by DND | May 11, 2023
You Should Focus on Muscle Not Fat Loss | Tommy Wood PhD
Tommy Wood MD, PhD is a neuroscientist and elite-level professional nerd who has coached world class athletes in a dozen sports. He received an undergraduate degree in biochemistry from the University of Cambridge, a medical degree from the University of Oxford, and a PhD in physiology and neuroscience from the University of Oslo. Tommy is currently an Assistant Professor of Pediatrics and Neuroscience at the University of Washington, where his research interests include determining how early brain injury impacts brain health across the lifespan, as well as developing easily-accessible and equitable methods with which to track health, performance, and longevity in both professional athletes and the general population. Tommy serves as associate editor of the Wiley Journal Lifestyle Medicine, is a Director of the British Society for Lifestyle Medicine, and consults for a number of digital health companies and charities that focus on how lifestyle and the environment can affect long-term health and chronic disease.
In this episode we discuss:
– Does muscle mass matter?
– How exercise makes you smarter.
– The ideal amount of protein for maintaining good health and preventing disease.
– Should you be lifting weights?
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Tommy. Wood, Dr Lyon
Dr. Lyon (01:00:00 -> 01:00:15)
Welcome Tommy. Wood. This is a long time coming and it is such a privilege for me to have you on the show. You are an M D phd, you specialize and actually have essentially worked as a neuroscientist for, I don’t know how long 20 years now.
Tommy Wood (01:00:16 -> 01:00:24)
Yeah, I’ve been working in neuroscience basically doing lab research since I was an undergrad. So, yeah, that’s now 20 years almost. Exactly.
Dr. Lyon (01:00:24 -> 01:01:53)
And you’re, you were at Cambridge Oxford. You’re now at the University of Washington. Is that correct? And you are an associate professor there and we have a similar love of special operations. Again, I have here that you won’t hold that against me, but all amazing. All amazing. So your contribution to neuroscience and cognitive functioning is critical. But what’s so unique about you? And it’s very unusual is your interface of skeletal muscle fitness and more of a integrative approach to medicine as an M.D. PHD than I would say the majority of people which makes you a unicorn. And we love having unicorns, no pressure, no pressure. We love having unicorns on the show. So we’re gonna get right into it. There is a lot of things to cover. And in particular, I, I’m super grateful for you because one of the things that you do talk about and I haven’t really heard anybody else talk about it is this concept of muscle health as it relates to cognition. And we can both agree that that’s critical. So I would love for you to talk a little bit about. I mean, you’ve got this paper that’s going to be coming out and its strength and multiple types of physical activity, but not low muscle mass, independently predict cognitive function and haines. And there’s a certain time frame of that dataset. So I’d love for you to kick it off and talk about muscle, muscle health and brain function.
Tommy Wood (01:01:54 -> 01:06:55)
Sure. So this is something that I’m very, very passionate about as you can probably tell or as you know, um and throughout my academic career. So like I said, I started during your doing neuroscience research 20 years ago and then after finishing undergraduate studies, medical school phd, um I, you know, throughout that time spent, spent a lot of time working with athletes on the side. I kind of had these two strands to my work. So one side was the formal academic work, the Neuroscience, I study ways to treat multiple types of brain injury from right at the beginning of life, neonatal brain injury, but also study traumatic brain injury and then late in life, cognitive decline and how those things kind of tied together And alongside my academic career. Um first as a student, I was a student athlete, I was a rower primarily. And then I was a, I coached other rowers and I became increasingly interested in athletic performance and was part of a company for a few years where we worked with various levels of athletes, including a wide number of professional and world champion athletes in something like 12 different sports at this point. And so I have these two parts where I’m studying the brain and I’m studying the body. And one thing that’s been nice about neuroscience over the last decade or so is that we realize that the brain and body are connected. They’re not just that these separate entities to be studied independently, which is what was basically done for decades prior to that. And what you see from multiple areas of research now, which you have talked about extensively because it’s so important is how protective muscle mass is in terms of like overall health, all cause mortality, metabolic health. Um and it’s essentially the same for the brain and for all the same reasons, you know, the kinds that are released during exercise, the benefits for the brain lactate is great for the brain, uh you know, which you produce during vigorous physical activity. And when you then try and pass some of this out, this is what we’ve been doing recently, you might think, well, what are the various contributions to brain performance of cognitive performance because you think, well, this physical activity and there’s the muscle mass that you get as a result of physical activity. And then there’s the function of that muscle as well. So those are the things that we were exploring in this paper. And what we essentially found um much to my disappointment was that more muscle was not more better for your brain, which is, of course, what I would have preferred to show, but that’s, you know, the data they give you the answer. And actually, I think what comes out is how important muscle quality is. So just having more muscle isn’t necessarily that useful if that muscle isn’t functional. And this is really the signal that we see from, from these data. So it was about 1500 people. They had dexter scans, they had cognitive function tests, they had strength tests, they did a leg extension test, this is foreign hands and when you look at these population datasets and it’s the same, it’s the same in other big ones like the you could buy bank. Um What you see is that the people who have the most muscle are just bigger people in general, right? If you gain total mass that you know which you would you gain. But most people gain by being in a caloric surplus. If you gain more mass, you gain some muscle tissue with that. Um But if you’re not training that muscle to actually do anything physical, you’re not getting an increase in function with it. And that seems to be detrimental. So that was kind of the signal that we saw from our data was that strength um is critically um you know, very strongly associated with cognitive performance um as are the various types of physical activity. So we looked at just general physical activity and sedentary. Do you walk a lot? You have to do heavy loads to lift things as part of your work. Do you do vigorous physical activity? And then do you do some kind of resistance training? So we looked at those separately. And what you see is physical activity predicts cognitive performance and strength predicts cognitive performance even after taking into account physical activity, but muscle mass does not. Um And you can then also like when we looked at this in various ways, you see that muscle mass is not predicted by the amount of physical activity that somebody does. So that means that people are not gaining muscle by doing by lifting weights, they’re gaining muscle just because they’re gaining more mass. And then along with that comes worse, metabolic health, worse body composition overall. Um So the idea really is that more muscle does seem to be protective, you know, overall. But the real benefit is if that muscle is functional and you only get functional muscle by actually moving it. Um and training it. And so I think that’s where we see this critical connection between the amount of muscle, the function that has in the brain.
Dr. Lyon (01:06:55 -> 01:07:07)
And uh to my knowledge, this is one of the first papers that’s been done kind of laying the foundation for this work really highlighting muscle quality and the way in which we accrue muscle.
Tommy Wood (01:07:07 -> 01:09:28)
Yeah. And, and I think it’s interesting to me because when you, when you hang out in health related social media as you and I do, you may have seen there was a recent paper looking at Muscle mass and cardiovascular disease and all cause mortality. This is it from the UK Bio Bank. So it was about 400,000 people I think they had in the end and they saw the particularly in men, those with the highest muscle mass had the highest risk of cardiac disease and the highest risk of death, which kind of disagrees with what we’ve seen previously, which is that muscle mass is protective. Um But what I think we’re seeing from that and this is really evident when this is one of my personal bugbears is that scientists, they get all this data and you can do all these calculations in your statistical program, whichever one you use and you can get some graphs of the relationship between a certain metric and an outcome like death. Um And you can do all that without really knowing what your data mean, right. So you basically have for one of a better description, you have people who don’t lift, sitting in a tiny box room somewhere just staring at numbers. And they have no, they don’t really realize how this connects to reality because they don’t understand, you know, what muscle does and how you gain it because that’s not their expertise right there. Epidemiologists. And I think this is what was happening. So they’re just like, well, look in this dataset, more muscle means that you die sooner. But they don’t think about, well, what are the ways that you can gain muscle which is beneficial, which isn’t. And they said things like, well, if you have more muscle mass, then you have more blood volume and then that makes it harder for your work harder for your heart to work. And then that causes cardiovascular disease, which I mean, if you’re an athlete and you have like healthy, um you have healthy vascular beds, like your cardiovascular function is good and that’s how you gain your muscle. Like that statement just doesn’t make sense. That’s not true. Like having more blood volume isn’t, it isn’t harder to work against it. Plus we know the exercise protective and that’s like your, your heart working hard. So like things like this, that just don’t make sense. And I think it’s because nobody’s looking at the data with this eye of, well, like thinking about athletes, like thinking about training muscle and what that results in. This is my personal bug bear.
Dr. Lyon (01:09:29 -> 01:10:36)
No, I think it’s amazing you’re bringing up two really important points. Number one, you’re bringing up epidemiology data, you’re bringing up large population datasets versus randomized controlled trials or things in which we can control outcomes to the best of our ability. And of course, there’s a difference between animal studies and humans, both of which are incredibly relevant. And you know, obviously there’s certain outcomes that we can push in in rodent type models and things. The other thing that you’re talking about is really the quality of the tissue that an individual would have some muscle quality. Um and also muscle mass. The paper was really well done. You talked about a few things like a apendecular lean mass, a fat free mass index in terms of what we know about muscle mass and what we know about. Again, we’re looking at populations and not only that when we’re looking at population data, the non exercise, the sedentary population is a disease state and you know, we speak about it is if it’s there’s normal healthy sedentary individuals, but that essentially is, is not accurate
Tommy Wood (01:10:37 -> 01:14:09)
when you look, you know, across various types of data. And this is human data. And of course, we have to rely on animal models in certain cases. I do, you know the majority of my work in brain injury is in animal models to understand the process, develop new treatments, things like that. So that is important. But when you, when you have say sedentary mice, um we know that generate just being sedentary, generates a pro pro inflammatory state, right? It is a disease state to not move at all. And so not, there’s like two parts of it. When you, when you move regularly, you’re kind of removing this negative state, this pro inflammatory state of being sedentary. Plus you’re adding on benefits of actually, you know, moving. Um and we see similar things in humans. So I think one of the best examples is those who have spinal cord injuries. So they cannot move significant parts of their body. And that in itself is a pro inflammatory state, that muscle tissue which is not being moved, becomes pro inflammatory, it becomes pathogenic unless you find ways to move it externally and it that, that muscle, the quality, you get less of it, first of all, and then the quality decreases. So you have higher amounts of intramuscular triglycerides, more fat in the muscle tissue. It’s more pro inflammatory and it’s associated with significant insulin resistance and metabolic disease. So we know that just being sedentary um is in itself a pro inflammatory state. And so that’s, that’s like, and that’s where most people stand. So if you’re sedentary, but you have a large amount of muscle mass, which is probably a cruise just to gaining more total mass. That is not, you know, high quality functional anti inflammatory brain supporting muscle tissue. And that’s where most people’s muscle come from. So you need to appreciate the population, that these things are being studied and any time um somebody’s looking at these population datasets. Um and this is an interesting thing because so those who are really interested in their health, right? You may get really hyper focused on certain biomarkers, blood tests, things like that. And you say, oh yeah, I know that my blood test for this, my blood sugar needs to be in this range because that that’s associated with the best health outcomes. And that’s probably true. But the population that was derived from is probably nothing like you. Like if you’re somebody who’s very active, you know, has good body composition, you know, sleeps well, eats well. Um Those people don’t really exist in the population data because you know, in general, they’re relatively rare. So if you think about this from a body composition standpoint, there is nobody in the in Haines dataset who has a body competition like mine there just isn’t. So I can’t use that data really to tell me anything about me. But I mean, I think I have good, good body composition. I think it’s going to be protective of my long term health. But actually I have to admit that’s also conjecture because there’s no study, long term of people like me and their health outcomes. So it’s kind of a double edged sword one we can say actually this population isn’t anything like me. So I don’t need to worry about the findings there but the other side is, well, there aren’t really that many populations of people like me. So I just kind of have to figure it out best as I go. And that’s just, that’s one very interesting thing about our population research and how we apply that to what are ostensibly quite healthy populations.
Dr. Lyon (01:14:09 -> 01:14:27)
And as we move over to think about what is a healthy population, how can we begin to think about optimal levels of muscle mass? And obviously, before we get to optimal levels of what muscle mass would be, we have to think about what potentially is pathologically low levels.
Tommy Wood (01:14:28 -> 01:16:54)
The in general that the literature also supports this idea that and I think it’s reasonable and supports the idea that what’s really bad is low levels of muscle mass, Tacopina, diana pina, you know, so the lack of functional muscle tissue like that’s what’s associated with higher um all cause mortality, worse cancer outcomes, things like that. Um And those cutoffs kind of differ from study to study. But I used to think about it in terms of F F M I or the fat free mass index, which is basically you take how much you weigh, you remove some estimate of your body fat percentage and then you calculate the same way you would calculate A B M I so divided by your height in meters squared. And this is kind of, you know, of other things like some studies use, like you mentioned the appendix color lean muscle index, which is something that we also tried in our, in our paper that’s basically have to a dexascan you then have to calculate how much muscle tissue is in your arms and legs. It’s just more difficult. Whereas an F F M R you just have to have some estimate of your, of your body fat and your weight and your height and you can get a pretty good idea. The cut offs, at least when I looked at the data and in other studies seem to agree Is that for women, the risk really starts to increase for things like all cause mortality effort for FFMI below 14. Um and for men, it’s about 17, Of course, there’s like a buffer there. You don’t wanna be right on the cut off and different people, you know, suggest different cut off. So probably something closer to 19 for men and 17 for women. And, you know, hopefully that’s something that most people can calculate. And that’s where that’s once you’re at those thresholds, that’s probably enough muscle tissue like that. We don’t yet have this good evidence that more is better above that point. Um Except for one study that came out recently that looked at this across like they took seven different data sets and they looked at FFMI and all cause mortality risk. And they said, well, first of all that, the relationship between F F M I and mortality was the same in men and women, which doesn’t make sense because men and women have in general different amounts of muscle mass relative to their height. And then they said that the cut off for the lowest risk was an FFMI of 22 which is pretty high actually
Dr. Lyon (01:16:54 -> 01:16:58)
Yeah that’s pretty athletic there.
Tommy Wood (01:16:58 -> 01:17:48)
Yeah, exactly. And I mean, great, like, if you get an FFMI of 22 is great. But I think this is another example of people looking at the data without really knowing what it means. Like, so for those who don’t think about muscle mass all day an FFMI of 25 is this sort of like theoretical cut off of where you can get to without performance enhancing drugs. Of course, there are people who are above that just by Accruing large amounts of total mass and we see that in the United States set but for like athletic individuals, 25 is, is high. Um and so like trying to get close to that and thinking that that’s where like a general population would see benefit. I don’t really believe that. So I think, you know, somewhere around 19 to 20 for men, you know, 16 or 17 for women, I think that’s probably the sweet spot. And then above that, you know, we don’t really know where there’s more benefit.
Dr. Lyon (01:17:48 -> 01:18:08)
I think that’s really important to point out because there’s a lot of talk about B M I and a lot of talk about body fat percentage, but there’s not a ton of discussion of what muscle mass looks like, how much fat free mass and individual should have. Now, where do you think, you know, when we talk about fat free mass index, we’re not, are we just talking about skeletal muscle mass or are we talking about all fat free mass?
Tommy Wood (01:18:09 -> 01:19:15)
Yes, it’s all fat free mass. And again, um, if you’re trying to isolate the effect of just muscle tissue, then something like A L M I, the apendicular lean muscle index, that’s useful because you’re just looking at skeletal muscle muscle and you’re just looking at it in the limbs, which is where, you know, you’re maybe most active and it’s most related to physical activity. Um However, uh we know that the other components of FFM I like bone are really important. And so that kind of gets rolled in there. And in our study, we found that the relationship between low muscle mass, either as A L M I or F FMI and cognitive function was essentially the same. Um And I think that, you know, including bone in there is helpful in some ways because we know that bone is incredibly important again, for preventing fracture risk. But then it’s also, it’s not just this completely dead weight that holds your body together, right? It’s an active tissue just like just like the muscle is. So, so, yes, FM I includes all of your lean tissue. But I think there’s some benefit from including that.
Dr. Lyon (01:19:15 -> 01:19:48)
Don’t you think that it’s interesting that our ability to specifically and only look at skeletal muscle is a bit prohibitive? You know, I mean, they’re talking about, I’m sure you’ve seen some of William Evans is data. He’s starting to look at D3 creatine is more specific ways to look at skeletal muscle. But, you know, essentially we don’t have a great way other than perhaps CTMRI to identify this tissue, which is a secretary organ and a whole organ system,
Tommy Wood (01:19:50 -> 01:21:38)
I think, yeah, there’s, there’s two sides to it. One is Like there’s the pursuit of knowledge mechanism, like really understanding what’s going on and that’s, that’s important, right? I think that’s incredibly important, the sort of this pursuit of knowledge for the sake of knowledge. And we don’t know when what’s just knowledge will actually become useful things to apply in real life. That’s always a part of science, right? You’ll discover something now that isn’t useful for, for 20 years. And that like that continued pursuit is important. But then the other side of it is like, what are the practical things that individuals can, can take away that they know is useful that has, you know, a meaningful implication for their lives. And that’s where I think simpler measurements and tools become important. So effort for my like you just remove the body fat component, you estimate your, your lean mass and it’s important for a whole bunch of things. So when we’re thinking about the brain, there are now several studies that, that show either looking at brain volume or brain atrophy. So like how much your brain shrinks with age, as well as elements of cognitive function. If you’re thinking about body composition, um muscle mass is the best predictor of those things. So muscle mass is more important than fat mass, is more important than BMI. And we’re so hyper focused on body fat when actually, particularly for the brain. But a whole bunch of other things like muscle mass is the thing that we should care about. And I like that as a takeaway because it’s also weight neutral, right? I don’t care about, you know, the mass that you exert on a scale, like the force due to gravity. What I care about is how much functional muscle tissue you have and that can improve and increase regardless of anything else. And that’s something that I think is really positive and that’s what we should be, that’s what we should be telling people about.
Dr. Lyon (01:21:39 -> 01:22:18)
I mean, I pretty much think that we should stop the podcast because that is the most critical statement of all time. And you and I could not be more aligned again. You are one of the only people that I have heard discuss it in this way. And I just feel so much in alignment with everything that you’re saying. It’s incredible. Yes, we are hyper focused on adipose tissue. It’s interesting, you know, there’s all these theories and paradigms of thinking and we’ve been so fixated on obesity numbers. You know, for example, we know that 73% of adults are either overweight or obese. What percentage of individuals have healthy muscle mass? We don’t even have that conversation. We have no idea.
Tommy Wood (01:22:20 -> 01:25:52)
And it’s probably, you know, and that’s like mixed in with this. Oh, yes. So first we just say, well, do you have enough muscle mass? But nobody asked, well, is that muscle useful or not? And I think that’s, that’s really what’s, what’s so important. And again, is something that it doesn’t take much, right? Any movement to stimulate that muscle tissue is particularly people who are sedentary has, you know, multiple beneficial downstream effects. So just small, small things like even with the muscle, you have, right? Improve the muscle quality of the muscle that you have, right? That is likely to have incredible benefits. And so, so what one thing that is important when we’re talking about this is like where is where the message is coming from? And so I actually have a story about you, which I think is really, really important. You don’t know the story. It’s good, it’s great. So um we’ll start by saying that most of the time when I talk about muscle tissue, like I can see people roll their eyes they’re like, calm down, bro. Like, clearly you love bicep curls. So, like, why should I don’t want to look like you. And of course, that’s not what I’m saying. Like we already said that more isn’t necessarily better. Like, I like to lift heavy things. It’s what I do for a hobby. Um, that doesn’t mean you have to, but I do think that you could do some more muscle strengthening type activities and it will have a great benefit to your health so that the messenger becomes important here as well because often people are talking about muscle mass are people who have a lot of muscle mass and the listener might not appreciate that. So, um I was at a conference for the British Society of Lifestyle Medicine last September. So, which is now the second largest Lifestyle Medicine Society in the world. And I’m one of the founding directors and trustees and I was speaking to a G P there. We were just like, sat in the back of the audience. We were having a conversation. Um And I was mentioning that was about to go on my friend podcast. You’ve been on his podcast. Um And what he said was, um, he was given a talk about muscle mass and all cause mortality and mortality risk. So that was what my talk was on. And he said, you know, I’ve been telling my wife that she needs to lift weights. Um, for years like the importance of muscle tissue. And like she just ignored me. She just hasn’t sunk in, but then she hears you on Rogan’s podcast and she sends it to her husband and says, look, look, here’s a woman talking about muscle mass. Now, I think I should gain, you know, go and lifting weights in the gym. So sometimes you need to hear this message from somebody who’s like you. I think that’s really important. So why am I saying that it means that somebody is listening to this um you have a sphere of influence of people who are more like you who are maybe more likely to listen to you than they are to listen to me, right? And I’ve seen this in multiple other scenarios, particularly with women where they would prefer to hear this message from somebody who’s more like them. So say postmenopausal woman, you know, here’s a message about muscle mass from another post menopausal woman. Great. So everybody just realized you have your small group of people who, you know, who are like you, who you can influence. And that’s how we spread the word and get this stuff out just like bit by bit with within our own groups. Um So that was my, that was a little tangent, but I think it kind of relates to getting this message out.
Dr. Lyon (01:25:52 -> 01:25:55)
I love it. And by the way, I’m not postmenopausal yet.
Tommy Wood (01:25:56 -> 01:26:03)
I didn’t mean that I didn’t mean that I had another conversation where that was relevant, not relevant to this conversation.
Dr. Lyon (01:26:04 -> 01:26:27)
I’m totally busting your chops. It is critical. The messenger is, is very important in terms of what is said, how it said. That’s where there’s room for all of us and especially the mission is so big from my perspective of changing this conversation of body fat. I don’t know if you know this, but I did my Geriatric and Nutritional Science Fellowship at Washington University,
Tommy Wood (01:26:27 -> 01:26:33)
The one in St. Louis? Yes.
Dr. Lyon (01:26:33 -> 01:28:28)
And um where I really realized this. So basically, I looked there was two parts to this fellowship. There was the clinical care in which I was a geriatrician and I worked in a cognitive clinic. You know, you go to the nursing homes, dementia, you work on the hospital floors, all of which actually you’re very skilled at in terms of geriatrics and cognition. I know that you work on the full spectrum. So my clinical work was geriatrics and the majority of that was cognitive performance and the clinical research I did was on obesity. So I looked at the interface between obesity and cognition. And that’s actually where this concept of muscle centric medicine was born. And I think that we all have our aha moment And I was imaging this woman’s brain. She was in her mid-50s, mother of three always cycled with the same 20 pounds. Yo yo diet her entire life. And you know, we did, we did insulin clamps and muscle biopsies. But also part of it was looking at the F M R I image of her brain and her brain, she had atrophy in her mid fifties. And it was at that moment that I felt really responsible that we had failed her as a medical society that she had constantly destroyed this tissue from years of yo yo dieting. And we were still telling her to, you know, eat less and exercise more. And we completely dismissed the fact that skeletal muscle was this organ system that could have interface with her brain above and beyond what she and her perception had been. And that’s really where this concept from, from me came from this muscle centric medicine. And I’m sure that you’ve seen the interface between cognition and muscle mass over a period of time. And I would love to hear, did you have an aha moment? Was there a moment that you really decided that perhaps changed the trajectory of what you were studying?
Tommy Wood (01:28:30 -> 01:32:43)
It was much more gradual than that I will say. So when I was a junior doctor in Central London, one of my rotations was in, in elderly, elderly care as we called it. Um and actually sort of relevant to all of this. It was, it was funny because I had a, had a consultant which is what we call an attending um who I was sort of attached to for a few months. And he’s this German guy, Dr Thomas Ernst, who would do all these, like, people would kind of like, talk about him because he was like, a bit different. Like his main focus, which I think is still important. Right? It’s not quite relevant to muscle tissue, but it’s relevant more broadly is his focus was, um, mindfulness. So he’d bring in, um, you know, he’d go around and see all his older elderly patients and he’d, like, spend half of his time talking about mindfulness type exercises. And everybody was like, what is this guy doing? Like, like what’s going on here? Um And then like several years later, I reflect back on this and you sort of, this is somebody who understands part of the bigger picture and it’s not part of traditional medicine and they sort of, they realized the impact they can have by bringing in these other ideas. And so when I then take that the work that I’ve done, um I sort of, like I said, I study the brain across the entire lifespan and a big focus of it is early brain development and then also being interested in athletes and what like what provides sustained performance and it’s usually sustained health, right? So I work with a ton of endurance athletes. And what’s the way if you want to keep showing up to the start line, you need to prevent injuries. What’s the best way to prevent injuries and endurance athletes get them to strength train like by far one of the most impactful ways to prevent injuries. And so you kind of see these pockets where regardless of the type of injury you have, regardless of like what you’re trying to do with your brain, the same things are important again and again. So like we think that next strength is important for minimizing concussions, right? So strength becomes like you’re just, you’re just providing this greater structure that, that’s protecting the brain. And then you look at uh say preterm babies. So I do a lot of work with babies born preterm and you see that those who who have these at risk brains. So the more preterm you’re born, the more likely you are to have some kind of neurodevelopmental impairment, cerebral palsy, some of the kind of brain injury um in those babies as they get older, they have improved cognitive function in those who gain more muscle mass relative to fair mass. So like even there seems like muscle mass is protective and and then the sort of the function of that muscle is important as well. So babies born preterm, those who have the best motor coordination also have the best executive function. So our ability to coordinate and move our bodies, which is an important part of muscle function is also related to the quality of the brain. So you can kind of see like regardless of how you look at it. Um Plus all the stuff we talked about earlier in terms of muscle mass being one of the best predictors of brain mass for one of a better word. Um These same things are important for the brain throughout, throughout the lifespan. So, you know, muscle tissue which relates to physical activity and all the reasons that can be beneficial. But then also diet, quality sleep, you know, all of these same things are important regardless of where you’re looking. And so it is that kind of like the tying together of, you know, you have, you know, I’m focusing on the brain, you have one brain um and the same things are important for the brain, regardless of where you look. And one of those things which I think is sort of less, well, people talk about physical activity in the brain. We know that we know it’s important, people talk about diet quality in the brain, but we start to appreciate that’s important sleep. The less people or fewer people are talking about muscle tissue. And I think that’s, that’s why, you know, then then decide to try and toot that horn.
Dr. Lyon (01:32:44 -> 01:33:03)
I think it’s, it’s so valuable and so important. When you think about muscle tissue, how do you think about quality? How do you identify the quality? Is it, is it a visual, is it a biopsy or is it more related to physical function, like strength or some kind of coordination?
Tommy Wood (01:33:04 -> 01:33:14)
So if I were, you know, a real exercise, physiologist, sports scientist you know, like my friend Andy Galpin.
Dr. Lyon (01:33:14 -> 01:33:16)
Who, by the way, I love Andy,
Tommy Wood (01:33:17 -> 01:34:32)
he’s fantastic and is actually some of the stuff that you see in that paper and some other things that we’re trying to figure out from these population datasets, is there a way that we can predict muscle quality without having to do a muscle biopsy which is very painful and difficult to do. Um So if you’re something like that, then you have an answer which relates to the types of muscle fibers, how much intramuscular triglycerides, like how much fat is around them. But you can, you can measure mitochondrial function, you can measure insulin sensitivity in individual fibers, right? That’s some metric of muscle quality and you know, from a scientific standpoint. But then you know, if you think about, well, how can I figure this out in an average individual? Then I think the most important function of a muscle is to move something against resistance, right? So, and that’s something that we can that we can measure. Um and one of the reasons why we used that particular chunk of enhanced data in 1999-2002 is because in that chunk, they did rather than doing grip strength when they did at different times they did and grip strength is another important predictor of longevity. And
Dr. Lyon (01:34:34 -> 01:34:35)
do you believe it is?
Tommy Wood (01:34:35 -> 01:34:57)
Yes, but only because it relates more broadly overall strength. So the way some people interpret it. Is there like train my grip strength that will make me live longer? Of course, that’s not true. I think grip strength is a proxy of overall strength and like physical health. So that’s why it’s a good predictor.
Dr. Lyon (01:34:57 -> 01:35:10)
Can I ask you one more question about this string is um grip strength. Of course, you’re talking about predictor of longevity and mortality. Are we born with a certain amount of grip strength?
Tommy Wood (01:35:11 -> 01:35:47)
So it will be. So there’s a few things that determine grip strength, right? So one is how long are your fingers? Right? So there’s a, there’s a, there’s a lever aspect. So bigger people with bigger hands will have generally have stronger hands and we know that the size of a muscle is proportional to its strength. It’s not true for everybody, but generally the more muscle you have, the stronger you are then, but not in the in sort of the general population. That’s kind of where we’re going. Um So there will be some predetermined aspects of grip strength. Yes.
Dr. Lyon (01:35:49 -> 01:36:02)
Um Just, just a question and a thought. But um yes, so the way in which we think about muscle quality you were saying is really get busy, do something.
Tommy Wood (01:36:03 -> 01:37:28)
So the, so the reason why we did this bit of enhances because rather than doing grip strength, which like I said, I think is a proxy of other things that we really care about. Um They did leg strength and if you’re thinking about risk of falls, hip fractures, a larger muscle mass that’s probably more related to your overall strength. I think leg strength is a much better test than grip strength. So that’s why we picked that, that chunk because they did leg strength assessment. Um And so then where I think you might get some idea of muscle quality in this kind of data set is to say, for a given amount of muscle tissue in your leg, how strong is that leg? So you can say if you have a lot of muscle mass, but it’s not very strong, you probably have low muscle quality. Whereas if you have less muscle mass, but it’s very strong, you probably have high muscle quality. Now, of course, in relation to, you know, very exact tests of the muscle fibers, it’s not, it’s a very imperfect test, but it’s one way that you might be able to start to unpick some of this stuff in a population. And then also say to an individual right here’s how strong, you know, it’s strong enough, right? Here’s how we know that your, you know, your muscle tissue is probably in good shape. And so that’s the, that’s how I think about it because then it’s more, it’s easier to relate it to something that’s useful to an individual who is listening to me talk about it
Dr. Lyon (01:37:29 -> 01:37:41)
and it’s totally translatable, which is amazing. Where do you think that this paper is going to lead you. What is the, have you thought about the next step in collecting this body of evidence?
Tommy Wood (01:37:42 -> 01:37:55)
So there are other datasets that we could explore this data set is relatively small. So the UK Bio Bank is a much larger dataset with similar metrics. They don’t have leg strength, they do have grip strength, your favorite.
Dr. Lyon (01:37:56 -> 01:38:05)
Were you surprised by that question? That question? I’m just curious about, you know, there’s some spectrum of understanding when it comes to grip strength other. It’s
Tommy Wood (01:38:06 -> 01:38:37)
so I’m not surprised by that question. I mean, only, only pleasantly because again, it’s one of the like when you see people apply this knowledge, right? So, so you, you’ll have health related um proponents that could be health coaches, doctors, people on social media, right? Who talk about strength and I’m glad they’re talking about strength is important, but they’re like, here’s this paper that shows that grip strength is, you know, x important for longevity here are all the grip exercises for you to do. And it’s like, well,
Dr. Lyon (01:38:37 -> 01:38:40)
Tommy Wood (01:38:40 -> 01:43:40)
it’s not that it’s not important, right? So imagine you stumble and fall, being able to grab onto something to stop yourself from falling, great, really important. But you know, if I was going to, if you’re going to do something like just one exercise, don’t grip exercises, do a dead lift. So, so that’s where I think things get that get mixed up. But interestingly, so, UK biobankers one day. So they have grip strength in that paper. We talked about earlier when they looked at muscle mass and, um, and cardiovascular disease and all cause mortality in UK biobank. They saw this discrepancy but didn’t see that. It was their, what they saw was the, those with the most amount of muscle tissue had the highest cardiovascular disease and death risk. But those with the highest grip strength had the lowest. So what you’re telling me is that it’s muscle quality that it’s an important predictor. These, these are people with a lot of muscle that isn’t very strong, that’s what’s important, not that they have more muscle. Um So I think we could, we could maybe pass some of that out. I’d like to do that. Um And then the next step I think is tie some of these metrics that you can get from a population data set um and turn them into some meaningful metrics. And so this is something that I’ve tried to do. So take power lifting data. So open powerlifting has basically the data for every lift that’s ever done in a power lifting composition anywhere in the world for, you know, years. It’s an amazing data like hundreds of thousands of people lifting. And what’s nice about that is, you know, there are people showing up to powerlifting competitions in the 90s, which is amazing. So you can say in somebody who trains regularly and I imagine that if you’re a power lifter showing up in your 90s, you probably go to the gym at least two or three times a week In people who are training regularly. This is how strong they are. And this is the trajectory of strength over the lifespan. So it’s not necessarily the same individual from their 30s to the 90s. But you can see this trajectory. And what you see is that the rate of um strength loss with age in powerlifters is actually very similar to the rate of strength loss in the general population. So and which was, which was surprising to me. Um But what you can say with some like statistical jiggery pokery, which I did, which is probably not, you probably couldn’t publish it because you kind of have to infer for a bunch of stuff. But basically, and the problem is that in power lifting people squat like properly squat in general population studies, nobody squats like the leg press and the leg press is great. If that’s all you have access to, please do it. Love it. But turning a squat number into a leg press number is really difficult and I’ve tried a number of different ways. So I’d like to be able to do that to say like here’s what it looks like in the train population, here’s what it looks like in the general population. But with that, you can kind of see that the, you know, with some kind of like hand waving, The power lifters reach the same relative strength about 20 years later compared to the general population. So that means that even though the rate of decline is the same in like in terms of percentage, Those who lift, they have a higher start point from which to lose strength. So you have a bigger buffer and that means that you can end up at any given age with a strength of somebody who’s like 10-15 years younger in the general population at least. So that, that’s where I think is important. So we can say here’s how strong, maybe you need to be to, to be live independently, that kind of stuff. I think that’s important relatives and you kind of use those comparisons. And then another thing that that’s important is we’re talking about muscle quality is how do we relate what we measure in terms of, you know, strength relative to muscle mass in the population to, you know, real muscle quality metrics. So finding some way to validate. So if I predict you’re somebody with low quality muscle based on how strong you are relative to the muscle you have. Plus maybe some, some blood tests, we know there is, you know, probably we need to metabolic health CRP some of the things, um you know, can we validate that in actual people where we have strength and body composition and actual muscle biopsies, I think that would be a nice thing to do. Um And that’s something that Andy Galpin and I have talked about and hopefully doesn’t mind me talking about it. Um But so finding some ways to say we’ve tested this in like the real lab situation. Here’s how it relates to you as an individual who doesn’t need to go and get a muscle biopsy. Maybe you just, you know, do a leg press and have a blood test and then we have some idea of muscle quality and, and what things we can, we can do to improve that.
Dr. Lyon (01:43:41 -> 01:44:05)
That’s brilliant. And I hope you guys do come up with something. I have two questions, kind of off the tail end of that. Do you think that will ever be able to measure my, ah kinds other indirect or perhaps direct markers of not just inflammation or inflammatory states or metabolic health, but actually blood markers of the impact of the health of the skeletal muscle?
Tommy Wood (01:44:06 -> 01:46:34)
Yeah, it’s a great question. And um, there were several of, of interest, right? You could think of BDNF, you know, um I reason was popular for a long time. Lactee, the like that, that combination of lactating female aniline, which was discovered, you know, just a year or so ago. You know, I think every couple of months there’s this big paper in like nature or science that says we discovered this new molecule that muscle releases when you exercise and here’s why it’s good for you. Um And so there’s like multiple things about that. To me, one is that like physical activity is probably the one thing that everybody agrees on is good for your health. But we still don’t know how it works. Like we know we have some idea of how it works, but we don’t really know how it works. So I think that’s interesting. Right? I can recommend it to you without really knowing any of the mechanism. So there’s like multiple parts that come out, I think, yes, we can do advancement Islamic studies. We can look at individuals based on their muscle mass and muscle strength and muscle quality. You know, we can do muscle biopsies and then we can look at, you know, the circulating metabolism like which metabolites that we believe are generated by the muscle tissue, you know, are circulating. The difficult part of it is then linking like what effect does that have elsewhere? We can sort of in mouse studies, we can kind of maybe knock one out or over express one and and see how that affects things. But then there’s also a temporal component that makes it trickier, right? So a lot of things, these things are released during exercise, generally proportional to the intensive exercise, but not necessarily. And then they may initially have one effect and then longer term they have another effect. So one of the best known my kind is probably the first my kind, I think was aisle six pro inflammatory sites kind, right. So initially exercise looks pro inflammatory. It also looks like it generates oxidative stress. You’re like this is terrible. Why would you want this? Like it’s a bunch of information oxidative stress. But then it has this sort of effect that it increases or decreases systemic inflammation and it increases capacity to deal with oxidative stress that then results in improved long term health. So yes, I think this is, this is possible, but just like I’m picking all of that stuff is really difficult. I find it really fascinating, but it’s, I think it’s gonna be a long time before we can really understand this as much as we might want to.
Dr. Lyon (01:46:34 -> 01:46:40)
Would you say that muscle sciences is still relatively new muscle and exercise science as we can understand it?
Tommy Wood (01:46:40 -> 01:49:01)
Yeah. Absolutely. Mainly because so, so I think the endurance and aerobic side had a bit of a head start, right? That’s been, that’s certainly been going for longer. We have a better idea of um how to improve aerobic fitness. Sort of people have looked at mitochondria function vo two max probably a little bit, you know, a little bit longer. And then, you know, muscle tissue and muscle focused research has sort of been coming, has been coming along and there’s a lot of great stuff that’s out there when we know how to help people improve muscle mass, right? You can kind of, you can quibble about the details, but mechanical tension plus some kind of metabolic stress in some ratio, you know, relatively regularly every two or three days. Right. That, that, that’s it, that’s what most people need to do. And so like professionals can, can argue about the details, but that’s essentially what you need. So there’s, there’s two parts of it. One is, do I know how to help somebody increase their muscle mass? Yes, I do. Like, I don’t necessarily know for one individual what the optimal training strategy is because we know the different people maybe respond to different rep ranges depending on where they are in their training experience. And maybe there’s a genetic component, all that kind of stuff. But I’m pretty sure that, you know, you go and you do three sets of eight in six exercises, right? You’re gonna, you’re gonna gain some muscle mass and that’s the kind of strategy that they’ve used in older individuals. One of my favorite trials, the smart trial looked at people in their seventies. That was the training regimen. They gave them three sets of 86 exercises twice a week, something anybody can do in like an hour or an hour and a half per week, right. Um And that significantly improved muscle mass strength and cognitive function, right? Anybody can do that. So, so I think that we’re probably a bit behind or muscle science is maybe a bit behind some of the other aspects of sports science in terms of like really digging into the mechanisms. But we’re still at a point right now where we can say this approach is probably gonna be beneficial to a lot of people and you probably don’t need that much, right? That’s, that’s not a bunch of time, an hour a week, doing some kind of resistance training to have significant benefits even later in life. You know, I think that’s, that’s really important for people to know.
Dr. Lyon (01:49:02 -> 01:49:22)
So there’s no excuse for any listener out there. There is literally no excuse. And I think that the recommendations are 100 and 50 minutes to 75 minutes of vigorous activity. So 100 50 minutes of moderate activity to 75 minutes of vigorous activity, which is essentially what, 15 minutes a day, uh, that’s, that’s pretty low.
Tommy Wood (01:49:23 -> 01:49:27)
It is pretty low and actually that’s, that’s the government recommendations. Um, and we
Dr. Lyon (01:49:27 -> 01:49:31)
We probably know that that’s even too low. But, yeah,
Tommy Wood (01:49:31 -> 01:51:33)
you could certainly make that, make that argument, you know, you know, up to a certain point more, you know, more is better. Um, and on a podcast recently, I think, I think I said that I was. It doesn’t matter what you do, anything more than what you do now is going to be beneficial. And some personal trainer jumped up in the comments and was like, no, people are going to be injuring themselves. I’m like, let’s be realistic, right? Warning people about all these injuries they’re going to get just because they’re going to go for a walk or touch a couple of machines in the gym… You’re doing more harm than good at that point. Bodybuilding training is, after walking, the most safe in terms of injury risk form of exercise. And you can look at professional powerlifters and bodybuilders who get injured, but it’s just a different beast. So I think people should know that it’s not that much that you need to do. The injury risk is very low for normal people doing normal weight training in the gym. Um and you can kind of mix and match if you’re thinking about say brain health, overall cognitive function, you can mix and match these things. So there was a recent meta analysis that looked at the minimum effective dose of physical activity to clinically significantly clinically improve cognitive function. And what they meant was what’s enough so that you actually see like a meaningful change on a test rather than just like something that’s statistically significant. And what essentially came out was what you just said, they looked at it in terms of minutes per week. So it was kind of like which is a so so met being how intense is the exercise? So you can kind of say, well, if you do less intense exercise, you just do more. And if you do more intense exercise, you don’t need as much. And So they said 700 minutes a week, which is basically 100 and 50 minutes of moderate to vigorous physical activity, which is what the government guidelines say. And that’s enough to, Like, significantly improved cognitive function. There’s probably more benefit above that. Right. But we’re not talking, training 30 hours a week. We’re just talking an hour of movement a day. Some brisk walking, lift a few weights. Right. That’s it.
Dr. Lyon (01:51:34 -> 01:51:50)
And it could be weights or it could probably be resistance bands if someone is traveling, could be blood flow restriction, right? A lot of the military guys post injuries, blood flow restriction or there. So it doesn’t have to be a big barrier to entry.
Tommy Wood (01:51:51 -> 01:52:33)
No, absolutely not. And so, you know, most people when they think of resistance training, right? They might think of a gym. You know, if you think about that protocol, I mentioned earlier, 6 machines go to Planet Fitness banging out in 30 minutes. I think most people can do that. But you’re right. Um, people might ask about those who are particularly frail or traveling. Blood flow restriction training is great. I do that almost exclusively when I travel resistance bands, body weight, really any kind of resistance, um, is all that you need, you can do it at home with just what you have around. Um, when I travel, I also use electrical muscle stimulation
Dr. Lyon (01:52:34 -> 01:52:36)
about that, which,
Tommy Wood (01:52:36 -> 01:53:13)
which I quite, which I quite like. Um, and I usually do it in concert with some bands or body weight movement to kind of, to kind of stack them, stack them together. So if I put the electrical muscle stimulators on my quads and then what, what it does is it, it sort of electrically stimulates the muscle from the outside. So it forces a contraction from the outside. And then when it’s contracting, I’ll do a body weight squat. So I’m kind of like doing an eccentric movement against this stimulated concentric like contraction and like you get really sore quads after that. It’s great.
Dr. Lyon (01:53:14 -> 01:53:31)
Do you use a suit? Have you ever used to say a catalyst suit or some of those electrical stim suit or is it individual target muscles? You know, maybe you put on your quads and then you move into your bicep or your glutes. I think everyone wants to see what you’re doing to share that. That would be pretty fun for everybody.
Tommy Wood (01:53:32 -> 01:53:52)
So I just because they’re the ones that I’m used to, I used the power dots. And so it’s, it’s one muscle at a time. If I made more money as an academic, I’d buy myself a catalyst suit, but that just hasn’t really been in the budget. So I’d love to try out something like that, but it’s not something I’ve done. Okay.
Dr. Lyon (01:53:52 -> 01:54:14)
Well, I’m sure we can arrange to get you a catalyst suit because again, we all want to see your workout plan because you have access to so much academic information. But again, what’s so interesting about you is the way in which you interface the academic information to the education and conceptually to the general public and that’s critical and you do it yourself.
Tommy Wood (01:54:14 -> 01:55:01)
Yeah. The, when I first got into this, like 10 years ago, I was, I was starting my phd, I started to write a blog and like my goal was how do I write the things that I know that my mom can understand it, right? That, that was, that’s kind of what really, really drove me. And then along the way, you get kind of like pulled into the bio hacking and the optimization and all the data and all that kind of stuff. But you know, the people who are focused on that are the people who need it the least. Um And so I think turning this stuff into accessible information that anybody can understand and feel empowered by. I think that’s what’s really important. So that ended up like that’s where I’ve ended back up doing because that’s really important to me.
Dr. Lyon (01:55:01 -> 01:55:19)
Isn’t that interesting that we kind of go full circle? And I’m sure you did this when you were um really focused on, did you see patients one on one? And you’ve also worked with a ton of athletes. So probably in the beginning of your career, you’re probably taking a ton of different blood work, urine samples, you know, like the whole shebang
Tommy Wood (01:55:20 -> 01:55:23)
all of it, all of which,
Dr. Lyon (01:55:23 -> 01:55:59)
by the way, if you are an operator listening to this podcast, you better believe you guys all need the stool test because the places that you have been. So I don’t want to hear it. You guys are doing it. But you know, when we think about the extensive amount of testing, what ultimately ends up happening with a clinician is you scale it back. You realize there are core fundamental tests that we should all be looking at. And the rest is, you know, if you’ve assessed the foundation and the foundation is broken, then you start there. Are there certain blood tests that you’re always looking for? Have you done that? Did you throw a wide net and then scale it back?
Tommy Wood (01:55:59 -> 02:00:19)
Yeah. Yeah, absolutely. So, as I got into what some people might call integrative medicine or functional medicine and I did it with athletes essentially. So, you know, some of them had gut issues or other related health issues, fatigue, but some were just like I want to perform as well as I can for as long as I can. And there was a point when like you come in the door, I mean, I’ll take it, you know, and this is something that sort of worked institute because it’s something that’s so important to a clinician. But unless you’re medically trained, you don’t necessarily know like the history, like taking a good history asking people about themselves. That’s like the most important thing in most medical training, they sort of drill into you or at least they do in the U K where the, the, the government pays for health care rather than the insurance company. Um, so then they have tight purse strings. So get as much information as you can for free before you start testing. Um, so history is really important, but then once you’re through the door, I just like, throw everything at you. Here’s a $700 blood test, here’s like a couple of $400 urine test. Here’s a $400 stool test, right? So you spent $2,000 before the person like does anything. Um, and what you realize is, first of all that, a lot of those tests aren’t particularly well validated, like you go start looking for evidence that they’re actually related to any of the things that they say they’re related to or that, you know, this metabolite that you’re measuring the urine in any way related to that metabolite as it is within a cell in a certain organ in the body. And you realize, okay. Well, actually that’s not, not true. We don’t know that. And then there’s also like, I would do a bunch of fancy hormone testing in urine and then every time I got a weird result back, I’d be like, I wish I just tested this in blood. I wish I, I wish I’d done a full pituitary screen up front. Um So that’s why that’s why I ended up doing so, particularly in particularly athletes, which is the population where I probably look at blood tests most frequently. Now, um the basics are still the basics. So complete blood count with differential is a whole bunch of stuff. You can, you can figure out from looking at red blood cells and their morphology and that kind of stuff. Um and the white blood cells and their distribution and the ratios. They’re like a comprehensive metabolic panel, like basic lipids, blood sugar regulation, maybe, maybe do a fasting insulin calculator. Look at homocysteine for some homocysteine is a really important risk factor for cognitive decline so that you can figure out whether somebody needs some additional B vitamins, something like that. So like that, which is again, it’s just the basic, you get it for 50 bucks. Um And but then if I’m working with athletes, yes, we’ll often do hormone panels. Um I, you know, people spend a lot of time worrying about the free engine index, free testosterone, total testosterone is the thing that really matters. Like you can have bound testosterone that still has a physiologic effect. So I get, I get a ton of athletes who have really high sex woman binding goby in there really worried that the testosterone isn’t available, but they have no, you know, they’re in great shape and actually S H P G is a really interesting market because the best way to decrease it is to become insulin resistant. Um It basically S H B G is linearly correlated with insulin sensitivity. So I, I see, I see really high values in the fifties and sixties all the time. Um it’s completely normal for me in athletes. Um But one thing that is important is a, is a full pituitary screen and I’ve had enough athletes come in with low testosterone. The people have been messing around, um looking at other things, you know, maybe they’re going to see some other integrative health practitioners who will just do lifestyle based stuff. And I’ve caught at this point, maybe four or five per elected members in May and athletes just and so like now I don’t, I don’t even like, don’t even send them back. You come in the door, you get, you get a pituitary screen particularly because, you know, concussions and hyper patriotism because of previous head trauma. You know, it’s, it’s an extra 50 or 60 bucks that, that always pans out as being useful. So that’s like the one thing that I do that’s maybe not standard. Um Just get that as they come to the door. But other than that, it really is the basics that matter.
Dr. Lyon (02:00:20 -> 02:01:02)
Isn’t that interesting? Again, you went full circle and listen, we’re not saying that there isn’t some value. But what you’re really saying that is very critical is that, is this test validated or not? You know, I am I have spent two decades studying protein metabolism. Don Lehman, again, still one of my best friends and longtime mentors. And when I was looking at the initial, some of these urinary tests, they or urinary blood, they look at amino acids in the blood which we know the flux is so high and that’s not even the primary site for the majority of amino acids. And you’ll hear people say, okay, well, you need more glycerin or you need this and, and the clinical relevance is not there.
Tommy Wood (02:01:03 -> 02:01:35)
It’s, I mean, I’ve seen people say like higher, higher circulating branched chain amino acids are associated with this disease. Therefore, you should consume less of them. It’s like that doesn’t make any sense. Like this is this is stuff that happens in concert these things increase as your metabolic health declines. So it’s like a proxy of a proxy of something that actually matters. So using those things to tell somebody they need to eat more or less of a specific amino acid. I mean, it just doesn’t make any sense. I mean, yeah,
Dr. Lyon (02:01:35 -> 02:03:30)
I couldn’t agree with you more. Um And this is just one clinician to another clinician kind of laughing about some of this stuff. And you know, we’re not laughing about it at the expense of a patient. It’s just really important to understand and be aware of the providers that you’re using. And what is the marker that you’re looking for? How is it relevant. Where are you allocating funds? You know, I will mention that, you know, stool testing, there may be some benefit for certain pathogens. Although right now and we don’t have to kind of go off on a tangent. But right now, they typically use PCR testing and there’s a very high false negative for PCR testing and there are other ways to address it and whether that’s infectious disease or looking at these, these stool samples under a microscope and really having an old school parapsychologist to it, which I typically recommend sorry guys. But um you know, just kind of thinking outside the box and what is it that we need versus want and the essential nature of some of these tests. But now moving on from that and the prolactin oma is interesting. Um I do have a question on muscle mass. You talked about how the muscle mass in and of itself, it’s more about the health of the muscle mass. You know, as I think about metabolic challenges, we know that muscle mass is the primary site for glucose disposal. Healthy muscle mass is the primary site. Well, all muscle, the primary site for glucose disposal, but you’d also mentioned an increase in uh intermodal cellular triglycerides and you know, their ceremonies and there’s all kinds of diets, a glycerol. Um Do you think that if we increase the amount of healthy muscle mass that we potentially just at rest, not through exercise at rest can increase the amount of glucose disposal. Is there a correlation, is it clinically relevant to be able to increase that glucose disposal? And thus, obviously, in the diet increase carbohydrates.
Tommy Wood (02:03:32 -> 02:06:37)
Yes, potentially. But I think that muscle also has to be active. Like I think there’s an interaction between mass and activity and there are some studies where they’ve taken um like some of my favorite studies they did back in the olden days when you could kind of do more and the Ethics Board’s didn’t question what, what people were up to. Um And so like, you’ll have people exercise one leg rather than the other for a long period of time, like 10 weeks of training one leg, but not the other leg. And you can fill people with canulars and measure everything and like arteries and veins and all this kind of stuff. And you can look at glucose disposal within a tissue, right? Because you can, that you can calculate the artery going into the leg and the veins coming out of the leg and get some idea of glucose uptake a lot, a lot of cool stuff. Um My, all my favorite studies are like seventies physiology studies because they could do weird and wonderful things. Um And what you see is that um if you have a muscle tissue that’s active, right? So you’ve trained it, then you have more glucose uptake per kilo of muscle tissue. So more muscle equals more glucose uptake and more activity equals more glucose uptake. Right. So they’re important together. However, if you have muscle tissue that was previously trained and then gets de trained, so it becomes sedentary, then actually it’s less good at taking up glucose. And there, there are some studies in individuals with pre diabetes or diabetes where you can see significant improvements in glucose responses, say to a meal or like continuous glucose throughout the day. But it’s only like really when those people are doing activity every day. So it’s the physical activity plus the muscle tissue that, that’s beneficial. So I think related to the other things we were talking about earlier if you have more muscle, but you don’t do anything with it. It has the potential to be detrimental because that’s, that’s essentially the definition of low quality muscle tissue. However, if you gain muscle tissue and then you move it and I do just mean like brisk walking, I don’t mean that you have to be running marathons every day, That’s enough to stimulate uptake. Um and so the, I think there’s an interaction there. Yes, more muscle tissue and even at rest will increase, will take up more glucose. But only if that muscle has been recently active, like, you know, within the last 24 hours say. Um and you know, there’s probably some, some drop off over time to like it goes down two or three days. But if that muscle tissue is continuously sedentary, even if you have more of it, I’m not sure you’re going to have a meaningful improvement. And we know that, um, sedentary muscle tissue sort of starts to generate this pro inflammatory environment. So there’s a possibility that you have a ton of muscle and it’s sedentary that’s worse than having less muscle, that sedentary because there’s just more of that tissue that’s expecting movement isn’t getting it. But that’s completely hypothetical. But possible.
Dr. Lyon (02:06:37 -> 02:07:14)
Interesting. That’s really interesting. And you know, you had mentioned something about relative strength and the decrease of strength over time. Do you think that that is inevitable? So there’s this, this kind of loss of muscle mass and strength and it can range what from point A to depending on how sedentary someone is 23%. So it’s, it’s pretty significant. Do you think that there that that is an inevitable part of aging? Because again, we don’t see eighties and 90 year olds have the same quality, maybe quality quantity of muscle mass that they did when say they were 40.
Tommy Wood (02:07:15 -> 02:08:51)
Mhm. So if I go back to looking at the open powerlifting data, um and you know, multiple strands of evidence, yes, I think to a certain extent, aging is inevitable. And with aging right right now, maybe at some point, we’ll figure out how to completely stop that physical activity for what it’s worth is the only thing that has been shown to either prevent or reverse all of the nine hallmarks of aging, right. So incredibly important is part of the aging process. Um But even in people who train regularly compete in power lifting as they get older, they get less, they get less strong, you know, they lose, they lose strength. And with that, I’m sure they’re losing muscle mass that wasn’t measured in the data that I’ve looked at. Um So yes, I think that loss is inevitable. However, whenever you start training in your life, you can change that trajectory. So we know that in sedentary older individuals, like even if you get in your seventies or eighties, you can significantly improve strength and strength will probably improve more than muscle mass. But strength is probably right, what we care about the most in terms of keeping you sort of safe and, and active as you get older. So you can always intervene, it’s never too late to get stronger and you can, you can always gain some muscle mass. You can definitely gain strength regardless of when you start and then the earlier you start, maybe the bigger the buffer you can build up. So then as you do lose strength and muscle mass, which unfortunately you will, we haven’t figured out how to completely
Dr. Lyon (02:08:51 -> 02:08:59)
Michael Hearn is never losing muscle mass. Let’s be, let’s be real. We love you, Mike. You’re never losing muscle mass, everybody else. Maybe
Tommy Wood (02:08:59 -> 02:09:16)
he, he also had a pretty, still has an exceptional buffer, right? He’s got a lot to lose. I certainly wish that I had as much to lose as he does. But right. So accepting Michael Hearn, who maybe,
Dr. Lyon (02:09:16 -> 02:09:20)
maybe, maybe Phil
Tommy Wood (02:09:20 -> 02:09:54)
also looks exactly as he did when he was at the height of his bodybuilding, accepting those guys who figured out the fountain of youth, we can’t prevent aging entirely. So we will lose muscle mass and we will lose strength, but we can change that trajectory at any point and we can increase our head room so that we get to the point where you know, we like significant loss of function and loss of mass associated with the health happens much later. If ideally, it happens after you die of something else. All right, that, that’s what, that’s what we prefer.
Dr. Lyon (02:09:56 -> 02:10:29)
So basically, you’ve mentioned resistance exercise and or even brisk walking, your recommendations are not excessive by any means which is critical and obviously, that translates to what you’re seeing in research in terms of nutrition. I’m sure you get this question a lot. What are your thoughts? And you, you actually come from it? I think from a two part perspective. Number one, a cognitive perspective and number two, I think a body composition perspective. Is that fair to say?
Tommy Wood (02:10:29 -> 02:11:40)
Yeah. Um I think if we’re, if we’re thinking about like total longevity or health span, however, you wanna call it, you’re also thinking about cognitive function. Um And hopefully those two go go hand in hand and in general, there are very few things where we can say this increases your risk of this, but decreases your risk of this. In, in reality, it’s very uncommon to say, um, you know, I’m going to give you this, this diet that’s gonna increase your brain health. Um, but you’re more likely to have cardiovascular disease. I that’s, I don’t really think those trade offs exist. Um, as long as we structure things correctly. So when I think about the brain, um there are a number of critical nutrients that we know are important for long term brain health. So, you know, enough Omega three fatty acids, all the B vitamins, right? We talked about homocysteine. So we’re talking B 12 folate B six riboflavin primarily um creatine, it’s my favorite thing for the brain. It’s good for literally everything. Um And I think everybody with a brain should take creatine,
Dr. Lyon (02:11:40 -> 02:11:45)
Do you take creatine even if you do? Um And do you eat red meat too?
Tommy Wood (02:11:45 -> 02:15:37)
Yes, I do. Um Do I eat enough red meat to meet the amount of creatine that? I think most people should get maybe. Um but I also know that creatine is incredibly safe for long term use and is incredibly low risk. So if there’s fractional benefits from the supplement from the creatine that I take, you know, I’m willing to take it. Um They’ve given creatine long term after loading dose 4 to 5 g a day in old patients with Parkinson’s disease for years at a time, no side effects. Um So I think it’s incredibly safe with a number of potential benefits. Um The though I probably get 2-3 g per day from my diet would be my guess. And then I take 5g on top of that every morning. Um So creating is important. Colin is important for the brain and those things actually interact very interestingly, you need in order to get create healthy membranes around cells in the brain. Um One of the most important things in your synapses is D H A, the long chain omega three fatty acid in order to get it into a phosphor lipid in the cell membrane, which is where you want it. You need both healthy methylation system, which is where home assistant will be vitamins come in and you also need something to attach it to which is where Colin comes in. So when, what really frustrates me is they’ll do randomized controlled trials or they’ll just give people with Alzheimer’s disease or cognitive decline D H A and say, oh look, it didn’t work well. That’s because you didn’t create an environment for that D H A to actually be used. Uh and, and make its way to the brain. Um And it’s the case, that’s the same case for, for a bunch of things we know they interact, this is not a single variable problem. Um So those are the things that I really think about um in terms of like individual nutrients for the brain. Um But then body composition, I think one of the best things that we can do in the modern environment is maintain muscle mass and prevent overall weight gain, right? Like just not get, not getting fatter in the modern environment is a big win. Um So when we know that protein is incredibly important for association, you can gain muscle tissue and strength in the absence of resistance training. If you eat enough protein, of course, they also interact. So if you add resistance training on top of protein, that’s where you get your best improvements in muscle mass and strength. So, you know, I imagine my recommendations are very similar to yours. I focus on protein first within a meal 1.5 g. Um on average per kilo per day, you know, a bit more than that is great. Um And so, and then you can build the rest around that. But, you know, I believe in elements of the protein leverage hypothesis, which basically means that your body keeps eating until it gets enough protein for the day. So if you front load that protein, get it in, then you’re probably gonna decrease overall caloric intake, improve the quality of your calories because generally protein in the absence of highly processed foods, you know, comes in sort of nutrient, dense, high quality foods and, but again, shakes and bars and things like that are great. If you need that to meet your protein requirements, I have no problem with that. Um, and then that’s, that’s really where I start. But then sort of more broadly, I believe that there are many ways to skin the nutrition cat. I’ve seen people, um, perform admirably on incredibly diverse diets which leads me to not think that there’s one particular way to do it, but I do think you should get enough protein and then you should eat food that looks like food. But other than that, you know, I think it’s great advice. Yeah, I think that’s, that’s it. There’s really the broad, broad recommendations
Dr. Lyon (02:15:37 -> 02:15:54)
essentially. I think you nailed it. And just to highlight one last thing, essentially, you’re talking about a food matrix. You’re not talking about the individual um Colleen D H A. But really how we need to start to think about foods as a matrix.
Tommy Wood (02:15:55 -> 02:16:03)
Steak and eggs gives you all of that together. I would be ideal plus plus, maybe a plus, maybe a side of sardines.
Dr. Lyon (02:16:04 -> 02:16:06)
hard pass, hard pass there.
Tommy Wood (02:16:07 -> 02:16:18)
The sardines are the densest food source of creating no idea really. For 4 to 5 g per 100 g of sardine. It’s a lot of creating.
Dr. Lyon (02:16:19 -> 02:16:51)
I had no idea. Well, my daughter loves sardines. Great, especially on a plane. Needless to say we get the whole road to ourselves anyway. Tommy Dr Tommy Wood. Thank you so much for coming on. This is just going to be one part of one episode. You are a phenomenal guest and human and I’m really grateful for your time. I know how busy you are. I will include all links on where people can find you. And again, I am, I am so grateful
Tommy Wood (02:16:51 -> 02:17:05)
this, this was so much fun. Like I love you and your work. I’m a big fan of it. So it’s a real honor to, to get to, to join you and talk about all things muscle, which I know that we’re both very passionate about and hopefully the listener is now more passionate about having heard us talk about
Dr. Lyon (02:17:05 -> 02:17:14)
They definitely are. And the next interview will have to do in person and of course, what we’ll throw in a push up or pull up challenge, we’ll see who’s gonna win.
Tommy Wood (02:17:14 -> 02:17:16)
Dr. Lyon (02:17:16 -> 02:17:18)
Okay. All right, my friend. Thank you so much.
Tommy Wood (02:17:18 -> 02:17:19)