Sports Science Dudes
The Sports Science Dudes cover all the cool topics on sports science, nutrition, and fitness!
Email: SportsScienceDudes@gmail.com or Exphys@aol.com
Hosted by Dr Jose Antonio
BIO: Jose Antonio PhD earned his doctorate and completed a postdoctoral research fellowship at the University of Texas Southwestern Medical Center. He is a Co-founder and CEO of the ISSN (www.issn.net), and Co-founder of the Society for Sports Neuroscience (www.neurosports.net). He is a Professor of Exercise and Sport Science at Nova Southeastern University. Twitter: @JoseAntonioPhD Instagram: supphd and the_issn
Co-hosts include Tony Ricci EdD FISSN and Cassie Evans MS RD CISSN
Sports Science Dudes
Episode 51 - Bridging the Gap Between Fitness and Medicine with Jordan Feigenbaum M.D.
In our latest podcast, we turn the spotlight on Dr. Jordan Feigenbaum, a physician, strength coach, and competitive powerlifter, who is breaking new ground in the world of fitness and medicine. As we chat, Dr. Feigenbaum opens up about his unique approach to blending modern medicine and strength conditioning, the critical gaps in lifestyle medicine training for healthcare professionals, and how addressing these could drive substantial positive change in our communities.
Timeline:
2:40 – How did Dr. Feigenbaum come up with Barbell Medicine? https://www.barbellmedicine.com/the-team/
4:02 - In 2015, less than 10% of primary care physicians knew that the exercise guidelines existed. Of that 10%, less than half are recommending to their patients.
4:58 – What should your primary care physician know about exercise?
8:51 – What should we expect of the modern-day physician?
16:20 - Use of glucagon-like peptide 1 (GLP-1) agonists (e.g., Ozempic, Trulicity, Byetta, etc.) to fight obesity – Dr. Feigenbaum’s philosophy on this.
22:40 – Nutrient deficiency may be an issue with those who use GLP-1 agonists.
32:32 – If your goal was to live as long as possible, would you change the way you train?
36:03 – The hype around zone 2 training – Dr. Feigenbaum opines on the silliness of it.
40:31 – When people make confident claims about zone 2 or anything for that matter, it would help to have a multitude of data to support it.
41:55 – Huberman follies
41:56 – Cold water immersion will reduce body fat?
43:01 – Tongkat Ali and Fadogia Agrestis – do they increase testosterone to a physiologically significant degree?
44:50 – Should you wait for 1.5 to 2.0 after awakening before drinking coffee to avoid the afternoon crash?
47:23 - People want confident claims. They don’t want nuance.
48:48 – The “soleus push-up” is a waste of time.
About our guest:
Jordan Feigenbaum MD is a physician, strength coach, and competitive powerlifter. He started Barbell Medicine in an effort to combine the best of modern medicine and strength and conditioning. Jordan is passionate about a variety of issues related to public health, education, and sport.
Education & Credentials
Eastern Virginia Medical School- Doctor of Medicine (2016)
Saint Louis University School of Medicine- Masters of Anatomy and Physiology (2012)
Truman State University-Bachelor of Science in Biology (2008)
About the Show
We cover all things related to sports science, nutrition, and performance. The Sports Science Dudes represent the opinions of the hosts and guests and are not the official opinions of the International Society of Sports Nutrition (ISSN), the Society for Sports Neuroscience, or Nova Southeastern University. The advice provided on this show should not be construed as medical advice and is purely an educational forum.
Hosted by Jose Antonio PhD
Dr. Antonio is the co-founder and CEO of the International Society of Sports Nutrition and the co-founder of the Society for Sports Neuroscience, www.issn.net. Dr. Antonio has over 120 peer-reviewed publications and 16 books. He is a Professor at Nova Southeastern University, Davie, Florida in the Department of Health and Human Performance.
Twitter: @JoseAntonioPhD
Instagram: the_issn and supphd
Co-host Anthony Ricci EdD
Dr Ricci is an expert on Fight Sports and is currently an Assistant Professor at Nova Southeastern University in Davie Florida in the Department of Health and Human Performance.
Instagram: sportpsy_sci_doc and fightshape_ricci
Welcome to the sports science dudes. I'm your host, dr Jose Antonio, with my co-host, dr Tony Ricci. If you're a first-time listener, hit the subscribe button and like the show. You can find us on YouTube, rumble, spotify and Apple Podcast. Our special guest today is Dr Jordan Faganbaum. I assume I pronounced that right, faganbaum.
Speaker 2:It's close enough. It's close enough, fagan. When I went to Germany, they said it's Faganbaum, right, which is how you said it, but we've been saying Faganbaum my whole life, right. And so I don't know, like I can't go back and fix my family. Somebody messed it up and I don't anyway, yeah, I don't know.
Speaker 1:Faganbaum and Faganbaum. Okay, well, there's two ways to say it. You're a physician and a strength coach, and a competitive power lifter. That's super cool. You started barbell medicine in an effort to combine the best of modern medicine and strengthen conditioning. You're passionate about a variety of issues related to public health, education and sport. And just a little bit about your educational background. You went to Truman State University, got your BS in biology, truman.
Speaker 1:Yep, I mean hopefully people will now know you got your master's in anatomy and physiology in 2012 at St Louis University School of Medicine and then you did your medical degree at Eastern Virginia Medical School. So, I want to welcome the good doctor to the sports science dude.
Speaker 2:Yeah, thanks for having me. I just I had a power lifting meet on Saturday, so I, yeah, still walking the walk and doing all this stuff and happy to be here. Thanks for having me.
Speaker 1:Hey, that's great. You know what's sort of as an aside we are in our we'll be having our 21st annual conference for the International Society of Sports Nutrition. So I've been doing research and Tony, to some extent working more in the strength and conditioning realm, research in the sports nutrition supplement area, and I'm always I guess I'm always happy to meet physicians who know the category, because I'll tell you what it's, it's actually where, and just to give you a 90 people like hey, can you you know an MD or DO that knows anything about so-and-so and like stuff? It's kind of it's hard to find and when I.
Speaker 1:When I saw you on Twitter, I'm like hey, we got MD who actually knows. He knows strength and conditioning, knows nutrition. Obviously you're you're self taught in this, because this isn't typical stuff you learn in medical schools. So could you tell Tony and I a little bit about the how you came about with barbell medicine? Are you sitting in med school and you're like sitting in a, you know physiology class.
Speaker 1:You're like this guy doesn't know what he's talking about. We need to do something to educate future physicians. So how'd you come up with it, jordan?
Speaker 2:Yes, no, that's a. That's a great question. My, my path into medicine was actually I mean, at the time it was non-tri, they just called it non-traditional. So I graduated, I opened a gym, I was a strength coach full time. That was my thing. And in fact, that's actually how I met you the first time in like 2009 in Orlando at the what a CSCC or SCCC, whatever it was in, yeah, in Orlando.
Speaker 2:And so I went into medical school, kind of having this background, not only as a competitive power lifter but also as a strength coach and being involved in that, and I thought, well, surely there's going to be some crossover here between medicine and sort of the health aspects of eating, a health rodent, dietary pattern, exercise promotion, things of that nature. It wasn't there at all. Even I mean, maybe we could be charitable and say, yeah, they paid lip service to sure people should be eating healthier and should be more active, but there was nothing prescriptive in there as far as, like, here's how we're going to do the behavioral change counseling here, the targets we should be shooting for, like the dietary guidelines, for example, the exercise guidelines, for example. And so my one of my senior, like capstone courses, you had to do a quality improvement project to like, hey, what do you want to do in medicine and how are you going to improve things? And I was like, well, let's just see, first off, how many physicians even are aware of the exercise guidelines. Do they know them? And then, of those who know them, how many are actually, you know, recommending it to their patients in any form, even if it's just the most rudimentary like here's a pamphlet? And so at the time this was 2015, less than 10% of primary care physicians that we surveyed was a couple thousand of them even knew that the exercise guidelines existed. Less than 10% of the 10%, less than half of them, were actively recommending it to their patients at the time.
Speaker 2:And it's like, okay, huge, huge opportunity. And so I had started barbell medicine as like a blog for me to just publish stuff based on my here's my strength conditioning background. Here's what I'm learning in medicine. How do I like bring these two together? I just didn't really know where I was going to go with it, other than it was a cathartic way for me to kind of write what was on my mind, put out information, and then it yeah, I got that, got honed in on as I went through some more medical training and realized, okay, there's a big opportunity here to do good in the community by training up other healthcare providers on this sort of stuff and, and you know, before we have you start recording, kind of made mention of, like yeah, there's not a lot of good doctors in the space that know, know about this, and that's true.
Speaker 2:On the one hand, you will kind of want physicians to work up to their level of training, right, I don't necessarily care if my primary care physician is like does he know the latest and greatest on, you know, exercise, volume, prescription for maximum gain, like well, no, but I do want them to know enough to be recommending exercise to their patients and and not recommending against things like resistance training, even heavy resistance training, to their patients, like oh, it's going to hurt you or it's going to, you know, be dangerous for you, because that's a big fear, it's a big barrier for people to participate in exercise.
Speaker 2:And so you want them to know enough not to kind of dissuade people from participating if they otherwise would, and know enough to like get their, get a foothold with their patients and recommend them to be more active and direct them appropriately. So that's kind of how this all came together. It was just me in 2012 to 2015,. We're one man kind of shop and now there's, you know, almost 50 or 60 of us kind of rolling around on the internet and gradual and places all over the world trying to spread the word yeah, disciples, if you will, so it's fun, yeah, we're, we're doing the thing.
Speaker 1:So this is so. You're basically trying to educate, not just. You're educating everyone, not just physicians, obviously.
Speaker 2:Sure, and you're doing it mostly virtually.
Speaker 1:Do you have face to face or in person seminars with groups of people?
Speaker 2:Yes, we've done about 40 something live in person seminars where we kind of cover all right. Here are the top 10 reasons why people go see physicians. Where's that sort of intersection between what we would call like lifestyle so exercise, dietary pattern change, sleep, stuff like that and modern medicine? And so, on the one hand, yes, you need physicians, other healthcare providers, to know about exercise, its benefits, how to prescribe it, how to recommend it and maybe assuage some of their concerns over it. So, for example, if a patient had high blood pressure that was not really well controlled, is it safer than exercise? It's like look, we have all this data. Yeah, in fact, not only safe, it's actually beneficial.
Speaker 2:But also trainers, coaches, strength enthusiasts or exercise enthusiasts want to know like, well, where does modern medicine fit into this? Like, if I'm doing all this exercise, eating this particular dietary pattern I still have in the case of blood pressure, elevated blood pressure or hypertension, what then? What sort of medications are available? Like what would be best for me as an athlete? And so we're kind of doing the whole the full spectrum here, where we're literally bringing the best of modern medicine to strength conditioning and vice versa. That's kind of our tagline. So, yeah, well, that's what we're aiming to do. We do live in person stuff, we do remote education, published stuff. You know, although I don't know that people are reading the things you know, if you come up to an article that's 10,000 words long, like, I don't know how many people are making it to the end, but we hope. We hope people are. So we'll see.
Speaker 3:I think our generation makes it to the end, but the younger, I think a bit more visually stimulated, right and video based.
Speaker 2:They want the TikTok thing. Yeah, they want. All. Right, In 30 seconds, teach me what I need to know. And I'm like, okay, I don't have a good dance moves, but we'll work on it.
Speaker 1:So do you think my father was a physician? He had implored me to go to medical school when, when I was an undergrad and my thing was I didn't like being around sick people, so that kind of turned it off for me. But I remember that he apparently wasn't. I'm just a kid, I'm like he's an expert on drugs. I mean he has all I remember going to his office he'd have a drug for this, a drug for that, and so that was my introduction to modern medicine. So I guess the question is do we, are we expecting too much from Western or allopathic medicine, such that people seem to want their physician to be? Hey, give me nutrition advice give me exercise advice.
Speaker 1:Oh, if I'm sick, if I have an infection, give me this antibiotic. Or maybe don't give it to me because it might ruin my gut. Microbiome Is it? Are we expecting too much from the profession? Cause I, it seemed to think. A lot of people like, for instance, there's no. I was about to use the word rolodex. No one even knows what that means anymore. There's not a rolodex of scientists. You can't look up scientists, but everyone has a physician. So what are your thoughts on that?
Speaker 2:Yeah, no, that's a great question, and I think where I kind of fall on this is that you want the physician to know enough about the important contributors to a person's health trajectory, right, the determinants of their health, to be able to set them on the right path, and so, from like a strictly medical base care, you want them to be up on all the latest evidence, all the latest practice guidelines and this, that and the other to be able to treat again, if it's your primary care physician elevated blood pressure, blood sugar abnormalities, you know, heart disease, risk, this, that and the other. When it comes to exercise and nutrition, you don't necessarily need them, or maybe even want them to be an exercise or nutrition expert, because they don't have enough time in the office to actually do that appropriately. What you would like them to be to do, though, is to be a facilitator. Okay, here is a trainer or a coach or another professional that I can refer you to, that I have a good relationship with. I know they're evidence-based as well. Go see, you know, whoever down the street Well, ideally down the hall, so you're limiting that barrier. You know that people have. That's what you'd really want, and just it's unfortunate because, when you look at again the amount of exercise counseling, dietary pattern counseling that actually happens in the office, it's very, very poor, not only like as far as frequency just doesn't happen that often, but the stuff that does happen, it's just not meeting the sort of points of performance that you would want to see for effective behavior change counseling.
Speaker 2:And that's what we're doing. We're trying to change behaviors. And so you can't do that in a five minute visit, right? Or even, you know, a 10 minute visit. You really need more time. And if you're seeing 30 patients a day, good luck. Yeah, that's tough. So I think there's, you know, on some of it. Some of it is the modern medicine kind of system that we're working within. That's tough.
Speaker 2:And then other things, other barriers for physicians and other healthcare professionals is just a fund of knowledge stuff. If you don't know anything about exercise, if you don't know anything about nutrition, especially again the behavior change components of those things and the current guidelines, I don't really know how you discuss this with any level of confidence. And in fact, when you pull physicians like, hey, you're not recommending exercise to your patients, why? The reasons why they cite that they're not actually recommending it comes down to time, at least, they feel like that I don't really know what I'm doing, and then like personal, like participation.
Speaker 2:So our thought was like all right, if we can train up the physicians on like here are the guidelines, you don't need to like memorize them, but know that they exist and that you can reference them and then also get them more active, walking the walk, so to speak. They need to do it too. They're humans, right. So if you can get them involved, they are likely to feel more comfortable and then also have that reference like oh, and here's what we should be striving for, at a minimum for exercise.
Speaker 2:And again, it's an uphill battle and if, like I said, less than 10% of physicians, primary care physicians, even know that the exercise guidelines exist, if we could get that number up to 30%, boy, huge, yeah, yeah, huge potential upside there. And so there are a lot of campaigns and public sort of health initiatives trying to get this going and I think it's going to come down to having more money being made available and more, you know, incentives, whether it's in the electronic medical record, for like hey, you got to check this box, did counsel patient on exercise, did counsel patient on nutrition and refer them appropriately. If that's in there, if it's a checkbox and you know that's somehow linked into the electronic referral system, maybe it gets better. But our role here, I think, is more educational and then also maybe just make awareness and we'll see how that changes over the next decade or so.
Speaker 3:Just a quick question, if I may I don't see, but at least modern education. When I was younger, definitely there were physicians that, like you said, you made a quick mention of almost actually dissuading you from resistance training as an example. That can still exist, though it doesn't oh yeah, oh yeah, really yeah, and again.
Speaker 2:So there's. It's not great data. For great data you'd want stuff that's repeated, like survey data that's repeated regularly to get a good sense of things. But in general, physicians tend to be. They know, they recognize the potential that exercise has for modifying disease trajectory and people's overall quality of life and functional scores and the set and the other. But again, when it comes down to their sort of fears surrounding exercise, there's a lot of we would call harmful language by which they discuss exercise through things like oh yeah, if you lift heavy, your body's like a car, it's gonna break down over time and you might hurt yourself, and it's like.
Speaker 2:Or even the description of very common medical elements like osteoarthritis, for example. Oh yeah, it's a wear and tear thing, problem with the joints, and it's like great, so what should I do about that, doc? And they're like well, you should exercise. And you're like you just told me that it's a wear and tear thing. You're saying I should do more wear and tear to get better. That doesn't really doesn't really work. Or even things with osteoporosis Okay, your bone mineral density is less and so we need to kind of load the bones to make them grow and you're like but the bones are brittle, that's what you said. They're at risk of fracture, like how do you square that circle? And so, yeah, it's happening. Even stuff that's been disproved for decades and decades, like exercise doesn't resistance training doesn't stunt growth in the pediatric population still out there, and you would think we've got to be past this. But again to Dr Antonio's point earlier, because it's not a part of the training that happens throughout medical school. You might you have medical graduates getting into residency and all the way through residency who have no exposure to any of this stuff, and so yeah, and so it just kind of persists. I mean one of the famous sort of lines in medicine. It's like the time lapse between when new guidelines come out and actual practice change occurs is about 17 years, which is 17 and a half years, yeah, and so, and so is it like a generational thing, like we need another generation to come through, like we're exercises sexy and cool and like more widely accepted. Maybe I don't know, but I think even if you had like a single lecture throughout medical training that was like here are the exercise guidelines, here's why exercise is safe, here's how many people are not currently sufficiently active and here's what you should do about it. I feel like that could move the needle forward.
Speaker 2:Same thing with nutrition. You pull a group of interns, so these are people who have graduated medical school. They're in the residency, first year residency, and you ask them very basic nutrition questions, things like hey, how many calories are in a gram of protein, carbohydrates, fat, right, and these are very intelligent people, they've demonstrated they're very smart. They're like I don't know, less than 5% gets the answers correct. They can't do a multiple choice answer and tell you, yeah, protein on average has four kilocalories of energy, for example. And you're like okay, so maybe my physician is not a good resource for nutrition and exercise. That's okay, fine, but there shouldn't be any sort of a harm associated with the counseling Like, ah, don't lift weights. Ah, just walk more. Usually that's not gonna be sufficient enough for most folks. Or, hey, don't worry about your diet, we've got some medications. It's like well, let's not do both, let's do both. Right, that's the goal.
Speaker 1:Actually, you bring up interesting the diet and medication conundrum and I want your opinion and this is sort of off topic, but your opinion of use of ozempic for treating obesity or overweight and also, I don't know if this is true, but the possibility of even using it for childhood obesity. Philosophically, what are your thoughts on that?
Speaker 2:Oh boy, well, we'll see how maybe this will be. We'll get some hate mail out of this. Yeah, no, I'm a fan these anti-obesity medications, of which ozempic, we go via Manjaro, all of them would be in that category. They represent a real opportunity, in my estimation, to put a dent in the obesity epidemic. The issue here, when people are like, all right, well, it doesn't treat the cause. What's the root cause of obesity? It's like, well, our genes really haven't changed. There's not enough time for that to change. What's really changed has been our food environment. Food environment is replete with high calorie, very tasty, easily available, cheap foods that are not very filling, not very satiating, and it's like, yeah, we can't really do anything about that in the short term. Yes, policy change would be helpful, but that's policy change at the community level, at the state level and big aggregate, like at every step of the game. So it's like what can we do?
Speaker 2:Lifestyle change alone, just getting people to exercise and engage in dietary pattern change through intensive lifestyle counseling works about 20% of the time to achieve what's called clinically significant weight loss, which is at least 5% weight loss that's maintained for at least a year. At a five year mark, that number drops by half and you're like, okay, so some people are gonna do well on this. They respond well to that sort of intervention. They have, as my grandmother would say, the chutzpah to stick with it. But then it's like, all right, well, what about the other 80%? Okay, so let's look at the data on anti-obese medications and in adults, about 75, 80% of them will respond favorably and have at least that 5% weight loss, whereas two thirds will have something like 15 or 20% weight loss. And it's like, wow, that represents an additional sort of benefit. But the way I view those medications, they're sort of behavioral change agents and I think, looking at through that lens, it allows people to do the dietary pattern thing with less sort of exertion, less sort of mental fortitude or willpower or whatever, that you need to stick with it. And it's like we use other behavior change sort of strategies to get people to exercise, eat appropriately, for example, modifying the home food environment. If you don't have trash in the home, you're less likely to eat it. Okay, well, if we had a medication that allowed people to choose to do the right thing more often, that seems like a win. And so the American Academy of Pediatrics recently came out with some recommendations talking about more stringent screening criteria and the potential for using these anti-obesity medications. In that population and based on the preliminary data that's been published it's not as much data as we have in the adults it does look pretty promising.
Speaker 2:And I think about disease most diseases, as far as like cumulative exposure right, like a short-term exposure to high blood pressure, for example Not particularly risky unless it's crazy, crazy high. But yeah, it's the lifelong exposure to elevated or high blood pressure, same thing with diabetes, same thing with heart disease, and exposure to high levels of LDL, another atherogenic sort of lipoproteins. And so you think about obesity. The issue here is how many years have you lived with excess adipose tissue, like smoking, same thing. How many pack years has a person been exposed to? If we can reduce that by reducing the rate of childhood obesity, thereby reducing the rate of adult obesity, then we're also likely to see less sort of adiposity-based chronic disease burden, because there's been less exposure and the food environment isn't changing anytime soon either. So I'm kind of in favor of them.
Speaker 2:I can see people's resistance to it. They view it Lay. People will view it like well, we're just putting a band-aid on it. We're giving people a pill instead of lifestyle stuff, and it's like the problem is our environment really, and I don't know that that's going to change anytime soon. So I'm in favor of it, with appropriate restrictions, appropriate screening tools and guidance and monitoring. It's probably better than just bearing our heads in the sand and telling people to just try harder the old Nike kind of approach, just do it. Or using the same strategy we've been using for the past half of millennia shame and blame, like, oh, this is your problem, work harder, fix it. It's like do you want the people to get better? Because, if so, we have some opportunities.
Speaker 2:And just the last thing I'll say on this there's been a liberalization of bariatric surgery recommendations. So before it was like oh, bmi had to be at least 45, for example, or it could be 40 with a single obesity-related disease, and now it's lowered by 10. It's like look, you could have a BMI of 30 and a single obesity-related disease and you're supposed to get screened for maybe a year a candidate for bariatric surgery. Or if your BMI is 35 and you have no obesity-related disease, you should potentially be screened for bariatric surgery. And people are like that's low, that's not a high BMI. Why? Why do you do this Well again, you're reducing the lifelong exposure. And then, thing two, you have healthier patients ending up on the surgical table, so there's less complications, so they ultimately tend to do better.
Speaker 2:And that's kind of the way I see it, as both like a physician and then also just a person involved, like in public health. It's like we need to have multiple options, multiple levers to pull for different folks, based on how they respond. If somebody is off to the races on lifestyle change, great Gold star, you win a prize. But the people who don't, we need another. What's the next level? What's the next level of intervention? It's the same thing you would do with exercise right, like, all, right, here's a standard program, let's get you going, or whatever. If a person doesn't respond to that, they need some tweaks, different levers to pull to get them stronger, gain more muscle mass gain, more carterist-tory fitness, and that's what we would do anyway. So that's kind of where I stand.
Speaker 3:That's it and I see that logic and I think it's well articulated. Just anecdotally, I know quite a few people using it because of my age and I hope it leads to some behavioral change. But what I've found and again, this is just an observation of maybe 20 people they eat less and it's garbage and their appetite is just down, I guess. Obviously the digestion time is longer. My concern is, to you know, maybe lean tissue preservation and almost nutrient deficiency, because I don't see meat in anything anymore, unless they're doing that when they're not with me, obviously.
Speaker 2:But yeah, there's some concern over this low energy availability. No weather, it's going to be systemic because they're eating less calories In general. We think the way these medications work is that they improve feelings of fullness or satiety in response to a meal and then, in addition, reduce appetite overall and so people will eat very few calories. But that's what you would want to happen in a perfect world anyways. If you had a healthy level of body fat, you'd basically want to be at energy balance to support that healthy level of body fat, and on days when you eat more calories, those energy stores expand and so your body compensates by saying, eh, I'm going to eat less the next day and because I'm fuller sooner. But in many folks, these obesity sensitive individuals, which is a large swath of the population, that doesn't happen. They maintain energy balance at a higher than normal, higher than healthy level of body fat, and so, like, how do we restore this relationship, this appetite satiety relationship? The medications seem to do that and the data on this. You're exactly right with the low energy availability thing. Particularly with respect to protein, it seems like people are not eating a good amount of protein. The average protein intake in the United States on people not on these medications is somewhere about one gram per kilo body weight in adults, yeah, and so when people are on these medications, they're far below that, far below even the RDA, and so you're like, all right, so maybe there's some additional risk of lean tissue wasting just due to low protein intake, and they're not if they're not exercising.
Speaker 2:Again, you could have this sort of you know two hit sort of thing. You're like not enough protein, not exercising, like, yeah, you could lose a lot of lean body mass. I will say, though, when you compare it to the amount of lean body mass loss with bariatric surgery or and or in lifestyle change, it seems to be somewhat similar than in fact, there's only been one study showing like a higher than predicted amount of lean body mass loss. But again, you'd really want to know are these people exercising? If not, we would expect more lean body mass loss. Are they enough protein? If not, you would expect more lean body mass loss. And I think there's only been one study addressing like functional sort of performance, like strength and in general strength, drop off hasn't been significant. And you would expect again, if there's a huge muscle cross sectional area loss due to these medications, that there would be a drop in performance.
Speaker 2:I don't suspect ozempic or any other these anti obesity medications to be like a PED, where people are going to start using them just to like, make weight or whatever. But at the same time you would want the sort of lifestyle recommendations to accompany the prescription of these anti obesity medications. You wouldn't want an either or situation, you want both. But to your point there are going to be people that won't do the lifestyle stuff right and they'll just get the medication. But it's like I'm kind of willing to accept that risk because I think even with the muscle mass loss it's probably still better than the exposure to excess atoposity.
Speaker 1:Yeah, yeah, I think, as Tony mentioned, you articulate it well. I think people need to realize there's a trade off with any of these decisions. If you go into medication, I mean there's your basic risk benefit analysis Okay, so you will lose body fat, which is really the primary goal. You might be chlorically deficient, okay, and the trade off is you might lose lean body mass, but I guess, depending on how much adipose, excess adipose tissue carry, that's where you have to make that judgment and everyone will be different. Now I want to segue this into.
Speaker 1:I saw a video of you and, I think, your colleague I forget his name, but Austin, yeah. Yeah, what you did, a, it was an interesting segment on. The question was can you have too much muscle? And before I ask the question, let me preface it with Okay, height and longevity. Apparently there's an inverse relationship. Tall people do not live as long as short people and anecdotally you see that you don't really see old people who are seven feet tall. They all tend to be small people. And then, of course, you know the relationship between you know BMI and longevity. If it tends to be high, you don't live as long, and if your BMI is over 30, you're not a bodybuilder. It's not like there's bodybuilders walking around when they do these population based studies. You're overweight and obese, so my question to you is can you carry too much muscle such that it is a detriment vis-a-vis longevity or lifespan?
Speaker 2:Yeah, I think my simple answer to that would be unlikely, unless you're also carrying too much body fat and that's why you're carrying the too much muscle mass. Right, it's hard to separate the two things. In general, people that carry a lot of muscle mass also tend to carry more body fat, and so my kind of inflection point there is when people's BMI get above 30 and or their waist circumference is an excess of the current cutoffs that diagnose like particularly abdominal obesity, abdominal adiposity, which for most men of European descent is somewhere in that 37 inch range. That's the sort of conservative cutoff. And then 40 inches the more like, okay, look, do not pass, go, do not collect $200. That sort of thing. So if you're in that field, I don't necessarily care how much muscle you have.
Speaker 2:Above and beyond that, I feel like the risk of carrying too much adipose tissue outweighs the potential benefit of carrying more muscle mass. But to your point, people are like, well, what about this bodybuilder? Or what about this, you know? What about Thor? What about you know whoever else? And it's like okay, so that's a statistical outlier, they're not even being captured by this data. Thing one right. Thing two in order to achieve the level of muscularity and body weight, body mass to have a BMI greater than 30, but a waist circumference below 37 inches.
Speaker 1:That's a unicorn.
Speaker 2:Right, it's not in the unicorn. But then I started thinking about well, what about polypharmacy? The risks from that is probably far in excess of what we're talking about with body fat, for example. But I don't think muscle in itself is particularly harmful at, even at a high level, unless concomitantly you're rolling around with a bunch of excess body fat or you used particular methods of getting there that have their own risks. That's kind of my stance on that.
Speaker 3:And might that be even particularly more true?
Speaker 3:Not that you know a PED could not be used effectively but, if it's a naturally occurring level of muscle mass, then I would think your body's well equipped to, probably again, with the reduction in body fat and all other factors being where they should be. You know, because in my age I hold a lot more than I want. I don't use any PEDs, I don't even TRT, I have nothing against it but I do have a lot of muscle from my age and that concerns me, you know. Is that? You know that don't concern me. But is it decreasing longevity? And you know, body fat stays in the teams, high teams, but it does at my old age. So you're saying probably then that if it's, you know, if all the variables are there in the right place, other than increased muscle mass, you'll probably be okay then yeah, and in fact I would say having excess muscle mass, we'll call it excess, right?
Speaker 2:So just above, like what will we consider healthy? I think that gives you a big physiological reserve, right? Should something happen, yeah, you have to go to the hospital for some reason. You have some illness for some reason where you lose some muscle mass. It's like, well, now you have a physiological reserve, a physical 401k to withdraw from, whereas the people with a low level of muscle mass, well, they're up a creek because they have nothing to draw from and we know that low levels of muscle mass increase mortality risk. When people go into the hospital, there's a relationship between their creatinine level, for example, just a measure of how much muscle mass is being turned over in kidney function and it's like, if they have a really low level of creatinine, we know that, unless their kidneys are working overtime, which is not usually the case when people go to the hospital that they're carrying a low amount of muscle mass and that has a really strong correlation to in-hospital mortality. And so there's like a baseline look, you need to lease this much muscle mass for us to like sign off on you. Like no risk of sarcopenia, no risk of like functional disorders, you can live a full and complete life. Go with God.
Speaker 2:Above that, again, I think you're hedging your bets Like, look, if something bad happens, you can make a withdrawal and again not be up a creek and further your performance is likely to be higher. Maybe the process of gaining that muscle mass, you enjoy it. That's all health promoting. I just can't see a point where it's like nope, that's too much muscle mass, it's too costly from like a energy economy standpoint, where you're like something bad. I haven't seen any data suggesting that until again. I guess you see that the people have too much body fat accompanying that amount of muscle mass or, again, have used particular substances to get there. But to your point, look the genetic freaks in the population that's only going to continue to increase as, like athletes start mating with more and more athletes. You're just going to get these hyperjacked, super tall people coming out and they're like my BMI is 35, my body fat's 10% on lifetime natural, and I'm carrying tons of muscle mass. I wish I had your parents.
Speaker 3:Although Travis Kelsey may be watering down his teeth with Taylor Swift.
Speaker 2:Right, we need more D1 babies. Like, let's, how do we pair these people up?
Speaker 1:You know, I think it's fascinating the whole idea of, you know, carrying too much muscle mass as it relates to longevity. I'll rephrase the question this way because most of us, like Tony, trains. He doesn't like lifting weights because, oddly enough, he gains muscle too easily, which is kind of crazy. You know, I hate to see it yeah.
Speaker 1:I actually quit. You know, I got, I honestly got sick of the gym. I quit lifting God, probably five or 10 years ago, and I transitioned Almost all of my training to stand up paddling because my I literally my backyards on the water. So I just drop aboard the water and I take off.
Speaker 1:So we all have our goals and obviously you're a power lifter. But when I phrase the question this way, it's interesting how people will respond. So my question you, jordan, is if your goal was to live as long as possible, would you change the way you train?
Speaker 2:Oh, yeah, okay, no, that's a great question. Yeah, so I just had a power lifting me. My last deadlift, for example, 733 pounds right at the time, go into the meat. I was like I just want to lift as much weight as humanly possible. I made a number of compromises. In order to do that, I paired back my conditioning training so I raced dirt bikes too. That's like my.
Speaker 3:Oh cool, I started that's where I started.
Speaker 2:In fact, that's how I got into lifting weights at all. I dislocated my hip when I was 18, and I couldn't walk for three months and then when I had to start rehabbing, the home PT was like you need to do squats and I was like, oh, okay, cool, and I got in a lifting weights and I was like this is this, is real fun. So, in any case, to be conditioned for that sport, I do quite a bit of conditioning somewhere on the you know three hours, four hours a week total, usually on a road bike or a rower or I'm actually doing some riding. But to get ready for the power lifting meat, I cut that down into half at first and then by the last week I probably did an hour total of conditioning the last week for the meat.
Speaker 2:If I was trying to live as long as possible, I don't think my training would look a lot like getting ready for a power lifting meat. I would likely still. I would still resistance train and it could be done with compound lifts, could be done with barbells, if that's my, that's my preference. But I would aim for improving my cardiorespiratory fitness to a much higher level because, again, we know there's this dose dependent relationship between cardiorespiratory fitness and sort of reduced heart disease risk and that's the number one killer in the United States and adults, maybe worldwide. Okay, I can see a dedicating or allocating more training time to improving that. So I would just do more cardio but I would still lift weights.
Speaker 2:So I would likely carry less muscle mass because more of my training resources would be dedicated to improving cardiorespiratory fitness. But I don't know how much less muscle mass. I mean. I'm a weight I weighed in at 208, for the meat I'd probably weigh I don't know 200 to 205 with a higher level of conditioning and maybe be 10% weaker. Right, hey, if I keep can keep that. I'm about to be I'll. I'm 38, I'll be 40 in a few years, like. If I could keep that through most of my fifth decade into my fifties man, I'd be a happy guy.
Speaker 1:So no, hey, it's interesting how people will alter what they do if the goals live longer, which which tells me a lot. It tells me most people do not train to live longer. They train because they like what they do. Yeah, absolutely yeah, which might be the most important thing. I mean, we always come out lifespan. You know, health span versus lifespan. Totally, keep doing what you're doing, you're going to be healthy. So at the end of the day, that's all that matters. I want to segue into a little what I have. A friend of mine in the UK is a physician he refers to. He gets quite annoyed with what he calls celebrity doctors and scientists.
Speaker 2:Oh boy.
Speaker 1:And he's always sending me. He's like you're not going to believe what this guy said. Believe me, I get the same stuff. And and part of this is the reasons comes up is you had you had tweeted something, as it relates to some claims Andrew Uberman makes, but also you could always. I've had people ask me about some of the claims Peter is made, and let me go to one where he talks about zone two training and longevity. And for the life of me, when you look at zone two training, you know, because he's big on cardiovascular fitness, longevity, which, of course, makes sense. You had mentioned that already. The problem I have with that is, first of all, no one knows their heart rate when they train. In fact, I don't even know my heart rate when I train and I do a lot of cardio. And he also talks about max VO2. We work in an exercise science lab. None of us know our own max VO2. So how is he making these claims when people who are in the field don't even know that data?
Speaker 2:Yeah, no, that's tough. I mean, there's a lot of hype around zone two training, right, and I get these questions all the time and I'm like, oh cool, well, what's zone two training? And you know people are like, oh well, it's like this heart rate percentage of your max heart rate. I'm like, great, so what's? How do you figure out your max heart rate? And they're like, oh, a formula Like yeah, that's, that's not going to work. And then, more accurately, that's not going to transfer from exercise to exercise to exercise you would have a different range for bicycle, for treadmill, for a rower, for a skier, for a stair, like it's going to it's modality specific, right. And so, in fact, probably one of the best resources on this is Joel Friel. He was a senior USA's men's cycling coach and he talks about using this sort of functional training threshold where, effectively, you do a piece all out max intensity, you find what is your max heart rate at this particular, on this particular mode modality, and then you can use percentages of that to train in different zones.
Speaker 2:And yeah, and ideally you would have a blood lactate meter as well, to kind of figure out like okay, here's.
Speaker 1:I have those.
Speaker 2:So right, exactly. But the point of like zone two would be your ride at that threshold where blood lactate has risen a little bit but is staying right where it's you know should be, just, you know, right just around two or just below that, something like that, and it's only good for a month, and you got to retest and then recalibrate. So, in any case, that's, that's all problems with like just defining zone two and like prescribing zone two, right. The next problem would be then okay, so let's say we have no problems with describing it, finding it, you know, whatever. Well then, is there good data that zone two, compared to zone one or zone three or zone four, at an equal volume or equal total total work done, promotes a more favorable health trajectory? Do people have less risk of heart disease or less mortality from from heart disease? Do they have a reduced risk of type two diabetes, like, is there some tangible benefit that we have good longitudinal data on? And the answer to that is no. The answer to that is no. So when people like zone two is better Like than what Than nothing, yes, agreed, you could. You could make maybe a tangential or sort of inference sort of argument that zone two would be more favorable than zone one. If you may, you have to make a number of leaps here. There's data looking at people like endurance athletes who spend more time in zone two than zone one for their moderate intensity conditioning, and then they look at measures of their VO two max, for example, and the people who spend more time in zone two have a higher VO two max than people who spend more time in zone one. Okay, so then we have to make the next leap to say well, look, vo two max is a good measurement of cardioretectory fitness and we know if there's a dose dependent relationship between cardioretectory fitness and reduced risk of cardiovascular disease, having a higher VO two max would be likely to improve your health trajectory. But we don't, again, have that longitudinal data. We've made a number of assumptions and inferences to get to that point. So what I would say is that, yes, moderate intensity conditioning is useful, full stop.
Speaker 2:But as far as whether that needs to be zone two, zone one and a half, zone one, zone two, I can't tell you. And again, I think the problem is is the prescription, even with the current exercise guidelines, right? It's like everybody needs to do 150 to 300 minutes of moderate intensity, or moderate to vigorous physical activity, or 75 to 150 minutes of vigorous intensity activity, and they're like, okay, cool, well, what's moderate and vigorous? And they're like we're going to use Mets. We're going to use Mets to prescribe this. You need 500 to a thousand met minutes of physical activity, of conditioning, per week. And then it's like well, the Met, the unit was derived from one dude, a 70 kilo guy sitting in a chair, and now we extrapolate this to the Met compendium. It's like well, your Met cost for an activity is different than mine, is different than my dad's, is different than my brother's, and so how can we use that? So what?
Speaker 2:There's been other studies where they look at like, okay, what heart rate is associated with these different Met costs, energy costs, what RPEs are associated with these different sort of Met costs and intensities. And that's where it kind of ends for me is that is prescription. So I'm thinking moderate intensity cardio, based on this talk test using RPE, moderate intensities like RP five to six. A vigorous intensity would be RP seven and higher, and you can use that to sort of prescribe the intensity. And then, as far as the distribution of intensity, we'd be thinking 80% of your conditioning should be from this moderate intensity zone, 20% maybe from the vigorous intensity, and how you mix and match that if other zone one, zone two, zone three, zone four for for vigorous, I don't know.
Speaker 2:I think it's more shoulder shrug and speculation, but when people make confident claims about zone two is the best.
Speaker 2:I'm like you got a reference for that and you do, and not only one reference. Do you have like 20 references because you're safe, you're stated it very confidently and so we're not trying to practice reference based medicine where you can find a single study showing a single relationship. What you want to know is what is the totality of the evidence say, and how does that you know, fit in with your recommendation here? So when people say a thing and they're like look one citation, I'm like great, so there's 20 other studies on this. What are those other 20 say? And then how does that shape your, your recommendation? And unfortunately what happens in this space, particularly with influencers and popular folks, is that it's more reference based than actual evidence based. But people in the lay public can't really tease that out, but nor do I expect them to write. How do you become a? You don't need to become an expert or read the research just to like get a recommendation. At least you shouldn't have to anyway.
Speaker 1:Yeah, I find it amusing when people will post their videos of look at me, I'm doing zone two training and I'm going to live longer. I'm like you fool. You're probably going to live longer because you're exercising.
Speaker 2:So totally yeah.
Speaker 1:And it's the it's the precision at which these exercise prescriptions are given that are really annoying. So we're going to play a little word association or phrase association. This is from Dr Andrew Uberman and I want your opinion on these. He believes cold water immersion will reduce body fat.
Speaker 2:Oh, no, yeah, no, I mean, I guess I assuming the relationship between, like brown fat activation or something, like that, always the brown fat. And that's going to increase total daily energy expenditure to a significant degree that persists over months and months and months, by which we're energy balance is struck unlikely and data to the point suggests otherwise.
Speaker 1:So no, However, many people believe that.
Speaker 2:Totally. But a new study just came out on cold water immersion and like, how does it fatigue recovery, rating some muscle soreness and effectively it's all a wash. And it's like, look, if you, if you like it, great. But you don't have to, you know, confound or confabulate a reason by which you're doing it, to say you like the way it feels, that's fine.
Speaker 1:Okay, how about this, tony Jeff, something to say about cold waters.
Speaker 3:No, no, you know, I guess if you spent eight hours in it there may be a difference, but there'd be other problems if you did so.
Speaker 2:That's right. Yeah, If you live in it. Yeah, maybe better.
Speaker 1:Okay, jordan. How about this? These testosterone boosters, tonga Ali and Fidozia Grestis, elevate testosterone to a, to a degree that is physiologically significant.
Speaker 2:Yeah, that seems highly unlikely, given the normal range of testosterone is somewhere between 300 and 800 nanograms per deciliter, and we don't have the existing longitudinal data suggests almost no relationship with people's starting testosterone levels and their sort of gains and muscle mass, muscle strength.
Speaker 2:Rather, what we think about testosterone based on the current evidence is that we know that people who are, in general, healthier and more active tend to have higher levels of testosterone compared to folks with diseases that we know lower than things like high blood pressure, type two diabetes, heart disease, et cetera, et cetera.
Speaker 2:And so it's like, yes, if you're saying that a person with a higher level of testosterone tends to be healthier than one with lower, sure, but that is more reflective of their current health status rather than predictive, in a way. And so, yeah, if you raised somebody's testosterone from 400 nanograms per deciliter to 600 nanograms per deciliter, thing one, they couldn't feel that. That's a normal sort of day to day fluctuation. Anyway, a biological variation is close to 15% for testosterone, so you couldn't even be sure those two values were actually different. But they don't also predict any additional benefit. If the went from 500 nanograms per deciliter, for example, to 1200 super physiological levels, well, sure, but now we're talking about something different and it sure as shit isn't Tonkhead alley or Fidogea, whatever it's testosterone Sipionate or some sort of actual testosterone product.
Speaker 1:Well, we know test tip works quite well. Yeah, Are you? By the way, are you a coffee drinker?
Speaker 2:Love coffee, okay, coffee guy, I love coffee.
Speaker 1:Well, one of the funnier posts from Uberman was oh no, he said, if you, when you get up, wake up, you should wait 1.5 to two hours before you drink coffee to avoid the afternoon crash.
Speaker 2:Totally. Yeah, no, it's like, if you're tired when you wake up, you should just wake up later, Like that's the what, yeah. And again, I remember this because we got tagged in this post all the time, right. And he's like, well, the adenosine dump that you get, you know, from the coffee, it's like, and it's a paper and mice, right. And it's like, oh, okay, so like, how does this work in humans? And further your recommendation Is there evidence suggesting that doing this improves cognitive performance? Cognitive, even if subjective ratings of cognitive performance? Nothing, it's nothing's out there. And again, it's like. It's like going to the doctor and saying, yeah, my elbow hurts when I do dips, and the doctor says don't do dips, and you're like, okay, that's not really helping me out here. So again, it's a more just reference based sort of science rather than actual evidence based. But the people can't really discern the difference.
Speaker 1:What do you think, Tony?
Speaker 3:To be honest with you, I wouldn't know the mechanisms enough to really argue about that from the coffee perspective. But I don't, I don't see the purpose in that, you know. I mean, I'm again from the adenosine side. I'm going to go, I'm going to take what Jordan said here and I'm going to run with that. Yeah.
Speaker 2:Yeah, they just isn't.
Speaker 3:I mean, look potentially, but it's, it's the certainty, to reiterate, and what you've mentioned, in which this is presented, that bothers me more than even it be suggestive or a possibility of no.
Speaker 3:no problem with looking into possibilities with with further research or or looking at a mechanism in action and going you know if we did this and explaining those mechanisms and saying, well, this might be the end result. That's fine, but the conclusive nature of it always would bothers me, and that discounts any individual variation that exists in individual biochemistry, amongst person to person and outside of having, you know, a head, two legs and two arms and many of the same organs were very different. It's all like yeah.
Speaker 1:I guess you can describe it as being confidently wrong. I mean it's it's it's the degree with which minutiae is promoted. That is really kind of I find it a bit of. It is fascinating because there's apparently there's a need for a lot of people enjoy and I'm sure when you give talks people want I guess they want some, they want something easy to follow. It's like wait, you mean I got to train, you know, five or six times a week to hit that goal and I have to clean up the crap that I eat. I mean, can I do something a little easier like sitting a cold tub for like 10 minutes a day with me?
Speaker 2:Yeah, it's human behavior.
Speaker 2:Yeah, and people and people want confident claims. They want concrete sort of ideas. Right, the the actual expert is generally saying well, most of the time we're in general, and here's what we think now. And that's not very confidence inspiring when people hear that rather than say, do this thing, so I get that. Now, just imagine the claim was hey, it may be that if you drink coffee when you first wake up, that there is this particular neurotransmitter, collection of neurotransmitters or other molecules that you know would be better served by delaying caffeine intake. We don't know that to be sure, but my point, but it's possible. Right, exactly your point. And that tweet one doesn't fit 160 characters and two doesn't get no traction Because people are like wait, what are you actually saying? Here sounds like you're just speculating, like I am in fact just.
Speaker 1:Hey, by the way, one final thing. Have you? Have you heard the one about the soleus pushup?
Speaker 2:Wait what? No, I know what the soleus is and I know what a pushup is, but what the heck?
Speaker 1:Well, technically it's plant reflection, but there's actually an interesting paper where they had people basically bounce their feet. You know it's your soul, is your gastroc basically doing plant reflection for about four hours a day, and we know the contractile activity you know promotes changes in skeletal muscle and you were, men, was promoting it as a way to train your muscles. Your well, I guess. So the idea that people would be bouncing their feet four hours a day while they sit at their desk typing oh, my God waiting for coffee waiting for coffee.
Speaker 1:Yeah. So I'm like okay, this is one way to avoid real exercise. You're going to bounce your feet for four hours a day. First of all, no one's going to do that.
Speaker 2:No, yeah. And the other thing. It's like, alright, so again, if it's a speculation, like if you do this for four hours a day, you're doing this with energy expenditure, this with muscle training, maybe it works for whatever outcome, and it's like, even if we are charitable and say, yes, it works, but does it work better than this other thing that requires less time as a larger magnitude of effect? And you know, if you're asking me, do I think four hours of toe tapping or, you know, plantar push ups or soleus push ups is better than doing, you know, a couple sets of calf raises to failure and your failure, that are loaded appropriately? No, the answer would be I would say no, just based on, again, existing evidence. Now that may change and in a decade we'll have to come back and do another recording and say, hey, you know what he was onto something.
Speaker 1:But yeah well, jordan, you will never become a celebrity physician.
Speaker 2:I know, yeah, I know, if I want to look, if I start making super confident claims that are, you know, maybe off off the reservation you'll know that I'm in a world of hurt financially and I need to make some money. That's what I started doing.
Speaker 1:Well, jordan, it's great to have you on the show. Could you tell the audience if they want to reach you? You know, if you're giving a seminar anytime soon or you travel, give talks and conferences, you know, let the audience know.
Speaker 2:For all of our stuff. You can search barbell medicine across platforms. We have a website, has all our media on there, all of our articles, a lot of free downloads, whether it's programming, whether it's nutrition stuff, health stuff, it's all there. We have our podcast, barbell medicine. You can find me on Instagram Jordan underscore.
Speaker 1:Instagram right there.
Speaker 2:Yeah, and then we have our main account, barbell medicine. So yeah, if you search barbell medicine on the worldwide web, you're going to find a bunch of stuff hopefully nothing bad. I'm still waiting for something to happen, but yeah that you can find us there.
Speaker 1:Hey, I do want to let you know that at the ISSN conference we need more physicians there. I think literally there's like two physicians that attend our conference that have an interest in sports nutrition. Obviously you have that interest. I think we really should. You know, come to our conference. It's always in Florida, so it's typically on the beach. I mean, you know you're going west coast, east coast, but it's always mid June. Next year it's in Bonita Springs, which is right outside of Fort Myers, and it's very pretty park to.
Speaker 3:Yeah, it's very pretty June 1819 and 20.
Speaker 1:It's a two and a half day conference.
Speaker 2:You had me at Florida, because there's some good golf out there.
Speaker 3:I would 10 out of 10.
Speaker 2:Yeah, yeah, I would love to be there. No, that's great. I love the ISSN and if I can make a work with my schedule,