Episode 4

Published on:

12th Jul 2022

Protein Truths and Myths: Does it Cause Cancer and Aging | Stu Phillips

Stuart Phillips is a Tier 1 Canada Research Chair in Skeletal Muscle Health. He is also the Director of the McMaster University Physical Activity Centre of Excellence. Dr. Phillips has authored more than 350 research papers. In 2018-21 he was named to Clarivate’s Highly Cited Researchers list as a being in the top 1% of all cited researchers in nutrition and physiology research. Dr. Phillips is a fellow of the American College of Sports Medicine and the Canadian Academy of Health Sciences.

In this episode we discuss:

•   Do higher protein diets cause cancer?

•   How the food industry pushes flavor instead of nutrients

•   The surprising data about Omega-3 supplementation

•   The importance of protein in aging


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Mentioned in this episode:

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Dr Lyon: Dr Stu Phillips. Now you are, I would argue, world renowned professor and tier one Canadian we won't hold that against you research chair, department of kinesiology, director of physical activity center for excellence at pace. And you're a full professor at McMaster university. Did I miss anything?

Stu Phillips: And the father of three boys.

Stu Phillips: Yeah. Thanks for having me on the show. It's a real pleasure.

Dr Lyon: Are you kidding? We've how many years have we known each other? So we met through Dr. Donald Layman. It's yeah, how many years ago?

Stu Phillips: I don't even wanna, so COVID warped time a little bit, but it's at least 10 years.

Dr Lyon: Yeah. Okay. Wow. Yeah. Botox is working well. Yeah, hopefully, ... I'm not talking about, I'm not talking about yours now. I am so excited to have you on. And for reasons that I believe are incredibly important to the listener. You are a voice of reason in this space.

Dr Lyon: I am a bit biased because I've been following your work for over a decade now, actually, as you know, Don Layman is my longtime mentor and obviously you guys are very good friends and have collaborated on many papers and letters to the editor.

Stu Phillips: yeah. Yeah. He's a great guy. Love, I love, I run into Don all over the world we've met in Chicago to New Zealand, to you name it places in the middle and far east.

Stu Phillips: And I'm "Hey Don, how are you doing?" In fact, I rarely see him in the United States, so it's, but it's always a pleasure.

Dr Lyon: Well, it is you know, I just wanna thank you for all the pivotal work you've done and we're just gonna start. So my question to you is what is muscle's role in health?

Stu Phillips: Yeah. Yeah. Lot to unpack there.

Stu Phillips: I mean, I think the most easy one that everybody can point to is if you don't have enough muscle mass or it's not working quite right, then obviously you can't move around. So mobility would be the key one. But I think, and my former mentor, Bob Wolf wrote a really cool paper, well, it must be pushing 15 years ago now, the underappreciated role of muscles.

Stu Phillips: So, when you distill resting metabolic rate down to the two tissues that really contribute to it, it's your liver. Although it's pretty small, it's very metabolically active and your muscle, because of its mass. And it's not as metabolically active, particularly if it's sedentary, but the more active you are, then it's a big contributor to your resting metabolic rate.

Stu Phillips: So huge determinant of whether you're gonna gain or lose fat, as you, as you age and depending on what you do. And then I think the last one that probably most people have a sense of is that the largest site of post meal disposal of glucose is in muscle. So it's the sink, if you like for post meal glucose.

Stu Phillips: So when you have a high, what we call high metabolic activity, high quality of muscle then really you've got a great place to put blood glucose. And so your blood glucose regulation is a little bit tighter.

Dr Lyon: So basically we were talking about the importance of the, I think that everybody talks about obesity and adipose tissue as their focal point, and that's a very fat phobic conversation.

Dr Lyon: And what you've done a fantastic job of is really focusing on muscle and muscle is this organ of longevity and muscle as the pinnacle and not kind of a peripheral tissue. And that's, that's really what I was asking was the, where do you see muscles role in health? And I know that you answer these questions all the time on a million different podcasts, but you know, I think you have a very unique perspective.

Stu Phillips: Yeah. I think, everybody recognizes, if you don't have enough muscle or it's not good quality muscle, you can't generate enough force, then mobility is gonna be affected and, as soon as human beings become immobile or less mobile, then their quality of life declines quite sharply. So I think that's the one that most people can point to, but obviously it has a key role in resting metabolic rate.

Stu Phillips: It's the one organ outside of liver, which is, although it's small, it's very metabolically active. Your muscle's not as metabolically active, but if you exercise, there's a lot of it. So I think that's a key one. And after you've consumed a meal, the largest site of postprandial or post meal storage of blood glucose or blood sugar is muscle.

Stu Phillips: So, if you don't have enough and it's not a particularly, high metabolic activity tissue, so in other words, you've been sedentary then you, you're gonna have a hard time controlling blood sugar. So, muscle plays a lot of other roles that I think people are probably not aware of, but you know, certainly, as we get older, we get weaker and that's primarily where people focus. Well you know, I'm fighting the fight, but you know, eventually aging catches up.

Stu Phillips: The idea is to, slow the decline, which is I'm definitely on the downward side of the curve.

Dr Lyon: So no, not you look great for 29. Really?

Stu Phillips: Thank you. No, yeah. 29 is a distant memory, but those were good days.

Dr Lyon: You mentioned something that is really important. And you mentioned the older adult and will define older right in the literature is really 65 and up.

this paper, I think this was:

Dr Lyon: Do you remember this paper?

Stu Phillips: I do very well.

Dr Lyon: And I just wanna state some of the things. That really were quite shocking for myself. And I think the media truly took this to a whole nother level based on, on this paper, which I certainly appreciate when someone publishes paper that a lot of work goes into it.

Dr Lyon: And basically it said that those in the highest protein intake group had a marked 74% increase in their relative risk of all cause mortality. And they went on to say and were more than four times as likely to die of cancer when compared to those in the low intake group. Curious as to what your thoughts are on that.

Dr Lyon: Which I know,

elatively new journal, but in:

Stu Phillips: And so this paper came out Valter Longo was one of the authors on there as well. And Morgan Levine was the first author. You know, let me say right off the bat you know, Dr. Longo and I probably are at odds on protein requirements. He's definitely a low protein guy. I'm a higher protein guy. His work that contributed in that paper is a lot of, transgenic animal work. Growth hormone receptor knockouts, these sorts of things.

Stu Phillips: It's incredible science. I, you know, lots of respect for his work and, and everything else like that. The work that I think that people took away from it. And that was really the headline of the message in the press was around the. Analysis of the NHANES data that was and that I understand is, was the domain of Morgan Levine.

Stu Phillips: And she I, you know, in my sense I think if you had taken those data and had them sent to a nutrition journal and reviewed there they wouldn't have passed the bar. So, what I'm saying is that at cell metabolism, I don't think the right reviewers got a hold of the NHANES data, which is the relative risks that we're talking about and people to adequately review the paper and we have some data that we're trying desperately to get published that actually completely refutes that analysis.

Stu Phillips: And we use a full and robust data set. It's not the small number of individuals that were used in that trial. I hasten to add that when somebody talks about four times more cancer that's on par with smoking and, smoking is generally sort of seven times, which is, it's, if there's one thing you'd never want to do is take up smoking.

Stu Phillips: But so non-smokers versus smokers seven times the risk of lung cancer. And everybody would be like, duh, I get that. But when you say cancer risk is four times greater in one group versus another you know, it's more than half the effect of smoking. That is a huge effect.

Stu Phillips: And so. Really the effect in that paper is an artifact of the very small numbers of people they had that actually had cancer and died from cancer. And so, once you get down to small numbers, like a few sort of blips here and there make big differences. And so relative risks in that sense are, huge.

e a promise. It'll get out in:

Stu Phillips: You'll see that it's, there's no increase in cancer risk with higher versus lower protein intakes, and not even any change in, in the hormone that's supposed to drive all of this, which is IGF-1.

Dr Lyon: IGF-1. Yeah. Basically what I'm hearing you say is there's a lot of mechanistic data that was utilized in this paper with in combination, which with the NHANES dataset, which is a very large database and can be chosen and certain individuals can be chosen certain data sets.

Dr Lyon: And it seems like it was very, I don't wanna say manufactured, but the end result, I, I hesitate to say that,

Stu Phillips: Yeah it's not, wasn't manufactured, but it's a small data set. It's a fraction of the data that's available for the data set that they actually used. And they,

Dr Lyon: why do you think that, why do you think that was done that way?

Stu Phillips: I have no idea. I mean again, if you took those data out of that paper, and submitted them to any decent nutrition journal worth its salt it wouldn't have been published. So I just think that the people at cell metabolism who got their hands on that paper looked exclusively or almost exclusively at the molecular data.

Stu Phillips: And it's, it's astonishing. It's very, very good. And, Valter Longo tells a great story about a particular type of individuals who have a form of dwarfism who lack of growth, hormone receptor, who have no cancer. And that's an astonishing finding and it's a genetic obviously mutation that results in people who are short in stature, but it certainly indicates that these growth factors do play a role in the development of cancer, the NHANES data that accompanied that analysis, it was in my opinion, very poorly done.

Stu Phillips: And, our hope is is to rebut that with our own analysis of of NHANES data with a much more robust sample size.

Dr Lyon: Do you feel that this has been misinterpreted by the scientific community?

Stu Phillips: I, it was definitely miss..

Dr Lyon: Am I putting you on the spot?

Stu Phillips: Yeah, I think it was definitely misinterpreted by the press.

Stu Phillips: The British press is great for this stuff. They have they love tabloid splashy headlines, and, it was like, eat a bacon sandwich, the equivalent of, smoking a pack of cigarettes or something. Let let's just say, is that paper planted the seed for a lot of other protein restriction work

Stu Phillips: that's subsequently gone on that I still think is grossly over interpreted in the in, in the lens of human health as to what it means. So, you know, there's a law, it's an Italian, I think he was a computer programmer Bordelini or somebody who said, once something's out there, what it takes to displace it is 10 times greater.

Stu Phillips: There's probably a few words I shouldn't say on your show, but let's just say, is that the more BS that's out there, the more BS, like it takes a lot of work to, to shovel up the BS that's out there. So, it's gonna take a lot of work to undo, like it took, to undo, protein

Stu Phillips: causes kidney disease, kidney failure. You know, that's not true. It doesn't make your bone soft either, et cetera, et cetera. But, but it's been around for so long now. It's beginning to become part of the lexicon of how we should prescribe dietary protein for for individuals. And even that paper I hasten to add showed that higher protein was better for older people.

Stu Phillips: So, chalk one up for the older people need more protein side of the equation. Absolutely I'll take that one away.

Dr Lyon: what do you think the unintended consequences of a publication like this are to the older population?

Stu Phillips: Yeah it's hard to say you know the paper is a scientific publication and I suppose it depends on the degree of knowledge translation that happens as a result. And, you know, I'm always cognizant of our work and the effects that it can have the knock on when it's published, people read it, people pay attention, practitioners do change practice. I have, I understand not everybody follows the literature. So sometimes it takes longer.

Stu Phillips: It, maybe it makes it into clinical practice guidelines or maybe it doesn't, but certainly it it stirred up in enough of a controversy in the area to begin to question a lot of the, higher protein recommendations and all of a sudden it wasn't protein makes your bone soft and causes your kidney to fail.

Stu Phillips: It was and gives you cancer. And there's a Joe Jackson song and. Maybe you know it, maybe you don't, but he has a little, well,

Dr Lyon: you sing it, you should sing it for us.

Stu Phillips: It's, everything gives you a cancer it's set to a kind of jazzy, piano beat and it's true, right?

doing a sabbatical there in,:

Stu Phillips: I was like, holy smokes. You know, like it's, the kids are reading it. They're like, dad, it says cancer. I'm like, we we're good. You know, let's, let's hop in the swimming pool, you know? So I think the tempered message is that. Four times the risk that's diabolical and, even the most reasonable scientist would have to look at that and think, that has to be a statistical, fluke right there.

Stu Phillips: It's created by a small number and if you look at the absolute numbers it's really, about the difference of about five people,

Dr Lyon: right? And you make a really good point, the relative risk versus the absolute risk. And oftentimes relative risk is used to make numbers seem much more robust.

Stu Phillips: Yeah. Well, if you have one person die in this group and four people over here, there's four times more and it seems like a big deal, but it's the absolute difference is three people. So, that's, that's the simple hand math, but people get the point, I think. And we need to talk about absolute risk in some cases and and their data in that paper There's some problems.

Dr Lyon: So do you believe that higher protein diets cause cancer?

Stu Phillips: No. In a word.

Stu Phillips: Now I need to back that up and I'm telling you, the data will come. The paper will come out there and, finally I'll say, there you go, take a read of that and, put that in your NHANES pipe and, you know, have a smoke of that because it, really like it's done by in collaboration with people who work with NHANES data all the time.

Stu Phillips: And and the reality is that there's no relationship between dietary protein intake and cancer or IGF-1, even. And even the relationship between IGF-1 and cancer is not particularly strong when you look across the human epidemiological observational data. So....

Dr Lyon: also true, also true this I think that that's very illuminating for a lot of people because as you know, having,

Stu Phillips: I'd better back it up now with that paper, huh?

Dr Lyon: Yeah.

Dr Lyon: That paper better be coming in hot Stu coming in hot

Stu Phillips: it's, you know, reviewers willing it's out there. I feel like it's actually been rejected from a few journals now, is that enough people have seen it as reviewers that I can call it almost in press, it's, it's been rejected from that, that many journals.

Stu Phillips: So, which is probably where the... I think people are are inherently mistrustful of NHANES self-report data. But it's, that was the key. That was the linchpin piece of data in this cell metabolism article that allowed people to beat the drum for protein causes cancer.

Stu Phillips: You know, and again, step back and take a look at the other studies where they've looked at this and it's nowhere near conclusive. So, it's sort of like the smoking gun analogy, like you just, waiting for the data. Exactly the same thing that happened after 50 years of the Brenner hypothesis, protein causes kidney failure.

Stu Phillips: You do a meta-analysis and we did one and a bunch of other groups, no relationship and people, oh, well, absence of evidence is an evidence of absence and I'm like, well, it's been 50 years guys. So where's where's the data like how long after the thesis comes out without data, do you say the thesis is wrong and people with established kidney disease failure, higher protein

Stu Phillips: probably not a good idea, but the causation part of it, no data.

Dr Lyon: Are you ready for my non-scientific question?

Stu Phillips: Go for it. Yeah. Okay. Go.

Dr Lyon: why do you think there's such disparity in terms of the anti? I don't wanna say anti animal narrative, but essentially that's really what I'm seeing. Why do you think that is happening from just a personal standpoint?

Dr Lyon: I have, I have not. In the last 10 years, I have seen more push to increase plant-based nutrition. Not saying that is bad. But you cannot discount that quality of protein matters. You cannot discount. I'm a geriatrician by training. I was in Sam Klein's lab at WashU and you know, part of my responsibilities are taking care of yeah.

Stu Phillips: Great guy, he is. He's an awesome guy.

Dr Lyon: Yeah. yes. And part of my responsibility was taking care of geriatric patients and no clinician would ever say go low protein. And I'm just curious. So back to my personal question is why do you think that we are seeing this?

Stu Phillips: Yeah. Like great question. Again, another one with a lot to unpack and, you know, again hand on my heart, I have to tell you like I live in Canada, our food guide now is very plant focused. There was a heavy and I mean, heavy lobby to in the last round of revisions when our food guide was revised to block eliminate, discount, any research that was deemed to be industry either funded or influenced in any of the the derivation of the food guide.

Stu Phillips: And there's a very heavy plant based focus to it. I think if you're a young, healthy person eating plant's not an issue. I think particularly these days with the increased choices of plant-based foods, many of which people say, oh, look, beyond meat it's plant-based.

Stu Phillips: And I say, yes it's processed plant-based food but it's, plant-based no question. You know, 10 years ago that didn't exist. So, you know, and 20 years ago on, in the early days of Don and I appearing on the protein road show together as we did, it was just soy. All we talked about was soy because that was really it.

Stu Phillips: And so, but now there's soy, there's pea. There's hemp, there's rice. There's, you, you name it just about every plant that we once thought, there's no protein in that people are able to extract protein or process the plant to some degree that makes the protein a little bit more bioavailable.

Stu Phillips: So now the choices are many. So I think that there's probably two pressures that have led to this first. There has to be an economic pressure or people wouldn't do this. There's no reason to look for plant protein, unless there's an economic pressure. And I think we all realize that the cost of animal protein is going up.

Stu Phillips: The cost of food is going up but just about everywhere and particularly during the pandemic, when I was the designated grocery guy and I did all the cooking and everything for everybody in the house.

Dr Lyon: How much weight did your family lose on that?

Stu Phillips: Yeah. Yeah, no, they I actually, I rediscovered during the pandemic, my love of cooking I, and I real I really do enjoy it.

Stu Phillips: I think people are in the house are happy for the most part . But you know, in seriousness, like I was looking at the cost of things. I was like, this is crazy. It's it, I, my wife and I have great jobs we're, we're doing well, but I can't imagine if you're on lower incomes, what it must be doing to look at some of these things.

Stu Phillips: So let's just say economics is the other one. And at the same time, a very concerted move by you know, people at EAT-Lancet and, you know, the cast that I'm

Stu Phillips: talking about,

Dr Lyon: I do. Can you just, for the listener, can you. Let them know who that, that crew is.

Stu Phillips: Well, I mean , yeah, so I mean, EAT-Lancet is a consortium of, uh, scientists and nutritionist and environmentalists who are really saying that, the key to planetary survival, is plant-based eating and that animal based eating is ravaging the environment.

Stu Phillips: And so methane gas production because of, you know, all kinds of livestock is causing greenhouse gas to go up, et cetera, et cetera. And, so I don't know anything about the accounting of greenhouse gases. So I'll just say that right off the bat. But I have had the pleasure of sitting in on a few discussions to look at those arguments and, through a simple slip of a decimal point, you can change it from mega to giga tons of greenhouse gas. And, I don't even know what a giga ton is, but I know it's more than a mega ton, 10 to the third more. And so it's almost like economic math, right? It's let's assume we, we do this in everything. And I don't think anybody would dispute that there are some environmental consequences we need to be cognizant of.

Stu Phillips: I don't know that I buy the argument that it's a switch to plant-based eating that is the solution. It may be part of the solution. And we, I think we can all agree. It's okay. We could eat a few more plants, but when it comes to, is it gonna solve the problem? I think there's more and bigger things that we need to tackle. Industry emissions, car emissions, and everything by far a much greater concern from an environmental standpoint, hands down you know, bringing it all back to, yeah.

Stu Phillips: Well, bringing it back to what we were talking about though. For an older person and this I share your concern here. I think that it's possible as an older person with very judicious choices in food to be plant-based, but I stress the very judicious part and it's not easy, and a lot of plant based, I know I'm gonna upset plant based because they gotta go, oh, my grandmother she finds it easy.

Stu Phillips: And I'm like, because she spent, X number of years doing it. But if you're gonna make this switch, it's tough. Now there's probably a generation of people that are gonna grow up. I think it's fair to say, my sons will eat less meat than I will, and their sons will eat less meat than theirs, so will it go down to zero and will it save the planet as a result?

Stu Phillips: I'm less convinced, but you're right. Protein quality as you get older becomes increasingly important and you're gonna have to stay tuned. It's gonna probably take us about a year and a half to two years. We're doing some work where we think we're gonna get a good answer to that question of whether it's important or not.

Dr Lyon: I think that can be very powerful. Do you have any concerns about, now when we are talking about going more plant-based in order to meet these protein needs, essentially we're talking about going to much more processed foods, and now we are not looking at the food matrix anymore. We are not looking at, for example, beef has bioavailable iron and B vitamins and zinc and selenium.

Dr Lyon: We're now looking at processed pea type and we don't even know what's in it, cuz I don't think we even know what that's gonna look like 10 years from now in terms of, it, it's not just pea there's all kinds of, with soy, we know there's isoflavanoids with pea we don't even really know what's in that.

Dr Lyon: I'm just curious if you have any concern about that kind of food choice, those kinds of food choices.

Stu Phillips: I think we've learned a lesson about processed foods. I think Kevin Hall has really taught us a very good lesson in terms of energy balance and about, carbs are bad, fat is bad, blah, blah, blah, blah, blah, and weight, and energy balance.

Stu Phillips: He did a great study, really elegant finding where he, basically gave people calorically matched diets, but one that was high in processed foods and, processed foods are generated by food companies. And, we see that the essentially, 800 new foods appear and it's not 800 new, milk or yogurt or eggs or beef, or, it's the middle aisles where the food blows up.

Stu Phillips: Right. So I, I think the key point is that anything, when you process it and you add salt to it, you add some flavor to it that makes it in the food manufacturer, lexicon it's moreish in your mouth. So you go that's good. Then you tend to eat more. Is that a bad thing? It is if you're not getting the nutrients that go along with the food itself.

Stu Phillips: From my perspective, as you point out, I think quite correctly, and we've done this analysis, is that animal based foods are nutrient dense. The more of them that you eat the, the better, the quality of your diet that, you eat dairy, you get calcium. If in north America, it's vitamin D fortified, you eat eggs, you get Leutine Biotin in that you don't get

Stu Phillips: in other foods, beef there's zinc, there's iron, et cetera. It's very nutrient dense.

Dr Lyon: What about creatine?

Stu Phillips: Yeah. Difficult to find those nutrients in other foods, for sure. Yeah.

Dr Lyon: You know, and I do have some concerns about in the next 10 years, what we are looking at in terms of osteoporosis.

Dr Lyon: I think that we are gonna see, I know that there are some bioavailable calcium, but it's very low spinach you're looking at maybe 5% compared to, to dairy. And I do have concerns about if we are going to see an epidemic of osteoporosis. How do you see, in terms of an older individual you've done a ton of work, right?

Dr Lyon: You, a lot of your research is based in older individuals, and I'm always curious in terms of anabolic resistance, individuals that are actually well trained older individuals. It seems as if the data doesn't necessarily take what we would think of as really well trained older athletes and seeing what does their muscle look like and how do they fit in into the research?

Dr Lyon: It's almost like we have a sedentary. You're laughing. We have a sedentary.

Stu Phillips: No, no. I'll, I'll tell you I'll tell you my story in a little bit. Go ahead. Yeah, no, you're right. I, people ask one of the key questions when I talk about, I show curves and they're population curves from, lots of different data sources and, muscle mass goes up it plateaus, and then it comes down and people say, so when does that start?

Stu Phillips: And I say, oh, like the downward stuff. And they say, yeah, like I can see on here. And I'm like it's, it's about 57 and they go 57? And I'm like, yeah, next year it's 58. And they go that's pretty specific. And I say it's just a personal observation, but... yes. So let's just say, if you look at the population curves and, interestingly enough, I was looking a few of these, like only in this morning.

Dr Lyon: So you knew I was gonna ask

Stu Phillips: some other work I was doing, I don't telepathic. Yeah. They tend to bend, around your forties, you begin to see that inflection and that, that curve comes down in our hands we think you can find people in their thirties where you already muscle mass is going down, like you, you go up and into your teens and your twenties and you're almost anabolic into your mid twenties.

Stu Phillips: Don would he goes, I think even later, and I'm like, okay, if you're active, I would probably agree. And you know, if you lift and do everything, you can still put the muscle on. If you know, not atypically, you take a sedentary job. You begin to eat the business lunches. You don't hang out with your friends and shoot baskets on Fridays or play hockey on Mondays or whatever it is.

Stu Phillips: And all of a sudden you're living, the, you spend the de facto state in your day, is sitting down in front of a computer screen. And all of a sudden you step on the scale. You're like, whoa, like what just happened? You know, so I think in those scenarios, you can find those individuals who are losing muscle mass and gaining fat mass on the other hand, we've come across individuals when we've recruited for some of these trials.

Stu Phillips: Like these older individuals, we put a pedometer on them and they're doing 22,000 steps, and that's incredible. And a lot of people say, oh, I've got, I've got five dogs. I do this, I do that. I go to the gym, I swim, I do everything. And in those people I think that they, they're hanging on to muscle you know, for dear life.

Stu Phillips: So are they on the downward slope? Probably. But it's definitely not that, they're not bending down like this. They're basically coming down in a very, very slow fashion. And the idea of course, is to preserve that as long as you can, because at some point if there is a threshold, let's say there is, we always sort of say below this threshold, what I don't know is the threshold per se, but at a certain point you become weaker.

Stu Phillips: It's harder to do things and your risk for disability, diabetes, obesity, cardiovascular disease, and everything goes up. So, and I think it's all sort of tied into as you said, muscle is, in my world, muscle's always in the middle, but I think it's particularly important.

Dr Lyon: That is, it's really interesting.

Dr Lyon: Because you're talking about it in terms of population, I think how, in my mind, I wonder do we, are we looking at kind of sick models, right? The, because we don't act, do we know what it would look like when individuals were moving the way in, which would be, I don't wanna say ideal, but really for optimal health, right?

Dr Lyon: Cuz we are so sedentary as humans. I mean, the anabolic resistance, all the aging studies are really, we say that they're sedentary, but sedentary is almost a sick model. I'm just curious as

Dr Lyon: to...

Stu Phillips: it is, it's a sick model. And look, look, we've done some work where we took older people who were, ostensibly healthy.

Stu Phillips: They're not on beta blockers. They're not taking statins. They're in good health, right? And for two weeks we say, here's a pedometer. You can take no more than a thousand steps per day. And everybody goes, that's diabolical. And I'm like, well, that's a hospital patient. That's what a hospital patient takes about 700 steps per day.

Stu Phillips: And they lay in bed or they sit in a chair and these are healthy people. So these are not even sick people in a hospital. And in two weeks they get weaker. They lose muscle mass. They become mildly diabetic. And the worst part is. Like this actually surprised us. We took the pedometer off and said, okay, go back, go and do the stuff you've done before.

Stu Phillips: And two weeks later they weren't better. So you know, this downward trajectory and, and you know, Doug Patton Jones, good friend of both Don and I sadly passed away really early in his life last year was the, he coined the term catabolic crisis. So you're doing this. You have a hospitalization, you lose muscle mass, like crazy.

Stu Phillips: And if you're a young person, you do that and you come back. If you're an older person, you come down and now you just continue on a trajectory. So you've hopped from one curve to a whole new family of curves, much, much below. And those disuse events are massive watershed moments. Now, if you're a robust, healthy, older, active person and have one of.

Stu Phillips: Still not good, but you'll weather it a whole lot better than somebody who's not. And that, those moments, I think like the pandemic highlighted just how important they were. Are really the differentiator between true successful aging. If everybody just followed the curve and went down, I think we'd be okay if you're doing this

Stu Phillips: and you have one of those disuse events it's hard to bounce back from, for sure.

Dr Lyon: In terms of disuse, do you think protein restriction would have close to the same impact or in, you know, in terms of weighing out in term for muscle health. So disuse protein restriction.

Stu Phillips: Absolutely.

Stu Phillips: Yeah. I mean, you know, the we've tried a number of strategies to out-nutrition disuse. It's very difficult. So the only thing you can do is really get protein up. You can give people lots of omega-3 fatty acids, and that helps but the truth is, if you're on a low protein diet coming in and so you're hovering around and you're doing this, and then you have a disuse event.

Stu Phillips: You're gonna tip over into that. So, I recently had an interesting conversation with an individual who followed a very low protein diet. He came off his bike and he was, you know, he was okay, but he took a while to sort of recover and rehabilitate. And he said on the backside of that, the recovery trajectory, he said I think I did myself a disservice by being on that low protein diet. And you know, he had listened to the, protein restriction extends longevity and et cetera,

Stu Phillips: et cetera,

Dr Lyon: which is not actually in humans. So that's only

Stu Phillips: No data in humans. And, and even, even there's no data in primates for that matter. So, and even the data on caloric restriction in primates is conflicting. So, kind of glaze over that but I, you know,

Dr Lyon: Not for long I'm coming for you. Next one. We're gonna talk about it now.

Stu Phillips: I know it's yeah. So I think the main point is, to say there, there's probably like there's simplicity in remain active, eat nutrient dance foods. Higher protein, I think is a, is a good part of it. Keep your brain sharp. Definitely. And particularly if you're at risk for dementia, Alzheimer's what you know is higher.

Stu Phillips: And have a good circle of friends and or whatever you wanna call purpose something in your life. If it's your church. I don't care what it is. If it's volunteering, if it's, something and you age well, and then people go, oh, but we could restrict protein. We could give you. And there's lots of sort of things that they throw in there.

Stu Phillips: And I'm like, yeah they might work, but I've got a lot of water squeezed out of the cloth with, be active eat right.

Dr Lyon: Yeah. And I would even go on the record of saying that for an older individual and aging, low protein is bad advice. I believe it's bad advice.

Dr Lyon: You mentioned omega-3 fatty acids. I'm really glad you did because there's a lot of stuff in the literature and I'm just not sure the mechanism of action as it relates to muscle health. I would love to hear from your perspective.

Stu Phillips: I wish I knew I, I I'll be honest. I had a postdoc he's left now.

Stu Phillips: He's actually got a faculty position of his own named Chris McGorry. He, he brought that concept into the lab. He was with us for almost five years. It was a great five years and he really changed my learning on omega-3 fatty acids. I was impressed by what they did. They improved mitochondrial function.

Stu Phillips: They helped the muscle resist against, so you lose less muscle. If you've got more omega-3s on board, we should,

Dr Lyon: Do we know why do we know?

Stu Phillips: It's we think it's related to mitochondrial function. So if you can prop up mitochondria, which obviously tank when you go into a disuse situation, we think that's part of it.

Stu Phillips: Now it's either signaling through that or it's preservation of their ability to produce energy. So I, stay tuned Chris will answer that question before, before I will, he left and I'm like, you gotta do that omega-3 stuff because I'm not gonna do it. But real it's rare in science to be surprised.

Stu Phillips: I like to say that but I've been pleasantly and sometimes not so pleasantly surprised with the effects that we saw on omega-3 particularly in a disuse scenario, when I saw it, I was like, wow. Okay. That's, that's interesting because I didn't expect for it to be as protective as it was appears.

Stu Phillips: The dose is pretty high. The dose is pretty high about, about a gram and a half of EPA and DHA a day. So it's, it's high dose and I hasten to add high quality stuff too. So it was tested for oxidized status and everything else like that.

Stu Phillips: So I don't know that you can you have to take a lot of pills if you were doing this, but for reasons we don't fully understand chalk this one up, it works better in women. And I don't know why, like it works. We showed it in young women and there's an abundance, a growing abundance of data in older women showing enhanced effects with resistance training.

Stu Phillips: And it doesn't tend to work as well in, in older men. So, and I have no clue there. I absolutely no clue. So, you know, incredible. It's been around for all this time. It was cardiovascular and heart health and everything. And now we're saying actually it's pretty important in muscle function as well.

Dr Lyon: That's really interesting. Any other supplements that you utilize that you've seen be protective in muscle regardless of their age?

Dr Lyon: Did you read about that this time?

Stu Phillips: I have a short supplement shelf. Yeah. Yeah, no, I didn't. I have a short supplement shelf.

Stu Phillips: It's got omega-3s on it. It's got creatine on it. And it's got vitamin D. And really after that, I think, you can sort of play around with a few others, but from my standpoint those are the ones that if I, somebody were to say to me, as I get older, what should I take? And they go creatine isn't that, is that gonna mess up your kidneys? And I'm like no, no, no. It's been around for 40 years. There's been no epidemic of kidney failure in people who use creatine. I think the really impressive part for me now coming out is showing the impact that it has on cognitive function and on brain function.

Stu Phillips: So another sort of spillover effect from it's not just muscle it's how it preserves my brain function as well. So, I'm privileged to run a center community access center, pace. You mentioned, average age of the people that come in there is about 73 there is about 500 of them. They're awesome people.

Stu Phillips: And what they tell me, the two things that they're concerned about one is losing their mobility and the other one is not being able to be cognitively intact. So we tell them frequently that the exercise that they're doing is not only great for their muscles, their cognitive abilities are better preserved as well.

Stu Phillips: We have sessions on, how to keep your brain active, what it is, what it takes to keep your brain healthy from a nutritional standpoint, which is a growing body of literature. So it's it's cool to see the effect that, creatine has for sure.

Dr Lyon: Yeah. It's really interesting. When you had mentioned I think it's amazing that you're doing this work with older adults.

Dr Lyon: Obviously because I'm a geriatrician by training and it's very important. I wish that we could have gotten to these groups earlier. Really. You had mentioned that in their thirties, we're seeing muscular changes, whether it's skeletal muscle, insulin resistance, whether it's changes in the tissue, infiltration of fat and just a lot of disuse. In your research are you looking at, or are there ways in which you're measuring muscle health? Are you guys doing biopsies? Are you using ultrasound? What do you guys do?

Stu Phillips: I agree. A hundred percent. I think you're, it is, it's the analogy is the ounce of prevention is worth a pound of cure.

Stu Phillips: So, you know, don't wait until you're 60 or 70 and the health crisis happens and you think, oh, I need to pick myself up from that. Yeah. When does aging start? From day one. But you know, for our teen years and into our twenties, we're on our way up. And everybody's Bulletproof as my three sons constantly remind me,

Dr Lyon: I mean, listen, they're not wrong.

Stu Phillips: no, no, no. They're in great that... watching them eat is actually like, I have to stand back. Like I can't even, I can't put my fingers on the table. It's like, it's a, yeah.

Dr Lyon: I will tell you that my husband walked in and he went for a corn dog, so I made corn dogs for the kids and there was this beautiful roast chicken comes in.

Dr Lyon: He's like pounding the corn dogs. anyway.

Stu Phillips: These boys they would go for the corn dogs too, but then they would eat the chicken as well. So, like if I don't get in there, I don't get any food. It is incredible to watch these kids metabolize food, no question.

Stu Phillips: You know, one of the things, like I said, when, and then you get into your thirties you've kind of plateaued. There's no more, unless you're doing something it, I think people can start to go downhill. So it's really about trying to stay on that plateau. And it's a little bit like love the analogy and the work that's been done and the concept's been hammered home really well for osteoporosis.

Stu Phillips: So build your peak bone mass generally up to about 30 or so. Ride into if you're a woman menopause with the highest bone mass possible so that when you decline, because you're going to, you start at a higher level and everybody follows the same trajectory. So don't start down here, start here. And I think the story's the same with skeletal muscle fitness, like everything.

Stu Phillips: Even master athletes lose muscle, they get weaker, they, they lose their fitness. But the difference is, if you're up here versus here, then, it's, you've just got a bigger tank and a greater reserve to be resilient when these things, these disuse events or some of these things happen with aging.

Stu Phillips: So, you know, keep the event horizon in mind. That's long. People say, they say, why are you training now? I, I saw a great Twitter post. Lady said you know, she was in the gym and a 20 year old said why you, what are you training for? I see you in here all the time.

Stu Phillips: She says I'm training so that people like you don't have to pick me up when I fall over , and I mean, it's true, right? What am I training for? I don't compete in anything anymore. I'm just training to age well, to like to ride, the rest of my life out in as good, a health as possible.

Stu Phillips: So, you're right. Start early. Don't wait, when does sarcopenia start you know, I don't know but definitely you can push it back and hold it and keep it at bay. But even the biggest, strongest, most muscular guys and, and women age gets you. So it's much better to start up here and go down than it is to start here and go down high protein, high activity.

Stu Phillips: All those things.

Dr Lyon: I mean, nobody you're right. Nobody makes it out alive. That I'm 100% sure of this. No,

Stu Phillips: yeah. The rate of mortality holding constant at 1.0 Yeah. No, no, no. And that's so I say to the concept is I'm always impressed with longevity extending experiments.

Stu Phillips: And, but I do say to people, I have no interest in living to be 120 and feeling like I'm 120 so we're talking about, lifespan to some degree, but what we're really talking about is health span. So that compressed morbidity, so that at the end, you just, you go to sleep and that's the end of it.

Stu Phillips: And it, we have one guy and it's a guy which makes it impressive that at pace, John, and he's 104.

Dr Lyon: That's good genes. That's good genes.

Stu Phillips: Well, it's good genes. It's good living and everything. And I tell him, I say, you move like a 75 year old and he goes, ah, thanks. And he does he, the way he moves around, like he doesn't shuffle in like he steps and he refuses to take the bus and he walks like, he's just like in one day, I'm sure he'll go to bed and he just won't wake up and what a great way to live your life.

Dr Lyon: So, you know, I, I know that my I'm running outta time with you, which I'm super bummed about. I will, don't worry. I know where to find you. I see a lot of aging individuals and I think it's really interesting when individuals are younger, they're constantly striving to make strength improvements, whether it's a one rep max or it's an improving sprint time.

Dr Lyon: There's this crazy thing that seems to happen. I don't know if it's a mindset shift or a physiological shift, but. Somewhere along the line, there's less of a drive for improvement and it, I wonder, do you think individuals should strive to continuously improve and how can they do that?

Stu Phillips: Yeah. While I'm on the opposite side of that curve for me right at the start of the pandemic I said to my wife, like it was, this was in the grim early dark days.

Stu Phillips: Everything's closing down, that you couldn't find stuff on the street. And I said to her, I said, we need to buy a Peloton. And she said, oh, I thought you said those were too expensive. And I said, it is a lot of money, but I said, I think this is gonna be bad. And it was literally two weeks before, D-Day everything closed and we got our bike.

Stu Phillips: And if somebody had told me prior to the lock down. two years later, or two little more than two years, I'd have ridden on that thing 500 times, I'd have been like you're joking, but that's where I'm at. I can tell you that at the start of the pandemic, I could do a lot more work on the bike than I can now.

Stu Phillips: Not a lot, but it like it's, it takes a monumental effort to get to those levels. So I can I know I'm on the way down, so I'm not hitting a PR every time I don't lift anywhere near as heavy as I used to. If I do occasionally I go to the gym I get foolish. There's a young guy. He's got something on the bar and I'm like, Hey, can I walk?

Stu Phillips: Can I work in? He's like, sure. You want me to take anything off? I'm like, no, bro, I'm all good. Drop five squats. And then, and I said to my son, who's taking exercise science. And I said he, he asked me about muscle soreness and I said, have you heard about IONS instead of DOMS, like not delayed onset muscle soreness.

Stu Phillips: He said, no, what is that? I said, it's immediate onset muscle soreness. Like when your dad goes to the gym and thinks that he can squat like he did when he was 20. So it hurts. It hurts. And, and it's not really the soft tissue where it hurts. It hurts in your joints, like your, my hips, my knees, my shoulders, my elbows, so I think there's something that signals to your body. Well first, pain is a great feedback. I... no pain, no gain is a mantra that was great when I could recover and feel like I was fully recovered the next day, which I could probably into late into my thirties. Sometime in my forties, I found it was taking longer and longer and I was a fool, played things like rugby and ice hockey.

Stu Phillips: I remember one time, my wife coming in and looking at me I was on the, I was on the couch and I could barely move. And she said, baby, in one hand, little kid in the other, she goes, you're useless to me. And I was like, okay, maybe it's time to give that up. And you know it's inevitable.

Stu Phillips: I think it's the connective tissue that breaks down the most, tendons ligaments joints, the cartilage in there and it's accompanied with you know, a degree of pain that you're just like, eh, no pain. I still push myself. Absolutely. But it's a, it's a more intelligent way of training.

Stu Phillips: I train smarter. I train less I train a little bit less frequently, although I'm still trying to do something every day, but I'll take a day where it's not a, it's not a workout on the bike or it's not a run or it's not, lifting. A lot of which is only five feet away. It's a walk and I, I enjoy the sunshine and take a look and, or listen to a podcast.

Stu Phillips: It's a small menu of podcasts, Gabrielle but you're on there.

Dr Lyon: Oh, I'm on there. That's great.

Stu Phillips: That I listen to, you are. Yeah. Or a book or something and just you know or sometimes do nothing and just smell the flowers.

Dr Lyon: So that's interesting. It sounds like perhaps you've yeah, there's a bit of wisdom there.

Stu Phillips: Yeah. Almost although my wife would, might argue a little bit. That's what I think. I think that it's a degree of it's a, yeah, it's a degree of maturity or call it whatever you want. And the research has shifted too. So in 24 years, you could say the first 12 years, I spent a lot of time studying younger people, and now it's gradually shifted and it's become older people.

Stu Phillips: And, research becomes research. Like I'm looking for things that are relevant to me, but running pace and seeing people in their sixties, seventies, eighties, nineties, one guy in his one hundreds, I'm like, wow, like, what is it that makes these people tick? How do they, what do they find in their day?

Stu Phillips: Because they don't work anymore. That keeps them going. And they've got all got stories. They've all got things that. Brighten up their day. And, and so that has become an increasing part of my understanding of what it is to age well, it's physical, it's nutritional it's cognitive, it's mental, but it's spiritual, psychological.

Stu Phillips: I'm not sure which, but they all have a sense of purpose.

Dr Lyon: Really incredible. This is a perfect place to end. And Dr. Stu Phillips, I am so grateful to be able to have this conversation with you. And the work that you have put out in the world is going to leave a legacy truly impactful work.

Stu Phillips: Thanks. Those are generous words. I say this all the time and I'll say it here again. I'm really fortunate, blessed to have a great family to have a great job McMaster University's treated me very well. But the thing that's made it all, teamwork makes the dream work.

Stu Phillips: I have a great group of students. They do stuff, they do the work actually. And I just,

Dr Lyon: You just do the pelotons. We know how it goes.

Stu Phillips: Yeah. I, and it's the key is surrounding yourself with smart people. So, you know, kudos to them I bask in their reflected hard work. Those are, those are powerful words and they mean a lot, but I, I'm only part of the machine.

Stu Phillips: I got a lot of other people that help me.

Dr Lyon: That's very, very kind of you to say. And I know that your students appreciate it. Not saying that I Don did not put me... He puts no undergraduates on papers. Regardless of the work that they do. You probably don't either.

Stu Phillips: Don and I have a lot in common. I just want like, and I got a ton of respect for that guy. There's a guy who I think is aging pretty well.

Dr Lyon: He's doing amazing. Amazing.

Stu Phillips: Yeah. He challenge still challenges me even to this day. And I still enjoy my interactions with him. Great guy.

Dr Lyon: Well, you know, we'll put links to everything. I know that you're very active on Twitter.

Dr Lyon: I follow you. And it's very fun and somewhat entertaining. Also we'll put a link to your lab's page. They can find you on Instagram. And I also heard that you might be coming out with a TikTok. just kidding.

Stu Phillips: So my kids said, dad don't do TikTok. They, there were my youngest who's 17 said dad, old people spoil TikTok.

Dr Lyon: So we won't put a link to your non-existent TikTok, but I will,

Stu Phillips: THere will be no TikTok. No

Dr Lyon: Any, anything else that you'd like to say?

Stu Phillips: No, I just wanna say thanks for having me on the show. Honestly, these things are I know people say you, you do a lot of these and I'm like, these are the chance to translate the knowledge, to get it to people.

Stu Phillips: The type of knowledge that I generate, I work in a publicly funded institution. I'm a publicly funded employee because everything is state run in Canada. The knowledge should be the property of the people not just in my ivory tower at the university. So thank you very much for giving me the, the forum and the venue.

Stu Phillips: I appreciate it. And for asking, difficult questions, but also giving me the opportunity to get on my soapbox a little bit. I appreciate it.

Dr Lyon: Thank you so much. And we'll see more of you.

Stu Phillips: All right. Take care of Gabrielle.

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About the Podcast

The Dr. Gabrielle Lyon Show
The Dr. Gabrielle Lyon Show promotes a healthy world, and in order to have a healthy world, we must have transparent conversations. This show is dedicated to such conversations as the listener; your education, understanding, strength, and health are the primary focus. The goal of this show is to provide you with a framework for navigating the health and wellness space and, most importantly, being the champion of your own life. Guests include highly trustworthy professionals that bring both the art and science of wellness aspects that are both physical and mental. Dr. Gabrielle Lyon is a Washington University fellowship-trained physician who serves the innovators, mavericks, and leaders in their fields, as well as working closely with the Special Operations Military. She is the founder of the Institute of Muscle-Centric Medicine® and serves patients worldwide.