How to stay healthy over 40: the doctor who prescribes weights and protein
Dr Gabrielle Lyon says that building muscle is the key to optimum health. She tells Peta Bee why. Plus: read an excerpt from her new book
Put away the diet books, throw away the scales. Staying slim and living a longer and healthier life does not come down to your body fat percentage. Rather, it is about how much lean muscle you have, according to a leading doctor in osteopathic medicine and family medicine practitioner in the US.
Dr Gabrielle Lyon has spent years researching longevity and the impact of lifestyle changes in the health of her own patients as they age. Now, in a new book, Forever Strong, she argues that what people should be focusing on for optimal health is not trying to lose weight but getting stronger.
“We are indoctrinated into a body fat-phobic way of thinking about our wellness,” Lyon says. “We focus constantly on what weight we have to lose, when we should switch to thinking about what we are set to gain if we become capable of building stronger muscles through eating more protein and resistance training.” Rebooting one’s health with an emphasis on building muscle, she says, will help people of all ages to boost their metabolism, have far more energy, stay mentally sharper and shift excess body fat.
As well as practising as a doctor both in New York and Texas, Lyon hosts her own Apple podcast with 2.5 million listens, has a YouTube channel with 2.75 million views, and has given aTED talk on what she terms “muscle-centric medicine”. In her forties and with two children under five, she bursts with energy, her hair and complexion shining with good health. Her toned physique is an advertisement for her approach, but also a hangover from her days as a fitness and strength competitor in her youth.
It was while spending two years at Washington University on a research and medical fellowship in geriatrics and nutritional sciences that she first became intrigued by the rising numbers of people struggling to lose weight and patients in their sixties and seventies being diagnosed with dementia, despite them following the latest science-backed advice on food intake and activity. Over time she concluded that the connection between these groups and others with ill health was not only that they were ageing or had too much body fat, but that their muscle size and muscle health had plummeted to levels far lower than those of younger people.
What was missing from their lifestyles, she says, was resistance exercise and enough protein in their diet — the combination needed to enhance muscle health. “Protein is critical for health,” Lyon says. “It plays a vital role not just in building new muscle, but in controlling the functions of other tissues and organs important for metabolic function and quality of life.” Also often overlooked, she stresses, is the importance of protein for “the production of neurotransmitters that keep our brains healthy and have a direct association with sleep and mood”.
Earlier this year the adventurer Bear Grylls, 49, told The Times how he transformed the health of his whole family by eating more protein: specifically an “ancestral diet”, in which read meat features heavily. “For millions of years we’ve thrived and been strongest and healthiest by eating meat, blood and organs,” he said.
Lyons says that by consuming more high-quality protein in the diet, from animal and some plant sources, and adding resistance training — starting with something as simple as bodyweight exercises and bands three times a week before progressing to weights — people will experience benefits even within days.
“A lot of people start to feel changes in muscle strength and function as well as neurological adaptations such as spatial awareness when they move even before they notice visible improvements to their body,” Lyon says. “There will be almost immediate improvements in blood glucose control, and within two weeks markers for a range of diseases will reduce.”
Emerging studies have proven that strong muscles are far better at helping the body respond to insulin, resulting in better blood sugar control after meals and a reduced risk of type 2 diabetes and insulin resistance, which affects the health of the heart. In a large trial involving nearly half a million adults published in the British Journal of Sports Medicine last year, a team of US scientists showed that adding more muscle-strengthening workouts not only enhanced fitness but reduced the risk of injuries and improved longevity.
Lyon says the importance of muscle for midlifers has been suggested in research, including a study from the University of Copenhagen that shows repeated contractions of skeletal muscle boosts the production of myokines, hormones that have been shown to influence the way in which the entire body responds to exercise. “We now know that these myokine hormones are extraordinarily valuable in leveraging the health of the overall body,” Lyon says. “For example, German researchers showed that the myokine boost with resistance training helps to regulate the processes that lead to improved cardiovascular and metabolic health.”
Lyon describes one recent female patient who had struggled with her health and weight for decades, but shed 4st within nine months of shifting her focus from calorie counting to consuming more dietary protein and lifting weights. “We worked on her protein consumption and her workouts to enhance her muscle health,” Lyon says. “Not only did she lose a lot of weight, but her joint pain disappeared, her biomarkers for autoimmune disease were dramatically reduced, and her levels of blood fats improved.”
It doesn’t end there. From our fifties onwards, she says, good muscle health also helps to maintain bone density and prevent osteoporosis. In our seventies it protects against falls. Best of all, perhaps, it has a powerful anti-ageing effect on the way muscle tissue works above and beyond aesthetics.
The TV presenter Davina McCall, 55, has said that this is the reason why strength training is an important part of her routine. “Stronger bones and muscles will stop me falling and help me stay well for longer,” she said. “Strength training keeps my mind young too.”
McCall has said she has protein shakes to “ensure I can maintain muscle tone”. She has recently created a shake with Foodspring, a sports nutrition company, called Protein + Relax, which she says she has as an after-dinner treat.
“By eating dietary protein and doing resistance exercise in middle and old age you enable your body’s muscle tissue to act more like youthful muscle tissue of your twenties,” Lyon says. “It can have life-changing effects on homeostatic mechanisms that influence the brain, ageing, memory and longevity.”
Dr Gabrielle Lyon’s 8 rules to reboot your health
1. You are probably not eating enough protein
Current UK and USA government guidelines suggest that you need about 0.8g-1g of protein daily per kilogram of bodyweight, which equates to 50-63g, or 2-3 palm-sized portions, for an adult weighing 63kg (about 10st). But these are baseline recommendations set to prevent deficiency and maintain health. I’d argue strongly it is not enough. As we age our ability to digest and utilise protein decreases, meaning we need proportionately more of it in our diets to get the same results. Research from McMaster University in Ontario has shown that intakes of up to 1.6g per kg for an active person are needed to support muscle health from middle age onwards. The minimum I’d ever recommend is 100g of protein daily for men and women who are also doing some resistance training. To give you an idea of what this means, a skinless chicken breast contains 54g, a 145g can of tuna 40g, two eggs 14g, a 250g steak 62g, and beans, peas and lentils anything from 5-8g per 100g.
2. It’s not just how much, but the quality of protein that matters
Protein in food is the delivery system for the 20 amino acids that are needed to support the body’s physical structure. Of these, nine ar
e considered essential amino acids because the body cannot produce them itself and they must be obtained from food. Animal-derived protein is, by definition, better quality than plant-based protein in that it contains the highest quantities of these essential amino acids. That doesn’t mean you won’t get enough if you eat a vegetarian, vegan or plant-based diet, just that it requires more effort and planning, and you’d have to consume more protein in total to get what you need. You will almost certainly have to supplement with some extra protein sources, such as a vegan protein powder, if you don’t eat at least dairy and eggs.
3. Prioritise protein for breakfast
We come out of an overnight fast after sleeping in a catabolic state, meaning our body is preparing to break down nutrients for energy because our reserves are low. Our skeletal muscle is primed for stimulation first thing in the morning, and by frontloading with 30-50g of good-quality dietary protein in your first meal of the day, you will set off this important process. You begin to impact your body’s intricate machinery, priming it to boost muscle growth and repair, supporting other important processes. Because it fills you up, having protein for breakfast also offsets hunger later on and helps you to make better food choices all day. For breakfast I have 2 eggs, sometimes as a frittata, and some Greek yoghurt, which has 10g of protein per 100g serving. And you can add some nuts. There is 6g of protein in a handful of almonds. Sometimes I even have minced beef, which has up to 30g per 100g serving.
4. Midlifers need protein after a workout
Following a resistance workout with a protein shake or snack actually matters less for people in their twenties and thirties than it does for those aged 50-plus. Our ability to use amino acids is reduced from midlife onwards, but taking a 20g dose of protein — the amount of a couple of handfuls of nuts or a shake with 20g of whey protein, for example — when blood flow is increased after the intense muscle contractions of weight training enhances the uptake. Make it a habit if you are older or are starting with very low muscle mass.
5. Lifting weights three times a week is a non-negotiable after 40
Increasing your intake of protein will bring benefits to your health, but these are multiplied several fold when you add resistance training, which means performing high-tension muscle contractions against any external load. When you use resistance bands or lift weights you immediately help your body’s skeletal muscle to remove carbs from the bloodstream, protecting against conditions such as type 2 diabetes in the longer term. Weights help to ramp up muscle-protein synthesis and build new muscle tissue by using your body’s amino acid reserves for each muscle contraction. Start resistance training as early in life as you can — I get my kids, aged two and four, doing bodyweight exercises — but by your forties and fifties doing it at least three times a week is essential to maximise the breakdown and repair process that keeps muscles strong. It is also a powerful switch for changing body composition, and you will quickly feel and look leaner and stronger.
6. Gradually add more deadlifts and squats (and wear a weighted vest around the house)
Progression with strength and resistance training is critical. We have to keep getting better with it or we simply won’t shift that metabolic needle. Don’t ignore aerobic exercise, such as walking and running, which is very important for cardiovascular health, but focus on adding a few more repetitions of squats and deadlifts or lifting a slightly heavier weight every few weeks. You can add resistance work to your daily life in any number of ways — even by doing 30-60 seconds of squats as you stand at your desk. I like to wear a 5kg weighted vest around the house all day.
7. Eat a protein-rich meal four hours before bed
There’s a school of thought — and some research to back it up — that eating 30-40g of quality protein, such as that in a bowl of Greek yoghurt, before bed can help with overnight muscle protein synthesis as well as increasing metabolic rate. I tend to recommend eating a meal containing 30-50g protein — for example a chicken breast — 3-4 hours before you go to bed. Eating anything too late can interfere with sleep and the circadian rhythm, and having protein that bit earlier doesn’t make it any less effective at repairing and building muscles overnight.
8. Consider taking supplements
The foundation of healthy muscle is a healthy, protein-rich diet and resistance exercise. However, there are some supplements that can support your quest for better muscle health, and my favourite is Urolithin A, a natural gut microbiome-derived food metabolite that has been shown in published studies to affect the turnover of muscle mitochondria and boost muscle health. Last year a study in the journal Cell Reports Medicine showed that a supplement of Urolithin A improved muscle performance in middle-aged adults over four months, while another in the Journal of the American Medical Association showed that it boosted muscle endurance in older adults. I use Mitopure (60 softgels for £102; mitopure.com). If you do eat a diet without much red meat, I would recommend a supplement of creatine, especially from the age of 55 onwards, as it has a phenomenal effect on maintaining muscle mass in conjunction with weight training. Since there are vitamin D receptors in our muscles, everyone should take a supplement of this important vitamin, and there is emerging research that omega 3 fatty acids and fish oil supplements impact the muscle health of women more than men.
How to get the most out of your resistance training
by Dr Gabrielle Lyon
1. Select exercises you know how to properly execute. Correct form is the foremost priority with any exercise.
2. Create a balance between muscle groups and movement patterns. Train each specific muscle group three to five times a week with 48 to 72 hours of recovery time in between.
3. Think of ways you can make your exercise selection more challenging once you’re ready to progress. Adding more load (weight)? Increasing time under tension?
4. Your performance will reflect the quality of your sleep and nutrition. Keep recovery as a high priority or your training will suffer.
5. For a higher payoff, do conditioning and interval sessions as a separate morning session, then complete a resistance training session approximately six to eight hours later. Research suggests that back-to-back strength and endurance sessions are less effective because of insufficient recovery time to achieve maximal benefit.
6. This type of scheduling is an ideal, not a requirement. Most important is that you get the sessions done.
How to plan a resistance programme
Remember that your body is three-dimensional. This may sound obvious, but too often I see people working out who seem to have forgotten that their bodies can move in ways other than forward and backward (referred to as the sagittal plane of movement). Our bodies also have the capacity to move laterally (side to side) and to rotate. A well-rounded programme requires balance between muscle groups and incorporates all our movement patterns. Your workout also needs to balance pulling motions (eg, a row, bicep curl, lat pull-down) with pushing motions (eg, push-up, chest press, overhead press). Leg exercises occupy their own category, beyond push or pull, because most incorporate both the anterior (front) and posterior (back) muscles synergistically, unless specific muscles are isolated on a machine.
Balancing your workouts among the push, pull and leg categories will also help to reduce feeling overwhelmed by deciding which combinations of exercise to choose. Next, it’s time to tie in planes of motion. For example, a chest press is like an overhead press in terms of mechanics, but the movement takes place in a different plane of motion. The muscle groups targeted in each of those exercises are different due to the positioning of the weights in space.
Perform the most important exercises first, when you have the most energy, mental focus and time. Prioritising which movements you execute at your peak will bring you that much closer to achieving your goal. If your workout ends up getting cut short, at least you will have consistently executed your workout’s primary objective.
Exercise starts in the brain
You can use physical training not only to enhance your strength but also to sharpen your attention skills. Several studies show that muscle improvement increases when we visualise the target muscle and consciously direct activity and concentration there during exercise performance. For example, in a bicep curl, focus your attention on the squeeze in the bicep at the top of every rep. Every exercise requires a mind-muscle connection.
Your intention is key. Directed attention correlates with increased activation, possibly reducing contribution from other muscles. Before you begin your workout, silence your phone and get your mind in the zone. Ignoring the ping of texts and alerts will help you to focus on the muscle you’re targeting in each exercise. Over the long term, this approach can improve your training, both mentally and physically.
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