[Transcript] – The Ultimate Guide To Maintaining Muscle (Even When You Can’t Workout)

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Podcast from:  https://bengreenfieldfitness.com/2016/07/how-to-maintain-muscle/

[00:19] Introduction/Earthrunners

[01:58] FitLife Organifi Green Juice

[04:33] About Muscle

[06:01] About Alex James Ritson

[07:14] What Got Alex Interested in Studying Muscle Loss

[09:26] What Happens to Muscle When Bed Bound?

[15:00] Why do We Lose Muscle as we Age?

[22:25] How to Maintain Muscle (Activities and Supplementation)

[31:46] Supplements and Nutrients that Stave off Muscle Loss

[45:11] The Fascinating Lessons From Astronauts and Space Research When it Comes to Maintenance of Muscle

[48:26] How to Strike a Balance Between Anti-aging, Longevity and Protein Restriction and Not Losing Too Much Muscle

[56:51] End of Podcast

Ben:  Hey, what’s up folks? It’s Ben Greenfield and I think you’re gonna dig today’s episode.  It’s about how to maintain muscle even when you can’t move a muscle.  We go over some really cool, cutting edge research that shows all the latest greatest things that you can do to actually keep your muscles around.  You might need ‘em.  Trust me.

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In this episode of the Ben Greenfield Fitness Show:

“The protocol that they did was 5 sets of 5 minutes occluding of the immobilized limb for I believe that’s 3 sets during the day, and I was sharing to help salvage it more lean body mass and that it seems terrible that I didn’t do it.”  “So as physical activity gets reduced, nutrients sensing to amino acids gets reduced as well, and this is what causes actual anabolic resistance being a one factor vitamins also and other kind of multiple factor as well.  Like microvascular preclusion and things I’ve described be the outtake of amino acids is not being up taken.”

Ben:  Hey, it’s Ben Greenfield and coming from an ex-bodybuilder, this might sound shocking but muscle is actually really not just for bodybuilders anymore.  You may have heard of the term that strong is the new sexy but really muscle, and I’m not talking about the big bulky stuff, but just like you know, tight, toned, lean muscle.  You know, not necessarily having guns or delts or lats that make you keep your arms held far away from your body when you walk, but like lean, wiry muscle.  It’s heavily correlated with everything from anti-aging and longevity, to cognitive performance to of course, metabolism and beyond.  And it’s very, very darn important even if you have no desire to strut in a Speedo on muscle beach but you know, I get a lot of questions from people who wonder for example, how fast you lose muscle when you stop working out or how much muscle you can expect to lose as you age, and what you can do about that.  And the best way to maintain muscle when it comes to exercise strategies, diet strategies, supplement strategies.  And you know from cutting edge NASA research that we’ll discuss a little bit in this podcast episode on maintaining maximum muscle as you age to pretty surprising nutrients that have actually been proven by science to keep muscle on your body as long as possible.

You’re gonna discover the answers and many more in today’s episode.  My guest is Alex James Ritson and he’s actually finalizing currently a Master’s Degree in Sport and Exercise Nutrition at Middlesex University in London.  And he’s the co-owner of Lean Body Performance, a fitting name considering we’re talking about muscle, that’s an online nutrition and training coaching company and he’s actually very well versed in this particular area of interest that he has.  Now he’s studying how protein intake affects lean muscle preservation.  So we’re gonna be talking about everything from the cellular mechanisms behind muscle loss, to how we lose muscle as we age, to supplements and nutrients that can stave off muscle loss, and much more.  So Alex, welcome to the show.                   

Alex:  Thank you so much.  It’s an honor to be here.

Ben:  Yeah, and I read a fascinating article that you wrote in a research journal.  The article itself was entitled “Protein Intake and its Effects on Lean Mass Preservation in Bed-Bound and Immobilized Subjects”.  It was a very good research based article and it generated some questions from me that I wanted to ask you about but before we delve into that, what got you interested in studying muscle loss in the first place?   

Alex:  Yeah, I mean first of all, I initially delve into a literature of you to dive into the literature on what you just kinda hit across which is what is the effect of reductions of muscle mass when you cannot have a subsequent deload or could have abstained from training for a while?  And the research in the area from which this pass, so I just thought would it be better into kind of delve into more research into bed rests and immobilization but a little bit more kind of, robust and kind of research there, and able to draw away some current conclusions from that level of research, some protein ingestion.  And it perhaps kind of affects some salvaging rates of muscular mass throughout those kind of models.              

Ben:  Have you ever been bed bound or injured in a way that kept you from actually maintaining muscle? 

Alex:  (chuckles) Not to an extravagant amount.  It’s kind of a brief injury et cetera, but nothing to the extent whereby I was completely immobilized for 2 or more weeks, you know?   

Ben:  Yeah.  You know what I find that tends to happen with a lot of athletes or a lot of active people is they don’t necessarily get bed bound or immobilized even though that does happen you know, people will get in a bike crash or whatever, but a lot of times it is that or whatever, “I injured my knee and I can’t exercise my lower body at all, or I injured my shoulder and I can’t do any upper body movements but I still wanna figure out how I can maintain muscle”, and a situation such as that.  I don’t think we have a lot of listeners who are in a full body cast bed bound in a hospital somewhere trying to figure out how to maintain muscle, but instead for me a lot of this stuff is relevant when I just can’t exercise a specific body part, or say if I’m you know, travelling and have minimal amounts of time to say, lift weights or load the body.        

Alex:  Yeah, absolutely.  I mean there’s gonna be some certain point when messages that we hear across in this whole course regarding what can we at least salvage in terms of rates of muscle mass even in subsequent levels of kind of.  Even so our injury whereby you might just be bed rested for a while thereby brief span of time or for instance yeah, you quite rightly said at least had this time having a brief deloading and not being able to train or what’s the actual extent of the rate of the muscle mass loss, you know?      

Ben:  Yeah, exactly.  So let’s start here.  When we get bed bound or when we get into say, we can’t work a specific muscle, what exactly is happening to that muscle?  I think this will help people wrap their heads around some of the suggestions that we make later on.     

Alex:  Yeah, love it.  Great question.  So right, just first of all we will be listing this up there.  So there are certain kind of [0:09:43.7] _______ there are sort of the skeletal muscle mass and that can focus straight rolls and nutrient disposal, liquid oxidation, liquid irregulation and the exchange of chemical energy to kind of contract or work in forced transmission.  The importance of skeletal muscle mass can’t be overstated really ‘çoz what we do find is that skeletal muscle is very clastic.  Us nerds call it clasticity and it changes and adapts in accordance with different ability and intense frequency and durations.  And subsequently in doubt, so bed rest unfortunately adapts by having you know, skeletal muscle atrophy.  In a recent review by Benjamin Wall in 2013 he kind of showed by looking at all the research on muscle mass being measured and bed rest or immobilization that 0.5 percent of total lean body mass today is shown to be reduced in rates with kind of bed rest with the initial kind of ten days [0:10:38.4] ______ [0:10:39.2] ______ which is reductions in muscle mass.            

Ben:  You know, in that study that you just talked about where someone’s losing 0.5 percent of lean body mass per day.  So we’re losing half a percent of our muscle per day when we start to not work that muscle.  Are we talking about like in that study for example, like total immobilization like lying around or just like not loading your muscle, not lifting weights?     

Alex:  So you know, context is so important and I think in most of those studies would be people who didn’t get a previous training behind them.  So in the context of someone who, we’re gonna touch on this later on but someone who’ll just probably just come off about training and maybe they will come some super compensation by deloading  and just kinda being  a couch potato for a week or so isn’t gonna see this effect.  But someone who’s been injured and kinda completely bed rested or immobilized, the severity kind of be to about 0.5% of good lean body mass per day.  With the initial ten day being the greater effect.

Ben:  Okay.    

Alex:  The health implications on this though are quite multi-faceted but their relatively extravagant so you’ll see kind of, reductions in metabolic rate, reductions in insulin sensitivity, increases in fat mass and emergence in functional strength capacity but with the latter being probably the most extravagant one with as I highlighted 0.5 percent of your total lean body mass being reduced today times that by three and that’s what you’ll see for reductions and shared capacity.

Ben:  Oh wow!  So muscle mass you lose at 0.5 percent per day but actual strength loss is three times, so 1 ½ strength loss per day of actual disuse of the muscle.

Alex:  Yeah, and in the review by Benjamin Wall that’s exactly what they put across.

Ben:  Now is that because you actually lose muscle fibers, is that a loss in say like oxygenation or blood flow to a muscle, a loss of mitochondria or what’s the reason behind that?

Alex:  Well, it’s certainly a reduction in the ones that you just said, could across five days in mitochondria etcetera.  I think in terms of strength I think it’s the massive neuro component that kind of [0:12:36.2] ______ that.  But in the context of athletic performance which we can touched on which is curbed mitochondrial regulation plummets as well and you got also kind of increase in tendon elongation and also excretion of calcium as well. So all these factors can affect athletes as well, as to have a very severe rate.

Ben:  What does that mean?  Increase in tendon elongation?

Alex:  So tendons are quite stubborn, right?  And what we actually see from bed rest or immobilization they’re totally the one whereby they weren’t atrophy so much but tendon elongation from what I’ve read in a study kind of around this area is that they tend to be more susceptible to injury.  That if anything is gonna be a little bit more stubborn to atrophy it’s gonna be tendons, but the elongation part I’m guessing from what I read in our research in the area would kinda indicate it being a little bit more susceptible to injury.

Ben:  Okay, got it.  So this would be with bed rest or lying around, this o.5% per day or a three times loss in muscle with a lot of that being related to just like you mentioned a big part neuro muscular like loss of actual neuro feedback from the brain to that muscle.  You lose the actual capability to recruit motor units or recruit muscle fibers, is that correct?

Alex:  Yeah, absolutely.  It’s just like I remember recently watching a seminar by Stuart Phillips and discussing to see that how you can tame rates of muscle hypertrophy with kind of low load and high kind of high load training and I think he said in terms of shared performance obviously you gonna get to attain more shared improvements via low load but that’s subsequently just because your body’s more used to lifting heavier weights so it’s just a matter of neuro component that if you transfer to bed rest as well is that I think it’s the same thing you know, strength reduction obviously get diminished quite rapidly just because it’s not covered seeing that load anymore that what kind of being susceptible to that level of contractual loading or as often as rapid reduction.        

Ben:  That makes sense because when you start to lift weights or you start to strength train the first benefit that you tend to see comes from a neuro muscular adaptation to training, and then a lot of times even though you don’t see changes in your body right, like in the way that the muscles look, those musculoskeletal adaptations take place several weeks after the neuro muscular adaptations begin to kick in.  So it seems to make sense that as you lose it, you tend to lose that neuro muscular component first.

What about as you age?  So aging is different than bed rest, right? So as I get older that doesn’t necessarily mean that I’m lying around in bed but I’m still losing muscle.  Why is it that we lose muscle when we age?  Have they actually studied this?

Alex:  Oh massively, yeah.  I mean, this is such a fascinating area.  And the thing is, there’s not one unique thing that can determine what is anabolic resistance.  Again, sees with the nerves of us, with myself included refers this anabolic resistance is whereby the protein ingestion, that level of sensitivity to protein ingestion is kind of diminished as you get older.  The one key mechanism I think, is just nutrients sensitivity to amino acids which is induced by physical activity which observes subsequently reduce in the elderly.  So as physical activity gets reduced, nutrients sensing to amino acids gets reduced as well and this is what causes anabolic resistance being a one factor, vitamins also, and other kind of multiple factor as well.  Like microvascular preclusion and things I’ve described being the uptake of amino acids is not being up taken.  It’s quite a complicated area but resurgence kind of peeled back that lace of exactly what’s going on there.

Ben:  Okay, so you call that anabolic resistance.  So we develop this anabolic resistance as we age and what you’re saying is a part of that is due to our inability to actually use amino acids to maintain muscle?

Alex:  Absolutely, so I said this also in induced by a reduction of physical activity that sensitizes the muscle to amino acid ingestion. 

Ben:  Okay, so when we exercise, when we engage in physical activity we stay more sensitive to amino acid uptake in the muscle to maintain muscle.

Alex:  Absolutely. 

Ben:  Now as we age, let’s say, and I plan on this, you know I plan on lifting heavy rocks and flipping tires and you know, swinging golf clubs and things like that as I age, so I’m gonna stay physically active, how much of this is like the digestive component right, like losing the amount of stomach acid that you have to break down protein into amino acids as you age, or losing the ability to absorb amino acids as you age, like how much of it is that versus that lack of physical activity?

Alex:  I think we just we don’t know yet if once would be Ben, and again they are pinpointing that there is obviously a complex signaling defect there is as well that have been talked and also this would be like the uptake of amino acids or into one called definitive answer is available yet after I think it’s like a combination of all those together.

Ben:  Okay, got it. 

Alex:  My knowledge on the stomach acid comparing there would be one that I’m not entirely kind of well-versed on.   

Ben:  Would you say that, so if as we age what you’re saying is that natural decrease in physical activity that might occur as we age is gonna lead us to be less sensitive to amino acids being able to allow us to build muscle or maintain muscle as we age, would you be able to also say that like in an athlete or an active person who’s maybe not old per se and at the risk of insulting our listeners, we don’t necessarily define old quite yet, but let’s say that they are in bed rest or they’re not able to be as active as they can be, do they run in to the same issue like if you’re taking in like protein powders or amino acid supplements and things like that and you’re not active, are you also experiencing this thing that you refer to as anabolic resistance?   

Alex:  So anabolic resistance is referring to people who are not overly active anyway even in younger cohorts would they also experience that?   

Ben:  Let’s say I’m injured and I’m taking like a protein supplement or an amino acid supplement right, but I’m not able to work out, does that mean that that protein or that amino acid is useless for me in terms of it being able to allow me to maintain muscle? 

Alex:  Okay, I get you now?  That’s a fantastic question.  In the literature at the moment you’ve got about 4 or 5 studies that look at young and old subjects in bed rest models with protein intake, and out of the 4 studies we’ve seen a positive effect with kind of protein intake training from kind of 1 – 1.6 grams per kilo body weight being shown to have salvaging effects on the body mass in young cohorts with only one real kind of obscure study in the elderly.  So I think it’s more of a sensitization even if you’re bed rested and young compared to the elderly so I think there’s more to it than just physical activity reductions.       

Ben:  Okay, got it.  The number that you just said, you said 1 – 1.6 grams per kilogram?   

Alex:  I know I can’t really give a definitive one and tell of the exact kind of protein and the reason for that is because the research kind of vary between 1 – 1.6 showing kind of different levels of salvaging long terms of lean body mass.   

Ben:  But when you say different levels of salvaging what you’re saying is that is if you’re in that 1 – 1.6 grams of protein per kilogram of bodyweight, all our apologies to the Americans who now have to go to the grams per pound conversion, what you’re saying is if you get that 1 – 1.6 you’re getting the amount of protein that’s been shown in research to at least allow you to maintain some amount of muscle if you’re injured or getting old?       

Alex:  That is absolutely correct.  And the thing is there’s also other things to bear in mind but I just want to talk to now ‘coz although the research says that, there’s even been a case study done if we’re gonna be discussing perhaps athletes here there’s an actually fantastic case study they’ve done last year on a professional soccer player for Liverpool Football Club.  Do you know the team Liverpool?   

Ben:  Ah yeah, I’m familiar with them.  I mean, I’m not necessarily a rabid soccer fan but I am familiar, yeah. 

Alex:  It was done by the Liverpool Center and Moores University, and they took a case study whereby the soccer player had a knee surgery.  I think that was anterior cruciate ligament and he was immobilized, and they kind of run through the interventions that they did with him and what they’ve shown was from the kind of the models that we know which is 0.5% of your total lean body mass being reduced today, they were able to half that extent by pertinent intakes of 2.6 grams per day.  So although I’ve come across in a literature saying 1 – 1.6 grams per kilo of bodyweight has been shown in the young cohorts to salvage muscle mass.  In a case study with an athlete, they even increased it to 2.6 grams and show the reduction of half or more of the potential atrophying rates of 0.5% total in body mass could have been.         

Ben:  Oh interesting.  So you’re saying is like this idea of when you’re unable to exercise as much or your injured, amino acid or protein intake would not be quite as good at building muscle as it would be if you were active because you develop some amount of this what you call anabolic resistance as you’re lying around.  But what you’re saying is based on this case study you could potentially overcome that by just like shoving more protein down the hatch like it sounds like almost twice as much protein down the hatch?       

Alex:  So you could obviously completely overcome it.  The post prime due anabolic resistance in what you see is a roundabout of some issues that prepared to prime due anabolic resistance being a reduction over all muscle protein synthesis is on average like 40-50% but in this athletic cohort of a soccer player whereby they gave him 2.6 grams per kilo of body weight throughout this case study intervention, he was able to half the amount of the potential muscle mass atrophy that they should have seen with the recommendation of course by Benjamin Wall.  Obviously in that our first bed segment where I kind of touched on the 0.5% of total lean body mass reductions per day.  So they were able to salvage quite a significant amount and that objective was pretty impressive but they also did other things, so I don’t think we can just solely put it towards kind of protein ingestion being at 2.6.  I mean…             

Ben:  What else did they do? 

Alex:  Yeah, so they post protein peaks progressively throughout the day which we know from a cup load kind of a key study you know, pulsating your protein peaks progressively throughout the day that transcend sugar rates of muscle protein synthesis was done which is in the average 3 straight sessions would be of benefit for potentials of lean body mass.  They also did electro stimulation, they also did, what else did they do?  They had supplementation of things like HMD, Vitamin D3, and fish oils and creatine monohydrate which you know, we can touch on and kind of break it all down and it’s in terms of what potentially the effects could be in kind of salvaging rates of lean body mass but all these in defense were done as well.  So I think it would be kind of careless of me just to say it was protein, but it certainly interests in that perhaps move that in kind of in synergies would may be electrical stimulation which could maybe sensitize the body to amino acid ingestion could obviously be a benefit.

Ben:  Okay.  So there are a lot of little things you brought up there that I wanna delve into.  The first is you mentioned pulsating the protein intake throughout the day.  Some people will say 20 grams, some 30 grams, some 40 grams.  What have you found in research if you’re spreading your protein intake throughout the day to be the optimum dosing?    

Alex:  So it depends on the cohorts.  So in younger heathier cohorts I believe it was done more.  I may be picturing the research names I do apologize, but then it was about 0.24 grams per kilo of body weight has been shown to maximum trigger rates of muscle protein synthesis.  In elderly populations I think it’s been to around about 0.4 to 0.5 grams and that’s just the anabolic resistance.  You’ll need a higher amount of protein should you get the same response of muscle protein synthesis if you are older.

Ben:  Okay, so it sounds like what you said was 0.25 to 0.5 grams of protein per kilogram of bodyweight for each protein feeding that you do.

Alex:  Absolutely, depending on obviously the age.   

Ben:  Okay, yeah that comes out to about twenty to forty grams – ish.        

Alex:  Makes sense.  So what the pros are doing you know, years ago is pretty correct. 

Ben:  Okay, got yeah.  And then the next thing that you mentioned after you said that one thing that we could do to maintain muscle is to spread our protein intakes throughout the day, the next thing that you said was e-stim.  Can you explain what they do with e-stim when it comes to maintaining muscle ‘coz there’s a lot like I’ve done e-stim that’s like I’ve done one called the ARPwave that’s literally like a full body intense contraction.  I mean, nothing will stimulate like a 600 pound squat and then I’ve also done the very light e-stim that just kind of increases blood flow to the muscle.  Do you know what kind of e-stim we’re talking about like how long, how often anything like that?          

Alex:  So off memory, I can’t give you a definitive answer in terms of what type of E-steam that they use but I know from research that they kind of measure it to that a little kind of 10 to 15 minutes per day that has been shown to kind of help definitely salvage roots of muscle atrophy that you use.  So I certainly think it provides a level of sensitivity to the muscle to amino acid ingestion.  But another one that they didn’t use actually was occlusion training which is also been shown that if you’re less familiar with blood flow restrictive training, which has also been shown in the research to be a definite viable option as it showed like in postoperative disuse atrophy and surgical reconstruction of anterior cruciate ligament.  The protocol they did was 5 sets or 5 minutes of occluding of the immobilized limb, for I believe 3 sets during the day and it was shown to help salvage more lean body mass than obviously the cohort that didn’t do it.

Ben:  The occlusion training you’re referring to for people who don’t know I think I talked about this in some podcast before but like there’s this Japanese form of training called Kaatsu.   

Alex:  That’s exactly where it came from, I believe.  Reading our review by Jeremy [0:26:15.8] _______ seems pretty much weight here what he kind of elaborates it on what this is kind of where it initially derived from, yeah you’re right, kaatsu.   

Ben:  Yeah, so it’s literally like putting a tourniquet around a muscle and the muscle gets pumped full of blood, and then or it doesn’t get pumped full of blood, you’re restricting blood flow to the muscle so it gets pumped full of lactic acid and then you do this set and apparently you get a big dump in growth hormone.  I’ve done it.  It’s very uncomfortable.  Have you tried that style of training before?        

Alex:  Yeah absolutely.  So in phases whereby I might be darting in giving leaner and I don’t wanna overtax myself with kind of heavy loading and subject to induce rates muscle hypertrophy.  When you look at the facets of what will induce muscle hypertrophy some muscle will build-up is one of them that can induce and help signal rates of mTOR and blood flow restriction training and certainly did show to do that.      

Ben:  Okay.  So we’ve got pulsating protein intake by splitting protein into 20 to 40 gram portions throughout the day until we get up to as high as what they use in this study which is like I think you said 2.4, 2.5 grams per kilogram, that’s one strategy.  We have electrical muscle stimulation at 10 to 15 minutes per day.  We have this use of occlusion training where you’re using a tourniquet or kaatsu or whatever to cut off blood flow to a muscle group and work it in that manner, and then also you mentioned creatine, you mentioned Vitamin D and you mentioned something called HMB.  Can you go into any of those supplements as far as like dosages, ways that they’ve been used to stave the loss of muscle when you’re bed rested or you can’t exercise?    

Alex:  Yeah, absolutely.  Just a touch from the protein one though, so they also kind of prioritize on leucine.  So leucine being a key amino acid for triggering rates of muscle protein synthesis, so the threshold that we’re looking out there for about 2 – 3 grams per protein feed which is typically what you’d find in that curve for twenty to thirty gram dose of high quality protein in any way, but just for people perhaps who are vegetarian, you might be looking at supplementing your protein feeds with that 2 – 3 grams of leucine just to make sure that you maximize to trigger that.  But just go…      

Ben:  Okay.  So just to touch on that real quick.  So 2-3 grams of leucine.  So let’s say I’m vegan or vegetarian or maybe you know, I don’t have access to a nice rib eye steak or whey protein isolate, what I would do is I would have whatever my seeds, my nuts, my quinoa, my brown rice protein whatever, but then I also I wanna get my hands on like a leucine supplement and take 2 – 3 grams of leucine.    

Alex:  Yeah, absolutely.  But we just have to learn in terms of you know, your nuts and your quinoa et cetera.  Just need to bear in mind that calorie intake over calorie intake is absolutely important here as well.  Certainly being in calorie deficit is that it’s been shown to increase rates of base MPS reduction by an additional 20%, so you’ll tend to lose even more muscle mass with the heightened issue on a calorie deficit.  For one, this is where the fine line is, because do you wanna get someone fatter to make sure that you can salvage more proper muscle mass throughout that bed rest or immobilized state or would you want you know, to cut into a caloric deficit to make sure that you don’t you know, to earn more fat mass or try and find that key spot of maintenance to try and hold them there.  And so face the finer line I think all coaches have to kind of make their own decision on that one.  Certainly in the case study there actually I believe the subject that you lost was in a slight caloric deficit and obviously with that loss is lower the lean body mass as they retrained him in subsequent increases in lean body mass are over pretty exponential by synthesis also due to the defense that we’re using that we’ve already highlighted.  But it’s a thing to consider what you first saw in the calorie, hypercaloric state so they can perhaps salvage a bit more muscle mass for the bed rest state or you’re just gonna kind of bite the bullet and go, okay, we’re gonna just you know, keep to your level of fat mass not being exceeded trying to keep you at maintenance and we might see a slight reduction to even more of lean body mass.               

Ben:  Yeah, that makes sense kind of like striking a happy balance between maintaining muscle without putting on too much body fat when you can’t exercise.  You know speaking of which, what about the use, because I had a guy named Dr. Minkoff on the show before and he’s talked extensively about the use of these things called Essential Amino Acids like taking anywhere from t10 to 40 grams of an essential amino acid supplement to help to stave off muscle mass, loss or to help an injury heal fast or things like that.  Is there any research or have you come across anything regarding not just the use of leucine but like essential amino acids?      

Alex:  Yeah, that’s been done too.  Paddon-Jones took the young, healthy subjects and put them in a bed rest model.  I think it was for like 28 days and they pulsated essential amino acids, I think 3 times during the day and that he saw  a bit of a more salvaging effect of lean body mass compared to the other cohort who didn’t do that, of course.  But another thing that didn’t as it states in that research paper is that the cohort that had essential amino acids as you put on smidges of fat mass as well, so they were in a hypercaloric state as well.  So I think that in accordance with the essential amino acids definitely help salvage some muscle mass.

Ben:  Yeah, well from what I understand like when you’re using essential amino acids and you’re not active, you get some gluconeogenesis from the high amounts of amino acids and I would imagine that could potentially contribute to fat gain as those get converted into sugars, triglycerides et cetera.

Alex:  Perhaps.  So just touching on the additional supplementation that you kind of wanted me to discuss HMB, Vitamin D3 and fish oil.  Let’s run through it ‘cause it could even quite an interesting areas.  First, let us touch on Creatine Monohydrate.  So creatine as so your listeners would know is methodically used in strength-based and power-based movements for increases in performance but in this case it has been shown as a supplement with potentially like an increasing intra-muscular cellular hydration and the facets of carbo induced muscle hypertrophy, one of them is cellular swelling and creatine monohydrate that has been shown in the research paper as lost on the intent [0:32:29.5] ______ I know it’s in regards to immobilization of an upper limb and is showing that 10 grams of creatine monohydrate has helped was shown to help salvage rates of lean body mass in that study.  I can definitely post that study in the podcast comments section if you have one.         

Ben:  Yeah, any studies that you send and by the way for people listening in, I’m keeping track of everything we’re talking about.  I’m taking notes here and just go to bengreenfieldfitness.com/maintainmuscle.  That’s bengreenfieldfitness.com/maintainmuscle, and I’ll put links in the studies that Alex sends me along with some of the things we’re talking about like, you know, compex or electro- stim or kaatsu or leucine, things like that in the show notes, but creatine monohydrate typically you’ll see like 5 grams per day is a good maintenance dose but what you’re saying is that when you’re injured or you’re trying to stave off lean muscle mass that a closer to a 10 gram per day dose of creatine could be beneficial.

Alex:  That’s what we came across in that research paper but also in that case study we find as well to use 10 grams initially for 2 weeks, and then they kind of brought it down to 5 grams perhaps it’s because the [0:33:33.8] ______ saturated the muscle with creatine previously and that’s why they probably tried to induce that.  The case study just after the first 2 weeks of 10 grams supplementation reduced to cover at 5.  So it might just be the case of trying to saturate that tissue quite quickly on throughout that kind of immobilized state.      

Ben:  Gotcha.  Okay, so the next one that you mentioned is HMB or I believe you refer to it as (pun) HMB.     

Alex:  (laughs) 

Ben:  As you folks do.  But HMB is something I’ve been actually seeing a lot of research about when it comes to performance, muscle gain et cetera.  It’s kind of like on my list of supplements to try and I’ll admit I haven’t done much with HMB yet.  But tell me about HMB like what is it and how would it work to stave off muscle loss and what would the dose just be?      

Alex:  You know what Ben, HMB is quite more of an area.  I think the research in this area is particularly mixed, so I think some of the research methodology are not overly great.  If I was to do from the research has been shown in bed rest models there was one particular research paper and you see out of the many research papers where they saw a salvaging effect in the elderly, and they gave the elderly subjects 0.8 grams per kilo of body weight plus 3 grams of HMB.  And they saw a reduction in the rate of atrophy of lean body mass compared to obviously the cohort that didn’t have the HMB.  Which is quite baffling considering there’s been other research papers on the elderly with similar doses used of leucine which is you know, which has been shown direct comparison to HMB to be a better benefit for increasing rates of muscle protein synthesis sorry, and reducing rates of muscle protein breakdown.  So I’m actually not convinced on it [0:35:15.0] ______.  Its effects on muscle protein breakdown, I still kind of high debate considering it’s not a sacred food for insulin as well.  So I am still on the sense of HMB [0:35:25.9] ______, Ben.             

Ben:  What is HMB for people who don’t know?

Alex:  It’s a metaboli of leucine, and it’s been shown to…    

Ben:  What’s that mean as a metaboli of leucine?

Alex:  So say, what would be the easiest way of explaining it?  So it’s a key component of leucine which has been shown just to increase rates of muscle protein synthesis that has been shown to reduce rates of muscle protein breakdown.  I’m just not overly convinced by with it being in comparison to leucine who’s been shown to might trigger rates of muscle protein synthesis indirect comparison to it is that kind of in better indirect comparison to our research, and then when you put in to certain in the recent papers that I’ve seen, it doesn’t really make too much sense for it to see the benefit that we do.  I think it’s found to the methodology which I’ve been shown and I think I’m not just overly convinced with it from the research that I have seen.  The effects of what you see with HMB are quite extravagant and I think it’s more down to the methodology than anything else.  Poor methodology that is.

Ben:  Yeah.  That’s interesting especially considering like you can get a ton of leucine from eggs, from chicken, from salmon, from beef.  I know it’s pretty high in whey protein and dairy sources as well, but considering how easy it is to find leucine in relatively high content in food based sources like whole food nutrition that you could eat when lying around or when under bed rest or when you wanna build massive amounts of muscle and just get swoll.  It sounds to me like from a budgeting standpoint that leucine or food sources of leucine might be favorable for HMB or compare to HMB?    

Alex:  Yeah.  With the recent paper where they thoroughly compared leucine to HMB and the effects, and they showed that the increases are what used in muscle protein synthesis were aimed to create for leucine but also reductions of muscle protein breakdown were great for leucine as well except that when compared leucine to elderly subjects and bed rested and showed no effect on rates of muscle salvaging BM.  One study whereby they supplemented 3 grams of HMB they saw you know, very, very significant effects of lean body mass retention.  I’m just not overly convinced about that at the moment.  I may have caused research students about you know, being tentative about your observations and making sure that in light of your new research you change your opinion, and so see if you’re more willing to do that just at the moment I’m gonna be sitting on the bench of HMB ‘coz I’m not entirely convinced by it.      

Ben:  Okay.  Got it.  Now what about, you also mentioned of course Vitamin D and Fish Oil.

Alex:  Yeah.  So Vitamin D we’ve heard some cool research [0:38:03.5] ______.  And Vitamin D [0:38:05.8] ______ be knocked out the Vitamin D research on mice and they demonstrate some impairment in the kind of regenerated their own muscle capacity and the smaller more varied muscle fibers.  In more recent research in the elderly have shown that Vitamin D, C or B deficiency kind of correlates it with a heightened risk of [0:38:21.2] ______.  And has could be used as a supplement to the susceptible elderly patients who are kind of frequently bed rested but in relation to kind of increasing the use of muscle hypertrophy certainly more research needs to be done in that manner for sure.  But definitely this can be another interesting area and for the people who are more susceptible to kind of forms of bed rest, that you may be Vitamin D deficient, it might be something to definitely consider.     

Ben:  How much Vitamin D was used in that study?

Alex:  Good question.  I think it was eight hundred international units.

Ben:  How much?

Alex:  Eight hundred at least.

Ben:  Eight hundred international units of Vitamin D. 

Alex:  Correct.  Yeah.

Ben:  Okay.  So that’s not a ton of Vitamin D considering a lot of supplements now are including 1,000 to 2,000.  I always like to mention when I talk about Vitamin D is that Vitamin K too is always important.  You know, when I take Vitamin D, I always try to take about one tenth as much Vitamin K too as Vitamin D.  So if I’m taking a thousand international units of Vitamin D, I try to include about a hundred micrograms of K too to enhance absorption and limit the potential calcification effects of Vitamin D in the body.  But I think one thing, and I don’t know if you’ve looked into this much is the potential for Vitamin D toxicity once you exceed about 80 for you know, your blood levels of VitaminD3.  So I personally think that the use of Vitamin D should be paired with you know, wandering into the doctor’s office and slapping down the forty bucks at least that you can do here in the US, you just get like a blood test for Vitamin D.      

Alex:  Yeah, I think that would be relatively a smart thing to do.  Levels of toxicity, I remember briefly running into this on the examine supplement page and running through that.  But yeah, I think what you put across though definitely and totally a smart thing to do if you getting your Vitamin D3 levels kind of tested and obviously of the back of that kind of supplementation but in the UK for instance the [0:40:11.1] ______ and athletes as well quite (inaudible) or relatively deficient.  Just getting tested you wanted to see if you’re deficient and obviously supplementing at the back of that would be a smart thing to do.     

Ben:  Yeah, a lot of people are deficient.  I looked at a lot of blood tests of folks and a ton more people are deficient than not.  So nine out ten people are deficient and you’ll run into a few people who are like eighty, ninety, a hundred and most of them I found they’re taking like five thousand plus international units of Vitamin D a day. So they’re on a supplement already.  Now, I wanted to ask you about some of the NASA research that’s pretty intriguing but before we do there’s one other that you mentioned that was fish oil.

Alex:  Yeah, absolutely.  So research ‘round about 3 or 4 years ago now I think they looked at kind of a post primordial increases in mTOR regarding fish oil supplementation.  How this provide this kind of I think there was high amino acid immune infusion.  So it kind of showed there could be an increase in mTOR signaling which is a key potent kind of signal for increasing rates of muscle protein synthesis with around about 3 grams of the fish oil.  And if it shown in young and elderly subjects.  A recent research from a wonderful university called Sterling in Scotland.  They’re doing some absolutely brilliant research there.  They’ve shown in a recent cohort study that young subjects with fish oil supplementation round about 3 grams in kind of synergies with protein intake emphasis is by training showed no effects on muscle protein synthesis rates.  So it’s a tough one at the moment because kind of a more practical base study was done recently were they showed no effect really with increases in muscle protein synthesis in kind of suggest would reduce base training protein intake and official supplementation, but this research helps in what’s being done in the elderly yet and whether it’s right to transfer into a best rest study as well and if we saw any heightened effects from muscle protein synthesis in the post parental stage.  So it’s still tentative.  It’s looking more likely that it looks would not have too much with effect.  It could potentially have an effect we just need more research there at the moment.                 

Ben:  I know a lot of people are kind of thinking as they hear you talk about 10 grams of creatine monohydrate, 3 grams of HMB, eight hundred international units of Vitamin D, 3 grams of fish oil, 2-3 grams of leucine, maybe throw in some essential amino acids in.  If people are thinking, “Okay well, I just wanna get as big as possible.  I just wanna put on muscle”, you know, let’s say we’ve got like whatever a high school football player listening in, maybe somebody who’s skinny person who wants to gain weight or get some curves.  Have you ever thought about the idea of just stacking all these stuff together as like a muscle gaining strategy or do you think that type of approach is unfounded or could be a waste of money?      

Alex:  I think It’ll come down to the master of economy I think money, time and kind of mental stress laid about what you could incorporating all these things together on whether it’s actually kind of scientifically needed. I think no.  I think being in a hypocaloric state kind of prioritizing on progressive overload within training and to making sure that you get at least 2 grams per kilo of body weight of protein would be sufficient to do all of that anyway.  I think creatine monohydrate certainly has in its place a Vitamin D3 in someone who’s deficient perhaps would be there too.  But I think that’s it and also making sure that you kind of pulsate your feet progressively throughout the day which I think you’ll probably do anyway to have 2 grams of per kilo of body weight.  If you’re ready to be sensible in your nutrition.  So I think it’s something necessary to kind of throw them all together.  As a coach what we’re trying to do is little as possible but have the biggest effect and I think it is something into a hyparchloric state they usually their kind of focusing on recovery and progressive overload with their training and having sufficient protein to do the trick.             

Ben:  I think what’s kind of interesting is this idea that a lot of times in the studies that you’re referring to where people are maintaining muscle mass with the use of these strategies.  They’re not lifting weights right, like they’re bed bound and a lot of people including myself, I get this mentality that if I’m travelling or if I’ve to lift weights I should not take creatine or I should not take amino acids, or maybe I don’t need to take my fish oil or my Vitamin D ‘coz I’m not stressing on my body.  But it sounds like what you’re saying that these are actually strategies that you can use to maintain muscle when you can’t work out and that you’re still going to get a big benefit from a muscle maintenance standpoint even if you’re not say loading the muscle when you’re using strategies like these.

Alex:  So the thing is like fish oil, you exasperate the trans-membrane and you wanna have to kind of like you know, you would not have to be worried about not taking it for 2 or 3 days or instead of things like creatine as well, you can saturate a tissue and not to worry about not taking it for 2 or 3 days either.  But I think they shouldn’t be your key thought behind the increasing rates of muscle mass or kind of salvage rates of muscle mass especially if someone’s an athlete and just taking 2 or 3 days off they shouldn’t really be worried about muscle mass reduction if from my practice and from being speculating from a limited data, you wouldn’t really see too much muscle mass reduction there if it’s just a basically a scheduled deload or something like that, you know.

Ben:  Yeah okay.  Makes sense.  Now I wanna talk about NASA and astronauts.  I was reading an article yesterday about this new exercise device that they developed for the space station Orion and it’s this thing, and I’ll put a link to it on the show notes if you wanna look at it.  It’s called a Rocky Device and it’s like thus ultra-compact light weight exercise device to help astronauts keep muscle on when they obviously exposed to this much gravity.  You mentioned in an article that I read that you wrote about research done in astronauts and muscle mass maintenance.  What did you find when it comes to what NASA or other people in the astronaut industry have done to help astronauts keep from losing muscle that might be applicable to the rest of us.

Alex:  Yeah correct.  Something in that things like bed rest models as you transfer well quite nicely into kind of space models as well just took  this to oversee the zero gravity component.  So over the past 30 years in particular like the skylabs, space labs, cosmos and mid flights kind of highlighted like an extensive kind of volatile concerns with what kind of forms of micro gravity settings like reductions in functional trend capacity for production and of course, reductions in lean body mass.  A really nice study that came out by tracking colleagues in 2017 would kind of focusing on forms of space flight, micro gravity and trying to look at salvaging rates and they found some interesting stuff.  A 24 young female subjects were kind of subjected to kind of sixty days of bed rest.  And they had to account through to some cohorts one was just bed rest, one was bed rest and nutrition and they gave ‘em 1.6 grams of protein plus bed rest, of course.  And then the other cohort was kind of 1 gram of protein but with an exercise intervention that would come out more applicable to what you could do in space flight.

So I think they did things like supine squats and some kind of treadmill activity which can be done in space quite fast age actually fast age signals.  When I look at some of the You Tube videos of what they can actually do in terms of exercise in space, right.  But what they found was in this study that with bed rest nutrition of 1.6 grams of protein but obviously with no exercise and wasn’t able to come to salvage rates of muscle mass are shown however, the bed rest with the exercise component and the 1 gram of protein was able to salvage a greater degree of muscle mass and strength.  So what we kind of [0:47:33.6] _____ kind of glean from that is that the exercise component kind of trumps the nutritional component when it comes to rates of kind of salvaging of muscle mass and certainly is more the important factor when it comes to space paced program should be kind of more the focus.  So we come across there and intend to be the interventions that we’re trying across for exercise.  It certainly have more of a benefit than the actual nutrition component.  I’m not saying it may have been a nutritional component is not important, it absolutely is, but we contract our [0:47:58.2] ______ and it’s gonna be the key part.  So the things that you’re seeing and what you’re gonna be putting across to your listeners in terms of the video and the article on new interventions for exercise you kind of provide a contract or a semblance or just absolutely amazing at what the can do in space now is just incredible to do that.  To achieve that.

Ben:  And even if you can necessarily move because you’re in bed you could use something like electrical muscle stimulation?   

Alex:  Absolutely.  

Ben:  Okay.  Now kind of playing devil’s advocate here.  We’ve talked a lot about protein intake and I know because we’ve had discussions about this in the past, protein intake when especially you’re engaged in excessive protein intake could potentially activate this mTOR path where you already discussed right, this anabolic muscle building pathway to the extent that it could increase the rate at which telomere is shortened or decrease longevity.  How would you say that one should strike a balance between enough protein to maintain muscle or to build muscle, and not getting say like a shortened life span or decrease in longevity?

Alex:  Okay.  Wow, that’s a really loaded question.  There’s a couple of papers one by Sharp which I’ll post in the comments section and one by Alene Hamilton Lee bringing two key researches from UK.  We try and touch on this quite briefly but I’ll provide my time, my 2 pens or cents or wherever you’re listening from.  I can’t say but basically there was a study by Ruiz and colleague when they come out carried out a really, really comprehensive study where they took eight thousand participants and followed them, and let them be influenced of muscle strength and cardiovascular fitness and healthy ageing, and the subjects on the web kind of vigorous strength test and what they found was that individuals over the age of sixty classified [0:49:48.5] _____ of strength were fifty percent more likely to die of [0:49:47.7] _____ mortality, okay, than the individuals in the upper set of extremes.  So although maximizing MPS isn’t indicative of strength improvement with no companions would touch before playing predominant.  Factor increases in muscle mass would certainly help, alright?  So the anabolic resistance as we know is quite prevalent throughout the elderly with mTOR co-signaling what you touched on being reduced to a cascade effect of [0:50:13.5] _____.  So studies indicate that protein in cohesion with physical activity does impart help sensitized in the salvage muscle mass.  So we know that ageing leads to anabolic in terms of the [0:50:23.0] ______ muscle mass so which in turn [0:50:25.3] _____ so much in strength.  So fact is directly associated with mortality rates in elderly so it makes sense to me that maintaining physical strength is a key strategy to lead to healthy ageing and the preservation of muscle mass is increased by the mTOR regulation of protein ingestion.  So I see they complement each other but we definitely need more research in this area, Ben.

Ben:  Here’s my take on this.  You know, I think that maintaining muscle and having plenty of muscle as you go into old age I was telling to my friends this yesterday actually.  My goal is to actually, I’m pretty lean right now, my goal is to actually put on a little bit of muscle and get a little bit heavier as I go into the latter half of my life for a lot of the anti-ageing benefits that you’ve just described.  But for me, my strategy is that on days where I really am attempting to put on muscle on days when I am lifting heavy.  I’m trying to get close to you know, I’m not weigh for that 2.5 grams per kilogram number that you mentioned that they studied in this athlete who was recovering from an ACL surgery but you know, I’m getting close to about 0.7 to 0.8 grams per pound of protein, that 1.5 –ish grams per kilogram range on those days where I am lifting heavy.  On those days where I need that higher MPS, that higher muscle protein synthesis that you talked about.  But then, my strategy Alex is I’ve been doing like an intermittent fast or protein fasting approach where I’ll have some days where I restrict protein.  Like easier days where I might be doing yoga or sauna or like an easy paddle board on the river where I know I am not getting a lot of eccentric load on muscle, I’m not getting a lot of need for muscle repair and recovery, so I miss a fan of kinda like the true Mediterranean diet not the modern Americanized version of the Mediterranean diet.  Having those periods of time in your life when you fast, when you restrict calories or when you get cellular apoptosis and detoxification, and in those times that you’re in an anabolic mode, I think it’s okay to kinda have both.

Alex:  That’s definitely interesting.  Yeah I mean, (breathes deeply) it’s a tough one until we can gain more research in that one and whether that there actually is benefit but I’m guessing that from anecdotal experience, it is working for you?      

Ben:  Well, I don’t know I’m not a hundred years old yet but I’ll ping you in about sixty five years unless you know how that’s going for me.

One other quick question I wanna throw out there, completely random question but I know some people have talked about it so I wanted to run it by you.  Infrared Sauna or sauna in general and the induction of heat shock proteins as a way to keep the body from losing muscle or to maintain muscle when one cannot say lift weights.  Have you looked into that at all the use of heat or sauna for muscle maintenance?

Alex:  I’m really sorry Ben, I haven’t.

Ben:  Yeah, I was just curious I know I threw you a curved ball there but I knew I interviewed Dr. Rhonda Patrick and she talked a lot about how hyperthermic conditioning can lead to an induction of heat shock protein expression that could stave off loss of lean muscle.  And that’s the strategy that I use sometime ‘coz obviously you can’t just lift weights heavy each day but on some of my recovery days I’ll do yoga and get to the point where I’m relatively hyperthermic in a sauna kinda going after heat shock protein expression.  So it sounds like you haven’t looked into it but I’ll put a link in the show notes for people who are listening in.  Just go to bengreenfieldfitness.com/maintainmuscle and I’ll link to that interview that I did with Rhonda where we talked a little bit about the potential use of heat to maintain muscle as well which perhaps you know, you talked to Alex about like occlusion training, and also electrical muscle stimulation, some of these supplements, it’s possible that maybe some use of the sauna could help as well.

Alex:  Well, Ben I’m likely to learn that.  So if you post those papers I’ll definitely read them.

Ben:  Yeah, for sure and of course, all the papers that you mentioned as we were talking I know you’re gonna send to me and I’ll link to them for all of you smart cookies and geeks out there in the show notes for this episode again which is gonna be at bengreenfieldfitness.com/maintainmuscle.  And I’ll also link over to Alex’s Twitter account, his webpage where you can follow him and some of the stuff that he’s doing out of lean body performance.

So Alex, thanks so much for coming on the show and sharing this stuff with us man, where I think we’re gonna keep a lot of people really, really swoll during bed rest.

Alex:  Yeah, and all the listeners if you’ve got any questions please just email me at [email protected] for any kind of concern or question regarding this podcast and I’ll be happy to help.

Ben:  Oh dude, we get like a hundred thousand downloads an episode, you just screwed yourself.

Alex:  Oh, really (laughs).

Ben:  You better hire an email assistant.  You know, and one thing you could do too ‘coz I know Alex said his email address really fast which may actually be his salvation, you can always leave a question in the comments section too, and I can forward those over to Alex and he can reply there as well if you guys would like to see the discussion as it gets generated.  That’s another option.  So anyway, Alex, thank you so much for coming in the show, man.

Alex:  Thank you for having me.

Ben:  Alright folks, well, this is Ben Greenfield along with Alex Ritson and again the show notes are at bengreenfieldfitness.com/maintainmuscle, we’re signing off.  Have a healthy week and have fun maintaining your muscle.



Muscle is not for bodybuilders anymore. Instead muscle (not the big, bulky stuff, but the tight, toned lean stuff) is now heavily correlated with everything from anti-aging to cognitive performance to metabolism and beyond. So it’s pretty darn important, even if you have no desire to strut in a Speedo on muscle beach.

But have you ever wondered how fast you lose muscle when you stop working out?

How about how muscle you can expect to lose when you age?

The best way to maintain muscle?

From cutting-edge NASA research on maintaining maximum muscle as you age to the surprising nutrients that have been proven by science to keep muscle on your body as long as possible, you’re about to discover all these answers and much more in today’s podcast.

My guest in today’s episode, Alex James Ritson, is currently finalizing a Master’s degree in Sport and Exercise Nutrition at Middlesex University in London, is co-owner of Lean Body Performance, an online nutrition and training coaching company and is very well-versed in a particular area of interest that he has: how protein intake affects lean muscle preservation.

During our discussion, you’ll discover:

-What exactly happens to your muscle when you are “bed-bound” or unable to exercise…

-How fast you lose muscle and how fast you lose strength when you quit working out (you’ll be surprised!)…


-The actual cellular mechanisms behind muscle loss…


-Exactly how much muscle you lose as you age, and the latest research that shows how you can slow down that muscle-loss process…


-Specific activities that have been shown maintain muscle that don’t involve lifting weights…


-The top specific supplements or nutrients that stave off muscle loss when you can’t exercise…


-The fascinating lessons we can learn from astronauts and space research when it comes to maintenance of muscle….


-How to strike a balance between anti-aging, longevity and protein restriction and not losing too much muscle…

-And much more!

Resources from this episode:

Compex for electronic stimulation 10-15 minutes per day

Kaatsu occlusion training

2-3g leucine per day

10-20g essential amino acids per day

10g creatine monohydrate per day

3g HMB per day

800-1000IU Vitamin D3 per day

3g fish oil per day

Infrared sauna

This article on a new NASA exercise device for muscle maintenance

Live strong and prosper: the importance of skeletal muscle strength for healthy ageing.

Nutritional strategies to attenuate muscle disuse atrophy.

Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest.

Influence of concurrent exercise or nutrition countermeasures on thigh and calf muscle size and function during 60 days of bed rest in women.

Case-Study: Muscle Atrophy and Hypertrophy in a Premier League Soccer Player During Rehabilitation From ACL Injury.

Fish oil supplementation suppresses resistance exercise and feeding‐induced increases in anabolic signaling without affecting myofibrillar protein synthesis in young men.

Effects of creatine loading and prolonged creatine supplementation on body composition, fuel selection, sprint and endurance performance in humans.

Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults.


Ask Ben a Podcast Question

One thought on “[Transcript] – The Ultimate Guide To Maintaining Muscle (Even When You Can’t Workout)

  1. li1972 says:

    From cutting-edge NASA research on maintaining maximum muscle as you age to the surprising nutrients that have been proven by science to keep muscle on your body as long as possible, you’re about to discover all these answers and much more in today’s podcast”
    I don’t agree that https://techcrunch.com/2013/01/02/best-health-app…
    Friendly, Li

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