In this episode, Dr. Rena Malik, MD, sits down with Dr. Gabrielle Lyon to explore the intricacies of protein intake and metabolic ...

why-protein-is-the-secret-to-longevity-ft-dr-gabrielle-lyon

Why Protein is the Secret to Longevity ft. Dr. Gabrielle Lyon

so let's say you're eating 150 gram of protein based on your ideal body weight how much carbohydrate and how much fat should you be aiming for in relation to that yeah um this is a great question it depends number one how metabolically healthy you are if you are metabolically unhealthy and that means diabetes high blood pressure high cholesterol metabolic syndrome hypertension overweight obese exactly then how I would do it is I would recognize first that the way in which you dose carbohydrates matter anything above let's say between 40 and 50 g but we'll say 40 requires an additional insulin response you do not want that because over 40 grams of carbohydrates now now you're requiring your body to kick in and manage glucose through insulin that should be a failsafe mechanism not what you are routinely doing and that becomes important to understand so the first thing that you do when you're planning a diet is understand how much protein you need MH first and we'll say that's one gram per pound ideal body weight uh you're going to figure out how you're going to dose it again that first meal for 150 pound person you could do 50 grams of protein three times a day do you have to no is it advantageous if you're thinking about skeletal muscle Health potentially yes the next question comes into carbohydrates so I do better with carbohydrates I very Physically Active the RDA for carbohydrates is 130 gram the average American eats 300 G of carbohydrates a day I believe that yes from a practical application is understanding that you're not going to consume more than 40 gram of carbohydrates per meal so if you say that that's 40 gram three times a day that's that's perfectly fine however I would say if you are metabolically unhealthy you could certainly make an argument to reduce those carbohydrates you could also on the other hand make an argument if you're very Physically Active for every uh hour of exercise with your heart rate over 120 beats per minute doing moderate to vigorous activity you could easily use between 40 and 70 grams of carbohydrates per hour one would have to recognize that that requires activity MH yeah so you earn your carbohydrates and then fat I would say fat Falls where fat Falls and I would say for your audience you know a lower fat diet can affect testosterone levels and so for men I typically don't go below 100 gram of dietary fat it's very interesting because we talk about diet in terms of percentages but that's not very helpful because um again it all depends on protein intake and understanding that you know someone might say well your diet is 20% protein well 20% protein on a 2,000 calorie diet is going to be different than 20% protein on a 1500 calorie diet right so that's how I would do it dietary protein first get that number correct determine if you're metabolically healthy or unhealthy again the minimum RDA is 130 G titrate up or down and then fat should just fall where it falls I never go out of my way to add in more fat because the essential fatty acid need is about four grams a day yeah so pretty low so in order to determine if someone's metabolically healthy like say they don't they don't have any of these conditions should they go get a dexa scan and what should they be looking for in numbers on the dexas scan the dexa scan is the best we have right now a CT or Mr would be more beneficial but again how many of our patients are going to go get an MRI to look at muscle mass yeah not not many no and CT has a risk associated with which is radiation an inbody is helpful and that's a bioimpedance or a dexa understanding that hydration matters time of day matters trying to be consistent I think that we're a bit too liberal on what we look at for body fat percentage so if someone is 30% body fat that's too high I would say also 25% is likely too high so consider yourself metabolically unhealthy at those percentages yes but I would say that the evidence you know might say well 24% would be considered healthy you really have to look at the individual I'll give you an example for me I Am Naturally a leaner individual 24% body fat for me would be very high yeah well and South Asians we have uh lower targets for Waste circumference and for body fat percentage to be metabolically healthy and so I think you have to know a little a little bit about your body but certainly sort of assessing how you feel too yes and here's what I would do from a number perspective I like to see fasting insulin around five which is low I like to see blood sugar depends again if it's in the 80s or 90s you blood sugar will run a little bit higher if you eating a high protein diet and one of the reasons is believed because the red blood cells live longer so as long as your fasting insulin level is low and your triglycerides under 100 100 or less to me looking at that picture that's healthy skeletal muscle and then of course being strong uh could someone do an oral glucose tolerance test yes uh do you necessar exactly do you necessarily need to no and then I will say that we don't have numbers for optimal skeletal muscle mass we could look at appendicular skeletal muscle mass index there's ways to look at Frailty but when it when it comes to an optimization level we don't have that yeah we don't have optimization level for a lot of things also very true like we really don't like it's probably very individualized to some degree you know I mean maybe protein not so much but certain things that we don't have optimization levels for it's because it's going to be individual yeah and I I'm actually really glad that you pointed that out that dietary protein we probably vary um Less in although I will say I think that there's going to be new research coming out about the gut microbiome and certain bugs being able to generate these essential amino acids which by the way that's extraordinary so it's probably from increased fiber intake right venture to yes fiber and also the bacteria breaking down MH crazy yeah um I think that we're still new to be able to say could that mean that an individual will be able to exist on a lower protein diet I would say probably some people but it might be 2% of the population but when it comes to body mass and skeletal muscle mass it is going to be very individual you can look at these charts but again my body habitus is different than yours is different than the producers everybody and I think that a way to think about it is understanding where your body fat percentage is I do think people should experiment with trying to go to the lowest body fat percentage they can while still maintaining good hormonal function yes because if you go too low your hormones are going to suffer right and to just try it and see where they're at yeah um but clearly we know that increase in body fat percentage increases uh low grade inflammation you might see that in hscrp many kind of inflammatory markers triglycerides so understanding that healthy skeletal muscle mass we don't have a target for it yet but I think now with the increase in better testing we will yeah before we move on I want to talk about animal-based protein because there's a lot of um I know there's a lot of push back on that and so what in terms of animal protein people hear meat is a carcinogen it's actually been labeled as a carcinogen so what do we say to that people would have to go back to the IR papers and actually reexamine those and understand that it's a committee uh committees also have biases and the papers in which they used they threw out a ton ton of randomized control trials they used a lot of epidemiology and as you know epidemiology is what we consider lowquality evidence and that all the high quality evidence that individuals have looked at if you look at the risk ratio or relative risk there is not an increase in uh cancer it probably depends on the type of animal protein you're intaking it does whether it's processed um again so that's another good point so Whole Foods we don't see an increase in relative risk of cancer uh processing is a problem there's some discussion about burning meats and that can certainly be a carcinogen but understanding that a diet that is higher and high quality protein is not a risk so outside of being Whole Foods what else do you consider high quality protein we protein shakes again because of the amino acid profile that would be considered high high quality proteins dairies egg but um you know if you were going to think about what would be a high quality protein that is processed and easy that would be a we protein shake um a casin based Shake obviously you would need a little bit more and the digestion of that is a little bit slower you can also get higher levels of protein on a rice PE blend would that be considered high quality protein based on the definition it would not again because the high quality proteins have the amino acid profile very similar to human muscle and that's what we need we need these essential amino acids so if something is low in essential amino acids by definition it would be considered a lowquality protein collagen is is actually has a protein score of zero yeah I I learned that from from you actually I didn't know that and because it's uh very low in these Branch chain amino acids and uh devoid of tryptophan so that has a protein score of zero it doesn't mean it's not helpful because again it's rich in Glycine and Proline other amino acids which do a number of other things that are highly beneficial but from a skeletal muscle standpoint it has no effect what about taking Branch chain amino acids I think it's a great solution if you are eating a lower quality uh diet then add in Branch uh Branch chain amino acids could be very beneficial so for example if someone is uh vegan or vegetarian using a branch chain amino acid with a meal I do not recommend Branch chain amino acids alone because having Branch chain amino acids alone is like putting a key into a car turning on the ignition and then trying to press on the gas but not having any gas in the tank so in order to put muscle protein synthesis into effect you need the whole spectrum of amino acids could there be a benefit of brand chain amino acids to just have certainly but again the human was not designed to be how do I say this we have a lot of variability and flexibility but protein should be ingested in discrete meals shouldn't be a little bit here and there but again skeletal muscle as a nutrient sensing organ that has been maintained over time it gives us Clues on how we should proportion our diet and then I'm going to kind of lump two myths together one is that red meat has a lot of saturated fat and the other one is that in time and time again Studies have shown that red meat correlates again these are probably epidemiological but there's people will say strong evidence that red meat is correlated with multitude of cancers or even or even cholesterol I think that that's a big one and I think it becomes really important to point out that these earlier studies didn't differentiate uh high protein and high fat so a lot of the data that comes out of um red meat being bad for cardiovascular disease didn't account for the fact that it's a robust amount of calories and also a lot of fat but when you look at low protein high quality sources we see a number of metabolic benefits including Improvement in triglycerides Improvement in blood sugar regulation lower levels of insulin lower levels of blood pressure we see time and time again that a high protein diet with a moderate amount of fat has metabolic benefits so for the audience who doesn't know what are some good sources outside of the typical chicken and uh that that people can eat that are high quality proteins moderate amount of fat not high saturated fat that people can consume yep and also I do want to finish up with a a cancer question because I know that people are concerned about that so I'm going to answer finish that and then I'm going to come back to the the sources when you think about cancer you have to think what kind of cancer are we talking about are you talking about prostate cancer are you talking about breast cancer uterine cancer whatever it is lung cancer so I think that understanding what kind of cancer we're talking about and understanding what are the actual risks that we know smoking and lung cancer we know um obesity and cancer we know very clear yep these are clear there's mechanisms when people say red meat and cancer you have to give me a mechanism what is that mechanism well people would argue it's inflammatory and I abs hear that my question would be we actually haven't seen that with high quality studies high sources of protein that are low in fat and Whole Foods we don't see an increase in inflammation and I think that that becomes really important to point out the other thing with let's say colon cancer one would have to ask where's the fiber in the diet what are the things that we know but again dietary protein and especially red meat has been the scapegoat for things for decades things like obesity lack of fiber intake right um these things that we know there's a relative risk that is much higher than and they've done the studies so dietary protein or red meat and cancer has a relative risk of 1.2 and we know that in order for something to be meaningful uh just to put this into perspective smoking and cancer would have a relative risk of 12 anything above two would be considered clinically significant or I'm sorry statistically significant we don't see that with red meat and cancer so I I just think that that's really important to point out because the conversation is complex and I think that we all want to age well and I think that when you think about the big Killers you think about cancer you think about heart disease um you think about infection you think about Falls kidney disease the CDC will list these diseases but at the core you will never see muscle mass a decreased muscle mass on that list and or obesity on that list and I think it's just understanding that these big Killers all have a metabolic component and when you go back to the metabolic component obesity is pathology and skeletal muscle is a solution so how do we design a diet that is going to help support a lean body mass and prevent a known carcinogen like obesity I think what's helpful also in terms of why it's so high quality is also the amount you'd have to eat of let's say Tofu for example compared to chicken or six cups of quinoa to equal one small chicken breast that becomes really important because we have to think about um so the limiting amino acids are lysine methine and Lucine and Lucine is what is necessary for muscle Health now each of these amino acids are limiting in different in different areas so for example a vegan diet is largely a methionine restricted diet that could be positive it could be negative but understanding um when we think about skeletal muscle Health we have to recognize that it is not just the overall protein intake but it is the individual amino acids and then one step further is focusing on just protein is very myopic there are nutrients of need that are declining in the American diet for example iron for example zinc selenium B vitamins these all ride along with high quality proteins and this comes back to this idea of what you said um the amount that you would have to consume so what you're talking about is nutrient density how do we pick Foods as we age typically we eat less how do we pick foods that will allow us to get the most amount of nutrition with the least amount of calories and that would be very clearly things like whey protein or lean red meats and I'll also say that you could be vegetarian or vegan and still be healthy it just takes more effort just understanding where the deficiencies could possibly be and also how are you going to design a diet that supports aging where it's something you don't have to think about we have to be able to recognize that we live in in a dynamic world and on on those nutrient topics we know that low zinc will cause issues with hormones that's right we know that low iron as you mentioned earlier on our podcast that low iron is related to female sexual dysfunction or sexual dysfunction in general probably and what about pregnancy what about um anemia for young women I mean there are all kinds of problems that happen when you eliminate whole food groups yeah let's give some examples of the lean red meats bison is very lean venison I don't know if you've ever have you ever heard of Maui Nei yeah I've heard of it it's amazing have you tried it I haven't tried it yet um well if Matthew was paying attention he would have sent us a lot more Maui Nei I'm not talking about you but um Maui Nei venison is amazing regenerative um but Le and certified pet Mones if you've never had that I'd love to send some to you these are amazing sources of lean red meats which are incredibly valuable and also valuable for children that's an example any kind of fish I mean aside from some of the fatty fish lean source of protein eggs have about six grams of fat per egg so if you were having five or six eggs that would not be considered a lean Source but Dairy lowfat Greek yogurt I love Greek yogurt is incredible yeah I should have offered that to you for lunch or breakfast um but those are all sources and there's one more thing also to mention is this has taken a very long time to die is this idea that dietary cholesterol increases overall blood cholesterol they took cholesterol guidelines or they took cholesterol recommendations out of the dietary guidelines in 2015 so when 2015 some cut back cut back your red meat to reduce your blood level of cholesterol that's that was taken out of the guidelines uh I will also mention that shrimp has higher amounts of cholesterol so there's um the body tends to make a certain amount of cholesterol and um you know whether you have diet and exercise influence but understanding that um the body regulates these things if you enjoyed this clip of the Reena malic MD podcast make sure you check out the full episode with my friend Dr Gabrielle lion right here

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