Obesity Is a Symptom—The Real Problem Is Unhealthy Muscle

Episode 12 | Fertility and Other F Words

In this episode of Fertility and Other F Words, Dr. Amy Pearlman and Dr. Larry Lipshultz sit down with Gabrielle Lyon—a healthcare disruptor reshaping how we think about muscle, strength, and longevity. A board-certified physician, bestselling author, host of The Dr. Gabrielle Lyon Show, and founder of Strong Medical, Dr. Lyon brings a fresh, evidence-based perspective to modern health. With training in family medicine and fellowship experience in nutritional and geriatric medicine, she has pioneered a muscle-centric approach that challenges conventional thinking. Her message is simple but powerful: muscle isn’t just about how you look—it’s a critical driver of metabolic health, resilience, and long-term survival.

In this episode, we cover:

• The newly released dietary guidelines—and what they actually mean in real life
• How these guidelines could impact institutional food systems like schools and nursing homes
• The politics of food: where science ends and policy, lobbying, and influence begin
• The myth that eating healthy is always more expensive—and what the data really shows
• How her research on muscle mass and brain aging reshaped her entire philosophy on health

Key Takeaways:

• Prioritize whole, nutrient-dense foods
• With the release of new dietary guidelines and updates to the food pyramid, there’s still a need for more nuanced research on saturated fats and individual carbohydrate tolerance
• Muscle health is central to overall health: her work in body composition and brain aging led to the foundation of muscle-centric medicine
• Resistance training is non-negotiable—it’s one of the most powerful tools for longevity and metabolic health
• The real concern isn’t just obesity—it’s the rise of sarcopenic obesity, where low muscle mass and high fat mass coexist
• Her book Forever Strong reframes muscle as an essential organ and serves as both a scientific and nutrition manifesto for building long-term health

To learn more about Dr. Gabrielle Lyon, check out the following resources

YouTube @DrGabrielleLyon

The Forever Strong™ PLAYBOOK: A Six-Week, Science-Based Plan to Sharpen Your Mind, Strengthen Your Body, and Get Healthy at Any Age available on Amazon

Notice: 

The Fertility and Other F Words webcast and YouTube channel are intended for general informational purposes only. They do not constitute the practice of medicine nor do they provide medical advice or create a doctor–patient relationship. Use of the information provided through this webcast, YouTube channel, or any linked materials is at the listener’s/viewer’s own risk. The content is not a substitute for professional medical advice, diagnosis, or treatment. 

Listeners/viewers should never disregard or delay seeking medical advice for any health condition and are strongly encouraged to consult their own qualified health care professional with any questions or concerns.

All content from the Fertility and Other F Words webcast is the property of PODCAST WITH DRS. AMY AND LARRY LLC.

Listeners and viewers may not use, distribute, re-distribute, reproduce, alter, or edit any portion of this content without the express written permission of the webcast owners.

The views and opinions expressed in this webcast are those of Drs. Amy Pearlman and Larry Lipshultz and do not reflect the official positions or responsibilities of Prime Institute, Baylor College of Medicine, or any affiliated institutions.

Transcript

SPEAKER_01 0:01

The new dietary guidelines have just been released. And this is a tremendous win for America. Obesity is not the problem. It's a symptom of the root problem, which is unhealthy skeletal muscle. I have spent 20 years working on protein and the last 10 advocating for change.

SPEAKER_05 0:26

Why does it take 10 years to change common sense behavior?

SPEAKER_01 0:32

If you follow the money, you often find answers. Because we've been up against a narrative. We've been up against a story just like testosterone caused prostate cancer. It was a story. And who made the story? Well, the story is perpetuated now by, quote, influencers because of the velocity at which information spreads. It was probably the most impactful experience ever because it shaped what I now call muscle-centric medicine. This book is different. It's the original book that I wanted to write. And it's a tactical field manual. It's not all the science, it is the science.

SPEAKER_03 1:06

But it's actually what do you want to do?

SPEAKER_01 1:09

You want to know how to implement the guidelines? Here you go.

SPEAKER_03 1:12

Yeah.

SPEAKER_01 1:12

You want to know how to go through a recovery process, whether it's cold plunge or uh heat or whatever it is? I got you covered. This was evidence-based and evidence-informed.

SPEAKER_05 1:24

So, two last questions for you. What is your message for patients or people? What is your message for providers?

SPEAKER_01 1:31

We have the ability to build stronger, better humans. And whether you are a patient and whether you are a parent, it starts with you. You cannot tell people to do anything else you are not willing to do. Better, stronger, more resilient. Whatever domain that falls into, patient, provider, kid, I do not care. But where we're at right now is weak, average, and unhealthy.

SPEAKER_05 1:58

Welcome to Fertility and Other F-Words, the webcast that tackles fertility, sexual health, and everything in between. No topic too taboo and no question off limits. I'm Dr. Amy Pearlman, board-certified urologist with expertise in sexual, hormonal, and genito-urinary health, and co-founder of Prime Institute in Miami, Florida.

SPEAKER_02 2:17

And I'm Dr. Larry Lipschultz, uh board-certified urologist, specialist in men's health and male infertility, a professor of urology at Baylor College of Medicine, and director of the Division of Male Reproductive Medicine and Surgery.

SPEAKER_05 2:33

So, Larry, you've been busy lately.

SPEAKER_02 2:34

I have.

SPEAKER_05 2:35

Anything good happening in the clinic?

SPEAKER_02 2:36

Well, we're always busy.

SPEAKER_05 2:37

I know you're always busy.

SPEAKER_02 2:40

Not necessarily by choice. Yeah. But anyway, I thought I'd bring an interesting case of something we really hadn't touched on. Okay. So this is a 19-year-old young man, came with his mom, has a history of low testosterone, and what he describes as malpositioned genitalia. So he has undergone, as an infant, uh reworking of his scrotum and penis, and we don't have the description. He has uh left unaccented testis that was brought down, which is called an orchiopexy, hypospateus, which was corrected. Um, but when we see him and run some lab tests, uh he has a testosterone of 451, which is not bad, but on physical, his testicles are three cc's. And it's very difficult to feel the vasa. I I don't think they're there.

SPEAKER_05 3:29

Yeah. So testicles are small, and you can't feel part of the plumbing that would take the sperm from the testicles to the rest of the urine.

SPEAKER_02 3:35

Exactly. And then we looked, we, you know, with then we have other hormone markers that tell us how well the testicles are working in terms of hormone production, male hormone production, and the necessary stimulation for sperm production. So his FSH is 50, normal is up to 12. His LH is 42, normal up to 10. I said his testosterone was 451, not bad, but at 19, he should be a little higher.

SPEAKER_05 4:00

Yeah. Well, I guess here's a question. The testosterone reference ranges are not age-based. No. Is that problematic?

SPEAKER_02 4:05

It's huge. Uh no one, I don't know why it has never been done. You could do it by decades. But you know, it's the the range is 300 to 1,000. That's a huge range. So I would think somebody at 19, kind of the the height of their manhood should be 600, 700, something like that. Uh, but it was not 400. Uh he the other marker that we use for sperm production is something called inhibin that tells us how well the support cells, the Sertoli cells in the testicle, are nurturing the sperm and how well they're developing. We like it to be over 100. He was 87. The marker for testosterone, we use 17 hydroxypregnenolone, was 174, which is great because it should be over 100. So here we have a a gentleman who uh and admittedly undermasculinized, you know, a little bit of pubic hair, not where it should be. Uh, and one of his problems is he cannot ejaculate, nothing happens. Uh, he does feel like he's having an orgasm, but nothing comes out. Um and he he's here for obvious treatment, you know, he's 19. So, what are some of the things you'd want to look at on the on this on this fellow?

SPEAKER_05 5:18

Genetic testing.

SPEAKER_02 5:19

So genetic testing showed him to be 46 XY, normal genetics, uh Y chromosome normal. And um what else?

SPEAKER_05 5:29

Full genome sequencing.

SPEAKER_02 5:30

So pending. I wanted to have it for today, and it takes about a month now to get these. Uh, but his normal genetics that you would get at your office are normal. So, what what is our differential diagnosis? Oh gosh, the mom is saying, you know, what's wrong with my son? Uh, you know, is he ever going to have a baby? You know.

SPEAKER_05 5:50

So CFTR mutation.

SPEAKER_02 5:51

Right. And that uh was negative, normal. Personally thinking that maybe partial androgen insensitivity because of this very uh abnormal uh genitalia at birth that had to have at least four operations to make it look like anything. It does not look normal. I'm telling you that the phallus is short.

SPEAKER_05 6:10

And did they do any of this testing as part of that initial workup when he presented?

SPEAKER_02 6:15

Not that I know of.

SPEAKER_05 6:16

Okay.

SPEAKER_02 6:16

But I don't know. It could have not been I think some of it was in Austin, but I know it wasn't, it was not in Houston. And I don't know the doctors who evaluated him. Um so you know, we're going, we're going to, we're waiting on the um uh whole genome sequencing. Maybe that's going to show us something. Maybe he's got an important gene that is mutated. Uh we we've not had a whole lot of yield so far on a whole genome sequencing. Uh but as you mean by that. In other words, we don't I thought with especially with these asospermic people, I thought we would find these very strange mutations.

SPEAKER_05 6:51

Yeah, like you'd find the reason. Yes. Yeah.

SPEAKER_02 6:53

And as it was explained to me, you need hundreds and hundreds of these people to find the mutation. Because even if it's 10%, you need a hundred, right? Anyway, um so we're waiting on that.

SPEAKER_05 7:08

And their big concern is can my child have a child in the future? Or do they also have concerns about his genital anatomy?

SPEAKER_02 7:16

They they were not that concerned because you know the mom doesn't look at him that closely. I'm sure he doesn't look at a lot of the guys. He doesn't know that he really looks strange. But the the main question question they're having is uh, why am I not ejaculating? Which could be explained by the fact that he doesn't have normal vasa, if if at all.

SPEAKER_05 7:36

And you know, I'm thinking I I brought up to the But that would just be a small volume of his ejaculate.

SPEAKER_02 7:42

Well, it's a right does he have a pro I mean, well, his prostate's super small, but usually the seminal vesicles are unusually small in men with vasal agenesis. Because, you know, they they produce they come with a production of about 0.5. Uh I had, but I can't get a sample from him. Yeah. So how am I going to find out what's going on in the testicle without getting an ejaculate? Well, I'm going to do a testiculospermic aspiration. And now we do it differently than is usually described, which is a fine needle. We use an actual large needle. We use an 18-gauge needle, which is about the size of a maybe bigger than a piece of spaghetti. And it's on a piston syringe, a suction syringe that they use for breast biopsies. So that's what I would start with first. Now, he only has three CC testes, so we're not going to miss the testicle. I don't know how much we'll get out. If that doesn't give us information, then he's going to have a testicular biopsy, which we can do in the office under local and send it to pathology if we don't see anything. Because we'll take the biopsy tissue, touch it to a slide and see if sperm are there.

SPEAKER_05 8:43

Yeah. Now it's you also bring up an interesting point, and I know he's coming in for the fertility concern and the anagulation. But for guys like this who come in who have had issues from birth, who let's say have a smaller than normal penis in terms of its size, is there a role for talking to him about, let's say, penis pump therapy or traction therapy?

SPEAKER_02 9:04

Well, the first thing I would do is start him on testosterone, get that testosterone up to about 700, 600, 700, see if that changes anything and give him about six months for that. If it doesn't, then I would introduce probably uh the uh stretching device, not a vacuum device. How come? I just don't think a vacuum device he's gonna have such a hard problem getting the band around the base or around the scrotum and base that I don't I think it's gonna be too uncomfortable and cumbersome.

SPEAKER_05 9:35

Well, it's definitely an interesting concept. I mean, I would say I see some guys that are as young as those patients, but I think you see a younger population of guys and um who may not be interested in using some of the therapies that a 60 or 70-year-old would be interested in using. Right, right.

SPEAKER_02 9:49

But I mean, and the other thing is, do we raise the question to him and in his own mind that he's small? Right. Right now, I don't think he thinks he's small. Right. So do I say, hey, you're small, let's get a vacuum device. I mean, because 19, that's a very impressionable, sensitive age.

SPEAKER_05 10:04

Yeah. Okay, so here's how I bring it up in my clinic because I do do penile enhancement specifically related to girth enhancement, but I talk to a lot of my patients on the use of penis pumps interaction therapy for length and girth concerns. And so I have plenty of guys that come in for that specific reason. So it's easy. They've already said, I want to have this conversation.

SPEAKER_02 10:19

Right, because they're they're they they have self-image issues. Right. He does not.

SPEAKER_05 10:23

Right. But let's say someone comes in. Well, let's say someone comes in for another reason. Let's say it's a low testosterone concern or fertility concern. I will just ask them as part of standard questioning, do you have any penal size concerns, length or girth? Right. And some guys say, no, I'm good. Or some guys say, Yeah, I'd like more girth. No, I'm totally fine with length, right? But I when I ask that question, I have yet to offend any of my patients, even if they're coming in for a different reason. So that might be one strategy.

SPEAKER_02 10:46

Well, I don't do girth enhancement.

SPEAKER_05 10:47

Yeah.

SPEAKER_02 10:47

But and I and I th I knowing the Houston population that I see, yeah, if I ask that question, they'd all want to be bigger.

SPEAKER_05 10:53

Right, right. So it's just it's sort of an interesting thing.

SPEAKER_02 10:56

So I will so let's stay tuned. Yeah. The next time we get together uh for recording and stuff, I will let you know what we find on the whole gene.

SPEAKER_05 11:04

I'll be sitting on the edge of my seat, Larry.

SPEAKER_02 11:06

I know you won't sleep until I until I see you.

SPEAKER_05 11:10

So I want to tell you about a patient that I recently saw. He's in his mid-50s, and he's coming to me because he wants to want to have sex with his wife. And but I wasn't entirely sure why he was scheduling the visit. It was kind of like this general men's health visit. And so he spends like the first hour of the conversation telling me how irritating. No, he did not ask me out. How irritating is that. How irritated he is by his wife. Literally for an hour, he's telling me all the things that she does that annoys him. So I just let him talk. I mean, sometimes I think my most therapeutic benefit is literally just sitting down in the chair and listening. And not laughing. And not laughing. And at the end of that sort of one-hour discussion, him talking, I wouldn't even say it's a discussion. I said, How are you hoping I can help you out today? And he said, Well, I want to want to have sex with my wife. And it was interesting because during this hour-long conversation, he's telling me he's had a history of like sex addiction, sex addiction and pornography addiction.

SPEAKER_02 12:07

And so, you know, I said to him Is he still watching porn and masturbating or anything?

SPEAKER_05 12:11

So he's he's tackled those addictions, right? And but I asked him, I said, So let me clarify, you like sex and you want to have sex, you just don't want to have sex with your wife. And he said, That's correct. And so problem solved. So I'm like, okay, well, I definitely, you know, I look at it from a biopsychosocial approach, right? So I said, I think one thing we need to do is I want to refer you to a sex therapist, right? Because the relationship with your wife, if you are annoyed by her, why would you want to have sex with her? It doesn't take a rocket science scientist to understand that concept.

SPEAKER_02 12:41

He didn't say I want to have sex with my wife, he said I want to have sex.

SPEAKER_05 12:44

He says he says he likes sex and he wants to have sex, he just doesn't want to have sex with his wife. Right. Okay. But he also isn't.

SPEAKER_02 12:50

So then why are you sending him to a sex therapist? He doesn't like his wife. He's 60. You don't want to have sex with her.

SPEAKER_05 12:56

Well, to understand their whole relationship, you know, what's going on in our relationship?

SPEAKER_02 13:03

Um so it's like, because I can see you saying to him, look, sir, you know, you don't want to have sex with your wife, you like having sex. Aren't you asking me for my permission to go have sex with somebody else?

SPEAKER_05 13:15

Um, I think he's asking legitimately for for my help because I think he wants to want to have sex with his wife. Oh, okay. That's why he's seeing me.

SPEAKER_02 13:23

He didn't say it.

SPEAKER_05 13:24

But he just doesn't, yeah. So we're going down. I think we're chasing our heads. All right, so go ahead. Okay.

SPEAKER_02 13:29

I'm I can't wait to hear what happens.

SPEAKER_05 13:31

So, but he's wondering if it's a low testosterone issue. Right? And so I check his testosterone. His total testosterone level is 361. And so you had mentioned that the normal range is a wide range, 300 to about a thousand, and his free testosterone level is at the low normal, in the low normal range, right? So looking again at this biopsychosocial approach, I ask myself, might his testosterone level be contributing? And I think a lot of people would say, no, this guy obviously needs to see a sex therapist, but what I've seen in my patient practice is that if someone has a low or low normal level of testosterone, it can make that person more irritable. So if I treat him with testosterone and I can improve his mood and reduce his irritability, maybe that will improve his relationship with his wife. And I'd love to pick your brain on your clinical experience with patients when it comes to the impact of testosterone on mood.

SPEAKER_02 14:22

Oh, I think it's extremely beneficial. Especially, you know, if it's causing depression, you know, problems sleeping, fuzzy thinking. I mean, I think there are definite psychological benefits of testosterone. And, you know, he's in the low 300. And I think you've said many times before, you know, why wouldn't I? What's the negative of my giving it to him?

SPEAKER_05 14:41

Yeah. So I think a lot of urologists in this circumstance might say, I don't really have a role. And I'm like, I want to do whatever I can to do.

SPEAKER_02 14:47

Most urologists would not treat this man.

SPEAKER_05 14:49

Yeah. So we'll see. What did you do? Well, I'm seeing him in about a week, and we're going to discuss how I'm going to put him on testosterone, and then I'll see him back.

SPEAKER_02 14:56

He's going to tell you he left his wife and he has a girlfriend.

SPEAKER_05 15:00

Well, stay tuned.

SPEAKER_02 15:02

So that you give me follow-up on that. Yeah, yeah, yeah.

SPEAKER_05 15:04

All right, we'll have to hold each other to it. All right. So let's get into some breaking bedside news. What you got?

SPEAKER_02 15:08

So I think we can't ignore the fact, and I don't know when this will be aired. So this whole thing gets a little awkward when talking about topical events, but we just learned that they've changed the food pyramid, right? They flipped it around. Now, this is very important. It sounds like it's not important. It sounds like it's grammar school stuff, but it affects everybody. Yeah. Um, and it has flipped uh the pyramid. It's putting literally just flip it. They put protein at the top and grains at the bottom, which upsets me because I can't eat raisin branch. All right. But anyway, so what do you think about this change and how impactful do you think it is?

SPEAKER_05 15:48

So I think it's a great change. And the more that I'm learning, and I never really paid attention to this three years ago, but I'd say over the last one or two years, all I hear now from my colleagues and people that are very well respected in the healthcare system is how important good sources of protein are. So I'm all about protein. So I love that change, right? They also talk about saturated fats, and they're acknowledging that we need more research in terms of, you know, the how much saturated fatal.

SPEAKER_02 16:14

They're not saying don't eat them.

SPEAKER_05 16:15

Right. And they're not saying eat a lot of it.

SPEAKER_02 16:17

No.

SPEAKER_05 16:17

Right. I think we're trying to figure out what's the correct percentage of saturated fats. But they mentioned we want people to eat whole foods. That is key, right? So fat is not bad. They recommended like an avocado. An avocado is a great option. And guess what? Avocado has fat in it, right? So I love the emphasis on whole foods.

SPEAKER_02 16:35

Yes. I think that's great. But no grains.

SPEAKER_05 16:37

Well, limiting grains. That's what they're saying. No cocoa.

SPEAKER_02 16:44

Well, I think the problem people, I think when they're mentioning grains, isn't bread in that grouping, or is that or do they put bread in the carbohydrate group?

SPEAKER_05 16:52

Oh, that's a good question. I don't know. I'd have to delve into that period. I have to see on that picture exactly where the bread is.

SPEAKER_02 16:56

Oh, I don't know. It's not big enough to see.

SPEAKER_05 16:59

Um, you know, the other thing that I think I think it's down there. Yeah. So the other thing that I think is really important in terms of this food pyramid is how it's going to impact just like people generally, right? We could change something. The question is, is this actually going to impact health?

SPEAKER_02 17:13

Right. And I think I think I think it's that's lost in here. And maybe I didn't read it that closely. But I mean, you know, kids in school, military, you know, big big change if they can give them more protein. I mean, they're going to be healthier.

SPEAKER_05 17:27

Yeah. My concern is that there are companies that make so much money off of processed foods. How do you f how do you stand, how do you get have a leg in front of those companies?

SPEAKER_02 17:39

You get them to make other stuff that's going to be, you know, mandated. Yeah. Proteins. You know, some type of but they can't get into the animal breeding industry. So what what what what's a good segue for them into something? So what are they manufacturing now? Processed food?

SPEAKER_05 17:54

Yeah, I mean, like Coca-Cola's. Like, how do you go up against Coca-Cola?

SPEAKER_02 17:59

You don't. But I mean, there's got to be something else besides water. So if you if you're not going to take give them fruit juices because it doesn't have pulp and skin and it has a lot of sugar, what are people going to drink? I mean, you've got to make better bad choices sometimes.

SPEAKER_03 18:14

Right.

SPEAKER_02 18:15

So, what is going to be the better bad choice for something to drink with your protein? Yeah. What are you going to drink?

SPEAKER_05 18:20

I don't know. We'll have to see. The last thing that I want to tackle what am I going to drink? I mean, I typically drink water, hot tea, and coffee.

SPEAKER_02 18:25

Okay.

SPEAKER_05 18:26

Yeah.

SPEAKER_02 18:26

There you have it, folks. There you have it. But the last one I want to bring up. Why?

SPEAKER_05 18:30

And we've had this discussion previously on a podcast with Dr. Aaron Spitz is that a lot of the research in the urologic space and the prostate cancer space and the men's health space really enforces a plant forward nutrition program, right? If someone were to ask what is the best nutrition plan to reduce the risk of prostate cancer, the research would suggest that a plant forward nutrition plan is best. So it's going to be reconciling that and still, but still up at the top of the pyramid on this new pyramid are fruits and vegetables. So we're still saying the same information. And honestly, I don't tell my patients when they when they ask me what I recommend for nutrition, I don't tell them to become vegan.

SPEAKER_02 19:05

No, but there was a there was a phase that we went through with prostate cancer and food where they said no no to red meat. Right. Remember that? So now the red meat's back up there. Right. And but I mean this is a food pyramid. It's not based, it's not like how to reduce the exactly.

SPEAKER_05 19:20

This is gonna be for the general population of people. So I think it's great, and we are going to delve into this food pyramid on today's episode with Dr. Lyon.

SPEAKER_02 19:27

With Gabrielle Lyon, and we're looking forward to that.

SPEAKER_05 19:30

Yep, absolutely. So why don't we get into today's episode and introduce our guest?

SPEAKER_02 19:33

Let's do that.

SPEAKER_05 19:34

Perfect. I am thrilled to introduce a remarkable guest today, Dr. Gabrielle Lyon.

SPEAKER_02 19:39

Fortunately, Dr. Lyon is a good friend of mine, and I'm really anxious to hear what she has to say as well. She completed her medical training in family medicine and a fellowship in nutritional and geriatric medicine, which shaped her muscle-centric approach to health. Her work consistently delivers a clear message, and that is muscle is not just about strength or aesthetics. It is essential for metabolic health, resilience, lifespan, what we now call health span.

SPEAKER_05 20:08

Dr. Lyon is a board-certified physician and one of the leading voices redefining how we think about muscle, strength, and long-term health. She's the best-selling author of Forever Strong, host of the Gabrielle Lyon Show, and founder of Strong Medical. She has just released her newest book, Forever Strong, The Playbook.

SPEAKER_02 20:27

Gabrielle, it is so nice of you to take time out of your schedule, which I know is packed, to come here and spend some time with us because you are unique, and we're very fortunate to have you in Houston living. So, and again, this was a very busy day because of the marathon, but you made it. Are you kidding? It was horrible.

SPEAKER_01 20:45

My husband, my husband, which by the way, as you know, but I don't know if Amy knows, is a urology resident, and he is really wanting to be your fellow. That is now out on, this is now told to the United States. I just I want to put that out there. And so as soon as the news was over, he was dressed. He was dressed very fancy. And he looks very nice. And he has his energy drink. He's like, okay, I've got your energy drink. I'm gonna need some food. Okay, we have to go. We can we cannot be late.

SPEAKER_02 21:11

I'm like, Yeah, so we're ready. I'm delighted again to see you. So, Amy, why don't you start off?

SPEAKER_05 21:16

Yeah, so you were actually recording a news segment this morning. Yes. What was the news segment all about?

SPEAKER_01 21:21

I don't know if you've heard the news, friends, but the new dietary guidelines have just been released. And this is a tremendous win for America. And what that means is not just for America, but those that receive federal funding. For example, kids, schools, military, nursing homes, the people that are really at risk for chronic disease and also low nutrition. And for the first time ever, I'm not sure if you know that protein is actually important for the body.

SPEAKER_02 21:54

I know it.

SPEAKER_01 21:55

It's like the most essential macronutrients ever. It now Has become front and center, which I joke and we're teasing because we're all very hilarious. But the reality is this is probably the biggest change that we have seen easily in the last 50 years and the most important change in the dietary guidelines since they have been instated.

SPEAKER_02 22:16

You know, it's I something I thought it just occurred to me when you said that. And when you switch these food groups around in importance, isn't protein the most expensive?

SPEAKER_01 22:25

That is a very smart statement. And the reality is, is it the most important or is it the most important? Yes. Is it the most expensive? I would say it depends. And here's how I will say when you have processed foods, a bag of chips will remain within a certain range, unless you have the fully organic, you know, fried with 14 karat gold. Right. The reality is those chips are expected to be within a certain cost range. But when you have something like meat, you can get a fillet, you can get a burger, you can get a New York strip. They are all varying in price depending on the cut.

SPEAKER_02 23:00

But they're all nothing's cheap. I mean, if you want good protein, you're gonna have to pay for it.

SPEAKER_01 23:04

I don't I don't know if that's true. And and the reason I'm gonna reframe that for you is the expense of being sick and overweight is way more expensive.

SPEAKER_02 23:13

That's a very good point.

SPEAKER_05 23:14

Well, and the price for the nutritional value, what are you getting out of a bag of potato too?

SPEAKER_02 23:18

So I understand all that. But what up but you know, she was you were talking about the government. You know, who's gonna pay for the kids in school? You know, who's gonna pay for the military? Yeah, and it's going to be more expensive. Yes, you'll recoup it ultimately because you'll have less sickness, but it's gonna be much more expensive.

SPEAKER_01 23:34

They are working, and I was just listening to Roland's talk.

SPEAKER_02 23:36

Yeah.

SPEAKER_01 23:37

Um, and the prices will be coming down. Also, ground beef is not expensive. A filet, maybe, but a dozen eggs, not so much.

SPEAKER_03 23:46

Yeah.

SPEAKER_01 23:46

It is, I think it's part of a false narrative because we compare really cheap foods that we shouldn't ever be eating and probably just use it for a doorstop. Not even palatable for human consumption.

SPEAKER_02 23:56

Don't you worry about ground meat? Is it, I mean, what are they grinding? I don't when you think about sausage and hot dogs and it's all right. Well, that's different.

SPEAKER_05 24:03

Yeah, that's that's I don't think she's promoting hot dogs.

SPEAKER_01 24:06

I mean, I love and also Amy's sister has a nutritionist who is probably over there just cringing. But you can have all beef hot dogs. You do you can. And then you bring up another point is the processing component. The reality is the food consumption that we have, the guidelines shifted for the first time to eat whole real foods. Yes, so that's the old guideline, it it prioritized grains.

SPEAKER_05 24:31

So he was saying this morning when we were talking about this.

SPEAKER_01 24:34

I want to hear. Okay, you're busted, yes. Go ahead.

SPEAKER_05 24:36

He said, but I thought whole grains were really good for us. So what do I do about my raisin brand?

SPEAKER_02 24:41

I didn't exactly say it like that. I said, come on, give me things. I'll give you a chance to do that. I said, I'm surprised that grains are at the tippy tippy tip when I said I thought grains were healthy. And then you started talking about why, you know, the the way we get the grains.

SPEAKER_01 24:58

And what was so fascinating about the old food guide pyramid is that it didn't actually emphasize whole grains.

SPEAKER_03 25:05

Yeah.

SPEAKER_01 25:06

It just said eat grains. And it really prioritized big industry and funding because it was processed food, big food companies. Oh, so tell me about grains. What can what can I eat? Now you're interesting because if you look at yourself, Larry, you're very you're fit. You are not overweight. Right. And the reality is it's not a grain conversation. It really is on a bigger perspective. How many carbohydrates should we be eating in our diet? And the current, you the current RDA, which is the recommended dietary allowance, is set at 130 grams.

SPEAKER_03 25:38

Yeah.

SPEAKER_01 25:39

Is that too high? Maybe. Is it too low for some people? Like my husband, we are teasing who runs to work and back.

SPEAKER_03 25:46

Right.

SPEAKER_01 25:46

But the average American, if we were to base this, and you are both practicing physicians, we have to base it in what we see in clinic and what the population suffers from. The average American is eating 300 grams of carbohydrates. The average American is either overweight or obese. So the guidelines are an effort to make people healthier. And if we'll, if we decide to dive into it deeper, carbohydrates are a fuel that is earned. And if we think about this narrative of obesity, which has been at the forefront and really shaped fertility, you and I talked about on my podcast about this idea of how obesity has affected fertility, then we need to reorient to skeletal muscle. Because obesity is not the problem. It's a symptom of the root problem, which is unhealthy skeletal muscle. And once we change that perspective, everything else falls into place.

SPEAKER_02 26:42

But isn't that for the average American getting way too sophisticated? Yes, no.

SPEAKER_01 26:47

It could be, which is just so happens that the playbook Forever Strong has the new guidance. Okay. Well, it just the timing worked out extraordinary.

SPEAKER_02 26:58

No, you had something to do with the food pyramid. I know.

SPEAKER_01 27:00

Well, not the food pyramid per se, maybe the reverse food pyramid. Um, and I've never spoken about this because all of this just happened, and I just got back from DC. Yeah. You both have worked in medicine and for a meaning for something that you believe in. I have spent 20 years working on protein and the last 10 advocating for change. Relentless. Much like you and Amy have a uh wonderful relationship where you don't need a PR agent. My mentor, Dr. Donald Lehman, who is a career academic, I would drag him to DC and introduce him. And every time someone would ask me a question, I would say, Oh, here's the answer. Oh, and by the way, Dr. Donald Lehman. And so he was able to become a member of the committee. And uh, no surprise, his responsibility was the protein section. And it just had a voice, even indirectly. Uh certainly indirectly. Yeah. Is it safe to say that he would not be on those guidelines if I had not pushed for it and advocated for your absolutely, and he will tell you the same. But to see something that you've worked for your entire career change is just, you know, I'm sitting up there, I'm, you know, RFK and Marty and and uh Rolands are talking. I'm just sitting there with a big sign that has eat real food and has steak on it. I mean, they did me a solid if they had to put like an egg or an apple. And I was just sitting there just trying to hold back tears. Because at the end of the day, it's not about any one person. It really is about how do we show it.

SPEAKER_02 28:38

But it's something you've been championing.

SPEAKER_01 28:39

So relentlessly out of it.

SPEAKER_05 28:41

So I mean, you know, why does it take 10 years to change common sense behavior?

SPEAKER_01 28:47

Yeah. There, and I don't know if medical, and actually in your field, I have seen this when it comes to testosterone and when it comes to fertility. There is something interesting about humans, and they have this cognitive bias. Once they hear something on the forefront, whether it's true or not, whether it makes sense or not, it no longer becomes a possibility, but it becomes a real belief. And then that belief becomes truth, whether it is true or not. Right. And for the last 50 years, people have been talking about how protein is bad and protein is bad for the kidneys, and animal-based products are killing the environment. When in reality, for example, in the US, the largest contributor to greenhouse gas, do you just happen to know what it is?

SPEAKER_02 29:36

Animals passing gas. I was being funny.

SPEAKER_01 29:40

Okay, you are funny. You are funny, truly. Electricity, industry, and transportation.

SPEAKER_02 29:45

Yeah.

SPEAKER_01 29:46

85 plus percent is related to our contribution. You're not gonna eat your way out of greenhouse gas emission, you're not gonna eat your way out of global warming. Agriculture might be 9.5% in totality, which doesn't even account for the percentage that you waste, which is at least half of that. And the idea that we're gonna do have a meatless Monday is ridiculous.

SPEAKER_02 30:12

And it's just dangerous. But this argument, because we got into like global warming electricity, was it because they were blaming the animals and the farmers for this problem? See, I didn't know that.

SPEAKER_01 30:25

Yes, and it's used as a smoke screen screen to get what they want. And I wish that it wasn't true. But who's they? It is um, it's complicated, but I'll let me lay it out for you like this. There is the USDA and then there's the FDA, and there's these various organizations. And much like in your industry and your field, there are certain restrictions as to what can be said. And if you follow the money, you often find answers. If you have a processed food, for example, you know how almond milk is talking about how it's a good or almond juice is a good source of protein. Almonds are what we call a commodity, a whole food. But once it gets sold to whoever then makes almond milk or oat juice or whatever that is, it is now a processed food. It is under a different regulation. Oat juice can say it's a better source of protein, it has um carbon negative food, it can make all of these claims. Meanwhile, do you remember milk does a body good?

SPEAKER_02 31:22

I remember that.

SPEAKER_01 31:23

That is the best of its claims. It can't defend itself against a processed food company. It um beef can't say it's a better source of protein than beans or the impossible burger because it's a commodity. And commodity, the collective, number one, the collective marketing budget of a commodity for all commodities, every single one: beef, eggs, soy, dairy, it's 750,000. And whose budget is that? It is the be, it's like, for example, beef checkoff. So farmers will contribute maybe a dollar, you know, and don't quote me on this, it changes, but a certain percentage, which is very little. Some of it goes to research, some of it goes to marketing, but the collective capacity of that is a fraction of the two billion dollars of PepsiCo.

SPEAKER_02 32:09

So I but but who is managing the budget? I mean, is there a farmers union or it's something like a farmer's like for example, USDA beef.

SPEAKER_01 32:17

And each one of them has their own, there's a national dairy council.

SPEAKER_02 32:21

And do they have lobbies? Is that how the whole thing gets to the government?

SPEAKER_01 32:24

Yeah, I don't know the details of that, but I do.

SPEAKER_02 32:26

But you're talking about following the money.

SPEAKER_01 32:28

I mean, it's gonna end up in the government. But I do know that it really shapes the narrative. So what happens is that you have these plant-based companies that really push for plant-based foods and this whole narrative that animal-based products, which is the biggest change in the guidelines that we've seen, is it now emphasizes nutrient-dense animal-based products.

SPEAKER_05 32:48

Which is the key, the verbiage that you're saying is very key. Yes. We're not talking about low-quality animal-based products. No, yeah.

SPEAKER_01 32:55

Um, and I in fact, I don't even know what those would be. Hot dog. Okay, great. There you go.

SPEAKER_05 33:00

That's a like a hamburger from McDonald's. Yes.

SPEAKER_01 33:04

But I would even argue. Is it meat? But I would even argue that I would have that over a bagel. Because again, the nutrient density is so much better. I'm it's not ideal. And hopefully we call for more um.

SPEAKER_02 33:17

Why did you pick a bagel? That was so nasty.

SPEAKER_01 33:20

I know, I'm so sorry. But but we are seeing a shift that we've never seen before. And why is it such a big deal? Because we've been up against a narrative. We've been up against a story just like testosterone caused prostate cancer. It was a story. And who made the story? Well, the story is perpetuated now by quote, influencers because of the velocity at which information spreads. People believe they're doing the right thing, and people can believe all they want, but the science is really pretty clear. What the guidelines did, though, however, which I really respect, is they highlighted areas of research and areas of need. And that is this saturated fat story. We still need more research on saturated fat. We still need more research on carbohydrates, carbohydrate tolerance. Um, but overall, like you said, common sense is common sense. This is a real opportunity to shift. And who pays for the research? Depends on which research. So for I will give you an example. Saturated fat. Where would that end up? I think that that will just be from the NIH. We'll see. That's going to be the big initiative now. And I'm going to tell you why it's important. First of all, saturated fat has gone down since the 60s. Saturated fat was roughly 15% of the diet. Today, it's 11%.

SPEAKER_02 34:30

Can you give our viewers some ideas of what's under saturated fat?

SPEAKER_01 34:34

Yeah, saturated fat is the fat that's solid at room temperature.

SPEAKER_02 34:37

Like butter?

SPEAKER_01 34:38

Yeah, butter. And people will say, well, beef is saturated fat. Well, beef is the fat in beef is 50% olive oil. It's 50% monounsaturated fat. But the big beef that people would think of like is tallow, which most people don't cook with, or butter, hydrogenated oil, Crisco. That's all anything that's solid around. Is there still Crisco out there?

SPEAKER_05 35:00

There is.

SPEAKER_01 35:00

Yeah, there is. I use it for my face.

SPEAKER_05 35:03

So let me ask you this, because we were on this conversation of following the money. And there are companies that make so much money off giving processed foods to elementary school age children. Yeah. It's gross. How do we go up against that money?

SPEAKER_01 35:19

Oh, we're doing it. It's these guidelines are going to transform everything.

SPEAKER_02 35:25

Companies can change their direction a bit. They're still want to make money. I agree. And they're going to see, well, if I make X instead of Y, I'm going to get money. They'll make X. They don't care.

SPEAKER_05 35:34

Sometimes hospitals are the worst. I mean, I was rounding at a hospital. I walked out of the room and I literally emailed the dean of the medical school and I said, there's level one evidence to say the foods that we are feeding our patients cause cancer and heart disease. Who do I talk to about this? There was nothing I could say.

SPEAKER_02 35:48

Well, you've got to come, you've got to come to the surgeon's lounge on a Friday when they serve fried chicken, macaroni and cheese, or bacon-laced green beans. Those, those, that's our lunch. I only have one country. Every Friday.

SPEAKER_01 35:59

Yeah, which are there waffles with that?

SPEAKER_02 36:02

Oh, sometimes. No, seriously, every Friday since I've been there, that's the lunch.

SPEAKER_01 36:07

And and what you're highlighting, which is also interesting, is the disconnect between health and wellness and nutrition. Yeah. And medicine and medicines influence in nutrition. So when they were talking, when RFK was talking, they are going to actually institute nutrition class for physicians more than the seven hours. But I I don't wanna I don't want to get too far off track because I want to, for your listeners or your viewers, the saturated fat story is an important one. And this is a bit misunderstood. The guidelines are set at 10% saturated fat or less. That number is a very soft number. We don't have evidence to say that beyond 10% of calories are controlled is a problem, or how low an individual can go. And to highlight it, if an individual, say for example, has a 4,000 calorie diet, like they're a crazy person. Like just let's take Shane, Shane Johnson, who's who in his spare time, and I gotta tell you the tattoo story. He's cringing because I'm sure he's out there. In his spare time, he used to run marathons, and now he's decided he's gonna run marathons. Yeah, I'm so sorry. So my husband is a former Navy SEAL. He is a very decorated, very humble, decorated war veteran who is trying to become Lipschultz's fellow. He's published, he's published uh roughly 50 papers. And do you know that he got all the VA covered for bladder cancer exposure?

SPEAKER_02 37:25

I know you know we're working on fertility now from the burn prints.

SPEAKER_01 37:28

Do you know why I know this? Because he's messaging all the groups like, hey, we need data. Hey, anyway, anyway, anyway We're off track. Yeah, we're off track. But don't worry, I I'm coming, I know exactly where we're going. His diet, if he has a 4,000 calorie diet at 10% saturated fat, then he can have 44 grams of saturated fat and his diet is considered healthy. If someone like me, who let's say have a 1,500 calorie diet, 10% saturated fat is roughly, I don't know, 14 or 16 grams of saturated fat. But above that, if I got 20% saturated fat, I would be considered to have an unhealthy diet. If saturated fat was so detrimental for human health, then what's the number?

SPEAKER_03 38:09

Yeah.

SPEAKER_01 38:10

Is it 44 or is it 14?

SPEAKER_03 38:13

Yeah.

SPEAKER_01 38:14

And this just highlights the disconnect between what we know and how we are asking people to implement. And saturated fat animal products are not the enemy. In fact, they're the most important aspect of human health because of nutrient density. Lowering total calories, making sure all the calories count and where you're getting these calories. I mean, protein-containing foods, they make up 60% of the essential nutrients and 100% of the amino acids, essential amino acids necessary for everything muscle mass, fertility, you name it. This is for the first time ever, we're prioritizing the things that count.

SPEAKER_02 38:53

Yeah. It's a great step forward, right? It's not ideal, but it's it's going in the right direction and it's where you want to be. Now, you would you were mentioning about skeletal muscle and the problem with skeletal muscle and fat and thinking more about fat and not realizing how important the muscle mass is. And I know that's an area that you feel strongly about. So why don't you tell us where that how did it start with you?

SPEAKER_05 39:15

Yeah, and you have a great phrase that you mentioned.

SPEAKER_01 39:17

Muscle is the organ of longevity, or that one and a different one. We are not over fat, we're under muscled. Now, I don't know about you, but my fellowship director, um, she was great, but let's just say she was really tough. I did my fellowship at Washiu in St. Louis. And your fellowship was in geriatrics and nutritional sciences. Typically, it's a one-year fellowship, but is it typically a combination?

SPEAKER_05 39:39

Okay.

SPEAKER_01 39:39

I did a two-year fellows.

SPEAKER_05 39:40

Because I mentioned that to him and he was like, I've never heard of the club. That's right.

SPEAKER_01 39:42

There were like there were like 11 graduates.

SPEAKER_02 39:44

Yeah.

SPEAKER_05 39:44

It's a very rigorous program.

SPEAKER_02 39:46

It was a nice graduation ceremony.

SPEAKER_01 39:47

No, 11 graduates in the country.

SPEAKER_03 39:49

In the country.

SPEAKER_01 39:50

Even better. There's geriatric training, which is not typically coupled with nutritional sciences. And frankly, I was not interested in geriatrics at all. It was um, you know, I'm all into the now and let's be fit and alive. And when I was first faced with my experience with palliative care and rounding, yeah, I don't see you. I don't see you in that space. It was brutal.

SPEAKER_03 40:11

Yeah.

SPEAKER_01 40:11

And probably only recovered just last week. I mean, but really, truly, it took years to recover mentally from that. Um, so the deal for me was this. When I finished, so I did two years of psychiatry, three years of family medicine, and then I was still and and am still mentored by Dr. Donald Lehman, the one of the world leading person.

SPEAKER_05 40:31

Were you thinking about going into psychiatry?

SPEAKER_01 40:33

Uh yes, and then I switched. Ah, okay. It was, it just wasn't for me. It wasn't as the way in which medicine was practiced, wasn't it, it wasn't what I had hoped. But that time was extremely valuable. I'd started at the University of Louisville, and they the training was at the extreme. So it was lockdown units and it was uh a psychiatric emergency room, and it it just the the way in which it was done wasn't something that I was totally aligned with. So I switched to family medicine. And again, I was still mentored by Dr. Donna Lehman. And when I finished those three years of family medicine, he said, you know, in order to truly have the impact that you want to change things, you have to do a fellowship. And I had applied to the Navy, and it was a decision, either go and become a Navy doctor and then do a fellowship later, or do a fellowship now. And um clearly I chose to just marry into the Navy. I was gonna say somehow you got that Navy connection. I got the Navy connection, um, but decided that the time was now, you have no, you never know how long those opportunities for really advanced fellowship last. So clearly I went to fellowship, but the deal was the reason I wanted to do a fellowship was to study nutritional sciences, not to study more medicine. Right. I mean, after five years and then medical school, I mean, I'm like, good, see ya, cyanara. That didn't happen. And the deal was, in order for me to get funding, because I was a physician, not a PhD candidate, I needed to be slotted into a medical fellowship. And that medical fellowship was geriatrics. It was probably the most impactful experience ever because it shaped what I now call muscle-centric medicine. The project that I worked on, and we work on many, you know, you, but you have your own project. And my project was looking at body composition and brain function. We were looking at women in their mid-50s, and this one woman, she just, you know, I mean, you have lots of patients, they bring you things, they, you know, you have all kinds of things, but there's typically one or two patients that when you're new and green, that really just they change things for you. And this woman, she was a mom of three kids, and she was just, you know, like so robust and funny, and I'm like, she's awesome. And I imaged her brain, and this was not an it was somewhat of an intervention, but it wasn't a brain intervention. We were just collecting data for the brain. The intervention was diet and nutrition, and her brain looked like the beginning of an Alzheimer's brain.

SPEAKER_02 43:01

Oh, she had the whatever they're called, bodies.

SPEAKER_01 43:04

Um, no, but she had a decrease in brain volume. She had um quite a bit of white matter. I know there's some that's normal for aging, but it was this brain volume, and it just it wasn't looking good. It tracked alongside what we would see with Alzheimer's. And I was like, oh my gosh, I don't understand. She'd been doing all of the things that the medical establishment had been telling her to do, which was eat less, exercise more. And year after year, she would, she was like a yo-yo dieter. And so when she started with a certain amount of muscle, by the time she was in her mid-50s, she didn't have that. Her body composition totally changed. She was, quote, exercising, but metabolically unhealthy. She had a very high body fat percentage of very low muscle. And I was like, oh my God, we totally failed her. How did we how was this the answer? And there was just this flash of insight where I realized that it this What I was looking at wasn't a body fat problem, but it was a muscle problem. And then I went to the the, you know, my senior uh colleagues and staff members are like, well, this is just the way that it is. Um, you know, this is the amount of protein that we recommend, and this is how people should do cardiovascular activity. I'm like, this is this can't be, this is not right. What percent? How are you just doing that?

SPEAKER_02 44:18

Were you into time exercising?

SPEAKER_01 44:20

Oh, yeah. Yeah. By the time I was five, I was doing like 10 mild bike rise. Yeah.

SPEAKER_02 44:24

So you were already into it.

SPEAKER_01 44:25

I was already into it. Okay. And that's probably what had primed me because I'd already been studying the idea of muscle quality and and all of the things. You know, I think that that's how insights happen. I mean, that happened to you when you tell your story about how is no one looking at uh male infertility.

SPEAKER_03 44:40

Right.

SPEAKER_01 44:40

And you just have this moment where it's like, how with no one's thinking about this?

SPEAKER_03 44:44

Right.

SPEAKER_01 44:44

And that really started muscle-centric medicine and then recognizing that muscle is an endocrine organ.

SPEAKER_02 44:51

Did you help the lady?

SPEAKER_01 44:52

Well, you know, it's you can't really You can't change it at that point. I mean, did you did she get better? Did she get her? I mean, I started exercising and all that. She did all those things, but you know, you don't have following up. It's there is this level of um, you know, you have to fall within. I'm not gonna we weren't going over the results of part of a study. It's part of a study. Yeah, exactly. Um, but yeah, she did have lifestyle and exercise interventions. Um, but again, as a a new fellow, I'm not gonna, oh by the way, your brain looks like it's going to, you're gonna forget your numbers and you know, gonna be one of the nursing home patients that I see that I'm reintroducing myself to. But it was at that moment that um, you know, if you have the ability to help and you don't, it's you know, I think it becomes a moral obligation to do something. And I couldn't live with myself not doing anything about it. And uh I remember when I finished fellowship, so I started developing these ideas and I started thinking about them and working towards them and working with other colleagues. And then when I finished fellowship, I went into private practice and I was not on social media at all. And I started seeing all this was the vegan, this was 2015, the vegan era was just, I mean, it was just pounded with this plant-based message. And you know, it's great when you're in your 20s, you have a ton of flexibility. Who cares? I mean, I was on the Twinkie diet when I was in high school, I turned out okay.

SPEAKER_05 46:16

I did the cabbage soup one.

SPEAKER_01 46:18

See, she's looking great, but the window of opportunity, while it's always open, isn't nearly as robust as it is when you're younger, right? If you were um, you know, an out-of-shape toad right now at your young age, Dr. Larry, it would be much more challenging than the way that you've spent your entire life. Yeah, right. It just, it's not the same. And um, I was seeing all this information, like red meat's causing cancer, all of this outdated, that's just not true. But it was getting such lift because of the velocity at which information spreads. That I remember my first post, like my armpits were sweating. And then I posted about how red meat doesn't cause cancer, and and that here's the mechanism and here's why it's not true, and there's no evidence. And people were like, You're so irresponsible. You're you should be ashamed to call yourself a physician. All of the things that I'm sure you heard and uh Dr. Morgenteller heard.

SPEAKER_05 47:14

Um being on the cutting edge can be hard and scary.

SPEAKER_01 47:18

Yeah. But when the why, when you're so anchored into the why the mission matters that it doesn't really matter. And also, who's laughing now? I'm kidding. You're not. You're right. I'm not.

SPEAKER_05 47:32

So you started off in private practice.

SPEAKER_01 47:33

I did.

SPEAKER_05 47:34

Then what?

SPEAKER_01 47:34

I started off in private practice. Where? New York City, okay. Fifth Avenue. Okay. Probably right by your apartment. From from Central Park on Fifth Avenue, right by the Ritz. Oh, I know where you were. Yeah. Really that was really expensive. Anyway, um, that would have been a lot of shoes. One month of rent there? Yes. That's like, wow. A lot of shoes. It's like 80 pairs of shoes. Anyway, um, so I started off in private practice and I really enjoyed that. And what I found.

SPEAKER_02 48:01

What did you you're in private practice as an internal medicine? What did you said you said you were at the time? Integrative medicine. Okay, so that was from the beginning. You're integrated medicine.

SPEAKER_01 48:12

My um godmother was so there's this concept of functional medicine, and I am careful of how I use it because it's it's been very diluted, you know. So many different things. Yeah, and people will call themselves functional medicine practitioner. Like, what is that? Are you a medical doctor or are you practicing medicine or you're not? Do you know what I mean? As physicians and as fellowship trained physicians, we've done our time, the board's certifications are very clear, the the governing bodies are very clear. You are not a no offense, this is gonna offend people, a chiropractor calling yourself a metabolic expert. It gets offensive. Uh you know, I don't know.

SPEAKER_05 48:45

Well, there are two specialists that insist that you call them doctor, a chiropractor and a podiatrist. I'm like, relax, you can call me an Amy. Like, I don't care.

SPEAKER_01 48:52

But that is, but it is a real, I love that you say that, but it's a real problem, you know? Um, and so when I started, I I used that word cautiously, functional medicine, but my godmother was uh a PhD in nutritional sciences. I graduated high school early and I moved in with her. And she was the generation before functional medicine even had a name, when it was this idea of root-caused medicine. So I had been working on this stuff and never changed careers or interests since I was 17.

SPEAKER_03 49:18

Yeah.

SPEAKER_01 49:19

Started practice and um it was to a very kind of upper end. Well, look where your office was.

SPEAKER_03 49:26

I mean, we're at Central Park South.

SPEAKER_01 49:28

I know at the Rits. At the Rits, right crossing the Ritz. But I will tell you what, what became so meaningful for me was not that patient population. Uh, this might come as a shock to you, but I shifted my focus. So the practice was expensive, but it allowed me to treat military operators at low or no cost, which by the way cost me so much money. My count was like, you have to stop talking about it. Now, was your husband already your husband? He was, no, he was not my husband.

SPEAKER_02 49:53

See, now this is where she was interested in the military.

SPEAKER_01 49:56

No, no, no. We no no. So the reason, no, are you kidding? When I met him uh and he told me that we should date, I said, don't ever call me again. I kid you not. I didn't pick up his phone call for almost two months. I was like, it's never gonna happen, bro. Don't call me. Don't call me. But where were you then? I was in my I was in my chiropractor. So I shouldn't draw I hated residency with a passion. I just hated it. Um, I hated the way that medicine was taught. I hated the the malignancy of the experience of the program. It was not team-oriented, these guys were all out of shape. And I was the crazy person doing push-ups in the call room, getting my protein and doing jump ropes while they're all sitting there like on Game Boy or whatever, bitching about people. And so that wasn't, it just wasn't my vibe. I hated it so much that I looked for a mentor. I thought to myself, okay, well, how am I gonna uh rethink this whole process? How am I gonna fake myself into it enjoying this suck? I went to who I thought the toughest people at the time were and still are. Is I went to uh I found a mentor who's a former commander SEAL. His name was Mark Devine, still a really, really great friend of, you know, we've been friends for over 10 years, probably going on 15 now. And I'm somewhat persistent and I refused to take no for an answer that he wasn't gonna mentor me to just teach me. He was meditation teachers, all these things, um, cloaked in this concept of being a Navy SEAL. So he called me and I was already taking care of operators and their families. I'm talking about tier, you know, SEALs, Green Berets, whatever, rangers. And he called me and he said, I have a SEAL that wants to go to medical school. Can you help him? I was, you know, sure. Okay. We met, we talked, we kept talking. Guess who that was? Bet you could never guess.

SPEAKER_02 51:33

But I don't understand how you gravitated towards the military in your practice on Central Park South. I mean, what did you realize what bad air they were getting?

SPEAKER_01 51:45

Yeah, um, they I I am this might sound really funny, um, and a little um and a little emotional, but I'm very mission-driven. If I can connect with the mission, I don't just do something for a reason to do it. I am someone that is extremely driven by a commitment to something I believe in. Right. And as I was seeing these famous people and these CEOs, it was really about them. And I didn't relate to that. And then I started seeing these operators, and I had this one guy who um had been a SEAL for 20 years. He was going, he was a career SEAL and he was a breacher, which means he's the first guy in, which you know you're in the military. And um excuse me, I was a doctor in the military.

SPEAKER_02 52:32

In El Paso. But that's okay. I'll take it.

SPEAKER_01 52:35

Thank you for your service. Thank you. Thank you for your service. Well, no, still on Valor here.

SPEAKER_02 52:41

No, I just didn't want to, I just didn't want to come across as you know, still on Valor. Using that, using that as my ticket to fame. But it's I was just a doctor in the army.

SPEAKER_01 52:50

Anyway, good, let's do it. Doing very well. So um, this my, you know, I'd always really been into physical activity, the harder, the thing, you know, when I was in um, I had picked up a mentor as a SEAL before I had been treating SEALs and I saw this huge need. But even within that, I had this practice. It was, you know, I was seeing these people, and I just it wasn't, it it didn't do it for me. I didn't care if someone was a professional athlete, and then it became also self-serving. I really gravitated towards those. Remember, I had already, you know, thought about joining the Navy, right? Of being very um of service, of service to other people. And this guy named Brian, he had been a career seal 20 years as a breacher, was home on a recent deployment. I think had just come home from Syria, and he was on his motorcycle in Las Vegas, and you know, shockingly he wasn't speeding. And this 17-year-old girl texting and driving totally took him out.

SPEAKER_02 53:41

Oh, come on, seriously? Yes.

SPEAKER_01 53:43

He lost his leg and he'd been to a Mayo Clinic, he'd been to all these places, and he still didn't feel well. Um, and yes, he did have low testosterone.

SPEAKER_03 53:52

Yeah, of course.

SPEAKER_01 53:52

But at that time, 10 years, you know, in 2015, no one's checking for that. I mean, we were, and uh he was sitting there, and he's sitting there with like his baseball cap and Solomon's, you know, what he probably Shane shows up in in grand rounds, except for shorts. And uh I was like, Brian, you know, how are you doing? And in my mind, if that happened to me, wouldn't you have, I mean, wouldn't you have just made up this massive story in your head about how life is you knew it was over? You would have. I mean, I don't know, I don't know, but I mean, I'm not that tough. I would have been bitching the whole way and just like, I can't believe this happened. And this woe is me. And so I had made up this whole narrative about how his life was over. I mean, this is a big alpha dude, you know, like you know, kind of like Shane, but very humble. And I was like, dude, how are you doing, man? And he looked at me, he's like, Well, Doc, I already, I told you, I'm having some phantom limb pain, I feel exhausted. Uh, my labs are quote good. I don't, I'm having some GI stuff, I don't know what's going on. I was like, No, no, no, no. You know, I'm here, I'm five-one, thinking like, no, I'm gonna show him. And I was like, Brian, how are you really doing? And he looked at me like I was like, Where's the box of condoms? Like, you idiot. I just told you five times. And I was like, he looks at me, he looked down at his leg, and he looks at me again. He's like, Oh, you mean my leg? He's like, Doc, that was like six months ago. You know, can we like move on for to get through this? I was like, Oh my god, I don't even get over stuff that happened six years ago. I'm still bitching about what happened in sixth grade.

SPEAKER_03 55:19

Right.

SPEAKER_01 55:19

And it was like at that moment that there was something different, that their mission and who they were as people was so cultivated and so much more meaningful to the mission and to the service that whether it was a leg or an arm, and you know, it it there was no narrative about it. And that really was a turning point for me that I then became very focused at using the money that I was able to make with the practice to really be of service to people.

SPEAKER_02 55:44

But you two clicked at the time. No, no. Oh, yeah.

SPEAKER_03 55:46

Back to shame. Back to show. So back to normal. Oh, oh, oh, sorry, sorry, sorry, broadcast.

SPEAKER_02 55:52

This patient who came in with this facade of I'm fine, I'm just feeling a little down, and you and you looked at him and basically said, You don't feel good, do you?

SPEAKER_01 56:00

But he was like, No, what are you what? So did you become Yeah? Well, he's I mean, there's a interest that's an interesting question. I um very friendly, but it's not, you know, we don't I don't call him like, hey dude, what you want to go hang out? It nothing like that. But there that uh kicked off a long-standing relationship. So I sit on the SEAL Future Foundation board. I've been very involved in veteran care, especially for our operators for since that, since that time because of the um the people and the culture. So with him, yeah, are we still in touch? Yes. But it's you helped him.

SPEAKER_02 56:33

I mean, what was the happy ending of the story?

SPEAKER_01 56:35

He had he also had schistomoniasis that we treated and tested. He's actually on his fertility journey now. And I said that you should go see Dr. Lip Schultz, by the way. Yes, so we'll have to follow up with him because he should he should come here. Um, but you know, we have stayed connected.

SPEAKER_02 56:50

And did the testosterone turn him around? Oh yeah.

SPEAKER_01 56:52

Oh yeah. He had sleep apnea, schistomoniasis, you know, probably endamoeba histolytica, elevated liver enzymes. And so what I saw was that these guys were treated as many people were treated well in various systems. And uh the the so I'm still in medical practice, believe it or not. I see patients on Tuesdays, and we see an integrated um approach. You know, we do some environmental medicine before it was even a thing, because I felt so desperate to find answers for these guys that I um I had to think outside the box. Yeah. I mean, you don't just naturally get diagnosed with schistaminasis.

SPEAKER_02 57:28

I was like, And you know, it's just so funny because I just assumed that your clientele were all the rich CEOs.

SPEAKER_01 57:34

They still, I mean, they still are.

SPEAKER_02 57:35

I know, but your real affinity is towards the people who really need you.

SPEAKER_01 57:40

Yeah.

SPEAKER_02 57:41

And I think that's so nice, it's very admirable, you know? Because you could have like turned your back on her at this point in your life.

SPEAKER_01 57:46

It's just not my style. I know. It's not my style, and I'll tell you what, I believe very much so that I take care of people that change the world. Yeah. And it doesn't matter the scale, but for me, it's really important about the kind of person they are.

SPEAKER_03 57:59

Yeah.

SPEAKER_01 58:00

Um, and they, you know, I've taken care of one. Uh, I have a great patient, her name is JJ Thomas. She's a physical therapist that I think is just gonna be able to transform physical therapy and physical health. And right now, she's a little bit of an underdog, she's very successful practice, but I believe in her. And so I'm I feel so connected to be able to, and we transformed her health. She's in a Navy SEAL fighting on the front lines, you know. But uh again, so it's not just the military. I would say the overwhelming desire is to help people that really believe in changing the world.

SPEAKER_03 58:34

You know? Yeah.

SPEAKER_01 58:34

So at one, at one point, I'm very interested in integrative medicine and nutrition. Again, my passion, I wrote uh Forever Strong, which is the first book highlighting muscle as this organ and how to do it. This is a science manifesto, nutrition manifesto. But the next frontier, which you guys have really championed, is hormones. Is hormones not just for men, but for women. And beyond the, you know, the the cookie cutter way of thinking about them, it's like really, it is really this uh beautiful interplay also with muscle mass. So Shane, Shane and I just published a paper which you were on, which is the relationship between muscle mass and strength and erectile function.

SPEAKER_03 59:15

Yeah.

SPEAKER_01 59:15

And there's just a lot of interest. And I think that muscle is the way of the future. And I think that hormones and also, and I say this cautiously, but again, um, maybe we've picked up 15 viewers. Uh, but I think that there is also a space, again, not publicly yet, but also a landscape for anabolics. Anabolics that are thought about in a uh very well-controlled environment and also less of a stigma. Yes. And what do I mean by less of a stigma?

SPEAKER_02 59:42

And I know exactly what you mean.

SPEAKER_01 59:43

But but the listener and viewer might not, and I I want to frame this up and then I'll shut up. No, I've you can go to your doctor and say, you know what, Dr. Amy, I want to be less fat.

unknown 59:57

Dr.

SPEAKER_01 59:57

Amy goes, you know what, Larry? No problem. Let me write you for a GOP1. No problem. I don't think twice. And again, just make believe. I don't think twice. No problem. But if you go to your doctor and pretend Dr. Amy wasn't Dr. Amy and I go, Dr. Amy, I want a medication that can help me build healthier muscles. Oh my God, this is the worst thing. You've got to be crazy. Oh my God, that's that's antibox steroids.

SPEAKER_05 1:00:22

And you know, this is not how I respond because I love when patients say that to me.

SPEAKER_01 1:00:26

Right. Yeah. But you guys are in a very small few, half of a percentage of a percentage, because the narrative is wrong. We don't have the same biases. I can say, I want to be less fat and I'll have to take a medication. And then, oh my gosh, everybody gets that. And it's so amazing. And there's it's no big deal. But I guarantee you, if I go to a physician, unknown physician, and I say, you know what, I don't even want testosterone, I want to try an anabolic agent. You know, the kind of anabolic agents that was in the Houston Buyers Club or in, you know, the the buyers clubs that protected those with HIV from wasting cachexia or sarcopenia, they would probably lose their mind. And so that's what I'm saying. Well they wouldn't even know what you're talking about. They wouldn't know what I'm talking about.

SPEAKER_02 1:01:07

And again, no- No, I 100% agree with you. I think it's just inevitable it's going to happen. Because they work.

SPEAKER_05 1:01:13

Well, and my favorite thing when people say when I say, What are your goals for today's visit? If they say, I want to gain more muscle, I'm like, come on in and have a seat. And I think, and I've mentioned this before to you, Larry, um, and you talk a lot about, you know, prevention of frailty and fracture, is maybe that could be our most impactful role as healthcare providers.

SPEAKER_01 1:01:30

Um it is, and it is unbelievably true. Yeah. And even myself, and I know you feel this way, I don't even feel uh totally comfortable. Um, someone wants to do, which I have talked to you about, someone wants to do an interview with us talking about these practices. Maybe I I mean, I don't totally feel comfortable. And what I say by that is there's so much stigma now, still. We no longer have the stigma about testosterone per se, but other anabolic agents that are FDA approved.

SPEAKER_02 1:01:58

There also is a stigma in the use of testosterone for muscle growth.

SPEAKER_05 1:02:04

And we were talking about performance enhancement, and he said, I don't really like that term, right? But it's like, don't we want everyone to perform at their best?

SPEAKER_01 1:02:11

Absolutely.

SPEAKER_05 1:02:12

So we're just taught how to treat pathologies. Now we're talking about prevention, but what about performance?

SPEAKER_02 1:02:17

I know. I'm here for it. And one of the problems we have is the term performance enhancing drugs because it's become like talking about heroin. I know. I mean, it's in that same mindset. And and I and we have to, we were trying I said to Amy, we have to come up with another name because performance enhancing drugs is a bad name right now.

SPEAKER_01 1:02:36

That's a really good point. It should um I I'm gonna take you up on that.

SPEAKER_05 1:02:40

I think that we should figure it out because another way to couch that class because but to say, I want you to live your best life, right? Like, what is that category of therapy?

SPEAKER_01 1:02:49

Yeah.

SPEAKER_05 1:02:49

And we talk about longevity, right? And that also has a very polarizing um sort of response.

SPEAKER_01 1:02:55

Yes. Yeah. And you know, basically longevity is Amy's saying, so there's this idea of lifespan. And this is the obvious. We know health span. We know health span. Okay, big deal. Health span is the length of time you live with, healthy, um, just a healthy life. Right. And then I think that at the top of that is muscle span.

SPEAKER_03 1:03:12

Yeah.

SPEAKER_01 1:03:12

Muscle as an organ system, the largest organ system. I guess the most important, but as urologists you guys might think something else is more important. No, I think.

SPEAKER_05 1:03:18

Well, but the penis has smooth muscle.

SPEAKER_01 1:03:20

This is true. We're not talking about the same thing.

SPEAKER_05 1:03:21

We're talking about skeletal muscle.

SPEAKER_02 1:03:22

But I mean, I th I think I think the the the fact that uh uh when you talk about health span, uh maybe you are talking about muscle span. We are talking about muscle span. So I mean, maybe you can't separate the two. Yes. And then maybe if you're not exercising and doing the things you should do that normally enhance muscle, maybe you won't have your health span. You won't. So I mean, I think it's not possible. It's it's the same thing. You're just talking about two sides of the same coin.

SPEAKER_01 1:03:47

And what we're really up against is what I think all of us as providers that are more forward-thinking is that testosterone and hormone replacement therapy and menopause replacement therapy has finally had a moment of liberation. Finally, I mean years decades late, decades and decades later. Well it's like protein. I mean, you're it's the same. I mean, I think it's a lot of people.

SPEAKER_05 1:04:09

It takes one highly publicized article to change things overnight in 20 to 30 years.

SPEAKER_01 1:04:13

Yeah, but on the flip side, but on the flip side, think about the totality of evidence that supports, for example, dietary protein.

SPEAKER_03 1:04:21

Yeah.

SPEAKER_01 1:04:22

And then you have one epidemiology, you know, some low quality study that has a lot of media push behind it and agenda change everything. And where we're up against is because of the use of GLP1s, which I'm totally in support of, we are going to trade one epidemic for another. You are. We are going to trade obesity for sarcopenia. Yes. And then the outcome will be sarcopenic obesity. Yes. And the data shows it's much more dangerous to lose muscle as we age than it is to gain body fat.

SPEAKER_03 1:04:57

Yeah.

SPEAKER_01 1:04:58

And this is a much harder. It is. This is a landscape that we are up against that no physician is prepared for. Actually, I take that back. The two types of physicians that are prepared for that are you guys, urologists, and those that treated HIV, those infectious diseases. Right.

SPEAKER_02 1:05:15

But I'm just worried about, I don't think the urology community is thinking even the people who do what we do in urology are not thinking the way the people in this room are thinking.

SPEAKER_05 1:05:25

Well, but the topic is out there. And I can say this because my sister and I have presented together on this topic gastroenterologists and urologists talking about the importance of lean tissue, minimizing lean tissue loss, and what our role is as urologists in supporting testosterone. We're so used to your, you know, as urologists saying, once you lose weight, we'll recheck your testosterone. If it's still low, we'll put you on testosterone therapy. What the heck are we waiting for? For them to lose more muscle?

SPEAKER_01 1:05:48

And one more factor in that is that we talk about muscle as if it's homogeneous, but it's not. And what happens over time and when someone is sedentary, then that muscle becomes infiltrated. With fat and you get intermuscular fat, which actually I don't think body fat matters. I think body fat percentage is somewhat of an outdated biomarker, unless, say, you're 40% or more, potentially. Maybe it's 35. I'm not totally sure. But what is more dangerous to metabolic health, insulin resistance, obesity diabetes is that eye mat. It's that intermuscular adipose tissue. Which you can only measure with what MRI, CT? Yes. And yes. And this is really just shows us how behind we are at looking at this organ system because we know nothing about the quality of that tissue. We're using DEXA.

SPEAKER_03 1:06:34

No.

SPEAKER_01 1:06:34

It's an extrapolation of lean mass. And so there are a few things that seem to improve intermuscular adipose tissue. So if someone's listening to this and they're like, what are they talking about? Imagine a wagyu steak and a fillet. You want your muscle to be like a fillet. You don't want to be like a wagyu steak. And with the old dietary guidelines and with this excess carbohydrate consumption, your muscle, when there's no flux, if you're not training, it's almost like a stagnant pond. And what becomes very liberating is the simple act of doing physical activity, resistance training or cardiovascular activity, you do a number of things. You improve plumbing, which we all know you care about plumbing and vasculature, you decrease intermuscular adipose tissue. Whether body composition changes or not, the simple act of partaking in physical activity improves muscle quality. And, you know, that is there's a third thing that I'm sure I was gonna say, but I I forgot. And the reality is if we recognize that muscle is an organ system, you know, urology is, I think, you know, in part going to be responsible, or those that are in sexual medicine to be in part responsible for this idea of how do we help and augment healthy muscle mass. GLP ones do it by decreasing intermuscular adipose tissue. Does it? It does. It does.

SPEAKER_05 1:07:49

And it's interesting because people think that GLP ones inherently cause muscle loss. Yeah, no, definitely. And they don't for that, yeah. Yeah.

SPEAKER_01 1:07:55

Probably improves the quality of that tissue. But again, um it does, it can accelerate aging. If you think about the sarcopenic curve, sarcopenia is roughly 4% per decade, maybe a little bit higher, maybe a little bit lower. Naturally, it's it's not that much. 4% per decade. When someone goes on a GLP1 without proper uh training, exercise, and hormones, they might lose 14 to 24% of their body weight. I mean, that is tremendous.

SPEAKER_02 1:08:25

Yeah, that's a big loss. So Amy Amy and Amy and her sister are focused on maintaining muscle mass while taking the GLP one.

SPEAKER_05 1:08:33

Well, my we have a bioimpedance scale. So my sister will titrate her GLP1 medications to muscle mass. Amazing. And she'll check it every month. And people, it's so interesting. And I'd love to hear from your perspective. People think, um, because it so I'm in Miami, so usually like I've learned only the poor people stay in Miami over the summertime. Like everyone travels to Europe for two or three months. And so they think, okay, if I just like take a month off from exercise and I'm not like hitting my protein goals, then I'll just maintain my muscle mass, but nothing bad will happen. They lose several pounds of muscle in a single month. Oh, yeah. People don't know that.

SPEAKER_01 1:09:02

It's so interesting. You know, I've this has been a really busy season for me. And normally my training is really on point. For the last two weeks, it's been push-ups, and I just have never been so off with training because you know you're working around the clock with this book launch because the message is so important. And I have lost muscle, someone who has been a lifetime trainer, someone who's training, not training other people, but exercising. And for me, it's hard. And the data supports that. And this is what you're saying is what is mirrored in the literature is called a catabolic crisis. It's a catabolic crisis model of aging. And people think that there's this trajectory and that we lose muscle over time that's just natural. It's not, it's discrete moments of physical inactivity or discrete moments of infection or injury or something that increases this shift towards a catabolic crisis. And that is how aging really happens. But what happens is when you're 40, 30, or 40, you can recover. But as you are inactive and then inactive, the ability to recover, you never get quite back up to baseline. And this is where the lifestyle intervention piece, so there's the training piece, right? Resistance training is non-negotiable. It's kind of like, do you wake up and brush your teeth or not? And then I say that, but I'm kind of being a hypocrite because I didn't train today yet. I mean, I will. And I've allowed it for the last two weeks to kind of it's because it's easy to not do the thing. And even those that are fully bought in, we still have to recognize that there's just no time not to. It's kind of like, do I brush my teeth or not?

SPEAKER_02 1:10:34

Right. You're right. And I think that's the attitude that we would hope people, but it's hard. It's hard even for me. Yeah. It's hard for everybody except for Shane. This is your new book. Yes. What what about this addresses some of the things we talked about today?

SPEAKER_01 1:10:47

Um, well, this book, first of all, it doesn't actually look like that. It's much nicer. No, no. This is the galley copy. And um Who's this on the cover? I don't know. Some toad. Who it's you? Some toad. Some out of shape toad. But anyway, uh I that was not my idea. That was the publisher's idea to put me on the cover. I like it. Yeah, it's awesome. It's tasteful.

SPEAKER_05 1:11:06

I mean, it's like what's you walk the walk and you talk the talk and you lift the lift. And that's why.

SPEAKER_01 1:11:09

You should be on the cover. I was like, are you guys sure? I think that we should do like muscle fibers just in a different color. Um, but this book is different. It's the original book that I wanted to write. And it's a tactical field manual. It's not all the science, it is the science.

SPEAKER_02 1:11:22

But it actually is a good idea. But what do you want to do?

SPEAKER_01 1:11:24

You want to see how to. You want to know how to implement the guidelines? Here you go. Yeah. You want to know how to go through a recovery process, whether it's cold plunge or uh heat or whatever it is. I got you covered. And this was evidence-based and evidence-informed. I chose the best of the best, and I it has recipes in it. I know, I saw that. They're amazing.

SPEAKER_02 1:11:42

I got the one I flipped and said pancakes. I'm going, you're going right there. All right. Are those my my oatmeal pancakes?

SPEAKER_01 1:11:48

It's better. I mean, like, it also has training in here. Yeah. I saw. Yeah, it's a really and it's um also has how to think. You know, we started talking about this. We started with the narrative, the challenges, and then what has driven me forward. And I realized that most people have 50 health books on the shelf. And if you don't know what you stand for and make the connection between the information and then being inspired but also educated, you're forever chasing the tail.

SPEAKER_03 1:12:19

Right.

SPEAKER_01 1:12:19

And so this book it starts with an ethos. You know, strength is a responsibility. It's not a luxury. And aging, unfortunately, is inevitable. But how we do it, a portion of that is up to us.

SPEAKER_02 1:12:33

I mean, that's why these longevity clinics don't make sense to me because you can't disprove that it's working. Right. You know, but what you can say is, am I going to be healthy till my aging's done? And also And that's the important message that we don't hear that much, right?

SPEAKER_01 1:12:48

And also, am I willing to do the uncomfortable thing now for the easier path later? Yes. And right now, people are like, oh, you're so stressed. Don't be stressed. Take a warm bubble bath. I promise you, that's not going to solve your problem.

SPEAKER_02 1:12:59

What was the the saying that you had about you're at a crossroads? What was that age?

SPEAKER_05 1:13:03

Oh, um, so Vonda Wright has mentioned like the decade of the 40s as being this critical decade where people have to get their shit together. And that's the age I see men and women in that age bracket all the time. And I tell them, you've got to get your shit together. Like you have to start moving your butt and you need to change your nutrition because you're at this crossroads where, like, if we make your life better, the next several decades is gonna be better. And if you don't, once you retire, you're going to die.

SPEAKER_02 1:13:31

And do you agree with the 40s?

SPEAKER_01 1:13:34

I let me let me tell you about my son.

SPEAKER_02 1:13:36

Okay. Okay.

SPEAKER_01 1:13:37

So my son, he trains twice a day.

SPEAKER_02 1:13:39

How old is he now?

SPEAKER_01 1:13:40

Well, let me just tell you what he does. He wakes up, he does some push-ups, he does some sprints in the evenings, he does a handful of other sprints, and he cold plunges. That kid, he's on the path. He's training for the SEAL teams.

SPEAKER_03 1:13:51

Yeah.

SPEAKER_01 1:13:51

He's four. Okay. He's four.

SPEAKER_03 1:13:54

Yeah.

SPEAKER_01 1:13:55

And so while we talk about is there a physiological change, it probably happens over from a muscle perspective, over 35. We see change in muscle tissue, but that's not gonna solve it. Even if they're doing the action, that's not gonna create lasting change. My kid is this kid is tough as nails, and we encourage that. So when things are hard for him, we're like, get it, brother. That's hard, right? No, no, no. But here's what I'm saying is that our thinking patterns around it are on autopilot. And every experience is an opportunity to reorient toward the harder thing. And until we begin to appreciate friction and actually put it in our lives, then for five years, your patient's gonna change. But if they don't change the core orientation of them as a human and how they see the world, then they are forever gonna be, you're gonna be having that conversation. You better get your shit together every fucking year. Yeah, let's not do that. That's she didn't say every fucking year.

SPEAKER_02 1:14:54

I must heard that, right? It was something else, it was every important year.

SPEAKER_01 1:14:57

Yeah. So again, and this is why when I see my kids, it's much easier for them to choose what they want to do than to spend 40 years trying to break bad habits. And um, do I believe that the 40s are a critical year? I do. And I believe every year, yeah, I think every moment is critical because if you cannot get your why together and really understand what the meaning is and the ability to embrace friction and do hard things because these are conversations, women are not having these conversations. The conversation is eat some protein, train. It's not like, what are the regrets that you have that you believe that you're not worthy of this health and wellness? Why is it that every time something gets hard, you have your handful of narratives that you fall right back on? And it's all BS, right? Everybody has whatever. And I think there's an opportunity. If we talk about giving people a program for how to eat and how to train and how to assess their hormones, then they have to have a program to understand how to think about it. And that's what the playbook addresses.

SPEAKER_02 1:16:04

Yeah. But you don't but but you don't think your psychiatric couple years had any has any influx into your way of thinking. I mean, it's because it's very, you know, kind of like I don't know what the word is, mental. I mean, because yes, it's physical. We're talking all morning about physical, but actually, the physical is not gonna happen if you don't have the mental. Because you have to have your path defined. And you have to have your path defined, you're not gonna go down it.

SPEAKER_01 1:16:29

Right. And, you know, as I sit here and I I think about you two and these guys that are here on a Sunday, you both have always leaned into the harder thing. And in fact, maybe it's not even considered hard for you anymore because it's the standard that you set. And people are always chasing fleeting goals as opposed to setting standards for how they show up. And the reason you both are so successful, whether consciously or unconsciously, is you set standards for yourself, for your expectations, for how you show up. And I think that a part of that has to be brought to the forefront so it can be taught. And so, you know, when I was in my fellowship, I uh Faden Makinos, who's just a world-class scientist, Harvard scientist, now he's in Singapore doing something, actually he's in Denmark or sorry, Copenhagen. And uh, I was like, Faden, you're always just so good. I mean, you're talking about major landmark papers, and he goes like Gabrielle, when you're average, no one cares, they have no expectation of you. And so what's happened, and I was like, oh my God, you're right. But because he's so good, we always expect him to be good. Yeah, and right now, because people are so average that it's so easy to spot a superstar. There's not a ton of them, but there's gotta be ways to do that. Did there used to be more?

SPEAKER_02 1:17:41

I mean, what am I missing? I mean, it just seems it changed.

SPEAKER_01 1:17:43

No, no, you know why? Because um distraction is more ubiquitous. Yeah, but you know what's so great about that? Is again, the best rise to the top. And it makes it so much easier to be the best. Yes, it's true. But I mean, I would rather there were more best because it would make my life better. And you cultivate them. You find them, they find you, you cultivate it.

SPEAKER_02 1:18:05

Yes.

SPEAKER_01 1:18:06

There's one last book.

SPEAKER_02 1:18:08

We gotta look at that.

SPEAKER_01 1:18:08

I'm actually working on my third book.

SPEAKER_02 1:18:10

Okay, like this?

SPEAKER_01 1:18:11

Is it is it's my third book is a book for women about women, and it talks about this perspective of real strength. What is it like to have a stronghold of a family? And what is it like to have a um a real standard? And how do we re-introduce that back? Yeah, yeah.

SPEAKER_05 1:18:28

I love that.

SPEAKER_02 1:18:29

I like the idea.

SPEAKER_05 1:18:30

So, the one last topic I want to talk about because you have an amazing podcast, the Gabrielle Lyons Show, and you've interviewed experts from all over the world. What are some of the things that you've been surprised by or that you've learned from doing your own podcast?

SPEAKER_01 1:18:44

Well, there's two sides to that coin. The first thing is the best of the best are very humble. The best of the best, it's never solely about them. Hands down, and I've interviewed people that were up for Nobel Prizes. I mean, these people are humble. And they're a lot like, I mean, Larry's been on the podcast. They have a, there's a, it's a genius, but it's um, it's an ability to think outside the box. When you meet these people, you're like, these people are thinkers. The other thing that was so fascinating is um this idea that uh muscle quality, that that this body fat percentage, this narrative, all of this stuff is wrong. And I think that we're at the precipice of if we want to really improve metabolic health, that we begin to recognize where our limitations are, specifically with muscle as an endocrine organ. Time and time again. Um, I had this aha moment. One of the world-leading experts in PCOS came to see me. Uh, she was in on the podcast, and I was like, Melanie, she's MD PhD. Uh, her name is Dr. Melanie Cree. I said, Well, what percentage body fat really pushes people over to infertility? Like, there's gotta be a percentage. If you're 40%, then you're gonna have problems. Well, it's not more, it's sometimes less that pushes you. But I said, let's just say those people we're talking about obese. Like, let's say we're focused on that problem and the metabolic component of it. And she looked at me and she's like, it has nothing to do with their body fat percentage. I'm like, what do you mean? She goes, we look under uh MRI of exercising muscle, and it's the um the intermuscular adipose tissue, it's actually the quality of their muscle tissue that really determines insulin resistance and then determines uh whether it's elevated levels of glucose and insulin and and all these other problems that relate to PCOS, but it there was a focal point of the quality of muscle tissue. And I think that, you know, that's that was just so fascinating.

SPEAKER_05 1:20:34

And you recently did a podcast looking at immunology and muscle tissue.

SPEAKER_01 1:20:37

I did.

SPEAKER_05 1:20:38

I've never even heard of that concept.

SPEAKER_01 1:20:42

And it it goes to highlight the fact that, you know, we have cardiologists, we have urologists, we have endocrinologists, but we don't have specialists in muscle that are both metabolic as well as structural. That it doesn't exist like it exists for urologists. It doesn't exist like exists for cardiologists. And this is a truly a new field of medicine that needs real work.

SPEAKER_05 1:21:04

Because orthopedic surgeons are musculoskeletal specialists, but they're more focused on bones. Yeah, they're surgeons. Right.

SPEAKER_01 1:21:11

I would say they're an endocrinologists, but non-operative.

SPEAKER_05 1:21:14

I want to hear your endocrine.

SPEAKER_01 1:21:16

And endocrinologists are focused more on diabetes. I mean, these people are.

SPEAKER_02 1:21:21

My take on endocrinologists as the group that I work with is they don't really see patients. You know, they they like to read and they like to do their stuff, but uh other than diabetes, they really don't, and maybe thyroid, but that's the end of their kind of focus. Yeah.

SPEAKER_01 1:21:38

And I mean, listen, there's various endocrinologists. Well, there are just like there's urologists. There is, but I think that um, you know, muscle-centric medicine is something we created. And that's one of the reasons why we published that paper relating muscle mass to sexual function. Because I think that if we can begin to circle um and create the consensus and create a body of literature, right now, muscle is typically performance-based.

SPEAKER_03 1:22:00

Right.

SPEAKER_01 1:22:01

I mean, when we had the obesity epidemic, muscle wasn't even considered to be part of that equation because movement hadn't really changed. It was, it was low. But from a muscle as an organ system, we do not have a good scientific consensus and good physicians that address it in the way that we're interested in the interest. But I think the interest is there. I think that maybe maybe.

SPEAKER_05 1:22:23

Well, the interest is the interest is growing because of the work that you're doing.

SPEAKER_01 1:22:26

It's growing.

SPEAKER_05 1:22:27

Yeah. Um, okay, so thanks to you. Yeah, yeah.

SPEAKER_01 1:22:30

I don't know about that. Oh, I do.

SPEAKER_05 1:22:31

Oh, yeah. I mean, for sure. I'll tell you right now, your podcast and the information you provide has greatly impacted the practice that my sister and I provide for patients in the education.

SPEAKER_01 1:22:40

I love hearing that.

SPEAKER_05 1:22:41

So, two last questions for you. What is your message for patients or people? What is your message for providers?

SPEAKER_01 1:22:49

So, yeah, two different questions. It's all humanity, so it's the same. We have the ability to build stronger, better humans. And whether you are a patient and whether you are a parent, it starts with you. You cannot tell people to do anything else you are not willing to do. Better, stronger, more resilient. Whatever domain that falls into, patient, provider, kid, I do not care. But where we're at right now is weak, average, and unhealthy. Why are you looking at me when you say I'm very passionate about these things? I'm very passionate about these things. I mean, it's uh I'm kidding.

SPEAKER_05 1:23:25

Gabriel, you're so awesome. We tackled so many different topics today.

SPEAKER_02 1:23:29

And I'm I really feel that I've got to know you, and we're in like an audience, but I've got to know you so much better than I knew you.

SPEAKER_03 1:23:36

Yeah.

SPEAKER_02 1:23:36

You just knew me as a fantastic, hilarious host. No, but I really do think you did. You were and I appreciate it. We all appreciate it.

SPEAKER_01 1:23:43

Well, listen, when Larry calls, it's just like, okay, you want to come on Sunday? My team's like, are you crazy? Well, thank you so much for joining us. Well, I can't wait to have you guys on the maybe separately. Whatever you want. We're there. We're at your disposal.

SPEAKER_02 1:23:56

No, really, because I appreciate so much what you do. Yeah. But more importantly, I appreciate why you're doing it, which I didn't understand as much as I did today.

SPEAKER_01 1:24:05

These guidelines, these guidelines weren't a win for me, even though I have spent years. Do you know I would go to the DC and I would drag Don Lehman to these luncheons and I would say, Oh, you've got to meet this, is this person. I would go there for an hour. I'd fly there. I have two little kids and a man child, and I'm running four businesses. I would fly there for an hour to have him have like a but the whole point is it's it's not about me. This is about something so much bigger. So, you know, and I think that's what we're all what we're all trying to do. Yeah. Yeah.

SPEAKER_02 1:24:36

And I just hope that more than 14 people watch this video. 16. I'm sending to at least two other people. It's a mother and father, but I mean my sister. And your sister. And your sister. And my sister. I have no brothers or sisters, so I can't do anything. Yeah. Oh, my sister-in-law is either. So perfect.

SPEAKER_05 1:24:50

Awesome. Thanks again, Gabrielle.

SPEAKER_02 1:24:52

Thank you so much. I really enjoyed uh listening to Gabrielle today. It was an eye-opening, kind of startling reveal of how she became who she is today. And uh I thought it was just a really good episode in terms of her personal um clarity. Yeah. Uh, and more importantly, about her view on skeletal muscle, the importance of muscle, health span, and of course the new food pyramid.

SPEAKER_05 1:25:20

Yeah. I think we got a real behind-the-scenes look on her life and her mission. And where we record this webcast, it's the room is a little bit chilly, but there were certain times when she was talking where I got goosebumps. And I think it's because the way that she mess gives her message, which I think is so inspiring and is what a lot of people need to hear, especially if they're not currently moving their body. But she puts the responsibility on people to take actions that will really change the course of their life. I loved it. She's super sweet.

SPEAKER_02 1:25:49

She is. And I really found it interesting that this whole process with her uh began only 11 years ago.

SPEAKER_05 1:25:56

Yeah.

SPEAKER_02 1:25:57

In New York City, where she had a private practice. And look what it has grown into.

SPEAKER_05 1:26:00

Yeah. But she even learned, I think part of what shaped who she is is like just during her training, right? Some of the challenges with her training. And I found it interesting to know like why she chose part of her training and what she did. But that's stuff that we actually, I couldn't find any of that online. So we got the real sneak peek.

SPEAKER_02 1:26:16

We did.

unknown 1:26:17

All right.

SPEAKER_05 1:26:17

So why don't you give us the final F-word for today's episode, Larry?

SPEAKER_02 1:26:21

Well, I don't think there's any argument that it should be fitness. I think you're right. Because she kind of epitomizes it.

SPEAKER_05 1:26:26

She does. And she, what I love about her message too is she walks the walk. Yes. Right? Everything that she's recommending people do, she does herself.

SPEAKER_02 1:26:32

As you do.

SPEAKER_05 1:26:33

Yeah. I try. I try my best. All right, Larry. Why don't you give us some foreplay for our next episode?

SPEAKER_02 1:26:39

Okay, I'll do that. So foreplay. For our next episode, we will sit down with Rick Manuel and talk about the latest and greatest to do with peptides. You won't want to miss this.

SPEAKER_05 1:26:50

Thank you for joining us today on fertility and other F words.

SPEAKER_02 1:26:53

And please don't forget to like, subscribe, and please leave a comment.

SPEAKER_05 1:26:57

Until next time.