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Prevent Muscle Loss and Decline | Emily Lantz PhD

Episode 67, duration 1 hr 19 mins
Episode 67

Prevent Muscle Loss and Decline | Emily Lantz PhD

Dr. Emily Lantz is an Assistant Professor in the Department of Nutrition, Metabolism and Rehabilitation Science in the School of Health Professions at the University of Texas Medical Branch. She has a Bachelor of Science in Agricultural Biochemistry from Iowa State University, a PhD in Nutrition Science from Purdue University. She completed a postdoctoral fellowship in skeletal muscle metabolism from the Division of Rehabilitation Science University of Texas Medical Branch.

Prevent Muscle Loss and Decline - Emily Lantz PhD

In this episode we discuss:
– Addressing muscle loss during injury and illness.
– How does sleep affect protein synthesis?
– What affects skeletal muscle mass in older adults?
– The difference between animal and plant protein.

00:00:00 Introduction

00:02:23 Dr. Emily Lantz

00:06:22 Muscle Mass Decline

00:15:04 Leucine and Muscle Loss in Older Adults

00:25:08 How to Build Muscle Mass as You Age

00:26:16 30 Grams of Protein

00:33:19 Diet and Exercise

00:34:37 Fasting and Muscle Health

00:38:43 Getting Enough Protein

00:45:20 Supplementation

00:51:13 Dangers of Bed Rest and Hospitalization

00:59:14 Sleep Deprivation and Muscle

01:03:10 Dietary Protein Distribution

01:05:37 Are Animal Proteins Better?

01:14:06 The Future of Protein Research

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Dr. Gabrielle Lyon  [0:00:01]

Welcome to the Dr. Gabrielle Lyon Show where I believe a healthy world is based on transparent conversations. In today’s episode of The Dr. Gabrielle Lyon Show, I sit down with Dr. Emily Lantz. She is an assistant professor in the Department of Nutrition, Metabolism, and Rehabilitation Science in the School of Health Professions at the University of Texas Medical Branch in Galveston. She has a Bachelor’s of Science and agricultural biochemistry from Iowa State University, a PhD in nutrition science from Purdue University. She completed a postdoctoral fellowship in skeletal muscle metabolism from Galveston.

We had a great conversation.In this episode, we focus heavily on Dr. Lantz’s research interests, which really focus on two main themes: number one, understanding mechanisms that impact skeletal muscle mass and functional capacity in middle-aged and older adults with an emphasis on aging women, and two, the application and mechanism of action of amino acid and protein consumption on acute markers of anabolism, i.e., muscle protein synthesis. Wealso touch on the impact of sleep and muscle protein synthesis.

This is a very usable episode. Even though it sounds very science-based, it is a very usable episode. As always, if you like this podcast, please take a moment to like, share, subscribe. We take it all very seriously. Now, with not a moment to lose, let’s dive into the content.

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Dr. Emily Lantz, I’m so excited to have you on the show. This is going to be such a treat for everybody. By the way, currently, your official title right now is you are an assistant professor in the Department of Nutrition, Metabolism, and Rehabilitation Science in the School of Health Professionals at the University of Texas Medical Branch.

Dr. Emily Lantz[0:05:13]

That was a mouthful.

Dr. Gabrielle Lyon[0:05:15]

But that’s actually why I read it. I wanted to make sure I got everything right. Not to mention, you are a current female researcher with five children. That is quite exceptional, so thank you so much for making time. One of the reasons why I really wanted to have you on is you are really someone I consider a teammate in the sciences and a teammate in this concept and discussion around protein. You worked with former Doug Paddon-Jones for nine years and had a very close relationship with Him. I would love for you to speak a little bit about where you did your PhD, what you did it on, and how you ended up in where you are now.

Dr. Emily Lantz  [0:06:02]

That’s a great question. My PhD training was at Purdue University. They had an interdepartmental nutrition program, which is a really great foundation for my PhD training because I got taught classes from people across different departments; psychology, chemistry, all these reallybroad background in nutrition. I did my project on the concept of fetal programming, so how a mother’s nutrition, even exercise, can influence the health outcomes for their offspring, for their kids. We use animal models to ask them different questions about exercise, about gestational weight gain during pregnancy, and looked at health risks in their offspring. That’s where I did my PhD, andthen I graduated, and I was like, oh, I need a job. I was getting married, and I moved to Houston, and I ended up interviewing with Dr. Paddon-Jones, with Doug, andwe just really hit it off with this great synergy.It was an hour-long phone call the first time we talked to each other. I loved his ideas. I loved the vision he had for his research, and so I that’s how I ended up at UTMB, or the University of Texas Medical Branch.

Dr. Gabrielle Lyon  [0:07:16]

That’s incredible. Actually what you did your PhD on is really a hot topic now. You’re not actually looking at those components.

Dr. Emily Lantz  [0:07:26]

Not anymore. I still think about it, and I think there’s still some future room. I have some collaborators in my department now who are interested inasking those questions. I’m not completely out of the game yet,but I haven’t looked at that literature for a while.

Dr. Gabrielle Lyon  [0:07:41]

Well, we need you in the vulnerable population, and we need you in protein research. For those individuals who don’t know Doug Paddon-Jones, he really made some incredible contributions to the science and particularly, I’ll say, really on two ends of the spectrum. Number one, this idea of a catabolic crises—which I would love to talk about; there’s many things that I want us to highlight—andthe protein distribution for the prevention of muscle loss, the prevention of potentially sarcopenia through aging, whichhim, Don Layman, and a few other individuals really paved the way for things that we take for granted. Then, moving into some of your other research, which we’re very interested in, sleep and muscle protein synthesis, and menopause.

Dr. Emily Lantz  [0:08:35]

Right. Where do you want to start? You want to start with catabolic crisis?

Dr. Gabrielle Lyon  [0:08:40]

I would love to start with catabolic crises.

Dr. Emily Lantz  [0:08:43]

I’m very interested in aging research. One of the strengths of UTMB is aging research. There’s really been a great group of people there for a long time I’ve gotten to work with on theseprojects. One of the ideas that Doug put forth is the idea where once we hit the age of 40or 50, we start to lose muscle mass, and about 1% a year or 10% per decade. When you would look at a lot of the theoretical graphs or if you’re measuring someone at 40 or 50, it’s a linear descent, if you will. But that’s really not maybe a correct way of thinking about it because what happens during periods of illness, or especially inactivitylike hospitalization, you see a very rapid decline in muscle mass, even over a period of five to seven days. What can happen during a period of illness or injury is when you lose that muscle mass, there’s an incomplete recovery because maybe you were in a cast for a while or a sling or you just are not feeling well and you’re not back in the game exercising, really being active, or maybe your appetite’s declined, so you’re not getting enough protein, and so you don’t recover that muscle mass as much, that strength.So, you have this very rapid declineas those illnesses or injuries perhaps become closer together. So, rather than being just this gradual slope, it’s actually a lot more steep than we originally may have thought.

Dr. Gabrielle Lyon  [0:10:11]

People think about this idea of decreased muscle mass and function. Again, you’d mentioned that they believe that it’s 1% per year. Do you believe that is accurate?

Dr. Emily Lantz  [0:10:24]

I think, initially, yes, when you’re in your 50sprobably. I think as we approach 70, it’s a lot more rapid in the latter years, so probably up to maybe 3% a year.You see a more rapid decline. But it’s hard to measure accurately. One of the most commonly used tools available to researchers is called a DEXA, which measures water content,so lean mass having a higher water content, that’s what we typically use to look at whole body lean mass not even at a population level, but just at a research level. In most institutions, you might have an access to a DEXA. But CT and MRI are much more accurate, but they’re much more expensive. It’s just difficult to measure.

Dr. Gabrielle Lyon  [0:11:12]

I want to highlight something you said about the DEXA. It really looks at lean body mass– well, actually, we’re looking at bone and fat mass and then actually subtracting it, and then assuming lean body mass, and then taking that number and looking at skeletal muscle mass. But lean body mass has connective tissue, organs, and muscle, but it’s really everything aside from bone and fat. So the question becomes, again, you’d mentioned population levels, how are we actively and accurately looking at skeletal muscle mass to determine this declined by 1%?

Dr. Emily Lantz  [0:11:53]

As far as I know, we’re not.It’s one of those pieces of data that we hang our hat on, but I don’t know that we’re actually actively measuring, at least I’m not aware of.There may be someone out there who has that really great project that they’re doing. But right now, we’re just—

Dr. Gabrielle Lyon[0:12:06]

Hurry up, people.Hurry up.

Dr. Emily Lantz  [0:12:08]

We need the money.

Dr. Gabrielle Lyon  [0:12:09]

Because we’re still using a DEXA. I just wanted to point that out, because while we’re talking about these changes in skeletal muscle, from my perspective, I think it’s probably much greater. Also, we don’t look at anything as it relates to actual muscle health, whether there’s that infiltration.

Dr. Emily Lantz  [0:12:26]

Muscle mass is important, but muscle strength and function is really, at the end of the day, what’s keeping you going, and muscle metabolic health, glucose disposal and muscle protein synthesis, all of those other really critical pieces that are more difficult to measure as well.

Dr. Gabrielle Lyon  [0:12:41]

I read in one of your papers, and you are very well published. I don’t know how you do that with five kids. I’m still looking for my socks. From 2000 to 2015, more than 3 out of 10 adults in the US were admitted to an acute care hospital. In 2018, the average length of stay was around 5.6 days. This is what you really say that kicks off this catabolic crises. Tell me some of the data that you guys have seen as it relates to the amount of muscle mass loss, potentially the amount of strength, the age differences. What can the listener really think about as the they go into the hospital or someone they love goes into the hospital, the number one treatment is bedrest?

Dr. Emily Lantz  [0:13:31]

When you’re in the hospital, you’re in bed. You are often not feeling well. You might be encouraged to get up and go to the bathroom, if that’s safe, but there’s not anyone in there actively making sure that you’re up and moving around. When I started my postdoc with Doug, I did a series of bedrest studies. For context, what we do in a bedrest study is we take what we call the best-case scenario which is a healthy community dwelling adult. We did a couple of studies. First, I’ll touch on the older adults, and then I’ll save the middle- aged adults for the next piece because I think that’s even more interesting.

We took healthy 60, 65-year-olds, put them in bed for seven days. What we saw is a change of 1 kilo of muscle mass from their legs just from that seven-day period. For context,that’s about 2 pounds of muscle just from their legs. So when you go into bedrest, that’s typically where you’re going to lose muscle mass and strength, is in your postural muscles in your legs. Actually, when we look at a whole-body DEXA, because we do use DEXA,we see that sometimestheir torso or their arms, you’re pretty neutral as far as muscle mass changes go, leaving yourself around in bed. It’s really your legs where you see that really critical piece.What do we use our legs for?Walking, balance, all of those really important functional piece. That’s often why when someone leaves the hospital, there’s this term called hospital deconditioning, and that’s because they’ve been in bed. They’re losing muscle mass. They’re losing strength. That happens in a really short period of time. We did a seven-day bedrest study, but we think it really happens within the first three to five days, which is the typical hospital length of stay for an older adult.

Then we did the similar study where we took the same model, seven days of bedrest, and we used middle-aged adults.So phenotypically, we’re talking 45; I think we did 45- to 60-year-olds. I’m approaching. I’m not there yet, but I’m approaching that.So phenotypically, they look healthy. They are doing well. You put them in bed, their muscle loss response was just like an older adult; a kilo of muscle from their body in the same seven-day timeframe because that’s what we measured. We think that it happens more quickly, but just for this particular model, we had used a seven-day period that we were measuring pre-post.There’s some other groups who have looked at a shorter timeframe in a differentdisuse model and seen that muscle protein synthesis declines, muscle protein degradation increases during just a very short period of time of disuse.

Dr. Gabrielle Lyon  [0:16:09]

Basically, what you’re saying is an older adult who is active in community dwelling, 65 or higher, typically, when they go into the hospital, they go on bedrest, which we all know, we’ve all written orders for bedrest. Those individuals will lose 2 pounds of muscle, on average, likely the first three to five days.

Dr. Emily Lantz  [0:16:34]

Yes.And again, we are using a best-case scenario. If you are thinking about an older adult who’s ill, you’re going to have a more pro-inflammatory environment, which means that muscle loss likely occurs either to a greater magnitude or in a shorter period of time.

Dr. Gabrielle Lyon  [0:16:52]

That is fascinating. A 45-year-old individual who is healthy will also lose the same amount, roughly 2 pounds. And that’s in what you’re saying is called the best-case scenario.

Dr. Emily Lantz  [0:17:06]

Correct. This is someone who’s not ill. We do a full medical workup, so no history of any metabolic illnesses or anything that would maybe contribute to  a pro-inflammatory environment, just that disuse model itself is enough to do that.

Dr. Gabrielle Lyon  [0:17:23]

Can you imagine if the majority of the American population is overweight or obese, and approaching whether diabetes or insulin resistance, would you anticipate that their muscle mass loss would be greater?

Dr. Emily Lantz  [0:17:39]

It’s entirely possible. Also, when you see that loss of muscle mass, we also see a decline insulin sensitivity very rapidly. In addition to looking at just this model of disuse, we also tried some interventions to see can we rescue that loss of muscle, and some very practical ways?Being protein researchers, our first instinct is to use a protein-based intervention. So, in both the older adults and middle-aged adults, we use leucine. We supplemented the middle-aged and older adults with leucine at each meal.

Dr. Gabrielle Lyon  [0:18:19]

So it was leucine on top of a–

Dr. Emily Lantz  [0:18:23]

Leucineon top of a fairly high-quality protein. We were at a 0.9 kilo per gram of body weight per day. It’s a little bit above the RDA, but not close to that 1.2 that’s really becoming more recommended for older adults. This is still very moderate amount of protein, but adding in that leucine partially rescued the loss of muscle mass.It cut it almost in half.

Dr. Gabrielle Lyon  [0:18:45]

Let’s dive a little deeper into this. Do you happen to remember the macronutrient breakdown, how many grams of protein you guys were looking at?

Dr. Emily Lantz  [0:18:54]

Do I remember in grams? I want to say it was–don’t quote me on this.

Dr. Gabrielle Lyon[0:19:01]

I won’t.Was it 30 grams of protein perhaps?

Dr. Emily Lantz  [0:19:05]

It was not quite 30. That 30 is recommended. One of the reasons it is around 30 is because you’re hitting that 2.6 to 2.8 grams of leucine that you need. Because we were supplementing with leucine, we didn’t think it was necessary to really bump up the protein content of the diet.One of the other things we did is we held– because they were in bedrest, we had to lower their caloric intake. We used one of the standard equations to calculate their energy needs to try and keep their body weight neutral.

Dr. Gabrielle Lyon  [0:19:38]

You added leucine to each meal. When we think about this from an at-home standpoint, if your protein is high enough, you potentially don’t need to addleucine. But you guys were adding leucine to bring up the leucine threshold, which, for the listener, if you’re new to this podcast, leucine is an essential amino acid. It is a branched chain, which is necessary for muscle protein synthesis.

Dr. Emily Lantz  [0:20:03]

It really initiatesthat process.Since there wasn’t enough protein in their diet itself, we didn’t need to add additional protein because we wanted, like I said, balancing the calorie needs versus the protein needs. That was really promising. One thing I will add is in one of the studies, we took the participants an additional week beyond that initial seven days, so it was actually 14 days of bedrest.Leucine was pretty effective at minimizing the loss of muscle mass during that first seven days, but then when you got into that second week, there was really no difference between the groups. We called it the leaky life preserver, if you will. It’s really good for the first seven days, but then that overwhelming catabolic environment of disuse really takes over, and leucine can’t really keep up anymore.

Dr. Gabrielle Lyon  [0:20:50]

What I’m hearing you say is that there is potentially a safety factor where the first seven days, the body can keep up.When you say that the catabolic nature of the body, the catabolic environment, did you guys look at was there an increase in inflammatory markers? What kind of things were happening physiologically?

Dr. Emily Lantz  [0:21:10]

We did not measure inflammatory markers in our study, but others,Micah Drummondon Utah, has done some studies looking at inflammationhalfways during disuse and especially systemically, you see inflammatory markers go up systemically, some locally in the muscle, but primarily it’s systemic. That  pro-inflammatory environment increases protein degradation. I think that’s one reason you see that increased loss of muscle with extended periods of disuse.

Dr. Gabrielle Lyon  [0:21:40]

Pretty concerning considering 50% of Americans are not exercising.

Dr. Emily Lantz  [0:21:45]

Right. Bedrest is a very extreme model. We have a setup at UTMB where we have video cameras in the room. We have research nurses who are moderate–

Dr. Gabrielle Lyon  [0:21:57]

Don’t you move. Don’t you get out of that bed. I have one of those setup in my kids’room.

Dr. Emily Lantz  [0:22:02]

But Stu Phillips actually did a really fascinating similarparallel study where they looked at just a reduced activity. They called it the Canadian wintermodel where it is older adults who don’t leave their house because it’s cold. They saw a very similar decrease in muscle mass, not to the same extent, but even just reducing someone who’s highly active or moderately active to a very low level, I think it was like 1500 steps a day, you saw a very steep decline in muscle mass.

Dr. Gabrielle Lyon  [0:22:31]

What was the big takeaway from the catabolic crisis model and just these studies that you worked on?

Dr. Emily Lantz  [0:22:37]

The biggest takeaway, I think that onebeing that you really need to start thinking about your muscle health in your 30s and 40s. Thinking about these middle-aged adults who are losing muscle, phenotypically, outwardly, they looked healthy. We wouldn’t think, especially if you’re a physicianor someone who’s taking care or even for yourself, if you’re going to the hospital, you’re not thinking about, hey, I’m going to have this procedure done, and I’m going to be fine. I’m young. I’m healthy. I can still recover.You really do need to start thinking about your muscle health earlier than we really thought.

The other piece that I wanted to highlight, one of our interesting findings from these two studies is we recruited healthy men and women for both studies. What we found in our middle-aged adults is that women actually seem to be somewhat protected against the muscle loss compared to men. They lost just a little bit less,and this is a pretty small study. It’s not statistically significant, but it was an interesting trend in the data. Then when we looked at that samegender breakdown in older adults, the older men and the middle-aged men, they lost the same amount of muscle, very similar, about a kilo.The older women lost a greater amount of muscle mass compared to the age-match men as well as those middle-aged women. My hypotheses coming from that is that there’s something about that menopause transition, probably the loss of estrogen, that really puts women at risk for disuse-based muscle mass loss.

Dr. Gabrielle Lyon  [0:24:17]

That is so fascinating. I think it’s an area of newer research as it relates to skeletal muscle mass and estrogen in particular. I know that you may be working on some of this that we’re not really going to talk about, do you have any hypothesis as to is it a slow decline? Do you think that there’s a time where there is a pretty significant drop off? And probably most importantly, if we identify those vulnerable populations, what can be done? Is it dietary protein? Do you think that there is a hormonal intervention? What happens?

Dr. Emily Lantz  [0:24:57]

That’s a good question. At this point, it would just be speculation because like you said, it’s a new research. But I think that there is something there. I think that women who probably are still in their 40s and 50s,so pretty early– the average age of menopause in the US is about 50. I think for those younger, middle-aged women, there’s still some estrogen floating around thereprobably. I think it’s really once you hit that 65-plus, you’ve been estrogen deplete for a longer period of time, you’re particularly more vulnerable. That tracks with risk for heart disease.That tracks with the risk for other chronic diseases like diabetes, and so there’s also, I think, this increased risk for loss of muscle mass that occurs in women compared to men. Women tend to be more frail. They’re at high risk for sarcopenia. There are some broader other diseases that we already know women are at risk for after that menopause transition. I think this just makes sense and adds another piece to that puzzle.

Dr. Gabrielle Lyon  [0:25:56]

It’ll be fascinating to be able to identify specific individuals that are at greater risk before going in. Maybe the initial orders going into the hospital will be higher protein diets. You had mentioned something.You said, you believe that it begins maybe 40s, and 50s is when we really need to start thinking about muscle health, maybe 40s? Do you think that even in the 20s–

Dr. Emily Lantz  [0:26:24]

Absolutely.

Dr. Gabrielle Lyon  [0:26:25]

Where do you feel it really should start?

Dr. Emily Lantz  [0:26:27]

You know, it’sa lifelong thing. I think it’s similar to how we think about bone health. We spend our childhood building in our peak bone mineral density, and then we start to decline. I think muscle mass meaning, not that different. So I think it’s something to take care of, be mindful of, and I think it’s about building habits. Dietary protein is important. You need it at every meal. If you start eating that way, it’s easier to just sustain as you get older. Now one thing that happens as you get older is your appetite starts to decline. If you are thinking carefully about, how do I want to continue to incorporate dietary protein for my muscle health– and it’s not something new that you have to learn, because you know when we get old, we don’t want to learn new things. But if it’s something you’ve already baked into your lifestyle, then it’s easier to maintain as you get older.

Dr. Gabrielle Lyon  [0:27:18]

Is this where the work started with the 30 grams of dietary protein, this distribution concept?

Dr. Emily Lantz  [0:27:25]

This is in parallel. Doug did a series of studies on how do we land on 30 grams of protein?Some of it has to do with leucine. But he really liked to push back against this more is more for protein sort of mindset that some people have. He did a couple of really interesting early studies where he took older and younger adults and gave them 30 grams of beef protein. The good news was that the young people and the older adults, their muscle protein synthesis responded the same way, which indicated that the older adults still were able to mount that protein synthetic response to a meal. Then he took that samepopulation and gave them 90 grams of protein, like more is more, let’s see if we can increase, and you saw no increase above that 30 grams, that level of muscle protein synthesis that occurred at 30 grams of protein. So what that tells us is there’sa threshold. We need enough protein. But if we need more, those amino acids are just being oxidized elsewhere for energy. We do need protein, but we probably don’t need maybe as much as you think, although 30 grams is still– you do have to be mindful about how you get that into your diet, especially in your breakfast and lunch meal.

Then the 30 came about that he and Don started working on a study together, looking at the distribution.NHANES is a population-based data set that’s done every so many years. They gathered a ton of biomedical information. One of that is diet records. When you look at just total amount of protein for the day, are people hitting the RDA, most Americans, even in the older adults, sometimes older women, struggle to hit the RDA for protein. But by and large, we all eat a sufficient amount of protein across the day to prevent deficiency. The RDA is for deficiency.

Dr. Gabrielle Lyon  [0:29:24]

Which is 0.8 grams per kilogram or 0.37 grams per pound.

Dr. Emily Lantz  [0:29:27]

Right. But when you look at how it’s distributed across meals, the NHANES data at the time indicated that the average breakfast was about 10 grams of protein; lunch, maybe 15 to 20; andthen dinner was like 60. That’s when we’re having the steak. That’s when we’re really loading up. We call it a skewed distribution because it’s really skewed towards the evening meal. Doug’s idea was let’s flip this on its head.Let’s test this idea of a skew versus even protein distribution where you’re getting the same amount of protein for the day, but the timing of how you eat your protein is really crucial. That was one of those papers that came out, I think, in 2014 that really got people talking about, it’s not just how much protein you eat, it’s when you eat it.It’s having that even distribution of protein across the day.

Dr. Gabrielle Lyon  [0:30:18]

One of the things in the data is that the idea of this even distribution is this first meal of the day, which you and I were talking aboutbefore we started, is this concept that it’s most easy to measure. I believe nearly all the studies, I haven’t seen any studies looking at the middle meal or the last meal, have you?

Dr. Emily Lantz  [0:30:40]

Not when it comes to protein synthesis. There’s a second meal effect, I think, that people have looked at for blood glucose and some other outcomes, but not that I’m aware of when it comes to proteins and muscle protein synthesis.

Dr. Gabrielle Lyon  [0:30:52]

I am not either. That first meal of the day, when you hitthat minimum, I will say that I’ve seen some data that potentially, if someone is really looking for hypertrophy, there may be some benefit to going closer to 50 grams at a meal. So you hit that first meal of 30 to, let’s say, 50 grams of dietary protein. There are initiation factors that happen, IGF-4, mTOR, muscle protein synthesis happens.For the listener, muscle protein synthesis, can we agree that we would define it as this physiological process where there’s an incorporation of amino acids? We assume it is a biomarker for muscle health over time. We believe that it leads to a muscle accretion over time. That first meal, we have a muscle protein synthesis,these eIF4E, which stimulates this machinery. So now I’m going to ask you, the even distribution,do we know that that second meal requires the same amount of protein if after that first meal, those initiation factors are probably upregulated? Do we even know how long? I know for five hours. Do we even know how long that they get to work?

Dr. Emily Lantz  [0:32:13]

I’m not aware.If you eat a breakfast meal, let’s say 8:00 am, it takes about two hours or so for those amino acids to be digested and hit your bloodstream.The peak is about two to three hours. The machinery is going to come on. They would probably still be elevated when you’re eating your lunch meal and maybe hang around. Do you get a sustained response? I don’t know. I don’t really know.

Dr. Gabrielle Lyon  [0:32:41]

Isn’t that so interesting? I also, by the way, think an even distribution, for anyone who is looking for muscle health, anyone looking for weight loss, for blood sugar regulation through aging,there is also no harm in getting an even distribution.

Dr. Emily Lantz  [0:33:01]

You’re not going to go wrong. I think you were getting that with that second mealeven if you can get just two really good meals a day, because sometimes for people, they’re just not that hungry, like I said, especially as they get older. Really focusing on the first and the last meal, I think you can’t go wrong there either.

Dr. Gabrielle Lyon  [0:33:18]

I totally agree with that. We know that first meal of the day is really crucial. Do you have a hypothesis as to why? I have my own thoughts, but I’d love to hear yours. Then I want to talk about fasting. But I want to hear your thoughts on that first.

Dr. Emily Lantz  [0:33:34]

You mean as far as why the first meal is so important? I don’t know thatI’ve thought about it all that much.Please share yours. I’m interested.

Dr. Gabrielle Lyon  [0:33:42]

You’re coming out of a catabolic state.

Dr. Emily Lantz  [0:33:46]

Sure. It’s a mini catabolic state.

Dr. Gabrielle Lyon[0:33:48]

Yeah, in a mini catabolic state after an overnight fast. If you’re eating earlier on, you’re in line with this circadian rhythm,not fasting.Maybe two hours after you wake up, you’re hitting a minimum threshold or optimum threshold. You’re stimulating the machinery, protecting skeletal muscle.

Dr. Emily Lantz  [0:34:06]

Yeah, it makes sense when you think about it. I don’t think you want to go that far in between because protein degradation will continue. You really need to be able to stimulate that muscle machinery to turn on muscle protein synthesis and rebuild and response to that meal.

Dr. Gabrielle Lyon  [0:34:21]

I’m curious, do you think exercise has the same stimulation? I mean, obviously, you can stimulate muscle through exercise. Do you think that one is more impactful than the other, the amino acid response versus the mechanical load response?

Dr. Emily Lantz  [0:34:40]

I think when it comes down to it, your diet is foundational because if you are exercising, but you don’t have that infusion of amino acids from a meal to support the rebuilding of muscle that occurs following exercise, then your exercise is not going to be as beneficial as you want it to be. I’m a nutritionist at heart,so I’m always going to say nutrition. But I think for people who may not be able to exercise the way they want to, focus on diet. Pick one and then build on to the other. But I think if you’re going to pick which one to start with, you just want to pick diet.

Dr. Gabrielle Lyon  [0:35:15]

I love that answer because 100% of people eat.

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Dr. Emily Lantz  [0:37:19]

Yes, you have to. I love eating, that’s why I love nutrition.

Dr. Gabrielle Lyon  [0:37:23]

So 100% of people eat, and I really do like that answer.There is again, great benefit. You can’t just eat protein without doing resistance exercise. But we do know that if you do that, you have the best opportunity to prevent and maintain the health of skeletal muscle mass. Talk to me a little bit about fasting because fasting has been really a hot topic.

Dr. Emily Lantz  [0:37:46]

It has been.There are different strategies for fasting. There’s time-restricted eating where you eat only during a certain window. There are some people who will do intermittent fasting where they’ll go skip a day to maintain or to lose body weight. You know, there’s not a lot of literature that’s published around how it impacts muscle health. Therewas a really great review, I think Dan Moore did it, he’s out of Canada, talking about what do we know about how time-restricted eating is impacting muscle health, especially in older adults?Often it’s middle-aged women who are trying out different diets or middle-aged men who are trying out dietary habits. We know from research that they’re probably at risk for muscle loss, more so than maybe their younger counterparts.

I personally think there is something there to look at. There’s one study, I think Lucvan Loon put out saying there was no difference between time-restricted eating and more of a spread out. But I think that needs to be repeated in different populations. I believe it was in overweight men, andI really would like to see that done in women because I think women are more vulnerable to muscle loss. When you’re restricting your eating, you’re only eating meals during a certain period of time. That’s the pattern I’m most familiar with. Maybe you only eat between 8:00am and 2:00pm. One, it’s going to be hard to get all the protein you need in a really short amount of time. Two, because your meals are so spaced together, are you really turning on muscle protein synthesis? The machinery does quiet down, and if you’re only stimulating it maybe a couple times instead of that three times with a more spread-out meal, it’s one of those things muscle protein synthesis is hard to measure.

Dr. Gabrielle Lyon  [0:39:30]

Why is that?

Dr. Emily Lantz  [0:39:31]

We use a technique called stable isotopemethodology. Some of them, like in the bedrest studies and some of the other studies have I’ve been involved in, what it involves is an infusion of a labeled amino acid, phenylalanine. What happens is that amino acid goes into the bloodstream and enters the muscle and into the intracellular pool of amino acids that happen in the muscle after a meal. As the muscle protein synthesis machinery is turned on, that amino acid is then incorporated into the bound muscle proteins. We can use special equipment to measure how much protein is available in that intracellular pool as well as bound up into muscle protein. But that requires a procedure called a muscle biopsy.

Dr. Gabrielle Lyon  [0:40:19]

Which I had to do. I was just sitting here thinking—

Dr. Emily Lantz[0:40:21]

Have you had one?

Dr. Gabrielle Lyon[0:40:22]

No, I have not.

Dr. Emily Lantz  [0:40:23]

I’ve never had one. I could get my husband to do it, but they don’t want to do it.

Dr. Gabrielle Lyon  [0:40:26]

Yeah, new study participants, hard pass on that. I was just thinking as you were talking, because I knew you weregoing to get to the muscle biopsy part, I’m thinking yeah, so who had fellows have you guys roped in to be doing those muscle biopsies? Yes, I had to–

Dr. Emily Lantz  [0:40:41]

We have some special participants who have completed our studies because it takes a lot.Asking someone to be in bed for seven days, it’s a big ask. It’s a big ask. I’m really grateful to our participants who have really helped us advance the science because really, we couldn’t do it without them.I’ve done very intricate studies, andso that really asked a lot of our participants, so I’m really grateful for that.

Dr. Gabrielle Lyon  [0:41:08]

This is a plug for any research participants,Dr. EmilyLantz would like to put you on a bedrest study. No, I’m kidding. But it is always difficult. Those individuals you would do obviously the muscle biopsies before and after, and you would examine all these–

Dr. Emily Lantz  [0:41:25]

Yeah, before the meal, then about two to three hours after the meal, look at that incorporation into the muscle. We can also look at plasma amino acids to see how they change as well after a meal, looking at different protein sources and how plasma amino acids change in response.It’s a surrogate for what would at least be available for muscle protein synthesis.

Dr. Gabrielle Lyon  [0:41:46]

You had mentioned this 30 grams three times a day, this even distribution. What we didn’t talk about is how are we getting the 30 grams? Tell me a little bit about howbecause again, a 30-gram protein amount may be different from quinoa, or how do we think about the 30-gram dose?

Dr. Emily Lantz  [0:42:07]

Dietary protein is not all created equal. There are different protein sources that have amino acid profiles or makeups that more closely match what our body needs. There are two factors that we look at when we look at protein quality.One is being the amino acid profile.Does it have the essential amino acids that our body needs?The other is digestibility. Is it even available to be digested by our intestine, taken up into the bloodstream, available to the muscle?Animal proteins are considered higher quality proteins across the board; dairy, lean pork, chicken, those are high-quality complete protein.They offer a complete essential amino acid profile. They’re easily digested by our bodies.

However, plant-based proteins, some of them like soy can be higher quality, they just don’t match what is available from animal protein. Now, I think if you want to eat a more plant-forward diet, you can probably meet your protein needs. But where you might run into issues are with volume. If you take a serving of lean protein, like beef, you need about 3 ounces. It’s about a deck of playing cards. It’s the palm of your hand, not a large amount of meat to really meet all of your protein needs for that meal. That’s 30 grams right there, super easy. But with plant-based proteins, you need a much greater volume. It’s a half a cup of quinoa or beans, that’s only about 6 to 8 grams of protein. If you’re thinking about, I need to get 30 grams of protein, first step is you’re going to have to eat a lot of plant-based proteins.

Dr. Gabrielle Lyon  [0:43:52]

Some proteins, they need it.

Dr. Emily Lantz  [0:43:56]

On top of thatis if you’re only eating a single plant source, often those plant sources are going to be lacking in one or two essential amino acids. You have to think about combining plant sources.

Dr. Gabrielle Lyon[0:44:11]

Like a lysine, like wheat would be lower in lysine.

Dr. Emily Lantz[0:44:13]

Wheat and beans, rice and beans.

Dr. Gabrielle Lyon  [0:44:15]

Low in methionine. You had mentioned earlier that as individuals age, they have a decrease in appetite. How would someone who is more plant-based be able to, if we’re really thinking about the protection of skeletal muscle, especially through menopause, how would someone do that? The other thing that you mentioned was the macronutrient protein. What about iron, zinc, bioavailable B-vitamins? How do we think about that?

Dr. Emily Lantz  [0:44:42]

You’re right, because we talk a lot about protein, but there are other macronutrients we need.There are other micronutrients we need that you may not be able to get if you’re really just focusing on plant-based protein. That’s what I really like about animal-based protein or incorporating even a small amount into your diet is it gives you room for other food sources because I think variety in your diet is more exciting. You’re going to meet your other dietary requirements much more easily rather than if you’re just focusing on plant-based proteins. As far as how can you do it? That’s a great question. I think it’s going to have to come down to some creativity and some more planning than perhaps supplementation, if you really struggle to get the amount of protein that you need. I think that if you are willing and it’s part of your lifestyle to incorporate animal-based protein, that will help you meet your protein needs much more easily.

Dr. Gabrielle Lyon  [0:45:35]

There’s the 30 grams of dietary protein with an even distribution. If you were to go more plant-based, would you say that’s maybe a 45-gram dose three times a day? Does it depend on the source?

Dr. Emily Lantz [0:45:47]

I don’t really necessarily need to go higher. Well, maybe you do to meet your leucine needs.I’ll give you an example. We were wrapping up a study, and we’re writing up a paper where we looked at complete protein sources versus some incompleteprotein sources and then combining a couple of incomplete protein sources together. We did this and looking at muscle protein synthesis. We did this in some older women. One of the biggest issues we ran into was satiety. Our participants just couldn’t finish.We started out with 30 grams, and we actually had to knock it back a little bit.We were taking it to an extreme because we were only looking at one plant-based, we were looking at wheat-based protein for one of the breakfast meals. It’s not very exciting to eat just wheat protein. It was nine slices of whole wheat bread.

Dr. Gabrielle Lyon  [0:46:44]

Which, that sounds disgusting.

Dr. Emily Lantz  [0:46:47]

No one really enjoyed that meal.

Dr. Gabrielle Lyon  [0:46:49]

Unless you’re wanting to commit carboxide, goright ahead.According to NHANES data, that’s the main source ofplant-based protein,which is from wheat, for majority of the Americans. Is that true?

Dr. Emily Lantz  [0:47:05]

I don’t know if I think it is because we eat a lot of bread. We love bread. Butno, I don’t love nine slices of bread.

Dr. Gabrielle Lyon  [0:47:12]

Nine slices, so they couldn’t finish that.If you were to—

Dr. Emily Lantz  [0:47:16]

We need knock it back.

Dr. Gabrielle Lyon[0:47:17]

The goal was to make an equivalent if it was just coming from wheat, and they couldn’t finish it.

Dr. Emily Lantz  [0:47:21]

They couldn’t finish it, yeah.

Dr. Gabrielle Lyon  [0:47:24]

Your overall recommendation would be to incorporate a combination of plants and animals. The other interesting thing that you said was that in your bedrest studies, you added leucine. Another way, potentially, to think about it is if you didn’t want to eat 3 or 4 ounces of an animal-based product, you could potentially half of that, andthen add in, I typically recommend either a full essential amino acid mix because you do need all of the essential amino acids, or potentially even a branched chain supplement may be beneficial. But then again, you’re also missing this food matrix.

Dr. Emily Lantz  [0:48:02]

Right, and those are hitting your bloodstream a lot more quickly than they would in a whole meal.

Dr. Gabrielle Lyon  [0:48:06]

What happens? What are your thoughts? A typical mix meal would take about two hours. What is the implication of a liquid meal, of a shake? Is there a potential downside to that robust amino acid response?

Dr. Emily Lantz  [0:48:21]

I don’t know if I can give you a really direct answer because we didn’t look at muscle protein synthesis. But in that bedrest model, we did another arm. We did a lot of participants where we replaced all of the protein in the diet, most of the protein in the diet was whey protein.Instead of giving them, for breakfast, maybe you had fruit and pancakes and then a whey protein shake, and the other group would get pancakes, sausage, and the same fruit salad. It was very matched in the content of the diet, it’s just instead of getting an animal-based protein, they would get whey protein. We saw that just improving the quality of the protein in their diet using whey protein had an effect and slowed the loss of muscle mass in those older adults offering them a high quality.Whey is pretty much the highest quality protein you can get. That was able to very partially protect the loss of muscle.

Dr. Gabrielle Lyon[0:49:20]

What dose was it?

Dr. Emily Lantz  [0:49:22]

We just replaced the protein, so it was 0.9.

Dr. Gabrielle Lyon  [0:49:25]

Okay, so probably one scoop.

Dr. Emily Lantz  [0:49:27]

Yeah, something like probably 20 grams or so.

Dr. Gabrielle Lyon[0:49:30]

Easy, super easy.

Dr. Emily Lantz  [0:49:32]

If that’s a concern for someone who’s like, hey, I’m really struggling to get protein in their diet, I don’t personally use protein supplements right now, but I’ve—

Dr. Gabrielle Lyon[0:49:41]

You have five kids.You are eating off their plate. It’s not good.

Dr. Emily Lantz  [0:49:43]

I pretty much– Yeah, I’m really—

Dr. Gabrielle Lyon  [0:49:46]

Is this all on the floor? No, it’stotally fine.

Dr. Emily Lantz  [0:49:47]

I’m a super taster. I did one of those studies where they painted your tongue. I can taste a lot of whey very easily, and it has a bitter taste to me.The taste of it’s kind of funny.But for those of you who like whey protein, it’s really a great place to start.

Dr. Gabrielle Lyon  [0:50:03]

I absolutely agree with you. Now you have been involved in translational clinical trials, which I think is a very fascinating focus on developing an understanding of the changes in molecular markers in skeletal muscle during the periods and immediately following disuse. Is the biomarker for that, is that muscle protein synthesis? Are there other biomarkers that you guys were looking at specifically? Just out of curiosity there.

Dr. Emily Lantz  [0:50:36]

There’s a study we’re looking at right now. One of the things we noticed during bedrest, so this is building on the bedrest study, is that you see, despite this very rigorous protocol—we had these participants locked down essentially—that you still saw a variation in how much muscle mass I lost.On average, it’s pretty consistent about 2 kilos, but you have some people where the muscle just falls off, and then some that are more protected. We really want to get out, are there some biomarkers apart from muscle protein synthesis? Are there some genes that are protective against muscle loss that these people are expressing? So not getting necessarily at genetic variation where we’re looking at alleles and genes per se, but more what’s differentiating people in how they’re losing muscle?

Dr. Gabrielle Lyon  [0:51:23]

That is fascinating. I did not know that. I haven’t really thought about that.

Dr. Emily Lantz  [0:51:28]

Right, because there’s responders, non-responders. Well, some people don’t like that term, but I’m going to say it because it’s easy to understand. But there’s some people who respond really well to exercise.You train them for 12 weeks, they put on muscle like they they’re supposed to, and then you have some who don’t.We follow a bell curveeven with something that should be the same stimulus, but there’s some people who are either high responders or low responders. There is that to disuse as well, so what’s protective.

Dr. Gabrielle Lyon  [0:51:54]

That’s incredible, this idea that there is a variation of this disuse and atrophy and hypertrophy, so both sides of the spectrum. Have you thought about– I’m going to lay out two things that just come to mind. Number one, past history of training. Potentially, I’m sure you guys looked at where they were starting with muscle massand probably body composition similarities, or is it a fiber type?

Dr. Emily Lantz  [0:52:20]

That’s a great question. That’s something we’re looking at is we’re taking muscle biopsies, because that’s what we do, to look at muscle fiber type composition. As far as training history goes, we tried to get people who are somewhat recreationally active, who maybe trained when they were in their 20s. But we use a middle-aged population, so they’re not currently super active.

Dr. Gabrielle Lyon  [0:52:45]

We’re working onchanging that.

Dr. Emily Lantz[0:52:46]

Or we’re going to change it.

Dr. Gabrielle Lyon[0:52:47]

Just wrote a book called, Forever Strong. We are definitely working on changing that trajectory of aging and thinking about it. But you did see variations of individuals that were more vulnerable. Do you have any hypothesis, or it’s really still early to tell?

Dr. Emily Lantz  [0:53:00]

It’s really still too early to tell.There’s probably some genetic play in it, but we just don’t know yet.

Dr. Gabrielle Lyon  [0:53:08]

I was looking at some of your earlier research, too. You were looking at those that were also more at risk for hyperglycemia. That was a genetic component.

Dr. Emily Lantz  [0:53:17]

Yes. I mentioned earlier that when you have that extended period of bedrest, insulin sensitivity drops. So from the diabetes research, to really identify what genes or what alleles are responsible for some of the physiological processes that we’re looking at, you need to have these huge genome-wide association studies, which, with diabetes, there’s thatliterature in the populations that are available. What we did is we took those probably top 10 genes that are most associated with hyperglycemia, and we looked at the genetic variants in our population. We were able to identify that, yes, if these participants had these genetic variants, then they were more at risk for uncontrolled glucose or not well controlled glucose during bedrest. It’s thinking about how that would be used in the clinic. We’re not quite there yet, but if you know yourgenotype when you’re going into a clinical setting, your healthcare provider could use thatinformation and say, hey, we need to more closely monitor this person’s blood glucose. We’re not there yet, but I think that’s where it’s going.

Dr. Gabrielle Lyon  [0:54:24]

Right, and overarching, if someone can be ambulating regardless of gene type, those individuals going into hospital or even you listening at home, if you’re listening to this eating a bag of Cheetos,you’re in big trouble. Hopefully, you will be inspired.Those individuals going into a hospital setting, we know that it doesn’t really matter your age.If you are going on bedrest, which again, is a pretty extreme model, but an average person will lose two pounds of muscle. If you’re younger, you will be able to recover faster than if you are older.But again, we are now more sedentary than ever before, and 50% of individuals aren’t even exercising, this becomes a challenge. Then the next thing is in my mind as a clinician who sees patients, the immediate thing that I would think is, are there some potential muscle stimulation devices, especially in leg muscles that you could put on like a stim suit or something to create that contraction?

Dr. Emily Lantz  [0:55:26]

I want to say there’s a couple of studies. I’m not familiar with the literature very much on stimulation. But I think there are some people who have thought about that. As far as walking goes, it’s walking a fine line, no pun intended, when you’re hospitalized because for some older adults, because of the medications they are on, because of problems with balancing, might be a fall risk, and that can be an issue for them. Another group in that bedrest study that we did, we had them get up and walk for 20 minutes a dayat a moderate heart rate. They were actually meeting, if you can believe this. They were meeting the recommended amount of exercise for the week.We should say this was in the absence of any other activity you would do in the background with their heart rate because we had them walking fast enough.Their heart rate was elevated enough for 20 minutes a day to meet that physical activity recommendation.

Dr. Gabrielle Lyon[0:56:28]

Which is 150 minutes.

Dr. Emily Lantz  [0:56:29]

It was 150 minutes in the absence of any other activity. So I will give you that caveat. But that was still not enough to prevent the muscle loss. They were no different than our controls. They lost a little bit less muscle than those that didn’t have protein support. They didn’t have any whey protein on board, but they were very similar to our controls. The one thing that we did see there was insulin sensitivity.

Dr. Gabrielle Lyon[0:56:54]

I was going to ask you, what about their insulin sensitivity?It was probably better.

Dr. Emily Lantz  [0:56:55]

That was preserved during bedrest, so there was that benefiteven though they still lost some muscle. I think their strength was somewhat preserved, too, because muscle mass and strength don’t always follow each other. Sometimes that loss of muscle mass will precede the loss in strength.

Dr. Gabrielle Lyon  [0:57:11]

The opposite is true. Sometimes you’ll get stronger before you see mass.You’ve authored quite a few papers, and I encourage everyone to go look upDr. EmilyLantz. This paperwas improvements in sleep quality and fatigue are associated with improvements in functional recovery following hospitalization in older adults, and this study focused on the relationship between sleep quality and physical functioning in older adults during their hospital stayat a four-week follow up. The goal was to understand how changes in sleep quality and related factors might impact recovery and functional independence after hospitalization. I would love to hear a little bit more about it. I’m not putting on the spot. By the way, I have no tariff if you’d like to–

Dr. Emily Lantz  [0:58:00]

Let me see what I can remember if I need you to slide it over. This was a study that started asa collaboration with a good friend who’s a sleep researcher. But she’s interested in bio-outcomes. So a lot of times, sleep researchers are somewhat self-contained and looking at sleep outcomes. But she’s interested in getting into more of what are some other health outcomes that sleep can impact, which is great, aside from cognition.In this particular study, we were looking at sleep and physical function in older adults posthospitalization.We know that sleep is disturbed in the hospital; that’s a really well known phenomenon.

Dr. Gabrielle Lyon  [0:58:40]

What is the average waking?

Dr. Emily Lantz[0:58:42]

I don’t know.

Dr. Gabrielle Lyon[0:58:43]

I think it’s like 37 times, something outrageous.

Dr. Emily Lantz  [0:58:45]

No way.

Dr. Gabrielle Lyon[0:58:46]

I’m exaggerating.

Dr. Emily Lantz  [0:58:47]

But it does feel like that. I can say, after having been in the hospital when I’ve had my five kids.One is I’m always lying in bed, I’m like, I’ve got to get up. I’m losing muscle.I gotto get up and walk. But the other one is they come in at night.They disturb your sleep. I think hospitals are recognizing thatand they’re trying to make changes, but that’s an institutional thing that takes time and changing culture. But what we did in the studies, we have an acute care for elders facility at UTMB. As patients were admitted, they opted to enroll in the study. We gave them a questionnaire at the beginning of their stayand then followed them until 30 days after their discharge.The questionnaires were about sleep. We also did some physical outcome measures. It’s called the SPBBor short physical performance battery. It’s a series of a few tests to look at lower limb extremity function, and it’s especially important for older adults.It’s really only valid in older adults.

Dr. Gabrielle Lyon  [0:59:50]

We did that in geriatrics where I did my training. That was one of the things that we always saw.

Dr. Emily Lantz  [0:59:55]

There’s chair rise, so can they get up and down, balance, walk,and then feet speed. They’re all scored. What we found is that one of the things that was most predictive of physical function posthospitalization was actually daytime sleepiness. When we think of sleep, we often think of, I couldn’t sleep at night. I wake up, and I don’t feel refreshed. But that also then follows you throughout the day. It makes sense if you think about it.If you are tired during the day, you don’t want to get up and do anything. These people are coming home from the hospital, and instead of getting up and even just walking or doing something very simple around the house, they’re not doing anything. So what that plays into is the incomplete recovery, lower physical function following hospitalization. So they’re more likely to be re-hospitalized. We follow that up then with another study and found a very similar outcome with a larger group of people where their sleep is very predictive of physical functioneven at 30 days post hospitalization.

Dr. Gabrielle Lyon  [1:01:07]

Do we have a molecular understanding?

Dr. Emily Lantz  [1:01:10]

We’re not there yet. Older adults post hospitalization, they’re not really up for muscle biopsies, so we’re not there yet. But there was a study that I did a few years ago with a group from Australia where we looked at sleep deprivation, so took a group of young adults, deprive them of sleep overnight and looked at muscle protein synthesis pre, post and found that just one night of sleep deprivation, there’s a decrease in muscle protein synthesis. Skeletal muscle has a high number of clock genes which are part of the circadian rhythm, so it’s not surprising that it’s impacted by sleep. But we’re just now starting to understand maybe the implications of sleep health and muscle health.

Dr. Gabrielle Lyon  [1:01:55]

Say that again. I just think it’s so important for the listener. Say that again for them.I’m assuming they went 24 hours with no sleep.

Dr. Emily Lantz  [1:02:08]

Yeah, I think that’s what it was. These young adults went about 24 hours without any sleep, and we saw a decline in muscle protein synthesis. There was another group that followed this upwhere they did five days of sleep restriction. It’s not total deprivation. I don’t think any of us could go five days with no sleep. But they restricted their sleep to, I think, maybe fourhours a night, maybe three or four hours, and saw a very similar decline in muscle protein synthesis. If you are someone who is chronically sleep restricted or has poor sleep quality, then it’s likely that is having an impact on your muscle health.

Dr. Gabrielle Lyon  [1:02:43]

Itimmediately makes me think of individuals that are staying up all night trying to work, raise kids, college students and beyond, entrepreneurs, and individuals with sleep apnea. Military folks going through hell week, well, there is not much you can do about that. Do we know what percent decline roughly or a percent of a blunted muscle protein synthesis response? Can that be overcome with dietary protein?

Dr. Emily Lantz  [1:03:13]

If I remember off the top of my head correctly, I think it was an 18% decline in muscle protein synthesis was one night of sleep deprivation. Now there are some groups have been looked at. I think it was in that same paper or same group that did the five nights of sleep restrictions, they used exercise to try and overcome it. But I think it was pretty heavy duty,serious exercises. The reason that people are often sleep restricted, like you said, kids, work schedules, may often prevent someone from exercising like they did in the study. So I don’t know if that’s always going to be a practical solution to overcoming sleep restriction or sleep deprivation.

As far as dietary protein goes, I don’t know because then it comes down to timing. When would you need that bolus to prevent the decline of muscle protein synthesis? So one thing I’m interested in thinking about in the future is how do we improve sleep in populations where that might be appropriate? So post hospitalization, if someone has a lot of pain, addressing their pain, to improve their sleep, improving their muscle health. I think it’s all pieces of the puzzle.Often, when we do a study, we can only look at one thing.But we’re really a whole body, and we have many systems, and they talk to each other, and so it’s hard to control that. But we can look at these individual questions one at a time.

Dr. Gabrielle Lyon  [1:04:42]

The idea that if someone is sleep restricted for five nights, and let’s say they’re getting four hours a night, but there may be some buffering with extremely intense exercise.Conceptually, it’s interesting that if you potentially are young and healthy and you’re going through a major push phase of your life, if you are not sleeping, potentially, could there be some offsetting result due to physical behaviors would be incredibly fascinating.

Now I want to talk to you about this protein distribution. I have looked at some of the literature, and it seems if we were to think about the hierarchy of protein importance, it really comes down to, in a normal population, a 24-hour response. I know that you have a paper dietary protein distribution influences this 24-hour muscle protein synthesis response in healthy adults. I want to talk about that. But before we do, if someone is getting a really robust amount of protein, let’s say they’re getting 1.6 grams per kg.So they would be double the RDA and aging between 1.2 to 1.6. So they’re going a little bit higher. Would a distribution matter in a young versus old population?

Dr. Emily Lantz  [1:06:06]

If you’re eating 1.6, you’re going to be pretty close to hitting your 30 grams just at 1.6 in a single meal. So I don’t think distribution matters as much once you’ve hit that threshold.

Dr. Gabrielle Lyon  [1:06:25]

I totally agree with that. I would totally agree with that. But where it does matter is if potentially you’re on the lower protein level or older or in some kind of catabolic crisis.

Dr. Emily Lantz  [1:06:36]

Right. Even maybe if you’re training, your timing of meals around exercise may matter a bit more. But ifyou’re justa normal person needing 1.6 to– I shouldn’t say normal. If you’re like me, and you don’t work out,if you’re meeting thatmoderate amount of protein, so 25 to 30 grams, distribution may not matter as much.

Dr. Gabrielle Lyon  [1:07:09]

When I think about the distribution, when there’s anabolic resistancepotentially for an individual, and then you layer in– some of that earlier research looked at old skeletal muscle and younger skeletal muscle, and there was a synergistic response of adding in exercise and then dietary protein. That older muscle mounted a robust response like a younger muscle, which I thought was really fascinating. Tell me about any of the others. I mean, you’ve got a whole list of studies here to talk about. Is there anything else that is really particularly interesting?Again, this dietary protein distribution, how it influences 24-hour muscle protein synthesispotentially.We talked about some of that. This, I thought was interesting. A moderate serving of a lower quality incomplete protein does not stimulate skeletal muscle protein synthesis.

Dr. Emily Lantz  [1:08:06]

I alluded to that study earlier when I was talking about how hard it is to meet protein needs with plant-based proteins. That was actually an abstract, and we’re about ready to publish the paper from that one. I don’t want to give it all away.People will have to read the paper, hopefully coming soon this fall to a journal near you. But one thing that we did notice is that it’s easier to moderate blood glucose with animal proteins because the carbohydrate-based wheat protein just has a robust response to the meal.So if that’s something that you’re concerned about, that’s another piece to be thinking about when you consider should you use plant- versus animal-based protein in your meals.

Dr. Gabrielle Lyon  [1:08:51]

Where do you see the future? I mean, we do have this issue of how do we feed a population? Where do you see the future of protein research going as it relates tothis? In the science world, I think people are much less emotional about this plant and animal proteins. It seems as if inthe social media world, there is really a lot of heated conversations. Again, you’re a protein researcher. I haven’t heard any emotion or any  thoughts either way. It purely is what is the data showing? The next question then becomes how do we reconcile feeding an entire nation?

Dr. Emily Lantz  [1:09:37]

I think that’s the question. I don’t know if I have a good pat answer for you because it is something that even experts still wrestle with at a global population scale. But I think we talked about this earlier. It’s really about how do we feed a population? There are a lot of plant-based proteins that are coming out that may be somewhat equivalent in amino acid profile, but I think it’s going to come down to the processing of them. Are they as bioavailable? I don’t know. And just the palatability, is this pleasurable to eat?Maybe we can produce these.The cost, is it going to be something, the acceptability? So there’s a lot of other questions that arebeyond my expertise that really have to be weighed in on for how we’re going to address those sorts of questions. I think we’re going to continue to refine our understanding of protein needs for specific populations, too.

Dr. Gabrielle Lyon  [1:10:38]

Yeah, and one of the other things, I don’t know if you have heard of the EAA9, have you heard of that?

Dr. Emily Lantz  [1:10:45]

I haven’t.

Dr. Gabrielle Lyon[1:10:46]

The EAA9 is this wise code group, and they’re coming out with a protein scoring that’s different than PDCAAS and DIAAS. It’s really based on the essential amino acids. It’s based on the nine essentials because not all amino acids are equally limiting. Also, the impact of these individual amino acids is obviously variable, whether it’s leucine, lysine, or methionine. But basically, it’s going to be a scoring system, so the idea is how do we move from thinking about protein as a macronutrient to each amino acid as an individual nutrient?

Dr. Emily Lantz  [1:11:23]

Interesting. That’s really flipping it on its head because for so long, we’ve just talked about protein as this singular force, but it’s really not. It’s a little more complicated than thatand nuanced.

Dr. Gabrielle Lyon  [1:11:34]

Exactly. How do we address it at certain populations that are more vulnerable? Do those individuals have different essential amino acid needs? Because we all know that amino acids have different biological roles, although we speak about it in protein.Again, these individual amino acids do multiple things within the body versus some of the other macronutrients and the way in which they break down. In terms of your supplementation, when you think about supplements or dietary supplements, have you thought about that much?

Dr. Emily Lantz  [1:12:06]

We touched on it briefly.Are you talking about outside of protein, or are you still talking about–

Dr. Gabrielle Lyon  [1:12:11]

Whey protein, thinkingif you were to think about muscle health, have you looked at any?Obviously, you look at whey protein. Are there other things potentially that you’ve been interested in or looked at, or you’re really focused on whey protein?

Dr. Emily Lantz  [1:12:26]

We’ve used whey protein in the pastbecause one, it’s very accessible to most people. I think one thing that Doug and I really valued when we were coming up with some of these ideas we did together was, can this be translated into a population?

Dr. Gabrielle Lyon  [1:12:40]

Doug was really phenomenal about making– for you guys who don’t know, Doug Paddon-Jones, he’s published numerous papersand multiple lectures out there. He really did a phenomenal job of the translational science into from bench to bedside. Yeah, really phenomenal.

Dr. Emily Lantz  [1:12:59]

I’m really trying to carry that legacy on. That’s one reason we chose whey protein is it’s something that eventually could be used in a clinical setting to support muscle health because it’s relatively cheap compared to some of the other supplements that are out there. But I think there’s still room.Soy is another one that’s very well researched for someone who’s looking for plant-based protein. There might be some other concerns about that.

Dr. Gabrielle Lyon[1:13:26]

Like what?

Dr. Emily Lantz  [1:13:28]

Just phytoestrogens for someone who might be concerned about that, although I think the literature hasagreed that it’s been probably okay. I’ll give you a personal story.One of my kids, when he was growing up, had a dairy allergy for a long time. Then he had a soy allergy, and he started dropping off his growth curve. As a protein researcher, I started looking for what are some other protein sources I can get into?

Dr. Gabrielle Lyon[1:13:56]

And you landed on cricket?

Dr. Emily Lantz  [1:13:58]

No, I skipped over cricket, skipped over cockroach. But there’s a pea protein-based milk that you can buy now, and that’s what saved us. That’s how he got back on his growth curve, andhe is doing well. He’s eight years old now.

Dr. Gabrielle Lyon  [1:14:11]

I think that’s incredible. It’s incredible to think that again, we’re thinking about protein, andthose amino acids obviously met his needs so that he was able to regain his growth curve. I always think about pea.Again, it’s that concentrated—

Dr. Emily Lantz  [1:14:25]

Right, it’s a concentrate.

Dr. Gabrielle Lyon[1:14:27]

I just don’t know how we would get what other– so there’s a protein in it, but there’s probablyother– I don’t know if they’re nutrients, but there are other compounds in there that as humans, we don’t consume in that quantity. It’s just something that’s heavy.You hadn’t thought much about that.

Dr. Emily Lantz  [1:14:47]

Not necessarily because concentrates tend to be more purified. There is that concern when it comes to supplements; they’re not regulated. I’m alwayscareful about recommending them for people. Whey is an isolate. It’s been around for a long time. But for the new and emerging things, I’m always more cautious. I’m a late adopter to a lot of things.

Dr. Gabrielle Lyon  [1:15:11]

Where do you think the future is just going in protein research? I know that you currently have a trial underway, and you’re looking at the sex-specific differences in recovery from skeletal muscles disuse, which I think I cannot wait for that.

Dr. Emily Lantz  [1:15:26]

Yes. I’m really excited for that one.

Dr. Gabrielle Lyon[1:15:27]

I am curious as to what the hypothesis is that you’re actually trying to test? Is this the future of protein research?

Dr. Emily Lantz  [1:15:36]

I think one of the features of research in general, probably not just protein and muscle research, but sex-based differences.Men and women are not created– we’re different.We have different needs. A lot of biomedical research was done in men. Women’s health in a lot of areas is still lagging.We’re basing a lot of our decisions and our assumptions in especially muscle protein research that is from male-dominated studiesand young men, college men, college ageguys. We’re going to start to seea lot more focus on what are some factors that may influence difference in response between men and women? What are those factors, and how can we optimize muscle health for both genders?

Dr. Gabrielle Lyon  [1:16:24]

Do you think that the distribution will change?

Dr. Emily Lantz  [1:16:26]

I don’t think so. I think the distribution concept is going to stay. I think, perhaps, the amount might continue.Is it always going to be 30? Do you need exactly 30? That mightbe tweaked over time. But is it necessary? Can we usethis wide umbrella? Because once you get too specific, it can be hard for people to remember like, okay, I’m 35 now, how much do I need? But if you are hitting that 30 mark, you are most likely covered.

Dr. Gabrielle Lyon  [1:17:00]

Any hypothesis as to where you think that some of the changes might be in terms of implementing strategies?

Dr. Emily Lantz  [1:17:08]

Let me think about that. One thing I’ve alluded to, I think in younger adults, I don’t think there’s going to need to be as much thought about because most of the time, their responses are fairly similar. I think it’s really once you hit that aging, as women go through menopause and their risk profile changes, I think that’s when we really start to think about what kind of recommendations should we be making for these populations?

Dr. Gabrielle Lyon  [1:17:37]

Maybe you will help change the protein recommendation. Currently, it still hasn’t changed since1968 even though evidence supports that for a more optimal aging trajectory, but it really has not defined hormone changes, whether it’s menopause or even low levels of testosterone and other ways.

Dr. Emily Lantz  [1:18:01]

Or a clinical setting, if you’re hospitalized, if you were in an acute care setting, do you need more? We can define need, but I think there’s also the delivery.How are you getting people who need dietary protein to support their muscle health? How are we getting that to them?

Dr. Gabrielle Lyon  [1:18:20]

Well, if I was a betting woman, I would say that Dr. Emily Lantz may potentially change that trajectory of what is happening. Is there anything that you’d like to add, anything that you think is really important that potentially we didn’t hit upon that is on the top of your mind?

Dr. Emily Lantz  [1:18:44]

I think that we’re going to continue to have a better understanding of– we talked about sleep.But I think there’s going to be other thingsas our body of literature and our knowledge grows. I think even the idea that you can’t do science in a silo anymore.There are still some single investigators out there,but now a lot of human research is really translational team-based science. You’re seeing expertise from so many different areas come together to address questions. I have collaborated with a really awesome sleep researcher to ask some questions I couldn’t ask on my own. I think as you see stronger teams being built, that we’re going to see wider issues addressed because we have a more complete understanding and a wider expertise space to start asking some really interesting questions.

Dr. Gabrielle Lyon  [1:19:33]

That’ll be incredible. We will be on the lookout for your papers as soon as it hits.Some of those are coming out. If they are free access, we will link them for visibility. Dr. Emily Lantz, where can people find you? Well, maybe we don’t want to say can’t find her anywhere. But you can find her research on Google Scholar.

Dr. Emily Lantz  [1:19:53]

Google Scholar, the UTMB website; I have a faculty profile there. I’m on LinkedIn.You can find me on LinkedIn professionally.

Dr. Gabrielle Lyon  [1:20:01]

Don’t message her, guys. Come on. Don’t message her. Thank you so much. Thank you so much for coming on. It is wonderful to have you in studio and very grateful for your time.

Dr. Emily Lantz  [1:20:12]

Well, thankyou so much. I’m really honored to be here, and I really loved having this conversation with you today. Thank you.

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Dr. Gabrielle Lyon  [1:20:19]

The Dr. Gabrielle Lyon podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No patient-doctor relationship is formed. The use of information on this podcast, YouTube, or materials linked from the podcast or YouTube is at the user’s own risk. The content of this podcast is not intended to substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions. This is purely for entertainment and educational purposes only.