Muscle Is Your Retirement Account: The Science of Building and Keeping It Healthy

All right, welcome back to Cell to Systems, episode 19. This topic is muscle-centric medicine, which is going to be tons of fun. Today, summertime, everybody's on vacation, but we have Kristi and we have Leonard, and we're going to talk about some really cool stuff.

Kristi, I always love the stuff that you talk about, like, hey, keep it at the foundational level. Think about nutrition, think about movement, think about all of those things. Leonard, you know, we always joke about the creatine days of 1998 and, you know, what was it, Body for Life or whatever the contest was that was going on with Bill Phillips at that moment in time. And then I think there were some interesting things that have come out in some studies around 2020 talking about how muscles—the training—signals throughout the entire body a whole cascade of things from that. And when we stop working out, obviously we can feel it immediately. If you really train all the time and you haven't worked out for a few days, you start to feel it. It's just a really interesting topic. Muscle-centric medicine is why probably a lot of people wind up coming to see you initially, Kristi—they want to be in great shape, they want to live healthy, they want to be mobile. Muscle is so important to mobility. So maybe you can kick us off, Kristi.

Yeah, thank you. So guess the way I first kind of think about it is, you know, muscle is not about looking younger; it's about staying younger. For years, we viewed muscle as something that athletes care about and think about. But thankfully, the science has completely changed that conversation. Now, skeletal muscle is recognized as one of the body's largest endocrine organs. Every time a muscle contracts, it releases signaling molecules called myokines. And these myokines communicate with nearly every organ system. They help regulate insulin, glucose, inflammation, fat metabolism, our immune function, cognitive health, and moods. When patients lose muscle, I think they're not just simply losing that strength—they're losing one of the body's most important communicating systems.

The strongest predictor of healthy aging is not what you weigh; it's what you're carrying around in lean muscle mass. From a longevity perspective, people think of longevity and measurements of birthdays, right? But that is not longevity. I mean, can you climb stairs, carry groceries, catch yourself when you trip? Can you get off the floor without having to push yourself up? And then, I think the big thing for the aging population is, can you travel independently? It takes a lot of muscle strength to be able to do those things. And those answers predict quality of life far better than cholesterol alone. Low muscle mass is associated with insulin resistance, falls and fractures, and hospitalizations. Leonard and I, we've all seen that, right? When he was working in the hospital and I was a hospitalist for those years, so many of the hospitalizations really started from the sense of just muscle loss occurring for years, and then there came the falls or the cardiovascular disease. Guess for me, the number on the scale doesn't tell you much; it's the body composition that tells us everything. The goal isn't simply adding years to your life—it's adding life to the years, and muscle is how you do it.

So true. I mean, when you think about falls, you just mentioned that. Think about like neuropathy—where does neuropathy come from, right? So the notion of like staying mobile and keeping your insulin sensitivity where it needs to be and all those things. What is it? I think it's some sort of crazy number of people who fall. In older age, that's where there's this huge downward effect that comes from that. It's pretty frightening for elderly people. All the things that you just said, maintaining that—it's so great that the science supports that notion of, hey, stay in shape, keep going. It's my stepfather's birthday today—he's 89 years old today. And actually, it's my son's birthday and my brother's birthday, too, on the same day. But my stepfather, this guy has literally walked so many times, every day consistently for as long as I've known him, 30-plus years. He's walked around the world in terms of miles, and he does it every single day whether he's feeling well or not. He continues to keep walking and keep moving, and I think that's had a huge impact on his ability to actually function in the world, which is pretty cool. So happy birthday, Wally, if you're watching the episode. Leonard, what's your take?

Well, muscle is such a big subject, you know, it's kind of hard like which direction do you want to go, is really the question. I mean, you can go into the immune system and immune dysregulation and the impact of muscle and what it's secreting, like Kristi was saying—like specific myokines and its ability to act like an endocrine organ and signal certain things. Or you can be talking about metabolism or cardiometabolic health, like how well you can dispose of glucose and how well you can perform or exercise. And so it's just such a broad topic, no matter where you go with it. You can go in so many different directions.

What I love about this topic around muscle-centric medicine is that, you know, it seems basic, right? You go in, you get a DEXA scan, you get an InBody, you see either you have a lot of muscle or a significant amount, or you don't. But actually, we're learning so much more about that now, in that it's not as easy as like, "What's your muscle mass?" There's different markers that can tell us a little bit more, and there's new diagnostics or MRIs that can show us even more about somebody's body composition. Just looking at lean mass by itself—while it's a great metric that we look at—you don't know the quality of that muscle. That muscle might have fat infiltrated within the muscle; it might have fat actually within the muscle cell or within the muscle fibers, right?

I really love that conversation because, you know, recently there's been this big conversation around the loss of muscle with GLP-1s, but it really depends on the function of that muscle. You could actually be helping somebody out that has a lot of muscle but has a lot of fat infiltration in that muscle, because it's not functional muscle. Where I see myself going and trying to figure out the body composition, it's there—you can get a DEXA scan, you can get an InBody, we can see where the muscle's at. We can see if you have muscle within your arms and your legs; it's much more functional. But the marker that I think that we haven't necessarily solved in a uniform way for this muscle-centric medicine is measuring somebody's strength, because that'll tell us what the functional output is, like what is the quality of that muscle? If you start looking at the research, there's even more when it comes to mortality risk around function.

It's just not a normal part of medical practice to measure how strong somebody is, for a lot of reasons. One of the things that I'm worried about is that I get someone in there that doesn't exercise normally and they don't know how to properly do a squat or a movement—I don't want them to get injured, right? That'd be so counterproductive. And so it's like, how can we measure strength in different populations, or different age groups, or different exercise experience? So we've been, you know, I'm always trying different things out on how we measure that. But I think that's something that we can get better at, cuz that's really telling us if you're making a difference when it comes to muscle-centric medicine—like, how strong is somebody getting? So yeah, we can take this conversation in a million different directions, it's just kind of like which direction do you want to go? But those are the things that are on my mind. I want a better, easier way to test how strong somebody is and see if they are getting stronger, and I don't want to have to do it in a very complicated way with a very expensive machine. I want it to be pretty quick. So yeah, I think that's a big piece that's missing in medicine that isn't tracked.

Well, just to Leonard's point, I mean, it's all over, but grip strength—that's something that we've recently, I don't know, probably the last six months or so, started adding when a new patient comes in. You know, they immediately get their blood drawn, do the InBody, and then they do a grip strength test. And I do think, just teaching patients how to do it right—I know it's a variable tool and we kind of get the markers all over the place, but to Leonard's point, it gives you a direction. Am I making a difference in this patient? We treat muscle like a vital sign. I mean, it's just as important to measure muscle as it is blood pressure. And then having their protein evaluated, the sleep questionnaire—the correlation of good muscle health and strength with sleep, and then obviously the hormonal assessment, making sure someone's hormones are optimized so that they're able to actually work together and build that muscle strength tissue. Because I mean, the muscle is one of the biggest targets for hormones.

I think it's so interesting, the number of things that you both have brought up. Going back to the fat-infiltrated muscle, I mean, I think that's one of the things I've experienced—like, you know, you start to train down, you notice some of the size that you were carrying before, and you realize, hey, I've been pumping excess calories, I've been in a surplus, and maybe at sometimes you go into a greater surplus than you really should. And those were kind of the older days, you know, I don't do that kind of stuff anymore where you're kind of training up and then cutting, training up and cutting. Now, if you're going to bulk up or you're trying to put more muscle on, it's going to be a lean bulk in my world anyway. But it's interesting to see that notion of that interlaced fat inside of the muscle and how that's maybe not functional muscle. And that is an interesting question when you think about how does a GLP-1 work within that—we're losing muscle, but are we really losing fat inside of the muscle? So, I'd love to hear more of your thoughts on that, Leonard.

Yeah. And so, our insurance policy on that is measuring strength, right? Because one of the lectures that we give a lot is on the importance of body composition and what all those metrics mean for longevity—what it means for what the literature is telling us about how long or how well someone's going to live, or their propensity for things like cancer, cardiovascular disease, and neurodegenerative disease. This is all the literature around things like body composition, visceral fat, and appendicular lean mass index, which is like how much muscle you have in your arms and in your legs. So one of the things that we talk about is like, how does the patient come and present, right? It's a completely different story.

If someone comes in and they have high fat tissue but low muscle mass, we don't want to sacrifice any muscle mass there. We want to work on strength. We want to do all the things we're doing, but we're not willing to sacrifice any muscle there because they're already sarcopenic—they're what we call skinny fat. But if someone comes in and they have a bunch of subcutaneous tissue or visceral fat, but they also have a lot of muscle, now we're thinking about it completely differently. Now we're thinking, okay, let's get a baseline of your strength, but let's really focus on the most dangerous thing that you have going on, which is this inflammatory visceral adipose tissue that is going to cause so many other problems, not just metabolically, but even in their immune system. And so we're okay—and this is like the dirty word to say—if someone is losing muscle mass with that phenotype, because we know, especially as long as they are not losing strength or they're even getting stronger. And we've seen this happen before where somebody is losing weight, losing muscle, and actually getting stronger at the same time just because they're functionally much better now. They can move a lot better. They can do interval training. They can work on their mitochondria. They can work on their cardiorespiratory fitness. All of a sudden, they can lift weights a little bit longer without getting out of breath. And so, it's completely different depending on how that person presents. But that's why I'm thinking so much about strength and how we get more doctors, more medical practices, and medical practitioners measuring this—because you're missing out on a really key biomarker, I believe, in assessing what you want to do next and how well your treatment's working.

Yeah. Yeah, I mean, I definitely noticed it in something I was doing just recently in periodization of my training, kind of going down in size but being much stronger—much, much stronger—and it was just really cool. Hey Kristi, I want to go back to the grip strength thing because often times, you know, when you're doing farmers carries and you're carrying really heavy kettlebells or even dumbbells or whatever, or you're doing hanging—I saw something the other day, people talking about hanging and grip strength, and how absolutely important that is to hang for like two or three minutes per day just doing that, maybe not every single day—but I'm curious, when you think about like adding grip strength or testing that inside your practice, how are you doing that?

We're first just starting with the baseline and then we're comparing it to their InBody. To Leonard's point, it's such a fun measurement to get because in our area of medicine, we can actually do something about it. I think for me, that's what adds excitement—if I see someone with a low grip strength, say they're that skinny fat or that other patient that Leonard was talking about. There's this one guy of mine in particular, I wished I had access to that MRI that Leonard talks about because he's going to have a heart attack, and I've done everything I can to try to undo that size—big is not cool. Because I can promise you, if I had that MRI, he is completely infiltrated with the fat inside his muscle. I know his cardiovascular, his immune, and just metabolism—everything that Leonard just talked about. But so the grip strength, like I said, really, it's a technique and it does take time for the patient to understand, as simple as it sounds. Especially for people that are not physically active, learning how to hold it and how long to hold it. But again, it kind of goes back to those myokines—it's that contraction, that ability for that muscle to actually contract. We don't use it in isolation, guess if that's your question, but we also use it clinically, like: are we making a difference with hormones? Are we making a difference with peptides that we might be using to help them with their strength?

You know what's funny? I think all three of us can probably in some way relate to this—I'm certainly going to speak for myself here—if I'm missing any period, like when I took a deload just recently just to kind of like, hey, I gotta give myself some rest and kind of cool out. But the reality is, I go a couple of days without training and I really start to feel it. It's almost like that thirst feeling, you know, that feeling when you start to get, "Oh, I'm starting to get thirsty, I'm like low on hydration." Why do you think that is, that feeling? It's almost like an addictive feeling, that feeling of, "I've got to get to the gym." It has to tie into everything that you just talked about, Kristi and Leonard—that sort of entire cascade of response that's coming from the muscle, from those contractions. So, is that what it is?

Yeah, you know, I was just recently doing some research in preparation for a lecture on mitochondrial peptides and what happens when you exercise and when you're stimulating muscle. I don't think people realize how closely some of these peptides that everybody goes crazy over are just mimicking what happens when you exercise. I was looking at one of the mitochondrial peptides and just going through the research of mechanistically what it's doing, and it is everything that Kristi was describing. It was the ability to dispose of glucose, to oxidize fat, to do just all these things that happen when you exercise. Even the ability for it to upregulate antioxidant enzymes.

One of the things that happens when you exercise is that, yes, you're doing all the beneficial things that people typically talk about, but it also is empowering your mitochondria to stimulate certain gene transcription factors that upregulate antioxidant enzymes because your mitochondria, it's almost like it's burning out, right? You're creating energy and so you have to deal with that oxidative stress that you're creating, and so the mitochondria itself can upregulate those enzymes. So it takes care of both of those things. You're creating energy, but at what cost? And so that's why you see people with immune dysregulation—they don't have that antioxidant to upregulate. And so you get them to go walk or exercise, and they're done for like a week because their mitochondria is not functioning properly.

But it's just wild how all these medications that we try to look at, all these peptides that we look at, it's just so closely related to exercise. Cuz I don't think people realize when you stimulate muscle when you exercise what it does on a cellular level—from your brain, to your clarity of mind, to your immune system, to your energy. Kristen, my wife, and I went on vacation for a week and she wasn't doing her typical yoga and her typical exercise routines and classes that she goes to, and you can see it on her sleep score, right? She didn't have one little of those crowns on her sleep score while we're on vacation. We got back and looked at her sleep score—like what it does for your sleep, what it does for your stress and your anxiety. And once you get in a routine of doing that, you want to feel good, you want to go get that—something's missing.

Now, the complete opposite happens when you take a break. Like what happens when you get sick or you're just traveling and you go off for like a month or three months and you're not exercising? It's so hard to get back into it. And those first few days, it's like you don't want to go there, you don't want to wake up, you're struggling to walk into the gym. It's completely different because you haven't had that positive reinforcement of that stimulation of your brain, of just feeling well. But once you get that going, it becomes like an addiction, like you said. And I love it when I'm in that zone where I'm thinking about my exercise the next day because I cannot wait to feel great. And that's the hard thing to explain to people that aren't making exercise a big part of their life—the benefit that they're going to have—because they just look at it as kind of this tedious thing that they have to do. But I think if they just did it consistently for some amount of time, they would get that addiction that you've felt.

Jo, it's so true. This morning, we had been hitting it hard and I was like, "It feels like we've only been here for 20 minutes and I could just keep going." And that peptide that you mentioned, as an exercise mimetic doing all those things, I mean, it's really so fascinating. So I can't wait for the day when we can really just talk about these things the way that we want to talk about them out in the open.

Well, you know what's crazy is that your body secretes this peptide when you exercise, and there are very few studies on it, but they measure what's happening in the blood, and when you exercise, this is the mitochondrial peptide that gets upregulated. It's in your bloodstream, right? And there are amazing studies on that. So like, we should be able to talk about it—it's kind of crazy. It's like, this is just a peptide that your body is upregulating when you exercise.

Well, we're not that far off, I think, from being able to talk about it, which is pretty cool. And yeah, that feeling, it's almost like the hydration thing. We talked about that the other day, Leonard, offline around hydration. And it's that feeling of—and Kristi, I've talked to you about it before—it's that weird thing that's running in the back. You're like, "What's wrong? What's wrong? I haven't had enough water." Which rarely happens to me cuz I drink just a ton of water, constantly drinking, continuously drinking water. But it's just really interesting, that feeling around exercise. When you get into it, you're so into it.

On the other side of it, Kristi, you've said this to me like, "Hey, don't overtrain because then you could deplete your ability to actually ward off sickness—you deplete yourself, right, if we overtrain. We're working too hard." And guess that's sometimes a fine line, it's difficult to kind of figure out. Kristi, you said to me at one point in time, anything past a certain point is kind of just worthless. We've heard about it before—junk volume in the gym. Where do you come out on this today? Do you have an opinion or a thought that you can share in a general way?

I mean, I think it really is individualized. I'm thankful that even though I was born in the '70s, when I was little, my parents worked out every morning. I mean, I just thought it was something that, okay, you're supposed to get up and you're supposed to work out and go about your day. And so, working out has just always been a part of my life. I'm thankful that I've never struggled with the desire to work out, but I can also tell you as I've aged and as patients age, your rest and recovery has to look different. I don't go nearly as hard as I used to. And I can feel it in my body that when I overtrain, or if I run too much or cycle too much or lift too many consecutive days, I feel it. And so I tell people you've just got to pay attention to that.

Metabolically, your body's also going to tell you. These women that are in their 40s and 50s, they go to every spin class, they go to every freaking cardio class, but they're not picking up a single weight, yet they're not seeing the changes. Well, I honestly don't do a lot of cardio anymore. I mean, I do some, but the majority of my workout is lifting, and it's very efficient. I'm in there 25–30 minutes max, cuz I do it in the morning before I get to work. And so I think as a patient, it has to be individualized.

When I'm talking to patients about living healthy, I tell them that muscle is the retirement account of health. The earlier you invest, the greater the return. I think that makes sense to a lot of people, especially anybody that owns a business and anybody that's just even interested in money, right? Invest in it early, and it's going to give you a bigger return because every decade after 30, you're either investing in muscle or you're paying the interest on losing it. That's kind of my approach for patients just to get them to understand the importance of muscle. And if they aren't a gym person—like I had a patient earlier today, she doesn't go to the gym, she walks her little bitty dog a few steps—I just said, "You know what, just hold your dog and walk a little bit longer with a weighted vest." It doesn't have to be done in the gym if that's not what you want.

Leonard, I saw you on the treadmill the other day with your weighted vest doing incline cardio. And you know, there's some stairs around my house where they're really steep, so if you're doing those stairs, you're really getting a real leg workout in. So, it's just kind of interesting. Taking it back to you, Leonard, I think it's hilarious to think about the fact that it's so amazing, this technology that's developing. We start with InBody and DEXA, and now you've got a device that can look at the intramuscular fat. So beyond the DEXA, the things that you're doing at NewHX are pretty revolutionary. That testing of strength, the way that you're doing it that we saw at the pre-conference on CSM—wow, that was just amazing stuff. It's got to be super exciting for you.

Yeah, I probably think about this topic the most because I think that you can get so much information and help people. There's a lot of ways you can help people, but this stuff that we're talking about today is just so foundational and moves the needle so much. We think about that a lot: how can we help medical practices understand these metrics better, understand the interventions and the recommendations they can make, and what compounds and potential supplements can they use to help their patients exercise better? At the end of the day, it really is that easy.

People talk a lot about peptides. Outside of all the benefits that people describe, where I see the biggest benefit is how well they help people exercise and how well they help them recover from exercise—especially for newer patients who haven't been working out forever and they get so sore that they can't go back. There are the recommendations of exercise, and then there's how you are going to help somebody exercise better. What recommendations can you make, or what things can you add, or what supplements can you add—or just basic things like we talked about before, like iCell water, hydration with creatine and amino acids? What can you do to help them exercise better? All that can stem from before you even get blood work, honestly. If you know someone's body composition—let's not even complicate it—if you know somebody's body composition and where their fat is located, it can tell us so much about their health.

I think it's an exciting part of medicine. It's like, how do we bring all these metrics together in a simple and easy way to understand, and how can we incentivize patients to come back and retest so that they can see longitudinally how they're improving? What's changing? So they can identify their change in energy, their change in mental clarity, along with these biomarkers that their physicians should be looking at. You say it's next-level revolutionary; to me, it just seems like it's basic—not because the understanding is basic, it's just because we kind of skipped over it. We were like, "Okay, we used to weigh patients on a scale," and then all of medicine just forgot about it. That's it, we weigh people, and then it went to like fancy diagnostics and genomics and all this other stuff. We're just going to go back to the basics and really understand what someone's body composition is telling us about their long-term health, and then what are the ways that we can intervene and make sure that the patient knows how important this is.

Like Kristi was saying, it's like the reserve currency. Even somebody that comes in that has a normal, good body composition—good muscle mass, good fat tissue—there is still some work to be done there because depending on what age they're at, you can only put on muscle for so long. So, now's the time to start stacking up that currency in the bank, because you never know what's going to happen. It's just going to make your life that much better when you're older. There are so many studies showing that when you have a traumatic accident, or you get very ill, or if you're in the ICU, the amount of muscle mass you have maintains your life to get through some difficult times. Muscle mass plays such a big role in the survivability of these very complicated or traumatic things that may happen. So, it's just always such a good idea to be muscle-centric, like how you guys define this podcast. It's basic, but it seems futuristic at the same time because it just hasn't been done in medicine. It hasn't been focused on until maybe the last few years. But yeah, we kind of skipped over it after we started weighing people.

Yeah, it's amazing to see. My uncle was hospitalized for—gosh, I guess he was in the hospital like three weeks. What's the metric that's used, Kristi, for the amount of every day that you're in a hospital bed, it takes x amount of time to recover back from that? And especially if you're in your 80s—I mean, I saw him afterwards and it was like, holy mackerel. This is a guy that played tennis every day, basically, and was in perfect, amazing shape, and then all of a sudden, you know, he's using a walker. It's really wild to think. So, what is that metric? Do you recall what that is? Like every day that you're in a hospital bed that you're sort of sitting there.

It really depends, to Leonard's point, on how you walked in. How did you come in? Because there's some people that can be in a hospital for a week and get out and start walking, but there are some that can be in the hospital for three days and have to be taken out in a wheelchair, stay in a wheelchair, and go to rehab. So, I mean, I don't know, maybe Leonard has a different thought on that matrix, but it really depends on the patient and how you came into the hospital.

Yeah, that makes perfect sense.

There was one study, I forget what it was, but it was shocking on how fast you can lose strength and muscle mass—like, how fast it happens. You could be training for a year and then be off for two months and lose so much, almost being back to square one. And that's why consistency is so important. I'm on a peptide kick today because it's not just like the peptides that help you exercise better, or exercise mimetics, or improve muscle; there's a lot of regenerative peptides that help you prevent or recover from injury, because that for me is an issue now. Every three or four months, I'll tweak something and then I've got to be out for a week or two, and then that's when the bad habits start, and that's when a week or two turns into a month or two. And so, the other thing that we've got to be thinking about as medical practitioners or as a patient is consistency is going to be more important than anything. How do I stay in the gym? How do I stay consistent and stay working out? That might be by potentially getting a trainer to make sure you're doing things correctly, and using some of these other things that you have available to you to be protective or even heal from injuries faster. It's about staying in the game and then just asking the patient: what are you living for? Because whatever they're living for is going to require muscle strength—regardless of whether it's being able to go on trips with your significant other, or still wanting to be in your career making money, or just being a stay-at-home mom, being the best mom or parent you can be for your child. Regardless of what you're living for, going back to the basics, you're going to have to have muscle—not only from a brain perspective, but from a functional perspective, a metabolism perspective, and then just to stay healthy.

Yeah, so true. You know, it's really interesting. I've been in the gym, and there are times, obviously, when work required that it wasn't as much as I would have liked it to be. But lately, I've seen a lot of people in the gym who go to the gym and don't really know how to use equipment, don't know how to train, and they can't put together a program. They don't take advantage of what you pointed out, Leonard, which is some sort of personal training. There are a whole bunch of apps available now that I think are kind of interesting—I'm not going to name them because they don't come to mind off the top of my head, but they're available in the app stores and they actually show you the exercises and help you put together a program based on the metrics that you feed it. So, I think now more than ever, the opportunity to exercise and the competitive landscape in the gym world seems to be growing and changing. And that's not the only place where you can get exercise.

Although, I do really appreciate what you said, Kristi—I think it's so true. Strength training and weight training are far better, in my opinion, for efficiency, and you guys are both pioneers in this space. Kristi, there's stuff we can't talk about, but there's big things for you on the horizon. And Leonard, you're doing NewHX. It's just an exciting time. I think people are tuning into this and really realizing that exercise not only is that currency that you're going to need in the future, but also, when you get into it, it just changes everything. It makes you feel so good. There are certain things I go, "Oh, I'm not doing that because that's going to mess with my training day tomorrow. I can't do that. Sorry, you guys can go ahead and go have fun, I've got to do this thing over here. This is what I'm into." Hydration—we always have to talk about that. You mentioned it, Leonard, but I mean, hydration—I see it every day in the gym. People are walking around just going back and forth to the water fountain. I'm like, "Oh, man, big mistake. You just don't have that big bottle of water." I just don't know how people do it. To me, it seems like you just can't get a great workout unless you're really putting the fluid in.

You've got to be really careful with all these interventions. You know, you've got peptides, you've got supplements, and you're trying to do the right thing. There are people that, unfortunately, are working hard and doing all the things, taking all the things, but they could be negating some of the things that they're trying to do. What I mean by that is, for instance, take hydration—take this subject. You're trying to stimulate an anabolic growth response for your muscle, and so you're trying to stimulate protein synthesis. Hopefully, you have enough protein in the system to take advantage of it. But something that people don't realize is that your cell volume or your hydration—the volume of the cell or how well your cell is hydrated—signals things as well. If you're not hydrated, it'll signal to degrade protein. So, here you are in the gym. You're eating protein—or hopefully eating protein—and you're working out, but your cell is in an environment and a state where it's inhibiting the very thing that you're trying to do. And so, it just cancels itself out. There's a lot of instances of that when it comes to peptide supplements; people kind of just go all willy-nilly taking a bunch of things. But hydration—I didn't take advantage of it for a long time, and it is just night and day. Night and day when you can stay hydrated while you're exercising.

Of course, we always talk about iCell water, which is basically amino acids that are osmolytes that draw water into the cell, like glutamine, alanine, taurine, and creatine. Creatine is this osmolyte that draws water into the cell. So when you're drinking water, you're actually increasing cell volume, which is putting your cells in an anabolic state that actually is conducive to protein synthesis and what you're trying to achieve while you're stimulating muscle and exercising. So, this is like a no-brainer. It is not just a recommendation—you have to have it. Cuz it's just so unfortunate if you're completely shooting yourself in the foot by not doing something as simple as hydration.

Yeah. I mean for me, I have a different blue bottle that I use, but this is a Hydro Flask, and it's like 40 ounces. So, I'll put ice in this plus my iCell combination that I use, and I'll go in and fill it, and then I'll drink it down to about a third of the way. Then I'll fill it back up in the gym, drink it down. So I get it in, and then I cut it off at a certain point in time so that I've got that mixture that I'm drinking throughout the day, but I continue to fill it up. We have this ultra-super-purified water here at the office that keeps me hydrated—always, always. And I take it home and I'm drinking it at night. So, the hydration piece is so absolutely critical, and I see people missing that all the time in the gym. I just can't believe it. I want to say something to them, but I always feel like—you know, it's like seeing the guy that's doing the exercise the wrong way—who am I to come up to somebody and say, "Hey, you know what? If you tried this differently, you'd get a better result. What you're doing right now is actually not good for you, and here's why." I would hate to have somebody do that to me.

You're rolling the dice. Some people are very appreciative, and some people want to fight you.

Yeah, exactly. Well, Kristi, any final thoughts?

We're so blessed to have that iCell water. I mean, Leonard and Frank, you guys did an amazing job with the creation of that. Because there's one thing that I will do consistently every day—I might not take all my supplements every day or might not do all my peptides, but I never skip iCell. I can tell when I'm flying; I feel better flying. I don't swell nearly like I used to when flying to and from volleyball conferences, whatever it might be. But I think that's where I've noticed it the most, to be honest, because I used to dread flying cuz I was one that would swell. But I no longer do anymore. And then just energy and skin. I think, with myself getting closer to menopause, you see it in those women. Being honest with patients when we see it—to your point of being worried to go up there and talk to someone at the gym, Jo, it's kind of the same thing Leonard and I deal with. People appreciate personal experience—maybe not unsolicited advice, but I honestly tell them my personal experience with iCell water.

Well, we all know that this stuff works for sure. One of our clients, who's a plastic surgeon, I said, "Here, let's do a 30-day challenge. I'm going to give you a bottle of this stuff, and at the end of the 30 days, I want you to try to go a day just drinking water." Gentleman's bet, he goes, "Where is that to get? I need that stuff." So, I already ordered a bottle for you so I can give you the other one. He's a good guy.

Well guys, this has been super fun. It's always kind of interesting when people are out and we get this opportunity to just be a few of us—it's always kind of an interesting way to go about it. And I really enjoyed this time with you guys today, obviously, always do. I want to thank you so much. And for the listeners out there, if you know someone who's really wanting to learn how to get back into exercise, this might be an episode you'd want to share with them. Please remember to like, share, and subscribe. And leave us a comment, send us a message, let us know what you want to hear about, because the panel of experts that we have are just phenomenal. Thanks everyone for tuning in, and we'll see you on the next episode.