139. JJ Virgin: Muscle Over Weight Loss

Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and, most importantly, extend your health span. We're living in an era of more health information than ever, yet metabolic health has never been worse. People are tracking calories, chasing the number on this scale, and following the eat less, move more mantra. But fewer than 30% of adults are metabolically healthy. So what's going wrong? In this episode of Extend, I'm going to sit down with JJ Virgin to dismantle the biggest myths keeping people stuck, starting with the idea that weight loss equals health. We talk about why the scale is often lying to you about overall health, why losing scale weight doesn't mean losing fat and how thin people can be just as metabolically unhealthy as those who are overweight. JJ's going to explain why muscle, not weight, is a true driver of metabolism and why fast switch muscle loss accelerates aging. Strength, power, and stamina are much better health markers than BMI will ever be. We also get practical. We're going to talk about how protein first changes hunger, blood sugar, and satiety and why calorie restriction backfires in over 95% of people. We're going to learn about exercise snacks outperforming long workouts and why just four and a half minutes of intense daily movement can totally shift your health trajectory. This episode is not about doing more. It's about doing what really works in the right order to become metabolically healthy so fat loss becomes a side effect, not a struggle. I can't wait for you to hear my episode with JJ Virgin. She's an exercise physiologist. She's a nutrition expert and a good friend. Let's get into it. Hey, everyone. Before we dive into today's episode, I want to talk about something that you hear me talk a lot about, your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog, and they see their doctor and the doctor tells them all their blood work is normal. But the problem is this doctor usually is only checking about 10 to 15 biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running. Then all of these have blood tests that we can test on how effective they're working for you every single day. So if someone is not close to one of my clinics, one of my next health clinics, then I tell them go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers. The same kind of comprehensive testing that we do at all of our next health clinics. And if you try to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They can even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements. They don't have pharmaceuticals they're trying to get you to take. you're just getting the data and you're getting insights from the data and you can bring this data to a clinic like ours. And we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com slash Dr. Shah and use the code DRSHA25 for a $25 credit towards your membership. JJ, it's so exciting to have you back on. So much to talk about. I know. We have a lot of incredible new news to talk about. And we also have a lot of incredible stuff that you and I have been talking about, about structures that we can put into place that are practical for people to use. So I'm super excited to just launch right into it with you. Me too. Let's dive in. I love it. So you were just on the podcast a few months ago as well. And for people that are listening to this for the first time and haven't heard from JJ before, please go back and listen to that episode. So much incredible information that we're going to make practical use of today. And I would just want to get right into it with you. Currently, you know, it's beginning of January, 2026. What's the state of health in America right now? It's worse than ever. Like, what the heck? Isn't it crazy that we have more information than ever, yet our health is more problematic than ever? But I believe that's actually part of the problem because people are in actual overload, overwhelm, and they also don't know who the heck to believe. Right. Right. I know. It's becoming a real problem. And people are getting so much conflicting information. Right. And what I love about you is you really are, you've done such a deep dive and you know how to bring all of the science that's deep in your brain to practical solutions for people. So beginning of 2026, we've just launched a new food pyramid that I think is a lot better than the old one. Well, that's not saying much. Exactly. So true. Isn't that so true? But there's a lot of nuances there. And I'd love to dive into that with you. we are going to do a deep dive into metabolic health and hormones and how all of these interplay together and how someone who's just starting their journey can get started on the path of truly not just fixing their health, but also just reversing chronic disease and feeling incredible again. So you ready? We all want that. Yes, I totally agree. So what is the state of metabolic health right now in America? The last stats I heard were that less than 7% of people were metabolically healthy. And I think it goes along really well with something I saw years and years ago. So we have 70% of the population now who are overweight or obese. Now we're not unpacking that to really know, are there some people in there who just have high muscle mass and they're considered obese? But I would say that's probably a very small group of people in there. Then of the other 30%, there was a very interesting study done years ago in the UK where they found that 50% of people who are maintaining their weight by diet alone were toffee. Yeah. Toffee, thin outside, fat inside. Right. We now know that you're better off having higher muscle mass and higher fat than being, you know, a skinny mini with not enough muscle. And so if you look at those numbers, you go, okay, that kind of fits with this metabolically unhealthy number of 7%. So somewhere in the 5% to 10% of people are actually metabolically healthy. That is wild to think about. Yeah, absolutely. And I'm so glad you brought this up of the fact about toffee. Toffee, for people that don't know, is thin on the outside, fat on the inside. And what this really alludes to is the fact that just because you're thin doesn't mean you're metabolically healthy. And that's why only 7% of people are metabolically healthy, is because you have thin people and obese people that are both metabolically unhealthy. And that's because people are looking at the scale to understand what their weight is. And that is the wrong measurement, right? When you look at the scale and you're just trying to reduce your weight, you end up reducing muscle mass, right? You actually damage your metabolism doing this. If I could leave one piece of legacy work, it would be that we no longer ever use a scale for anything but seeing if our suitcases are going to be overweight getting on the plane. Other than that, you've got to know what your weight is made up of. Because losing weight at any cost, costs. Costs your metabolism, costs your metabolic health. And what the GOP ones have really done is unpacked a problem that's been going on for decades. This whole idea that when you lose weight, you're just losing fat, unless you've got a very well-designed program. Every time someone goes on caloric restriction, if they're not prioritizing protein, if they're not doing resistance training, they will lose muscle. Right. And it is why we have a 5% success rate in weight loss. When you look at it, you go, okay, so someone goes on caloric restriction without doing the right things with it. They're using their scale as the metric of success. Well, if I wanted to lose a lot of weight quickly, I would just drink a little sugar water all throughout the day, and I would sit on the couch. And I would lose a lot of muscle, right? And I would just use just enough calories to not go nuts, right? So just a little sugar water, sit on the couch. It would probably be 50% of my body weight loss was from muscle. Then you stop the diet because that's not sustainable and you go back to eating as normal. Your resting metabolic rate has dropped because you've lost muscle and muscle is your biggest metabolic driver, right? Your body knows that it needs to build back muscle so it's overcompensating with hunger. So now you're hungrier than you were before, but your body doesn't put the muscle back on. It puts on primarily fat. So now you've shifted your body composition to be worse than it was before. You've probably overshot and gained more weight back. You're in a bigger metabolic hole than you were to begin with. Absolutely. And so well said. And so that's why for the last five decades, we've gotten more and more obese, our entire technique. And rapidly. Yeah, exactly. It's a hockey puck of obesity. It's not like climbing along. Do you know what? In the 19th century, the turn of the 19th century, one half percent of the population was obese. It is 40%. Like obesity is now going faster than just being overweight. Right. Like that is crazy. Right, right. And so you have obesity plus being overweight, plus you have the TOEFIs and all of those fell into the bucket of metabolically unhealthy because we've been doing it all wrong for decades now. And so, you know, I just said this on stage the other day, yesterday, actually, in Phoenix, where I said, the first thing everyone here needs to do is throw away their scales. Yes. Just garbage. Thank you. Ditch the scale. But get a body composition scale. I believe that we should be getting on a body composition scale every single day. However, with a caveat, we only look at those numbers once a week. So you get it to report to your app. And once a week, you look at the trends. And you look and you go, am I holding on to or building muscle as I'm losing fat or am I maintaining? Right? The thing you want to make sure you're not doing is losing muscle while you're losing weight. So if you use a body composition scale, not a regular scale, and you look at the trend line once a week, then you've got the information you need. Because we know that people who are able to maintain their weight, like if you look at James Hill's research, which I think is so fascinating. Here's a guy who's devoted his life to what you need to do to keep the weight off. He said the hardest thing was finding those people because they are people who have kept the weight off for 10 years or more and lost 70 pounds or more. I think they've done like 10,000 people in this weight loss registry. But one of their habits is that they weigh in every single day. Yeah. And I think a lot of people, you know, there's a movement for a while. Oh, to get rid of that said to not weigh in. I know I saw that because it triggers me. I go, why don't we reframe weight? first of all, we got to look at what your weight's made up of. We're not looking at weight. But if we looked at those metrics the same as we would look at blood sugar or blood pressure, no one's going to go to the doctor and say, please don't test my blood pressure because it triggers me. Right? So we've got an emotional component here that we've got to get rid of. Because having excess body fat, not excess weight, having excess body fat is a symptom of poor metabolic health. That's it. It's not a symptom that you're a bad human. Right. Exactly. And having poor metabolic health is also the result of having lost muscle mass or not having adequate muscle. And so if you focus on your muscle mass number going up, that's the key metric to look for. Everything else follows that. The important thing there is we've got to look at your muscle, but we also want to know that that muscle, which we would look on a scale as fat-free mass, we've got to know the quality of it. Yes. Let's talk about that. Yes. And this is super important because you want to have quality muscle. You want to have muscle that's strong, that's powerful. We know that starting at around age 30, we're losing muscle mass each year up to 1%. It's about like 3% to 8% per decade, but can be as high as 1%. But that's not the scary part. The scary part is actually that we're losing strength, how much you could move something one time if you had to like lift the car or something and power how quickly you can move. And so why is that? Well, we have two types of muscle fibers, as you know, slow twitch and fast twitch. And then we have these hybrid ones that can go either way. As we age, we are told to slow down, do things, you know, walk instead of sprint, right? You hear this, you know, do a yoga class instead of lifting weights. Well, we start to emphasize more slow twitch. So the ones that could turn into fast twitch, turn into slow. And we know with aging, and I believe that it's actually not with aging. I think it's because we stop doing hard things as we age. We start to lose more fast twitch. So we slow down. And we now know that gait speed is directly correlated to your cognition. Right. Absolutely. Right. And your overall health. Right. So we've got to look at not just maintaining that muscle, but really making sure it's quality muscle, it's strong muscle. It's fast muscle. It's powerful muscle. So how does one understand the quality of their muscle? What are some simple tests or things that people can do to not just... So we have the bioimpedance scale. Right. They can tell you how much. How much muscle, which is great. I mean, that's definitely a great number to follow. Like you said, get on there daily, track it over week over week, see your head in the right direction. By the way, I love that technique also to determining what is your actual protein need? Because if you're decreasing and you're working out, You're not getting enough protein in for sure. But anyway, that's the way to know how much, how do we check quality. And the important thing to know is the bioimpedance machine is giving you fat-free mass. Right. And fat-free mass is not muscle. It's a proxy, right? So we're giving our guesstimate of how much of that is muscle. One day, I just interviewed Dr. Bill Evans. And one day, hopefully, we'll be able to actually do D3 creatine and we'll know how much muscle. But for now, that's better than what we, you know, better than a regular scale. We're going to see fat-free mass and predict because the biggest way to change that is to add more muscle. However, that doesn't tell you anything about the quality of the muscle. And so there's three tests. The one that I think should be in every physician's office is a grip strength test. I mean, we know that if you're in the lowest quartile of grip strength, you have the highest risk of all-cause mortality, right? So just a simple, you hold on to a hand grip dynamometer and you squeeze hard. You do it three times to each hand. And what's interesting is not only will that just give you your overall strength, it will also, the disparity between the two hands is an early marker of cognitive decline. Oh, really? Yeah. Okay. So, I mean, these are incredible things. It's also a great, you know, over the years, we've looked at different ways to kind of tell if someone's overtraining. Obviously, a decline in HRV is one way, but a decline in grip strength is also a sign you're overtraining. So that's the first one. But there's two other tests I love, too, that are great and easy to do at home. One of them is a push-up test. Yep. Do good form. That's the one thing I see is I'm like going, okay, well, those like, I am the push-up police at the gym. I watch people. I'm like, what is that that you're doing there? I'm guilty of that sometimes. You look like a flopping fish over there on the ground. So a push-up test. And, yes, if you're thinking I can't do a push-up, warning sign. You know, if you have to start on your hands and knees or even doing a wall push-up, fine. Do a wall push-up. Then do a counter push-up. Then do a bench push-up. Then do hands and knees. Do whatever you need to do to finally get up onto your hands and toes. So that's one. How many push-ups can you do in good form? And then the second one. How many push-ups can you do total or within a minute? It's not. This one's not a time test. Okay, got it. So this is just go until you can't do any more. Right. Right. Right. Okay. The other one that is timed is a squat to stand. This is not the get on the ground and get back up. That's a mobility test. That's a sit-to-stand mobility. This is a squat test. Yeah, this is a squat test. And really, when we're looking at these things, the push-up test is great because it's going to give us our endurance, our stamina. The hand grip is going to give us our strength. And then the squat test will tell us our power because it's timed 30 seconds. And it's from a normal, like these chairs wouldn't work, they're too low. But a normal-sized chair and you just sit to stand, don't use your hands, cross them over your chest, right? How many times can you do sit to stand in 30 seconds? And those are the three tests. Those are the three tests, age-adjusted, sex-adjusted for norms. And everyone should do these three tests, probably even at home. You don't have to go to a doctor's office to get a grip dynamometer. You can buy one online. They're $30 on Amazon. Yeah, for a really good one is $30. I've had some that are $15, $14.50 actually, last I looked. So everyone should get a grip dynometer so they can do this test. Everyone has a chair to do the squat test. Yes, and everyone has a floor. Right, exactly. So there you go. And here's what's great about that is track your progress because you will see changes in your strength very quickly. If you've never resistance training, these are my favorite people, the person who forgot to work out. I love them because I know that we can see strength changes very quickly. Four to six weeks, you see just dramatic increase in your strength. You won't see any hypertrophy, any increase in muscle size during that time, because the very first part of resistance training is getting your muscles and nerves to chat with each other. And so you don't see a big change in muscle. And by the way, you'll never see a big change in muscle. Like you don't wake up one day and go, wow, my muscles grew. Muscles are... You don't get those arms in like a week? Yeah, people always go, I want to get those arms. What do I need to do next week? I'm like, well... and I don't want to get big. I'm like, I'm trying to get big. I want to pack on as much muscle as possible. Good luck. We would be lucky as women to be able to put on, or men, eight to 10 pounds of muscle in a year. It is like watching grass grow. So anyone afraid that they're going to get bulky because this literally just came up. We were at Eudaimonia. I was doing a class with Dr. Vonda Wright and this woman came to me and said, I don't want to get bulky. You won't. No, don't worry about that. You don't get bulky working out. You get bulky not working out. Yes, exactly. You're not worried about having muscle. You're worried about having body fat. Right, right. So resistance training done correctly. You'll get that fast twitch fiber going, which is important. That's your metabolic spanks that holds everything in tighter. It's your sugar sponge where carbohydrates now can go into your muscles instead of being converted to fat, getting stored around your organs. And then the most exciting part about muscle is really how it impacts metabolic health is it's this multitasking messenger. I feel like we don't talk about this enough. I mean, it improves your insulin sensitivity. Fastest way to improve your insulin sensitivity, which is going to get your blood sugar better and stop you from storing fat. You've got high insulin. You are not burning fat. And you will be hungry all the time. It's like the worst case scenario. It's boosting your immune system. It's boosting your mood. So like you look at this muscle and you go, this is the most important thing. It changes everything. It does, yeah. I always say your metabolism lives in your muscle. Over 50% of your body's mitochondria, which is a huge number considering your brain has a ton of mitochondria. 50% of it lives in your muscle. And if you have strong muscles that are also large, you have a lot more mitochondria than the person who doesn't. And then that's where the sugar sink is. That's where all the sugar goes and gets utilized and insulin levels normalized. So metabolic health basically is a proxy of your muscle. And so this test that you recommended these three items how often should someone be tracking these So you could do what I would do is hand grip every month Agreed And also if you feeling really wiped out do it to see should I train tomorrow Most people are not overtraining, I will say that. There's all this fear out there online right now about cortisol and overtraining. You're not overtraining. 40 years of doing this, I rarely have ever seen anyone overtrained. That's not the problem. The problem is you're under-training. And probably, you know, usually you're not under-eating and over-training. Sure. You know, that's a very specific athletic population. Right. That's not most of us. Right. Exactly. So the other ones, really, as you're first progressing, it's fun to do them every month because you've got such a rapid increase in strength. But once you're in more of a place where you're lucky to put on a couple pounds of muscle a year, you could do them every quarter, every six months. Agreed. But I like to use them to begin with because it's so motivating to see these shifts because these shifts will happen faster than you'll see the shifts in your increase in muscle mass. Exactly. Nothing's happening. Right. But all of a sudden, and it is why I love resistance training. You go, wow, I was doing, you know, three sets of five push-ups. Now I can do three sets of 15 push-ups. Right. Like, that's incredible. Yeah, it is. And I think also they're great to start, like you said, do them monthly to start. And then once you get good at it and once you get normalized, you get to a normal level for your age and your sex, then moving to every quarter, because what you're probably going to start doing then is you're going to start tracking like how much weight are you actually lifting with a leg press, with a bench press at the gym. So you're going to have other measures that you put into place. But these are great measures to track longitudinally over time, to detect a problem early, understand if you're making progress. And I love it that you have three of them. Like let's just keep it simple. There's three tests. Do these every quarter. and you know what direction you're going. And so to build upon that, say you do this test, and you're not doing too well, you're not happy with your results, you're in the low average or even very low average range, what's an easy way for people to get started with a good strength training routine? And I bring this up because people don't have time. Time is at such a premium now, and I've heard you talk about some structures around starting and getting into a workout routine that is low time commitment but high impact. That new study that came out in Nature, I was like beside myself excited. And this was a study that looked at moderate versus vigorous exercise. And we've always believed that 75 minutes of vigorous exercise equals 150 minutes of moderate. Nope. What we discovered is actually, it's more like one minute of vigorous exercise depending on what markers of metabolic health you're trying to impact, is anywhere from three to nine minutes of moderate exercise. So I'm going to use that study. Also, that study on vigorous intermittent lifestyle physical activity that showed that just four and a half minutes of vigorous activity a day could make a dramatic, it was like a 40% reduction in cardiovascular risk. I'm not directly citing it, but it was somewhere in that range. So when you look at that, it could be as simple as this. I divide the body into four parts, but I focus on three. So upper body pushing, upper body pulling, hip and thigh hinging, and then power core. Now, I don't ever do single joint exercises unless I'm doing rehab. Other than that, I focus all on compound multi-joint exercises because in life, that's what we do. See, I just want to just, sorry to interrupt you, but I think it's so important to highlight this fact. Because when you go to the gym and you start working with a trainer, nine times out of ten, they're going to put you through ten different exercises on single hinge movement. It's silly. And then you're there for an hour, and then you're like – Nothing happened. Yeah. And not only that, though, you end up getting frustrated because you go to the gym twice a week, and you're not making any progress. Right. Three times a week, you're not making any progress. You're spending a lot of time doing it. And money. Right. Yeah. And I also want to highlight the fact that there's a lot of confusion now about zone two versus zone five. Oh, my gosh. Yeah. And the conversation has gotten to where people give up because they just don't have enough time to do all of the exercise that Peter Atiyah does, for example. I know. Well, Peter's an anomaly. But let's also – so I'm going to unpack the push-pull hinge. Please. Then I want to – let's give him a very simple prescription and a hierarchy of exercise needs. Let's do it. Maslow, the exercise triangle. Yes, exactly. Like I'm going to create my exercise. Maslow's – okay, good. Okay. So first, in terms of resistance training, there's the whole thing out there about you got to lift heavy, lift heavy stuff. I'm not sweating, but that's, you know what it is. Absolutely. You need to challenge your muscles. I want to say it that way because I think the lift heavy, lift hard is scary to people. You actually want to train and the chance you're going to get injured in the gym actually is very low. The chance you're going to get injured in life is very high. If you work correctly at the gym, you're going to train to get better at life. So the more we can do things that are free weight focused, you know, dumbbells, cables, bands, body weight, the better off we are because that mimics normal life. And I want to pull in my core. When I train, I actually don't do specific core work because I bring my core into everything that I'm doing. So I'm training to get better at life. Now, I'm assuming you've already done some ability work. Very important as your warm-up to move through all the different ranges of motion. Then we're going to go into your resistance training. And I love to focus on compound movements for each of these different areas. And again, the power core got pulled in. If I'm doing a squat, I better be using my core. If I'm doing a push-up, I better be using my core. If I'm doing a pull-up or a bent-over row, I'm doing my core. So I also like to do something called supersetting because this is very time efficient. when I'm doing a superset, it means that I'm doing two different exercises. So during the rest break of one, which is about 90 seconds, I'm going to be doing the other exercise. So I go back and forth. So an exercise will take- And that's critical because we know in the research that if you take a two-minute rest break in between working out the same muscle group, there's a 30% increase approximately in muscle gain over time. Yeah, you need to have the rest break. Most people are not, they're taking too short of a rest break and it's actually then you're just continuing to do the exercise. Now you've turned it from something where you're building muscle to building endurance. And there's all, you know, in the exercise physiology world, there's how hard you need to go for strength. There's shorter, heavier reps. For power, it's faster, lighter. And for hypertrophy, it's like kind of a 6 to 30 range. But if you want to do endurance, those are those 90s. It's the long ass. Right. Oops, sorry. Long stuff. It's the long ones. It's the one I hate. So you want to take those rest breaks. They're very important for hypertrophy. But if you're short on time, all you need to do is if you're doing a push-up, in between your push-ups, do squats. Or in between your push-ups, do bent-over rows. So you alternate between two of these. What's exciting about that is it also gets in a little bit more of that high-intensity interval training, right? So you're getting cardiovascular benefits and you're getting that HIIT training, that oxygen debt benefit as well. Now, you could go and do this literally in 20 minutes. You could do a push-up, alternate it with a bent-over row. You could do an overhead press. You could alternate it with a squat. You could do a pull-up or a high pull, and you could alternate that with a deadlift or a lunge. So you could literally do that. And those exercises I just listed are things you could do at home with free weights, with a TRX, with bands, easy enough to do. So the excuse just went out the window. But let's say you really don't have any time. And I would say make time. But you really don't have time. But you're going to do this in 10 minutes a day. Well, Monday you could push. And what you could do is you could decide to do a set of push-ups. And then you could do a little work. Then you could do a set of push-ups, a little work, a set of push-ups, a little work. Then do a set of overhead presses. So you could just put it all throughout the day. Right. Right? And you could get it in. Right. Then on Tuesday, you could do your pulling. You could do some bent over rows, some high pulls. Then on Wednesday, you could do your lunges and squats. Right. So you could literally do this a little bit every single day as well. Yeah. At work. Every 45 minutes, take a little exercise snack. Right. You're not going to get sweaty, right? Those exercise snacks, I call it the 10 minutes to win it. I mean, there's such clear research. One of the things that's super important is to do small bits of movement all throughout the day. Right? I told you I was just in the Amazon. They never sit for eight hours. No. There's no sitting for, first of all, you know, there's like scary things out there. You're not sitting for eight hours. But, yeah, they're not doing that. They're moving around all throughout the day. every time you move, you're going to support better blood sugar balance. So one of the fastest things to do to make a difference is just to set some timer every 60 to 90 minutes. They just get up, even if it's just get up and go do some squats. Like we now know that doing a set of air squats, say 30 to 60 seconds of air squats is the equivalent of maybe going out for a walk for 10 to 20 minutes. Absolutely. I had a patient I just saw a couple of months ago. He told me a story about how he had a huge blockage in one of his blood vessels, having major chest pain, went to the hospital, got a stent put in. And, you know, obviously they want to put him on statins. And he started taking his statins. And he asked his doctor, very smart guy, how do I get off these statins? And he said, well, there's really not much you can do, but I will recommend one thing. Just squat every day. Do deep squats every day, three, four times a day, sets of 10. And so this guy, you know, he had nothing else, no other advice, but he did that. A year later, they re-angiogrammed him, and almost all of his blockages were gone in a year of just doing four or five times a day. First of all, I love that a cardiologist said that. I know. I was so excited about this. And I love that he actually followed the instructions. Religiously. That near heart attack just scared the bejesus out of him, and he was like, I'm going to do something. And all he did was that, just do deep squats, three or four times a day sets of 10 changes life. If I had to pick just one exercise, it would be squats. Yeah. And now I say this as someone who blew out their knee at 17. And I've been squatting my whole life because people say, I can't do it. I've got bad back, bad knees. I go, but you have to get off the toilet and get out of the car and grab groceries. So you are actually doing this movement all the time anyway. And one of the biggest disservices we did early on, and I still remember, Like the things I was taught in school, and I was a biomechanics major first. Yeah, you were. So what I was taught in school is don't lift weights until you lose the weight. Wrong. And then never squat, never drop your hips below your knees. Oh, no. And then I lived in Japan. And this was in college. I went to Japan to bring aerobics to Japan. And everyone there sits in a squat position with their butts hitting their heels. And by the way, they don't have seated toilets where I was living either. You had holes. Try doing that in the windows. Yeah. But like, and somehow we were taught if you ever drop your hips below your knees, I don't know, some horrible thing is going to happen to you. Yeah, yeah. Crazy. You know, and it's incredible because like I grew up, you know, I'm Indian origin and we do a lot of praying. And when you pray, a lot of times you just sit, you know, crisscross applesauce or you in a deep squat for hours sometimes, and you just get used to it. And then now, like my mobility and being able to do that is preserved. And so I think, you know, I think a lot of times people think they can't get it back, but you can get it back. You just got to do it consistently every day and you'll get it back. And I've taken people through this. And you know what I love about kind of your structure that you're putting out there, and you actually have a name for this, a two by two by two by two. If we could like solidify that for people, there's a lot of people probably listening to this podcast that are time poor, they don't get enough time in the gym. And this is a really great way to start, right? So what is a two by two by two? So two by two by two is, so we talked about the push, pull and hinge. Two days a week, you are going to hit each of those. So that means again, you could do it all at once, or you could do it Monday, Wednesday is push-pull, Tuesday, or I'm sorry, Monday, Thursday would be push-pull. You just alternate it, right? Alternate. So then it's two exercises for each of those areas. So if it's pushing, that could be a push-up because anyone can do a push-up, right, anywhere. You can do it against the wall if you're deconditioned. And an overhead press. And I specifically love an overhead press standing because it loads the spine. and I want to get as much stress on my bones as possible. Got it. Right? Or a squat would, and the hinging would be squats and deadlifts or squats and lunges. So then it's two sets of each exercise. Now, when I say that, I mean two working sets. Right. So if I was going to do an exercise, I first do a very, like 50% of what I could do as part of the get my muscles firing, paying attention, and then two working sets of that exercise. And here's the thing. You want to do an exercise once you're used to it. So the first couple of weeks, you're just teaching your body how your muscles and nerves to talk. But once you've gotten to that point, the next thing that you want to do is push yourself so hard that you feel like you could maybe get one or two out. But form is your limiter. That's your limiter. It's not push it out in terrible form. When you start to feel like you're slowing down, your form's starting to drop, that's when you stop. Right. That's how you know the upper limit of how much you can do. Exactly. And that will change over time, which is what you're aiming for. And here's the thing. Don't go slow. Don't go slow. When you train slow, you go slow. When this whole super slow movement came out in the fitness world because of time under tension, being good for hypertrophy. I remember that. Remember that? But I'm not going. I was doing this a year ago. Yeah. But if you train slow, you live slow. You go slow. Our bodies are very specific. Go fast because we keep that power in there as well. and then just watch because all of a sudden when it gets hard, you'll slow down and your form's like you're kind of going, that's when you stop. Got it. And how long does a two by two by two workout typically take for an average individual? Well, remember you can superset it. Yes. So this is like can become a 20 minute workout. It's magic, right? It's like in 20 minutes, you get a really powerful workout in. And we know if you superset it and you go fast, that is going to replicate a HIIT workout, which is three to nine times more powerful than a low intensity workout. And, you know, I'm a believer in morning routine. So get this over with first thing in the day and it's done. You have a major win. Well, the research also shows that people who work out in the morning tend to not miss their workouts. And I know for me, like if I leave it to the evening. Oh, yeah. It's not happening. It's just not happening. It's not happening. Right. First thing in the morning, just get it done. And you've won the day already with your exercise. And it really sets the tone for the whole day because you're like, I worked out. Yes. I did this. Yes. So you could do that. Now, I talked about a hierarchy. Yeah. My exercise pyramid. So I'm going to actually take it to not exercise but activity because when you look at metabolism, you've got your resting metabolic rate, which we know really the only way we can affect that is with putting more muscle on. We've got the thermic effect of food. Swap out some carbs and fat for protein. You just boosted your thermic effect of food. And then we've got activity. Activity thermogenesis is two parts, non-exercise activity thermogenesis and activity thermogenesis. The actual bigger modifiable one is non-exercise. It's making sure you're moving all throughout the day and you track that with your steps. So that's the first thing. I always start with that because I know that if I'm not getting someone to track their steps, when we add an exercise, they move less. And it is really clear. It's like you don't think about it, but your body is very compensatory. It wants to stay in homeostasis. So if we don't do that piece of going making sure that you get all your steps in every day, non-negotiable, then we're going to start to add on top of it. So that's the first part is that, you know, the latest research was like 7,000 steps. I go 8,000 to 10,000. More is better, but I don't want you to do more steps and not do the exercise. guys. So I would say the next thing I have a lot of people purchase after they buy a grip dynamometer and a bioimpedance scale is a little foldable walking pad underneath their desk. Right. Yeah. It works so well. Just bring it out, unfold it, walk while you're on a Zoom call, walk while you're talking on the phone. I have one that's permanent that I walk when I work and I actually am more productive when I'm on it. And people get 10, 20,000 steps in a day sometimes. And it's you can really. And it didn't take you more time. No, it's just an easy one. It is my And the right thing under my desk, too. I have that one in my movable desk. Yeah, there you go. So I'm with you there. Exactly. It's the easiest thing to do. Right. When I'm traveling, I always make a, you know, I walk like I walked here today. I always walk to all my restaurants, walk to whatever I'm doing. So I walk as much as possible. Yeah. It's critical. Yeah. I love that. I take a walk every morning whenever I travel to just see the town that I'm in as well. And I try to get, you know, five to seven thousand steps in in the morning. The stairs in the hotels. That's my other hack. The hotel stairs. Exactly. So, and that's also becomes my workout if I'm absolutely in a place where I'm like, there is nothing here. I do travel with bands. I have these TRX bands called bandits because they have handles. So I can always make something work, even if it's just body weight. There's winners find ways, right? Right. So you get your need in, then you add your resistance training. If I was going to add something next in my hierarchy, it would not be zone two. it would be high-intensity interval training. Right, absolutely. Yeah, because the fastest way to improve your VO2 max is going to be with high-intensity interval training. And when I say that, because there's so many different types now, there's sprint training and this training, and I'm sure people are going, what the heck? It is just you go hard and then you actively recover. And the reason I say actively recover is because you go hard to raise your lactate. And then you actively recover because the lactate becomes a fuel source. Right. And lactate is such a powerful fuel source for your heart and your brain. And so the simplest HIIT workout is go hard for a minute, recover for a minute. So it could be run for a minute, walk for a minute, go up the stairs for a minute, come back down for a minute. One-to-one is easy. It could be a minute, could be 30 seconds on and off. But it also is really teaching your body how to go hard and recover. Right. Right. And what is the average effective dose on a weekly basis of minutes of HIIT training someone should do? Two days a week and getting about 10 minutes of the hard. So you could do it that way. There's also, you know, you could do Tabata, you could do, which is 20 seconds on, 10 seconds off. You could do the Norwegian four by four, which is going to be longer. It's a 20 minute one, but it's four minutes hard, three minutes for cover, four minutes hard. So you can play around with these different ones. I like to do different ones because here's what our body does. It adapts. And exercise should be progressive. If you are not progressing, you're actually not maintaining, you're declining. So you got to change things up. Absolutely. So that's the pyramid of how you want to think about it. Now, zone two, because you hear about this, I think that a great thing to do with zone two and it's what I try to do when I finally get home again, which is becoming rarer and rarer. But I have a girlfriend there, Dr. Lisa Coach, I think you know. Oh, yes. Yeah. So we go out for walks, wear a weighted vest, get your heart rate up. And she's like 5'4 and she jams. Yeah. Right. So this can be a fast walk, an easy jog, a cycling, or I'll jump on my Stairmaster. But something that you do for like 30 to 60 minutes, I try to do that once a week. Yeah, I'd go for a hike once a week in the hills with friends, and we put on rucksacks, actually. Yeah, perfect. And that's the zone two for us. And it's fun. Oh, and one other thing. Now, I think you can accomplish this in a variety of ways You can do mobility workout before your workout Not stretching mobility workout Stretching lowers your hypertrophy It lowers reduces your gains And I still see people stretching before they work out I go stop that But do mobility work For sure Moving through ranges of motion, just don't statically hold and push. Right. But the other thing I do when I'm home is I do a yoga class. Under duress, I do not like it, You know, but that has been a game changer as well. So in my perfect exercise prescription, it would be doing your resistance training twice a week hard, doing one day a week of yoga, one day a week of zone two, two hit trainings. And, you know, getting your steps in. So I'm 52 right now, but I'm still pushing all of my limits. I'm running long distances. I travel across many time zones to support my work. and I just want to live my life to the fullest. Staying active as I age isn't just about willpower. 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Your future self will thank you. one quick thing on getting the steps and i just thought of too i have a lot of people like you know i have them show me their phone when they come and see me for the first time and we go right to their apple app and i see is your phone on you all day yeah it's on me all day and we look at the number of steps average per day over the course of last month there's always somewhere between two to four thousand that's the average american the average american crazy so they're like how am i going to get more steps in and we talk about the walking desk of course but that's always something that they are usually skeptical about, they do later, or maybe just doesn't fit into their life. And what I tell them is, okay, well, we know you need 7,000, 8,000 steps. Let's do 8,000 minus the 3,000 you're getting, 5,000. Get those 5,000 steps in first thing in the morning. Just whatever you need to do. Go for a walk. That's a great way to do it. Yeah. And then that way you get it done, and you know the rest of the day you're going to get your 8,000. Because I think people have this anxiety towards the end of the day that they didn't get 8,000, and now it's like, what am I going to do? It's night already, you know? And so they don't do it. So first thing in the morning, add that number in compared to your average steps that your phone tells you. I'm going to use that because I will tell you a funny story. It's just exactly proves your point. I was at a meeting in Scottsdale and we are like sitting in this meeting all day long. So I am in the back up pacing like they're like, would she just sit down? But I'm literally back to the hotel. I'm at 5,000 steps. And I look at Tim and I go, we have to take the stairs. It's 20 plus flights up. He's like, I'll meet you up there. I'm not taking the stairs. Anyway, I take the stairs up. It's not enough. So I was like, well, darn it. I go, I have to go back outside and walk the neighbor. He's like, oh, gosh, because now he has to come with me. Now he's a trooper. He did it. But leaving until then. I'm a big believer in getting your wins in first thing in the morning because that's the only time you really have control over your day. After that, it's just like, oh, my gosh. You're reacting. Your reactive, right? Exactly. This is an incredible, fantastic exercise prescription. And I love that coming from you because you know the science. You know, you're very practical. You know that people just don't have time to overcomplicate it. Like, let's focus on the big things. Let's make the biggest difference. Well, I feel like there's so much information out there right now that is just going to make people do nothing. Because it sounds like you have to do so much stuff and it's so hard. And again, the important thing with that exercise prescription is if you're starting from that point of I forgot to work out, you're going to get amazing results. So go you, you know. And the first thing is just let's just build it. Let's start with that walking steps. Then let's add in the resistance training twice a week, 20 minutes. The two by two by two. Then we'll add in the HIIT training twice a week. Then we add in that zone two. Right. We've done some mobility in front of the two by two by two. Sounds like you should lead the mobility workout. And, you know, you can throw a yoga class in there. Yeah, throw a class in once a week. Yoga, Pilates, whatever have you. Whichever those types of things. Incredible. Incredible. OK. Exercise. We covered it incredibly. Let's talk about diet. And, you know, the food pyramid just came out. step in the right direction. But you and I had this great conversation earlier about how the way we've been managing calories and macros is just so backwards and it hasn't served anybody. And so can you dive into our conversation a little bit of how you think about things? Yeah. So this, first of all, it's also hard unless people love math, which I don't run into too many people who love math, but doing it as percentages. And I think that the percentages for macros, you know, the 30% of this, I think that all came out with the zone diet. Yeah. That must have been when this all happened, right? Because you needed to be in the zone. The way people used to do it is like you calculate the number of calories you supposedly need for the day, and then you do the zone, which is what percent is its carbs, protein, and fats, and then you like somehow turn that into a diet. It's like this big math equation. The number one, no one really knows how to do correctly. Number two, no one can stick to because it's just really hard to figure this out, you know, unless you're like a professional bodybuilder athlete and you have someone doing it for you. And there's such an easier way to do it. Right. And the bodybuilders don't eat that way anyway. That's true. They eat based on protein, based on their fat-free mass. Right. So when you really look at it, the number that's not going to shift here. Like I look at my macros this way. Protein is my function macro. Right. Right. It is there for structure, for rebuilding, for recovery. And then I've got my fuel macros, fat and carbs. I can play around with those. Right. Right. I cannot play around with the function macro. Exactly. The function macro needs to stay the same. It will shift if I'm under a lot of stress, if I'm recovering from an injury, you know, so it would go up. But like there's a there's a minimum threshold here, which I don't think the food guide pyramid hit. My minimum threshold is 0.7 grams per pound of target body weight. I love that you said 0.7 because a lot of people are talking about one gram per pound of target body weight as well. And I don't think it needs to be that high either. It doesn't, but that's the easy math. And if I've got someone who's really doing caloric restriction, heavy training, I'll do the one gram. I think it makes a ton of sense. Recovering from an injury, et cetera, one gram. But from all the research I've looked at, 0.7 seems to be the most important. That's where you're getting the biggest benefit. One gram is easy math. I'd rather you err higher than lower. So, you know, if you're going to go for it, don't go under. Like 0.7 is the floor. Right. And honestly, like in 40 years of doing this, I haven't had someone come in and go, I binged on salmon last night. The protein is definitely self-regulated. Yeah, it is. I can overeat the protein sometimes. It's hard, yeah. Yeah, it's hard. Now, if you're eating some big fatty thing, it's easier to overeat because you're eating a lot of that fat. But most, I mean, you don't hear people just go, I binged out on steak, chicken. They just don't. Right. So I'm not worried about that. I'm more worried they're not getting enough. So to me, everything starts with eating protein first because if you eat protein first, it's more satiating, right? It's got a bigger thermic effect. We know you got it in. You didn't do that because I hear from women all the time. I don't know how you eat that much protein. And I'll sit with people, and I'm sorry I am. I'm a judgy. If I had a little bubble next to my head, you would be horrified at the things I'm thinking as I'm watching the spooks. I'm keeping my poker face. But literally, I'll give you an example. I did a talk in New Orleans, one of the great places to do a nutrition talk, New Orleans. Anyway, I did a talk, and then I went out to dinner with some of the people. And it was a talk, and I went through, unpacked everything they needed to do nutrition-wise, and this woman sat down, and she had a salad. She had the hors d'oeuvres, which the appetizers were some fat carb bomb. Oh, yeah, I'm sure. Right, New Orleans. And then she ordered eggplant. Well, eggplant, when you order eggplant as an entree, which has no protein whatsoever, is a oil sponge. Let's call eggplant what it is. It's an oil sponge. The only way eggplant tastes great is it's so good. It only tastes good because you put a ton of oil, you breaded it, you threw cheese on it. There's nothing there. So I'm watching all this, and she's looking at me, looking at her, and she goes, you're judging me. You're going to protein shame me, aren't you? And I go, absolutely, because you are sarcopenic. You are the exact person I was talking about during the whole talk. I'm looking at you going, you're a skinny fat. You're sarcopenic. If we were actually testing for sarcopenia, it would be amazing, like low muscle mass. Right. And you're absolutely the person. And I'm going to force feed you part of my steak. Absolutely. I got enough. You take some of this. But, you know, this is someone who said, I don't know how you get all this protein. I'm so full. I'm like, you're full because you ate the bread, the salad, you know, and let's call salad what it is. Unless you're eating arugula with a little squeeze of lemon, a little bit of a little bit of olive oil. Most of you are just eating fat. You know, you got five calories of arugula and you got 300 calories of cheese and oil and then those glazed nuts that just turned it into a sundae. Yes, yes, yes. When they say glaze, that's a sundae. I can't wait to see the salads that we have coming. Let's see when they come after this podcast. Well, those salads, I know. I know we're going to look at them and we're going to assess them. Right. We're going to do a salad assessment. Salad assessment. This is my favorite salad. But the reality is like it's not the lettuce. No. Right? Okay. So if you just eat protein first, we solve that problem. And then to me, the next thing that should come in are the non-starchy vegetables. Non-starchy. Non-starchy. I just, when we were at Eudaimonia, we did a panel with Tim Spector, who was the guy who did the research on those 30 plants a week being the best for gut microbiome diversity. And that really, once he said that, I was like, okay, like game on, challenge. But if you think about it, because we tend to get in food ruts, I'm going to eat cauliflower rice and broccoli and asparagus, right? So how do we get all these different types of plants in each week? Now, if you're eating protein, I think you should eat as clean and lean as possible. Because even if you're eating clean protein, you're still toxin-storing fat. So I like to get as lean as possible there. But you're still going to get some fat with your protein, right? And the exception would be like wild salmon. I want to get a fatty fish there. But we're getting some fat there. Likely when you're making your vegetables, you're getting some fat there. You're using some olive oil as the dressing or preparation, likely, because, I'm sorry, steamed broccoli, not delicious. I'll put a little ghee on it or something. And then once I've gotten through that, now I'm going to start to look at, because I want to make sure I've got my polyphenols and my fiber from my non-starchy vegetables. Then I'm going to look at, okay, what do I need for the rest of the time? Fat and carbs, right? If someone's more insulin resistant, they might do better going on a lower carb, higher fat. If someone's really athletic, they might be better. Right. You play around with that. Exactly. Like it's like if you look at all of the diet research, they can never show that one trumps the other. Right. Right. So. Absolutely. It's just so much easier to think of it that way. Don't worry about the percentage macros. Stop counting calories. Obviously, if you're eating too many calories, that's a problem. but the way you avoid that is starting with protein you're obviously going to get satiated a lot quicker lean protein sources so you don't get the fat and the toxins in there and then you're going to get fat anyway and then go to vegetables from there right and then whatever you do after that base it on your how much you want to lower your overall glucose levels etc but it's almost like a non-issue at that point because you're really satiated because you're full because you had your right you know if you look at it went if i'm getting in 30 to 50 grams of protein at a meal and I'm getting 10 grams of fiber, I'm probably full. And I literally will track my food to make sure I'm getting enough calories now because you just get full. Yeah. And the other magic about this structure is that if you're someone that's following your continuous glucose monitor, this takes care of all your insulin spikes. Your insulin spikes are basically gone by eating in this methodology. And you'll see if you got some weird thing going on, like some food just doesn't work well for you. Right. Which you'll discover with the CGM as well. Amazing. So moving on from food choices, let's talk about metabolic health. And, you know, I introduced that introduction with a CGM and glucose spice, etc. I'd love to dive into how you're utilizing GLP-1s in this thought process and this structure and just further diving into metabolic health and improving it. Muscle being absolutely the core that we need to focus on. Food being second or very equal to that. What's next? What's next? And here's the important thing. You know, with the obesity and, you know, overweight obesity epidemic, I think we've approached it all wrong. This idea that we lose weight to get healthy is backwards. We actually have to get metabolically healthy to lose weight. Now, my favorite thing to do is get people doing the foundation so we can see the metabolic holder in. Like if you've got someone eating healthy, if you've got someone who's doing the resistance training, they're going to start to improve that insulin sensitivity, their insulin resistance. But if they're still struggling, it's because they've really landed in a deep metabolic hole. And maybe it's sleep issues, stress issues, hormone issues, etc. But we see what their baseline is, their true baseline. And then you can start to look, okay, you're insulin resistant. GOP-1s could be a great option here for you. Or you're not able to build muscle. Like, let's take a look. Do you need some estrogen and testosterone? What's going on there? You know, or you really are struggling with your metabolic rate. Maybe your thyroid's too low. But we can start to look and go, what else is going on here? Because when you improve metabolic health, then fat loss and muscle building become, you know, muscle building's never effortless. You got to do the work. But fat loss should not be a struggle if you're improving your metabolic health. We've just done it wrong. We focused on losing weight rather than losing fat, which is a big mistake. We've got to focus on building muscle because muscle is where we burn fat. So muscle, we always have to take a muscle-first approach, right? That's the thing. But if we did that and we focused on improving your metabolic health, having body fat, excess body fat, especially visceral adipose tissue, is a symptom of poor metabolic health. You don't try to lose the fat to improve metabolic health. You improve metabolic health and you'll lose the fat. Right. Absolutely. And so now we're bringing hormones into the equation, which I think is important even if you're a young person trying to lose fat. But it definitely becomes more and more important as we age because we have a natural decline in testosterone, estrogen. And at what point do you believe that we should be testing for these hormones to see? And thyroid as well. You just mentioned thyroid is a big piece of the puzzle. And GOP-1 is a hormone basically as well. So these are all hormones that we can modify, that we can bring into the picture to really accelerate your journey towards health. And the critical element there is testing to see where you're at. So what point should people think about testing? How often should they test? What do you think about? Wouldn't it be great if we got hormone levels when people were at a more ideal place? I look back and I go, gosh, if I just had access to those levels I had in my 20s or 30s, but I didn't know what I didn't know. I'd love to have those levels. Back then, we're kind of aging ourselves here. You had to go to a doctor and ask for a prescription. Lots of times the doctor would be like, what are you asking for this? You're normal. You don't need this. They would never have tested those numbers back then. Now we live in a different age. Anyone can get anything tested anytime they want. and is critical if you're a young person listening to this podcast, go out there and just get your tests done. I mean, wouldn't you love to know what are my normal levels? Right, right. Like how much testosterone do I have as a female? And by the way, females, you have more testosterone than estrogen and progesterone. Right. So I think that you get these things done younger and then you really pay attention to how you feel. This is where tracking your body composition is important. This is where looking at your energy because you'll start to notice things shift. For me, I noticed that I was not recovering well from working out at the gym. Now, I had a very smart doctor who first put me on testosterone. That was the first thing because I was like going, I'm just not able to recover. What's going on? And I knew my thyroid was off the minute my thyroid was off because I'd been teaching weight loss resistance courses to doctors. And I'm like, oh, I can tell this is off. So I had that. And by the way, it was in normal range. What symptoms did you have to know your thyroid was off? So I started losing the outer third of my eyebrow. I was cold all the time. I was always one who sweated all the time. And all of a sudden, I was cold all the time. Right. And my hair started to kind of come out. Now, I don't know what my thyroid used to be because whoever tested this, but it was at 2.7. And I feel best around 1 for a TSH. But just those little things started to go off. And 2.7 is in the normal range. It's in the normal range. That's the problem. It's in the normal range. And I can't, and by the way, of course, they weren't looking at the whole picture either. Fortunately, I had someone who was a thyroid expert look at this and go, oh, but I could feel it. You know, I knew exactly what was going on. I was like, help. And a little thyroid, boom. You were back to yourself. I was like back to myself. So then I could tell that I wasn't recovering well at the gym. Now, I think most people think, oh, I'm just aging. Oh, I'm just tired. Oh, I'm just, no, like pay attention to these things. The next thing that happened is I started to have bleeding gums. Mm-hmm. And that was one, and this is why it's so important to get all this information out, because I was like, what the heck is going on? My dentist, who was a guy, was like low estrogen. Wow. I was like, oh, my gosh. Wow. And, you know, classically in perimenopause, testosterone will come down, progesterone will come down. Estrogen is kind of the last one to fall, but not for me. Yeah, I shouldn't have went first. Yeah, and so fix that, and I was like, fine. You know, so I think the important message here is be very aware of how you feel and don't get gaslit when you start to have these things of this is just, oh, you're just, you're just, you know, hyper fixated or you're just, you know, you're getting older. That's normal. That's normal for you. I'm like, no, it's not normal. It is a sign. We don't have to suffer. Right. We can start to. And I think that you should start to take care of these things and replace these things as quickly as possible. But you need to have the foundation of good eating, good exercise, doing what you can for stress management. And the other one I noticed was my tolerance level, patience level, irritation level, like plummeted. I literally was like, could I just unzip my meat suit here and leave and come back? I mean, like the things that would get on my nerves. Oh, my goodness. It's like, wow. Yeah. Paying attention is critical. I think the whole concept of age-related decline being a normal inevitable, to me, I just tell people, look, if you are having age-related decline, it's because you're letting it happen with inactivity, with not paying attention to your hormones, with not focusing on what type of diet do you need in this moment right now. You can stop the age-related decline, and we have so many examples of that. Look at the blue zones and look at people that are routinely making it to 80, 90 and still having a very active life. They didn't let it happen to them. Right. Well, I mean, I was just in the Amazon with a woman hiking at 80. There you go. I'm like crying a little bit, but I'm hungry, and I've been hiking for five hours, and it's 90% humidity, and there's big bugs. I was like watching her going, I need to just be quiet. She like just bleeding the pack out there Oh my gosh Yeah Amazing stuff I will tell you I feel better at 62 than I did at 40 Wow That says so much right Like, you don't need to subscribe to the fact. No, I'm just not buying into that. Right. Exactly. And I do not believe that this whole we're losing muscle because we're aging. No. We're sitting on our butts and losing muscle. We are falling prey to all the things that we hear. Oh, as you're aging, you should do less. You know, don't go do that hard class. Go do the easier class. You know, all this stuff that we're not supposed to do these things. I'm like, we better do those things because if you use it or lose it. Yeah, absolutely. And I want to highlight one point because I think for us, it's so natural to speak about hormone replacement therapy is like, of course, right? Like, of course, you're going to replace hormones when it's needed to replace hormones. but I still talk to, and I would say about 80, 85% of the people I talk to that are in the general public still think there's a big taboo around it, right? And so I would love to hear how you address that with people. You know, early on, I was working out of a plastic surgeon's office in Rancho Mirage, helping them. I would look at their patients, look at their labs and help get them as optimized as possible before surgery. But when they, like, before I got to sit down with them, I'd get their labs. And these were all women, you know, perimenopausal menopausal women, I could see if they were on hormones or not. It was so clear with their labs, because what would start to happen is their inflammation markers would go up, their insulin would go like all these things. And I think we look at hormones and we're scared. But you look at what happens when people are not on hormone replacement therapy, their bone density, like you can see this with women, 2% to 5% decline in bone mineral density per year when they go through menopause. That is frightening. It's completely avoidable. Completely avoidable. But here's the thing. It's really hard to get bone back. That's trying to unscramble an egg. You do not want that to happen. So that's the first one. Then you look at the Alzheimer's risk, the dementia risk. When are we going to have that study? I don't know how we're going to do it. I don't know how to ever get through an IRB to do that. Yeah, right. But we can just look and go, of the women getting Alzheimer's and of the women having cognitive decline, are hormones or no hormones? Right, absolutely. You know, so you look at your brain, you look at your bones, and you look at those cardiovascular markers that I could so easily see. All of a sudden, their LDL's going up, their insulin's going up. I mean, so what's scarier? Most women are going to die of a heart attack. Sure. They're afraid of breast cancer, but breast cancer is not what's killing women. It's heart attacks. Heart disease, right? It's heart disease. Right. And, you know, I just interviewed a cardiologist a few months ago, and it's really important for women, especially because women suffer from a different type of heart disease than men do. It's more microvasculature, and the symptoms are very different. It's not the typical chest pain going down your left arm. It could be just, you know, brain fog, tiredness. It could be shoulder pain, neck pain. And it's very, very different when you have a microvascular disease of the heart. And usually that's due to low estrogen levels. And so getting hormone replacement is not just for your bones, is not just for aesthetics, it's also for your heart and your brain. Did you interview Jane Morgan? No, no, not yet. You've got to get Dr. Jane. She's amazing. But that's what she was telling me is a woman will go into the hospital, into the emergency room with these symptoms. Anxiety is one of them too. Right. And if a man comes in, they get screened right away. They get EKG, they get screened. The woman doesn't. No, exactly. And they get sent home with like Prozac or something, right? Absolutely. It happens all the time. Yeah, crazy, especially with 50% of them dying from their first heart attack. I know. It's really, and so just to highlight, you know, women's number one cause of death is heart disease. It is not breast cancer. It is heart disease. So it needs to be an area of focus. When estrogen goes down, all of the markers, your cholesterol, your LDL starts to come up in the small dense particles. You start to become more inflamed. So all the things you started to talk about with being microvascular, you start to see all those markers come up along with becoming more insulin resistant. Right. Can we talk a little bit about GLP-1s and how you get people to just think about when that's part of their journey? Is it at the beginning, middle, end? What are the indicators to you to think about GLP-1s for somebody? What are your thoughts there? GLP-1s are such an interesting thing. Now, I'm not a physician, so I'm not prescribing GLP-1s. But I think this is, if there was ever a case where you needed a nutritionist and exercise physiologist on board, this is the time, right? Because I do not believe that these should ever, ever be prescribed. In fact, I would go so far to say is I think it's medical malpractice to give GLP-1s if someone is not eating enough protein. And I believe that they should also be on essential amino acids during this time because it's a perfect insurance policy to make sure that you are going to hold on to muscle. But if the person is not willing to do resistance training and eat protein, they should not be given a GLP-1. They should not because everything bad about weight loss is just amplified with a GLP-1. And so you're going to make someone sarcopenic, low muscle mass, which is going to set them up for insulin resistance, cognitive decline. We know the size of your leg muscles is now correlated with your brain function, right? So it's going to set you up for all of these problems. So you have to do it as part of a program where first you're starting to get someone eating optimal amounts of protein based on their target body weight and their fat-free mass. and you're tracking their fat-free mass. You've got to track that. You cannot be on this and not track that. You can't just look at scale weight. No, no, no. In fact, if you're doing it that way, you're going to absolutely damage someone's metabolism and put them into a big metabolic hole. So you've got to be tracking their fat-free mass. You've got to be optimizing protein and doing resistance training. And then you're qualified. Like if I was the health czar of the world, then you would qualify to be able to use these, but not till then. Yeah. And that's exactly the protocol that we have here at MyNextHealth Clinics. We make everyone actually sign a piece of paper saying that these are the things they're going to be doing while they're on GLP-1s. Otherwise, they don't get them. Yeah. Because you can't use this just for weight loss for the full number of just bringing the scale weight down. It's going to lead to all these problems. And going back to the beginning of this conversation, that's why we're in the metabolic and obesity crisis that we're in today. And it's going to get worse because of these. And that's what you hear is the big problem with GLP-1s. It's like it doesn't need to be a problem. These are either the most amazing or most dangerous, depending on your use. Exactly. And they can be the most amazing, quickly improving insulin sensitivity, reducing inflammation. Oh, my gosh. Like, incredible use correctly. But that means you're not just calling in somewhere and getting them shipped to you and you're just monitoring weight. Right. Absolutely. That's going to give you the wrong information, and that information is going to damage your metabolism. And then even if you stay on them for life, because I know that's the – even if you stayed on them for life, you've now become sarcopenic. Right. And now you've set yourself up for a whole host of other problems in your life. Agreed. I like how you said that. They're either the most incredible drug or they can be the most dangerous depending on how you use them. And so it's critical to be working with a practitioner. like you said, nutritionist, exercise physiologist, medical practitioner, working in concert to make sure you're doing them correctly, because there are tremendous benefits to doing them correctly. But just ordering them online and, you know, just trying to inject yourself, that's going to lead to a disaster. Yeah. Right. I love it. Wow. We got a lot in. We did. When are we going to the gym together? Let's go. Let's do that. I'm a little scared to go with you, though. I feel like I'm going to be embarrassed. I do have a funny Mark Hyman gym story where he was crying for a week after the workout. See, there you go. That's why I'm scared. No, I love it. You look like you're doing pretty well here. Thank you. Yeah, I try to make it three, four times a week, and I just built a new one in my house. I'm going to start doing the two-by-two-by-two workout. So we didn't have enough room in our house for a gym, so we bought a shed. So I'm putting it in a shed, which, you know, like I think for me, a lot of times I need to like rush to either do a podcast or see a patient really early in the morning. And it's just too much travel to go to a gym and back. And so, you know, the first step of habit formation is just make everything easily accessible. Right. So that's what we're doing. Perfect. Yeah. It's going to be super simple. Yeah, super simple. It's just going to be a treadmill and some weights. That's it. Huh? That's all you need? I know. That's all you need. Although I closed off a floor of my house and built a big... Oh, my gosh. I was like, I need this to do videos. Yes, yes, yes. You have amazing content. By the way, can someone see the 2x2x2 workout on your YouTube page? I am going to need to put this together, clearly. Yes, please. Because I was like, I talk about it all the time, but I'm going to start doing some 2x2s, especially with supersetting, because this is easy in my spare time. I love it. Yeah, yeah. I would love to refer people to those workouts. So what's next for you? What are you doing now? Well, thank you very much for this. I am super excited about this. Kind of a leading question because I know the answer. Yes. I'm so glad. I'm trying to remember where we were where you're like, I have a great thing for you. I'm like, what's the thing? We were backstage and you were about to go on stage and I told you about it. I know, you're such a tease. Yeah. I was like, what is it? What's this great thing? Right. I feel like, you know, first of all, I've been working in the weight loss field for 40 years. And for 40 years, like 40 years ago, I was taking people to the gym saying, you need to put muscle on. And they're like, I'm afraid, you know, and taking them on field trips to Goldstrom and Venice. 20 years ago, I was teaching weight loss resistance and all the things could get in the way of you losing weight and cause you to gain weight, like cortisol and insulin and sex hormone imbalances and thyroid and toxins and gut microbiome. And I feel like it's all come full circle now. And I just am so excited, thrilled, honored, and appreciative because I am now going to be the chief. And I love the title, first of all, the chief metabolic officer. Like, how cool is that? That's who you are. That's what you've always meant to be. Thank you for saying that. I feel so seen, Darshan. The chief metabolic officer of Lindora. Yeah, I'm so excited about this. And the funniest thing is I was a personal trainer back in the day in L.A. And my clients went to Lindora. What? Oh, I knew when they started in Los Angeles. So I knew about Lindora. Right. So I've known about Lindora. I mean, it's 55 years. And here's what's really exciting. You know, I felt like it was really cool when I was in graduate and doctoral school that I was actually working in the outside because I could see if what they were teaching was actually correct or not. I mean, one of the things is you've got the lab. You've got real world. You need both. Right. You know, I think sometimes the lab scientists get stuck in the lab and they're one area and they don't realize humans actually have to be able to do the thing. Yeah. Right. But if you don't have any science and you're just out in the real world, you do crazy things. So you need you need the intersection of the two. And I was fortunate that I've had the intersection of the two. And you look at Lindora, 55 years in this field. And so they've seen everything. And, you know, they've been on really cutting edge. And this to me just shows how cutting edge they are, that they're making this shift into really focusing on you have to get healthy to lose weight, not lose weight to get healthy, that you have to really focus on metabolic health. It's so exciting. And so as chief metabolic officer of Lindora, which has locations all over, not just Southern California now, they're going national. There's locations everywhere. You're putting into place programs for people to do all the things that we just talked about. I know, it's so fun. Yeah. Right. improving their diet, using GLP-1s, getting their exercise routine in order, hormones, all of it. Yeah, microbiome, detoxes, the whole thing. All in one program. It's so exciting. All those areas I like to think of as the areas of weight loss resistance, the things that can get in the way of you losing fat or cause you to gain fat, despite you thinking you're doing everything right. Like you've dialed in your nutrition, you've dialed in your exercise. If you're not sleeping well, you're still going to be at risk for obesity. Yeah. You've dialed those two things in, but you've got high stress. Your hormones aren't balanced. Your thyroid's low. So really, this is an opportunity for someone to really peel their health onion, like take layer by layer by layer going. Because, you know, the thing with health is we're never done. Yeah. We're not done. No. Right. And so you might and you may have dialed it all in and then you have some crazy stressful experience that happens. Right. And you have to address that. So it allows people to have just this great opportunity to get in and kind of pull themselves out of that metabolic hole. Because anyone who's been out in the world or maybe they've tried a GLP-1 or they've gone on some crazy weight loss program or done some detox, juice detox, those make me absolutely crazy. And they've just dug a deeper metabolic hole for themselves. This is a chance for them to get a lifeline, get pulled out, and then, you know, one by one. And that's what I love this focus. I find so often with programs, they are overwhelming. We're going to do all these things. I'm like, let's just focus on getting your protein and your exercise dialed in. Now let's add in the GLP-1. Now let's balance your just one by one. Get it together so that all of a sudden you look back and go, I am feeling the best I ever have in my life. Yeah. And when you have someone that can curate that program for you, it's surprising how it doesn't take as long as you think it's going to take, right? We have all these, previously in weight loss, we would tell people one pound a week or you know, half a pound a week. And now my belief is you can accelerate that to a certain degree. You don't want to lose weight too fast. Of course, the problem in the past was people would make two steps forward, one step back, three steps forward, another step back. And it would take a long time or they just fall off the wagon for three months and then re-engage in January. You see that a lot, right? And you can totally get to a place a lot faster when you have someone curating a program for you that will keep you, number one, on the right track as well. And number two, bring in all the modalities you need. Right. It's not just about caloric restriction. It's about all the things that we talked about today. Yeah. And so I'm so excited that you're creating this program with them. You're the chief metabolic officer and people have a place to go that we can kind of hold their hand through the entire process. It's nice because I have a place to send people now. Yes, yes. And I really haven't. Yeah. You know, I've been sending them piecemeal to places to get this thing done and that thing done and hormones balance there. And, you know, and now I have one place that can do all of these things. But do them in a prioritized order. And that's a big challenge. Like you look and go, OK, if someone's weight loss resistance because maybe they are insulin resistant and they need their hormones, you don't just throw it all at once. Right. there's an order that is, you know, you've got to prioritize correctly. And that's the other piece is I know I can send them in, and they will get what they need. And they will get it done in the right way so that they can never have to go in a weight loss program again. Incredible. Right? I love this. It's going to be a game changer for people. And like you said, it's not just about weight loss anymore. It's about metabolic health. So even if you are TOFI, Even if you feel like your weight is okay, but your hemoglobin A1C is off and you're metabolically unhealthy, a program like the one you're putting together, Lindora, can help these people. Well, I actually think everybody should be in this program because let's say that you are metabolically healthy right now. You want to know where all your numbers are and then also start to look at other things. Are your hormones really where they need to be? Is your gut microbiome really where it needs to be? What about your total tox? I just did a toxicity test. I told my husband when the cold pledge leaked in our house, I was like, I think we've got a problem here. He goes, no, we don't. That's just the floor, blah, blah, blah. No, we blackmold. And because I did a test, I was like, uh-oh. You know him. Yeah. I wouldn't have known otherwise. So, you know, these things are important. I would have found out probably years down the road when I'm like, why am I so messed up here, right, when the symptoms got bad enough? Exactly. Well, I'm so excited for you and for us. Yes. Well, thank you. Thank you. I appreciate it. Yeah, no, thank you. And this is going to be an incredible episode for everyone that's looking to just get started on this journey. Or maybe you're halfway around, considering GLP-1s. This is a really great starting place. So thank you so much for joining us today. Thank you. Where can people find you? JJVirgin.com. Everything's there. And I've got my there with my Well Beyond 40 podcast with you on there. We've got to get you back for another one. Let's do it. I can't wait. Thank you, JJ. Thank you. So that was an awesome episode with JJ. I just learned so much all the time with her. Here are my top five takeaways. Number one, the scale is not a health metric. And often it really is actively misleading you. Weight loss doesn't tell you what you lost. You can lose weight rapidly by actually just losing muscle. And that makes metabolism worse, not better. Toffee, thin on the outside, fat on the inside, is a really common problem. JJ's biggest wish is that people stop moralizing the scale and start tracking body composition instead, because losing fat while preserving muscle is what's going to actually improve your health. Number two, muscle is a metabolic organ, and fast-switch muscle fibers matter the most. About 50% of your metabolic capacity lives in your muscle, and not all muscle is created equal. As people age, they abandon strength and power for only walking around or yoga, accelerating the loss of what's called your fast-switch muscle fibers. And this is tightly linked to frailty, injury risk, and mortality. Grip strength, push-ups, and sit-to-stand tests are better predictors of your long-term health than weight or BMI. Number three, eat less, move more. This fails because restriction triggers metabolic adaptation. Calorie restriction works in the short term, but fails over the long term in 95% of people. because the body adapts by lowering energy expenditure and increasing hunger. You don't lose weight to get healthy. You get metabolically healthy, so weight loss becomes effortless and follows afterwards. Excess body fat is a symptom of poor metabolic health, not the root cause. Number four, protein first changes everything. Hunger, blood sugar, and fat loss. Protein is a functional macro, not just another calorie. Eating protein first increases your satiety. It stabilizes your blood sugar. It supports GLP-1 release and preserves muscle during fat loss. JJ recommends 30 to 50 grams of lean protein, non-starchy vegetables with fiber, and not calculating complex macros ratios that overwhelm people and do absolutely nothing. Number five, you don't need long workouts. You just need strategic intensity. Metabolic health doesn't require hours in the gym. Short, intense exercise snacks, strength training using their 2x2 method every week with push-pull hinge movements, and brief HIIT workouts outperform long cardio for preserving muscle and insulin sensitivity. As little as four and a half minutes a day of vigorous movement can significantly reduce mortality risk, proving consistency and intensity matter more than duration. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.