Does Ozempic Destroy Muscle? - Dr. Gabrielle Lyon

Here's a question that I uh actually have no idea the answer to, but I know that uh the first generation, and correct me if I'm wrong, of the GLP-1 drugs was semiglutide, but now they have these other these newer ones, right, that um are more broad in terms of their effect. There's trozepatide, there's rea if I recall correctly. Yeah. Are any of them safer from the standpoint of muscle health? — I don't know. I think it's really in the dosing — and I also actually paradoxically believe that the GLP1s are going to be good for skeletal muscle mass health but it's the amount that we're using because uh GLP1s they're incrretens and it affects the brain it slows gastric emptying protein is considered nature's GLP-1 which interestingly at a dose of 30 grams or higher maybe has something to do with lucine I don't know but I do think that they are here to stay and there is utility for them especially when it comes to the health of skeletal muscle. Yes, it helps with food noise. all these other things. But I do think that it can help with interuscular atapost tissue and we're going to start to see more of that. But again, we don't have good sensitive markers on a population level to be able to test for these things. DEXA looks at lean body mass, body fat, and bone. And that's where the challenge becomes because it's what difference again inter uh personal do you expect to see between study participants you don't expect it to be very sensitive. — Yeah. — So we don't have a great answer but we do know going back to what people can do. We know that reorienting their nutrition there's a million different ways to do it well. But I do think that if we chase less novelty, we can double down on foundational health principles, which again, this is the plate. I put this in the playbook. It is the plate of how we look at it visually. And we went back and forth. We're like, do we track calories? Do we not? But we've been trying to do that. So, let's give people something different. — Yeah. — And then how do you actually think about dosing carbohydrates for muscle health? — Because I haven't heard that talked about, have you? That there's a carbohydrate threshold — for dosing for muscle health. There's something called the Randall hypothesis. Have you heard of that? Randall hypothesis is that fatty acids dominate metabolism. — Well, not necessarily. If you give enough carbohydrates, carbohydrates do dominate metabolism. And it's are you burning fat or are you burning um carbohydrates? And if you have a ton of carbohydrates, you force your body into the position to burn that. You shouldn't do that. Don't force your suitcase closed, right? It's just messy and it's all kinds of problems. You're probably going to ruin your clothes. Don't do that. — And it's understanding that in order to have healthy muscle tissue, you have to not be sedentary. And that is the primary goal. Whether it's resistance training, whether it's high intensity, whether it's cardiovascular, you have to maintain both type one and type two fibers. — Yeah, I'm a fan of carbohydrates. I think that they're great for — then you need to buy some for your house so I can come next time because it's brutal. — What favorite source? Like give me give me — potato. I went so I went to dinner with the uh Kushners yesterday. — All right. Next time you come over, I'm going to have a baked potato ready for you. — And Leanne, I love you guys. And we ordered baked potatoes. I was like, they're like, do you eat that? I'm like, in fact, give me two. Just kidding. I ate half because that's about 30 grams of this baked potato. And then I ate a 6 fillet and then I had three bites of dessert. I tell it sounds like a perfect meal to me. — It was. — Yeah. — Not hard. There's only one way to do it wrong. — It's just hard to find like quick access sources of carbs that aren't also loaded with added fats. — You know what I'm saying? Like a baked potato is pure starch. I could have made some rice for you. Give me a heads up next time, — Max. Never. It's not going to happen. You're just going to give me those protein chips and I'll just have to be happy with it. But also again, if something is high in fiber, it's I'm not as concerned about it. But if it is low in fiber, white like rice and pasta, all that stuff, you have to be very careful about and intentional. How are you eating for muscle health? I don't care about obesity. It's true, but I do care because it's much easier to gain fat than it is to build muscle. Hm. — It's kind of a design flaw. But again, how do we shift the conversation to focus on muscle health? We know that we have to train and you know, women and men, you don't have to actually train heavy. You have to provide enough stimulus to get that tissue healthy. — Well, it actually it makes sense from an evolutionary standpoint that it would be more difficult to build and maintain muscle because muscle is metabolically expensive. I mean, you've talked about this on, you know, many times that

muscle burns calories. Not a huge amount of additional calories, but it does burn extra calories just sitting on your frame. And back prior to the to prior to food security being something that we as a species were able to secure for ourselves. You know that was a risky proposition cuz it's you know muscle is um yeah it's a it's expensive to maintain. — Yet now we're here and now we know what we have to do if you want to age well. Alzheimer's type three diabetes the brain. It doesn't start in the brain. It starts with the health of muscle because as we become more metabolically deranged, elevated triglycerides, elevated glucose, this affects, you know, when I was at WashU, part of I don't know if we've talked about this, but part of my research was looking at body composition, brain function. — Did you know that? — Uh, I think yeah, probably. Yeah. — Okay. So, — I imaging I paid him to say that, guys. So I was imaging these people's brains and the heavier they were, the less muscle mass they had, the worse their brain volume. — And it wasn't an obesity problem. It starts as a muscle problem. And even those individuals that were quote skinny fat with low skeletal muscle all had abnormal metabolism. This is all about reorienting ourselves to more impactful conversation and especially in the landscape of the use of GLP1s. We are going to see sarcopenia earlier and more often with sarcopenia comes osteoporosis. Low muscle mass is a possible indicator of low bone density. I don't know about you, but I think that the idea of having a frail future, that's terrifying. — Yeah. No, I mean your observations are completely consistent with the literature that I've seen linking uh frailty to increased risk for Alzheimer's disease in even you know going to dietary food questionnaires higher levels of protein seem to be and animal protein actually specifically seem to be linked to uh reduced shrinkage of the hippocampus um a slowing of the atrophy rate of the hippocampus. That was a recent study that came out. there's all kinds of data now, you know, painting a fairly clear picture for us that, you know, everything that you're saying checks out from the standpoint of aging well, especially with regards to the brain. So, — more to come. The interuscular atapost tissue is going to be the next thing. Mark my words, — interuscular atapost tissue. We have to get really good at figuring out the numbers and the influence of that, the dietary influence, the exercise influence, just really, really specific and the treatment protocols. And does hormone replacement therapy help that? At what level do GOPs work? And also, can we talk about my playbook before we leave? — Absolutely. Of course. Yeah. I mean, your work is so important. So, the Forever Strong playbook. I mean, Forever Strong obviously was a huge hit of a book. Tell me about this new uh spin-off that you've created for us. — This is a standalone book. This is the book that I wish that I had. And it is How to Think. Very cerebral. How to Think. How to Get Out of Your Own Way. How to Think. It has visuals. Super cool. How to eat. — Look at how good you look on the cover. — That is not airbrushed, my friend. — What do you mean on the cover? I'm just kidding. — Um, how — chiseled — how to eat exactly plate style, everything. Grocery list, you name it. Recipes, which they're amazing. How to eat, how to move. It has protocols for exercise. You do not need a gym. There's a million different ways to get it done. But this is a playbook. If you want X, let me deliver X. How to eat, how to think, how to move, how to recover. — I love it. It's very I'm very proud of this. I'm actually way more proud of this book than I am of the last one. — Wow. — Yeah. And I never do I ever really say anything like, "Oh, wow. This is great. " Never. You've never heard me say that. — Well, your books are like your children. So, I mean, those are strong. — Well, then I have a first unruly child and this is my second well- behaved one, which again, this has visuals in it. And that is I spend a lot of time on these graphics as to how to construct. Some people are visual learners and then some people can just read. But for me, I wanted what does the visual plate look like? What do these I even have workouts in there. The whole thing with visuals. It's cool. — It's amazing. Very excited for it. Uh well, I love having you in. You're the best. — Are you going to have carbohydrates next time? — Of course. Yes. Baked potato ready to go. — Okay. I'm going to You know what I'm going to do? I'm going to door dash it to your house so that it's there when I'm I'm — deal. And a big brontosaurus rib for you to gnaw. Hey, if you like that video, you need to check out this

one here and I'll see you there.