[ 00:00:00 ]Welcome to the Dr. Gabrielle Lyons Show, where cutting-edge science meets innovation and practical application for everybody. This is a very special episode in which I bring you my dear friend, Dr. Jamie Baum. She’s an associate professor at the University of Arkansas, and I trained with her at the University of Illinois. In this episode, we discuss some fascinating things that I guarantee you have not heard anywhere else. We talk about the role of skeletal muscle in appetite regulation. Yep, you heard that right. We also discuss perimenopause, postmenopause nutrition, where the science is, and where we need more of it. We discuss the different forms of dietary protein and their impact on appetite regulation so much more. Please sit down with me for this episode with Jamie Baum. Dr. Dr. Dr.

[ 00:00:57 ] Jamie Baum, welcome to the show. You are currently an associate professor in the Department of Food Sciences, and you are the director of the Center for Human Nutrition at the University of Arkansas. But wait, more importantly, you and I, we go way back. We go back to undergraduate. That’s correct. And we both trained with Don Lehman, which is amazing. You went on and you’ve actually done extraordinary things. You’ve gone on as a PhD in nutritional sciences. You’ve played a role in industry, as well as current research and really educating. Welcome to the show. Thanks. I’m glad we finally made this work. Yeah. I mean, listen, I’ve been asking you to come on to the show for like two years. Yeah. And it’s been awesome to see what a rock star you’ve become.

[ 00:01:50 ] Well, thank you. And obviously, we don’t do it alone. I do it with people like you and Don. Um, I, I am really excited to share you with the audience because when I have a question, I will call you. Oftentimes, I will call you. I will say, hey, Jamie, what are you thinking about? Where are we at with protein for women? This perimenopause, postmenopause space seems to be growing exponentially. And, um, you know, your original research really focused on the role of dietary protein, amino acids, fatty acids, and regulation of skeletal muscle. Mm-hmm. And you are now very interested in, um, women’s health, among other things. That’s right. I was actually thinking about this as I was preparing to come here today, because I think one of the first projects, I’m not sure if you helped with it or not, that I worked on with Don was in weight loss in women with higher protein intake.

[ 00:02:43 ] And as the decades have passed and I sit at conferences, I noticed that the protein space is really underrepresented. Uh, women are really underrepresented, both in research and as the people doing the research. And I think, you know, that’s kind of fueled my passion in these last few years is to get us more represented and at the table. Yeah. Um, I think that that’s very true when you, and women in all research, but very much so in the protein and muscle space. And, um, there was Emily, do you know Emily Lance? Yes. We met a couple of times. Okay. So she is, I think she’s not a gal, listen, she’s yeah, I think she is. She is a Galveston. And she was talking about how dietary protein recommendations are not exactly know why not based on muscle mass, maybe different for women.

[ 00:03:38 ] Um, I don’t know where you are with that, or if you’ve thought about it or where some of the current research is that around women. Yeah. So what is it? We’ve published a few review papers several years ago with Bob Wolf, who sort of, we all know Bob Wolf. Yes. The Mecca of protein and protein requirements. And, you know, the initial work for protein requirements was done in young college-age males. That’s where the whole 0. 8 grams per kilogram body weight protein started. There hasn’t been much update since then. Um, isn’t that crazy? There has not been updates for changing guidelines. That’s right. And I know they recently did a literature search. They’re trying to see what’s out there. Do the, can the guidelines be updated based on the data? Yeah.

[ 00:04:26 ] So, um, and the benchmark has not moved since these guidelines were created. So it’s amazing to me that this hasn’t been done at least with the dietary guidelines. They’re recognizing finally that not everyone age 19 and older and has the same requirements for protein. Um, but it really just seems that whatever they’re looking for, um, in terms of moving the needle on recommendations, the research just isn’t there yet to make a declaration. Do you have any sense as to why? And, you know, Don will tell us, I’m sure, you know, he’s expressed this to you that really it’s complicated that when we make a recommendation for the guidelines, we have to also interface that with the WHO and think about how that affects the rest of the world.

[ 00:05:15 ] And perhaps that’s one reason why dietary protein requirements have not increased. I don’t know what your perspective is. Um, I think all of those things are true. I think the studies are also true. I think the studies are also true. I think the studies are also very expensive to do that work and they’re complicated. Um, it requires, you know, use of usually stable isotopes, which are usually a mate, which are amino acids with a special label on them that you can trace through the system, figure out if they’re going into muscle and how much muscle they’re building or breaking down. So those are really expensive, time-consuming, and complicated projects. And I think the number of people you would have to study to get some sort of idea for the general global population is really, really expensive.

[ 00:05:56 ] And I think the number of people you would have to study to get some sort of idea for the general global population is probably massive. And, um, it’s just not there yet, but really most of the data is with healthy young men or now that we see a lot with older adults, you know, with muscle protein turnover and things like that. Making meaning it’s, they’re getting increased frequency, increased rates of protein turnover. It seems to be very challenging to keep muscle on them. Um, you know, I spoke with Blake Rasmussen, do you know Blake? And Blake was talking about how, you know, mTOR signaling, which for the listener is mechanistic targeted rapamycin. It’s one of the key regulators for muscle protein synthesis is actually essentially not suppressed, but it’s constantly on and it’s moving faster.

[ 00:06:39 ] And the expression of it is increased as we age. Yeah. I’m not sure what the human work I’ve seen, some of the stuff I’ve seen, I think in public papers from Blake’s lab seems that what you see physiologically. So the changes in muscle protein synthesis or maybe even increasing in bulk or responses to a meal with protein in humans, they don’t always um reflect a phosphorylation of mTOR. And we’re in animals. If you give a protein response, you will see a phosphorylation. So what do you think that, what does that mean? I think we’re just complex individuals and our bodies, nothing is an on-off cycle. I think it was Don one time explaining to me as a grad student, think of our bodies as on as like 52 percent.

[ 00:07:26 ] And I was like, I don’t know what that means. I don’t know what that means. I don’t know, and off is something is like a 48% because we are made of checks and balances. Um, and mTOR is expressed in all the cells in our body. So it’s not just something magical that happens in muscle. So I think it’s just a hard thing to study. What are you working on now? That’s an exciting question. Um, so right now we sort of have three focus areas in my lab, all centered around dietary protein or amino acid profiles and how they impact long-term health. So we conclude, just concluded a study, um, in post-menopausal women looking at protein supplementation and whether that impacts markers of mood or wellbeing.

[ 00:08:14 ] So we looked at, you know, um, profile and mood states, which are things like tension, anxiety, depression, and sleep outcomes. Um, the preliminary data from that study was enough to get us more funding to do a larger clinical trial that we’re looking at the impact of higher protein intake with or without physical activity in post-menopausal women to see if we can really see significant changes over time, um, and mood and sleep. We’re in turn. Oh, go ahead. No, I want to hear what everyone’s thinking, okay, well, if I increase my dietary protein, is my mood going to get better? And am I going to sleep better? And what’s happening? Dr. Anneke Vandenbroek. So one of the interesting things we saw with sleep, and I’ve heard from peers that they’ve observed similar responses.

[ 00:09:00 ] And so when we measure sleep, I’d say maybe more scientifically. So someone goes home and they sleep, sleeping with a wrist-like actigraph monitor on, um, we don’t really see a difference in logged sleep according to what we’re measuring. However, women report that they feel that they’re sleeping better and that they’re getting higher quality sleep and they feel better and better. So, um, so, um, so, um, so, um, so, um, so, um, so, um, so, um, so, um, so, taking protein supplementation and there were five arms to this study. And this response was really unique to the women receiving protein supplementation. Why do you think that was? Um, at first I thought maybe it was like a placebo effect. I’m taking like a special supplement, so I’m going to feel better, but this study went on for four months.

[ 00:09:44 ] So, this was something we saw every month when they came back to report on sleep activity. Um, and we had other groups being supplemented. There was a placebo, so they how did they do? They were okay, I mean the control group, so they were they kept on living; no big change that for you know. The first month, there’s always a change because they’re excited to be part of a study um but when we also gave participants protein um with supplemented with omega-3 fatty acids then omega-3 fatty acids alone and omega-3 fatty or in a control fat so just a corn oil with protein it was really only the corn oil with protein, so the protein plus a placebo and the protein groups that were reporting this um self-reporting improvement in sleep.

[ 00:10:31 ] So I think you know our sample size was small, it was finishing up right when we had to shut everything down during the pandemic but we did some predictive modeling with a statistician and if we had had this higher sample size we would have probably seen significant differences in mood and sleep with supplements why that is? I mean it would be really difficult to study you know. You think about sleep, you think about increasing glycine one of the amino acids um there hasn’t really Been a ton of work on these individual amino acids, I think that they had tried uh a long time ago with looking at tryptophan and some of these other um large uh larger amino acids, but to my knowledge there doesn’t seem to be a lot.

[ 00:11:17 ] Yeah, so we were actually thinking maybe it’s tryptophan or some of these like um serotonin precursors that are having this effect. I mean they were being supplemented with protein, so of course we did see elevated levels of tryptophan in the plasma um but you know we don’t have the mechanism so we can maybe say there’s an association but we don’t know why sure or why um at the university. Of Arkansas, I think by the end of this year or early next year, they will have a new research facility where we will have 24-hour metabolic chambers that we can assess sleep, um, and other things in a very controlled environment. So, I hope once we’re able to launch that facility and use those resources, we can maybe get some more mechanistic answers.

[ 00:12:03 ] And for the listener, if you get a result or an association, one has to ask why; what is the reasoning? What would be the mechanism? I’ll give you an example: oftentimes, we hear this myth that red meat causes cancer and one would say, okay, if that is true then we should be able to say that There is a very specific mechanism of action that holds up, uh, again that’s a myth we we don’t know that to be true. And I think that’s a really important point across science in general, especially in nutritional sciences: that there are a lot of associations people look at big population data and they’ll see a lot of associations, and they’ll see a lot of associations, and they’ll see you know people who exercise or participate in physical activity five days a week or more live longer, or you know people who eat more fruits and vegetables have less rates of cancer.

[ 00:13:01 ] But it’s really just an association; there’s no um, I’m Not saying that these things aren’t true, but you have to have sort of the mechanism to cause it to identify cause and effect. So that’s where we’re talking now-is that it could be tryptophan, um, it could be maybe they participated in the summertime or it was before they were on lockdown, so people were still, you know, happy living their daily lives, so um, personally I do think there’s something there in talking to chatting at conferences and talking to other people about their findings in different populations and observing similar effects. It’s just identifying what that is-and that that’s very hard um to do in people because It does require some sort of some invasive measurements that not everyone is game for, which include things like muscle fat biopsies.

[ 00:13:59 ] They include things like euglycemic insulin clamps, even isotope tracer studies. Those are those are robust to do in humans, especially free-living humans, and they’re costly; they are they’re very expensive. What kind of protein did you use? Was it whey, casein, soy? Because I do want to talk about the different types of protein and then their impact on appetite. Yeah, so we in this study we used whey protein. Um, we picked it mostly um because it’s easily available; most people are familiar with it. And we used unflavored whey protein because it was a 16-week study. There’s a lot of variations you can do recipe-wise for consuming whey protein, and when you do longer-term studies, some people may say 16 weeks isn’t that long term, but you need to make do everything possible to make sure that people follow the rules and stick with the diet plan.

[ 00:14:55 ] Um, so we chose whey because of its versatility, and also we wanted a complete protein. What is the research regarding the various forms of protein-whey, casein, soy-and their impact on appetite and satiety signals? Because one of the the things that people really struggle with is Weight management, um, and one has to think, okay, is it an intake problem? Is it that they can’t regulate these hunger signals? Are there things that we can do? We know that protein is satiating, and then on a deeper level, what about the various forms? Yeah, so those are all great questions. Um, I think a disclaimer, i guess first, the area of weight management and weight loss is complex and multifaceted; protein is just one part of that, I believe, of the answer.

[ 00:15:52 ] Um, and I think, so, I don’t know if a lot of people know this when I teach undergrads, they’re always surprised by this information that there is a hierarchy in our macronutrients, so Macronutrients, um, I’m sure most of your listeners are familiar with macros being carbohydrates, protein, and fat. There is a satiety hierarchy so, in order to how full these different nutrients make you feel, and this is consumed alone not with each other. So, protein is the most satiating or filling macronutrient, followed by fat, and then carbohydrates. Um, so I think that’s an important thing to understand especially if you are thinking about designing a meal plan or dietary pattern that keeps you fuller longer. And so, in terms of protein source and type, and I will say haven’t had her on yet um Dr.

[ 00:16:48 ] Heather Leidy um she’s coming. On, okay, she’s coming on in November, yeah, okay, she is the expert I would say in protein and appetite regulation, especially in adolescence, um, so I would always refer to her and her expertise first in this matter, so I’m glad she’s following me, yeah, up in this, um, but you know some research has come out looking at not only type of protein, so whey protein versus casing versus soy, and also the amount of protein and how that impacts appetite and satiety, and this is kind of older research, I think it’s close to like 10 years old or more, and it was conducted in the University of Maastricht, and they looked at giving people either 10 grams I think 10 or 15 grams of whey, soy, or casein versus 25 grams of whey, soy, or casein.

[ 00:17:42 ] And they found at this lower amount of protein, they had animal sources of protein were more satiating-it was whey protein followed by casein and then soy. But once they got to these higher levels of protein, appetite response didn’t really seem to differ. I think some of the hormonal or molecular responses differed between protein source, but it did not seem to impact food intake at 25 grams. Where at this lower amount of protein there was an impact on food intake and you point out something that I do think is is really important-that ultimately We’re looking for outcomes, and in the literature, you can take this study, I think it was a randomized controlled trial. Is this a randomized controlled trial? Is this the dose-dependent effects of whey relative to casein or soy?

[ 00:18:29 ] Is at the end of the day there are randomized controlled trials, and then we have to think how would that play out in the real world, correct? What can we learn? How can we deploy some of these potential strategies to help people control their protein with body weight regulation. And what you were saying is that regardless of the source of protein, whether it was whey, casein, or soy, if it’s high enough, that regardless, for example, if there was an increase in GLP-1, glucagon-like peptide 1, we’ve all heard about it. There’s semaglutide. There’s all of these agents coming out. But the end outcome for overall energy intake wasn’t different. Kind of disappointing. Yes, but I think it’s just one factor.

[ 00:19:23 ] I mean, when I first read this paper, we actually found it because we conducted a study looking at breakfast skipping or young adults or replacing breakfast or protein source at breakfast. I can’t remember. It was a while ago. And we saw no difference. We had a plant-based high-protein sandwich and an animal-based high-protein sandwich. And we wanted to see if there were any differences. And we saw no difference. And we wanted to see if there were any differences. And we saw actually differences in glucose response and some of the other metabolic markers. We did not see a difference, though, in appetite. And that’s how we sort of looked at this paper, found this paper when we were looking through the literature. But that’s just one thing to consider. So regulation of appetite.

[ 00:20:04 ] But what else is happening? And I think your listeners probably, you know, are pretty familiar with protein, muscle protein synthesis, glucose regulation, and all of that. But what else is happening? And I think your listeners probably, you know, a lot of the other metabolic effects like energy expenditure or energy metabolism, fuel use. So I think that’s where you’ll start to see some of the differences related to protein source. And basically, it’s this was looking at very specific markers. It looks like it was looking at glucose, insulin, and GLP-1. And also to note, the way that appetite profiles are analyzed, it’s subjective, right? Don’t they use a scale? It’s not, they’re not measuring CCK in the gut, right? I mean, it looks like they didn’t in these studies. So this is the perception of appetite.

[ 00:20:55 ] Yeah. And I remember when my first job in food industry, my boss was an expert in satiety and appetite regulation in his academic life. And really, at some point as adults, we disconnect what our body is telling us in our signals versus what we are actually eating. So we, even though our satiety hormones may be elevated in telling us ‘stop’, eat, stop eating, stop eating, we’ve learned to override those signals and eat whatever we want anyway. So, in the research, just because you’re seeing changes in like physiological changes in the signals that are telling our brain to stop eating or to continue eating, it doesn’t mean we listen to them and that we do those things. So that’s where those subjective changes are. So that’s where those subjective changes are.

[ 00:21:44 ] So that’s where those subjective measurements are important because I think you’ll see in this paper, for example, and we’ve seen it in other papers, just because the signals are there, the people aren’t listening to them. When do you think that that dysregulation happens? Do you think that’s an environmental dysregulation? I think it’s environmental. You know, I’ve had several debates about this, and you know, Heather probably can answer more of the science behind a lot of this thought. Is that, as we’re growing up, we live like in the United States, for example, in a society of abundance. Our portions are huge. I guess it depends who you were raised by or when you were raised. I was raised by a clean plate parent.

[ 00:22:26 ] You can’t get off, you know, get away from the table until you finish everything on your plate. Well, right there is an example of repeated ignoring your satiation cues or your stop eating cues and you’re forcing yourself to keep eating. So I think it’s a lot of environment, probably social. Your family life, you know, going to the restaurant and being served a humongous portion. And I don’t know about you, but if you’re out there eating with friends or you’re having like a couple of cocktails with dinner, it’s easy to just keep picking at your plate and going and ignoring what your body’s telling you. Absolutely. And I think that that’s where actually being educated, because how do you override brain function?

[ 00:23:06 ] You have to, at some point, be able to surf the urge and tolerate whatever that psychological, emotional, emotional, emotional, emotional, emotional, emotional, emotional, psychological or even physiological discomfort is. Yeah. And this is getting out of my area of expertise, OK, fair. But if you listen, you know, like to social media accounts or firsthand accounts or listening, I listen to like some obesity doctors on TikTok, I think, or just people using these GLP-1 agonists. That is something they are starting to learn. For the first time in their life, their brain is quiet about food. And what is the term? Like food noise. The food noise is turned off. And so I think that’s a really good example of how you can turn off. So I know there’s a lot of controversy surrounding these medications.

[ 00:23:47 ] I’m not a medical doctor. But what I find fascinating is that for the first time, people like their brain is turning off when it comes to like conversation, internal conversations about food. And maybe another tool that these, you know, medications offer is sort of that learning process. Maybe it’s a chance to reset how we think about food and start fresh with like a new relationship and new understanding of our body’s needs. I would say that in our clinical practice, I don’t know if you know this, but I have a full active medical practice. I see patients. We also have other providers. Shout out to Dr. Lisa Hunt, one of the providers. And we use GLP-1s and other medications similar for exactly that reason.

[ 00:24:34 ] And it’s fascinating because if you were to look on social media, you will hear that these medications inherently negatively affect skeletal muscle. We don’t see that in practice. Okay. When individuals are robust in dietary protein, especially high-quality protein because their appetites are lower, and they are resistance training, we do not see negative effects on skeletal muscle. So, do you see preservation during weight loss, just like if you were following a higher protein energy-restricted diet? We do. That’s awesome. Which is fascinating. And I think that if one were to dive deeper into literature, there are positive effects on skeletal muscle from these GLP-1 agonists. Which actually, you were the first person to bring up, to me, appetite regulation and skeletal muscle. Oh, that’s right.

[ 00:25:23 ] In general, I am going to let you kick that off to whatever level you feel comfortable in terms of talking about it. But again, skeletal muscle and appetite regulation, you were the first person to actually bring that to my attention. So I can’t take credit for that concept. When we were all in lockdown during the pandemic, and I had a bunch of PhD students graduate, and in an academic life, had this unique situation where I wasn’t really having to mentor anyone, but I was stuck at home all day. So I just started searching on PubMed, which is like the Google for science, and just started looking at appetite, muscle, appetite, protein, whatever struck my fancy. I had just gotten tenure a few months before, so I had this freedom to sort of change my focus.

[ 00:26:13 ] And I found this paper, or view paper, or thought piece by John Blundell, who I have not met personally, who is faculty, I think, in the UK. And he had published work suggesting that it’s not traditionally how we would think with overweight or obesity, the fat mass that is driving dietary intake, but the fat-free mass, which muscle is a part of, that’s driving food. We have to pause, because this is a novel concept that you guys have not heard before. Here’s my 30-second routine to improving my health, my gut health, and overall well-being. That is AG1. This covers anything and everything that I could be lacking in my current nutrition plan. AG1 is an evidence-backed multivitamin and gut health and beyond supplement that has uniquely formulated whole food compounds that act synergistically together, making it a highly bioavailable and bioactive product to enhance your health.

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[ 00:32:11 ] com/ slash Dr. Lion. That’s D-I-V-I official. com/ slash Dr. Lion for 20% off your first order. You know, my dream for these listeners is that they have access to the best scientists, the most creative thinkers, so that they can go out and think from their own perspective. And so right now, what we see in social media and just in general is that people repeat concepts over and over again. The more repetition, a concept gets, the more, quote, truthful it becomes, whether it is relevant or truthful. Correct. It is just repeated. And right now, people will say that fat tissue, right, it’s the obesogenic model that drives food intake. But what you are saying is there is literature to suggest that it’s fat-free mass that actually potentially influences appetite and food intake.

[ 00:33:10 ] Yeah, and I think he’s just gone back and looked at a lot of studies he has published over the years to create this new hypothesis or new way of thinking. And I encourage people who are interested, the papers, I think, are pretty easy to read. And they’re really interesting. And I think it’s in a more obesogenic, like you said, context. But my guess is that it would hold. It would hold true for a lot of populations. And one of the reasons is that, or one of the foundations for this hypothesis, is that muscle is more metabolically active than fat. And that muscle is driving energy expenditure, which is then in turn driving energy intake. And it has to do with long-term regulation, short-term regulation. So it’s not muscle that’s necessarily regulating our short-term response to the meal.

[ 00:34:07 ] That seems to be just a feedback loop. Of we eat, our satiety hormones are secreted, we stop eating. But more about the long-term intake over time is where fat-free mass would play a role. Which is fascinating. Yeah. And to be fair, muscle at rest isn’t that metabolically active. I guess you’re right. But I think the difference is that when we think of our whole body and food intake, our organs are very metabolically active. But we don’t change them. I mean, I guess, you know, I guess there are ways to get a bigger liver, right, Matt? Yes, there are ways. I was like, you know, there are things we can do to damage our organs. But in general, you know, the size they’re going to be and they’re metabolically active is they’re going to take the fuel that they need.

[ 00:34:55 ] And they are going to be prioritized over our skeletal muscle. But, you know, we can change our skeletal muscle. We can make it bigger. We can make it smaller. Which can then make changes in sort of energy expenditure in the food we eat. And I think even though it’s not super metabolic, it’s kind of mind blowing, though. But if you think, what is it? A study came out several years ago looking at weight gain, how much Americans gain in weight a year. And I think it’s like we gain on average, what is it? Two pounds a year over our lifetime. I have, by the way, I have some of these statistics. Are you ready for it? Thank you, Julia Mitchell. Ready? Weight gain trends. Here you go. Midlife women.

[ 00:35:38 ] Defining midlife women ages 40 to 65 gain an average of 1. 5 pounds per year. Okay, fair. The Nurses’ Health Study found women gained an average of 6. 8 pounds over eight years. And 70, here comes the other news, which I think is modifiable. 70, almost 70% of women reported weight gain during the menopause transition. Okay. And what, is this live that she’s looking up this information? No. Okay. Do we want her to be live? That’s what Matt’s here for. Well, no, I was like, wow. Wow, that’s really impressive that she’s like feeding you things. Yeah, no, we, so we’re trying to get Matt to be there, but we’re working on it. Because then I read another paper, I think it’s in that transition of 20 to 30, which would fit some of these statistics that women gain on average, I think, like 7 to 15 pounds.

[ 00:36:30 ] Where was I going with this? Oh, yeah. So that translates around, what is it, like, say like one to two pounds a year. Yeah, it’s about. It’s about. So we can change our energy expenditure or our food intake. By even just a couple hundred calories or less a day, as it could prevent or at least postpone or mitigate that weight gain. Yeah, it could at least attenuate. I agree with that. I also don’t think, I don’t really know the answer to some of this stuff because, you know, you had mentioned early on, you said, you don’t know if I worked on these studies. Yeah. As a matter of fact, guess who packed your meals for your body composition postmenopausal women’s study? Was that you? Yeah, it was me. Well, thank you so much.

[ 00:37:14 ] And do you remember the large jugs of urine that they used to bring in? Oh, you had to do that? I had to do that. I avoided the lab on those days. You, I was the one doing it and I was doing it on Saturday. Gross. Underneath the fume hood. Yes. And I was just thinking to myself, Don, and you know, I didn’t get on that paper. Oh, that’s. Don, you should be ashamed of yourself. Do you know why? He said undergraduates should not be on papers. Oh, that’s old fashioned. Old fashioned. But anyway, to answer your question. Sorry. But in all fairness, if you go back and you look at the literature, regardless if these women were postmenopausal or not, they were able to change body composition.

[ 00:37:52 ] They were able to decrease body fat. They were able to increase lean body mass. And we do have to mention, you know, we’re talking about lean body mass. That’s not the same as muscle. I call you, I call you at least every few months like, hey, Jamie, what’s the way that we’re going to be measuring skeletal muscle mass directly? And I actually flagged a paper. I think it’s on one of my 600 tabs open in my browser that talked about measure. It came out recently. Did I send it to you? No, but then it’s on there. Who was it? Who was it? I can’t remember. But it was just some sort of maybe a review article. It wasn’t a like a method-based paper, but talking about all the methods available for measuring.

[ 00:38:32 ] Oh, we got to send that to me. But we know what they are right now. I mean, basically. People will make. People will make statements saying that we are seeing changes in muscle mass, but really, in body doesn’t directly measure skeletal muscle mass. DEXA doesn’t measure directly skeletal muscle mass. CT and MRI do at a whole body level. We are not routinely doing CTs and MRIs are really expensive. And not all academic institutions have access to MRIs. And there is a method developed. D3 creatine. The D3 creatine. But it is also you have to have someone on the other end. Very difficult to do. Analyze the samples. Right now, there’s only one place that because we actually so I do research out of Baylor and we are working on a study.

[ 00:39:20 ] I don’t want to give away too much of it. I’ll tell you offline because it’s exciting. But it is so difficult to analyze skeletal muscle mass directly, that for us right now, D3 creatine is not an option. And we’ve done it several times. How’s that working out? Well, it’s easy to do. It’s easy to do. Because it’s only three milliliters, which is a very small amount for people to take. Kids, adults, whatever. The problem is on the other end. So I’m working with Dr. Elizabeth Borsheim, who is trained by Bob Wolf, a stable isotope expert. You know, Bob was on the podcast. Oh, he was? He was. That’s awesome. And we’re getting the method to work and having the right machines to get it to work. And we think we’re really close.

[ 00:40:06 ] That’d be amazing. But it’s been we did the study. Four years ago, and it’s taken over two years in the lab to get to a point where we now think we’re ready to analyze the sample. So I guess the message is, it’s not easy. It’s not time efficient or cost efficient for the general population at this time. And because of those difficulties in research, I don’t think that we have great answers that we think that we know certain things, but we just we just don’t. And, you know, going back to this biology. And so the paper is the biology of appetite control, do resting metabolic rate and fat-free mass drive energy intake, which, again, is really fascinating and it’s going to be interesting to see because what I’m hearing you say without saying directly is that maybe you will be challenging some of these traditional adipocentric views of appetite control.

[ 00:41:06 ] I think that John Blundell really opened up a new avenue or way of thinking about research and also about maybe a potential mechanism for protein and appetite regulation, and yet, like you said, changing the way we thought one reason I think muscle does play a role in appetite regulation is years ago, I asked Bob Wolf if he had muscle samples from an old study that he would be willing to share. And he was like, ‘Yeah, they’re in my closet at home.’ Yeah, willing to share with us. So we did look at expression or we looked at these muscle cells for expression of appetite receptors on in the muscle cell. So, we it was very small amount of tissue.

[ 00:41:57 ] And I got this idea because one of my colleagues at the University of Arkansas, who’s actually a poultry scientist, had found expression of appetite receptors on chicken breast, which is chicken skeletal muscle. And I thought, I wonder if that’s true for humans. So, we did find expression of P. Y. Y. We also but then it was such a small amount of tissue. We ran out. And again, we only looked at gene expression. We don’t have protein. We don’t know if it translates to quantity of protein in the muscle. Wait, what do you mean? Meaning? So we have the genes and we can see. No one is by, by the way, nobody’s eating chicken breast after this. I think that they are going to be on. I’m already on a chicken breast hiatus.

[ 00:42:39 ] I’m already on a chicken breast hiatus. After thinking about P. Y. Y. And orexin expressed in the chicken breast hard pass. I mean, I think it’s, you know, what’s in our our chicken has a very similar nutrient composition to our own skeletal. Okay, fine. Yes, not just chicken animal protein. Right. But the idea that P. Y. Y. and orexin both are. What would you say? So, P. Y. Y. Is releasing the gut and releasing the gut in the brain. I’m, I’m not sure I have to go back and look. Orexin comes from the brain. Right. So, I guess, so I read, so I kind of had this idea from these reviews. We analyzed these receptors on humans. No, these are on chickens. Okay. Coming from this idea from chicken breast.

[ 00:43:27 ] But actually, I think we did the gene study before I read this paper from John Blundell’s lab. And then we just kind of sat with it around the same time. And we haven’t published this data because all we have are like the potential for these two. Like hormones to be, have receptors on muscle cells. Anatholica Mercer, who’s in Alabama, she published a paper showing that P. Y. Y. Receptors are an expression on human muscle cells. So it kind of validates that it wasn’t just like a whim or we weren’t just imagining things. I mean, this is all about what we’re talking about-Body fat regulation, right? Body fat regulation. And kind of this adipocentric view, you know, and even in this paper, they’re talking about the term lipostasis referring to the reciprocal relationship, which this is fascinating between the relationship of food intake and body fat.

[ 00:44:22 ] And really, this kind of paper is challenging this body of literature by Blundell by John Blundell is really challenging the traditional way of thinking that fat-free mass. I would have thought. Maybe this is a perfect example where muscle mass may have a component to appetite regulation. And you and I know that the only person that’s growing their liver is Matt, the producer. But everybody else really, our organ systems aren’t growing, but our muscle mass could be. Yeah. And so that also brings me back to regain. My thought at the beginning of our conversation is that is there this brain-muscle crosstalk? We know what exists. People in exercise. Science have been looking at this connection for several years and it’s a paper right there that records how we’re working.

[ 00:45:07 ] I read when I worked for Don as a PhD student, and it was an animal study. And they infused leucine directly into the brain. It, through mTORC1, regulated hypothalamic response. So our hypothalamus is our appetite. One of the things it does is our appetite control center. So when you start thinking of all these things, so we have mTORC, we know it’s responsive to the essential amino acids. It exists in every cell. Leucine acts through it to regulate appetite within the brain in an animal model. Now we see that our muscle potentially has receptors for these hormones secreted by our hypothalamus. What is the connection? And so coming back to our earlier conversation, this is one avenue where we don’t have funding yet, but I’m putting all my extra pennies into funding a really brilliant PhD student.

[ 00:46:01 ] And use her creative freedom to start looking into this idea. And, you know, it could be something that explains why we lose or decrease appetite with age. Well, we lose muscle with age, our appetite goes down. Is it because there’s just less mass, so less, you know, metabolic activity happening? Is it that our muscle quality is decreasing? And so the affinity for appetite brain, appetite receptors is decreasing, or our brain-muscle crosstalk is decreasing, becoming blunted? I think it’s really interesting. And I think there’s a lot to learn also from this work they’re doing with exercise on brain-muscle crosstalk to figure out what is this mechanism. One thing, there’s one thing for certain that we can take away from all of this. Are you ready for the just the mic drop moment?

[ 00:46:49 ] Guys, totally not a mic drop moment. Is that muscle is important. Exactly. Skeletal muscle, regardless if we understand that it controls appetite, which, wow, when you are ready. I will bring you back on and we will talk all about that. Because this then begins to expand the conversation of the impact of skeletal muscle mass on overall health, not just from a energy intake perspective, right? So I’m thinking, as individuals age, their skeletal muscle mass declines. Do they? Does it have to decline? Are we just very sedentary? Could we overcome biology by doing things that you and I both have learned about? And maybe we throw in blood flow restriction? Who knows? Right? I don’t think that there’s an inevitable decline. I think a lot of individuals in the literature are sedentary models, or quote, healthy older adults.

[ 00:47:44 ] And and that sedentary behavior is in a disease state, in and of itself. Would you agree with that? That’s just not that’s like a disease of inactivity, which is what they talk about in Copenhagen. And if we can do everything that we can to maintain integrity of skeletal muscle, maybe we’ll have better appetite control. Right. And one of the things I’ve been thinking about, I guess, as I age, You look great for 25, friend. Oh, you are so kind. And sort of in my life experiences, so working in infant and toddler nutrition within the food industry, thinking about aging, thinking about postmenopause, what are these? Where are the inflection points in life where protein and muscle really make the impact?

[ 00:48:31 ] And I mean, I don’t know, have to me there have to be pinpoint times in life where we’re influencing our muscle health. I mean, maybe it isn’t all like a day-to-day lifestyle thing of accruing positive muscle. But we don’t know a lot about birth to 19 years of age. And this grant I actually just submitted this morning was really focusing on the period of adolescence. And I know, we share mutual acquaintance at the National Cattlemen’s Beef Association who had recently hosted sort of a mini think tank on what’s happening in nutrition in adolescence. And we don’t know. But it’s a time of really poor dietary intake. And this is the part of life where we are setting ourselves up to become independent, make our own food choices.

[ 00:49:24 ] And we don’t think of I didn’t think about these things when I was 16, 17, 18, or even 19 years old. But is that an inflection point for muscle, ensuring muscle health, we believe it does. So we, so myself and my colleague, Gerard D’Onofrio, and we have some other colleagues, whether they are physicians or PhDs, and Don as well, working on putting together a conceptual model of this. Okay, because we believe that it’s important, right? As physicians, we are practicing, we are seeing this in real time. You mentioned something that’s critical. We have a lot of parents that are listening to this. Okay. So about infant and toddler nutrition, what can we say about what we know and what we don’t know when it comes to protein?

[ 00:50:08 ] So I am not an expert in infant and toddler nutrition. I will say that my role in industry was really working on like fruit and vegetable intake, so nothing related to protein. Get out of here. I’m kidding. Actually, working on that project was what made me realize that I’m passionate about protein and that food industry wasn’t for me at that time. I am not an expert. I know we’ve gone back and forth and I’ve looped Dr. Elizabeth Borsheim into this. Because I call you and I say, Jamie, there are no good studies on infant and toddlers. And then I text Elizabeth. And I know she’s going to listen to this because I’ve been texting her about it coming on.

[ 00:50:48 ] So, I mean, I think there’s a lot of different opinions about protein and sort of the zero to three age. And I think that’s a time of rapid growth in life stages that I don’t feel comfortable commenting on. But I think there’s other periods after we’re out of the complementary feeding stage that could be inflection points for protein or muscle sparing. Or, even, or muscle preparing your muscle. Yes. How about muscle preparation is maybe a way. Yes. To think about it. And I think we spoke briefly about this before, like maybe last week. And what we’ve noticed. And our work with children. So some of the work I’ve published earlier and that we’re getting ready to publish is in kids’ ages around seven to 17 years old looking at protein intake at breakfast.

[ 00:51:39 ] And usually we’re picking breakfast just because it’s the first meal of the day. People are usually eating at home, and it’s an easy point of intervention. And what we have found is that kids who are normal weight-so usually they’re physically active. They’re in good metabolic health. It doesn’t matter. It doesn’t matter what meal we’re challenging them with. If it’s one time, if it’s over six weeks, they have the same metabolic response. And what I mean by that is like the energy expenditure. So the calories they’re burning in response to that meal are the same. The fats and carbs they’re oxidizing are the same. Their glucose levels are the same. But as soon as we look at response to a protein-based meal in children with overweight or obesity, we do see differences.

[ 00:52:24 ] So we see more dysregulation after higher carbohydrate meals in kids with overweight or obesity. But as soon as we change the protein, and it’s really using sort of Don’s initial model of higher protein intake. We’re not talking about a no-carb scenario. We’re just talking about a 15% change in protein versus carb intake. We see improved post-meal response, regulated blood glucose levels, an evening out of insulin. So it really seems to be as soon as your body is metabolically damaged, whether that’s being. Sedentary, overweight, or with disease, that’s where protein really seems to make a difference. And I think it’s with muscle because like your whole hypothesis, as soon as your muscle becomes unhealthy, personally, I think the rest of you becomes less healthy as well.

[ 00:53:12 ] And when you begin to think about from 7 to 17 years of age, and we’re thinking about, you know, I am truly worried about our children. I am worried about what is going to happen to them. From a muscle perspective, they are more sedentary. I would say they’re tracking along the lines of adults. I did have a statistic up. I don’t have it up right now, but we know that 50% of Americans don’t even work out. Yeah. Well, where do you think kids get there? I still think that’s like. Low. Low. I know. Well, I mean, closer to 72% don’t meet the recommendations. Right. Of both. Yeah. Of the. Yeah. You know, 150 minutes a week, the two days a week of resistance training. Right.

[ 00:54:02 ] If our children, for all parents out there, kids do not care what you say. They watch you. Right. They care what you do. And if we have increasing sedentary and increasing in obesity in children, we have to think about how do we design diets to correct their metabolism. You know, it is much more difficult to change a habit that begins in youth. Mm-hmm. And metabolic, metabolic disadvantage in youth. I mean, I don’t want kids to struggle that long. Right. Think about it. That’s a lifetime of struggle. Like, I’m a parent of a picky eater who also has some sensory issues. So, mealtime is, I think it’s been a 10-year battle. And what I do prioritize is lean proteins. Because when you have a picky eater and someone who doesn’t like chewing things, it’s finding the right protein.

[ 00:54:57 ] But I am constantly worried about, like, future dietary habits and physical activity. So, you know, he does a lot of physical activity, maybe not by choice. But I say, like. Get down and drop and give me 20. And so, you know, I always worked out growing up because my dad always emphasized the importance of working out. And I think that’s the only thing that has protected me into middle age. Because I come from a family with a history of, like, familial diabetes, high cholesterol, high blood pressure. And I’ve made it to almost age 50, like, medication-free. And I 100% credit that to being physically active from, like, a young age. I think that that is your best insurance policy. When you were looking at the adolescents and you look at traditional Don’s literature, basically, there was the food guide pyramid.

[ 00:55:49 ] He would do the food guide pyramid where it was, I don’t know, I think 75% of the calories came from carbohydrates. And then. He readjusted it to more of a 40-30-30 model, 40% carbs, 30% protein, 30% fat. When individuals increase their dietary protein to double the RDA at 1 . 6 grams. So this was some of the early work that you did. Is that kind of the guideline that you were seeing is beneficial in adolescents? Were you guys thinking about the grams? So if the parents are thinking, okay, well, I have a picky eater. How do I rework a diet or make the best dietary choices available? So we didn’t think of it in terms of per kilogram body weight because we had a wide age variety and it’s a lot of work.

[ 00:56:41 ] And it’s a lot of mental gymnastics for a parent to figure, to calculate this. And children are in a growing state. So I think it’s really hard because, you know, I remember one participant in our study. The graduate students. The graduate students came in freaking out because they thought there must have been an error in six weeks, the participant, like, grew two inches and gained, like, seven pounds. So I was like, this is not protein, guys. Like, it’s not the magic protein. It’s just like growth and development, adolescents, things like that. So I tend to think of it as a percent of energy intake or even, um, looking at the MyPlate model, if they just want a visual, I think if you build your protein sort of according to just how the government suggests or recommends that that’s just a good ballpark.

[ 00:57:31 ] And I think, um, and you’ve probably discussed this on your podcast before, maybe with Don, but he was always working within the framework of the dietary recommendations. And I think that’s an important thing for people to understand that it’s not an elimination diet. It’s if we look at the higher end of protein intake and the lower end of recommending carbohydrate intake, what you can see vast differences, at least in the adults in metabolism and body composition. And I would always ask him because I’m on the higher end, he he’ll say, you don’t need to go above 1. 6 grams per kg, which would be 0. 7 grams per pound. But he would also say that there’s no danger in going beyond that. And I would always challenge him.

[ 00:58:16 ] I would say, okay, Don, well, why work within these guidelines in these frameworks? And he said, because there’s a certain level of evidence collectively, then we can say. This can be supported by evidence while we can have these hypotheses. We just don’t have enough information yet. And again, this is now you’re talking about decades later, which is still his answer. And that really brings me to women and this idea that, um, you know, as women age, it seems like their nutritional needs change. And I would ask you, because I do feel that you are very interested in this, what role does protein, uh, intake play in healthy aging? What would you, what would you say to that? And. What would women have to do or do they have to adjust it specifically?

[ 00:59:01 ] Yeah. And, um, I will say I’m passionate about this. It’s like the only time I’ve ever written a negative comment on social media. And this was a long, long time ago. Just last week. Just last week. It was actually NPR had, was, had been interviewing a dietitian about protein intake. And the answer was so, it might’ve, what was the last? Was it 20/20? I guess when the last dietary guidelines were released, it must’ve been in 2020 talking about high levels of protein aren’t safe. And it was just very, it was so uninformed about the latest science. Um, and I think it had to do with aging and things like that. So that’s like the one time I’ve ever been like, check your facts. And that was the last we ever heard from Jamie.

[ 00:59:50 ] And I went dark. She posted and then that was it. And then I’ve liked clearly felt guilt over leaving a negative comment for four years. Um, so what, what do women, what do women have to do? So, okay. Yeah. Women in general have lower protein intake than men. And in general, as Americans, we are consuming, I think, what is it? Like 13 to 15% of our energy intake from protein, which is pretty far off from the 30 to 40% of like increased protein intake that would get you to that 1. 2 to 1. 6 grams per kg body weight that is recommended as we age. Um, and I think sometimes, you know, protein becomes scary for people because of like we are, you were talking about earlier, um, this misconception.

[ 01:00:45 ] If you repeat something over and over and over again, it becomes a reality where, you know, they think animal protein is not bad for you. We only should eat plant. Protein because I think it was with the last release of the dietary guidelines that started to advocate for like Meatless Monday, increasing animal or plant sources of protein, but without any sort of understanding or description of what essential amino acids are, amino acid profiles, proteins are. So, I see this in my day-to-day life with really educated women, not in nutrition science, but think now that eating animal protein is bad for you because we should be eating like plant protein or we should become vegetarians for the planet. And I have nothing against becoming vegetarian or vegan.

[ 01:01:30 ] I just think in terms of protein content, you have to really be thoughtful and intuitive in planning your meals to make sure you’re meeting your essential amino acid needs. And it does become more difficult to hit that 1. 2 to 1. 6 grams of protein per day. And as you and I are on the same page to maintain muscle mass, which I think is the driver of living. So when we think of postmenopause, I think we’re thinking, and I think of it as in a different frame of life. It’s about living independently longer, preventing our bones from breaking, decreasing frailty, and being able to do all the things that we’ve dreamt of doing once we’re able to retire.

[ 01:02:08 ] And so sort of this, I guess it’s also personal because I’m approaching that phase of life and often research is driven by what is what we think is interesting is interesting. I think it’s really an area that has not been studied. Which is wild. But. But we’re going to see more of it. And I was reviewing, there has been, I think, a longitudinal study. I think it’s called like the SWAN study. That has published some interesting research, but it’s not an intervention. And it’s not looking at dietary, like increasing protein intake for muscle health and longevity. And coming back to your point about people reporting weight gain with the menopause transition, we really don’t know yet. Is that a change in hormones?

[ 01:02:56 ] And I think you do have some connections with women in medicine that probably are more versed in this. It just depends, right? Or is it aging? So I think it’s a real challenge because I have my personal perspective. Right. And my personal perspective, I cannot find supported by the literature. So I have to be honest about it. Yeah. And my personal perspective would be, okay, you go through perimenopause, postmenopause. And you gain weight. It has to be something to do with maybe FSH, follicle stimulating hormone. Maybe the decrease in estrogen. We know that when estrogen is lower, maybe people might decrease spontaneous activity. And then, of course, there’s estrogen receptors on skeletal muscle. But when you control for diet and training, we find that weight gain is not inevitable.

[ 01:03:52 ] That it is not that all of a sudden you’ve. I mean, it’s not that easy to hit menopause and maybe there are multiple influences, and maybe some people are more sensitive to weight gain during menopause than others, but could it just be an aging? It’s just hard for me to wrap my head around because so many women say, ‘I hit menopause and I gain weight.’ So I think this is also one of those associations. So we gain weight with age or we observe as we transition through menopause, there is a weight gain. But we do. But we don’t know the mechanism. And so that’s one of the things I’m really interested in. I don’t think that it’s not true. But we don’t know what’s causing this weight gain.

[ 01:04:35 ] So I think it’s a. I mean, I’ve seen it in myself. I don’t think it’s. I think it’s a valid concern. But I think we don’t know what’s causing it. Is it? We know most Americans are like we’ve already discussed in this last hour. Do not meet physical activity guidelines. We know our diets aren’t the best. We know what is it now? Seventy two or three percent of Americans have overweight or obesity. So is it lifestyle? Is it change in hormones? And this is why we need, and I think scientists and government agencies are starting to recognize this. This is why we need investment in women’s research. And you see that at the national level, at least on all the calls for like from the National Science Foundation, the USDA, the National.

[ 01:05:24 ] Institutes of Health, they are starting to prioritize research related to women and women’s health because we really don’t know. We don’t know. And I would say that for physicians listening and for people that then go on hormone replacement, their weight doesn’t go back. There is no if. And these are some of the things that I struggle with because hormone replacement doesn’t necessarily change weight. It’s not a standard treatment. Would increasing testosterone, potentially increased lean body mass, again, and or skeletal muscle mass, I would say, yes, but it’s not as simple as saying, OK, we have calorie restriction. We know that if we increase dietary protein to this, we expect to see this kind of weight loss because we have those studies. We have those randomized control trials that control for diet and lifestyle.

[ 01:06:20 ] So it’s it’s complicated. And, you know, we so with the randomized controlled trials, I think that’s also complicated because when we recruit people to participate into research, it’s often not the reality of most of the population. So we don’t want people who are taking blood pressure medicine or cholesterol if we are looking at the impact of, let’s say, increased protein intake on cardio metabolic health. But the reality is most people who are in the aging process are on some sort of lipid or blood pressure regulating drug. That’s right. We don’t we don’t want people who have undergone hormone replacement therapy. And this is speaking outside of my expertise. But as someone, I guess, thinking about hormone replacement therapy, people stop taking doing hormone replacement therapy for ages because they thought it was unsafe.

[ 01:07:08 ] So we have decades where research could have been done or observations could have been made. But the Women’s Health Initiative really changed people’s perspective. We don’t so we don’t have the data. And I think a lot of the studies that are done, some of the things reasons we exclude people. People are really giving us a subset of the population that we’re conducting research with that isn’t actually representative of our current population. So that’s why it’s really important to understand how studies are done, who what are they including, what are they excluding before we start making conclusions and like sharing that across. Would you say that there are certain foundational things from the literature that people could all do to maintain healthy muscle mass and weight? So I used to have a very clear answer on this.

[ 01:08:01 ] This is what happens when you really get into the research. So it’s not always black and white. Sorry. And now I have, I’m starting to think less about maybe body weight in general and more about muscle health. And it’s but without. A. It’s an easy, effective way to measure muscle math mass. But it’s very difficult. Muscle health, muscle health, because and how are we defining? We know from the MRI images that do exist in the in the literature, I’m sure in medicine you’ve seen a lot more than I have access to. When you look at a cross-section of muscle from someone who is older or with obesity, you do see fat infiltration into this skeletal muscle mass. So, to me, that would say it’s probably going to start causing a lot of adverse metabolic effects or increased disease risk.

[ 01:08:57 ] So my theory would be to prioritize healthy muscle, but to get healthy muscle, you have to think about what you’re eating and how you’re going to grow it and exercise it and feed it the things that it needs, which then should potentially change body weight. But I don’t know. You know, in thinking of like the BMI controversy, I don’t think it’s just to have a BMI 25 and then your muscle. I don’t think it’s just to have a BMI 25 and then your muscle or lower your muscle is healthier. I absolutely agree with you. So I guess it’s. I’m trying to separate vanity as I age from like physiology and like reality and but you can’t have healthy muscle, in my opinion. And based on the science that I’ve read without working your muscle and feeding it properly.

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[ 01:13:55 ] So choose a time that works for you. Go and book instantly just by visiting Zocdoc, and you will be able to get an appointment typically within 24 to 72 hours of booking. How amazing is that? You can even score some same-day appointments. You have no excuse. That’s exactly how I found my local dentist and primary care physicians. So if you are putting off your doctor’s appointment, don’t; because appropriate screening and care can save your life. Go to Zocdoc. com. That’s Z-O-C-D-O-C. com slash Dr. Lion. Sign up, find your doctor and take care of your health. I would agree with that. And I do think that we’re at the cusp of various ways of training muscle beyond strength, hypertrophy, stability. All of the things that we think about.

[ 01:14:47 ] You know, there are going to be various stim suits and radio frequency ways to contract skeletal muscle. I think that we’re going to start to see an increase in kind of technologies that will help people overcome this atrophy issue. I think we’re probably in the very near future going to see medications. Yes. There are some under clinical trial now to help with preserving muscle loss. Yes. So I was at the Obesity Society meeting last year and they were presenting some preliminary data on some of the like I think injectables for preservation of lean mass. So I’m going again in November. Yeah. In San Antonio. You know, Faden. Faden is going to be there. Faden Makos. He came on the podcast. Yeah. So I’m only, I’m going.

[ 01:15:41 ] The whole reason I’m going is to see follow-up data on what’s presented. Mostly related to lean mass. And the GLP-1 agonists. It’s going to be fascinating. Yeah. And to see the new drugs that are coming out. And I’m really interested to see what are, what is the medical profession finding and presenting related to lean mass and protein intake. Because last year I did not attend all of the days. But in the two or three days I did attend, I only saw one physician speak about diet, like in dietary intervention along with these GLP-1 agonists about protein. And a protein-based lifestyle. And lo and behold, it like, like you already said, and what you’re observing in your practice, it preserved lean mass. And actually, you know, I have an undergraduate student that, you know, he wants to do an honors project.

[ 01:16:31 ] So I have sent him around to start asking a lot of these weight loss clinics that are popping up everywhere now, what diet advice are they giving people when they like start these. And it is like some it’s none or they’re just telling people to eat more protein. And then we’re asking for a copy of what they’re giving people. And I think it looks like my 10-year-old could have copied and pasted like facts from the internet and stuck, like the fonts don’t even match. So I think there’s a lot of work to do, especially as a lot of these drugs are still not at a price point that people can afford. And I don’t, they’re not teaching you new habits. Yeah.

[ 01:17:08 ] And, you know, and I think as it’s fascinating that they’re continuing to look for new drugs regarding muscle mass. Yeah. As opposed to doubling back on drugs that are used for HIV and cachexia. So there are anabolic agents that are utilized and have already been studied for things like cachexia. And I would argue, coming back to our discussion about children, is that we have to go even further back. Yes. And change our messaging and focus on behavior from a really early age. What about women PCOS? Yes. They often struggle with insulin resistance. Have you studied PCOS and maybe how protein consumption influences insulin sensitivity or any of those things? Have you looked at that? So I just got a pilot grant to start looking at that. I am not an expert in PCOS.

[ 01:18:03 ] So the piece I bring to the table is the protein, skeletal muscle body composition aspect and metabolic regulation. I got the idea because of a professor I met at Texas University. Her name is Heidi, I think, Vandenbrink. And she is more of an expert in PCOS. And I just happened to be giving a seminar at A&M. My lovely host was writing a grant. So she had me visiting people in the department. And we just clicked and started talking about her work in PCOS and the role protein could play. I recommend having her one day if you are interested. She’s local-ish. All right. Let’s get her on. So she – we started talking about it because of the role dietary protein.

[ 01:18:46 ] Or the regulation of diets higher in protein with metabolism and with cardiometabolic health and the work that we did when Dawn started all these like dietary interventions. So a lot of the issues women with PCOS face as far as metabolism are similar, like insulin regulation, changes in body composition, things like that, a struggle with weight gain. Can we mitigate some of these with protein? And I thought surely these studies must be helpful. And I thought surely these studies should be done a million times over. And there’s a – so Heidi actually shared with me this position paper. And they did a systematic review. Have you ever spoken about what that is? Where you systematically search the literature for research that has been done on a specific topic.

[ 01:19:32 ] So they looked at all the dietary interventions with PCOS. And then usually you set criteria for what makes it a good study or what makes it a bad study. And this is – I’m not sure how large the nutrition part is. But this is a 3,000-page, I think. Yeah. Position paper. Massive. It’s massive. So of all the dietary interventions, I think like 15 or 20 – only 15 or 20 made it and only one protein and none like in adolescence or early adulthood. So there is some work to be done there. And hopefully she’ll be coming out with more of these studies. Yeah. It will be interesting to see what your pilot study shows. What about in terms of the glycemic control?

[ 01:20:16 ] How would we think about – if we know PCOS, those individuals seem to have higher levels of insulin, higher levels of glucose. It’s one of the major causes of infertility, especially with younger women that want to get pregnant for the first time. Is there a role for dietary protein to help with potentially glycemic control and insulin sensitivity? Definitely, yes. I’m not sure. I guess, you know, in my understanding. In my understanding of PCOS, they don’t really know what causes it. It’s thought to maybe have genetic roots. Are you more familiar with that? Yeah. So – but I think one thing I want to emphasize, especially when – because, you know, I’ll have young women come up to me after class and start asking me questions. Protein is not your magic bullet.

[ 01:21:04 ] So especially when we’re – Also true. Yes. When we’re thinking about – Also true. – Glycemic regulation, you can’t just like eat your normal diet and then start like chugging your whey protein. I told you, Matt. Why are you doing that? So it’s – I mean, this is something that, you know, I guess was ingrained to me 24 years ago when I started working with Dawn is that it’s an exchange. So if you are going to start adding protein to your diet, you need to take something out. And that’s usually where – at the – to me, it’s refined carbohydrates. So it’s well established that increasing protein intake while reducing your refined carbohydrates can regulate glycemic response and regulation of blood glucose.

[ 01:21:55 ] I think in almost all types of metabolic dysregulation, with obesity, with type 2 diabetes, with age, I think you have to do it the right way, but also with energy restriction. So it’s not – It’s not eating calories in excess of what your body needs to maintain its weight, but it’s more protein. So that’s going to be – it may help your glycemic regulation, but it’s not going to help a lot of other things. And just because you have higher protein intake does not mean you can’t also have weight gain due to excess energy intake. So this is something I have had students yell at me in class. That’s crazy. Did you fail them? What happened to them? That’s insane. I can tell you offline because it’s sort of a political drama.

[ 01:22:41 ] Yeah. That’s why I would never argue with a student that’s yelling me at the end of class. But, you know, it’s always, well, my trainer told me this, or I saw this influencer on social media. It’s not you. It’s not Lane. So it’s not people – We never had to deal with this. People don’t understand, you know, when we talk about this difference between plant-based and animal-based protein and, you know, when we were doing research – and you’re still doing it – we did not see this huge divergence and this huge emotional charge. Yeah. And it – well, you know, food – everyone needs food to live. Food is emotional. High-quality protein is also an issue, I think, of accessibility. And people view that oftentimes lean, high-quality sources of protein are not affordable or they’re not accessible to them.

[ 01:23:28 ] But that has nothing to do with the people yelling me in class. These are usually, you know, young men hitting the gym. And I always call it the end of one science. A former Ph. D. student of mine, sort of coined this term in the lab. It worked for me, so it must work for you. And it must be the golden rule because it worked for, like, the end of one myself. But I think there’s so many nuances. And, you know, it’s just like you can’t go to the gym and skip leg day and then expect to have, like, jacked legs. So you can’t just eat a bunch of protein without physical activity, without resistance training, without some energy restriction if we’re coming back to PCOS and issues with glycemic control.

[ 01:24:09 ] And often PCOS comes with weight gain and expect to see results. Yeah. And you have to move muscle, right? You have to create a stimulus where you’re also depleting muscle glycogen. You have to create enough flux for, you know, whatever the metabolites are. I don’t know if we know whether it’s ceramides or diacylglycerides or intramuscular fat, whatever it is. You have to exercise. Yeah. You have to exercise to use whatever those metabolites are. Right. And when you’re not training, body composition management is going to be a struggle. Yeah. And to me, I always tell people protein is giving you the substrates you need or, like, the components you need to build more muscle. Protein itself cannot build more muscle for you. And that’s a hard one because then you have to put in the work.

[ 01:25:05 ] Yes. What about – have you found differences between – Yeah. – plant-based, animal-based proteins when it comes to their impact on weight management? So we haven’t really studied it specifically in terms of weight management. I know in a conference I attended, I think it was this spring, and Luke Van Loon and Stu Phillips were there presenting some of their data looking at plant versus animal protein in terms of fractional synthesis rate. And they didn’t seem to see much of a difference. But I think it also may have had to do with, like, the essential amino – the essential amino acid profile in the proteins they were studying. Again, I think, to me, they would be comparable in a weight management or weight loss situation as long as you’re hitting that protein threshold and that you’re ensuring that your protein sources, whether they are from animals or they’re plant proteins, they’re becoming complementary to give you the essential amino acid profile you need.

[ 01:26:03 ] And I think that the literature supports that. And I don’t think that’s something – well, people probably know about or talk about enough within the, like, social influencing sphere. Yeah. If you say complementary protein, someone’s like, what? And so I think that’s something that has gotten lost in this push for plant protein intake, the need to complement your proteins. Yes. Because it is about your essential amino acids. And then if we were to take it one step further, yeah. The needs, for example, things that ride along with, let’s say, high-quality proteins, things like iron and zinc and selenium and other micronutrients that are critical that may be different in plant-based proteins. Right. Yes, there is the essential amino acid need. We can all agree on that.

[ 01:26:53 ] And then thinking about what has the most nutrient density. Right. Because, you know, let’s say a woman who – Who is a menstruating female. She might become iron deficient. Iron deficiency anemia is a huge challenge. Right. They’re all things to consider. And you actually – you worked on the SHAPE study. Mm-hmm. Which is-was protein, omega-3 fatty acid supplementation in postmenopausal women. Can you just give us some of the highlight, any of the key takeaways from that? So that’s the one we did discuss earlier with mood and sleep. But, you know, we did not see changes in body composition. Which is a little surprising. But I would say no because I didn’t set this up earlier. It was a weight maintenance study. It was a weight maintenance study. With no physical activity.

[ 01:27:42 ] Because the primary endpoints in that study were really focusing on mood, like well-being, sleep, markers of – we call it well-being. Because there’s a construct that was started, I think, decades ago called successful aging. And in the last few years, we rebuilt that in the context of what successful aging is. What successful aging means to our lab. So – and how nutrition or protein plays a role in ensuring that we age successfully. And so we said, well, part of successful aging is well-being, sleep, quality of life. So that was the purpose of SHAPE study. But we did look at body composition. And we did not see changes. But again, we were just supplementing. We weren’t changing the ratio of carbohydrate to protein. Do you remember what they-the average female gets what, around 68 grams of protein a day?

[ 01:28:35 ] Yeah. And I can’t remember-I mean, I can tell you offline because I can look up the data. But I can’t remember exactly how much protein they were eating. But the essential amino acid profile, the fasting essential amino acid profile in the plasma was higher than in the groups receiving the omega-3 fatty acids or the placebo groups. So-but again, you know, that was the-That was the study where we had to cut short because of the pandemic. And we’re reworking that study in a current dietary intervention that’s actually funded by the National Cattlemen’s Beef Association to look at higher protein diets, which we’re just talking – but it is weight maintenance with or without resistance exercise in postmenopausal women to see if we can really see a robust effect.

[ 01:29:28 ] Where do you think – what do you think it would take? What would it take for research to really move the needle? I mean, I think that we have a good sense of the impact of dietary protein. I don’t think we know enough about muscle. I don’t think we know enough about appetite regulation and fat-free mass. I don’t think we know – you know, you’re talking about these inflection points. Infant-toddler nutrition, we can understand that certain things are really important. But if you could do whatever it is that you wanted to ask a question and get to a specific endpoint, what do you think it would be? So I’ll start more general because, you know, as an academic, our quest is to get funding and come up with the novel idea or a different way of thinking than anyone has been doing previously.

[ 01:30:15 ] And so when I started my lab, it’s, you know, natural to pick up where you were trained. And then I realized, like, been there, done that. We know – and there are several amazing researchers that you have had on your show or will be having on your show in, like, recent years. And, you know, in upcoming months that have done it with higher protein, with resistance training, with weight loss under type 2 diabetic measurement. So I think we know – I think it’s safe to assume or generalize that increasing protein – percentage of protein in the diet can help with what we’ve already talked about. Maintaining lean mass, targeting fat loss, appetite regulation, glycemic control, things like that. But I think to move the needle. And where I’m taking it.

[ 01:31:00 ] Is what else does muscle do beyond strength, beyond, you know, clearing glucose from the blood? What are we missing? Like, as scientists and as experts, we know that it’s really important. But, like, why? And so that’s where I’m putting all these extra thoughts I have into defining mechanisms around, like, muscle regulation of food intake or muscle-brain crosstalk in terms of nutrition and aging, not just in terms of, like, exercise. So I think it’s – so you see a lot of gut-brain access or fat-gut crosstalk. No one ever puts muscle in that mix. So I think-Why do you think that is? I mean, I guess it’s not, like, the sexy organ right now. It is the sexy organ, though. I mean, because, like, gut microbiome. I mean, it’s still having its day.

[ 01:31:51 ] Suzanne of COTA. Yes, we’ve had her on. Also came out of Don. Don Lehman’s lab. Yeah. So, and – But, you know – But what about muscle? So I don’t know why people sort of, I think, decentralize it, but I think it’s – I think muscle-brain interaction is where it’s at. Do you think it’s because skeletal muscle is hard to measure? Even just from a biopsy perspective, for example, we could take a punch biopsy of my quad, your quad, and Matt’s quad. It would be different. Right. And it will hurt. And we would not be – Don’t be such a wimp. It doesn’t hurt that bad. I’ll put the divot. I think that’s part of it, but I don’t really think that’s the issue because of animal models. What do you mean?

[ 01:32:39 ] Like, we can – so a lot of this gut microbiome work, a lot of the other brain work, it’s all done in animal – rodent models to get the idea or the preliminary data proof of principle ideas. I think we could answer it or begin to define some of the mechanisms using animal models. I think in humans, yes. It is a difficult – I mean, at least, you know, with some of the gut studies or, you know, you can get a sample maybe daily in a pretty – Exactly. How are we doing that? Gross. You’ll have to get back to me on that. Okay. But fair. But, you know, but, yeah, like you said, we don’t have a clear way to measure muscle health.

[ 01:33:17 ] We don’t have an easy way to measure what’s the flux in and out of muscle. We don’t have an easy way to visualize muscle. It’s just not easy. Yeah. But I think if more people talked about it – Yeah. Maybe, like, you know, and you need money and investment and capital to develop the technology and to move forward because that will lower the cost. Yeah. It’s going to be really fascinating. I agree with you. I do think it’s decentralized. And when we look at skeletal muscle, it’s in very discrete groups. It’s in – you know, we’ve had lots of exercise physiologists on. They look at muscle from a performance perspective. Mm-hmm. We think about it in terms of how do we protect and maintain skeletal muscle for many of the issues that you talked about.

[ 01:34:03 ] Mm-hmm. And then, you know, really centralizing the concept of skeletal muscle as this organ system, which I think that you’re beginning to bring up, is this what is its effect on the brain? Yeah. What is the inter-organ crosstalk from exercising to sedentary muscle? Right. And, you know, it’s – Well, you know, like, muscle requires work. Yeah. So maybe it’s because people – so I – like, you’re just voicing out loud the – my internal daily monologue. Mm-hmm. And what keeps me up at night is that to see changes in muscle mass, it’s not just eating. No. It’s not like having a good night’s sleep. You have to put in the work. So no matter what we eat or whatever we’re intaking in our diet, it really is just serving as the substrate or the fuel for what our muscle is going to do.

[ 01:34:54 ] Right. But to have our muscle perform, you have to exercise. Yeah. To exercise it. And I think what also that we’re beginning to see is that potentially there is – and, you know, I’ve also been thinking a lot about this, and I reached out to Faden about this idea of type 2 diabetes, which we’re starting to see more of, and obesity. And do those individuals have skeletal muscle that has the same response to exercise? And I-I think there are-so John Blundell, who we’ve talked about already, who, you know, came up with this sort of-this theory of muscle-driving food intake or appetite regulation-or fat-free mass, I should say, not muscle. And I think he’s very specific to not call it muscle because the data isn’t about muscle. I know. I know.

[ 01:35:38 ] It’s not on-I noticed that. Because I’ve looked through his papers a million times for the word muscle. Maybe he has a way that he’s not sharing. But I want to say that it’s him. So, I’m sorry if I’m quoting the wrong person. But when I lived in the Netherlands, I went to a conference that he spoke at. And it was about exercise responders versus non-responders. And I think he did a lot of this work. And I – because I think it’s – some of the science is not old for us but old for newer generations. A lot of this core foundational work has been done 20 or 30 years ago. So there are some answers about, like, who’s going to respond or not. And they may have even identified some genes of responders versus non-responders.

[ 01:36:23 ] And I have been – and maybe one of your followers can find this information. I swear that at some point 10 to 20 years ago when people started-when the Human Genome Project was coming out, I swear they identified a gene that would make someone a protein versus a carb responder. And I cannot find that paper to save my life. But in the end, it didn’t matter. And, you know, right now in the medical space, Yeah. there’s a lot of-you know, there’s traditional medicine. And then there’s preventative medicine. And then there’s lifestyle and precision medicine. And there are many providers that will look at-you know, we’ve gone back and forth in our clinic. Do we look at individual genes? What does that collection of gene mean? What does that collection of genes mean?

[ 01:37:13 ] And I just don’t know if we’re there with the data because, yeah, I just don’t think we’re there. And I think that’s, like, the challenge. And I actually don’t know – you know, because precision nutrition, personalized nutrition, precision medicine, all of these are hot topics. And I do agree that tailoring recommendations to meet individuals’ needs are going to help with compliance and things like that. But as we came back, like, at the very beginning of this discussion, just because, like, you have one gene – like, we were talking with mTOR. Our bodies are a series of checks and balances. So I remember this paper where these protein responders versus carb gene people that they should have lost more weight, right, if you were following a higher protein diet versus a higher carbohydrate diet.

[ 01:38:02 ] And then I think they switched the people. And it didn’t matter. And I think it’s because we have so many checks and balances. And there’s so many other environmental things that we have to set ourselves up for success with. Yeah. And it’s multifaceted. And, like, there’s never going to be one magic answer except we know from muscle. You need to give it fuels, essential amino acids. We find them in protein. And you need to work it out. Well, Dr. Jamie Baum, I’m so grateful to have you on. You are really paving the way with these thoughts. And I know that academic research is hard and there are many roadblocks and challenges. But you’re doing an amazing job. And I’m so grateful that I call you a friend and can call you with questions.

[ 01:38:51 ] And, you know, whether it’s amino acid questions or various other types of consulting questions, I am so grateful. And I would say I will link people where to find you, which is we will put your I think it’s a Google Scholar link. And then where if people want to email you, we’ll link your professional University of Arkansas Email and kind of home page. So thank you so much for coming on. Thank you. And I’m glad we finally made this work. Yes. 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 healthcare services, including the giving of medical advice. And 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 doctor. If your company, health healthcare professional, or any such conditions. This is purely for entertainment and educational purposes only.

[ 01:40:55 ] 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 healthcare professional for any such conditions. This is purely for entertainment and educational purposes only.