#1 Longevity Doctor: The Truth About Disease, Obesity, Muscle, Sleep & Exercise | Gabrielle Lyon

Dr. Rangan Chatterjee 0:00 So Dr. Lyon, you believe that all of us need to be focused on the health of our muscles, whether we want to burn fat, live longer, improve our hormonal profile, increase our energy, or reduce the risk of getting sick in the future, you believe that our muscle health is really, really important. Why?

Dr. Gabrielle Lyon 0:19 The quality of our muscle is the cornerstone for overall health and wellbeing. And quite frankly, it's the organ of longevity. There's nothing more important than skeletal muscle. It is different than this idea of looking good in a bikini and athletic performance, which is, you know, when we think about skeletal muscle, that's often what we think about. I'd love to start with a story about-- that will really highlight where this came from. I did my fellowship in geriatrics and nutritional sciences, and by the way, as you know, as a physician, geriatrics is over the age of sixty-five. It is end of life. There is palliative care involved. It is nursing home rounds. Quite frankly, it was something that I didn't wanna do. But in order for me to have an advanced education in nutritional sciences, it was the deal. I had to make a deal. In order for me to do a two-year clinical fellowship, I had to work as a geriatrician and get my fellowship training in geriatrician-- in geriatrics. And in the mornings, early morning, I did obesity medicine research, and during the day, I would see patients in the hospital, in the nursing home, in clinics, in memory and aging clinics, and then in the evening, I would go back to doing obesity medicine research. And one of the things that we were looking at was body composition and brain function. And, you know, there's always that one patient, right? I'm sure you've had that one patient-

Dr. Rangan Chatterjee 1:57 Yeah

Dr. Gabrielle Lyon 1:57 ...that changed everything for you. Any trainer listening will have that one client, any other physician listening, any person will have the influence of one person that really changed the trajectory of their life. And for me, it was a woman named-- we'll just call her Betty. She was a mom of three kids in her mid-fifties. She had always struggled with the same twenty pounds. We know a ton of people like that. Twenty pounds over a lifetime. Always put herself last, showed up for her family, showed up for, uh, her friends, and did exactly what the medical community had told her, which was eat less and exercise more. And quite frankly, I gave her the same advice. We imaged her brain, and her brain looked like the beginning of an Alzheimer's brain in her mid-fifties. As you can imagine, it really struck me. It struck me because during the day, aging and Alzheimer's was very real to me, and I was seeing the implications it was having on the family and the friends and, and the people around individuals who have cognitive impairment. I realized that she'd done everything we told her to, and in the process, she lost weight, just as many people lose weight, go through a process of yo-yo

Dr. Gabrielle Lyon 3:29 dieting. But she also lost skeletal muscle and destroyed her metabolism and impacted her brain. So I started thinking, okay, how is this the standard of care? So I started to really begin to put these pieces together. What was the one thing that all these patients had in common in the nursing home, in the hospital rounds, in the dementia unit? It wasn't that they were over fat. It was that they had unhealthy skeletal muscle first, and that we had been trying to fix this obesity epidemic for the last fifty years. And all of the things that ride along with obesity, Alzheimer's, cardiovascular disease, you name it, hypertension, insulin resistance, these are not diseases of obesity. In fact, these were diseases of skeletal muscle first. Insulin resistance, insulin is a hormone released from the pancreas that moves blood sugar out of the bloodstream into the cells. And I realized, I had this aha moment, that in order to get people healthy, and if we really truly cared about longevity, we had to course-correct the way in which we were thinking and shift our focus from the pathology of fat to the building, the maintaining, the cultivation of the health of skeletal muscle. And that's really where this concept of muscle-centric medicine came from. And of course, I'm sure you have questions, and I am gonna talk to you about exactly what skeletal muscle does, why it's an organ system. But I think it's important that everyone put themselves in the framework of understanding that we've had a narrative of constantly focusing on, uh, all these other diseases as if they're out there, but truly these diseases begin in our thirties.

Dr. Rangan Chatterjee 5:20 It's a powerful story. And yes, we all have, I think, as physicians, as healthcare professionals, as personal trainers, we all have that one patient, that one client that started to change things in our brain that made us question some of the things that we've been taught or certainly question some of the ways in which we were practicing. But you mentioned there Alzheimer's in the brain. You've also mentioned the importance of skeletal muscle. Now, I think for many people, they're gonna go, "Well, yeah, I get it. Skeletal muscle's important, but what on earth has it got to do with the health of our brain?"

Dr. Gabrielle Lyon 6:00 Yeah. It, it's a really great question. You originally asked me why do I believe, why is my working hypothesis that skeletal muscle is the cornerstone for health and wellness? Let's talk about what skeletal muscle does. Number one, it is an organ system. It is an organ system that you have voluntary control over. Quite simply, this means it's the only organ system you can directly do something about with conscious thought. You cannot exercise your liver. You cannot exercise your heart specifically to tell it to beat 135 beats a minute. Maybe if you're Wim Hof, it's possible. But for the rest of us, we're unable to tell our thyroid to produce T4. We are unable to tell other organ systems exactly what to do. Skeletal muscle as an organ system is under direct voluntary control. What does this mean, and what does it do? Skeletal muscle is your metabolic sink. This means that the food that you eat, primarily, let's say you were eating carbohydrates, 80-some percent of carbohydrates are disposed of in skeletal muscle. You hear a lot of people talk about elevated levels of blood glucose, elevated levels of insulin. These are directly related to the health of skeletal muscle. How could a listener visualize this? Think about skeletal muscle as a suitcase. I love to pack for a trip, and let's say I am going on a trip for four days, and I pack for 30. Think about your skeletal muscle as that suitcase. So, for example, I am way overeating carbohydrates, and skeletal muscle only can hold so much carbohydrates in the form of glycogen. If I am not exercising that skeletal muscle, or I don't have a lot of it, or it's unhealthy, I have nowhere to put that glucose. Eventually, that glucose stays in the bloodstream, goes to other tissues. We see an increase in, um, fatty acid deposition all over the body, not just in skeletal muscle. Over time, skeletal muscle that is not exercised and unhealthy ends up looking like a marbled steak rather than a filet, which is exactly what it should look like. It becomes less efficient at utilizing energy. Skeletal muscle is one of the primary sites for mitochondria. Mitochondria, which I know that you've talked about often, is the powerhouses of the cell. It's where we generate energy. Skeletal muscle is a primary site for fatty acid oxidation. People are worried about their cholesterol, and they're worried about triglycerides. Skeletal muscle is a primary site for utilization. When we think about metabolism and metabolic regulation, skeletal muscle is the primary site, and it's 40% of our body. This is just one aspect from a metabolic perspective when you talk about brain function and the health of skeletal muscle. If you do not have healthy skeletal muscle, you do not have a healthy metabolism. The body becomes insulin resistant just as the brain becomes insulin resistant. You know, um, Alzheimer's is often thought of as type three diabetes of the brain, which means our metabolic health has a direct impact on our brain function, and we know that the lower the waistline, the smaller the waistline, the less body fat an individual has, the better over time the brain will function.

Dr. Rangan Chatterjee 9:42 It's just remarkable to think about all of the different things that skeletal muscle influences. Yet as we discussed the first time you came on my show about 18 months ago, many of us for years have just thought about it as a physical thing. You know, dumb muscle. It's, you know, a bit more if you wanna look big and be a bodybuilder, but otherwise it doesn't really matter. And we very much have undervalued the importance of skeletal muscle. One of the key points we mentioned in our first conversation was that as we get older, above the age of 30, unless we're doing something about it, we are losing our skeletal muscle every year, right?

Dr. Gabrielle Lyon 10:28 Yeah.

Dr. Rangan Chatterjee 10:28 We did cover that in quite a bit of detail the first time round. And Dr. Lyon, my first book that came out at the end of 2017 set out what I consider to be the most important four pillars of health, food, movement, sleep, and relaxation. And in our first conversation, we covered in detail food, specifically protein, how important that might be for skeletal muscle. We mentioned the kinds of exercise that you recommend. You mentioned, I think, you like HIIT training once to twice a week, strength training three to four times a week, and a good cardio base, for example, walking 10,000 steps a day, something like that. I definitely wanna revisit some of these things in this conversation, but two of those pillars, sleep and stress, we didn't really cover. So I wonder if we could start off by talking about the relationship between sleep and skeletal muscle.

Dr. Gabrielle Lyon 11:29 Most certainly. You know, it's a, it's a very interesting, um, tie, sleep and skeletal muscle, and I'm gonna highlight some of the emerging research, which I think is quite fascinating. One thing to keep in mind is that the research surrounding skeletal muscle has largely been based on performance, which is why we've truly missed it as a medical profession, which is why the world still thinks about skeletal muscle as this performance organ, and it's so much more than that. It interfaces, uh, with, you know- The brain, the other endocrine organs, just everything. And sleep and skeletal muscle is interesting. The-- here's what is commonly thought about. When you get good sleep, you will have better recovery. This is the time that growth hormone is released. It allows for optimization of hormones. We do need to get into deep rest. It also is a time where the brain cleans itself, the glial cells of the brain clean itself. We do know that sleep deprivation over time has significant effects on cognition. One night of sleep deprivation can impact muscle protein synthesis by eighteen percent. So it can decrease your ability for your body to create this robust response, and muscle protein synthesis is a physiological process in which amino acids are incorporated into skeletal muscle. It's what we would consider a biomarker of the health of skeletal muscle. It's one of the ways in the literature in which health, you know, skeletal muscle health is measured, and also that muscle is doing what it should be doing from a muscle protein synthetic response. Um, skeletal muscle is highly plastic and highly responsive to diet and exercise. When you have suppressed muscle protein synthesis, and eighteen percent is a pretty robust suppression, with one night of sleep deprivation, and that-- I think that this-- the, the data was four hours or less, impacted the ability for skeletal muscle to respond to, again, muscle protein synthesis. And this could be thought of in the-- or under the influence of both amino acid influence or training influence because those are the two ways in which we stimulate muscle. Now, here's the catch. A lot of the military operators will go through periods of time where they have sleep deprivation. And what some of the data suggests is that if you go through a few days of sleep deprivation, one way to counteract the influence of sleep deprivation on skeletal muscle is actually pumping up your exercise, which is completely counterintuitive. You would think that if you have gone through a week of sleep deprivation, you should probably just rest. And in fact, that's not what some of the data suggests. Some of the data suggests that an individual should really kick up their training during that time to protect metabolism and to protect and counterbalance the influence of lack of sleep. Because a whole host of other things-- So muscle protein synthesis is just one portion of what muscle does. We know that with lack of sleep, and we see this in shift workers, there is an increase in insulin resistance, there is an increase in blood glucose. All of these things, I believe, to be centered around the influence on skeletal muscle.

Dr. Rangan Chatterjee 15:13 It's really interesting that if you don't sleep well, you decrease your sensitivity to the stimulus of training the next day, right? You mentioned muscle protein synthesis goes down. And as you say, you could then make the case, well, one shouldn't train. But that, that new bit of data there, that's fascinating, that actually you sort of insulate yourself from some of those negative effects by training. When I spoke to Professor Matthew Walker on this show a few years ago, I remember one of the things he said to me was, "If you're losing weight and you're sleep deprived, then the majority of that weight will come from muscle as opposed to excess body fat." So the whole system, the whole body is connected, right? And that's why I really love these four pillars as a way of looking at everything, including skeletal muscle, is because each one of those four pillars influences the other ones.

Dr. Gabrielle Lyon 16:17 Yes, it does. You know, we don't exist in this silo. And, um, and I'm, I'm so glad that we're talking about stress because it's often something that people don't necessarily ask me about, but I, I think that it's a, a critical importance. Sleep definitely influences the way in which our metabolism works. Skeletal muscle has probably the biggest influence, by the way, on our entire homeostasis. If you were to ask me, what did I-- what do I believe is most important, is it food or is it training or is it, uh, name something, ice bath, et cetera? I would say the influence of exercise trumps nearly everything because of its influence on all other body systems. That is how impactful training is for people. And when we talk about stress, I'm gonna sh-- I'm gonna, uh, throw a loophole here. When I say stress, or you say stress, that could mean, I don't know, the kids are home for Thanksgiving. That could mean I have to go to the DMV, the Department of Motor Vehicles, and I don't know if I have my right paperwork. It could also mean the death of a loved one or the sickness of a family member. We have one word to define various different states or experiences or life, um, tragedies, you know, on any scale. Nowhere in the human language do we have another word that describes all of these different things.

Dr. Rangan Chatterjee 17:51 Yeah.

Dr. Gabrielle Lyon 17:52 And, you know, and I will say the evidence supports that how we imagine and think about stress truly does influence our physiology.

Dr. Rangan Chatterjee 18:00 Yeah. I think it was a paper I read about if you consider the stress to be adaptive for you as opposed to harmful, it has a different physiological effect, which is absolutely incredible. The way you think about that stressor will determine its effect on you.

Dr. Gabrielle Lyon 18:15 I have seen this in real time in my patients, and I, I have to say it, it's one of the topics that is not discussed, but is probably one of the most critical. When we hear stress, we typically think of-- What do you think of when you hear stress? What is the response?

Dr. Rangan Chatterjee 18:32 I mean, normally it's a negative word, isn't it? Because I think we're talking about this chronic, unrelenting stress that we never switch off from, we never allow ourselves to recuperate from. But of course, not all stress is bad. We need stress to be our best selves, don't we? I think the problem for most of us these days, and why stress has such a negative connotation, is because, you know, we're no longer having our stress responses activated now and again because there's a wild predator approaching our camp. We're having it activated chronically by the state of our lives, our email inbox, the kids we're having to look after, the elderly parents we're having to care for, the negative comment we saw last time we went online, whatever it might be. These are the multiple stressors that are firing themselves at us, and a lot of the stress researchers would argue that the way your body responds is very, very similar, whether it's a physical stress or a psychological stressor.

Dr. Gabrielle Lyon 19:32 Yeah. And I would say that I absolutely agree with you. What we hear is stress, and then we hear fight or flight. Fight or flight is the stress response that we are all taught about. There's an increase in catecholamines. There's an increase in blood pressure. It's, there's a very sympathetic response. Now, I would also say that that is an initial stress response, and that stress response is a physiological response. There are two other stress responses. There is tend and befriend, which is somewhat of an attunement response, and this is, for example, I have, have two very little kids. When I see them in distress, instead of going into fight or flight, I go to tend and befriend. What can I do to make their life better? Some people, when they are stressed, rather than go into fight or flight, will turn to reaching out to help people. I would say that that is my initial stress response. This does a few things. It increases serotonin. It increases oxy- um, oxytocin. It allows us to bond. The other stress response, which I see with a lot of individuals, is a courage response. And there was-- And the courage response is actually something that can be cultivated. And how is this important, and how does this relate to the health of skeletal muscle? Well, I would love to tie that all back in. And the courage response is something that also can be trained. I'll give you an example. My husband was an elite military operator. He was a Navy SEAL for ten years. He loves jumping out of planes, which is insane. If I were to get up and jump out of a plane, I am sure that my blood pressure would be five hundred over three hundred. I would be so, uh, scared, and, uh, there would be a whole host of things going through my head, and it would certainly be a fight or flight response. My husband getting up, ready to jump out of a plane might have a slight bump in blood pressure. He might have a slight increase in some of these catecholamines, but his response is courageous. It is much more facilitating. It is of action. And that is another stress response that we are often not taught about. And there was a, a very interesting, uh, study that took individuals who were deathly afraid of snakes, put them in an MRI machine, put a very large snake on a conveyor belt that would then move towards an individual's head.

Dr. Rangan Chatterjee 21:56 I'm freaking out just hearing this. [laughs]

Dr. Gabrielle Lyon 21:58 Okay. Uh, right. I would be too. And initially, everybody had a fear response, and they were, they were looking at fMRI images. They were also measuring, um, you know, various aspects of their body chemistry. But what happened was the second time, the individuals were coached up into what could be considered a courage response. And what they saw was different aspects of the brain lit up, and they were mounting-- There was evidence that they were mounting a different stress response, and this was one of courage. So this goes back to saying that fight or flight is a response, and courage is a choice. And if we can readjust our understanding of stress-- Humans are very interesting, and I'm gonna tie this back into this obesity narrative. Once we hear something over and over and over again, humans believe it to be true. And we believe that that is the framework for understanding. Just like with an obesity epidemic that we've been trying to fix for the last fifty years, we focus on the pathology of fat. And I would argue that if we ask the right question, then we'll get the right answer. And I think that that can be translated to stress. I think that we have been taught over and over again that we have this one stress response, and we should reduce stress, and it's a fight or flight response. I would say that that is a repeated narrative that we can readdress and make individuals much less, I don't know if the word is fragile, but much more resilient-

Dr. Rangan Chatterjee 23:48 Hmm

Dr. Gabrielle Lyon 23:48 ... in the way in which they interpret their environment. And what becomes so important, I know that this is really about medicine and kind of this muscle-centric approach, is that when we do things like train, this does create for some people an initial stress response. We begin to cultivate courage. We begin to cultivate behaviors that allow us to acquire skeletal muscle, which take drive and a different way in which we interface with the world. And I hope that that's not too esoteric. But truly, the message that I'm trying to deliver is one of strength. And with that message of strength, I'm going to challenge the way in which we have traditionally thought about medicine, but also challenge the way in which we thought about mindset. And I believe that stress can be enhancing. And I believe that when we recondition individuals to also believe that, then they can have a different control of their physiology, which will allow them to take massive action.

Dr. Rangan Chatterjee 24:55 I just love what you just said. I really do. In fact, one of the things I enjoyed the most about your latest book, Forever Strong, was how you covered the psychological aspects of change as well as the physical ones. Because what I'm writing about, the things I think about more are these mindset issues. Because actually, once you've got the foundation of mindset right, I find that those downstream behaviors of food and movement, whatever it might be, are so much easier for people to incorporate into their lives when they have these self-limiting beliefs. It doesn't matter how many podcasts they listen to, how many books they read, they don't take action. So I was gonna bring those things up with you during this conversation because I think you give a masterclass in that in Forever Strong. The other thing I just wanted to comment on, you mentioned your husband, who was a former Navy SEAL. I think this is a really important point. If he was jumping out of a helicopter thirty years ago, right? I imagine he may have been really, really scared. But by training it, by practicing it, by developing his confidence in it, he's now at a point where he can actually enjoy it, whereas you haven't done that. So you or me, we're gonna freak out when that happens. What does that tell us? It tells us that the stress response, or much of it, is internal. The same external event is happening with jumping out of a helicopter, but how we interpret it is determining the impact on our bodies. And how we interpret it depends on our experience, our level of confidence, what we've practiced. And again, you can tie that into exercise. You can tie that into muscle. The more you practice exercising, the more you train, you are working out your stress response system, and therefore, whatever that stressor is in life that comes before you, you're better able to handle it.

Dr. Gabrielle Lyon 27:00 I have to tell you something. I am so grateful for you and your openness to have this conversation. It's actually one of my most favorite topics because as a provider, as a physician who still sees patients, you know, a, a good clinician is really good at recognizing patterns of diseases.

Dr. Rangan Chatterjee 27:19 Yeah.

Dr. Gabrielle Lyon 27:19 We can all agree on that. But an effective physician is good at recognizing patterns of people. And I have been a physician since two thousand and six, and I will tell you, I have seen what makes individuals successful. And if you allow me, I would love to share some of the aspects that I have seen that really change the narrative for people. And every single person listening to this podcast will be able to take what I am saying and implement it immediately.

Dr. Rangan Chatterjee 27:51 Yeah, please.

Dr. Gabrielle Lyon 27:53 Okay, I'm gonna tell-- quick story time. We have plenty of time. I have one entrepreneur who hosts a massive event in Las Vegas every year, thousands of people. And every year, I wait for the call, the call that comes after the big event. And that call is, "I am depressed. I'm not motivated to train." By the way, he's super fit. "I am eating junk food, and I just-- I know you wanna see people. I just wanna-- to lay in bed." And every year, he's shocked by this. He is shocked by his own human nature. And you're thinking, okay, so let's break this down. Everybody's striving to do things, whether you are a mom trying to get your kids to a big event, or you are a business owner, or you are a doctor, or you are a writer. Everybody has some level of thing that they are working towards. And once you are at that pinnacle, right? So let's say when your next book comes out, you will be spending months and months and months prepping for this thing, and then you will be at the top of the world. You have this high level of dopamine drive, and obviously other neurotransmitters, but we'll just relate it to dopamine. And at that peak, at the pinnacle of success is where people are most vulnerable. And right after they reach their most successful moment is their second point of vulnerability. I am gonna circle back how this all relates to mindset and what these individuals listening, guys out there listening, guys and girls out there listening, what you can do. As high as an individual is going to go is as low as they are going to go. It is predictable, and it is human nature. The best of the best are very neutral, and they practice neutrality, and they practice ways of dopamine preservation. If we think about the neurotransmitter dopamine related to drive and motivation, again, to say it simply, when you have a big event, this is your place of vulnerability. You will look for the next car to buy, the next thing to do, the next food to eat, the next thing to buy at the peak of your success. There is nothing that will take you off track faster than not understanding this. As high as an individual is going to go is equally as low as they were going to go. I did this massive push here for the book Forever Strong. How pumped up do you think I allowed myself to get before the day before the book release?

Dr. Rangan Chatterjee 30:36 I would imagine extremely pumped up.

Dr. Gabrielle Lyon 30:39 Extremely neutral. Here's why. Because I knew that as high as I was going to get with this book release would be as low as I would go. You hear people that go off and do some kind of physical event. Following that physical event, whether it's running a marathon or taking a test or doing the thing that they had trained to do, become extremely depressed afterwards. Have you heard that?

Dr. Rangan Chatterjee 31:05 I have heard it, I've experienced it myself, and I'm delighted to hear that you have presumably gone through a process to get to this point where you're able to maintain neutrality even the day before your very first book launch, which for many people is a hugely exciting moment. But I totally agree with you. I've had it before when I wasn't emotionally neutral, and I'd have the highs and lows. And for the last few years, I'd say the last two or three years, I feel generally pretty neutral a lot of the time. It doesn't mean I don't enjoy life. I, I enjoy life more now than I ever have-

Dr. Gabrielle Lyon 31:43 Right

Dr. Rangan Chatterjee 31:44 ... because of that neutrality. People will often say, "Yeah, but I want the highs, you know. I don't mind the lows, but without the lows, I don't get the highs." You can have it, just not with that same amplitude, and it's much more sustainable. For me, Dr. Lyon, a lot of that is coming from, I guess the sort of things we were talking about related to your husband jumping out of a helicopter. It's come from the fact that I understand deeply that a huge part of my response is down to me, and I've worked very hard and cultivated this skill. I don't think it's something you're necessarily born with. I think it's something you can get better at. One of the ways I've done it is by looking at every day as a school day. So every time for the last years when I would get emotionally triggered by the thoughts or the words or actions of somebody else, instead of thinking they were the problem, I would reflect it back onto me and go, "Why is this bothering you, Rangan? Do you expect to walk around the world and expect everyone to say the things that you wanna hear? No, that's completely unrealistic." So therefore, I can't control other people's words and behavior and actions, but I can control my response. And so by doing this as a diligent daily practice, I've now got to the point where a lot of that is default. And bringing it back to health, for people tuning in who wanna have more vitality, they wanna live longer, they want more energy, they wanna lose weight, whatever it might be, I, like you, Dr. Lyon, believe that this is one of the most important skills because if you can maintain that neutrality, it's easy not to go to the alcohol. It's easy to not comfort eat the sugar or the ice cream because those things are, in my experience anyway, they are usually downstream consequences of these kind of upstream patterns.

Dr. Gabrielle Lyon 33:44 It's so brilliantly stated, and I will say congratulations because the best of the best have that level of neutrality. Again, I take care of patients that are the best in the world at what they do. They do exhibit that neutrality, and it is something that they have learned over time. And by doing that, they don't have the highs and lows. And it's exactly what you're saying. It's not that you are not excited about something, but it is a moderated excitement. And I can give individuals very practical tools, which we're gonna talk about right now, what they can do to begin to build that neutrality muscle over time. Exactly what you said.

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Dr. Gabrielle Lyon 35:52 So you are able to think of every day as a school day, which is genius, and begin to think about what are some of the things that may be a negative experience. For example, for you, maybe it's comments. You're very much in the public eye. That does take time to kind of build up that neutrality. Here's a couple of very simple things that people could do for dopamine preservation. We'll just-- we'll identify it as dopamine preservation. Go through your week and don't celebrate every win. I am not talking about not being kind to yourself. I'm not talking about belittling yourself. I am just saying that don't celebrate every win. Intermittently celebrate a win of doing something great. Flip a coin. You flip a coin, heads you celebrate, tails you don't. If you are an individual who loves loud music and some kind of stimulant before you go to work out, whether it's caffeine, et cetera, flip a coin. One day have it, the other day don't, and you don't know which day that's gonna be. You begin to build up these muscles of dopamine preservation. Let's say you wanna go shopping and you can afford to buy something, you flip the coin, whether you get it or you don't. And over time, you begin to then translate that to these big events and things that people are doing. Again, little things will then translate to big things because it is about the long term, the way in which we wanna show up for our family, for our work. It is a long-term game, and the highs and lows make people very vulnerable to human nature in a way where the habits that they create, the habits that you create in your 30s, 40s, and 50s become much more difficult to break each defining decade. So if someone is listening, really begin to initiate some of these practices, and you can begin to change your habits very, very quickly, and it won't be a habit that you have to deal with emotional eating in your 50s. And that, that's just one aspect that I think is extremely beneficial. The other thing is people talk a lot about positivity, and they think, "I'm gonna do this exercise and diet program because I'm going to lose weight, X, Y, and Z." I would say that that is not an effective strategy. What is an effective strategy is if you can collapse your future self with your current self. And let's just say caring what people think. If you care what people think and that consumes your mind, imagine the cost of that behavior and that thought process if you do it for a year, and then if you do it for five years, and then you do it for 10 years. Imagine the cost on your life. You could do that for diet and exercise. Let's say you have kids, and Friday night you've done great all week, and you sabotage yourself every Friday night because that's how you relax. Imagine what that toll is going to be if you continue to do those habits over a year. Each time you repeat a habit, you are much more likely to repeat that habit again. So when you collapse your future self with your current self, and yes, it does have a bit of a negative spin, but it's kind of like, what was that, that movie, um, that, that Christmas movie with the three angels? Do you remember what movie that was?

Dr. Rangan Chatterjee 39:23 Garris in the background, he's saying It's A, It's A Wonderful Life.

Dr. Gabrielle Lyon 39:27 It's A Wonderful Life. That is an example. If someone [laughs] wants to see what I am talking about, watch It's A Wonderful Life. It will snap you out of whatever you are telling yourself instantaneously.

Dr. Rangan Chatterjee 39:38 Yeah.

Dr. Gabrielle Lyon 39:39 You do. You do. You have to collapse that future self with the current self.

Dr. Rangan Chatterjee 39:44 I think what we're talking about here is so, so important and so, so undervalued generally in the health conversation that takes place everywhere these days. It's all about more information. And look, I'm all for giving people information, and in our first conversation together, you gave a masterclass in protein, in resistance training, and hopefully we can cover some of those things again today. But I think people, even with that information, don't always manage to make change. So let's imagine a scenario, and given the time of year, it's January, and someone is thinking, "This year something is gonna be different. You know what? I'm getting my stuff sorted in 2024." And in my view, if you don't take a different approach, why is it that 2024 is gonna be any different than 2023 or 2022 or 2021?

Dr. Gabrielle Lyon 40:45 Right.

Dr. Rangan Chatterjee 40:45 So instead of trying to buy a new book or a new diet plan or a new strength program, whatever it might be, sure, do that, but you need to go a little bit further upstream as well. So can you relate what we're talking about now to people wanting to create healthy behaviors?

Dr. Gabrielle Lyon 41:03 I have a great solution for this. Are you ready? The solution is we set standards. We don't set goals. Standards for how we show up, standards for how we execute. You no longer need to set goals. If you have a weight loss goal, this sets you up for failure. The first thing that people should do is set a standard for how they want to show up. For me, I show up, I train. It is a standard that I have set for myself. I eat a certain kind of way, a certain amount of protein, certain kind of carbohydrate. It's a standard. It is not a goal. And when we shift away from goals, because goals are variable, and you have an opportunity to meet that goal, or you have an opportunity to fail at that goal. But when you set a standard for the way in which you function in your everyday life, and I encourage people to write it down.

Dr. Rangan Chatterjee 42:01 Yeah.

Dr. Gabrielle Lyon 42:01 What is the standard that you are going to set for yourself? And then execute on that standard. An individual will find that everything else falls into place.

Dr. Rangan Chatterjee 42:13 It's really interesting because you're saying set a standard, right? Say what you're gonna do, and do it. You know, be accountable. In fact, there's a section in your book, I think, called Erecting Guardrails for Accountability, which I really enjoyed. And something you said in that section was, "You need to know what integrity is and what your responsibilities are to yourself." That was really, really powerful for me. What do you mean integrity and your responsibilities to yourself?

Dr. Gabrielle Lyon 42:44 Nothing will under- undermine how you feel about yourself if you have standards that you set and that you don't keep. And for me, you know, there was a period of time where I was all over the place. I was training a lot, many hours of the day, and it was taking away from the things that I needed to do. And, you know, that might be the opposite problem some people have, but it wasn't being truthful to the integrity that I had set for myself. For me, training an hour a day is plenty. Anything above that is me running from whatever it is that I'm supposed to be doing because I'm, quote, training and I'm doing something healthy. When you set a promise to yourself, whether it is you're going to eat a certain nutrition plan, and I don't care actually, quite frankly, what plan that is. You can define it, which you should, exactly what you are going to do. If you are comfortable having a drink on the weekends, that gets written out. You define what it is that you are going to be doing. That is your plan. You make a promise to yourself that you're going to keep that plan, and every single time that you don't, you come out of alignment. And what is the best effective way to put something back into alignment? I mean, from my experience, it's a consequence. You have to have a consequence for your action. If a consequence is big enough, it'll-- it makes you reevaluate what it is that you're doing. If a consequence is big enough and it allows you... You know, it's like with a little kid. If you change their focus, they'll forget why they're angry. And it's not that the thing that they were angry about was a, w- you know, was an important thing. Maybe I didn't scramble the eggs in an appropriate way.

Dr. Rangan Chatterjee 44:31 [laughs]

Dr. Gabrielle Lyon 44:32 Right? You, you're laughing 'cause you have kids, and maybe-

Dr. Rangan Chatterjee 44:34 Yeah [laughs]

Dr. Gabrielle Lyon 44:34 ... the eggs got thrown in my face, and then I show them, uh, some new handwriting book that I got them, and all of a sudden, this is the thing. So it's very rarely that it's a thing. And what I appreciate so much, and I'm so thrilled that you're a physician talking to me about this, is that I could give someone the perfect program. I could say, we must exercise our skeletal muscle. Fifty percent of people don't exercise. Maybe twenty-four percent of people are even meeting that daily recommendation. By telling people to do the thing or increase dietary protein, none of that matters. It's not gonna happen. If the brain chemistry and the initial framework for understanding is not addressed, then an individual will never see success.

Dr. Rangan Chatterjee 45:26 I completely agree. Gabrielle, when you were mentioning your commitment to yourself, I think you mentioned it was one hour of training per day.

Dr. Gabrielle Lyon 45:35 Mm-hmm.

Dr. Rangan Chatterjee 45:36 And you said, I believe, anything more than that is too much and is you trying to, in some ways, run away from the more important things in your life. Now, I think that is such a key, key point. Many people will do this. Many people will not have the awareness that they're doing this. And I wanna tie this into this broader concept, which is I think people take on too much, particularly at times like January, where they think, "Right, I'm gonna overhaul everything. I'm gonna eat fantastically well. I'm gonna, I'm gonna do Dr. Lyon's plan. I'm gonna strength train four times a week. I'm doing ten thousand steps a day. I'm doing HIITs training twice a week." And they do it for two or three weeks when the motivation's high, and then real life gets in the way, and they fall off.

Dr. Gabrielle Lyon 46:24 Mm-hmm.

Dr. Rangan Chatterjee 46:24 So when I hear you saying that your commitment to yourself is one hour of training per day, no more than that, I think it's, it's really, really powerful. You seem to have found what works for you. It doesn't mean that's gonna work for someone else. That's what works for you in the context of your life.

Dr. Gabrielle Lyon 46:43 Mm-hmm.

Dr. Rangan Chatterjee 46:43 And there was a section in your book when you're talking about mindset and overcoming resistance, where you said you admitted to previous thought loops that you had, and you said this: "My thought loops told me I would never be fit enough, which drove me to train for hours per day whilst neglecting the other aspects of my life." Can you speak to that a little bit, please?

Dr. Gabrielle Lyon 47:09 I think it's really important that we understand, um... I will say this first, that motivation comes and goes, and you have to plan for that. You cannot be shocked by the fact that you will not be motivated. I was able to address all of that stuff many years ago. There are many times now I do not feel like training. I have two very little children. My husband is a first-year surgical resident, which means he works a hundred hours a week. Here's what I do. I am not surprised by the fact that I am not motivated to train. What I do is I have it all set up. For example, I have training partners that I know are going to be meeting me at the gym. I am not gonna let them down. I would never not say I'm gonna show up for something and then not show up for it. I know that when I get off of a plane, I will go, and I'll train. I don't feel like it. I'm already trying to-- Every Saturday, we do this, or every Sunday, we do this big group workout. Every Saturday night, I am trying to talk myself out of how I'm not gonna be going and showing up for Sunday. Yet we're all surprised that we're gonna start on a program January first, and then we're shocked by the fact that we're not motivated by-

Dr. Rangan Chatterjee 48:24 Mm-hmm

Dr. Gabrielle Lyon 48:24 ... in two or three weeks. Plan for that. You're not gonna feel motivated. You are going to feel motivated the first week. Failure to understand and plan for the fact that is absolutely going to fall off is a complete misstep. You plan for that. You have your teammates in place that you are going to show up for because if you're not willing to do it for yourself, you will definitely show up to do it for another person. And yeah, that's all I can say about that. I am definitely not motivated a lot of the time, but I still will show up

Dr. Rangan Chatterjee 48:58 I think relating also to your one hour a day of commitment to training, I think is this idea that there's a cost to everything we do. There's a consequence to everything. So in the modern world and the way we're living these days, many people feel time pressured all the time. And then they will hear, let's say you on your first podcast with me, you gave some recommendations that some people are gonna find very tricky to fit into their life. Your advice was that most people need a good cardio aerobic base. That could be with ten thousand steps of walking a day. You thought they need some form of high intensity training maybe once to twice a week, and some form of resistance strength training, ideally three to four times per week. Now, for some people, they're gonna go, "No chance. There's no way I can do that."

Dr. Gabrielle Lyon 49:57 Let's push back on that, and let's say that you truly don't have time. There are ways to make it happen. And let's say, realistically, you might not have an hour a day. You can get in there, then maybe you're an individual who needs to do more high intensity interval training, and that could be accomplished in twenty minutes. There is a baseline physical activity that you must meet. You must be out and moving. We are not designed to be sedentary, and we must rethink this domestication of humanity.

Dr. Rangan Chatterjee 50:31 I'm with you. Like for most of my life, until the last two or three years, I would say I prioritized intensity, right? So for a variety of reasons, um, throughout my adult life, I feel I've been under huge amounts of stress. There's that word stress again. Um, now, I would always move my body. So listeners of this show will know that I do a five-minute strength workout every morning whilst my coffee is brewing. Now, you may argue that five minutes is not enough.

Dr. Gabrielle Lyon 51:02 I'll take it.

Dr. Rangan Chatterjee 51:02 But I would say I keep in pretty good shape from doing that. Now, over the last two years, things have changed. As I have got older and I look in detail at the research on movement and exercise, I'm like, "Hey, Rangan, listen. If you want to be a capable, strong, resilient human being, you've got to move your body." So I am now committing to one hour's movement a day, right? And I love these daily things because if it's daily, it's a habit. Now, it doesn't mean I'm gonna run every day, right? Some days it'll be a one-hour fast walk, other times it will be a run or whatever it might be. But by making it a rule, by making it a standard that I'm accountable to myself, and I want to tie that in to this time of year, right? Even if people just commit to one thing and they do it, I think that is the best thing you can do. You give yourself evidence that you do what you say you're gonna do.

Dr. Gabrielle Lyon 52:14 You are on to something, my friend, and what you're also on to is shifting a narrative and a way of thinking of how we have to age. Does this take time commitment? Does it take physical effort? Is it sometimes uncomfortable because the last thing you want to be doing is push-ups and squats in your kitchen? Yeah, it's a drag, potentially, but the outcome is so beneficial when you are leveraging this organ of longevity from a lifetime trajectory of-- it's like putting money in the bank. You are doing what you need to do. It's an organ system. It is an organ system designed for movement.

Dr. Rangan Chatterjee 52:59 Yeah.

Dr. Gabrielle Lyon 53:00 When you are sedentary, your muscle becomes insulin resistant. When-- You know, it goes back to this analogy of the suitcase, of going on a trip for four days but packing for thirty. You are creating flux within your skeletal muscle. The other thing that you are doing that one must recognize is that skeletal muscle is currency, but it is the only currency that cannot be bought, cannot be sold, it cannot be traded for. Skeletal muscle is a currency that must be earned, and you are earning it daily. And through that process, you are becoming a certain type of person, someone who is physically strong, someone who is mentally disciplined. You are becoming a certain person capable of having skeletal muscle. And the two are not different.

Dr. Rangan Chatterjee 53:56 Yeah. In that chapter, I think it's chapter nine, you say, "Don't think of training as an activity with health benefits. Instead, consider it as a baseline requirement for wellness and an essential component of maintaining health and protecting longevity." That is exactly how I see it these days. We'll be back to the conversation in just a moment. Now, many of us struggle to find time to eat all of these incredible whole foods. That's why I'm a big fan of good quality whole food supplements like this one that's been in my own life for over three years now. It contains over seventy-five whole food source ingredients, vitamins, minerals, pre and probiotics, and can help us support our energy, focus, digestion, and our immune system. AG1 are giving my audience a fantastic offer, one year supply of vitamin D and five free travel packs with your first order. You can see all details at drinkag1.com/livemore or just click on the link below. And now Back to the conversation. That is exactly why on most days I'm not perfect. You know, yesterday I think it was 40 minutes, it wasn't an hour. But by having that as a standard, I'm constantly having to justify to myself when I don't meet it. So what's really interesting is that since I moved to this you're moving for one hour a day model, and I'll give Helen Hall, my coach, huge amounts of credit for this, she's a, an incredible movement coach who I work with. It means now that even when I get 40 minutes, I'm like, "Oh, man, yeah, but I, I, I didn't get the hour in." Whereas if I was just leaving it to do it three or four times a week, then, you know, I may have missed yesterday because I was really quite time pressured yesterday. But because my commitment is an hour, I'm like, "You know what? Get, just get out. Just, just do it." It was raining, it was dark. I was actually outside. I, I picked up my son from school. He was having a lesson, a- an extracurricular lesson, and I was waiting, and it would've been easy to stay in the car. It was warm, listen to a podcast, put the radio on, whatever. And I was like, I had this nagging thing at the back of my mind, "You've, you've not moved today. You've not moved today." So I didn't even have a raincoat with me. I thought, "You know what? Screw it. I'm just going out there. I'm getting this walk in." And you feel incredible. You get energy. Yes, I got a bit wet, but I honestly don't care. So I don't want to sidetrack this, Dr. Lyon, but I think these things are... These are the important foundations we all need upon which to build our behavior habits.

Dr. Gabrielle Lyon 56:47 You held yourself to a higher standard.

Dr. Rangan Chatterjee 56:49 Yeah.

Dr. Gabrielle Lyon 56:49 Which is incredible, and you felt good about it. Remember, we're not training to become better at exercise. We are training to become better at life. You are doing actions that allow you to become better at life. And if people understand as they are going into the new year, let's say you don't like exercise, fine. Think about how you are going to cultivate yourself to become better at life. You just talked about how going out in the rain, it's dark and cold, and you got your physical activity. You also kept a commitment to yourself. You also put a notch in the fact that you are much more likely to go ahead and take that action in the future.

Dr. Rangan Chatterjee 57:31 Mm.

Dr. Gabrielle Lyon 57:32 Didn't matter that it was raining. It didn't matter that it was cold. You're actually, yeah, you're cultivating your muscle, but you're also cultivating your resiliency.

Dr. Rangan Chatterjee 57:41 Yeah.

Dr. Gabrielle Lyon 57:42 It makes you an individual who's not willing to negotiate, and you're not w- negotiating with yourself. The brain does a lot of things. The brain likes comfort. The brain tells us not to do all these things, but the brain is just an organ that pumps out thoughts. That's just what the brain does. It doesn't mean that they're relevant. It means that one can be discerning. You can have all the thoughts that you want, but when you commit to an action, you don't wait on motivation. You don't have to force yourself into doing anything. You might have a, a moment of negotiation, which is exactly what you did, but you took action. You're much more likely to take action in the future, and you build upon that, which is exactly the goal for society. How do we become stronger and more resilient as a society mentally, which then begets physical resilience?

Dr. Rangan Chatterjee 58:35 For that person who wants to get into strength training, let's say they heard our first conversation together when we're inspired, but life got in the way. They haven't quite got round yet to bringing resistance training into their lives. Or perhaps someone's coming across you, Gabrielle, for the very first time and just going, "Wow, I didn't know skeletal muscle was that important." Let's maybe go through a couple of scenarios here. For someone who's never done anything, and let's say they're in their 40s, how would you advise that they start getting into resistance training?

Dr. Gabrielle Lyon 59:11 Well, you had mentioned that you have a great coach, and I think now that we have access to online coaches and, and there's just a whole host of information, find a modality that works and be under the guidance of someone or at least curate information. There's tons out there. Because when you start, you are going to have much more of a response than someone who is tr- who has already been training. The just doing basic body weight stuff like pushups or squats or moving your body or doing lunges, this is an amazing place to start. You are doing something. Again, when we talk about resistance training, moving your body weight would be considered resistance training. Then you graduate to bands. If you want to use bands, I think that that is very, very, very helpful. It is easy to do at home. And then after you graduate from bands, and let's say you are doing things, I think being able to squat, get off, up off the floor, because again, we are training for life. Being able to do a pushup, you have to be able to fall well, you have to be able to push yourself up off of the ground. Let's say you don't want to do any of those things, then you pick up a couple heavy bags and you walk and you carry them. Eventually, you progress to kettlebells. What are actions that you do within your normal life that will allow you to get better at doing those things?

Dr. Rangan Chatterjee 1:00:31 Yeah.

Dr. Gabrielle Lyon 1:00:31 We know that people have to carry groceries. We know that you have to, if you are traveling on an airport, that you have to put your, uh, suitcase overhead. We know that it is very critical to be able to get off the floor if you were to fall. Begin to think about things within life and put actions to those things. Let's say, I don't know, you don't want to buy weights, so maybe you spend $20 and you get a weighted vest on Amazon.

Dr. Rangan Chatterjee 1:00:59 Mm-hmm.

Dr. Gabrielle Lyon 1:01:00 There are a whole host of opportunities and options, and there's only one wrong way to do it, by the way, and that's by not doing it

Dr. Rangan Chatterjee 1:01:11 Yeah. I, I circle that quote in your book. "There is one slam dunk way to exercise wrong. Don't do it at all." So I think that's empowering. You know, at the start of this conversation, you mentioned how you did geriatric medicine early on in your career, as did I. My second or third placement as what we call the senior house officer, so our second year as a junior doctor, was in charge of the care of the elderly ward at the Western General Hospital in Edinburgh. And when we think about these functional movements, and it's hard, right? I get it. In my 20s, I wasn't thinking about what do I need for when I'm 70 or 80, right? But something so practical that people probably don't think about unless they've seen it with... You know, like we have in our patients. To go to the toilet, you need to be able to squat, right?

Dr. Gabrielle Lyon 1:02:09 Mm-hmm.

Dr. Rangan Chatterjee 1:02:10 And it is something that people take for granted until they can't do it.

Dr. Gabrielle Lyon 1:02:16 Mm.

Dr. Rangan Chatterjee 1:02:16 Again, I, I know that may not land for someone in their 20s or 30s who's listening, but I hope it does because nobody wants to be that person when they're older. No one-- I don't think anyone would choose to say, "Yeah, you know, when I'm older, um, I hope that I can't get up and down off my own toilet." I mean, no one wants that. It doesn't mean people can't have a quality life when they have that. Would help, I-- for sure, but that's a very real thing for people to think about when we're thinking about, you know, functional exercises and what we need to be able to do, right?

Dr. Gabrielle Lyon 1:02:51 And it's also not if challenges are gonna happen, it's when. It's not an if thing, it's a when thing. You train for life, and you train for sickness, and I know that that sounds morbid, but the more healthy muscle mass you have, the more resilient you are going to be in midlife and later on. And the time to take action is now. The wor- the best time was yesterday. The second best time is today. You have to take action, and you have to do it regardless. It's not that it's going to get easier. So if people could think about what the future is like, you don't have to think about yourself. You know, if you're in your 20s, you're thinking, "Well, that's in another 30 years." And I will tell you that as someone who's not in their 30s, as you and I are both not in our 30s, that the actions and the habits that you develop now are much easier addressed now than they are later on. Being strong and being capable and taking the action necessary is your best health insurance possible. It is not an if the-- when these things are going to happen, it's a when. Whether someone gets the flu and they are laid up in bed, uh, an older person might lose two pounds of muscle if they are on bed rest for seven days.

Dr. Rangan Chatterjee 1:04:11 Yeah.

Dr. Gabrielle Lyon 1:04:11 The more healthy muscle mass you have going into any kind of, um, disease or illness, the more capable you will be to fight it off. Also, I have never heard a patient say to me, "You know, I regret being strong and capable. I regret that." Never in the history of ever.

Dr. Rangan Chatterjee 1:04:37 There's something also about strength training or exercise or training full stop that I don't think people talk about enough, how it makes you feel, right? When you can lift something heavy, when you're able to go on a one-hour hike in the hills, and you're able to do that, you come back, and you've given yourself a shot of resilience. You feel like a capable, strong human being. We can talk about what having muscle mass does to lower inflammation, improve the health of your immune system, lower your risk of cancer, all those kind of things. Great. But it also does something arguably more important than any of those things. It gives you confidence in yourself.

Dr. Gabrielle Lyon 1:05:24 I know. Isn't it amazing? Muscle is the cornerstone to longevity, and what is longevity? It's not just living longer. It's living happier. It's living more capable. It's being able to fulfill what you intended to fulfill. You're absolutely right. It makes you more confident in the way in which you show up in the world. It makes you more physically capable. It's incredible. It also makes you more independent.

Dr. Rangan Chatterjee 1:05:51 Yeah. You said start wherever you're at. There's plenty of online resources now. You said if you can get a trainer, get one. Let's just think of two more scenarios, okay? One scenario is that person who thinks, "Trainer? You've got to be kidding me. I've barely got enough money to pay the bills, put the heating on, and feed my kids." So to them, they may be thinking, "No chance can I afford a trainer. I may not even be able to afford a gym membership." So I want your take on what that person can do, and then I want you to move on, if you don't mind, Gabrielle, is to another person who thinks, "You know what? I'm pretty good. You know, I've been listening to Rangan's podcast for a few years. I've been implementing some of the advice. I've got energy. I've lost a bit of weight. My mental wellbeing's better. I'm now prioritizing health in a way that I never was." What is optimum? What would you ideally have me do? And let's say this person is in their 40s or their 50s. I wonder if you can give them your top prescription based on what I've just told you.

Dr. Gabrielle Lyon 1:07:00 Those are two great questions. We'll start with a person who is really struggling financially. YouTube is free. I would suggest going to YouTube and finding bodyweight exercises. There are a whole host-

Dr. Rangan Chatterjee 1:07:13 Mm

Dr. Gabrielle Lyon 1:07:13 ... of ways that you can get healthy if you have access to a computer or a phone. Or even the library. So the library is free. You can go to the library. You can get online there. You can go to YouTube, and there are actions and ways in which people can execute immediately. Again, doesn't cost anything to do push-ups. It doesn't cost anything to do squats, and what happens is over time, you can continue to increase the amount. So let's say when you start, you can do 10 squats. Well, then you can do 20, and you continue to push yourself, which would lead me to the second question that you asked. So number one, if finances are very tight, YouTube has a ton of free resources. If you do not have a computer at home, you can go to the library, a free public library, and listen there.

Dr. Rangan Chatterjee 1:08:06 Yeah, and I just wanna add to that something you, we were talking about before about self-limiting beliefs. That individual, if they go to work somewhere, and they have colleagues, there's always that colleague somewhere who, you know, takes pride in their appearance and is really buff and clearly works out regularly and likes to train. We're often fearful about asking others for advice or help. You know, I challenge someone listening to this, if you're that person, go up to someone who you know trains and say, "Hey, listen, you know what? I wanna make this year a really good year for me. I can't afford a gym. I don't know where to start. Would you mind showing me two or three simple exercises that I could do by myself at home?" I think it's another... I know some people get really scared about doing that, but if you can lean into that fear-

Dr. Gabrielle Lyon 1:08:56 Yeah

Dr. Rangan Chatterjee 1:08:56 ... and actually go and ask someone, people wanna help, right? People who train, they'd be delighted to say, "Hey, listen, no worries. I was there once before 10 years ago. I didn't know either. I'd start with A, B, and C." So that's all I was gonna add to, to, to what you just said there.

Dr. Gabrielle Lyon 1:09:13 I, I love that. I love that. Now let's talk about the next question that you had asked is, someone who's in their mid-40s, they're already prioritizing their health. What is their optimal goal? I love this question. My challenge to them would be, you should be training to get better at multiple different modalities. You pick one, and you train that up for 10 to 12 weeks, depending on whatever your goal is. For example, let's say you are really great at doing a bench press, squat, and you've been training in this hypertrophy zone. I would challenge you to get better at high-intensity interval training. And how would you do that? Well, you would measure it. So for example, if you were gonna go on a rower, you would say, you would test yourself, find out where you're at. How long is it gonna take you to row 500 meters? You'll get a baseline, and then you'll continue to improve that. Or you can do a SkiErg or a AirDyne bike. But really understanding that the key with training, just like the key with life, in my opinion, is that you strive to become better at the thing. If weightlifting is easy for you, continue to do that. Now pick something else. Maybe you're not good at, at yoga. Maybe you're not very flexible. Lean into that. There are so many fun ways to train. Let's say I don't have time to go to the gym. I will find a creative way to train that potentially I'm not good at. I'll throw a Bulgarian bag, which is a kind of off-centered bag. I'll throw it over my shoulder. Maybe that's 35, 40 pounds, and then I'll pick up a kettlebell, and I'll be walking in my neighborhood. So I'll have a, a Bulgarian ba- bag and a kettlebell in one hand. I'll walk up and down. Maybe I'll lunge. I'll turn around. I'll do it again. Might be something that I'm not good at, but I'm always trying to leverage the movements that potentially I'm not good at.

Dr. Rangan Chatterjee 1:11:12 Yeah.

Dr. Gabrielle Lyon 1:11:13 Because that's what life's about. You don't just continue to do the thing that you are good at. You do that, and then you add to it. And you get creative, and you figure out your weaknesses. And you leverage your weaknesses because fitness is multidimensional.

Dr. Rangan Chatterjee 1:11:27 Information is not enough to make change in your life. You have to take action. So to help you take action after watching this video, I've created a free nutrition guide for you. This contains the five most important practices I've seen in over two decades of seeing patients. They work for you no matter what your dietary preference. There's a step-by-step action plan to help you implement those changes in your life. If you wanna receive that free guide right now, just click on the link in the description box below.

Dr. Gabrielle Lyon 1:11:57 Let's say you love training hard. Maybe you need to add in some yoga and get more flexibility.

Dr. Rangan Chatterjee 1:12:01 Mm.

Dr. Gabrielle Lyon 1:12:01 Maybe you need to add in more stability work.

Dr. Rangan Chatterjee 1:12:05 Yeah. I love that. You're clearly of, uh, maybe a similar mindset to me, where you're, you have no problem going out into your neighborhoods wearing crazy stuff or putting st- you know, weights on your back and going rounds, okay? I think that would be me, whereas I think many of my patients, [laughs] a lot of my family, a lot of my friends would go, "No way." But that could be applied in your house, right? Let's say you've got stairs. Well, you could pick something up and go up and down your stairs, couldn't you, right? You d- you don't have to do it in public if you don't have that kind of, I don't know, self-confidence, whatever you might wanna call it.

Dr. Gabrielle Lyon 1:12:44 Or maybe you should. Maybe you should cultivate it, and the first three people that look at you weird, good. Keep going because then the next time you do it, you're not gonna feel uncomfortable.

Dr. Rangan Chatterjee 1:12:53 Yeah.

Dr. Gabrielle Lyon 1:12:53 Or maybe, you know, you can keep testing yourself. Wear a, I don't know, your kid's headband. Be crazy. But it's just that initial restraint that we put on ourselves.

Dr. Rangan Chatterjee 1:13:06 Yeah.

Dr. Gabrielle Lyon 1:13:06 You can do it.

Dr. Rangan Chatterjee 1:13:07 We're touching on something which I think you cover towards the end of your book in the section about environment design, and you talk about these four, I guess, avatars, the performer, the soloat, the chameleon- ... and the reluctant. Can you explain how you came up with those four, and just walk us through each of them? Because I think all of us will go, "Yeah, that, that's probably me. Oh, that's probably me. That's my partner. That's my brother," or whatever it might be. I, I really loved it.

Dr. Gabrielle Lyon 1:13:37 Yeah. Well, really, these came from... And by the way, there's probably more, but this came from just seeing patterns of people. And once you figure out what kind of person you are, you know how to get the best of yourself. So a, a soloist is a person who they don't care about external stimuli. They prefer to train alone. They will either turn music on or not, it doesn't matter. These are highly, highly driven individuals that are working out their own stuff. Doesn't matter where you put them, doesn't matter who is there, doesn't matter. Um, these are the people that will train by... Like David Goggins. David Goggins isn't gonna care who's around, right? He doesn't matter. It, it, whether someone, whether there's a camera there or whether there's not, that guy's getting it done. A chameleon, a chameleon type of patient will... You can really put them in anywhere, and they'll make it happen. One of my best friends, Don Saladino, who if you guys are looking for a training, uh, online training, he has many, many programs. This guy is such an athlete, it doesn't matter. He can train alone. He can train in a group. You drop him in anywhere, and he's dominating. He just loves training. The reluctant is, uh, a few things. A reluctant, uh, a reluctant patient is they actually do wanna get better, but they'll tell themselves that there's no point, and they've tried everything, "So what's the point? I'm just gonna stay at home and eat whatever I want."

Dr. Rangan Chatterjee 1:15:00 Mm-hmm.

Dr. Gabrielle Lyon 1:15:00 And, you know, "What's the point of me, you know, uh, training, 'cause my body composition's not gonna, not gonna change. Um, it's not really gonna matter." And, and those are the people that there's typically a lot of pain involved, right? That they're just not, um... They haven't really identified that there's a risk that they might not achieve the thing that they're looking to achieve. Which, by the way, just taking action allows you to get better either way.

Dr. Rangan Chatterjee 1:15:29 Hmm.

Dr. Gabrielle Lyon 1:15:30 And I think that that's really important. And what was the last one? There's one more.

Dr. Rangan Chatterjee 1:15:35 The performer.

Dr. Gabrielle Lyon 1:15:36 Oh, these, the performers are the best. Now, these are a lot of the people that you will see on stage, that are very much out in public, that do better being witnessed.

Dr. Rangan Chatterjee 1:15:48 Hmm.

Dr. Gabrielle Lyon 1:15:49 Meaning, they can go to a gym, they might not wanna train with anybody or want you talking to them, but they need to be in an environment where people are witnessing them. And it's not this... Because they will push themselves-

Dr. Rangan Chatterjee 1:16:01 Hmm

Dr. Gabrielle Lyon 1:16:01 ... knowing that they are being witnessed. And again, it's not this ego thing, it's just the way in which they seem to function best. Um, many entrepreneurs, again, they'll be so competitive within themselves, but they don't necessarily wanna do it solo.

Dr. Rangan Chatterjee 1:16:16 Yeah.

Dr. Gabrielle Lyon 1:16:17 And they don't necessarily need a training partner, but they will have to go to a gym to, quote, "get the environment right."

Dr. Rangan Chatterjee 1:16:22 Yeah.

Dr. Gabrielle Lyon 1:16:23 So I'll give you an example. I take care of a very well-known entrepreneur, and he was training as a soloist. How good do you think his workouts were? Terrible. Terrible 'cause he didn't wanna go to the gym. He didn't want people to recognize him. But for a performer to be training solo, it's like the kiss of death. So he'd go to his home gym, do a couple reps, be on his phone, "This is boring." We put him into the gym, even if the gym... We'd find out when he, the gym wasn't busy. Go to the gym. We'd go there with a trainer and kinda keep people at bay. Completely crushed his workout. So knowing how you navigate your environment is crucial-

Dr. Rangan Chatterjee 1:17:08 Hmm

Dr. Gabrielle Lyon 1:17:08 ... because you leverage your environment for success.

Dr. Rangan Chatterjee 1:17:12 Yeah. A huge part of this conversation has been about getting to know yourself better, understanding yourself, knowing your limitations, knowing your patterns, knowing when you go off track, right? I had planned to do a masterclass on muscles today with you, and we've probably done a fraction of that. But nonetheless, I think this is so, so valuable for people because this is really where it's at if you want to make changes. So in the remaining time then, um, I wonder if we can go through a few sort of almost like a quick-fire run through different topics that maybe are of use to people. So you-

Dr. Gabrielle Lyon 1:18:01 Sure

Dr. Rangan Chatterjee 1:18:01 ... you are, you've been practicing medicine for years now.

Dr. Gabrielle Lyon 1:18:04 [laughs] Yeah.

Dr. Rangan Chatterjee 1:18:06 What are the top five blood tests that you would recommend people do on themselves-

Dr. Gabrielle Lyon 1:18:13 Mm-hmm

Dr. Rangan Chatterjee 1:18:13 ... to get a snapshot of their short-term and their long-term health?

Dr. Gabrielle Lyon 1:18:17 Uh, fa- Now, in no particular order, understanding your fasting glucose levels, understanding your fasting insulin levels, understanding your triglycerides. So that's three. Understanding your hormones. Whether you believe in hormone replacement or not, really getting a sense of where your free hormones are. For men, what is your free testosterone? For women, what is your estradiol? Uh, depending on, um, you know, where you are, your progesterone also is helpful. Looking at ApoB, which is a very important marker for cardiovascular health. Also knowing your Lp (a) . This is a genetic marker, and this also helps you understand your risk for cardiovascular disease. Those are just a handful of things. A full thyroid panel, that's important. That's important for energy, metabolism, muscle function. Most people don't correlate thyroid with, uh, muscle health, but I will tell you, um, early on in my career, I had a lot of Hashimoto's and hypothyroid patients, and one of the things I started seeing with the volume of patients that I was seeing, is they would- Constantly be getting tendonitis

Dr. Rangan Chatterjee 1:19:32 Mm.

Dr. Gabrielle Lyon 1:19:32 They would be getting issues with tendons, and one of the things that can impact tissue turnover of tendons is thyroid hormone. So looking at what your thyroid hormone is. I think that there's some argument to be said for an omega-3 index. I typically like to see my patients around 10. Um, another vitamin D number would be great. There's a whole host, but the top numbers I would say, if you just wanted to do a few, would really be the ones related to metabolic health. Insulin, fasting insulin, fasting glucose, triglyceride levels. Those would be really the top three if I had to pick.

Dr. Rangan Chatterjee 1:20:14 Yeah, mine are pretty similar as well, and of course, depending on where you live, depending on which country it is, depending on when- where you are in the world, you will have different levels of access to some of these tests, like an omega-3 index, LP little A, ApoB. These are not available everywhere. Certainly they're not available currently in the National Health Service in the UK. You, you have to pay privately to get those tests, and many people would argue that they are well worth paying for if you have the resources to do that. But I completely agree. There is so much that we can learn just from a fasting glucose, maybe a HbA1c, your average blood sugar.

Dr. Gabrielle Lyon 1:20:52 Oh, yeah, I totally forgot about that. There you go.

Dr. Rangan Chatterjee 1:20:54 Yeah.

Dr. Gabrielle Lyon 1:20:54 HbA1c. Yeah.

Dr. Rangan Chatterjee 1:20:54 Triglycerides. Even those three you get a lot of information from. Uh, again, insulin, fasting insulin is not that commonly available here in the UK. I hope that changes given how prevalent metabolic health is. Okay, so there are some blood tests that people can think about doing. What are some of your favorite strength exercises, Dr. Lyon?

Dr. Gabrielle Lyon 1:21:16 Definitely squats are important. Um, and it could be a regular squat, it could be a sumo squat. Um, again, just de- depends on the positioning of your feet. I also think, um, uh, some kind of kettlebell activity is important, and that could be a Turkish getup, which is a little bit of a complex movement. Um, but you could start with a kettlebell swing or kettlebell carry. I like it because the kettlebells mo- you know, make me think of, um, ways in which we move that are not as easy as, say, like a dumbbell.

Dr. Rangan Chatterjee 1:21:48 Mm-hmm.

Dr. Gabrielle Lyon 1:21:49 I do think, um, a deadlift is really important because that's a full body exercise, and that can be done with a, a sumo deadlift or a regular deadlift. And then I, I think adding in some unilateral activity, which would-- could be a walking lunge, moving things into motion. And you know, I've thought a lot about what exercises are best, and I, I don't know if I, if I have an answer because it really depends on how the person has been moving for their life. Uh, many people are very sedentary. We don't have strong glutes, so really working on your glutes and posterior chain are important. I do think upper body strength is extremely important for both men and women, and that could easily be a plank or a pushup.

Dr. Rangan Chatterjee 1:22:33 Yeah.

Dr. Gabrielle Lyon 1:22:33 Uh, and I, I, I could go on and on, but to just bring it back, bring it back home, definitely be able to do some kind of squat.

Dr. Rangan Chatterjee 1:22:40 Yeah.

Dr. Gabrielle Lyon 1:22:41 Definitely be able to do some kind of deadlift, and definitely be able to do a kettlebell carry or a swing.

Dr. Rangan Chatterjee 1:22:47 Yeah. Thank you. Dr. Lyon, just to finish off this conversation, there is so much you have shared in the first conversation with me on my podcast and this conversation, and of course, in your brand-new book, Forever Strong, which is just a phenomenal resource for people who are wanting to improve the quality of their lives. Right at the end of this conversation, for someone who has decided, yeah, that's it now, I'm sick of not prioritizing myself, I'm sick of not putting my health and wellbeing first, the time has come now for me to change things, given everything you know about health and wellbeing, and you can cover stuff from our first conversation as well in terms of first meals, protein, all that kind of stuff, could you just list off some of your very top practical tips that will help anyone at all if they're in the business of improving their health?

Dr. Gabrielle Lyon 1:23:50 Yeah. One thing that one hundred percent of people do is eat. So getting your nutrition right. A hundred percent of people do that. That would be prioritizing dietary protein, whether you're animal or plant-based, it doesn't matter. I want you to prioritize dietary protein. My recommendation would be one gram per pound ideal body weight. Your next question is going to be, what is my ideal body weight? I'm going to say, I don't know your ideal body weight. The last time that you felt great in your own skin is where I would start, and that's one gram per pound ideal body weight. The way that I would distribute protein, that first and that last meal are really critical. The first meal having between thirty and fifty grams of dietary protein when you are coming out of an overnight fast. This is great for any age, whether you are in your thirties or sixties. This is the way to help maintain the health of skeletal muscle. That last meal of the day is also critical because you're going into an overnight fast. Again, the goal is how do we protect skeletal muscle? Nail those, that first and that last meal.

Dr. Rangan Chatterjee 1:24:59 Right.

Dr. Gabrielle Lyon 1:24:59 Priority number one, get enough protein. You do not have to go as high as one gram per pound ideal body weight. You could do point seven to one gram if that made you feel more comfortable getting that first and last meal of the day appropriate. I would also say that for carbohydrates, one way to think about it is, is to understand, are you carbohydrate, uh, sensitive? Do you have a good body composition? Um, and again, how would you test that out? You would look at your body fat percentage. If you felt that you had weight to lose, calorie control is critical. Most people will say it doesn't matter how many calories that you consume. I, I disagree with that. Understanding how many calories you are currently eating to be at the current weight that you are, and adjusting appropriately. I typically recommend no more than fifty grams of carbohydrates per meal, depending on what your total carbohydrate intake is. You have to determine that. The current recommendation is around a hundred and thirty grams. But the way in which you mitigate insulin, uh, a robust insulin response, would be to have a tight amount of carbohydrates per meal. And what works really well is if you do a one-to-one protein-to-carbohydrate ratio to make it super easy if you are someone who enjoys carbohydrates. A one-to-one protein-to-carbohydrate ratio, so that means in the morning, if you are having thirty grams of dietary protein, you can have thirty grams of carbohydrates with that. The next thing that I would say is you have to train. If I were to prioritize what kind of training that would be, my first recommendation would, would be to do some resistance exercise two to three days a week. I'll give you a, a day less. So I'll say two to three days a week. And the less you do it, the more you're doing full body. The more you do it, the less you have to do on that third day. But resistance training is a non-negotiable. And then I would say the last thing is know your weaknesses. Don't be surprised by them. Plan for them. They're coming, and they're totally predictable. You cannot be shocked by your own human nature, and when you plan for that, then you can follow the first three or four recommendations I just gave you.

Dr. Rangan Chatterjee 1:27:27 Gabrielle, fantastic advice. I really appreciate what you are doing. You're spreading the message of health and wellbeing. You're spreading the message that skeletal muscle is really, really important. The new book, Forever Strong: A New Science-Based Strategy for Aging Well, is fantastic. Thanks for coming on the show again.

Dr. Gabrielle Lyon 1:27:48 Thank you so much for having me.

Dr. Rangan Chatterjee 1:27:49 [outro music] If you enjoyed that, I think you are really going to enjoy this conversation about the most important things that you can do right now for your health and longevity.

Guest 1:27:59 If at 37 your limit is just being able to run that 30-minute park run, at 75 you're gonna have a very difficult time getting around