Muscle, The Organ For Longevity: Forever Strong Book Review

This week we thought we would take a different approach to the podcast and article, hopefully a welcome diversion from the usual topics. With all the information out there these days understanding concepts for our health and wellbeing can be confusing to say the least. With these podcasts we look to help you better understand your back health and one related topic that we’ve explored from time to time has been your muscle health.

With the recent release of Dr Gabrielle Lyon’s book “Forever Strong: A new, science-based strategy for ageing well” we thought it was worth sharing with you all. The hope is that in sharing this information it can give you a better understanding of such an important organ, our skeletal muscle, and how it helps us in ways you certainly were not aware of. The vulnerabilities it has when we are unwell and much more. 

To this end, we’ll be drawing on some concepts that we found interesting in the book, tying the comments back to your back health to help you make more informed decisions going forwards. This is a longer book, 9 hours of audio or about 400 pages long. Of course we will not be covering it all in today’s episode. If you do find some of the points we cover of interest we would definitely recommend checking the book out yourself, especially the second half for some really practical tools that will help you move forwards!

Your low back pain, injury & recovery in mind

As we go through today’s episode please consider the following truth: your back pain or sciatica is fundamentally an injury, damaged tissue. This tissue is predominantly derived from protein. On top of that, the rehabilitation & strengthening process involves you building muscle tissue and improving the health of the muscle tissue you have. If you fail to act on this understanding, it will be tremendously difficult to recover. A simple thought experiment would be that we need oxygen to breathe, and we need it to perform in life, if we withhold this entirely from our bodies the outcome is obvious, but if we withhold it in part, life becomes extremely difficult, just ask anyone altitude training, or with emphysema. We need to give our bodies what it is asking for, and when we are undergoing regenerative processes we need specific things to fuel that process as “raw materials”.  

What is your body made of and what it does

Over 60% of your body is made up of water, of the remainder, 50% is protein. Protein forms everything from the collagen that connects your tissues together, in the way of ligaments, discs and tendons, as well as the connective tissue between these and other bodily parts. It forms enzymes within your body that carry out more functions than are worth counting, from digesting food, to producing mRNA within cells and executing their function within the cell itself. Protein goes on to produce hormones that control various aspects of our body. Protein is used in the natural waste management and detoxification process, for example, the creation of a well known compound called Glutathione that removes toxins from your body. Protein is used in the repair and regeneration of all of your body’s structures, brain, lungs, kidneys, liver, bones and of course your muscles.

We’ll come back to protein, and more specifically amino acids later on but suffice to say, there is a significant demand on the body for the use of protein in our day-to-day life. However, when we are unwell, injured, or looking to rebuild, these demands are even higher, something that we should be acutely aware of if we are suffering from a long-standing back issue, that is associated with a degree of weakness and insufficiency in the muscular system. 

Why you need more muscle

Muscle as an organ seems to be lower down on the pecking order when compared to the many other demands your body has for protein, they could be considered much more important than the maintenance of muscle mass. Is it any wonder we often lose muscle strength and mass when we are unwell, more on that later… Here are just some of the functions that muscle has within our body: 

Muscle as a sink for your blood sugar levels:

This important role of muscle is completely overlooked by many, which is surprising given the pervasive nature of diabetes & obesity in modern society, and all the health consequences that run downstream of these issues. Through your muscular glycogen stores you have a “sponge” that soaks up excess sugar after a meal. This muscle plays a vital role in the support and regulation of normal blood sugar levels, as we discussed in last week’s episode on metabolic health. Dr Lyon talks about thinking about your muscle tissue as a suitcase, the larger the suitcase the more room we have to stuff sugar into, however too many of us have small suitcases, and when the suitcase is full, the sugar is left circulating around the body. The response from your body is to try and pump out more insulin, but you can only put so much in the suitcase. Over the years, this over-secretion of insulin results in insulin resistance, preceding the onset of type 2 diabetes

Your muscles as a pancreas saviour:

The really interesting concept that Dr Lyon covers in the book is the role that muscles can have in a process called insulin independent uptake, this is whereby the muscles, when used, act as a big sponge pulling excess sugar out of your bloodstream without the need for insulin. Of course, the more healthy muscle tissue we have, the more effective this process is going to be. Particularly for those who’ve struggled with weight gain (fat) and muscle loss, over the years, even before considering the role that back pain could have on accelerating this unfavourable occurrence. Some of the positive effects of this “activation” of your muscle tissue even continue beyond the 24 hour period.

Protection from gestational diabetes in pregnancy:

The two aforementioned features of muscle tissue combine to be particularly important to ladies of childbearing age when considering pregnancy. Natural changes in the body free up more sugar into circulation which can have minor, or severe negative consequences during the pregnancy. Having more muscle tissue to support your body giving excess sugar places to go when stimulated by insulin, and being actively pulled from circulation in a response to exercising this muscle through the insulin independent uptake is a potentially life changing benefit for some ladies who may be more prone to gestational diabetes. This is something that should really be covered as part of the pregnancy education process, unfortunately it is not currently.

Your muscle is a resource when you’re unwell

It shouldn’t come as a surprise that when you are unwell you lose muscle, but why is this? On the one hand the lack of activity creates issues, Dr Lyon quoted an interesting research paper stating a 3% loss in leg muscle tissue from 7 days of bed rest, yes, just 7 days! We all know this having experienced it, but what about 6 months or 6 years of significantly reduced activity because of back pain or sciatica? You can see how this can start to impact health so negatively. 

What was quite revelatory for me was more about precisely what happens when we are unwell. The muscles that we do have, are used as a resource to pull amino acids (more on these later) from our muscle tissue. Literally breaking down our muscles to fuel the immune response amongst other things. Diet can offset this but as we’ll see later on, all too often it does not. This is one of the reasons we are so insistent that you look after yourself when unwell, focusing on getting better, which means fueling your body properly and recovering, reducing the wastage that occurs in the muscles. If your body doesn’t get the protein (amino acids) from food in sufficient quantity during this period of illness, it will break down your body to provide what you’re not giving it, muscle first!

When we think of back pain, for some the recovery and rehabilitation process takes time, you therefore cannot afford not to provide your body with adequate nutrition, or rest on your laurels when you think your back is feeling better. The more muscle you have, the more you have to lose. Which follows on nicely to the next topic

Your muscle increases your survivability

No matter the condition, no matter the illness, in nearly all cases of ill health, the person with more muscle tissue can fare better than the one with less. Dr Lyon goes into some detail around a process that those undergoing cancer treatment can suffer from, “cachexia”. This is where there is severe muscle wasting. From the previous section it is easy to see why! 

Another issue that I have the poor fortune of experiencing in the family, like so many, is the presence of conditions such as Alzheimers and Dementia. Referencing studies that are almost predictive of things like dementia years, or even decades in advance, this gives rise to some real opportunities for corrective action. One such reference was looking at waistline circumference as a predictor of lower brain volume. As the waistlines go up, the brain volume goes down. 

There are other examples such as autoimmune conditions and hip fractures from falls, which all continue to stack the deck making it more and more obvious that we should all be prioritising our muscle health. This is rounded off again by the catch-all that: 

“Higher muscle mass leads to greater survivability from all causes of mortality”.

Oh, and it helps your lower back injury no end too!

Your muscle plays a vital role in your health and wellbeing

Fundamentally your muscle is there, as Dr Lyon states, to be a “suit of armour” through life, whether it is there to protect from horrible diseases, make the process of pregnancy smoother, reduce the likelihood of falls in older age, or protect against diabetes, the list goes on. 

This provides yet more ammunition for why building your muscular system should be a real priority for life. One of the things we sincerely hope you continue to do, no matter whether you’re a member of the Back In Shape Program or not. Too many have inadequate muscle for their lower back health and recovery. The little muscle you do have, or are building, is also there to be used in times of illness as a resource, and perhaps is a little more useful than we first envisioned. 

Difficulties with improving muscle health and mass with age

It is crystal clear that the process of building and maintaining muscle gets harder as we get older, this is however made worse by erroneous beliefs that lead us to consume less of the fuel that supports muscle health as we get older. 

“I don’t need protein, that’s for young bodybuilders, not me!” 

Wrong, you need more protein, of better quality than you did when you were younger, not less, or more precisely you need more of specific amino acids!

As soon as we hit the late 30’s early 40’s there is a point at which we can get away with inefficiency no more. There are a number of reasons for this but here are some, which become more relevant as you get older

• You lose about 1% muscle mass per year from 40, this increases beyond 50
• You lose more than 1% muscle strength per year, (over 40 & 50, same as above).
• Your body is less responsive to the protein
• You’re more likely to get unwell and suffer the consequences quicker.

It is clear that as we get older the ability to maintain and build muscle tissue becomes more challenging, but it becomes more important too, especially considering everything we’ve covered so far. 

The important thing is to note some of these changes, such as decreased sensitivity to protein, so that you can act accordingly, and offset the inefficiency that develops with discipline and action. For those of you over the age of 50, struggling to progress and build strength to recover from lower back pain, know that this is vital for you! The 25 year old you would have got away without being this disciplined. That being said, if the 25 year old you had the choice to be disciplined, doing so would give you much more to lose before problems were to occur. 

Protein, the forgotten resource needed for your muscle

Before we get into the specifics of protein, which is really important, it is worth covering the history that Dr Lyon maps out, in such an interesting way in the book, to see why protein has been ignored for so long in favour of detailed conversation on fats and carbohydrates over the recent decades.

One interesting historical event of particular interest occurred during the world wars of the last century. Where the population of the US were instructed by President Hoover that supplies of Meat in particular were as vital for the soldiers as ammunition and that keeping troops adequately nourished was of national concern. As such the population moved to sacrifice this vital resource so the troops could be supported. Context is important here and it was only in 1926 that the first vitamin was identified and so the fortification of food was something that was underway in the ensuing decades, although perhaps in its infancy. Dr Lyon goes into very enlightening detail here, suffice to say, like a child with a new toy, these newly identified vitamins took centre stage in the following years, at the expense of other avenues for research. 

The interesting thing to observe fast forwarding 50 years from the war is that you now have voluntary abstention from meat based production by the population. 

Muddled information confuses us all & vested interests

Heart disease, diabetes, obesity, all issues which have commonly been put squarely at the feet of meat, in decades gone by putting people off providing their bodies with a resource we will see shortly is in a league of its own. 

Even just this past week in the news an abysmally designed Harvard study has cited that eating red meat is as bad as drinking soda for diabetes, and is making the media rounds. The sheer poor quality of this research for example in failing to identify that people that ate more red meat, smoked more, were overweight, drank more alcohol and did less healthy practices than those that consumed less red meat. Perhaps a better way to phrase this would be: 

“People that smoked more, drank more alcohol, consumed more fast food, exercised less and were less likely to take vitamin supplements & eat enough fruit and veg… also happened to eat more red meat”

You see how when we phrase it like that we get a whole different understanding than if we phrase the “red meat first” or just ignore the additional context. In this instance, getting people to fill out a questionnaire on what they ate and did in the recent months and years. Firstly, I’m not too sure how good we are at remembering what you ate and did yesterday, let alone over the last month! So accuracy is an issue, secondarily, there is no mechanism in this to figure out what precisely is the cause of the increased diabetes, yet it is put forward that it “must be meat”.

Obesity & diabetes on the rise with a little surprise

It is widely considered that obesity and diabetes are on the rise and have been in the recent decades. It is also reasonable to state that meat has been strongly implicated in such a rise. However, interesting observations that are similarly true in the UK as the USA is that in the period since 1970 there has been a significant reduction in meat intake, particularly red meat. Although causation is not the same as correlation, these sorts of facts that seem to be left out, create a much more nuanced picture on health.

When we move to consider the vital role of protein, the superior quality found in red meat in particular, and the vital protective role of muscle as previously discussed, such confusing messages for the population clearly seems to be having a detrimental effect on societies health at large. 

We do not eat protein for protein.

Take a look at the back of the pack of any food produced here in the UK and you will see fats and carbohydrates broken down into their building blocks, the bits we use in our bodies and the different types in the case of fats. For example, sugars, polyunsaturated fats etc. But you’ll see protein is just “protein”. This isn’t helpful. You see, protein actually consists of 20 amino acids. It is these amino acids that our body uses. A clear issue with including all 20 amino acids would be that we’d end up with a laundry list of ingredients on all foods. 

Of these amino acids our body’s can actually create many of them “in house” meaning we do not need the specific amino acid to be provided as our body will manufacture it from other spare parts as required. However there are 9 “essential” amino acids that we MUST get from our food. Dr Lyon goes into the details of these but one in particular is Leucine, this one is of particular importance as it is responsible for protein synthesis and the building of muscle.

You must get enough Leucine in order to build muscle, regenerate muscle, create good quality muscle. This is a binary thing, you either get enough to make processes happen in the body, or you do not. 

Although there is much more interesting detail in the book, as you would imagine, protein can really be evaluated in terms of “quality”. This means, does the protein you’re consuming have enough of the various amino acids or are you required to combine various sources of protein in order to meet your needs.

Action points from Forever Strong

If you’ve found this episode interesting and want to learn more it is certainly worth checking out the book as mentioned earlier, I couldn’t possibly put all the wisdom and nuance into this podcast. However I will leave you with some simple comments that will hopefully help you move forwards especially if you have a lower back issue, or any health issue for that matter. 

• Muscle is your organ of longevity, the more you have the more you can lose before problems run away with themselves, your muscles make you more resilient to EVERYTHING.
• Muscle must be fueled by good quality protein in your diet, as we cannot rebuild ourselves out of thin air! 
• Quantity of specific Amino Acids matters, without enough, things do not occur as the signals are not strong enough.
• As you get older, your sensitivity to these signals gets WORSE, so it is more important that you get the right amount of quality (complete) protein. 
• The easiest way to do this is through meat, however if you are plant based it is possible but simply requires some research and combination of plant sources. 
• Additionally, if you’re getting your protein from plant sources you’ll need 30-45% more, so be mindful of how this affects your calorie intake.
• Getting your protein right means you will fuel your muscles appropriately, and that they will then be able to respond to your workouts and rehabilitation.

It is not complicated, although the above might seem a little overwhelming especially if you’re coming to this for the first time. It can however be simplified as:

“Your muscles are your body armour to protect you from both physical and constitutional illness, protein is the resources they need to function and grow. Get this right consistently and you will have health and wellbeing for the long term.” 

If you’re interested in the book, the audio is a great listen to get the information in that medium. However, the physical copy has lots of recipes, detailed instructions and guidance that will be really helpful for those of you who want a little bit more step-by-step guidance. I couldn’t possibly cover it all here but hopefully this has made you think about this facet of your health and wellbeing in a new way!