn't go to bed, I'm up. I'm up till like 11:30.

• 5:16Dr. Mary Claire Haver?

  Yeah. If I don't like hit my normal, then like I'll, I always read when I go to bed, and I'll just keep reading and reading and reading, you know, like whatever happens with my circadian rhythm, it's not good. And it's getting worse with age, you know, and I'm fully replaced on HRT. It's not that. So I have to protect my sleep with my life now. There's no, it's non-negotiable.

• 5:36Speaker 01

  Well, I hope I get there. I mean, really, I just, yes, I hope I get there. But sleep is really important for muscle health, and it's also really important for metabolic regulation. Something else that's really interesting is if someone misses a night of sleep, number one, it can actually suppress muscle protein synthesis, which makes perfect sense.

• 5:55Dr. Mary Claire Haver?

  Yeah.

• 5:56Speaker 01

  But there's ways to compensate for lower levels of sleep. And that is, there's some evidence to support high intensity interval training.

• 6:02Dr. Mary Claire Haver?

  Really?

• 6:03Speaker 01

  To offset a few nights of poor and shortened sleep.

• 6:08Dr. Mary Claire Haver?

  So if I'm traveling, and I'm jet lagged?

• 6:10Speaker 01

  Yes. I always, yes. There is some data to support that it offsets the-

• 6:16Dr. Mary Claire Haver?

  Interesting.

• 6:17Speaker 01

  -outcomes of poor sleep.

• 6:18Dr. Mary Claire Haver?

  So you touched on amino acids. This is a supplement, right? This is not a food.

• 6:22Speaker 01

  Right.

• 6:23Dr. Mary Claire Haver?

  You talked about this, you know, complete amino acid. Where would you find that? Like, I don't use that. Where would I find it if I wanted?

• 6:29Speaker 01

  Essential amino acids. I use Body Health, amazing product, very clean. And I use Perfect Amino's. I use Perfect Amino's in tablets and in packets. It's extremely convenient, because, and especially for women who are, number one, looking to maintain their muscle, or even having a lower total calorie count, so if they want to lose weight.

• 6:50Dr. Mary Claire Haver?

  Okay.

• 6:51Speaker 01

  If they want muscle recovery, this is the way to do it.

• 6:53Dr. Mary Claire Haver?

  Do you use it in conjunction with a GLP-1, or do you think it's important?

• 6:57Speaker 01

  You can't. Oh, it's critical. When we have patients that are on GLP-1s, we always give them Perfect Amino.

• 7:03Dr. Mary Claire Haver?

  Okay.

• 7:04Speaker 01

  Because otherwise, they're, you know, when you look at some of the data, and you see that as women age, their total calorie intake goes down, and then you look at when you put them on a GLP-1, now every bite matters. You've got to get that nutrient quality-

• 7:19Dr. Mary Claire Haver?

  Yeah.

• 7:20Speaker 01

  -and nutrient density up.

• 7:21Dr. Mary Claire Haver?

  Okay.

• 7:22Speaker 01

  Which goes to creatine.

• 7:23Dr. Mary Claire Haver?

  Yeah. My next question was creatine.

• 7:24Speaker 01

  Creatine.

• 7:25Dr. Mary Claire Haver?

  Are you a fan?

• 7:26Speaker 01

  I am a huge fan.

• 7:27Dr. Mary Claire Haver?

  Same.

• 7:28Speaker 01

  But let's just think about creatine and where it is found. Creatine is found in red meats.

• 7:34Dr. Mary Claire Haver?

  Yeah.

• 7:35Speaker 01

  You could not eat enough red meat to be able to get to five grams a day for muscle. It is, it's something like one, it's something like-

• 7:42Dr. Mary Claire Haver?

  I thought it was 12 chicken breasts, or something ridiculous.

• 7:45Speaker 01

  It's ridiculous. It's a pound of red meat for half a gram of creatine. Don't quote me on that, but something, it's either a pound for half a gram, or one gram. If five grams is the minimum for muscle, and 10 to 12 for brain function, that's, no one is going to consume that much. But what I think becomes really important is, yes, we have a lot of evidence for how it supports muscle, and how it supports performance, but this brain function aspect of creatine seems to be really promising. And it seems to be most promising in the more mature individual, 60s and up. Again, Darren Kandau, if you've

• 8:25Speaker 01

  not had him on, he is one of the world leading experts on creatine. And, again, most of the data that I've seen has been in older women, in older individuals, but potentially,

• 8:37Dr. Mary Claire Haver?

  Yeah.

• 8:38Speaker 01

  there's going to be more for younger.

• 8:39Dr. Mary Claire Haver?

  I love it. We recommend it.

• 8:41Speaker 01

  And it's good for mood, cognitive function, processing speed.

• 8:45Dr. Mary Claire Haver?

  Awesome. So what's one thing women are doing, or being told to do, that you want them to stop?

• 8:53Speaker 01

  Well, that you should reduce your red meat intake. That's probably the biggest one. It is highly nutrient dense, and especially for young women.

• 9:00Dr. Mary Claire Haver?

  Is there ways to make it unhealthy, though?

• 9:02Speaker 01

  I mean, yeah, sure. If you want to go to the gas station and eat, it's the same as eating a donut.

• 9:08Dr. Mary Claire Haver?

  Processed.

• 9:09Speaker 01

  Yeah. But that's probably one of the biggest things.

• 9:12Dr. Mary Claire Haver?

  Okay. Most women have never heard of anabolic resistance.

• 9:18Speaker 01

  I know, it's like a swear word, but different.

• 9:19Dr. Mary Claire Haver?

  So, what is it?

• 9:22Speaker 01

  Anabolic resistance is what is considered a normal aging process of muscle.

• 9:27Dr. Mary Claire Haver?

  Okay.

• 9:28Speaker 01

  And it is less sensitive to the normal stimulus of skeletal muscle.

• 9:33Dr. Mary Claire Haver?

  So, I go to the gym at 20 and I eat X amount of protein, of healthy, high-quality protein, and I lift heavy.

• 9:41Speaker 01

  Mm-hmm.

• 9:42Dr. Mary Claire Haver?

  I'm gonna have a different response than I am at 58.

• 9:45Speaker 01

  Yes, ma'am.

• 9:46Dr. Mary Claire Haver?

  Next month, with the exact same stimulus.

• 9:48Speaker 01

  Yes, ma'am.

• 9:49Dr. Mary Claire Haver?

  Sub-straight into stimulus and I'm gonna have a different response.

• 9:52Speaker 01

  You are. Um, you know, this is like the unfortunate part about aging. We get wiser, we get sage wisdom, we can now integrate our thinking, and then all of a sudden, it's like the body falls apart. And I think it's a design flaw. But, uh, it can be circumvented.

• 10:09Dr. Mary Claire Haver?

  I'm embracing it, I'm embracing it.

• 10:10Speaker 01

  It can be circumvented. When you are young, you're on the Twinkie diet. You go, you lift weights, even the lighting makes you look anabolic. I mean, you got, the lighting's making you look jacked already. But as we age, we think about the aging process of our heart and our brain and our ovaries. Muscle as an organ system follows the same trajectory, but it's manifested differently. How does aging muscle manifest? And I do also want to point out that there are some nuances here, because if you look in the literature, it says healthy sedentary people. That's, it's not possible, that's a diseased archetype, it's a diseased cohort. That represents something that is not a

• 10:51Speaker 01

  healthy state, right? And I say this because where does anabolic resistance flow through this conversation? Anabolic resistance is what we think of as a normal process of aging. I'm not so convinced that it is a normal process of aging.

• 11:06Dr. Mary Claire Haver?

  Really?

• 11:07Speaker 01

  Yes. I mean, I believe that maybe when you are 80, in your 80s and 90s, potentially, you know, that there are some of these fa- and again, this is controversial and I would probably be fighting with my mentor because he would say, well, no, it is a normal process of aging. But I would say that we don't have highly physically active cohorts of a normal population.

• 11:30Dr. Mary Claire Haver?

  To be able to measure this.

• 11:32Speaker 01

  How can we say, because elite athletes, that's, there's nothing normal about them.

• 11:35Dr. Mary Claire Haver?

  Mm-hmm.

• 11:36Speaker 01

  These elite athletes that have been training their whole life, their muscle will look different than, you know, a normie like myself. It's going to look different. So, I just want to point out that, that little caveat, because I do want to be fair in the literature. Anabolic resistance, now I'm gonna go back to the definition, is the, it is somewhat of an insensitivity to a stimulus like protein, or more specifically branched-chain amino acids, even more specific to that, which is leucine.

• 12:04Dr. Mary Claire Haver?

  Okay.

• 12:05Speaker 01

  How do we overcome anabolic resistance?

• 12:08Dr. Mary Claire Haver?

  Yeah.

• 12:08Speaker 01

  And why does it matter? Anabolic resistance manifests exactly what you say. All of a sudden, I've eaten this normal diet, something has changed, but I'm doing exactly what I did since I was 20. And now, all of a sudden, it's not working. You will require more protein for muscle to recognize that signal. Amino acids are just signaling molecules. If you have your two eggs in the morning, you're not gonna stimulate muscle. It's going to be resistant. It's not going to kick in that machinery. But if you hit that 30 to 50 grams, which is again, four and a half ounces of a meat of your choice, or, you know, we use, this is where essential amino acids come in, which we should talk about, how, if someone

• 12:51Speaker 01

  is thinking about this, how they could augment their nutrient density without increasing total volume of food.

• 12:58Dr. Mary Claire Haver?

  Yeah.

• 12:58Speaker 01

  Uh, because we're using this in our practice and it's transforming people's body composition without having to eat all this food. So, um, anabolic resistance, you can lower it, you can make old muscle act like young muscle by bumping up the quality of the protein, i.e. essential amino acids, all essential amino acids, and doing resistance training. I know that that was a lot of words, so, um...

• 13:24Dr. Mary Claire Haver?

  Yeah, because I want our audience to understand that you can grow muscle at any age, at 70, at 80, at 90. It is possible.

• 13:31Speaker 01

  And...

• 13:32Dr. Mary Claire Haver?

  It's just harder.

• 13:33Speaker 01

  It's harder. It just takes a little more diligence and you can have older muscle respond like younger muscle. Anabolic resistance is not a static thing. You can improve and lower the resistance by doing the things necessary for stimulating muscle. For example, and there's some really good data, um, I think it was Kat Stanos and Simmons, they looked at a younger person having, and when I say younger, in their 20s, having 15 grams of protein, and they get a maximum response of muscle. And that's, the next cohort, 60 plus, had no response with that same 15 grams. But once you bumped up that protein intake

• 14:17Speaker 01

  to 30, the 60 plus responded just like the 20-year-olds.

• 14:21Dr. Mary Claire Haver?

  Okay.

• 14:22Speaker 01

  And I do think that we should segue into what are the practical takeaways people need to do to understand muscle health. Okay. And the reason I'm saying this is because with the landscape of as we age, our appetite reduces naturally, and with the use of GLP-1s, we're seeing a further suppression of overall food intake.

• 14:42Dr. Mary Claire Haver?

  Yeah.

• 14:42Speaker 01

  That the quality of that food becomes critical. Now, the dietary protein recommendations are set at 0.8 grams per kg. The RDA hasn't changed. The new dietary guidelines recommend a higher amount, but the recommended dietary allowance stays the same and it is set at the minimum. And people, that's, um, just a point of confusion for people. 0.8 grams per kg of protein, so for some women, that's 45 grams a day, is set at the minimum to prevent a deficiency. Last time I checked, Mary Claire, you and I are not looking for how not to be worse than yesterday, right?

• 15:22Dr. Mary Claire Haver?

  Right.

• 15:23Speaker 01

  We're not looking for that. That is the minimum to prevent deficiency.

• 15:26Dr. Mary Claire Haver?

  Mm-hmm.

• 15:27Speaker 01

  How does...

• 15:27Dr. Mary Claire Haver?

  Different than optimal.

• 15:28Speaker 01

  How does muscle deficiency show up on a daily basis? It doesn't. It takes 10 years for us to begin to see problems.

• 15:37Dr. Mary Claire Haver?

  Yeah.

• 15:38Speaker 01

  Overtly. Not in blood work, but overtly. So, when we think about how much protein we need, the average woman is getting 1.1 grams per kg, which means, people are like, oh, well, the new recommendation is 1.2 to 1.6, they're close. No, that means 50% of people are below that number.

• 15:58Dr. Mary Claire Haver?

  Yeah.

• 16:00Speaker 01

  For women in their 60s, anywhere from 20 to 40% are below the RDA.

• 16:07Dr. Mary Claire Haver?

  This I know. Yeah, they're having toast for breakfast.

• 16:10Speaker 01

  And we, and we know...

• 16:12Dr. Mary Claire Haver?

  Almost no protein at lunch, and they'll stack a little bit more at dinner.

• 16:15Speaker 01

  Devastating. Not only the metabolic consequences, but fracture risk increases. We know that protein is what makes bone. These are really important aspects that people have to understand because the landscape changes in terms of how we talk about protein, because anyone listening to your, anyone listening to your podcast in their 50s has heard that red meat is bad for you, that I should be concerned about saturated fat. They've heard all of these things and we have to fight for the women in the middle that are like, okay, well, I've tried lowering my protein and now look what has happened. So, um, again, this is a very long-winded way of saying, how do we design a diet? Well, we have to

• 16:55Speaker 01

  first focus on protein total. You'd asked earlier, is it the length, is it timing, does timing matter? Timing only matters if you are lower protein.

• 17:07Dr. Mary Claire Haver?

  Oh, okay.

• 17:08Speaker 01

  Timing doesn't matter if you are a high-protein person. If you're getting closer to 1.6 grams per kg, then timing doesn't matter. But I will also say, almost every single study on protein is done with that first meal of the day. Easy to measure, you're highly catabolic, there's no reason why you wouldn't set yourself up. And we do see data that it does transform body composition, assuming calories are within control.

• 17:35Dr. Mary Claire Haver?

  Okay. Animal, you touched on this, but is it...

• 17:39Speaker 01

  We have to clear this up, we have to clear this up.

• 17:41Dr. Mary Claire Haver?

  Yeah, animal versus plant protein, what's your position? You know, I, today I had a comment on social media, but I'm a vegetarian and, you know, it was a protein post. And...

• 17:53Dr. Mary Claire Haver?

  And I, I, I was just, okay, and I wanted to say, why? Because they think it's healthier. Or they have problems with killing animals and, you know.

• 18:02Speaker 01

  Yeah. So, this is a real challenge, and I think in the geriatrician landscape as well. Dietary protein is not just one thing. It does come in those various qualities, the higher quality and the lower quality. If someone is vegetarian or vegan, could they build a healthy diet? They could. The statistics show us that it's unusual.

• 18:28Dr. Mary Claire Haver?

  It's right.

• 18:28Speaker 01

  It's hard. It's, the statistics show us that people are struggling with obesity. People are struggling with menopause. People are struggling with osteoporosis and things that are really, and movement. So, we know that these struggles are well documented. If someone wants to design a diet, the first thing that they have to determine is, how much protein are they gonna get a day? No less than 100 grams. From my perspective, higher is better. In our clinic, you know, in the playbook, we shoot for closer to 1 gram per pound of target body weight. We also, and people are like, oh, my gosh. So, if there's 130-pound woman listening to this, she's like, oh, I have to eat 130 grams of protein?

• 19:11Speaker 01

  No, you would be perfectly fine with 100 to 120 grams. Could you go a little bit higher? Yes. Is protein important for things other than muscle? Yes. It's impro, it's important for every enzymatic reaction, for mute, for all, you know, like you listed, it's there. But how is she going to practically speaking, design her diet? She knows that she needs 100 grams of protein. If she chooses to be vegan or vegetarian, this is where we use essential amino acids.

• 19:40Dr. Mary Claire Haver?

  Okay.

• 19:40Speaker 01

  As an absolute non-negotiable in that first meal.

• 19:43Dr. Mary Claire Haver?

  All right. What are the, or what is essential amino acids?

• 19:46Speaker 01

  Essential amino acids, there's nine. And if you are going to eat, for example, two eggs, if you're gonna eat two eggs, you're gonna get 12 grams of protein. We've already discussed that as you age, that's not going to be enough to stimulate muscle. What you are going to do is you are going to augment that with a scoop of essential amino acids so that your body recognizes that as 30 grams of protein, and it's going to start the machinery. For us, we use, I only work with one company with essential amino acids, and that's Body Health. We use essential aminos with those two eggs. One packet or two packet raises that protein quality now to then stimulate muscle.

• 20:29Speaker 01

  So, if a woman doesn't wanna eat between 30 to 50 grams of protein, but still wants to maintain her muscle and maintain her lean tissue, i.e. bone, and everything else that's important, you have to get that, those numbers right.

• 20:43Dr. Mary Claire Haver?

  Okay.

• 20:43Speaker 01

  Um, and I'm sure you've got other questions as to how. So, that is one way, a vegan or vegetarian, which it's really important that they get that right.

• 20:53Dr. Mary Claire Haver?

  Okay. Well, walk us through, what does a 50-gram breakfast look like?

• 20:57Speaker 01

  Well, there's two, there's, yes, 50, 50 grams of, 50 grams of protein breakfast. You wanna know what I had this morning?

• 21:03Dr. Mary Claire Haver?

  Yep.

• 21:04Speaker 01

  Okay. I had two screaming kids. Uh, one drew blood to the other, but, you know, it's, it's fine. I had two eggs. I had some cottage cheese. Two eggs is 12 grams. Um, a small serving of cottage cheese, and I did a pack of essential aminos. In orange. That was it. That raised my quality up to 50 grams of protein. That's not a ton of food. On a Saturday or Sunday, I might have six eggs, which people are like, oh, but that, that's so much. You could also have Greek yogurt. I know, I think that you.

• 21:37Dr. Mary Claire Haver?

  Yeah, I make a shake.

• 21:39Speaker 01

  So, you make a shake?

• 21:40Dr. Mary Claire Haver?

  Three days a week, four days a week.

• 21:41Speaker 01

  You make a shake, you make a protein shake?

• 21:42Dr. Mary Claire Haver?

  Yeah.

• 21:42Speaker 01

  Your protein shake, without overcomplicating it, it could be 20 grams. You use whey protein, right?

• 21:48Dr. Mary Claire Haver?

  Yeah, I use whey. I have also put Greek yogurt in it, so three-quarter cups.

• 21:52Speaker 01

  So, you're hitting it?

• 21:53Dr. Mary Claire Haver?

  Yeah, so it's about 40 grams of complete protein, and then I do add some collagen, but not counting that as my protein.

• 21:58Speaker 01

  Because we know collagen has a protein score of zero.

• 22:00Dr. Mary Claire Haver?

  Yeah.

• 22:01Speaker 01

  But the whey protein with the Greek yogurt, that's perfect. That is a high-quality breakfast. Um, do you hear people having pushback on, what does that look like? It's too much? And that's, if it's too much food?

• 22:15Dr. Mary Claire Haver?

  I mean, it takes me a couple hours to get it down, like, half of it's still in the fridge.

• 22:18Speaker 01

  So, you can't do that.

• 22:19Dr. Mary Claire Haver?

  So, oh, no.

• 22:20Speaker 01

  You can't do that. If you don't have it at one time, the, the leucine level, the, the amino acids in the blood will never reach peak. So, you have to have that shake at once.

• 22:29Dr. Mary Claire Haver?

  Okay. Okay. I just have to drink it faster. What would a 50-gram dinner look like?

• 22:34Speaker 01

  My favorite is lean steak. Lean steak and vegetables.

• 22:39Dr. Mary Claire Haver?

  Yeah.

• 22:40Speaker 01

  Plate. One-third of your plate should be lean proteins. One-third of your plates can be some kind of fibrous carb, and one-third of your plate can be starchy carb.

• 22:49Dr. Mary Claire Haver?

  Okay.

• 22:49Speaker 01

  Very simple. Uh, red meat gets a really bad rap for aging women, and a lot of women feel that it's unhealthy for them. I would say it is very healthy, and almost 50% of the fat in red meat is olive oil. It's monounsaturated fat.

• 23:08Dr. Mary Claire Haver?

  Wow. So, are you pro shakes or anti shakes?

• 23:11Speaker 01

  I'm pro shake.

• 23:12Dr. Mary Claire Haver?

  Okay.

• 23:13Speaker 01

  They are so convenient.

• 23:14Dr. Mary Claire Haver?

  It's, for me, it's like, I can hit, because I put extra fiber in it, you know, add in, I have my berries. So, like, I can hit so many of my overall nutrition goals, and it's convenient. I know exactly what it tastes like. I don't have to measure anymore, like, if, if I can get that down, I am like halfway home, you know, for my nutrition goals.

• 23:31Speaker 01

  I would agree.

• 23:32Dr. Mary Claire Haver?

  It's delicious.

• 23:33Speaker 01

  So, it's, and it's easy.

• 23:35Dr. Mary Claire Haver?

  Yeah.

• 23:35Speaker 01

  We're busy.

• 23:36Dr. Mary Claire Haver?

  It's easy.

• 23:36Speaker 01

  Someone's, you know, my kids are screaming, the other ones, you know, like, why are you drawing on the wall? But you have to get that right, because again, if we're talking about health outcomes that matter, we want to have good metabolic health, like, again, glucose, insulin, triglycerides, they all have to be in check. There's another thing that I think is really important that, um, is critical to understand as we think about designing a diet. The dietary guidelines that have been set have had 10% saturated fat since the smoking days. It's never changed. When we think about 10% saturated fat, it allows us to either knowing or unknowingly demonize all animal products.

• 24:19Speaker 01

  Eggs, steak, everything, those foods will almost never be considered a healthy food, even if an egg has a gram of saturated fat, and a donut has more saturated fat than an 85% lean hamburger. Okay?

• 24:36Dr. Mary Claire Haver?

  Yeah.

• 24:37Speaker 01

  We have to shift away from thinking about foods as a number, like, this component of the food, only saturated fat.

• 24:45Dr. Mary Claire Haver?

  Right.

• 24:45Speaker 01

  Thinking, and even protein, but really thinking about the whole food matrix. Because if we demonize saturated fat, then you see people push towards more plant-based foods, and plant-based foods are important, but they're not important at the expense of high-quality proteins and foods that are all nutrient-dense. So, the best of both worlds is really a combination of the two. And, you know, I just wanted to say that because the dietary guidelines, we have to ask, are these guidelines to inform the public, or are they meant for medical interventions? And where is reducing saturated fat potentially helpful? Well, if you are someone that has a high LDL level, what percentage of people have an LDL cholesterol above 160? It's like 6% of people. 6%.

• 25:30Dr. Mary Claire Haver?

  Yeah.

• 25:31Speaker 01

  So, we create dietary guidelines that are potentially going to address LDL cholesterol. What is, how is that going to help someone who already has healthy LDL cholesterol numbers? Does that make sense?

• 25:46Dr. Mary Claire Haver?

  Yeah, no, totally. We're designing something for such a small percentage of the population.

• 25:51Speaker 01

  Right.

• 25:51Dr. Mary Claire Haver?

  Where it would lead to less healthy behaviors for the majority.

• 25:56Speaker 01

  But they are now designing or being forced to design diets that then have to fall within that umbrella. And then the other thing for carbohydrates. If try, you know, when I think about, how do we know if your carbohydrates are in check? That's a triglyceride question. If your triglycerides are elevated, then you should reduce your carbohydrates. So, this now moves us into personalized nutrition. If someone is like, I did the Forever Strong playbook, my triglycerides are elevated. What do I need to do? Well, then you would reduce your carbohydrates. Then you would reduce your carbohydrates below 130 grams or below 140 grams. And we've seen that in the data. We'll see a 20% reduction in triglyceride levels.

• 26:38Speaker 01

  And so, we just have to ask ourselves, are we utilizing dietary patterns and guidelines as medical interventions? And if we are, then they have to be specified as medical interventions, or are we using it for optimal health?

• 26:52Dr. Mary Claire Haver?

  I love that. I mean.

• 26:55Dr. Mary Claire Haver?

  You know, I love that because we do the same thing in our clinic. You know, we have generalized guidelines, but then I get to look at a very extensive lab panel and look at the patient and be like, okay, for your nutrition, for your needs, for your, maybe you don't, your vitamin D levels are great. You're getting plenty, you know? We don't need to supplement this, but your triglycerides are elevated. You've got insulin resistance. Now we need to like target your nutritional goals to meet your health goals.

• 27:22Speaker 01

  Right. And then that is how we then move into the era of personalized nutrition.

• 27:25Dr. Mary Claire Haver?

  Okay. Um, let's talk about women specifically because there's just so little data for us. Um, but most of the muscle and longevity research has been done on men. Am I correct in that statement?

• 27:38Speaker 01

  You are.

• 27:39Dr. Mary Claire Haver?

  What changes when you apply this to your female patients, to women? Specifically to like our listening population, which are usually somewhere perimenopause, menopause, postmenopause, so 40 plus.

• 27:50Speaker 01

  Yeah, there's a few things. Um, number one, what we see is with a good resistance training program and calories controlled with higher protein, regardless if they are on hormone replacement therapy or not, which is really shocking because in my mind, I'm thinking we're going to replace uh, people's hormones and their body composition is going to change. We don't always see that, right? And it's not a

• 28:13Dr. Mary Claire Haver?

  We don't see it in clinic either unless they do the work.

• 28:16Speaker 01

  And this is really important. What we

• 28:19Dr. Mary Claire Haver?

  It's a tool, but it's not everything.

• 28:20Speaker 01

  And it's a tool that isn't going to work if you do not have the fundamental principles in, in check. And so

• 28:27Dr. Mary Claire Haver?

  I tell patients hormone therapy will not keep you out of a nursing home.

• 28:30Speaker 01

  It will not. It will not. The biggest needle mover is resistance training. And people will say, well, what about zone two? Zone two is great. You've got different fiber types, type one, type two, type, you know, there's a hybrid type. People will say, well, it's different in men and women. And is that true? It's probably more dependent on your training because that's the reality is that we have agency. So resistance training, two days a week will be critical. Dietary protein is critical if you want to build muscle and maintain muscle. Uh, one of the things that we do see is that women, sometimes what becomes really important is that they have to increase their stimulus. So there's this idea of progressive overload.

• 29:15Speaker 01

  Uh, we don't believe that is, doesn't just always have to be heavier. You can

• 29:19Dr. Mary Claire Haver?

  Really?

• 29:20Speaker 01

  Yeah. So you can change the stimulus. It can be heavier. It can also be

• 29:24Dr. Mary Claire Haver?

  Be a different exercise?

• 29:25Speaker 01

  It can be a different exercise. It can be a change in tempo. It can be a change in, um, yeah, so speed, exercise. There are so many levers that you can change. It doesn't just have to be heavier. And that is, you can change volume. There are a handful of other things that you can change beyond

• 29:47Dr. Mary Claire Haver?

  Just going heavier and heavier.

• 29:48Speaker 01

  The weight. And so progressive overload should now be termed progressive stimulus.

• 29:52Dr. Mary Claire Haver?

  I love that. That makes me feel better because I, you know, I, I'm human. I get injured, we travel, I'll, you know, and then I'm like, oh, and I'll go back and look and I'm like, I'm not gaining, you know, I'm, my, my weights are not increasing that much. Definitely I'm stronger than when I started or can lift heavier. But I'm like, I think I'm plateauing a little bit just because life gets in the way. But like, I could switch it up, change it, do something different and still get enough stimulus.

• 30:20Speaker 01

  You can. And again, we have to help. If there are all these narratives that create our limitations

• 30:26Dr. Mary Claire Haver?

  Yeah.

• 30:26Speaker 01

  And that there's one way to do, to do something, then it creates a lot of limitations within the person, within the listener who is saying exactly the same thing that you're saying. Do I love lifting heavy weights? I do. Do I get injured? Yeah. I decided that I should be doing clean and, you know, cleans at a hundred pounds. I'm a hundred and, I mean, I'm a small person. I couldn't move my left shoulder. I'm like out of the gym for a week.

• 30:50Dr. Mary Claire Haver?

  I know you had hamstring surgery.

• 30:51Speaker 01

  Okay. So, I mean, from hamstring to shoulder, you name it. But the, the real key is, and there is a lot of information in the space that, you know, what is the impact of estrogen and muscle? What is the

• 31:03Dr. Mary Claire Haver?

  Yeah, walk me through, what do we know? What do we know about a woman goes through the menopause transition? What happens to her muscle?

• 31:09Speaker 01

  I'm going to tell you my personal perspective.

• 31:11Dr. Mary Claire Haver?

  Okay.

• 31:11Speaker 01

  Because I don't think that, I think there's a lot of mechanistic data. I don't think that the mechanistic data is translating over to, uh, women yet that we can say in clinical practice. And here's what I will tell you. That does the, does the menopause transition change body distribution of fat because of the change in estrogen and the change in testosterone? You and I have seen it in clinic.

• 31:35Dr. Mary Claire Haver?

  Every, every cohort shows it.

• 31:37Speaker 01

  Okay.

• 31:37Dr. Mary Claire Haver?

  Yeah.

• 31:38Speaker 01

  Now, what does that mean for the quality of skeletal muscle? We see mechanistic data that there are estrogen receptors on skeletal muscle, but if someone is taking estrogen, it doesn't mean that they're building more muscle. If someone is suppressing their hormonal status or estrogen on birth control, are we seeing that it's changing their musculature? We're not. I mean, there might be outliers, but what I believe that it comes down to, I mean, again, this is my perspective. I, I want to be fair. I don't think that, that we're there with the data.

• 32:08Dr. Mary Claire Haver?

  Right. We need biopsies throughout the transition, thousands of people.

• 32:12Speaker 01

  I think that there is probably an influence, which we know, right? Um, to what extent if someone is training and is highly physically active? I'm not sure if it's relevant. Would I want to believe something else? I do. Is it possible? Is it plausible? Yes. Have we proven it yet? Maybe not yet. All that to say, I think that the jury is still out. But what I will say is during the aging process, as hormones decline for both men and women.

• 32:45Dr. Mary Claire Haver?

  Testosterone declines in both.

• 32:47Speaker 01

  For both men and women, we do see changes in body composition. But is it because of that or is it because of the activity? And I just think we have to be really fair. It could be one, the other, or both.

• 33:01Dr. Mary Claire Haver?

  So I decided to start testosterone, um, three years ago, maybe. And I didn't meet the qualifications for HSDD, though I have seen an uptick in that area and I'm super happy with it and I would feel sad if that went away. Um, but I didn't like have distress with, you know, frequency or whatever. But I, but I'm a naturally very thin person and I'd been lifting and I knew the studies had shown that women who naturally had higher testosterone levels as they aged, you know, when they looked at per quartiles, the women with the highest testosterone levels had more muscle mass. And I was like, well, if I supplement a little bit, maybe that'll help in my efforts

• 33:44Dr. Mary Claire Haver?

  to hold on and grow some muscle for my aging process. And one of the side benefits was, you know, an increase in libido, which was amazing. So, um, was I, was I ridiculous to think that or to use that? You know, because we don't have studies, we're not looking at that data, you know, other than just looking at what woman happens to naturally by luck or whatever, have a higher testosterone level, you know, what quartile does she land in at 50, 60, 70? And what's her muscle mass?

• 34:12Speaker 01

  I believe that, obviously I believe in hormone replacement. Um, and you, you guys call it in the menopause

• 34:19Dr. Mary Claire Haver?

  Oh, God, yeah. Yeah. PET.

• 34:21Speaker 01

  I want to just say it right because

• 34:23Dr. Mary Claire Haver?

  PET, progesterone, estrogen, testosterone.

• 34:26Speaker 01

  I have seen the benefits in my clinical practice. I believe in it. Did it improve muscle mass for you? Testosterone?

• 34:35Dr. Mary Claire Haver?

  I don't know. It's hard to measure.

• 34:37Speaker 01

  It's hard to measure. Uh, we don't measure

• 34:40Dr. Mary Claire Haver?

  I'm eating protein, I'm lifting weights and I'm growing muscle. So I don't have, it's my N of one.

• 34:46Speaker 01

  Right.

• 34:46Dr. Mary Claire Haver?

  You know?

• 34:47Speaker 01

  I think that it's possible if you're doing all the other things right. Again, we see great benefits for the reasons that you mentioned, sex drive, libido, maybe energy, all for all of the other things. You also have to recognize that, um, muscle mass changes are really hard to detect. And one of the things that you will see in the literature is, for example, um, protein doesn't matter because if you're not doing resistance training, you're not going to see a change in, in muscle. Muscle is very difficult to detect. I mean, it, in 10 years, you might see an 8% change. How much is that per year? 1%?

• 35:31Speaker 01

  A 1% change in muscle mass per year? Again, because I think that the, it's the quality of that tissue that we're not addressing. It's again, this big gaping hole. Will testosterone help it? I mean, hopefully, but also the levels that women are getting are different than the more robust dosing of

• 35:50Dr. Mary Claire Haver?

  Men.

• 35:50Speaker 01

  Men.

• 35:50Dr. Mary Claire Haver?

  For sure.

• 35:51Speaker 01

  Um, but also we know testosterone is important for so much more.

• 35:55Dr. Mary Claire Haver?

  There's a lot of debate right now.

• 35:56Speaker 01

  Is there really?

• 35:57Dr. Mary Claire Haver?

  Oh, in, in my world, you probably don't see a lot of it. So there's, there's researchers, um, who have studied testosterone, like really smart, good researchers who are coming out very strongly saying, and they're very academic minded, I don't think they actually see patients, um, that, you know, we're overselling testosterone. Like we need to hold back. Don't be talking about brain or mood or cognition, like, like testosterone has no place in this conversation or we don't have enough data, so we shouldn't be talking about this.

• 36:27Speaker 01

  But we know about androgen deprivation therapy, don't we?

• 36:29Dr. Mary Claire Haver?

  We know a lot about men, you know? And, um, yeah, when we block estrogen, androgen receptors, what happens?

• 36:37Speaker 01

  Changes in brain function, all kinds of things.

• 36:39Dr. Mary Claire Haver?

  So, you know, I, I think there's some gatekeeping of data. I think that a lot of people want to control the narrative. Um, then I just know clinically in my patient population, I'm seeing very positive results.

• 36:54Speaker 01

  We're in multiple organ systems. We are too. And that is the challenge of academic medicine and research. Oftentimes unless you're like the guys at Baylor, like our friend Mohit Kara, who are doing the research and seeing patients, you have one group that are PhDs that are looking at, you know, what is the hardcore data? And then while hardcore data is important, we might not just be there yet in the randomized control trials saying that testosterone for women, say vaginally, will improve sex drive for X, Y, and Z, or any of these other things.

• 37:30Speaker 01

  But I think that we're gonna get there.

• 37:32Dr. Mary Claire Haver?

  Yeah.

• 37:32Speaker 01

  And I think in the next 10 years, if someone goes to their physician and they're caring about aging and they're not on hormone replacement, that that physician is gonna be out of date.

• 37:44Dr. Mary Claire Haver?

  Yeah, and it needs to be a part of the conversation.

• 37:46Speaker 01

  Well, also, which kind of segues nicely into GLP-1s. We talked about the beginning of the obesity epidemic. Food Guide Pyramid happened, the late 80s, early 90s, all of a sudden, people became obese, with diabetes, but they were trying to address heart disease and then they increased heart disease and metabolic syndrome underneath the umbrella of trying to correct for cardiovascular disease. Remember, so this was just a whole big human experiment mistake. We are at that precipice again.

• 38:24Dr. Mary Claire Haver?

  With GLP-1s?

• 38:25Speaker 01

  We are.

• 38:26Dr. Mary Claire Haver?

  Yeah.

• 38:26Speaker 01

  We are.

• 38:28Dr. Mary Claire Haver?

  What do you think we're doing wrong? What do you think we're getting wrong?

• 38:31Speaker 01

  Okay. My prediction, and I really hope that I'm wrong, in the next 10 years, we are going to see an accelerated rate of sarcopenic obesity, sarcopenia and osteoporosis that no one is ready to manage.

• 38:45Dr. Mary Claire Haver?

  Is there a way to safely give a GLP-1 without that risk?

• 38:51Speaker 01

  We do in our clinic.

• 38:52Dr. Mary Claire Haver?

  So do we.

• 38:53Speaker 01

  And we manage nutrition and resistance training and lower dosing of these medications. It doesn't have to be very high doses. I think it's a double edged sword. The data, I believe, that is coming out and will continue to come out improves muscle quality, lowering the fat within the muscle. I think, you know, there's some data to support that it improves strength and, you know, a whole host of promises, but that could be because healthy muscle is stronger muscle as opposed to connective tissue and fat, you know, there's various.

• 39:25Dr. Mary Claire Haver?

  Infiltrating.

• 39:26Speaker 01

  Infiltrating underneath the fascia, around muscle groups, within the muscle tissue itself, within the muscle bellies. There's various places for it, but I think GLP-1s are improving that. We're gonna see more data lowering inflammation. However, if someone goes on a GLP-1, and by the way, they don't magically cause muscle loss.

• 39:46Dr. Mary Claire Haver?

  Right.

• 39:47Speaker 01

  They track in line with when an individual loses weight, we see, it's the same percentage. It's not something magical, but the problem is, if individuals are abusing GLP-1s, not training, seeing the celebrity sphere become very skinny sarcopenic, I believe that we're going to have an epidemic of sarcopenia that we defined as an aging change in muscle accelerated years earlier, right underneath our noses.

• 40:21Dr. Mary Claire Haver?

  How are you monitoring body composition in your clinic?

• 40:24Speaker 01

  Well, like I mentioned before, we don't have great ways of measuring skeletal muscle because MRI is not feasible for most people. But we use bioimpedance and we use a DEXA and we always measure and keep strength metrics.

• 40:39Dr. Mary Claire Haver?

  Oh, wow, how do you do that? We're not doing that.

• 40:41Speaker 01

  We just report, I mean, we usually are in contact with their trainers and we, whatever it is that their programs are and their lifts, are they evolving, where are they from a strength standpoint?

• 40:51Dr. Mary Claire Haver?

  So you are, 100% of your patients are doing strength training?

• 40:54Speaker 01

  Yes, they are. So you're not coming to me, yeah.

• 40:57Dr. Mary Claire Haver?

  Okay.

• 40:57Speaker 01

  Because it's, nothing moves the needle more than exercise. And we were talking about the fat that infiltrates into the tissue. The fat that infiltrates into that tissue, the most effective way to get rid of that is not diet, it's movement. You have to get a flex. If you think about your muscle like a pond, when a pond is stagnant, it gets bugs and all kinds of things, muscle is the same. Even if you then revert to a healthy eating behavior, if your muscle is full, muscle glycogen, fatty acids, and you're not leveraging this turnover through activity, then your muscle doesn't, I mean, it will improve, obviously, because the quality of your diet improves,

• 41:40Speaker 01

  but the most effective way to improve that muscle quality is through movement.

• 41:44Dr. Mary Claire Haver?

  All right, so let's talk about the training prescription, which is, I love, so you have two books. Let's talk about these real quick. So I love the playbook, you know, what's the difference between the two books?

• 41:52Speaker 01

  This is, this one, this book has pictures. This book is written for now who people don't want all the heavy science. The heavy science is all in Forever Strong, but this is how to do what to do.

• 42:05Dr. Mary Claire Haver?

  So.

• 42:08Speaker 01

  And you know what? We're gonna do a challenge and maybe you will pop on the challenge and talk about your own.

• 42:15Dr. Mary Claire Haver?

  Lots of recipes in here.

• 42:16Speaker 01

  Yes, and protocols. And it tells you exactly how to design a diet to support muscle health.

• 42:22Dr. Mary Claire Haver?

  So that's why this is how.

• 42:24Speaker 01

  That's right.

• 42:25Dr. Mary Claire Haver?

  Okay, protein without resistance does not build muscle.

• 42:28Speaker 01

  It does not, but.

• 42:29Dr. Mary Claire Haver?

  Resistance without protein doesn't build muscle.

• 42:32Speaker 01

  Right.

• 42:32Dr. Mary Claire Haver?

  You need both.

• 42:33Speaker 01

  Okay, but both are valuable without the other, meaning.

• 42:37Dr. Mary Claire Haver?

  Oh, okay.

• 42:37Speaker 01

  If you are, if you must consume calories, you still need beyond building muscle, again, skin repair, hormones, brain function, precursors, methionine for glutathione production, the Manchester antioxidant, but yes.

• 42:55Dr. Mary Claire Haver?

  So define resistance training for Maddie, who does, she is lifting weights now, but like forever Pilates, Pilates. For the woman who's doing Pilates and walking and thinks she's covered.

• 43:08Speaker 01

  This hurts my heart a little bit because all activity is good activity.

• 43:11Dr. Mary Claire Haver?

  Yes.

• 43:12Speaker 01

  And I believe we should hold people to a higher standard if they want to age well.

• 43:15Dr. Mary Claire Haver?

  Okay.

• 43:16Speaker 01

  When individuals age, again, we had touched on these fiber types. When our parents age and we've watched them age, they become thinner and more frail. Typically, there's a transition of fiber types to those bigger, bulkier fiber types, to the more thin, what we would consider more endurance.

• 43:34Dr. Mary Claire Haver?

  Muscle fibers.

• 43:35Speaker 01

  Muscle fibers. The only way to protect those muscle fibers, to maintain that size, is to do resistance training. There's no other way. Is Pilates great? Pilates is great. Is it going to be enough stimulus? If Pilates was the, and Pilates is great, and people get very offended, but if Pilates was going to build the most amount of muscle, then you would think the Navy SEALs and the football players, that's all they would be doing. They wouldn't be at the weight room, they would be doing Pilates. And I would say it's a great place to start and it's a great adjunct and it's very hard. And I would like people to lift weights.

• 44:15Speaker 01

  Resistance, again, it's lifting up against something that is heavy, right?

• 44:21Dr. Mary Claire Haver?

  That's hard for you.

• 44:22Speaker 01

  And women will say, I have never lifted weights, is it too late? And you know what I will say?

• 44:26Dr. Mary Claire Haver?

  It's never too late.

• 44:27Speaker 01

  I will say, lady, you have been lifting weights your entire life. Whether you have kids, my kids are 40, 50 pounds, whether you have groceries, you have been lifting weights your entire life, you are so much less fragile than you think you are. So if you are mature, the one thing I would say is there's a lot of discussion around power and force production.

• 44:51Dr. Mary Claire Haver?

  I think that muddies the water, you know, talk to me, talk to the woman who's listening who's 50, and she's the first woman in her entire bloodline who is going to try to do this, and she's never lifted in her life. Where does she start?

• 45:07Speaker 01

  She, well, number one, she's amazing and there's a ton of, typically, she's not ready to go to the gym. She's like, I'm embarrassed, I don't want to go to the gym.

• 45:16Dr. Mary Claire Haver?

  It's overwhelming.

• 45:17Speaker 01

  It's overwhelming. I said, you know what? We're gonna start with either body weight or we're gonna start with bands. And you are gonna recognize that everything that we start is always hard at first. And then, after she feels comfortable, she will then progress to machines. She doesn't have to do free weights, she doesn't have to do complex movements, and then she's gonna say to me, doc, I don't have time. And you know what I'm gonna say to her? If you don't have time for strength, how are you gonna have time for sickness? And then she's gonna go, oh, yeah, okay, I thought about that. Then she's gonna go to the gym and we're gonna start her with machines. There's a low injury rate with machines because there's not a ton of variability. You're not getting under a barbell, doing a squat, you're not doing broad jumps, you're

• 46:02Speaker 01

  not doing any of those things. And then eventually, you maybe progress with a trainer or someone online to begin to see how to explore different movements, because I'm gonna give you another prediction. The first prediction is we're gonna talk about muscle in totality. When we think about muscle, we think about body parts, biceps, back, legs, improving insulin resistance, improving strength. Once we move a little further, what I believe is next is the movement patterns. So it's now no longer thinking, again, this is not for the beginner, but this is for the people that have been following you and have been doing what you're doing, it's, now we have to begin to think about how are we moving? What are the patterns that we are moving in?

• 46:47Speaker 01

  And I think that that's the next thing, rather than bicep curls and leg extensions, which is perfect and you will be perfectly healthy if you always do that. But when we think about injury prevention over time, we have.

• 46:58Dr. Mary Claire Haver?

  Ball prevention.

• 46:59Speaker 01

  Yeah, we have to begin to think about what are the patterns and how we're moving.

• 47:03Dr. Mary Claire Haver?

  Okay. How about the woman who's been doing cardio her whole life? And she's fit by, you know, our usual definition of fitness. She's running, she's spinning, she's in great cardiovascular shape, but she's still losing muscle.

• 47:18Speaker 01

  First thing I would say-

• 47:19Dr. Mary Claire Haver?

  These are my runners.

• 47:20Speaker 01

  Yes.

• 47:20Dr. Mary Claire Haver?

  You know, my competitive runners. They are very frustrated by this.

• 47:23Speaker 01

  Um, I have a patient, her name is Sharon. She's 60. When I inherited her as a patient, she was running ultras. She was running 50 to 100 miles. And, um, she wanted to be able to run for the rest of her life. Instead of having her run more, we pulled off two days a week of running and adding- and added in compound movements and weights and sled pulls. And she's 60. This woman puts me to shame in the gym. Shame. And you know what? She's gotten faster and stronger. Because she's diversified her program.

• 47:58Dr. Mary Claire Haver?

  Awesome. What does heavy enough mean for women our age?

• 48:02Speaker 01

  Yeah, um, you know, I was chatting with your team and, and there was the lift more trial.

• 48:07Dr. Mary Claire Haver?

  Lift more, yeah.

• 48:08Speaker 01

  Yeah. And basically the lift more trial-

• 48:10Dr. Mary Claire Haver?

  80% of max.

• 48:11Speaker 01

  Exactly. I don't think that people really understand their one rep max. I think it's unrealistic.

• 48:16Dr. Mary Claire Haver?

  So one rep max for our listeners is the heaviest you can lift and do one repetition, one, one bicep crawl before you cannot do a second one. So that's your max.

• 48:25Speaker 01

  Right. Most people are not testing that out or doing that. You know, but basically what this showed, it was this, like you'd said, 85% of one rep max. And heavy enough meant two to three reps of a set should be very, very challenging. What we also see, and this says twice weekly, 30 minutes, but what we also see is that the volume is just about the stimulus. And there's a million different ways to get to the stimulus. Should you be challenging yourself? Does it have to be heavy? It doesn't have to be heavy as long as the volume is there.

• 48:56Dr. Mary Claire Haver?

  You just have to fail, right?

• 48:58Speaker 01

  Just depends on, is that 25 reps or is that, you know, 10 reps? And, and I understand that this is very contentious in the exercise space, but we are not talking about elite athletes. And it is unfair that we take our perception and the data of elite athletes and sport performance and we push that on to our general population. It's unfair and it's not right. You know, there's all this talk about zone two training. Well, zone two is different for you than it is for me, than it is for my husband who runs 100 miles. So what she needs to do is she needs to get enough stimulus where things are challenging-

• 49:38Dr. Mary Claire Haver?

  Yeah.

• 49:38Speaker 01

  To improve, you know, as doctors, we're thinking about health outcomes. What are the health outcomes? I want you to have lower blood pressure. I want you to have better metabolic control. I want you to be able to live long and well and be able to stay independent. I don't need you to do a one rep max and risk injuring your back or be an idiot like myself doing cleans, clean and jerks. I mean, what am I doing? Because it's fun? Okay. Well, I have to be a little more disciplined in that because then you're out for a week.

• 50:11Dr. Mary Claire Haver?

  Yeah.

• 50:11Speaker 01

  And again, this is the long game.

• 50:12Dr. Mary Claire Haver?

  Yeah. I'm like, in my mind, when I'm in the gym, and my gym's in my garage.

• 50:16Speaker 01

  I've been there.

• 50:17Dr. Mary Claire Haver?

  Convenience.

• 50:18Speaker 01

  Yes.

• 50:19Dr. Mary Claire Haver?

  I am thinking about that BDNF. I'm like, whenever I'm like getting tired or frustrated or like this is taking so long or whatever, I'm like, no, no, no. You're making those important, you know, messengers in your brain that are going to decrease your risk of dementia. And at the end of every workout, I'm like, one last day in the nursing home.

• 50:37Speaker 01

  Oh, I love that. I bet. I mean, that's very positive reinforcement.

• 50:40Dr. Mary Claire Haver?

  Yeah. Like, I'm down here to, this is my nursing, nursing home prevention program.

• 50:44Speaker 01

  You know, this is, um, this might sound a little negative because nobody wins the war.

• 50:49Dr. Mary Claire Haver?

  Right? Yeah, we all die.

• 50:50Speaker 01

  We all die. But not today, and we can win the battle. And it's just not today.

• 50:56Dr. Mary Claire Haver?

  I just want to decrease the time that I lose my independence. I know I'm going to lose my independence one day.

• 51:03Speaker 01

  You might not. You might, you might not.

• 51:04Dr. Mary Claire Haver?

  Maybe not, but like-

• 51:05Speaker 01

  You may not.

• 51:06Dr. Mary Claire Haver?

  The trajectory of the women in my family who beat cancer, you know, who've run the cancer gauntlet and, and make it past 70, okay, is not great. It is over a decade of loss of independence and requiring others to care for you in your daily needs. My mom's in it right now, both frailty and dementia. So that's my motivation. And like, I'm, I want the science to say, okay, there's no promises in life, but like, how can I stack the cards in my favor? And I just was never taught, didn't learn in med school that I have more control over this than I ever imagined. And it has everything to do with what I put on my plate, you know, and how I move my body.

• 51:48Speaker 01

  It's all your agency. It's your choice. And that's really important. That muscle and strength is a choice. Weakness is a different choice, you know?

• 52:02Dr. Mary Claire Haver?

  What do you think the longevity movement is getting wrong for women?

• 52:06Speaker 01

  In the longevity space, the idea of stimulating mTOR is a problem. And that those that suppress mTOR, which mTOR is in every cell, it's for muscle protein synthesis, it's, you know, it's apparent in all things. It's kind of this growth, it, it's a switch. It's a switch. And one of the things that they were saying is that when you are fasted or you are calorie restricted, mTOR levels are low, which is true, AMPK is up. But one of the things is mTOR C1 is one complex, and that's the building complex. And then there's mTOR C2, which is another complex. And they kind of ride along the same

• 52:48Speaker 01

  lines, right? Nothing in the body is completely separate. You and I would agree with this. And there's this big headline that when you inhibit mTOR, you extend life. And that's kind of the premise as to where it comes from. And I will say, what it doesn't tell you is that when you chronically suppress mTOR, which again, there's a ton of different, a ton of problems with even the framework of this, is you also affect glucose. You become glucose intolerant. You change your lipid profile. There's all these whole hosts of other problems with it. So it's not just muscle. Insulin resistance, weakened immune

• 53:29Speaker 01

  system. A lot of the data in the longevity space is rodents.

• 53:35Dr. Mary Claire Haver?

  Clinical.

• 53:35Speaker 01

  Was also, right. So it's rodents. And here's the thing that people will say, well, mice are not people. The rodents used are obese model rodents. They're not, quote, normal human subjects. They are feeding all day, 24 hours. They are, in essence, a diseased model. Um, so that's, that's one part. And by the way, mice don't die from the same things we do. And I was reading about this-

• 54:03Dr. Mary Claire Haver?

  They don't die of dementia?

• 54:04Speaker 01

  No. Um, so mice in these landmark studies of longevity, they die mostly of lymphoma and connective tissue tumors. They don't get atherosclerosis. They don't get Alzheimer's. And, um, they're, you know, without getting too technical, this is really in the scope of rapamycin. I'm, I'm sure you've heard lots of-

• 54:24Dr. Mary Claire Haver?

  Heard of it, of course, yeah.

• 54:25Speaker 01

  Talking about it. But basically, they did this analysis, again, this was a landmark study, 2013, found that rapamycin barely touched the markers of aging in those mice.

• 54:36Dr. Mary Claire Haver?

  Wow.

• 54:37Speaker 01

  But what it did, it was explained by suppressing those specific cancers that kill lab mice.

• 54:43Dr. Mary Claire Haver?

  I've read the two biggest longevity books that have come out in the last five-ish years, um, but I don't want to name names.

• 54:53Speaker 01

  I'm going to be offended.

• 54:54Dr. Mary Claire Haver?

  I've also read yours and Vonda's. And so what do you think those blockbusters got wrong about women?

• 55:03Speaker 01

  I mean, well, first of all, the whole premise that mTOR suppression is going to help with longevity, they've never worked in a nursing home. mTOR is necessary. This idea that we're going to suppress this one pathway and that that is what's going to make us live longer is foolish. It is the same pathway that is stimulated with resistance training. By default, if you believed that suppressing mTOR was going to extend lifespan, then you would also have to believe that resistance training is going to decrease lifespan.

• 55:37Dr. Mary Claire Haver?

  My gosh.

• 55:38Speaker 01

  And they're just the core fundamental arguments are wrong. And ideally, it would just be better if someone says, okay, I made a mistake and perhaps I'm looking at this wrong. But that is, I mean, that is one of the biggest, biggest problems. And then when the data was analyzed, there was a big 2014 study that talked about lowering dietary protein, but it was very self-selected data. And when they expanded the full data set, it actually showed that those with lower protein intakes died earlier.

• 56:10Dr. Mary Claire Haver?

  Yeah. So what are your top five, top three, you know, things you want a woman to take away from this conversation? Like, what would be, what are things she can change in her life right now that will change the trajectory of how she's going to age?

• 56:27Speaker 01

  Yeah. The most important thing is that she's strong.

• 56:30Dr. Mary Claire Haver?

  Okay.

• 56:30Speaker 01

  I don't care how you get there. I don't care if it's, um, carrying your children around the house and doing pushups in between, but you do not have time to waste. You must get strong. And you will not get bulky. The greater risk is becoming frail. Becoming bulky is not a real risk. It's like going to medical school and going, God, I don't want to go to medical school because I might get too smart. It's never going to happen.

• 56:53Dr. Mary Claire Haver?

  Yeah.

• 56:53Speaker 01

  And neither is getting bulky. Right?

• 56:55Dr. Mary Claire Haver?

  Right.

• 56:55Speaker 01

  How many women do we know that are too bulky because they've been lifting? It's just not, it's a, it's a inherited scientific belief, just like you should wait an hour before you go swimming.

• 57:06Dr. Mary Claire Haver?

  After eating a meal. That killed me as a kid. I think our parents made that up.

• 57:09Speaker 01

  They made that up.

• 57:10Dr. Mary Claire Haver?

  Just to like, give themselves a break.

• 57:11Speaker 01

  The idea that women are going to lift and become too bulky is, is in line with that. Um, so they have to do that. They have to eat their dietary protein. High quality protein, fine. If you want to choose plant-based, that is your prerogative. You should be then utilizing essential amino acids if that is going to be the deal and how you are going to do it. But high quality protein and nutrient density are everything. And doing it over the long haul. And the third is, again, this could be, is it going to be hormones? Is it going to be sleep? I think the third thing is knowing what you stand for. And when you know what you stand for and you have standards, then everything else allows you to make a good decision and be very discerning.

• 57:51Dr. Mary Claire Haver?

  So what do you mean by that?

• 57:53Speaker 01

  I mean, that with our evolving landscape, there's so much information. People have access to other people more than ever before. It is noisy. And if you don't know what you stand for, and if you don't know what your standards are, then you will go off course and you will fall for anything. And as a geriatrician, I saw people at the end of their life, and there was nothing more profound than regret. Not cancer, not Alzheimer's. It was the regret at the things that they didn't do or the chances that they didn't take. And that's why the third thing has nothing to do with, um, protein or muscle. I think that, you know, and why I'm writing the third book.

• 58:38Speaker 01

  My third book on strong women is I think women become whatever they've been told to become. And I don't want that for my daughter. I don't want that for your daughter. We can get rid of the labels and you can be relentless and you can be ambitious and you can be kind and you can be all the things.

• 58:55Dr. Mary Claire Haver?

  I feel like in, in clinic, I'm often writing a prescription for a patient to put herself first, to really focus on her, to be, to be, and she thinks she's selfish because she's not putting everyone else's needs.

• 59:10Speaker 01

  That's like the oldest story tale-

• 59:11Dr. Mary Claire Haver?

  A head.

• 59:12Speaker 01

  That needs to stop. Right? It's like the self-sacrificing of-

• 59:16Dr. Mary Claire Haver?

  Like, I don't have time. I'm like, you don't have time not to do it.

• 59:19Speaker 01

  And we-

• 59:20Dr. Mary Claire Haver?

  Who's going to take care of you?

• 59:22Speaker 01

  I agree. I agree. And that starts with being able to unwind that way of thinking because it's not useful. It's dangerous. And it creates a setup for the downfall of families. It's not, it's not selfish to be doing the things that you put the standards for that you would want your children to do.

• 59:44Dr. Mary Claire Haver?

  Okay. How can our listeners find you?

• 59:46Speaker 01

  They can go to my website, drgabriellion.com, also on Instagram and our YouTube, both Dr. Gabrielle Lyon. We see patients at Strong Medical and anywhere, again, we have a podcast which you've been on, newsletter, the whole thing.

• 1:00:02Dr. Mary Claire Haver?

  Okay, awesome. Well, Dr. Gabrielle Lyon, thank you so much for joining us on UnPaused. You've been an incredible guest and I can't wait to share this with our listeners.

• 1:00:11Speaker 01

  Thank you for having me.

• 1:00:14Dr. Mary Claire Haver?

  You can find full episodes of UnPaused on YouTube at Dr. Mary Claire. Also, you can find me on Instagram at Dr. Mary Claire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. UnPaused is presented by Odyssey in conjunction with Good Roommate Media and Long Wave Digital.