"Forever Strong" - A Book Review

Dr. Gabrielle Lyons is a board-certified family physician who earned her undergraduate degree in nutritional sciences from the University of Illinois. She completed a research and clinical fellowship in geriatrics and nutritional sciences from Washington University in St. Louis. Her first book, "Forever Strong", was published in 2023. It is a significant departure from the typical health advice and information that you will hear from the mainstream medical establishment. The main thrust of her approach is something that she calls Muscle-Centric Medicine, which stresses treating the skeletal muscle as an organ. She believes that, "Your ability to survive and thrive - no matter your age - is directly related to muscle tissue health."

In the very first chapter, Dr. Lyons sets the table for the rest of the book by discussing the need to shift from a fat-focused paradigm to one centered around building muscle. She notes all of the conditions that poor muscle health can influence, from cancer to sarcopenia and even Alzheimer's. The author highlights the importance of skeletal muscle and its role in your immune system, saying, "Training also boosts your immune function via peptides - small molecules composed of amino acids - released during muscle contraction. Key peptides can send signals in the body that help fight off germs and reduce inflammation." Later in the same chapter, she discusses myokines, which are hormone-like proteins released by the skeletal muscles that circulate in the bloodstream and help regulate other body functions, particularly glucose metabolism. One myokine in particular, BDNF (brain-derived neurotrophic factor), boosts the formation of new brain neurons, which can facilitate learning and memory.

When discussing disease, Dr. Lyon correctly points out the limitations of traditional Western medicine, saying that it, "...Skews its emphasis toward what's making us sick while overlooking prevention. This tendency leads many doctors to focus on fat and glucose while disregarding the skeletal muscle that could correct the imbalance." The author is right; when is the last time your family physician ever talked about lifestyle changes, weight training, or nutrition? I would add the over-reliance on pharmacology to the doctor's assessment. She goes on in chapter four to discuss nutritional science and is quite critical of the government's recommended guidelines. Dr. Lyons says, "To repeat, it's critical to recognize that the goal of government-funded nutritional guidelines was never (her emphasis) to help individuals achieve exceptional health. Instead, setting forth minimum (her emphasis) intake values was intended to prevent deficiencies." Ignore the RDA; it won't help you to live your best life and be disease-free. The author believes that most people do not consume enough protein, which makes it hard for them to maximize muscle growth even if they regularly strength train. Eating one gram of protein per pound of body weight is the starting point that she recommends.

There is a lot of good information in this book, and it speaks to the overall attitude that each one of us controls our own destiny. Dr. Lyons details five fundamental attributes that all of us have inside of us, which are courage, perseverance, self-discipline, adaptability, and resilience. We will all face adversity at some point in life, and developing these qualities will help us to succeed when the going gets tough. Building muscle is your best ally in the larger plan of fighting off chronic disease, and the author does a commendable job in emphasizing the importance of weight training. The good doctor lists all of the essential amino acids, the ones that our bodies cannot make and must be obtained through our diet. I won't go through all of them, but she mentions that leucine is the most important amino acid for muscle health. There is a terrific understanding of nutrition (as one would expect from someone who earned a degree in nutritional sciences, but not generally common in the medical field), and I was pleased to see that she dismissed the myth of the connection between dietary fat and body fat. Again, her anti-establishment approach was wonderful to see.

Unfortunately, I was disappointed by the exercise advice given in this book. Much of what is prescribed here constitutes overtraining in my opinion, and there are references to steady-state activities that are high-force in nature and can lead to overuse injuries. The author has a poor understanding of several concepts that are quite relevant to proper exercise, namely the dose-response relationship of exercise, which explains that just like in pharmacology, you want the minimum dose necessary to stimulate optimum benefit. She seems to be unaware that you cannot segregate the aerobic metabolic pathway from the anaerobic pathway, and that while you may use more of one pathway than another in a given activity, both are always in play. Dr. Lyons recommends exercises that involve the use of dumbbells as well as unilateral and alternating movements, which leads me to believe she doesn't appreciate the dangers they pose to the pelvis and spine. There is no mention of speed of movement, so I can only infer that she doesn't fully acknowledge the dangers of excessive force on joints and connective tissue. Finally, when Dr. Lyons talks about "cardio training" she makes reference to VO2 Max, which most regular readers of this blog know doesn't actually measure anything, and has been called "the Monopoly money of exercise" by Dr. Doug McGuff. The scientific stuff in this book is great; the exercise advice, not so much.

In spite of my criticisms, I enjoyed this book. As I mentioned before, very few medical doctors really go to these lengths to espouse the importance of skeletal muscle and the benefits of regular strength training. In my own experience, I can now include Dr. Lyons with Dr. McGuff, Dr, Carol Currier, and Dr. Michael Hasz as physicians who "really get it ". There is a positive message in the book and an underlying theme of self-empowerment that can serve as a convincing inspiration to spring into action. I encourage you to read the book and decide for yourself.