Some say that up to 80% of patients present to the emergency department with conditions that are a result of the decisions that they make. In fact, a common refrain when my residents present a patients is something like this… "This is a 50-year-old patient with a history of hypertension, hyperlipidemia, obesity, type 2 diabetes, chronic kidney disease, pulmonary hypertension and heart failure with preserved ejection fraction..." They are describing a constellation of symptoms that early in my training I dubbed "Harrison's Syndrome," named after Harrison's Textbook of Medicine. It was my way of saying that these patients had every medical condition in the book.
When I was in medical school, the most difficult class I took was biochemistry. The professor displayed a dizzying diagram of all the pathways that we would learn over the course of the semester. I was told that by the end of the course, I would be able to hold a hamburger and describe how every part of that hamburger is metabolized. For the entire semester I labored over memorizing each pathway. During the last 2 weeks of the course, we discussed the hormonal regulation of the pathways. We learned how the body activates glucose storage when levels are high or glucose regeneration when levels are low. To discuss the regulation of all the pathways that I had just memorized was to see the page come to life. It was like feeling the swelling and quieting of a finely tuned car engine as the accelerator is depressed and released.
What I have come to learn now after a decade and a half of seeing biochemistry in action in my patients is that is that all of the conditions that comprise "Harrison's Syndrome" are predictable and linked by a common entity called metabolic syndrome. Classically defined, metabolic syndrome is constellation of excess abdominal weight, hypertriglyceridemia, low HDL, elevated blood sugar and elevated blood pressure.[i] Fundamentally the syndrome is drive by an excess of glucose and an impaired ability of the body to process that excess. How the body handles this simple molecule, in turn, has a huge impact on overall health and wellness.
In this book, Dr. Gabrielle Lyon discuses metabolic health and how it is at the root of our overall health and longevity. More specifically, she discusses how skeletal muscle health, in particular, is the fundamental component to maintaining optimal metabolic health. Do accomplish this, the book is divided into three basic parts.
In part 1, Dr. Lyon introduces the concept of metabolic dysfunction as an overwhelmed ability of the body to process glucose. Healthy skeletal muscle, though, plays an important role in soaking up excess glucose for consumption in the muscle or conversion to glycogen and is therefore not just protective but also the antidote for metabolic syndrome. However, the push by most in medicine and nutrition over the last half century has focused health metrics on calorie consumption and fat loss ignoring the benefits of sufficient healthy skeletal muscle throughout all stages in life. This has left us with an epidemic of aging people with sarcopenia despite a wealth of literature demonstrating that increased muscle mass offers protection from morbidity and all-cause mortality.
After discussing the health benefits of developing healthy skeletal muscle and the harms by failing to do so, Dr. Lyon begins to lay the foundation for using muscle to combat metabolic disease. Part 2 focuses on nutrition. In this section, Dr. Lyon begins by discussing the history of nutrition science and shows how minimum consumption recommendations that were established in the Great Depression and World War 1 era coupled with sometimes duplicitous marketing in the food industry and ill-informed nutrition cultural trends have resulted in the "Modern American Diet" that has led to a society that is poorly nourished.
She then follows this discussion by breaking food down into the three main macronutrients (protein, carbohydrates and fats), and shows how each play a pivotal role in our overall health and nutrition.
Protein is the macro that is responsible for not just muscle synthesis but also for all of our cellular machinery. Protein in the form of amino acids are the key building blocks of ribosomes, peptide hormones, neurotransmitters and more. Our body has the ability to synthesize some of the amino acids, but many can only be attained through dietary sources. While there are amino acids in many different foods, the most efficient source is meat. When there is scant supply of amino acids, our body will scavenge existing proteins - usually muscle to supply its needs. To maintain adequate functioning of our body and also allow sufficient amino acids for muscle protein synthesis, we should, therefore, seek to consume between 0.6 - 1.0 grams of protein per pound of ideal body weight daily.
Carbohydrates are the fuel source for the body. The body converts carbohydrates into glucose, which is in turn is converted into ATP, assuming a healthy quantity of cellular mitochondria. Those carbs that are not immediately processed into ATP is stored in the muscle as glycogen. But when the shelves are full, additional excess glucose is stored in adipocytes as adipose (fat) tissue. While carbs are important for fueling our body, most processed foods that we consume are heavily carb loaded and greatly exceed the ideal 1:1 carb to protein ratio.
Fat has been the shamed macronutrient as most nutritional advice tries to push "low fat" diets and foods as a way to prevent obesity. While not all fats are created equal and certain fats are less helpful, lipids are a key part of normal cellular architecture and hormones. Thus, consumption of mono-unsaturated fats and poly-unsaturated fats can play an important role in our overall health.
As we synthesize and seek to digest this nutritional primer, Dr. Lyon proposes that focusing on a protein centric diet is the key to optimizing our overall health and achieve body recomposition (i.e. fat loss and muscle growth). This brings us to part 3. The first 2 parts would be sufficient to make this a very helpful book. But in the final section, Dr. Lyon takes the information out of the realm of the theoretical and into the realm of the practical. She doesn't just leave the reader with a bunch of knowledge but no understanding of how to implement the information. She lays out very practically how to compose a nutrition plan and fitness regimen that are geared toward appropriate macronutrient consumption, muscle protein synthesis and ultimately body recomposition. She includes detailed daily meal plans, protein rich recipes and workout plans with reps and sets. After reading this book, the reader is fully equipped to lean into healthier living by improving skeletal muscle health.
This is easily one of the most important books that I have read on the topic of health and nutrition. Dr. Lyon shows the science behind a concept that I have come to believe sincerely and feel strongly about - the importance of fitness and nutrition for healthy living. For this reason, I highly recommend this book.
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