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…that will help you and your patients learn about protein timing, while also liberating you from some of the constraints we've had over the years regarding protein consumption.
First off, you absolutely can build muscle while losing fat.
For a long time, it circulated that this was a very difficult thing to achieve.
It's actually not quite so difficult.
We'll go through the studies first, and then I'll kind of just free-flow it a little bit.
There’s a study in ADCN where females on an extremely low-calorie diet, which was 803 calories—a ridiculously low amount—who performed resistance training, still managed to increase muscle fiber size despite losing 16 kilograms a week.
The control group lost both fat and muscle, highlighting that training is vital during caloric deficits.
The control group was losing muscle, and the other group was not, and that was not even with super high protein.
That particular study was just with stimulus.
I talk about this probably ad nauseam on my channel.
But when you look at the hierarchy of preserving muscle or even building muscle, the top of the food chain will always be stimulus.
Okay, Dr. Don Lehman's work—Gabrielle Lyon was here; maybe she has already spoken; I'm not sure—she trained under Don Lehman. Don Lehman is like the pioneer of leucine research and protein research.
He has gone on record multiple times stating that 60-70% of the stimulus for building muscle comes from actual training itself.
Beneath that, then you get to protein as a stimulus, then calories, and then carbohydrates.
So that's the hierarchy of what’s most important for building muscle.
Those who know me know I’m a big intermittent fasting guy. I've always been a fan of that.
I firmly believe, based on the literature, that as long as there is resistance training—as long as you're putting stimulus on the muscle—it’s quite hard to break it down.
I shouldn't say quite hard. It can be easy, but it’s pretty hard to break it down if you're not in a ridiculous deficit.
Then, there’s protein intake.
Another paper in ADCH showed that overweight men in a 40% caloric deficit who consumed higher protein—in this case, 2.4 grams per kg per day—gained significantly more body mass compared to those in the lower protein group over four weeks, despite having identical caloric intake.
So we're starting to move away a little bit from the traditional calories in, calories out model, even though that’s still a fundamental piece—probably the most fundamental in terms of the literature we have available.
But what we’re starting to see is that macro-digested composition and stimulus might be a little more in the driver's seat, while calories might be slightly more in the passenger seat compared to vice versa, as we thought even 10 years ago.
This is cool because it gives us a lot of slack.
A lot of people are really having to focus so much on their caloric intake all the time.
You start telling your patients, "Hey, don’t go freewheeling; eat whatever you want."
If you spend a little less time focusing on that daily calorie number and stressing about it and focus a little more time on your stimulus and your protein intake, you might find that you have possibly an equal or better result without all the stress.
So, "protein anchored" is the term we use.
We always anchor everything in protein and let the rest kind of fall into place for most of the patient population, especially those with metabolic disorders or mitochondrial dysfunction.
From a body recomposition perspective, the higher protein group in that same study lost more fat than the lower protein group, suggesting that protein and exercise are key for body recomposition.
And again, probably because of the change in resting energy expenditure. That means just the sheer intake of protein itself adds a thermic effect.
And, of course, the resting metabolic rate changes due to the muscle mass itself.
I got really excited at the end of 2023 when this study came out, and I made a bunch of videos on it. I probably drove people nuts.
It discussed sustained absorption versus a bolus of protein.
Again, respectfully—I'm someone who really likes the intermittent fasting research and time-restricted feeding stuff—I enjoyed this study because I frequently go extended periods without eating and then have a large bolus of protein.
I knew in my heart that this was working. I wasn’t shrinking; I wasn’t losing mass. The protein was going somewhere.
But most of the literature was saying, "No, you have to eat 30 grams over multiple servings throughout the day. We’re going to eat 75 grams, 75, 75."
The Cell Reports Medicine study challenged the idea of the protein absorption cap.
It found that 100 grams of protein in one sitting sustained muscle protein synthesis for over 12 hours, with higher and prolonged amino acid availability.
I'll explain what that means in a minute.
There was enhanced utilization: 100 grams of protein ingestion actually increased the amino acid flux, meaning more protein was used rather than oxidized.
Whole-body protein synthesis was greater with 100 grams than with the 25-gram route, with only slightly increased oxidation.
I’ll get to the muscle protein synthesis part in a second, but first let me break down what this study did.
They used labeled proteins and labeled the leucine so they could trace where the leucine went—leucine being the primary amino acid for muscle protein synthesis.
Subjects either ate 25 grams of protein or 100 grams of protein in one sitting.
They traced in radioisotope fashion where the leucine went within the human body.
It was probably one of the most well-designed studies I’ve ever seen because they went down to the granular level like this.
Not only did they watch protein digestion; they also observed where the protein went and the subsequent muscle protein synthesis as a result.
They found that the 100-gram protein group over 12 hours continued to absorb and trigger muscle protein synthesis the same, if not even more, than the 25-gram group in certain situations.
But overall, basically the 100-gram protein group utilized everything just as well as you would utilize 25 grams in one serving, with just a slight diminishing effect as the day went on.
The lead author made a pretty bold claim—the study's title essentially suggested that there may not be any upper limit—indicating the potential to even go up to 200 grams in one serving.
Not that I would recommend everyone do that, but for people who like one meal a day or two meals a day—or even occasionally intermittent fast—you've seen people like Dr. Peter Attia and Dr. Rhonda Patrick recently sort of abandon fasting because of protein concerns.
Then this study comes out and states, "Well, it doesn’t matter because on the days that you are eating less, as long as you get your protein—even if it’s in one sitting—it’s still pretty solid."
This is really cool for regular people, even if they’re not fasting—people who say, "Okay, I’ve worked out in the morning, and then I’ve got a busy day and can’t just get my protein in. I have to do what I can; I go to Chipotle for lunch and do my best"—in this case, they could literally finish their workout, sit down, have 100 grams of protein or more, get their protein allotment, and not have to stress about it throughout the rest of the day.
This is very cool for athletes, but I think it’s even cooler for regular people who have trouble getting in protein throughout the day.
Of course, there’s a difference between protein absorption and actual muscle protein synthesis, too.
This study demonstrated that muscle protein synthesis increased significantly.
I recently had Dr. Mike Wormsby at Florida State on my channel. He’s a super awesome dude and well-spoken—a diamond in the rough if anyone's ever looking for a good protein scientist who isn’t one of the mainstream kind of people.
His name is Dr. Michael Wormsby. He’s great.
He has led some of the leading studies on protein feeding and protein timing.
His hallmark study is the protein at night study.
I’ll give you a sort of a loose outline first, and then we’ll get into the specifics.
Long story short, there’s all this metabolic research, mainly coming from the glucose side of things, suggesting that we don’t want to eat before bed.
That’s a common theme—don’t eat within a couple of hours before bed because it’s going to disrupt sleep—nothing really new there.
But Mike Wormsby’s work actually showed the opposite when it came to protein.
They fed people cottage cheese, whey protein, and several different proteins.
The major caveat was it was only protein—no carbs, no fats, really. Just trace amounts of fat from cottage cheese.
They found that in this case, it did not affect sleep; it actually improved fat loss the next morning, believe it or not.
And it, of course, improved muscle protein synthesis.
So again, the takeaway from this study is not necessarily that you need to have protein before bed. Let’s be clear; that’s going to make it harder to achieve a certain amount of time between meals.
If you don’t need it, you don’t need it.
But there are many times—like in my case—where I go to work, I’m doing my thing, and I get to dinner time. I’m like, "Shoot, I’ve got maybe like 75 grams of protein on board today because I just haven’t had time to eat."
Being able to have that extra protein shake or a bit of cottage cheese before bed, up until recently was just out of the realm of possibility for me because I thought, "I don’t want to eat before bed. That’s not a good thing to do. It's going to affect my sleep. It’s going to impede fat oxidation in the morning."
The cool thing about Wormsby’s work is that it shows that it actually has more of a positive effect than a potential deleterious effect.
So we can tell especially an older population, "Hey, have a little bit of cottage cheese before bed, or have a protein shake before bed."
We don’t have to worry about this negative metabolic impact that we’ve been so concerned about before.
This is really what this study demonstrated.
Again, you guys will get the slides, and you can dig into the study more.
There’s also a benefit in terms of morning satiety, which is good.
So what is more important?
If you are someone who doesn’t eat a couple of hours before bed and you’re potentially low on protein, and then you go to bed and get up in the morning feeling ravenous, you may end up eating earlier in the day because you’re so hungry.
However, if you have a protein shake or some cottage cheese before bed, you’ll be satiated in the morning, making it easier to roll into a fasted workout or just start your day in a fasted state more comfortably.
Just some food for thought.
Another important note: There’s no significant impact on insulin sensitivity either, which is really crucial because we need to remember that over 90% of people are dealing with some level of mitochondrial dysfunction, which means they're likely experiencing some level of dysregulated insulin.
So the fact that protein was not affecting that in the morning is a huge deal.
Next, let’s talk about protein timing post-workout.
This is one of my favorite topics.
The Journal of Applied Physiology published a study that looked at muscle protein synthetic rates increasing rapidly post-exercise, stating it was more than double at 24 hours, and thereafter it declined rapidly.
This suggests that the whole anabolic window is much wider than we previously thought, flipping everything on its head.
Basically, after a workout, there's a 50% increase in muscle protein synthesis, which is pretty significant.
But what people don’t realize is that it continues to go up.
At 24 hours, protein synthesis is more than double that.
So muscle protein synthesis is not just an anabolic window of time where you have to get your protein shake in immediately after your workout; you certainly can, and there’s a little nuance there when carbohydrates are in the equation.
Post-workout, yes, you have an optimal period to resynthesize glycogen, but we’re not necessarily talking about that right now.
We’re primarily focusing on the protein piece.
At the end of the day, as long as you’re getting enough protein in that 24-hour period after your workout, you’re good.
In fact, you could argue that having protein a little bit later might be better.
The best course of action, in my opinion, depends on the time, right? It depends on how much time the patient or the person has to finish their workout.
You have that post-exercise or exercise post-oxygen consumption, which is a really nice wave to ride.
You can work out, then get a little more fat loss after your workout by riding that wave for a couple of hours and then starting to load the protein.
Make no mistake, even if you were to have protein right after the workout—that could be beneficial—but it will stop glycolysis to a certain degree.
Because any time there's an insulin spike—whether it’s from carbohydrates or protein—you're going to stop glycolysis for a period of time.
Don’t let that dissuade you from having protein, but the point is, if ultimate fat loss is your goal, then I strongly advocate for giving those couple of hours to achieve additional fat burning.
You also have that elevated heart rate and a bit of that fat oxidation that occurs for a couple of hours after a workout.
You have about 36 hours until it comes back down to baseline.
How much protein? This is always up for debate.
I firmly believe that someone's training history, overall muscle density, and other factors play a part. Also, inflammatory markers tend to get lower as we get older.
That’s the primary takeaway we need to focus on.
Without diving into the super granular, you’ll notice the amount of protein needed for someone who is 20-30 years old compared to someone who is 60 is significantly different.
We often worry about things like kidney function and whether they can handle the protein intake.
However, with solid evidence backing it up, I can say that some of the leading kidney researchers, like Dr. Jacob Torres at UCSB, spend all day studying this. It is really hard to overdo protein unless you have some pre-existing kidney issue.
Granted, there’s always a potential for overdoing it to some extent, but as far as the kidneys are concerned, that really comes from the old creatinine myths.
If you’re elevating creatinine, it does not always mean you’re causing damage to your kidneys.
When you’re activating or elevating creatinine by consuming more protein or taking in creatine, it doesn’t necessarily mean kidney damage is occurring.
As patients get older, their ability to synthesize protein declines significantly.
We need to find different ways to incorporate protein into their diets.
We’ve learned a lot through crash dieting and different methods used by older populations to lose weight.
People in their 40s, or a female in her 40s shortly before menopause, who might crash diet to achieve their goals, often face hormonal shifts, bone density declines, and muscle mass loss.
On the other side of that, they require much more protein to get back to where they were before menopause.
It's a slippery slope, and I don’t intend to scare anyone, but the more you monitor this scale and consider patient age groups, the more effective you will be.
It’s not going to be as simple as 0.8 grams per kilogram; there’s not a lot of real literature providing a clear playbook for this.
In recent years, we’ve only begun to recognize its importance.
Just keep that in mind, even as a loose guideline when consulting with older patients regarding their protein needs.
It doesn’t matter if they’re plant-based or not; we just have to get the protein intake right.
Next, we’ll briefly address workout timing, specifically as it pertains to carbohydrates.
This is interesting.
When looking at the room, it’s hard to tell who follows my videos and who doesn’t.
I lived in what I would consider a low-carb echo chamber for a long time, where that research was my primary focus because that’s how I achieved my own weight loss.
But over the years, I’ve found that we need to examine a much broader spectrum.
Even within that, you’ll find that carbohydrates are necessary for optimal fat loss or performance.
You will have patients who prefer one approach or another, so it’s good to look at the literature.
A true systematic review of findings—a pretty recent study—done in the Journal of Nutrients with 49 studies, was quite large.
They focused on carbohydrate intake and resistance training performance, finding that carbs are not essential before workouts for strength, performance, or muscle growth.
I’ll dive into those specifics.
From an acute supplementation perspective, 19 studies out of those considered acute supplementation, meaning carbs consumed within 24 hours prior to exercise, showed no significant benefits in most cases.
When improvements were seen, they were attributed to higher total energy intake, not carbs alone.
Some effects may have been placebo-driven.
As a matter of fact, this slide is actually being kind of nice, to be honest, because they found some really interesting stuff.
In one particular study, they had subjects consume maltodextrin, and in another study, they had them consume a sweetened maltodextrin solution.
So they added a sweet taste, but it had carbohydrates in it.
In a third group, they provided straight water, while another consumed a sweetened, artificially sweetened drink, believing it contained sugar.
The group told it was sugar and the group that actually had sugar experienced the exact same performance increase over the control group.
This suggests that, similar to the research conducted by Dr. Tim Noakes, much of carbohydrate's impact on performance may stem from psychological aspects rather than nutritional contributions.
We treat carbs as an exogenous supplement.
Not saying that carbohydrates are good, bad, or ugly, but when it comes to performance, the most critical factor is your calorie load the day before.
We’ve seen that with the bulk of studies in this meta-analysis: it doesn’t matter how many carbs were ingested; what matters most is the total energy supply the day prior.
If someone had 800 calories the previous day with no carbs in their system, they probably would not perform very well.
But if someone has adequate nutrition the prior day and consumes the same amount of carbs, they would definitely perform better.
The bigger theme here is how energy-depleted they were.
The next piece is glycogen sufficiency.
As long as glycogen stores are not fully depleted, carbs consumed prior to exercise do not significantly enhance strength performance for typical strength training; glycogen levels remain sufficient without pre-workout carbohydrate intake.
I’m not suggesting you approach patients and say, "Hey Bob, that oatmeal you’re having for breakfast is a total waste; get rid of it."
That oatmeal might be essential for Bob’s satiety throughout the day.
We also have to consider the psychosomatic effect it may have on his workout performance.
However, we need to assess the net positive. If someone consumes, hypothetically, 200 calories of oatmeal because they believe they must, they might end up burning 160-180 calories during their workout.
Consequently, they are at a net positive or surplus overall.
It’s our responsibility to educate our patients on how to achieve this balance.
I suggest that, for practical application, don’t tell your patients not to eat that oatmeal before their workouts because they might genuinely feel they need it.
What you can do is teach them how to train some days fasted, some days without carbs, and then occasionally include carbs, explaining the benefits of being dual-fueled and training their bodies to run on both systems.
That is how I've found to convey this concept in a way that doesn't come across as aggressive or one-sided.
It’s crucial because they may experience some additional benefit by training in a slightly depleted state.
I won't say fasted, because that doesn't have to be the case. Just being somewhat depleted due to cellular signaling matters.
The key takeaway is that when discussing athletes, what works for one cohort is often different from another.
For athletes, it’s not about the carbs they eat before workouts; it’s really about their glycogen stores.
If someone has topped off glycogen stores two days before a training session or an event and doesn’t eat the next day but remains completely sedentary, they will likely perform just fine.
Carbs matter when trying to reach a certain muscle storage level of glycogen; if you’re below 25%, you might see a decrease in performance.
We learned from previous discussions with Dr. Mike that carb timing doesn’t matter much unless you're following a ketogenic diet and want to avoid an insulin spike—but that’s a different situation entirely.
I’m still a fan of fasting cardio, and I don’t want to make enemies, but I’d like to know—by show of hands—how many of you like to work out on an empty stomach?
A lot of you, okay.
It looks like about 70% of the room.
It’s interesting how divided people get about this topic on the internet—not even just intermittent fasting versus not, but fasting training in general.
There aren’t many people suggesting fasting training is necessarily better.
Many people discuss why they do it and the benefits they receive.
At the end of the day, just get in there and get your exercise done.
There are solid benefits to training fasted, but the studies haven't always demonstrated statistically significant outcomes.
You can still have a meaningful difference or experience something significant without it being statistically significant.
When it comes to fat loss and motivations, a meaningful difference can matter.
I’m aware that I might have some biases; fasting training logically makes sense to me.
We always joke, "In God we trust; for everything else, give me David."
Your personal anecdotal experiences matter, too.
It’s always made sense to me that if I’m going to work out with nothing in my system, I’ll stimulate a stronger AMPK phosphorylation effect, leading to better adaptation and likely more fat loss.
We sometimes take a lesson from the bodybuilding crowd, which has claimed for decades that fasted cardio is the best way to lose fat.
However, I’m not claiming it’s the only way or the best way—there’s probably something to it.
Additionally, there’s an increase in VO2 max effect associated with training in a fasted state.
A cool study from the Journal of Science and Medicine in Sport found that untrained subjects showed significant VO2 max and resting glycogen concentration improvements after four weeks of fasted cycling training compared to fed training.
They improved their VO2 max better.
When considering patient populations, those whose VO2 max directly matters—elite athletes and individuals trying to stave off cardiovascular disease—will especially benefit from this.
For untrained individuals who want to enhance their VO2 max and improve their chances of surviving respiratory or cardiovascular events, this is relevant.
In a fasted state, those who work out realize a significant increase in their VO2 max over control.
That’s certainly awesome and a point we should emphasize.
One reason is due to the increase in fat oxidation.
In a study published in the British Journal of Nutrition, researchers found that 27 different studies indicated increases in fat oxidation during exercise in a fasted state compared to a fed state.
This results in greater fat loss, even when energy expenditure is equal.
Calories being equal and energy expenditure being equal, consider two individuals burning 300 calories—the person in a fasted state will likely burn a greater percentage from fat.
This is not high-level physiology; it’s simple math regarding oxidation—if you don’t have fuel on board, you’re going to tap into fat a bit more.
However, fat oxidation doesn’t always mean someone will lose the right kind of weight; it does mean they’re losing fat but may also lose muscle without mitigation.
I personally challenge myself to train fasted, but if it feels too easy, that may indicate that I should occasionally train fed to introduce extra challenges.
Why? Because perhaps I've limited myself metabolically by only training fasted.
Given thousands of years of history, humans have likely exerted themselves without food on board.
If our bodies were that fragile, we wouldn't have made it this far; we are highly adaptable creatures.
The more we build on this adaptation and assess the longer-term impacts, the more we'll understand its benefits.
Training fasted increases SIRT1 expression and phosphorylates lipid AMPK pre-exercise.
CARS inhibit this effect.
AMPK influences gene expression, altering mitochondrial biogenesis, substrate utilization, and ultimately autophagy.
I won't going deep into this, but exercising to the point of being in a calorie deficit is a superior way to promote autophagy.
One of my closest friends, Dr. Tommy Wood, showed that there’s about three times the autophagy achieved through exercise than through a 24-hour fast.
As much as I champion fasting—having glorified autophagy—I must emphasize that exercise is probably more effective for inducing autophagy.
The benefits received from fasting-driven autophagy can be prolonged and extensive.
When you combine aerobic exercise for 60 minutes or longer at 55-70% VO2 max, it stimulates autophagy activity in skeletal muscle, providing another mechanism beyond fasting and caloric restriction for triggering crucial cellular cleanup.
I don’t need to spend a lot of time outlining exercise benefits; we all know it's good.
I want to ensure we have time for questions as we move on.
Some recent research suggests that resistance training is just as beneficial for mitochondrial health, if not more so, than cardio.
Although we think of endurance work as primary for mitochondrial density—since type 1 muscle fibers (dark, red) carry more density—resistance training offers different mitochondrial benefits: improvements in function, and reduced inflammation throughout the day.
One of my favorite practices is sauna therapy.
These topics are widely discussed, but the idea of mimicking exercise through sauna use fascinates me.
I’ve had success with individuals who dislike exercise, having them start with the sauna and later integrate exercise.
Sauna therapy acts as an exercise mimetic; it doesn’t replace exercise but offers similar downstream effects.
For the best benefits, I recommend using dry heat saunas over infrared ones, as those seem to deliver better outcomes.
If you lack access to a dry heat sauna, hot baths can yield fantastic benefits.
Taking a hot bath up to your neck—at a temperature you can tolerate without burning—helps to mimic sauna effects, leading to improved mitochondrial function.
Another dimension is exposure to cold.
Though its popularity fluctuates, I still believe in its benefits.
Cold exposure focuses on two main factors: central nervous system stimulation, which can trigger an afterburn effect and promote the discussion of white vs. brown fat.
While cold exposure appears beneficial for fat loss, most of the research is based on rodent models, where brown fat is much more plentiful than in humans.
"Cold exposure has more relevance for brain health."
Focusing on antioxidant supplementation surrounding exercise, I’m a big proponent of antioxidants and antioxidant-rich diets.
Yet we have to consider when making these interventions, as consistent antioxidant consumption may hinder the body’s own natural ability to upregulate antioxidant production.
Superoxide dismutase is an important mitochondrial antioxidant.
The optimal use of antioxidants will align with a strategy of supporting natural antioxidant production.
Research showed that taking antioxidants, such as vitamin C and vitamin E, during fasting negated improvements triggered by fasting.
I recommend introducing antioxidants after breaking your fast, allowing the body to manage the oxidative load afterward.
Let’s touch on some supplements I recommend.
I’m a big fan of taurine; its research indicates significant performance benefits. It plays multiple roles—it’s conditionally essential in hydration, calcium signaling, and antioxidant defense.
While the body naturally produces taurine, vegans have lower levels due to insufficient dietary sources.
Evidence shows that 1-6 grams a day reduces lactate, enhances fat oxidation, and improves overall metabolism.
Taurine supports cardiovascular health by lowering systolic blood pressure and preventing arrhythmias.
Trimethylglycine (TMG), also known as betaine, is a methyl donor that regulates homocysteine levels.
It’s found in meat, spinach, shrimp, and wheat bran and has been connected to enhanced mitochondrial biogenesis, improvement in insulin sensitivity, and fat loss.
Creatine enhances cognitive function following sleep deprivation, and methylene blue serves as a mitochondrial enhancer and antioxidant.
Methylene blue has shown promise for individuals with metabolic dysfunction; it can help improve cellular respiration and energy efficiency.
As a final note before taking questions, I’d like to discuss the benefits of peptides.
MBC157 is a commonly talked-about peptide; it creates a more favorable environment for healing, particularly in injuries.
Lastly, we have growth hormone precursors (such as CJCI and amaryllin) stimulating the pituitary to produce its own growth hormone.
It's essential to guide patients utilizing these with appropriate tests to evaluate and monitor IGF levels.
An influx of information allows us to better optimize our approach with patients.
Thank you for your attention, and I’m looking forward to your questions!
