Forever Strong: A New, Science-Based Strategy for Aging Well

What you are about to read has the power to transform your life. My goal with this book—and with all my work in Muscle-Centric Medicine^®—is to overthrow conventional wisdom on the foundation of good health. I want to help you get to the root of where your body’s strength lies so you can take swift and effective steps to feel stronger, look better, and add years to your life.

You’ve already heard that you need to eat right, exercise, and lower your stress level to live longer, right? So why does it feel so difficult to make even the most basic commitments to a healthy life? I believe good health starts with the most important muscle of all: your mind. After I completed med school, I spent two years in psychiatry to study what makes people the best versions of themselves. The thinking patterns and brain pathology I studied have since become invaluable to my work helping patients get well and reach their full potential. And yet, after my transition to family medicine, patients came to me in the prime of their lives already showing signs of type 2 diabetes, cardiovascular disease, and obesity. Still, there seemed to be no room to talk about prevention besides generic recommendations—with limited impact. The chance to provide nutritional counseling as part of my residency, which focused on obesity and weight management, granted me another window into the painful consequences of damaging lifestyle patterns. So many patients felt trapped on a hamster wheel of frustration. I felt just as frustrated by the limits of mainstream medicine.

After my residency, I attended Washington University for a combined research and medical fellowship in geriatrics and nutritional sciences. I engaged with next-level nutrition research in the lab of Dr. Sam Klein, who is known for studying the clinical and metabolic aspects of obesity and type 2 diabetes. For two years, I ran an obesity clinic, sitting week after week with the struggling participants. I witnessed the pain of people trying, unsuccessfully, to lose weight, and it kept haunting me: Why, with all our scientific insights, are we still chasing obesity?

The question felt especially urgent when I attended to my clinical responsibilities as a geriatric fellow providing advanced aging care. Daily, I witnessed the devastation wrought by dementia on patients and their families. The ramifications of that focus for the aging population pained me, but working with these two patient populations helped me connect the dots. This combination of duties revealed to me the before-and-after consequences of nutrition and exercise choices made by individuals who’d been left floundering by flawed recommendations. I also had an even bigger revelation when I discovered that the one thing that both these groups had in common wasn’t a “weight problem” but a muscle problem.

One study I worked on examined the connections between body weight and brain function and found a correlation between a wider waistline and lower brain volume. The working premise was that obesity causes insulin resistance in the brain—a sort of “type 3 diabetes” of cerebral matter—that could lead to dementia. Our research showed that people with obesity often had impaired overall cognitive responses, such as impulse control, task switching, and other mental challenges.¹ I became very invested in the study’s participants, especially Betsy, a mother of three in her early fifties, who had always put her family and others first. Betsy had spent decades struggling to lose the same fifteen or twenty pounds she’d been carrying since her first pregnancy. But she shouldn’t have been advised to focus on the weight she had to lose. The real threat lay with what she had failed to build. Imaging her brain revealed her future—the pictures I saw looked like those of someone with Alzheimer’s. I knew what was in store for her within the next few decades, and it crushed me. I felt that I, along with the mainstream medical community and society, had failed her. To me, she represented dozens of patients I had seen in the same position. Then it hit me.

These people had one thing in common: low muscle mass or some impairment in their muscle. They all lacked the strength to perform certain basic movements (like those listed in chapter 8), and they had low physical tone along with blood markers that indicated unhealthy muscle. Their issue wasn’t body fat, I realized; it was a lack of sufficient healthy muscle tissue.

We, in medicine and in society, have long been telling people to lose weight. But by focusing on fat, Betsy, like so many, had failed to get healthy, no matter how hard she tried. I realized that we had gotten the narrative all wrong, and the consequences for countless individual lives would be devastating.

Desperate to repair what I felt was the medical community’s biggest failure, Muscle-Centric Medicine® became my mission. I am so grateful for the chance to share with you the groundbreaking science that has the power to revolutionize our pursuit of longevity for extraordinary health at any age.