The Muscle Mindset: The Missing Link to Health, Longevity, and Brain Power with Dr. Tommy Wood

In this episode of Sound Living, Dr. Mike Banna speaks with Dr. Tommy Wood, an assistant professor at the University of Washington. They explore the vital role of muscle mass in health, longevity, and cognitive function, emphasizing that strength, rather than mere size, is key to well-being.

Tommy highlights the Fat-Free Mass Index (FFMI) as a more informative health measure than Body Mass Index (BMI) and advocates for resistance training over endurance activities to maximize health benefits. They also discuss protein intake recommendations and aim to dispel myths associated with muscle-building and wellness trends.

Guest:

Dr. Tommy Wood (@drtommywood)

Episode Transcript

Mike: I'm very excited today to be joined by Dr. (00:28):
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Mike: Tommy Wood, who is a trustee of the BSLM and also a, I think your background (00:32):
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Mike: is in neonatal neuroscience, isn't it? (00:38):
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Tommy: Yeah, my academic background, yes. (00:41):
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Mike: Well, look, tell us a little bit about your background and a bit about who you (00:43):
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Mike: are for those who don't know. (00:48):
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Tommy: Sure. So right now I'm an assistant professor of pediatrics and neuroscience (00:50):
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Tommy: at the University of Washington in Seattle. (00:55):
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Tommy: I grew up in the UK, and that's where I did most of my training. (00:58):
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Tommy: So I was a graduate entry medic. (01:03):
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Tommy: I did undergraduate degree in natural sciences at the University of Cambridge. (01:06):
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Tommy: Then I did graduate entry medicine at Oxford. (01:11):
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Tommy: I worked as a junior doctor in central London. I was an academic FY doctor at Guy's and Tummy's. (01:13):
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Tommy: And then I got asked or invited to do a PhD in Norway in neonatal neuroscience. (01:22):
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Tommy: And that's kind of where the bulk of my academic work sits. (01:29):
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Tommy: And so I look at animal models of neonatal brain injury and how to treat that. (01:34):
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Tommy: But then sort of increasingly, I'm involved in clinical trials, (01:40):
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Tommy: analyzing clinical data, trying to then implement what we find in the lab, (01:43):
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Tommy: actually in the population that we care about, which is babies with brain injury. (01:47):
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Tommy: But along that journey, particularly as a student, I was an athlete, I was a rower. (01:53):
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Tommy: I then coached a bunch of rowing. I was head coach of the medical school boat (02:02):
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Tommy: club at Oxford for a couple of years. (02:08):
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Tommy: And then during my PhD in (02:10):
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Tommy: particular worked with a company that was sort (02:13):
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Tommy: of coaching athletes from a like a sustained health (02:16):
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Tommy: performance kind of bent so looking (02:20):
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Tommy: at their diet and sleep and training strategies and stuff to try and improve (02:23):
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Tommy: their or sustain their performance so i've kind of had these these two streams (02:27):
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Tommy: of sort of the academic well there's the medical side then the academic side (02:32):
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Tommy: which is sort of in basic neuroscience and then working with athletes so so (02:35):
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Tommy: now i still do work with athletes. (02:39):
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Tommy: I mainly work with Formula One drivers as a performance consultant. (02:41):
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Tommy: And so these threads then come together in my other interests which are around. (02:46):
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Tommy: Uh traumatic brain injury and concussions particularly as (02:53):
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Tommy: it relates to athletes but then also long-term cognitive function (02:56):
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Tommy: cognitive decline health span how that relates to physical activity muscle mass (03:00):
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Tommy: all that kind of stuff and what's nice about being an academic is you can kind (03:05):
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Tommy: of do whatever you want so like one one day i'm in the lab you know doing some (03:09):
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Tommy: doing some studies and then the next day i'm writing a paper about muscle mass and cognitive function, (03:13):
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Tommy: in a population cohort. (03:19):
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Tommy: So it's nice to be able to do all these things at the same time that kind of (03:21):
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Tommy: come together in that thread of how do we keep a brain and a body healthy for (03:24):
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Tommy: the entire lifespan, you know, just that small, that small thing. (03:28):
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Mike: What we're going to talk about today mainly is about muscle and how it relates to lifestyle medicine. (03:32):
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Mike: And I guess my question about that is, do you think that your interest in that (03:38):
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Mike: and your focus on that has come about because of your interest in athletics (03:43):
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Mike: and being involved in sports and all that sort of stuff? (03:50):
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Mike: Or do you think it's come about because of your realization of how important (03:52):
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Mike: it was from a lifestyle medicine perspective? (03:57):
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Mike: Where did that sort of arise? (04:00):
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Tommy: Yeah, it's a good question. And it's probably a bit of both. (04:02):
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Tommy: What I think my various experiences have allowed me to do is help to see sort (04:10):
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Tommy: of common strands across different areas. (04:15):
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Tommy: It could be based in neuroscience, it could be different times in life when (04:19):
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Tommy: physical activity or muscle mass might be important to health. (04:24):
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Tommy: And so that's kind of been important. But the other side of it is that I like lifting weights. (04:29):
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Tommy: And that's probably something that's driven at least part of my interest is (04:35):
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Tommy: personal experience as well of course sort of feeds into a lot of what we do. (04:41):
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Mike: Yeah. And I think a lot of people share that. I think the, and this is, (04:46):
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Mike: I think both a blessing and a curse with, with lifestyle medicine, (04:51):
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Mike: I think, because so many of us who get involved in talking about lifestyle change, behavior change, (04:54):
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Mike: often it comes from that sort of personal passion, doesn't it? (05:00):
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Mike: So that's why I think we have so many differing perspectives in the lifestyle (05:03):
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Mike: world, because we've all got that different background. (05:07):
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Mike: We've all got those different things that we found to be (05:10):
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Mike: beneficial to us um and then we (05:13):
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Mike: we sort of gravitate towards trying to promote (05:16):
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Mike: those to other people which is a which is a great thing in in many respects (05:18):
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Mike: um but has it has its pitfalls and and i suppose that's why like i'm really (05:22):
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Mike: keen to talk about um to talk about this from like an evidence perspective you (05:27):
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Mike: presented a talk at the bslm conference last year, (05:32):
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Mike: and it was a really interesting and fascinating talk and it was i really (05:37):
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Mike: enjoyed it because like yourself i am (05:39):
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Mike: a proponent of training and i really enjoy it and (05:42):
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Mike: i always love hearing things that that confirm (05:45):
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Mike: that i'm doing good stuff i think we all (05:49):
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Mike: do um but you did present quite a (05:51):
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Mike: lot of evidence that actually i hadn't even been aware of and um that was really (05:54):
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Mike: great to hear about so i would like to delve into that a little bit if that (05:59):
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Mike: would be okay today um so the first thing that i would like to talk about if (06:01):
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Mike: possible um is ffmi which was a concept that i hadn't really. (06:08):
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Mike: Heard of before your talk, actually. So, tell us about that. (06:14):
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Tommy: Sure. So, FFMI is the Fat-Free Mass Index. (06:17):
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Tommy: It's very much like the Body Mass Index, BMI, but you essentially calculate (06:21):
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Tommy: it after taking away body fat. (06:28):
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Tommy: So, you would do, it's usually a DEXA scan, but you can use calipers. (06:31):
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Tommy: So, there are other ways to estimate body fat levels. And then you just kind (06:36):
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Tommy: of ignore them, and then what's left of your mass you use to calculate a number (06:39):
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Tommy: that's similar to BMI, so it's divided by your height in meters squared. (06:44):
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Tommy: And this is something that people who lift think about a lot, I think. (06:48):
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Tommy: And there's been some studies on FFMI as it relates to resistance-trained populations, (06:56):
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Tommy: for want of a better word. (07:05):
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Tommy: And we think in general that an FFMI of say 25 is like the maximum you could (07:06):
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Tommy: achieve without some extra help from the end of a needle or a pill. (07:14):
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Tommy: And so then that allows us to kind of scale, you know, where you might want (07:20):
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Tommy: to go, but you can then use that. (07:25):
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Tommy: You can use FFMI as a measure to say, well, how much lean mass or, (07:27):
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Tommy: you know, fat-free mass does this person have, you know, relative to their height? (07:33):
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Tommy: And then how does that relate to their long-term health? (07:37):
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Tommy: And what you see from multiple studies, actually, and what I think is really (07:40):
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Tommy: important, and I'd like more people to know about it, is that in general, (07:45):
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Tommy: your FFMI or your fat-free mass, which includes bone and organs and all that (07:52):
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Tommy: kind of stuff as well, and we know that having enough and strong bones is critically (07:56):
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Tommy: important for long-term health. (08:01):
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Mike: And organs. (08:03):
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Tommy: And organs, yeah. You want some of those. (08:04):
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Tommy: And when you look at how these things predict long-term health, (08:09):
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Tommy: your fat-free mass is a much better predictor than your fat mass. (08:14):
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Tommy: And that could be cognitive function. It could be just overall mortality. (08:19):
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Tommy: And the funny thing, and it was not funny, it's quite sad because as a society, (08:26):
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Tommy: we're so caught up on fat mass, (08:32):
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Tommy: for good and for bad. And there are people on both sides of that debate that make very good points. (08:38):
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Tommy: But what's sort of critically underlying that, which is much more important, is muscle. (08:45):
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Tommy: And so I believe that focusing on muscle tissue is a weight neutral way to improve (08:50):
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Tommy: health because you don't need to worry about anything else. You just add muscle tissue, right? (08:56):
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Tommy: That's an important thing. Anybody can do it. And we know that it has significant benefits. (09:02):
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Tommy: So that's why I think focusing on FFMI as a measure is much more sort of empowering (09:07):
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Tommy: and equitable and all encompassing because we know it's important and then we don't have to, you know, (09:11):
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Tommy: sort of bow down to some of these prejudices that have been built into the healthcare (09:18):
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Tommy: and society that have sort of been, you know, damaging people's health as well. (09:23):
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Mike: Yeah, 100%. I mean, I know that there have been, you know, (09:27):
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Mike: lots of people have savaged BMI as (09:31):
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Mike: a measurement and obviously it is a measurement (09:34):
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Mike: that is i think it's ease of use is what has (09:37):
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Mike: made it so ubiquitous and and so widely used (09:40):
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Mike: rather than necessarily how valid and (09:43):
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Mike: useful it is but some of the proponents of of bmi (09:46):
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Mike: have argued the arguments that i've heard (09:49):
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Mike: in the past which i think are odds with what you're saying so that's why (09:52):
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Mike: i'd sort of like to to to explore that (09:55):
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Mike: because i think this isn't true what i'm about (09:58):
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Mike: to say and i'd like to confirm that um so people (10:00):
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Mike: have said when arguing that bmi is a valid measurement (10:04):
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Mike: of health because when people talk about trained individuals who (10:06):
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Mike: obviously you know by bmi scales might be in the (10:10):
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Mike: obese or very obese category but are (10:13):
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Mike: you know let's say rugby players or power lifters or whatever um and might be (10:17):
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Mike: relatively lean and a lot of people have argued that well it's because they're (10:23):
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Mike: carrying around more mass so their hearts have to work harder and things like (10:28):
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Mike: that but that's not the case is it with I mean, unless we're talking about, you know, (10:31):
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Mike: performance enhancing drugs and stuff like that, which I think then puts people (10:35):
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Mike: into a slightly different category, which isn't really covered by this, (10:38):
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Mike: that wouldn't really be the case, would it? (10:43):
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Tommy: No, I don't think so. And I think there's been some misconstruing of some population (10:46):
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Tommy: data related to this. And I think it is important, right? (10:52):
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Tommy: So muscle mass as a measure, I think is important. But what's probably more (10:55):
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Tommy: important is muscle function, and we'll get to that as well, (11:00):
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Tommy: because I think it matters how you gained your muscle mass. (11:04):
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Tommy: And so if you look at BMI as, say, a predictor of mortality, (11:09):
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Tommy: there's been this quote-unquote phenomenon. (11:15):
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Tommy: Obesity paradox, which is that individuals who are overweight or obese actually (11:20):
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Tommy: live longer than those who are underweight on the BMI scale. (11:25):
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Tommy: And when you account for muscle mass, that essentially goes away. (11:30):
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Tommy: So it seems to be that that signal is driven by individuals who have enough (11:35):
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Tommy: muscle mass, and it's the muscle mass that's important. (11:42):
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Tommy: And then at the other end, if you have a very low BMI, you have low muscle mass, (11:45):
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Tommy: you're probably close to sarcopenia and all the things that come along with that. (11:51):
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Tommy: However, there's been some more recent studies that suggest that those with (11:56):
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Tommy: a large amount of muscle mass have an increased risk of cardiovascular disease, particularly men. (12:01):
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Tommy: There was a publication that came out on that recently. (12:06):
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Tommy: However, so they showed that the more muscle you had, the worse your heart disease risk. (12:11):
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Tommy: But the stronger you were, the lower your heart disease risk. (12:16):
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Tommy: So there's this discrepancy then, because usually you'd think if you have more (12:19):
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Tommy: muscle mass, you're stronger. (12:25):
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Tommy: And on average, that's generally true. (12:26):
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Tommy: But a similar study that actually I did with some colleagues we just submitted (12:30):
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Tommy: looked at this in relation to cognitive function in older adults. (12:35):
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Tommy: We had leg strength, we had body composition, we had a whole bunch of blood (12:39):
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Tommy: tests related to nutritional status and stuff that's important for dementia (12:43):
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Tommy: risk and cognitive function. (12:46):
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Tommy: And we saw actually something very similar. (12:48):
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Tommy: And the first thing that surprised us was that muscle mass was not correlated (12:52):
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Tommy: with physical activity. (12:56):
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Tommy: So muscle mass was just being gained as part of gaining mass in general, (12:58):
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Tommy: but actually those who are more physically active didn't have more muscle mass. (13:03):
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Tommy: And so what I think is happening in these population data sets is that muscle (13:07):
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Tommy: mass is being accrued just as we accrue more total mass. (13:10):
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Tommy: Like if you gain weight, some of it will be muscle. (13:13):
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Tommy: And these, and total mass and muscle mass were positively correlated. (13:16):
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Tommy: But if you are getting stronger with that, then that's associated with lower (13:23):
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Tommy: mortality, lower cardiovascular disease risk, better cognitive function. (13:29):
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Tommy: So the takeaway from that is more muscle is useful, but only if you gained it (13:32):
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Tommy: in a way that's functional, right? (13:38):
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Tommy: But what I mean by that is you gained it through working your muscles, (13:42):
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Tommy: and that's not how a lot of people gain their muscle tissue. (13:46):
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Tommy: So, this is similar to the mortality stuff that I presented at BSLM, (13:49):
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Tommy: which basically shows that the action of muscle that's important for all of (13:54):
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Tommy: these health outcomes is in strength and function. (13:59):
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Tommy: So, if you gain muscle by doing some kind of physical activity, (14:02):
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Tommy: that's the benefit right there. (14:06):
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Tommy: So, your muscle is important, but it has to come with increased function as (14:08):
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Tommy: well as just the total muscle itself. Does that make sense? (14:12):
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Mike: It does make sense i suppose just for the benefit of our listeners what are (14:15):
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Mike: the ways apart from just accruing like what what ways would you increase muscle (14:18):
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Mike: mass without increasing the function or the strength. (14:23):
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Tommy: So that's so that's essentially the the gain of muscle mass just through a caloric (14:26):
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Tommy: surplus without any associated physical activity um which you know uh there's (14:33):
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Tommy: there's some i think there's some protective function of more muscle mass in that setting, (14:40):
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Tommy: but in terms of the real signal of benefit, (14:44):
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Tommy: it would be, you know, to gain muscle mass, usually you probably need to be (14:47):
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Tommy: in a caloric surplus, so that's fine. (14:52):
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Tommy: Um, but although it is possible to gain mass in a, in a, in a deficit, (14:54):
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Tommy: if anybody wants to get really nerdy about that, we can. (14:59):
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Tommy: Um, but there needs to be a stimulus to the muscle. So I think that's the most (15:02):
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Tommy: important thing, uh, actually. (15:07):
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Tommy: And, and the, the reason why we may focus on muscle in studies is because it's (15:09):
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Tommy: easier to stick somebody in a scanner and calculate how much muscle they have (15:14):
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Tommy: than to like really formally test their strength in a useful way. (15:17):
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Tommy: Like people might test grip strength, but it's kind of a weak proxy for like (15:21):
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Tommy: total body strength or leg strength, which may be more important. (15:27):
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Tommy: So the main takeaway in my mind is just providing a stimulus to the muscle tissue, (15:30):
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Tommy: which would then help build muscle tissue and increase strength, (15:38):
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Tommy: which, you know, in function, (15:41):
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Tommy: that's where the real magic happens. (15:43):
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Mike: So it's not like the difference between, let's say, like a bodybuilding training (15:46):
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Mike: program, which focuses purely on hypertrophy and a strength training program, (15:51):
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Mike: which like would focus on other factors. (15:55):
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Tommy: But no, both of those would achieve the desired result. Absolutely. (15:58):
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Mike: Very interesting, very interesting stuff. And like, just again, (16:03):
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Mike: just to very briefly, I suppose, bring that back to the topic of the brain as (16:08):
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Mike: well, because something that you talked about in your talk as well was about (16:15):
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Mike: the connection between muscle mass and brain function as well. (16:20):
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Mike: Can we go into that? And I think we might go into that calorie deficit thing in a minute as well. (16:23):
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Tommy: Yeah, so there's a number of reasons why the peripheral body and the muscles (16:29):
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Tommy: in particular seem to be important for brain health and cognitive function. (16:38):
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Tommy: And in sort of two broad categories, one is like a direct neuromuscular stimulus. (16:43):
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Tommy: So as you move your muscles in complex ways with some kind of resistance or (16:50):
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Tommy: some kind of coordination type movement, (16:58):
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Tommy: you're actively stimulating pathways that connect the brain to the body. (17:01):
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Tommy: And by stimulating the brain, we're improving cognitive function. (17:06):
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Tommy: There's many different ways that we can do that, but that's really important (17:09):
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Tommy: for long-term cognitive function. (17:13):
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Tommy: Then the other part of it is that your muscle tissue is not just this static (17:14):
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Tommy: thing that looks good in a t-shirt. (17:20):
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Tommy: It's a hormonal organ, right? (17:23):
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Tommy: So it releases stuff into the circulation that supports the health of the body (17:28):
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Tommy: and the brain in general, or the brain and the body in general. (17:32):
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Tommy: So neurotrophic factors that support neuron growth and function. (17:35):
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Tommy: Then it also releases cytokines that improve the sort of like modulate inflammation. (17:41):
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Tommy: Lactate, which is a metabolic substrate for the brain, (17:49):
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Tommy: And there's some studies that show that if you do some really intense exercise (17:52):
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Tommy: and you release a whole bunch of lactate, as long as you haven't pushed too (17:56):
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Tommy: hard, that can actually acutely improve cognitive function. (18:00):
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Tommy: So your muscle tissue does a whole bunch of things that could help support the brain. (18:03):
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Tommy: One final one may be that your muscle mass is also your best sink for glucose. (18:08):
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Tommy: And we know that having persistently elevated glucose with prediabetes or diabetes (18:13):
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Tommy: is associated with more rapid cognitive decline. (18:18):
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Tommy: Um and if you have more muscle and you move it more frequently that sort of (18:21):
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Tommy: improves uh blood sugar control so multiple different ways that the the muscle (18:26):
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Tommy: that your muscle can support uh the function of your brain that's. (18:32):
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Mike: Really interesting and i think that's something that is just it is very poorly (18:38):
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Mike: understood i think by by people um i just there's one more thing about your (18:41):
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Mike: talk specifically that I just want to touch on. You put in a quote. (18:46):
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Mike: I think you attributed the quote potentially to Fraser Birrell, (18:50):
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Mike: although he didn't actually say it. You just imagined him saying it. (18:54):
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Mike: The quote was, calm down, bro. Isn't muscle mass just an indicator of better (18:58):
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Mike: health? But there is more to it than that, isn't there? (19:01):
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Tommy: Yeah, absolutely. And this is funny because when I show up to try and tell people about muscle mass, (19:05):
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Tommy: like it's clear that I like to lift weights, right? And there have been many (19:16):
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Tommy: times in my life where actually, you know, to some degree, I've been stigmatized (19:20):
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Tommy: because I look like I spend all my time in the gym. (19:24):
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Tommy: Like if I walk into a very serious neuroscience conference, they're like, (19:27):
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Tommy: who is this? Who is this bro? Like, what is he doing here? (19:30):
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Tommy: And so sometimes it's difficult for people to hear the message from me. (19:34):
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Tommy: And I appreciate that. And that's why I think it's important to have multiple (19:38):
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Tommy: messengers saying the same thing, because you might not hear it from me, (19:41):
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Tommy: you might hear it from somebody who's more like you. And I think that's, that's important too. (19:44):
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Mike: Are you saying I don't look like I spend all my time in the gym, Tommy? (19:48):
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Tommy: No, I didn't. I wasn't including us. Wait, let me grab my shovel as I try and (19:53):
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Tommy: dig myself out of this hole. (19:58):
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Mike: It's fine. I know I hide it well. I try not to intimidate people. That's all. (20:01):
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Tommy: What was I saying? Yes. So, so what often happens is I turn up and I'm like, (20:06):
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Tommy: hey, muscle is this amazing thing for like your brain and your body. (20:10):
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Tommy: And if you live a long time and not fall and break a hip and die of pneumonia (20:14):
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Tommy: in hospital, right? All that stuff. (20:18):
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Tommy: And they'll be like, yeah, yeah, but if you're healthier, you just have more muscle, right? (20:20):
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Tommy: And that's true because if you have, you know, individuals with cancer, (20:24):
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Tommy: you know, cancer cachexia is a real thing, right? (20:29):
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Tommy: You lose muscle mass because of the disease rather than because, (20:30):
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Tommy: you know, the muscle mass is causing or, you know, it's not the other way around. (20:34):
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Tommy: And it is true in general, people who are healthier have better, better muscle mass. (20:40):
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Tommy: But, um, when you then look at things like we talked about, like function, (20:45):
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Tommy: when we look at the actual process of training and how that supports your health, (20:50):
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Tommy: it really does look like, uh, (20:55):
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Tommy: purposefully training your muscle tissue, making it stronger to a certain extent, making it bigger. (20:59):
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Tommy: And again, we could talk about sort of standards that I think are important, (21:06):
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Tommy: and they're really not as, they really don't, it doesn't require much to be (21:10):
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Tommy: sort of have enough muscle and be strong enough. (21:15):
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Tommy: But the process of doing that really is associated with a large number of improvements. (21:19):
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Tommy: And there are randomized clinical trials looking at taking individuals in their (21:24):
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Tommy: seventies, you put them on a very basic resistance training program and you (21:27):
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Tommy: see significant improvements in cognitive function, right? (21:32):
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Tommy: Just really good quality evidence that says this is something important that (21:35):
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Tommy: we can do, anybody can do, and can significantly improve your health. (21:39):
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Mike: Okay so yeah i mean i guess then in that case how much is enough. (21:44):
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Tommy: So in the data sets that i've looked at so i had some population data sets like (21:48):
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Tommy: here in the u.s there's nhanes there's uk biobank um in the uk which has sort (21:55):
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Tommy: of become this big resource now as well where they have similar data, (21:59):
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Tommy: and what it looks like is um if you (22:02):
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Tommy: calculate your ffmi which basically means you need to (22:05):
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Tommy: know how much you weigh and some estimate of (22:08):
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Tommy: your body fat level and it could be uh calipers you (22:11):
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Tommy: could get a dexa scan if you want it's very common over here (22:14):
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Tommy: in the us less common in the uk um but even (22:17):
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Tommy: there are some there are some things on the internet where you can find like (22:21):
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Tommy: photos and they're like if if your body kind of looks like this this is your (22:24):
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Tommy: your your approximate body fat percentage and that's probably good enough um (22:29):
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Tommy: to and and then actually uh one thing that I did do for the BSLM, (22:33):
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Tommy: and I can send it to you if anybody's really interested, is that if you know (22:39):
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Tommy: your weight and your sex and your waist circumference and your height, (22:43):
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Tommy: I can estimate your FFMI based on population data. It's just a simple calculation. (22:49):
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Tommy: And that's probably good enough. The error isn't enough to then have you say, (22:58):
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Tommy: well, this is wrong are right. (23:02):
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Tommy: And then if you look at that, the significant reduction or significant increase (23:05):
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Tommy: in mortality is at the low end. (23:12):
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Tommy: So again, it's not that more is better, it's just that not enough is bad. (23:14):
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Tommy: I don't want to say bad, but you know what I mean. It's associated with increased mortality risk. (23:19):
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Mike: Less healthful. (23:23):
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Tommy: Less healthful, that's the way to say it. And so in women, it's an FFMI of around (23:25):
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Tommy: 14, and in men, it's an FF of my of around 17. (23:30):
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Tommy: And in reality, um, you know, if you wanted to sort of be sure you might add (23:34):
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Tommy: one or two points to that. (23:40):
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Tommy: So like 16 for women, 19 for men, something like that. (23:41):
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Tommy: And that just puts you in the top 50% of the population, right? (23:44):
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Tommy: So you take a room of 10 people like you, you have more muscle mass than half of them. (23:48):
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Tommy: And this is average people, So we're not talking huge bodybuilder level amounts of muscle. (23:53):
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Tommy: Maybe even, (24:01):
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Tommy: somebody looking at you wouldn't be able to tell that much of a difference, (24:04):
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Tommy: but just like a small increase, a couple of percentage points is enough to have (24:07):
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Tommy: to make a really big long-term difference. (24:11):
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Mike: Yeah. And I think that's what makes it so difficult for people to comprehend (24:14):
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Mike: is because a lot of people, I think when you talk about building muscle, (24:18):
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Mike: people imagine an idea of, like you say, looking like a bodybuilder, (24:23):
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Mike: which I think a lot of people don't necessarily want to (24:27):
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Mike: do or think that it's achievable so i think that (24:31):
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Mike: that's part of the reason why i think sometimes people (24:33):
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Mike: are a bit resistant to it because they they don't (24:36):
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Mike: necessarily know what the term building muscle actually means (24:40):
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Mike: um which does bring me on to kind of the next phase of that because i think (24:44):
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Mike: you've done a great job of um of advertising building muscle as a as a healthful (24:48):
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Mike: thing to do um but i would like to talk about a little bit about why it doesn't (24:54):
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Mike: seem to be such a such a widely, (25:00):
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Mike: um promoted thing you know like even among (25:05):
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Mike: among the whole sort of lifestyle medicine world (25:08):
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Mike: we definitely talk about promoting physical activity (25:12):
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Mike: you know there are mentions of things like resistance training (25:15):
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Mike: for things like bone strength and osteoporosis and stuff like that but (25:18):
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Mike: there isn't as much of a focus on building muscle as you know one might expect (25:22):
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Mike: there to be from you know from what we've discussed so i am kind of interested (25:27):
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Mike: to explore why you think that might be and maybe to do a bit of perhaps myth (25:31):
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Mike: busting based on on those those sorts of things that are people's preconceptions about it. (25:36):
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Tommy: It's it's funny because as a society we've kind of idolized, (25:41):
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Tommy: actually pretty extreme endurance exercise as (25:51):
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Tommy: like this amazing health fulfilled swing train for a marathon there's very little (25:55):
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Tommy: about that that's good for your body uh let's be honest and i've done it and (26:01):
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Tommy: i've done ultra marathons i've done ridiculous ultra endurance events i thought (26:05):
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Tommy: i was doing these amazing things really was just crushing myself um but but (26:08):
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Tommy: we've kind of taken this, (26:13):
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Tommy: um, we, we, that that's become the thing, you know, um, (26:15):
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Tommy: like the midlife crisis recently, it stopped being, buying a fancy Harley Davidson or something. (26:18):
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Tommy: And it became spending 15,000 pounds on a time trial bike. So you could do triathlons. Right. (26:23):
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Tommy: And, and this, and then, then it was not just an Olympic distance triathlon. (26:30):
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Tommy: Eventually you had to do an Ironman. (26:33):
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Mike: Yeah. (26:35):
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Tommy: Right. Um, and when you then, but the, the, the funny thing to me is if, (26:35):
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Tommy: so say you look at professionals in this sport, right? (26:41):
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Tommy: Um, you look at marathon runners and they're amazing athletes at what they do, (26:46):
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Tommy: but ask them to pick up your shopping and carry it in. And they're going to, (26:52):
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Tommy: they're going to struggle. (26:59):
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Tommy: And if you, if you think, if you then think more broadly, right. (27:00):
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Tommy: So, so what, so if you think about an athlete that you might say that looks (27:04):
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Tommy: like a really sort of healthy person, right. (27:09):
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Tommy: And you're not going to pick a bodybuilder. Absolutely not. (27:14):
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Tommy: Cause we know that's not healthy, but you might pick like a heptathlete or a deck athlete, right. (27:17):
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Tommy: Or a sprint or a sprinter, you know, or like a middle distance runner. (27:24):
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Tommy: And those people do a lot of weight and strength (27:28):
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Tommy: training and then they do yeah they do some you (27:31):
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Tommy: know endurance training you know little bits (27:34):
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Tommy: here and there that's important and then some like some sprints and i think (27:37):
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Tommy: that's the kind of physical activity that really promotes health and is well (27:41):
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Tommy: rounded and like that's the kind of thing that i'd like that i'd like to promote (27:45):
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Tommy: so you do a bit of everything right but it includes some resistance training (27:49):
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Tommy: and like you don't have to learn how to throw a javelin. No, you can if you want. (27:52):
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Tommy: I tried that a few times. I was really bad at it. (27:57):
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Tommy: And so I think there's been this, for some reason, this fetishization of this endurance training. (28:01):
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Tommy: And I think because of the extremes of the sport of bodybuilding. (28:10):
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Tommy: We've kind of pulled back away from that. (28:16):
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Tommy: And maybe there's like Private Eye used to make fun Arnold Schwarzenegger all (28:19):
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Tommy: the time, right, for being stupid. (28:24):
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Tommy: And there's some other bits, it's societally driven. (28:26):
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Tommy: Plus then, if I say build muscle, it's kind of hard to quantify that, right? (28:32):
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Tommy: If I say run 5k, it's easy. You go out and you do it and 5k is run. (28:39):
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Tommy: But if I say build muscle, you're like, well, what does that involve? (28:45):
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Tommy: I go to the gym, what do I have to do there? it's not just loathing up my shoes (28:48):
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Tommy: and pounding the pavement for a little bit. (28:51):
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Tommy: I think conceptually, it might be harder for people as well because it's just (28:54):
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Tommy: not something they're as familiar with. (29:00):
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Tommy: But it's interesting to me that this is where we've gone with how we think about (29:02):
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Tommy: physical activity and almost to our detriment. (29:08):
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Tommy: If you really enjoy running marathons, like, great, please don't let me stop (29:13):
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Tommy: you. And I've done a ton of them myself. (29:18):
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Tommy: But I don't think we should be telling people this is healthy for their bodies because it's not. (29:22):
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Tommy: I would rather take the people at the London Marathon and have them go to their (29:26):
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Tommy: local fitness center and do some squats. But I'm not in charge of that. (29:30):
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Mike: I think that, yeah, I think you touched on some really important things. (29:37):
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Mike: And I think there's a couple of things about strength training and about gaining muscle. (29:42):
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Mike: There is a strong association with vanity, isn't there? like you know if you (29:47):
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Mike: see somebody um doing bicep curls in the like looking at their form in the mirror (29:50):
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Mike: you're more likely to assume that they're vain than somebody who's running on (29:56):
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Mike: a treadmill because it almost appears (30:00):
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Mike: like people are doing it for their appearance and i think that those, (30:02):
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Mike: preconceptions and sort of perhaps what we've seen in the media and and like (30:05):
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Mike: you say the sport bodybuilding as well has has perhaps influenced people to (30:08):
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Mike: to believe that that it isn't a functional method of training it's a it's an (30:12):
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Mike: appearance or a vanity type thing whereas like you say running 5k the idea is (30:18):
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Mike: that you're getting fitter you're more cardiovascular. (30:23):
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Mike: Cardiovascularly fit you can do more stuff but actually like you (30:25):
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Mike: say you can probably do more if you build more (30:28):
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Mike: muscle but then you talk about things like squats (30:31):
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Mike: which i think people do associate more with with function but (30:34):
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Mike: then people i think are quite frightened about stuff (30:37):
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Mike: like injury i think you mentioned in (30:41):
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Mike: your talk didn't you that that actually strength (30:44):
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Mike: training is one of the least likely methods (30:47):
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Mike: of injury can we please talk about that because i (30:50):
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Mike: feel like that is one of the things that i hear most of and actually (30:53):
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Mike: um not very long ago i (30:56):
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Mike: was telling my dad who was a gp for for many decades (30:59):
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Mike: um about how i'd hurt my back and he said well i'm not surprised i've been seeing (31:02):
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Mike: what you've been doing in the gym with all of these one-way ticket to back destruction (31:08):
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Mike: and it's hard because people genuinely have these these really strong preconceptions (31:13):
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Mike: about about injury don't they yeah. (31:19):
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Tommy: And and so if (31:21):
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Tommy: we think about again the extreme of course you (31:25):
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Tommy: know when people talk about lifting weights and injuries they (31:29):
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Tommy: always use those at the pointiest edge of (31:31):
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Tommy: the spear as as the example right competitive (31:34):
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Tommy: powerlifters or bodybuilders who are getting injured in the (31:38):
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Tommy: gym i mean they're ridiculous i mean they're lifting ridiculous amounts (31:41):
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Tommy: of weight um right at the edge of their of their capacity right and often this (31:44):
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Tommy: this may be this may pay the bills right it pays for them to to push themselves (31:50):
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Tommy: that hard but i would say the same about any professional athlete um that that (31:55):
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Tommy: that's a risk that comes with it and it's a risk worth taking for them because it pays the bills. (31:58):
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Tommy: Injury risk with training is really difficult to quantify because you're getting (32:06):
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Tommy: access to a big enough population that's representative. (32:12):
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Tommy: But if you look at novice trainees. (32:14):
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Tommy: And then you look at the rates of injury in those who do bodybuilding style training. (32:22):
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Tommy: And what I mean is that you go to a gym, you sit on the machines and you do (32:27):
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Tommy: three sets of eight to 12 repetitions, right? (32:33):
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Tommy: For, I don't know, five or six different machines. And you do that two or three (32:37):
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Tommy: times a week. But that's what I mean by bodybuilding training, like the real basics. (32:42):
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Tommy: And the only reason we call it bodybuilding training is because that's kind (32:45):
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Tommy: of, that's what it most looks like bodybuilding. but in reality, (32:48):
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Tommy: it's just some kind of resistance training. (32:51):
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Tommy: The rate of injury in novice trainees going and doing that, within your limits, (32:54):
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Tommy: and actually, again, particularly when it comes to lifting weights, (33:00):
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Tommy: maybe because they're worried about risk of injury. (33:04):
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Tommy: Novice trainees really underestimate what they're capable of. (33:08):
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Tommy: So actually, if you've never lifted weights before, you will regulate your effort really well. (33:12):
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Tommy: You'll probably be more conservative than you need to be. But the rates of injury (33:18):
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Tommy: in that type of trainee are three to 20 times higher if they went running instead. (33:23):
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Tommy: They never run before and they start running. (33:29):
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Tommy: Three to 20 times more likely to be injured than that's per hour of training. (33:31):
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Tommy: And then if you think about how much time you need to spend in the gym to get (33:38):
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Tommy: the kind of stuff that I'm talking about, I'm talking about maybe 90 minutes (33:42):
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Tommy: a week max, right? That would be plenty of time. (33:45):
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Tommy: Whereas if you're going to train for a 5k, you might train for five, (33:48):
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Tommy: six hours a week, right? That would be reasonable. (33:52):
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Tommy: So not only are the rates three to 20 times higher per hour of training, (33:55):
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Tommy: you're also going to do four times as much training, right? (34:00):
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Tommy: So then you're talking, you know, dozens of times higher, higher injury risk. (34:04):
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Tommy: And again, this is not to tell people that you shouldn't go running, right? (34:07):
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Tommy: Running is great. But I think it's mainly to highlight that standard going to the gym, (34:10):
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Tommy: working the machines for an hour a week or 45 minutes twice a week, (34:20):
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Tommy: the only thing that I think is safer in terms of training is walking. (34:25):
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Tommy: I don't think there's anything else that has a lower injury risk than doing (34:31):
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Tommy: some machines in the gym. (34:37):
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Mike: Well, there you have it. It is incredible to hear that statistic because it (34:39):
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Mike: is just totally at odds with everything that everyone seems to think, isn't it? (34:44):
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Tommy: Yeah. And again, I mean, I'm not entirely sure why there's this sort of fascination (34:49):
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Tommy: with the risk of injury with lifting weights. (35:00):
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Tommy: And again, particularly if you want to compete in a certain of the thing, (35:03):
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Tommy: right? You want to be a powerlifter, you have to do squats and deadlifts. (35:08):
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Tommy: And I think squats and deadlifts are great. I do them every week. (35:10):
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Tommy: But if you're just trying to improve strength for long-term health, (35:13):
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Tommy: you don't need to do that stuff. Again, machines in the gym are great. (35:19):
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Tommy: And the injury risk is super, super low. (35:23):
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Mike: It is very interesting. And I don't know, I mean, I guess there's like, (35:25):
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Mike: I don't know, maybe if it's something to do with the (35:30):
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Mike: idea that lifting weights is somehow inherently intimidating like (35:33):
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Mike: I know a lot of people feel intimidated by going to the gym or they (35:37):
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Mike: feel that like the you know the people who are really (35:40):
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Mike: good at lifting weights are quite (35:43):
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Mike: intimidating themselves um you know (35:46):
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Mike: the the kind of people going to the gym and hearing like the the loud (35:49):
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Mike: training noises and stuff like that can be quite sort of put off (35:52):
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Mike: by it I don't know if it all just just kind (35:54):
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Mike: of fuels just this overwhelming idea that that's (35:58):
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Mike: not a good idea i'm just gonna stick to things over here (36:01):
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Mike: but i think it is it's really important to (36:04):
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Mike: try and empower people and i think it is changing like i think that we've really (36:07):
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Mike: seen like a a real shift especially since people have been i guess i don't know (36:11):
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Mike: whether it's to do with social media but i think since more and more people (36:16):
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Mike: obviously do training um it does seem to have become more popular. (36:19):
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Tommy: Yeah, I do believe you're right. It's going in that direction. (36:26):
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Tommy: Part of the issue may be access. It's harder to get yourself to the gym and (36:35):
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Tommy: pay for a gym membership than just going out and going for a walk. (36:42):
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Tommy: I think if anybody was going to do just one type of exercise, (36:46):
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Tommy: they should probably just walk more, right? (36:50):
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Tommy: Anybody can do that, and they should. (36:52):
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Tommy: So there is an access issue, but equally, it could be you spend 20 quid on some (36:55):
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Tommy: resistance bands and you just do this in your living room. (37:03):
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Tommy: Even that, I think, is going to be enough to get you most of the way there. (37:06):
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Tommy: So hopefully, people realize injury risk is low, benefit is really high, (37:11):
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Tommy: can be tailored to your own personal situation. (37:18):
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Tommy: If you did a whole bunch of bodyweight squats and some pushups and things at (37:21):
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Tommy: home, even that, that's great. (37:26):
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Tommy: And then it's a lot faster than dedicating a lot of time to going out running and stuff. (37:30):
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Tommy: So hopefully, and I guess the other side of it then is that there's this sort (37:36):
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Tommy: of myth within people who do resistance training, they're like, (37:44):
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Tommy: well, this isn't enough, right? (37:48):
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Tommy: People might not believe that doing pushups at home is enough to actually have a meaningful effect. (37:50):
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Tommy: But I mean, that's a lot of work and there is a huge benefit there. (37:56):
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Tommy: If you do as many bodyweight squats as you can in one go, that is a significant training stimulus. (38:02):
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Tommy: And so that that's the other part of it is often people might not believe that (38:08):
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Tommy: what they do or can do is enough and therefore it's not worth doing it and. (38:13):
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Mike: And that. (38:17):
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Tommy: Probably you know becomes an issue as well. (38:18):
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Mike: I think a lot of people were very humbled in the (38:20):
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Mike: pandemic when when they couldn't go to gyms and people started getting the resistance (38:23):
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Mike: bands and started doing training at home and i think a lot of people realized (38:27):
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Mike: you know how how hard body weight training actually is yeah because yeah using (38:32):
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Mike: a machine in the gym is is fairly easy and actually i was um, (38:38):
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Mike: I switched to kind of Skype training sessions and we started, (38:44):
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Mike: my coach very sadly lent me a weighted vest. (38:47):
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Mike: And I had a weighted vest and a bunch of resistance bands and a kettlebell. (38:51):
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Mike: And we gradually built up, started doing press-ups and gradually built up the (38:56):
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Mike: weight with press-ups so that initially it was just bodyweight press-ups and (39:00):
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Mike: then it was with the resistance bands and then it was with the weighted vest (39:03):
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Mike: and the resistance bands. (39:08):
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Mike: And he invented a thing called the bag bell which (39:09):
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Mike: is where you put a kettlebell in the rucksack and then (39:12):
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Mike: have that on your back as well so by the end of of lockdown (39:15):
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Mike: we were doing sort of push-ups like that and actually what (39:18):
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Mike: i was doing in my bench press when we got back to the gym was better than it (39:21):
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Mike: had been before because it was you know it's incredible how that stuff works (39:25):
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Mike: and actually how you know if you've got someone that knows what they're talking (39:30):
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Mike: about with regards of advising you what to do with regards to stuff like that (39:33):
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Mike: it is amazing how much you can achieve with relatively little isn't it. (39:37):
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Tommy: Yeah and so i had when (39:41):
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Tommy: i first moved to the us or the house that we live (39:44):
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Tommy: in now um i didn't have (39:47):
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Tommy: a gym and kind of getting to a gym was a bit (39:50):
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Tommy: of a pain so for i don't know like six months (39:52):
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Tommy: all i had was resistance bands i did some blood (39:56):
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Tommy: flow restriction training as well which is a really (39:58):
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Tommy: great zero impact way to to to (40:01):
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Tommy: sort of increase the stimulation um (40:04):
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Tommy: and i know for like six months that was how i trained resistance bands and and (40:08):
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Tommy: and the some blood flow restriction you know all just stuff i could do it do (40:13):
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Tommy: at home and i don't think i lost any muscle mass or strength just just with (40:17):
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Tommy: those and it was like 25 quids worth of stuff that i had in my. (40:22):
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Mike: Life yeah it's it's pretty cool it's a pretty pretty cool little world i think (40:26):
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Mike: um i just to to go on to kind of the myth busting stuff i would just like to (40:30):
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Mike: touch a little bit on the nutritional side of muscle building i think we often (40:36):
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Mike: hear about things like protein and the benefits of having protein in our diet um, (40:40):
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Mike: I'm sure that you know what myths I'm going to ask you to bust or the things (40:46):
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Mike: that I'd like you to touch on. (40:50):
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Mike: But I would like to just touch on a little bit about a lot of people worry about (40:51):
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Mike: consuming too much protein, how much effect it has on their kidneys, (40:55):
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Mike: whether it's okay to consume protein in a processed form. (40:58):
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Mike: We often advocate the benefits of avoiding processed foods and technically things (41:02):
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Mike: like whey protein and protein shakes, protein yogurts, (41:09):
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Mike: protein bars are all considered to be processed foods but i think the rules (41:13):
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Mike: are slightly different in this in this way and how much protein should we be (41:18):
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Mike: consuming as well i suppose is the other thing to say so if you if you could (41:21):
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Mike: whiz through those like seven questions yeah i was gonna say that i. (41:25):
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Tommy: Was gonna say that sounds like seven questions i'll try and i'll try and remember (41:29):
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Tommy: all of them um but i mean the short answer is you can't eat too much protein (41:32):
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Tommy: as um in except there's one very weird thing called rabbit starvation, (41:37):
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Tommy: which is when you eat only protein and then weird stuff happens. (41:43):
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Tommy: But we're not talking about that. (41:46):
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Tommy: So you basically can't eat too much protein. It's not bad for your kidneys, (41:48):
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Tommy: anybody who says that, or bad for your bones. (41:53):
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Tommy: It's just not true. And the amount of protein that you should eat, (41:57):
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Tommy: there's some nice sort of meta-analyses, There's studies and many studies that (42:02):
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Tommy: show probably the optimal amount starts at about 1.5 grams per kilo of body weight per day. (42:09):
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Tommy: If you are somebody who is trying to change your body composition, (42:17):
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Tommy: you may target your sort of ideal body weight. (42:21):
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Tommy: That can be an option too. But basically, the easy calculation is 1.5 grams (42:28):
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Tommy: per kilo of body weight per day. (42:34):
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Tommy: And you see that even in the absence of lifting weights, muscle mass and strength (42:36):
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Tommy: increase with increasing protein intake up to about that point. (42:42):
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Tommy: Um, if you are older and as people get older, uh, something called anabolic (42:47):
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Tommy: resistance is induced, which basically means that it's harder to gain or maintain muscle mass. (42:54):
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Tommy: So more protein seems to be more beneficial, uh, in that setting. (43:00):
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Tommy: So maybe we're talking 1.8, uh, grams per kilo of body weight per day. (43:04):
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Tommy: Um, then how do you get that protein? Like often people are, (43:09):
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Tommy: that's really hard to, to get that protein. And what I generally recommend is (43:13):
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Tommy: that the protein is like the first thing you think about when you're eating. (43:18):
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Tommy: Does my meal contain enough protein? And that's like the starting point. (43:23):
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Tommy: Because once you've eaten enough protein, you've probably eaten enough of all (43:28):
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Tommy: the other stuff that you need to eat to get your macronutrients and calorie (43:31):
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Tommy: intake. but sort of making protein the focus helps. (43:35):
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Tommy: And ensuring there's some kind of protein-rich food as part of every meal, (43:38):
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Tommy: that improves satiety as well as a whole. (43:42):
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Tommy: There's this idea of the protein leverage hypothesis, which basically says that (43:46):
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Tommy: your body will be hungry all day until you've consumed enough protein. (43:52):
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Tommy: And one of the reasons why we generally, as a population, are in a constant (43:57):
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Tommy: caloric surplus is because we tend to eat foods that are low in protein. (44:03):
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Tommy: And part of that may be driven by the fact that we want more protein and we're (44:07):
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Tommy: just eating and eating until we get more protein. (44:11):
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Tommy: So focusing on protein can help, but getting it in a processed form, (44:14):
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Tommy: I think is actually just fine. (44:20):
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Tommy: So if you need to have a protein shake or a protein yogurt or a protein bar, (44:22):
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Tommy: I do that occasionally when I'm busy and it's difficult to get a meal, (44:26):
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Tommy: a full meal in, and I think that there's lots of evidence, again, (44:34):
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Tommy: to suggest it's not bad and it's probably good if it's helping you reach an (44:37):
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Tommy: adequate protein intake. (44:41):
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Tommy: One thing I will say is that a lot of protein bars, (44:44):
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Tommy: kind of come with this sort of stealth, um, high caloric intake with them. (44:50):
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Tommy: They're like, here's six grams of protein. (44:58):
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Tommy: And in order to get that, you're going to eat 700 calories of peanut butter. (45:02):
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Tommy: Um, so, so it is worth bearing that in mind. (45:06):
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Tommy: Um, and the trick that I use, and it's not foolproof, but the trick that I use (45:09):
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Tommy: is that if you look at the, (45:14):
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Tommy: the, the nutritional information on the back you look (45:15):
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Tommy: at how many grams of protein are (45:18):
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Tommy: in it and the grams of protein should be at least 10 percent of the total calories (45:21):
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Tommy: so if it's 20 grams of protein it should be around 200 calories and then you (45:27):
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Tommy: know that it's a good amount of protein for what you're getting so that's the (45:32):
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Tommy: kind of the rule of thumb that i use i think can be helpful. (45:37):
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Mike: I think that's really really important and actually and i (45:39):
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Mike: think because so many of the like food brands (45:43):
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Mike: have recognized that being high in protein is (45:46):
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Mike: beneficial and there are very shady rules around what you're allowed (45:49):
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Mike: to call high-end protein or a source of protein or whatever so actually there (45:52):
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Mike: are there are lots of things that that say protein something and they might (45:56):
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Mike: have one or two grams more of protein than their non-protein equivalent yeah (46:00):
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Mike: i got stung by some protein pancakes the other day that actually to consume (46:05):
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Mike: 25 grams of grams of protein, (46:09):
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Mike: I was going to have to consume about 700 calories worth of pancake, (46:11):
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Mike: which while I was at a challenge, (46:14):
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Mike: wasn't quite the intention of buying protein pancakes. (46:16):
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Mike: And I sort of wished I'd just got normal ones, which tasted decent. (46:19):
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Tommy: Yeah, exactly. Just at that point, just have actual pancakes and then an egg. (46:22):
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Mike: Exactly, exactly. Yeah. So (46:28):
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Mike: I think that that's something that's sort of really important to touch on. (46:29):
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Mike: And thank you for clearing up those myths i wonder if you (46:33):
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Mike: wouldn't mind if we touched on a few neuroscience bits (46:36):
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Mike: have you got time yeah absolutely excellent so (46:40):
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Mike: i just thought we would we would use you (46:43):
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Mike: as a double-edged sword and and and just (46:46):
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Mike: touch on a few because i think there's been a big um shift (46:49):
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Mike: in i wouldn't necessarily say in lifestyle (46:53):
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Mike: medicine but in generally the wellness industry and (46:56):
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Mike: the well the world of well-being there's been (46:59):
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Mike: this um sort of insatiable appetite for evidence-based (47:02):
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Mike: practice when it comes to lots of different things and (47:06):
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Mike: i think that sometimes that appetite has been (47:10):
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Mike: coupled with a response from certain sectors (47:13):
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Mike: to label things as evidence-based and really exciting (47:16):
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Mike: and perhaps over egg the pudding where it where it comes (47:19):
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Mike: to the evidence because it sounds much more um sexy and exciting to say that (47:22):
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Mike: that something might um might spike your dopamine then it might say you might (47:27):
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Mike: enjoy this um and i would i would sort of like to talk about a few of these (47:32):
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Mike: sorts of things that are kind of coming into um. (47:38):
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Mike: Into i suppose ubiquity one of the biggest things that we see people talking about is um, (47:42):
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Mike: is cold water therapy and and often it's it's really kind of the neurological (47:48):
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Mike: benefits of cold water therapy that that seem to be um most heavily pushed in (47:52):
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Mike: that cold water therapy industry, (47:57):
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Mike: um and big cold water yeah i wonder what your um i wonder what your thoughts are on that Um. (48:01):
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Tommy: So I think in general, I am a fan of small stresses because they improve our (48:09):
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Tommy: resilience in multiple ways. (48:20):
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Tommy: And some of those are like measurable physiological changes, right? (48:22):
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Tommy: Exercise is a stress, a cold is a stress. (48:25):
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Tommy: Um, and as we are exposed to these, there's this process of something called (48:28):
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Tommy: hormesis, which means that we improve the resilience of our physiology in response. (48:33):
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Tommy: And I think one of the reasons why we suffer as a society from so many non-communicable (48:38):
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Tommy: diseases is the lack of those kinds of stresses that are beneficial. (48:45):
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Tommy: And so I think cold can be one of those things. And, (48:51):
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Tommy: uh it's not very nice right and (48:57):
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Tommy: you like you expose yourself to something cold (49:01):
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Tommy: and you're like i did a hard thing today that's that's really i think that's (49:04):
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Tommy: really good you know in a number of ways even if it has no effect on fancy physiological (49:09):
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Tommy: processes just like the knowledge that you've done something difficult i think (49:14):
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Tommy: can actually be really can really be beneficial so there are some benefits there. (49:18):
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Tommy: You know, it can also be, you know, you do that kind of thing first thing in (49:24):
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Tommy: the morning, of course, it's going to activate a whole bunch of like stress (49:28):
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Tommy: pathways, and you're going to get a whole hit of adrenaline, (49:31):
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Tommy: and it's going to wake you up, and you're going to feel good and energized, (49:35):
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Tommy: you know, like a cold shower first thing in the morning, I think can make you (49:38):
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Tommy: feel good for that reason as well. And that's great. (49:41):
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Tommy: However, for a number of things, we've kind of taken, say, epidemiological data, (49:44):
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Tommy: like compared those people who do a lot of cold water swimming to those people (49:52):
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Tommy: who don't do a lot of cold water swimming, and then ascribed the differences (49:56):
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Tommy: that we see in those people to cold water swimming. (50:01):
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Tommy: And as most people probably know, association does not equal causation. (50:04):
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Tommy: And it's the same with a number of things that people talk about in this arena, (50:11):
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Tommy: I think sauna may be similar, where people who have the time and the ability (50:15):
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Tommy: and enjoy cold water swimming are different from people who do not. (50:21):
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Tommy: And these studies probably have some degree of what we call residual confounding, (50:26):
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Tommy: which is that we haven't taken into account other things that might explain (50:30):
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Tommy: some of these differences. (50:33):
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Tommy: So it's not that there isn't potential benefit from exposing yourself to cold. I think there is. (50:34):
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Tommy: Some of the pathways that are thrown out there aren't really that well supported by the evidence. (50:42):
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Tommy: So I think it's a good thing. People can do it. If you enjoy it, (50:50):
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Tommy: great. I think there's a number of reasons why it may be beneficial. (50:55):
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Tommy: But what happens is that we often, like you said, overreg the pudding in terms (50:58):
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Tommy: of evidence, and everybody likes to ascribe something to a pathway, right? (51:02):
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Tommy: You're going to expose yourself to cold, you're going to upregulate brown fat, (51:08):
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Tommy: and then you're going to burn all these extra calories and all this kind of (51:11):
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Tommy: stuff. And, you know, it's interesting. (51:14):
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Tommy: It happens in animals. It may happen in some humans. It doesn't happen in all humans. (51:16):
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Tommy: You know, do we even have the evidence (51:21):
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Tommy: to sort of say that this is why you should do it? I don't think so. (51:22):
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Mike: That's very interesting. I mean, I think it's a very hard topic to navigate because. (51:28):
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Mike: What I really hate doing as someone who wants to try and be more evidence-based, (51:36):
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Mike: I really hate seeming to be down on certain activities because they are over-promoted (51:41):
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Mike: with a potential lack of evidence. (51:48):
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Mike: And this is, I think, why I get so frustrated by (51:50):
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Mike: them being over promoted with a lack of evidence is because it (51:53):
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Mike: makes me want to tell people that the that evidence (51:56):
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Mike: isn't really valid yeah without telling them (51:59):
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Mike: to stop doing that thing in the exactly same way (52:02):
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Mike: that you were talking about marathon running and stuff earlier is that yeah it can be (52:05):
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Mike: really beneficial it could be really helpful to people but it doesn't necessarily mean (52:08):
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Mike: that it's the best thing that they can do yeah um and i (52:11):
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Mike: just i wish that we were just a bit more i guess (52:14):
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Mike: open and honest about what these things mean and i (52:17):
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Mike: think that it's it's what's so difficult when so much of our (52:20):
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Mike: information comes from I guess competing interests (52:22):
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Mike: to a point like you know we get so much stuff from social media (52:26):
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Mike: for example and in the world of social (52:29):
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Mike: media everybody is competing for people's attention so the most exciting thing (52:32):
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Mike: that you can say is more likely to get a better reaction and more likely to (52:36):
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Mike: spread so you can see definitely why people with the very best of intentions (52:40):
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Mike: would go right I think cold water swimming is great for all of this number of reasons. (52:45):
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Mike: But if I want to spread the word and talk about it on Instagram and get it to (52:49):
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Mike: beat the algorithm and get people to share it, I have to make it sound really, (52:53):
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Mike: really, really sexy and exciting. Otherwise, it's just not going to work. (52:58):
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Mike: So it's not necessarily that I think anyone means badly by doing any of that stuff. (53:01):
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Mike: And I think it's all well-intentioned. And like we say, it's a positive probably thing to do. (53:06):
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Mike: But I think it's also potentially harmful for people to (53:11):
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Mike: go about life going oh my god i haven't (53:14):
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Mike: done my ice bath today so i'm gonna be miserable um (53:17):
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Mike: you know and i think there's so many things that we could (53:21):
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Mike: be doing in life and in lifestyle there's so (53:24):
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Mike: many things that we can improve before focusing super (53:28):
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Mike: hard on these minutiae and we see it with supplementation we see it with with (53:31):
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Mike: all of these different sorts of activities that that people tend to promote (53:35):
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Mike: and you know i keep i keep hearing people now like people don't say um oh yeah (53:39):
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Mike: because I really like doing that they say because that gives me that dopamine hit that I'm after, (53:44):
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Mike: I'm like well it's not that's not really what's happening though is it it just (53:49):
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Mike: sounds really cool on a podcast. (53:52):
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Tommy: Uh, yeah, I mean, I, I agree. And what is re what's really interesting to me (53:55):
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Tommy: is how, um, our mindset really affects our, our physiology in, in, in documented ways. (54:02):
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Tommy: And there, there are, this is like my own personal soapbox. Um, (54:10):
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Tommy: so around say sleep tracking, right? (54:14):
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Tommy: You're going to, your Fitbit or your ring is going to tell you how many minutes (54:17):
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Tommy: of deep sleep you had last night. and that's going to be some important thing for you to track. (54:21):
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Tommy: But there's some really nice studies, a lot of them are done by Ellen Langer, (54:25):
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Tommy: who's a psychologist at Harvard. (54:30):
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Tommy: And so one study that they did was they took individuals and what she does a (54:32):
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Tommy: lot of is manipulating clock time. This is like her expertise. (54:37):
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Tommy: And so they put people in a lab and they had them sleep in the lab overnight. (54:40):
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Tommy: And then they either had them sleep eight hours or five hours, (54:46):
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Tommy: they were randomized, but they were also randomized for the clock time to be manipulated. (54:50):
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Tommy: So then they were told they slept five hours or eight hours and they were crossed over. (54:55):
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Tommy: So there were some people who slept five hours, but were told they slept eight (55:01):
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Tommy: hours and vice versa, because they woke up and eight hours had passed on the (55:05):
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Tommy: clock, even though they'd only been asleep for five hours. (55:08):
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Tommy: And what they showed was that those people who'd slept for five hours, (55:11):
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Tommy: but were told they slept for eight hours, did just fine the next day. (55:14):
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Tommy: But people who slept for eight hours and were told they slept for five hours, (55:18):
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Tommy: performed worse cognitively because they were like, oh, I didn't sleep well. (55:21):
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Tommy: And we see this when we're trying to optimize everything, so optimize our sleep, (55:27):
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Tommy: our sleep tracker, where the data aren't great anyway, is telling us, (55:33):
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Tommy: hey, you didn't sleep well last night. (55:38):
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Tommy: That will actually affect you for the rest of the day, whether it's true or not. (55:39):
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Tommy: And there's some similar data from, say, I mentioned NHANES earlier, (55:43):
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Tommy: this big population data set in the US, where they looked at individuals and (55:48):
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Tommy: they looked at their mortality risk. (55:52):
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Tommy: And they adjusted for everything, diseases, blood chemistry, (55:54):
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Tommy: all other kind of socioeconomic factors, things that are important for mortality risk. (55:59):
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Tommy: And they had them wear accelerometers. (56:05):
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Tommy: So they quantified how much these people were moving. And then they asked them (56:07):
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Tommy: the question, How active are you compared to people like you? (56:12):
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Tommy: And they found that people who said, I'm less active than people like me. (56:17):
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Tommy: They lived less long, regardless of how active they actually were. (56:24):
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Tommy: So what that's telling you is that if you constantly think, I'm not doing enough, (56:31):
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Tommy: other people are doing more than me, other people are doing better than me, (56:36):
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Tommy: I didn't do my cold shower today, so therefore I'm not going to perform my best. (56:39):
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Tommy: You telling yourself that can have a negative effect on your health. (56:44):
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Tommy: But the thing that you're telling yourself isn't true, but the fact that you're (56:49):
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Tommy: telling it to yourself can have a meaningful effect on your physiology. (56:53):
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Tommy: And they've done a whole bunch of studies where they've randomized people to (56:56):
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Tommy: tell them about their genetics, and that affects how they respond to food. (56:59):
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Tommy: Physiologically, you can see differences in hormones because you've lied to (57:03):
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Tommy: somebody about their genetics. (57:07):
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Tommy: All these ways your mind plays tricks on you. (57:09):
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Tommy: So this is one of the reasons why you know i used to (57:12):
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Tommy: be you're one of these optimize this do this like be the best but like now i'll (57:14):
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Tommy: i'll sort of start to raid against it because the process of telling yourself (57:21):
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Tommy: that you're not optimal that you're not doing things right you're not doing (57:25):
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Tommy: enough that can have like an actual harmful effect and measurable effect on (57:28):
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Tommy: physiology and health and all these other kinds. (57:32):
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Mike: So interesting isn't it because i think genuinely as a as a human it is so hard (57:34):
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Mike: to find the balance between, you know, pushing yourself to improve things. (57:40):
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Mike: And like you say, having, you know, having more resilience. So pushing yourself (57:45):
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Mike: to do things that are difficult, um, while also going easy enough on yourself (57:48):
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Mike: that, you know, that you're not having sort of those impacts as well. (57:53):
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Mike: It's hard to be a human these days, isn't it? (57:56):
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Tommy: It is. Yeah. And so that's why I think, you know, at this point, (57:59):
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Tommy: you know, we should focus like more on, particularly when it comes to our health, (58:04):
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Tommy: yes, there are a whole bunch of things that we know we can and should do better, right? (58:11):
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Tommy: These are some of the fundamental pillars of lifestyle medicine, (58:15):
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Tommy: whether we like them or not. (58:18):
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Tommy: And I believe that all of those things are very impactful, both at the individual (58:20):
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Tommy: and the population level. (58:24):
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Tommy: But then the social media-driven constant strive to be the best or the optimal, (58:25):
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Tommy: I think there's harm there. (58:32):
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Tommy: So you have to be kind to yourself at the same time, whilst celebrating the (58:34):
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Tommy: wins that you do make in terms of the improvements and changes that you're making. (58:38):
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Mike: I agree 100%. I'm going to have, I'm going to give you one final question. (58:43):
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Mike: It's a question I've been asking all of my guests on this podcast. (58:48):
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Mike: As an organization, which you're part of, to be fair, so we should already know (58:52):
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Mike: this, but what do you think is the, what do you think the BSLM can do to improve (58:56):
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Mike: the things that we've talked about today? (59:03):
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Mike: How can we promote people to be healthier in ways that we might not be doing so already? (59:05):
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Tommy: So I think the BSLM can and should work at sort of both ends of the spectrum, ground up and top down. (59:12):
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Tommy: And so from the ground up, I think it's giving people information, (59:21):
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Tommy: hopefully like it's coming out on the podcast, simple ways, things that they (59:26):
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Tommy: can change around their lifestyle environment that can make big impacts on their health. (59:30):
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Tommy: But then some of it has to come from the other side as (59:36):
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Tommy: well so you have to build up a society or (59:39):
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Tommy: an organization that has some kind of power (59:42):
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Tommy: to influence policymakers and i think that's somewhere that you know bslm is (59:45):
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Tommy: really approaching that that that point now because we need to give people access (59:50):
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Tommy: to gyms we need to you know improve the quality of of of processed foods and (59:55):
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Tommy: the foods that people can afford and people can have access to. (01:00:02):
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Tommy: And we need to acknowledge that social determinants of health are major drivers (01:00:05):
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Tommy: of non-communicable disease and health inequities, (01:00:12):
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Tommy: but those have to play together at the same time, right? (01:00:16):
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Tommy: So saying that diet is important for your health doesn't discount the fact that (01:00:21):
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Tommy: not everybody has as much control over the food that they have access to, (01:00:27):
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Tommy: or the food that they can afford, or the food that they can eat. (01:00:31):
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Tommy: These things, they're not mutually exclusive. (01:00:33):
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Tommy: And so I think the important thing an organization like this can do is to show (01:00:36):
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Tommy: people that and then make sure that both ends of that spectrum are moving in the right direction. (01:00:42):
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Mike: Brilliant. I completely agree. Tommy, thank you so much for your time. (01:00:49):
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Mike: I have really enjoyed this podcast. It's been awesome. (01:00:53):
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Mike: Hopefully our guests will learn lots from it as well. (01:00:56):
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Mike: Before we go, can you just tell everybody where they can find you if they want (01:00:59):
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Mike: to ask you how to calculate their FFMI or simply ask you how to get bigger biceps? (01:01:04):
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Tommy: Well, obviously, the latter is the most important thing. (01:01:11):
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Tommy: The biceps are just biceps of life. (01:01:16):
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Tommy: When I was an undergrad, I was working on my final year dissertation. (01:01:21):
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Mike: What are you going to say? I was working on my biceps. (01:01:27):
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Tommy: I was working on... Well, no. So this is one of my favorite quotes ever from (01:01:30):
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Tommy: a friend of mind, who's actually a doctor now, Omar. (01:01:33):
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Tommy: I think I texted him, he wanted me to go to the gym with him. (01:01:40):
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Tommy: And he was like the first guy who exposed me to powerlifting and deadlifts and this kind of stuff. (01:01:42):
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Tommy: And I texted him, I was like, no, I've got to work on my dissertation. (01:01:47):
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Tommy: And he just texts me back, guns greater than sign dissertation. (01:01:50):
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Tommy: And I was like, yeah, okay, right. And so I went to the, (01:01:54):
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Tommy: um yeah uh sorry for that random interlude (01:01:58):
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Tommy: um uh instagram is (01:02:01):
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Tommy: the best place to find me probably at dr tommy wood (01:02:05):
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Tommy: um and i usually post like random stuff in my stories it's like pictures of (01:02:08):
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Tommy: my dogs most of the time um so if you like that kind of thing uh but then if (01:02:16):
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Tommy: there's like if if there's like reels of podcasts and things like that i usually (01:02:20):
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Tommy: share those as well um i did just start, (01:02:24):
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Tommy: um my own podcast um with a (01:02:28):
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Tommy: friend of mine neurologist at dr josh turknet called the (01:02:31):
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Tommy: better brain fitness podcast um so you can look for that wherever you find your (01:02:34):
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Tommy: podcasts and it's a it's a question and answer style so there's a website where (01:02:38):
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Tommy: you can either record a question or you can type in a question and so we just (01:02:42):
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Tommy: answer people's questions about the brain mainly so if you like that kind of (01:02:45):
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Tommy: thing, that's an option too. (01:02:50):
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Mike: Brilliant. Thanks very much. See you soon. (01:02:53):
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Tommy: Great. Thanks. Thanks, everybody. (01:02:56):
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