Resistance Training and Muscle Mass — The Key to Longevity (2024)

Muscle Mass Is a Key to Longevity 

Dr Gabrielle Lyon and Dr Joseph Mercola both strongly believe muscle-centric medicine is part of the solution for many chronic health problems, including obesity, yet very little attention is given to it.

muscle mass key to longevity


"Obesity, Alzheimer's diabetes and cardiovascular disease actually begin in skeletal muscle, years before they become apparent," she says. "Obesity, diabetes, these are diseases of skeletal muscle insulin resistance.

But what's so shocking is that everyone is focused, especially in the medical community, on attacking obesity, as opposed to fixing the underlying problem, which is really augmenting skeletal muscle and optimizing muscle with nutrition, which is primary, and training, secondary."

As explained by Lyon, while there's certainly benefit to cardiovascular exercise — mitochondrial biogenesis, for example — resistance training is far more foundational to your long-term health, because skeletal muscle is the organ of longevity. Muscle mass optimizes you for longevity.

The greater your muscle mass, the higher your survivability against all diseases, including cancer. According to Lyon, cachexia, for example — the loss of muscle mass — kills 1 in 5 cancer patients.

You need protein reserves to survive serious disease, and most of your protein is stored in muscle. If you have very little muscle, you're going to pass away prematurely because you have no amino acid reserves. Your muscle also interfaces with your immune system. 

"Listen, aging can be highly catabolic. There's this immunosenescence that happens. The body doesn't regulate the way that it used to. But moving and contracting skeletal muscle is the best defense that we have," Lyon says.

Muscle Is Your Metabolic Regulator

As explained by Lyon, muscle is the regulator of your metabolism, and here's why:

"Skeletal muscle is your primary site for glucose disposal — 80-some percent. Individuals who are struggling with elevated blood sugar, elevated glucose, elevated triglycerides, skeletal muscle is your primary site for disposal and utilization of these nutrients, these substrates. Having healthy skeletal muscle will manage that metabolic currency.

It's really interesting because, as we age, the health of muscle decreases [unless] we become extremely focused on stimulating muscle through diet — I think the diet is most important because it is accessible to everybody — [and] resistance training and cross training … [resulting] in states like diabetes, hypertension, cardiovascular disease. Insulin resistance actually begins in skeletal muscle."
The good news it's never too late to start building muscle, even if you're in your 70s or even 80s, using diet and exercise. It becomes more difficult to add muscle with advancing age, yes, but it's far from impossible. To prove it is possible, I'm 67, and over the past year, I've put on 25 pounds of muscle mass and now weigh over 200 pounds.

The Case for Animal Protein

In terms of diet, skeletal muscle requires high-quality dietary protein, ideally animal protein, to stimulate muscle protein synthesis. There's 20 amino acids and nine of them are essential, which means you have to get them from your diet, as your body cannot make them from other substrates. In particular, skeletal muscle requires branched-chain amino acids — leucine, isoleucine and valine.

Must you eat animal protein? No, but one of the problems with avoiding animal protein is that it is quite difficult to obtain enough complete essential amino acids, especially branched chained amino acids to stimulate mTOR.

While there are plants that are high in protein, they're not identical or even equivalent to animal protein in most cases. Certain micronutrients found in animal foods you simply cannot get from plants. This includes vitamin B 12, vitamin A (retinol not beta-carotene), creatine, bioavailable iron, carnitine and carnosine, all of which are important for muscle growth and health in general. Lyon comments: 

"I consider high-quality protein to be animal-based proteins. That's not to say, if you are an individual who is vegan or vegetarian, that you cannot get the same amount of protein. You can, but that would require additional supplementation …

But one has to understand that 30 grams of protein from hemp is different from 30 grams of protein from, say, a chicken breast. (NOTE: I don't advise anyone to eat chicken because of the high linoleic acid content).

In fact, as you age, it becomes really important to realize that, if you are going to try to get your protein from, say, quinoa — people say quinoa is high in protein — it would take 6 cups of quinoa to get the equivalent of one 3-ounce chicken breast.

So, if you are listening to this, I really want you to take to heart that you need to focus on high quality proteins, and if you are vegan or a vegetarian, that you need to then supplement with something — some branched-chain or essential amino acids — in addition to your meal."
On a side note, glutamine, a non-essential amino acid (meaning your body can generate it) is an important nutrient source for your immune cells, and the way your body generates glutamine is through muscle contraction. So, when you're contracting skeletal muscle, you're quite literally nourishing your immune system! 

Finding Your Ideal Protein Intake

To determine your personal protein requirement, Lyon recommends 1 gram of protein per pound of ideal body weight (the weight you would ideally be, not necessarily the weight you are now). Once you have that number, you can divide it by the number of meals you eat to get your per-meal quota which, for older adults should be around 30 to 50 grams per meal.

For reference, there's approximately 7 grams of protein in each ounce of steak, so a 5-ounce steak would give you 35 grams of high-quality protein. For children, the average amount per meal is around 5 to 10 grams, while young adults typically can get away with 20 grams per meal.

For most normal-weight adults, 30 grams per meal is really the minimum you need to stimulate muscle protein synthesis. If you have a robust strength training program, you may need to go even higher. To make sure you're getting enough protein in your meals, consider using a free nutritional tracker like Cronometer. That way, you're not guessing.

Will a High-Protein Diet Harm Your Kidneys? 

Some avoid protein for fear it might damage their kidneys. People with chronic renal failure do need to limit their protein intake so as not to tax their kidneys, but if your kidneys are healthy, you don't need to worry about this. Lyon explains: 

"I think the majority of individuals have healthy kidney function. Actually, protein intake has been shown to improve glomerular filtration rate, not have a negative impact. The body should be capable to manage high-quality protein without an issue, and there's been multiple meta analysis with individuals with healthy kidneys in terms of protein consumption. It's another falsehood.

The same thing with osteoporosis. People will say, 'You don't want to each too much protein because it's bad for your bones.' Well, what do people think bones are made of? Bones are made of proteins. Yes. They are made of calcium, but the requirement is through protein. [Editor's note: Protein is the matrix that holds the calcium]. So, that's another falsehood.

When I went through my geriatric training, it became so apparent that what we were seeing in clinic, and what we were doing to protect aging individuals was so vastly different than what was out in the public sphere.

It's interesting. Individuals can ride the wave of youth for only so long, and then what ultimately happens is, as you age, you have to get good information, because the wiggle room for mistakes and the wiggle room for actually executing important and correct information becomes less …

[Protein] is the one nutrient that will really be able to save people's lives. It is the pinnacle, because it protects skeletal muscle. Yes, carbohydrates have a protein sparing effect. Yes, you can do a ketogenic diet, and there may be protein sparing effects. But the question I would ask is why?

We know we need to prioritize protein because we have to optimize skeletal muscle. It is important for neurotransmitters. It is important for the immune system. It is important for regulation for mucin from gut lining. It is important for all things in the body, hands down, and it's essential.

Skeletal muscle goes through this process of anabolic resistance, and as we age, the efficiency [decreases]. Muscle is also a nutrient sensing organ. Its efficiency to utilize and sense protein decreases as we age."

Should You Work Out Fasted?

I believe time restricted eating (TRE) is best done 16 to 20 hours a day, every day. Sixteen to 18 hours is probably the sweet spot. This schedule will give you virtually all the same benefits as calorie restriction with respect to longevity benefits, but without any of the downsides, the primary one being compliance.

I prefer to do my workout in a fasted state, followed by an infrared sauna and swim, and then break my fast afterward. This will reduce the carbohydrate load in the muscles as they're using up glucose during the workout. This, in turn, gives you the additional benefits of autophagy.

Lyon also points out that when muscle contracts, it releases myokines, which play a role in both lipolysis (the breakdown of fat) and glucose utilization. When you train in a low-glycogen fasted state, myokine release is increased.

While we're on the topic of time-restricted eating, this will also help prevent excessive activation of the mechanistic (previously referred to as mammalian) target of rapamycin (mTOR). As explained by Lyon, mTOR is found in every tissue and responds to different nutrients and stimuli, including dietary protein, insulin, carbohydrates and exercise.

About five years ago, largely due to Dr. Ron Rosedale, co-founder of the Colorado Center for Metabolic Medicine, I was concerned about too much protein stimulating mTOR so I restricted my protein intake. However, mTOR is activated not only by protein but also by carbohydrates. A key misunderstanding about mTOR is that it's not protein that's the problem, or even carbs. You stimulate mTOR on a vegetarian diet as well.

The other more serious issue is that most people eat more or less continuously throughout each day, which will keep mTOR continuously activated. When you're eating all your meals within a window of, say, six to eight hours, and fasting for the remaining 16 to 18 hours, mTOR gets stimulated only once or twice a day, which is not a problem.

mTOR is best activated twice a day in a pulsatile fashion. When you activate it continuously as most people do, it can lead to an increase in risk in diseases like cancer.
 

Timing of Your Post-Workout Meal

As for the timing of your post-workout meal, Lyon disagrees with the common notion that protein feeding can occur any time after your workout as long as it's within 24 hours.

The current recommendation is very low for exercise. It's 150 minutes per week … I would say that's probably the bare minimum that anybody should do, not the optimal; 30 minutes of moderate intensity exercise, five days a week, is likely not going to be enough. ~ Dr. Gabrielle Lyon

She believes it's far better to eat that meal shortly after exercise. "In a geriatric population, we know that blood flow is optimized post-training, and we know that adding in a protein meal right after training … is extremely beneficial," Lyon says. This goes for carbs too. 

"To gain muscle mass, you do need calories," she says. "Protein and carbohydrates play a different role post-training, whether one is for glycogen repletion versus muscle protein synthesis or muscle repair, both are very valuable." 

You Need Carbs to Build Muscle

1. Carbs Provide the Body Energy to Build Bigger Muscles

Increasing muscle mass involves adding more contractile units (sarcomeres) to your muscle — increasing muscle length and cross-sectional area. The act of building that muscle tissue after the workout requires rest and food, as the act of building muscle is an energy-intensive process.14 Building muscle requires energy — our body does not run on thin air.

Eating protein is of course important (almost a no brainer!), as it provides the body the building blocks (amino acids) for the muscle tissue. But just eating protein is like delivering logs to build a log cabin, without any employees to assemble the cabin. Rebuilding something requires TOOLS and ENERGY (carbs).

2. Carbs Replenish Muscle Glycogen Levels

Glycogen is a storage form of carbs that is used for energy throughout the body, especially during your strength training sessions since fat is too slow of a fuel source for high power output. (So you use up a lot of these glycogen stores during your training session.)

A 2022 meta analysis discussed how a single strength workout will decrease muscle glycogen levels by 24% to 40%.15 And just 3 sets of 12 reps performed to muscular failure was shown to result in a 26.1% decrease in muscle glycogen levels. So one of the main reasons to consume carbs after your workout is to replenish these stores.

3. Carbs Lower Stress Hormones

Smart exercise is a good stress that yes, elevates cortisol levels. But we should try to lower that cortisol peak ASAP after the workout. Our muscles rebuild when we are in a rest and digest state, not in a state of fight or flight. Consuming carbs as part of your post workout meal significantly decreases cortisol and helps you recover faster.

One study showed that the inclusion of carbs to a post workout meal decreased cortisol levels by 11% (relative to the cortisol levels measured during the exercise session). The no carb group had a peak cortisol increase of 105%.

Carbs help suppress the exercise-induced cortisol release, so that you can recover faster, keep your hormones balanced, and maintain strong thyroid health and a robust metabolism.

“But our body can make all the carbs it needs” — this is a very common counter argument we receive, largely from men. That we don't need to consume carbs since our body can make its own carbohydrates via a process called gluconeogenesis. We get it fellas, we used to be obsessed with this dogma, and ideology, too.

I will counter and say — well, technically our body can make all the fat it needs if we don't consume dietary fat. But is that optimal? No. Carb restriction and strength training doesn't make sense when you learn human physiology. Not consuming carbs may “work” — but at what cost? What processes and functions get down regulated to allow for this excessive gluconeogenesis?

Your body uses carbs during strength training, full stop. So either you eat some dietarily, or your body makes it. Relying on this pathway will down regulate metabolism and thyroid health over time — you will be simply surviving, not thriving. And being in a low metabolic state leads to more catabolism (breakdown of muscle tissue) — not what we want!

Are You Getting Enough Exercise? 

When it comes to executing an exercise program to optimize muscle, Lyon recommends working with an experienced coach to create a suitable program.

"Volume is very important, and volume is exactly what it sounds like, it's the amount of repetitions. It's all cumulative in terms of weight and repetition. That is what we have seen in the literature. When you are new [to exercise], it is much easier to stimulate muscle tissue. So, if you are an untrained individual, you could get away with 10 sets per week.

I preface this by saying I don't actually develop training programs for individuals. I think doing this in-person with a professional trainer is really where you're going to get your benefit, because they can watch you. They can determine what moves you need to do.

You don't want to get injured, because injury really sets individuals back. There are certain groups of people that may have a predisposition to get injured, for example, an individual with hypothyroidism. I see that they have poor tissue turnover. They get joint pain. The recovery tends to be a bit of an issue, so getting with someone who knows what they're doing is really important. That said, the current recommendation is very low for exercise. When I say very low, it's 150 minutes per week. That could be 30 minutes, five days a week of exercise … I would say that's probably the bare minimum that anybody should do, not the optimal, but the bare minimum; 30 minutes of moderate intensity exercise, five days a week, is likely not going to be enough."

Exertion Is Important 

A key part of resistance training is actually exerting yourself. "It's called resistance exercise for a reason," Lyon says. "There needs to be a component of effort that I don't see people putting in." If you're on your phone or watching TV, chances are you're not putting in sufficient effort.

"It's not just about putting in the time. I expect you to execute in a way that requires focus and a way that requires exertion that is intense enough that you are fatigued … I would consider going to failure. Perceived exertion is really important.

There's a mind-muscle connection. You can do a lot of movements, but it doesn't mean you're actually targeting the muscle group that you are intending to target. If you do a certain exercise, maybe you're going to do a squat, and perhaps you compensate in a different way. You use your quads more than you use your hamstring or your glute.

Really focusing on the muscle that you are training is of extraordinary importance. You do need to create muscle damage. You do need to change the metabolic homeostasis in your body. You do need to have enough recovery, enough nutrients for recovery, but you do have to tax that muscle, and one way in which you tax the muscle is through effort.
 

One way that you also tax and understand the effort is through perceived exhaustion. I'm not saying you have to train to maximum exhaustion, but, if we are thinking about how to really step up and protect ourselves as we age, people are always looking for this external fountain of youth. It's not. 

It's not something you're going to take in. The fountain youth truly is within this muscle system as the organ of longevity. That's how people are going to really excel and change the trajectory of the way in which they age."

Exercise and COVID-19  

More than 60 studies show statistically significant improvements in isolation. Statistically significant improvements are seen for mortalityventilationICU admissionhospitalizationprogressionrecovery, and cases

Reference links on Exercise and COVID-19 studies are available on this dedicated webpage: c19early.com/ex.

Do note that most studies analyze exercise/physical activity levels before infection, comparing regular/moderate exercise and lower/no exercise. Risk may increase with more extreme activity levels.

Strength as a Predictor of Survival

Strength can also tell us a lot about an individual's chances of survival. Brendan Egan, Ph.D., (Associate professor of sport and exercise physiology at the School of Health and Human Performance and the National Institute for Cellular Biotechnology at Dublin City University in Ireland) presented data from a study in which people's chest and leg press strength were measured to arrive at a composite score of whole body strength. The pattern is quite revealing, showing the strongest one-third of the population over 60 had a 50% lower death rate than the weakest.

Exercise guidelines recommend getting 150 minutes of aerobics exercise and two strength training sessions per week. As noted by Egan, you need both. It's not just one or the other.

Research shows aerobic exercise in isolation reduces your all-cause mortality by 16% and strength training-only reduces it by 21%, whereas if you do both, you reduce your all-cause mortality by 29%. (R)

Exercise and Cholesterol

Researchers found that high-intensity physical activity was much better at lowering LDL cholesterol and triglyceride levels beyond the type of exercise performed. Yet during resistance training, they discovered it was the increased number of sets and reps that had the greatest impact on cholesterol levels, rather than lifting heavier weights (R).

Fasted Exercise Can Boost Your Health Benefits

You can boost the benefits of exercising in the morning even further by exercising in a fasted state. As noted in a 2012 study, “aerobic training in a fasted state lowers body weight and body fat percentage,” while “fed aerobic training decreases only body weight.” Exercising and fasting together also increases acute oxidative stress which, paradoxically, benefits your muscle. A 2015 paper explains:

“Since the discovery of exercise-induced oxidative stress several decades ago, evidence has accumulated that ROS [reactive oxygen species] produced during exercise also have positive effects by influencing cellular processes that lead to increased expression of antioxidants.

These molecules are particularly elevated in regularly exercising muscle to prevent the negative effects of ROS by neutralizing the free radicals. In addition, ROS also seem to be involved in the exercise-induced adaptation of the muscle phenotype.”

In other words, fasted exercise may actually help keep your brain, neuro-motors and muscle fibers biologically young. Fasted exercise is also a potent prevention strategy for Type 2 diabetes.

In one 2010 study, those who exercised while fasting increased their levels of GLUT4 — a muscle protein that plays a pivotal role in insulin sensitivity by transporting glucose into the cell — by 28%, compared to those who had a carb-rich meal before training, or those who did not train. This occurred despite eating 30% more calories than was required for health.

Is Protein Supplementation Necessary for Building Muscle?

A meta-analysis of 49 studies in the British Journal of Sports Medicine (2018) sought to prove whether protein supplementation boosts muscle mass and strength. The researchers found that protein supplementation significantly increased muscle size and strength, but only alongside resistance exercise training.

So how much extra protein is necessary to build muscle mass when combined with exercise training? 

However, scientists don’t agree on how much protein is enough. For athletes, the American College of Sports Medicine(opens in new tab) advises eating 1.2-1.4 g of protein per kilogram of body weight to maintain muscle mass and recover from training. The recommendations from The International Society of Sports Nutrition(opens in new tab) are higher – up to 2g grams of protein per kilogram. And according to a meta-analysis published in the British Journal of Sports Medicine, eating more than 1.6 g of protein / kilogram will not provide any further benefits.

Animal-based foods are considered complete protein sources because they contain enough of all the amino acids, whereas plant-based sources or meat substitutes may not. But you don’t need to eat meat to get protein. If carefully planned, vegan and vegetarian diets can provide the same results, according to the Nutrients journal. It’s also been suggested that the branched chain amino acids (BCAAs) leucine, valine and isoleucine could be more effective at building muscle than the others.

Sarcopenia Is Not an Inevitable Outcome of Aging

While muscle loss occurs with age, it's not an inevitable outcome — provided you take proactive measures. To summarize, the way you prevent it is by regularly engaging in some form of resistance training, and BFR has many advantages that makes it an ideal choice.

This is especially true for those who are older, frail or struggling with a condition that makes regular strength training difficult or potentially dangerous. In addition to that, you'll want to make sure you're getting enough high-quality protein.

Organic grass fed whey protein is ideal, as it provides high amounts of both leucine and glutathione, both of which are important for muscle growth and maintenance.

Excessive Weightlifting Will Shorten Your Life

However, excessive weightlifting might shorten your life, according to a systematic review and meta-analysis in the March-April 2023 issue of Missouri Medicine, the journal of the Missouri State Medical Association, radically changed Dr Joseph Mercola's views on exercise, as it concluded that, above a certain amount, strength training begins to backfire and, eventually, results in lower life expectancy than if you do no exercise at all.
 

Other Studies Confirm Importance of Strength Training in Moderation

Among them is a systematic review and meta-analysis of 16 studies published in the British Journal of Sports Medicine in 2022.

Muscle-strengthening activities were associated with a 10% to 17% lower risk of cardiovascular disease (CVD), total cancer incidence, Type 2 diabetes and all-cause mortality. As in O’Keefe’s study, this review found a J-shaped association, with a maximum risk reduction of all-cause mortality, CVD and cancer (10 % to 20%) being observed at a dose of 30 to 60 minutes per week.

After 60 minutes, the benefits of strength training started to diminish, and above 140 minutes per week, it was associated with an increased risk of all-cause mortality. 

Another 2022 systematic review published in the American Journal of Preventive Medicine (AJPM) found that:

“Compared with undertaking no resistance training, undertaking any amount of resistance training reduced the risk of all-cause mortality by 15% ... cardiovascular disease mortality by 19% ... and cancer mortality by 14% ...

A dose-response meta-analysis of 4 studies suggested a nonlinear relationship between resistance training and the risk of all-cause mortality. A maximum risk reduction of 27% was observed at around 60 minutes per week of resistance training ... Mortality risk reductions diminished at higher volumes.”

Dr Joseph Mercola's Updated Workout Recommendations

Dr Mercola tweaked his own workout regimen considering these updated findings, reducing the amount of vigorous exercise and strength training he does, and instead making sure he walks more on a daily basis. Typically, he aims for 12,000 steps (about six miles).

Experimentation has also shown me that I really need to rest at least twice a week. Giving myself these rest periods has significantly boosted the quality of my sleep and ability to feel strong when I reengage my resistance training.

Overall, walking appears to be one of the best forms of exercise in terms of making you fitter and increasing your life span. So, focus on activities like daily walking, hiking, gardening, and leisurely bike rides first. Again, more IS better when it comes to moderate-intensity activities like walking. For most, I think it’s better to get your walking done before you start resistance training.

However, if you want to avoid frailty and sarcopenia (age-related muscle loss), it would be wise to consider doing both. So, if you’re already getting an hour of moderate activity per day, add in 20 to 30 minutes of strength training two to three times a week on non-consecutive days, or 40 to 60 minutes once a week.



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