Episode #373: Deadlift Data- The Truth About Sumo vs. Conventional, New Study Finds Hard Cardio 9x Better, and Ozempic's Muscle Secret

0:00 [SPEAKER_03]: Welcome back to the Barbell Medicine podcast where we bring modern medicine to strength conditioning and strength conditioning to modern medicine. [SPEAKER_03]: This is another episode of the rundown where we weigh in on the latest in medicine, fitness, nutrition, and sports. [SPEAKER_03]: This week we're diving into the latest science and breaking news across strength longevity and policy.

0:16 [SPEAKER_03]: And first up, we're going to take a closer look at the deadlift. [SPEAKER_03]: A lift that we know and love, but specifically we're going to talk about the heaviest deadlift ever done in a meet. [SPEAKER_03]: and what historical powerlifting data truly says about the sumo versus conventional deadlift debate.

0:31 [SPEAKER_03]: Then we're going to flip the script on public health. [SPEAKER_03]: First up, with new research came out, comparing the efficiency of vigorous physical activity to moderate and light physical activity for reducing the risk of multiple medical conditions. [SPEAKER_03]: Then a new consensus statement was published on exercise intensity definitions that to my mind, increases confusion about exercise intensity definitions.

0:52 [SPEAKER_03]: Plus we'll cover the future of anti-obesity medications, looking at some new data on some agglotide and how it may actually preserve muscle during weight loss. [SPEAKER_03]: And a new controversial mandate in China requiring influencers to be certified experts. [SPEAKER_03]: And also we're going to talk about lead and protein powder.

1:07 [SPEAKER_03]: All that and more packed into this show on the barbell medicine podcast. [SPEAKER_03]: But first, I do have to introduce the second was handsome, Dr. North America. [SPEAKER_03]: Dr. Austin Baraki, what's going on, man? [SPEAKER_00]: Hey, doing all right, squeezed in some training this morning.

1:19 [SPEAKER_00]: Dev lifted, I thought you'd need that back. [SPEAKER_00]: Six hundred. [SPEAKER_00]: Yes. [SPEAKER_00]: Yeah. [SPEAKER_03]: But it's a moderate sumo, so it's not real sumo. [SPEAKER_03]: True, true. [SPEAKER_00]: Yeah, the deadlift is slowly coming back, not obviously where I've been in the past, but now I can run and do a lot of other things that I was not able to do as effectively before.

1:33 [SPEAKER_00]: So I'll take it. [SPEAKER_03]: Is the moderate sumo stance really like harm reduction? [SPEAKER_03]: Like, you know what I'm saying? [SPEAKER_03]: If you went full sumo, like toes out to the plate, like Johnny Candido dropping the toe, his, the plate on his toe at IPF worlds in like 2017, if you go, yeah, I mean, really sumo.

1:50 [SPEAKER_00]: Many years ago, when I first started dabbling with sumo, I did give myself a nasty case of a doctor and high hamstring kind of tended up at the end. [SPEAKER_00]: I think I was just quite strong on conventional. [SPEAKER_00]: And I was like, oh, I can pick this up, but my growing was not ready for it.

2:04 [SPEAKER_00]: And so I think that was why I transitioned to the modern and it kind of stuck. [SPEAKER_00]: is what it is. [SPEAKER_03]: But you know, when I first started lifting, I didn't know that a conventional deadlift existed. [SPEAKER_03]: Like you just looked up how to deadlift online and all it was was Dave Tates deep squatter website at the time and it's all just sumo.

2:24 [SPEAKER_03]: So like I just thought that's how you did how you deadlift it. [SPEAKER_03]: Uh, as it turns out, I mean, I worked up to it was like 545. [SPEAKER_03]: I think [SPEAKER_03]: how good it would have been if I figured out a conventional deadlift early on. [SPEAKER_03]: That's the next year of training training history.

2:41 [SPEAKER_00]: What would have been about the same? [SPEAKER_00]: No, what would have been about the same? [SPEAKER_03]: No, what have completely changed my trajectory would have completely changed my trajectory and anyway. [SPEAKER_03]: All right. [SPEAKER_03]: Well, let's get right into this because we do have a lot to discuss.

2:52 [SPEAKER_03]: First up, we're talking about the world of strength records. [SPEAKER_03]: So you sent me this video of Kyle Curvey deadlifting 420 kilograms. [SPEAKER_03]: That's 924 pounds. [SPEAKER_03]: previously we've talked about like different strongman records or whatever, but the important factor here is that this was done on a stiff bar and if you're not a power lifter or barbell kind of sewer, let me just explain this to you.

3:15 [SPEAKER_03]: In power lifting, they're traditionally use a power bar for the squat and the bench press in most federations. [SPEAKER_03]: Some federations will use that same barbell for the deadlift, so like usapl and ipf, they'll use the same barbell for all three lifts. [SPEAKER_03]: and other federations like the USPA, WRPF, ABS, et cetera, et cetera, we'll use a deadlift bar.

3:37 [SPEAKER_03]: Now the differences between these two bars are, there's multiple. [SPEAKER_03]: First, the stiff bar is 29 millimeters in diameter and seven foot long, okay? [SPEAKER_03]: compared to the deadlift bar, which is 27 millimeters in diameter, where you grab the bar, and it's seven and a half feet long at minimum, someone will even longer than that.

3:54 [SPEAKER_03]: It makes the bar with beer to flex more, most people report that they can lift more on a deadlift bar. [SPEAKER_03]: And we're going to kind of talk about that and also compare these different records. [SPEAKER_03]: The other thing is, and I don't know how much people can found like, oh, the deadlift bar and it being with beer makes it easier for me to deadlift more weight versus just the grip itself because it is smaller.

4:15 [SPEAKER_03]: So anyway, [SPEAKER_03]: You sent me this deadlift cow curve a deadlifting 924 pounds on a stiff bar. [SPEAKER_03]: Oh, by the way, beltless. [SPEAKER_00]: Yeah, just one of the most impressive feats of strength for anyone who has experienced deadlifting in this fashion. [SPEAKER_00]: I think it will recognize that.

4:29 [SPEAKER_03]: It got me thinking I was like, that might be the heaviest deadlift ever done on a stiff bar. [SPEAKER_03]: Now, Hazus Oliveris, I believe has done this in training as well for 20 as well, which [SPEAKER_03]: just place. [SPEAKER_03]: No, but then I compared this to what happened has happened in competition.

4:47 [SPEAKER_03]: And yeah, in the IPF, which is, and there are affiliates. [SPEAKER_03]: So like powerlifting American in the United States, they're effectively the only powerlifting Federation, but the largest one that uses a stiff bar for the deadlifts. [SPEAKER_03]: So then in the USAPL, they formally were affiliated.

5:05 [SPEAKER_03]: The heaviest deadlift ever [SPEAKER_03]: So basically you sent me a casual video of a dude two weeks out from a meet, deadlifting nine kilos more than the heaviest deadlift ever done on this particular type of equipment. [SPEAKER_03]: Now obviously, this guy didn't do a full meet, he didn't do squats and bench press beforehand, untested, you know, whatever, but still.

5:27 [SPEAKER_00]: Yeah, yeah, thank you comprehensively, even for folks like us who are maybe closer than the average person might be to come up with something like that, but still just not even anywhere in the same league. [SPEAKER_03]: Yeah, the top five deadlifts in on a stiff bar for all time range from 400 kilos to 411 kilos.

5:45 [SPEAKER_03]: So everything's clustered at the top and oh, by the way, four out of five of those were conventional only one was sumo, so just shout out to conventional deadlifts. [SPEAKER_03]: Now, you compare this to the top five dead lives of all time, irrespective of drug testing, irrespective of equipment, and things get a little different.

6:01 [SPEAKER_03]: So the top deadlift of all time is 487.5 kilos, which is a thousand 74 pounds by Danny Griggs B. [SPEAKER_03]: In 2022, that was done sumo, and it is on a deadlift bar actually a Kabuki bar, as I recall, which is even more specialized equipment. [SPEAKER_03]: So, [SPEAKER_03]: I didn't want to, you know, belabor the point on equipment differences and drug testing in weigh-ins, you know, 24-hour weigh-ins in the, in the WRPF and USPA versus IPF is two, two-hour weigh-ins.

6:30 [SPEAKER_03]: But I did want to kind of get your take on this. [SPEAKER_03]: If the heaviest deadlift ever done in a, in a meet with a, uh, deadlift bar is 487.5 kilos. [SPEAKER_03]: and the heaviest deadlift ever done on a stiff bar is 420 kilos, even though it wasn't done in a meat. [SPEAKER_03]: And so that delta is, you know, 65, 67 and a half kilos.

6:56 [SPEAKER_03]: That seems like a lot, as far as the difference goes, right between a stiff bar and a deadlift bar. [SPEAKER_03]: Does that match your expectations as far as what people, you know, how different somebody's deadlift would be if they trained on a deadlift bar versus a stiff bar and like what sort of difference does it make outside of the deadlift?

7:16 [SPEAKER_00]: I think the challenging aspect of trying to come up with an answer here is that [SPEAKER_00]: the variables that we're looking at are not just the bar but also the different people complete competing in executing these lifts. [SPEAKER_00]: And so obviously there's the variable of different people having different kind of mechanical advantages and disadvantages, leverages, proportions, training histories, environments, things like that.

7:38 [SPEAKER_00]: It's not just the same person on one or the other. [SPEAKER_00]: Even if you did have the same person on one versus the other, they're still going to be [SPEAKER_00]: are they a little bit better trained at one versus the other? [SPEAKER_00]: I have a decent amount of experience training both conventionally and sumo simultaneously with relatively equal emphasis for many years and perhaps unsurprisingly they ended up being in a similar place.

8:04 [SPEAKER_00]: And this was all on, you know, stiff bar type performances, they were maybe ended up being about 15 20 kilos difference at my level of performance and so rather than looking at it in terms of absolute kilos, I think if you look at it as a percentage right so say 60 kilos out of about a 400 kilo overall deadlift, you know, whatever percentage that ends up being probably a, you know, set let's call it, I don't know, maybe.

8:30 [SPEAKER_00]: 10 and somewhere between five to 15 percent is probably a reasonable range of variation to expect between these two lifts depending on the person they're training history and they're like relative advantages and disadvantages. [SPEAKER_00]: That's kind of my take. [SPEAKER_00]: I do suspect that there are probably some people who [SPEAKER_00]: may still have a relatively equal or may even perform better despite consistently attempting to train sumo for whatever reason that might include you, as somebody who's particularly, I would say, a little more awkward on the sumo than conventional, but for those who are maybe of more average proportions or advantages that it might actually be relatively similar within maybe 5% 10% I think is like a reasonable expectation in my mind.

9:10 [SPEAKER_03]: I don't know, what do you think? [SPEAKER_00]: actually kind of both to be honest it's the quite the open question would be will do these kind of stacked do they augment on one another or how does that had the because again it's just you're throwing multiple variables in the mix on top of a people who are variable inherently in between them so it gets pretty messy but yeah [SPEAKER_03]: Yeah, my personal experience is that between a deadlift bar and a stiff bar, I have almost no difference in my top pulse.

9:38 [SPEAKER_03]: I mean, at meats, I think my best with a convention with a stiff bar is only 320 kilos, 705. [SPEAKER_03]: And then my best with the deadlift bar is 332, five and a meat in training. [SPEAKER_03]: They're more similar. [SPEAKER_03]: You know, maybe 10 pounds apart and I could easily chalk that difference up to like, [SPEAKER_03]: I didn't have as much oatmeal in the morning.

9:59 [SPEAKER_03]: It's just something, something unrelated really. [SPEAKER_03]: So I personally don't see a big difference between a deadlift bar and a stiff bar. [SPEAKER_03]: And I think that those who do see a big difference between the two, either there's some sort of anthropometric advantage that they get with the greater deflection or whip of the deadlift bar or it's a gripper-lated thing that's otherwise that's really being captured rather than like the actual bar itself.

10:27 [SPEAKER_03]: hunch, but I can't prove it that the sumo deadlift responds maybe a little more favorably to switching to a deadlift bar, but again, I can't prove that it's just more just on vibes. [SPEAKER_03]: But here's the more important thing, right? [SPEAKER_03]: So let's just say that there's a range between 5 to 15%.

10:44 [SPEAKER_03]: The difference between a stiff bar and deadlift bar, sumo and conventional. [SPEAKER_03]: It provided both are reasonably either either both untrained or both relatively well-trained. [SPEAKER_03]: What are the differences outside of the deadlift and outside of performance between, you know, with this weight delta?

11:00 [SPEAKER_03]: And I think ultimately there's none. [SPEAKER_03]: Basically, I think that any sort of advantage you have in the amount of weight that you can lift with a very specific style of a lift is ultimately those those benefits are concentrated on that lift. [SPEAKER_03]: Right. [SPEAKER_03]: So this goes back to like the low bar versus high bar, you know, comparison.

11:18 [SPEAKER_03]: People like, oh, you can deadlift or squat more weight with the low bar. [SPEAKER_03]: And it's like, well, that may be true for a lot of people. [SPEAKER_03]: But it doesn't make your legs any stronger outside of the squat compared to training the high bar squat or a front squat or a safety squat bar squat, you know, whatever.

11:34 [SPEAKER_03]: It's just very specific to the demands of the exercise that you're talking about. [SPEAKER_03]: And so doesn't mean you can leg press more weight, doesn't mean you can jump higher, doesn't mean you can run faster. [SPEAKER_03]: And so ultimately, I think that stylistic preferences is what's going to predominate here.

11:49 [SPEAKER_03]: And I don't know that the absolute difference in weight actually matters outside of the competition setting in which case, [SPEAKER_03]: should adopt whatever style allows you to live more weight because that's the sport. [SPEAKER_03]: Yeah, I'm inclined to agree with that part. [SPEAKER_03]: Okay.

12:00 [SPEAKER_03]: The last little note here, the thing here and again, it's just more nerdy now and on powerlifting that I realize that only a few people care, but they happen to be concentrated in our audience. [SPEAKER_03]: Sumoverse deadlift, or the conventional deadlift, there are people out there that have said, and continue to say that, look, everybody, or most people, in fact, if they're taking a more reasonable approach, they're stance on this, they'll lift more weight if they do it, sumo.

12:28 [SPEAKER_03]: they just need to practice and whatever. [SPEAKER_03]: Not saying that it's almost easier than conventional, they're just saying there's mechanical advantage. [SPEAKER_03]: And so if you want to be the best power of the free shipping, you should do sumo, but then when you look at the actual data here, and the data that we're using, I try to control for other variables like way in time, drug testing, et cetera.

12:47 [SPEAKER_03]: So I just used the top 100 raw dead lists in the IPF, which is drug tested to our way in stiff bar, et cetera. [SPEAKER_03]: Top 100 for men, top 100 for women. [SPEAKER_03]: 52% of men pulled sumo, 48% of these top 100 were conventional and then a women who is 65% sumo and 35% were conventional.

13:09 [SPEAKER_03]: There's some distribution differences, lightweight, middleweight, heavyweight, but yeah, ultimately to me, this isn't like a slam dunk. [SPEAKER_03]: like everyone should pull sumo, because again, the top 100 deadlifts by definition, you're capturing the, you know, the pointy end of the, of the spear here.

13:30 [SPEAKER_03]: Mm-hmm. [SPEAKER_03]: You think they would have figured this out? [SPEAKER_03]: Yeah. [SPEAKER_03]: Like, if there was a different squat pattern that I could adopt that's going to turn me into a world record squadron, I would have figured it out. [SPEAKER_03]: I would have tried it. [SPEAKER_03]: I've been trying it.

13:41 [SPEAKER_03]: I just, you know, can't do it. [SPEAKER_03]: So I don't know. [SPEAKER_03]: Do you think this, these people all just need a coach that knows that the sumo developed exists or do you think that maybe it's just really more of an anthropology, you know, and personal choice here. [SPEAKER_00]: I think that with sufficient time and a sport and especially or ideally if you do have some competent coaching guidance, then over time you do end up kind of dabbling and experimenting with different things even if you just use one or the other variation as a supplemental movement for part of your training or during an off season or something and then you might find oh this actually feels.

14:17 [SPEAKER_00]: Maybe better in this way, or I have a knack for it, or it's getting stronger quicker than I expected, or whatever the case is. [SPEAKER_00]: And so, you know, it's not that so many of these things you can't necessarily predict upfront when somebody is just starting getting into this sport or really any sport.

14:32 [SPEAKER_00]: But rather, it is the process of training over time that tends to reveal a lot of these things. [SPEAKER_00]: The same thing happened, like when I started swimming, [SPEAKER_00]: As a kid, I was never going to be able to predict what strokes I was going to be better or worse at what distances I was going to be better or worse at or what my eventual best performances were likely to end up being.

14:53 [SPEAKER_00]: Rather, it took a long time training all the different strokes, training and racing all the different distances before I was like, oh boy, that race was miserable, I'm never. [SPEAKER_00]: really wanting to do that again versus this other one. [SPEAKER_00]: It's like, man, I'm actually doing pretty well in this.

15:05 [SPEAKER_00]: I'm enjoying it. [SPEAKER_00]: I'm racing well, I'm placing well, et cetera. [SPEAKER_00]: And so these kind of patterns and preferences and things like that emerge over time. [SPEAKER_00]: And it doesn't mean that you end up doing those things to the exclusion of everything else. [SPEAKER_00]: It's just like this constant long-term iterative process of [SPEAKER_00]: experimenting.

15:20 [SPEAKER_00]: That's the same way how I discovered like, oh, I can reverse sprint bench and I actually enjoy it and it got super strong. [SPEAKER_00]: It got within 10% of my best regular grip bench press. [SPEAKER_00]: That was just trying it and seeing what happened and giving it a chance. [SPEAKER_00]: And so I do think that there's some value in that and a lot of people will end up kind of, these patterns will emerge over time kind of organically.

15:41 [SPEAKER_00]: If you're doing it yourself or under the guidance of a of a coach who is [SPEAKER_03]: Yeah, yeah, the job of a coach to my mind with respect to like exercise technique or style and like programming at least two full thing one is the coaches trying to maximize train low that they can that a person can can [SPEAKER_03]: bottlenecks are going to be time and physiological tolerance.

16:14 [SPEAKER_03]: And so a coach's job is to like, well, how do we fit all this in? [SPEAKER_03]: Right. [SPEAKER_03]: So that's job one job two with respect to technique is sort of like a shaman, you know, or like a, you know, the, you know, the, you're guide to the sorting hat. [SPEAKER_03]: You're basically trying to sample a lot of different not only styles, but different, you know, slightly different, you know, assistance exercises, supplemental exercises, to try to find the sort of key that unlocks the individual, right?

16:43 [SPEAKER_03]: It's the same thing with like a coach in sports, or maybe like a program director that's like, oh look, you play football, but have you tried, have you considered running track? [SPEAKER_03]: Have you considered, you know, [SPEAKER_03]: So, lacrosse, rugby, whatever. [SPEAKER_03]: And so you can identify where people thrive or how they can be kind of unlocked to thrive.

17:00 [SPEAKER_03]: I mean, that's the job of a coach. [SPEAKER_03]: Cheerleading is fun too. [SPEAKER_03]: I like to cheer for my clients, but ultimately, my responsibilities are a little bit more with respect to training load and figuring out the best way for them to move right now. [SPEAKER_03]: And yeah, as you mentioned, it does change over time.

17:15 [SPEAKER_03]: But I thought this was interesting. [SPEAKER_03]: Maybe your listenership will agree. [SPEAKER_03]: or disagree. [SPEAKER_03]: They've all clicked off already. [SPEAKER_03]: They're like, they're not. [SPEAKER_03]: All right. [SPEAKER_03]: Next topic. [SPEAKER_03]: New intensity science.

17:28 [SPEAKER_03]: So this paper came out talking about the comparison between vigorous physical activity and moderate intensity, physical activity. [SPEAKER_03]: Previously, there was this assumption that one minute of vigorous physical activity, this is just cardio. [SPEAKER_03]: vigorous cardio was equivalent to two minutes of moderate cardio.

17:51 [SPEAKER_03]: I mean, because this is effectively in the public health guidelines for minimal minimum physical activity recommendations. [SPEAKER_03]: So you should do at least 150 minutes of moderate to vigorous cardio per week, or you should do at least 75 minutes of vigorous intensity cardio per week.

18:07 [SPEAKER_03]: But this new data set or analysis of an existing data set kind of calls that into question. [SPEAKER_03]: So what they did is they took Excel erometer data, but basically it's just a wearable that measures when somebody starts to move, right? [SPEAKER_03]: And actually they used this interesting machine learning program that categorized it.

18:27 [SPEAKER_03]: as a particular type of activity, which I thought was interesting, rather than just counting, they normally count its counts of like steps and like displacement. [SPEAKER_03]: This was a little more refined than that. [SPEAKER_03]: So anyway, they used that sort of data to analyze 73,485 adults over about eight years on average.

18:47 [SPEAKER_03]: And it quantified the amount of moderate intensity cardio or light intensity cardio really physical activity because I don't think they make sure this is all just straight up cardio that amount of conditioning that would achieve the same amount of risk reduction for various diseases as one minute of vigorous intensity.

19:06 [SPEAKER_03]: physical activity. [SPEAKER_03]: And so they, yeah, they measured this for all cosmortality, mortality related to heart disease, major adverse cardiac events, types of diabetes, cancer, et cetera. [SPEAKER_03]: So what they came up with was for all cause mortality, that one minute of vigorous intensity physical activity was equal to four minutes of moderate intensity physical activity.

19:32 [SPEAKER_03]: Right. [SPEAKER_03]: And for cancer related mortality, it's 1 to 3.5 and for heart cardiovascular disease, related mortality, it's 1 to 7.8. [SPEAKER_03]: All of this is saying like, look, actually vigorous intensity, physical activity seems to be way more efficient and protective than moderate intensity.

19:50 [SPEAKER_03]: The ratios for vigorous compared to light physical activities, they're even crazier. [SPEAKER_03]: So the question first question is, why does this massive difference between the assumed relationship, between vigorous and moderate intensity physical activity compared to the observed why is there this massive disconnect?

20:14 [SPEAKER_03]: Why do you think that is? [SPEAKER_03]: I don't know. [UNKNOWN]: This is a sin. [SPEAKER_00]: Straight up, I'm happy to say when I don't know things, and this is one of those occasions. [SPEAKER_00]: I found this paper, this discussion topic, interesting, because you're right. [SPEAKER_00]: It is so embedded and ingrained in the general public health and physical activity guidelines to either do the certain amount of vigorous or essentially twice the amount of moderate, or some combination to achieve a similar overall energy expenditure throughout the week.

20:42 [SPEAKER_00]: It does feel a little bit too neat and tidy and simplistic for that to be completely equal in all ways. [SPEAKER_00]: I do wonder, though, if even this data ends up taking us in a slightly erroneous direction to where moderate or lower intensity activity ends up getting almost neglected in some layer D-prioritized where people might say, if I just do a minute, then I'm good for it.

21:09 [SPEAKER_00]: That would be the rest of the day or something like that, you know, because I think that, you know, we've talked about before how in the context of exercise prescription or when you're programming for someone. [SPEAKER_00]: The intensity of exercise relates somewhat powerfully to the type of adaptations that people get because there are unique physiologic demands to higher intensity activity compared with lower intensity activity.

21:32 [SPEAKER_00]: This is the same. [SPEAKER_00]: argument that you know has come up in recent years when zone two exercise got super popular and it's was seemingly almost to the exclusion of a lot of other things where there were all these unique benefits to it and it's like yep it has unique benefits just like doing any exercise has unique benefits from that exercise but that doesn't mean they're so unique that they are necessarily superior to those that you can get from exposure to other intensities and types and varieties and durations of activity as well.

21:59 [SPEAKER_00]: And so I have some reluctance to jump [SPEAKER_00]: I think what some might take to be the implications of these data and say, oh, well, you know, low moderate or low intensity are out high intensities in. [SPEAKER_00]: I'm back on the hit train. [SPEAKER_00]: I'm just going to lift and then push a few hard intervals and then I'll be good.

22:17 [SPEAKER_00]: And it's like, well, you're going to be way better off than a lot of other folks are going to be way way better off than any patient that I tend to see in the hospitalized setting for sure. [SPEAKER_00]: But are you getting all the potential benefits that you might actually have from [SPEAKER_00]: intensity activity, because the only things that you can determine from these data with confidence is the outcomes that they specifically measured.

22:42 [SPEAKER_00]: There's a whole bunch of things that they, you know, health outcomes that weren't necessarily measured that may also be important or valuable or not captured across an eight-year time span in this cohort of people or something like that. [SPEAKER_00]: So I don't have a great explanation for why there's this huge difference.

22:56 [SPEAKER_00]: I said, I wonder, you have some thoughts there, but I'm more so found the observation [SPEAKER_00]: cautious about how aggressively I want to alter or narrow my prescriptions based on the the findings that were described here. [SPEAKER_03]: Well, I actually do have a theory here, so bear with me on this.

23:18 [SPEAKER_03]: Okay. [SPEAKER_03]: Because even though this machine learning that they use to basically, again, use the [SPEAKER_03]: intensity of that movement, so how much are they accelerate? [SPEAKER_03]: For example, it's still, they still ended up using Mets. [SPEAKER_03]: So Metabolic equivalents to ultimately categorize the activity of, you know, light physical activity, moderate or vigorous.

23:41 [SPEAKER_03]: And Mets, we've just, we've explained a number time why we hate Mets, but the main thing is is that [SPEAKER_03]: It attempts to be this one-size-fits-all measurement, like one-met is equal to what 3.5 milliliters of oxygen per kilo per minute. [SPEAKER_03]: It's basically something used for research to try to estimate energy expenditure of an activity.

24:01 [SPEAKER_03]: And there's a metabolic compendium so you can see, like, on average, for a person who maybe weighs 70 kilos and is of average level fitness, you know, this is how much the each activity costs energy-wise. [SPEAKER_03]: but it varies so much between individuals like what a particular activity at a particular intensity, the amount of energy that they use.

24:22 [SPEAKER_03]: Like it's just not really something you can use on an individual basis. [SPEAKER_03]: And so my theory here is that this is really just an artifact of using meds. [SPEAKER_03]: Once you basically have a person is moving fast enough or at a level where the watch, [SPEAKER_03]: Then effectively, they're expanding enough energy for it to actually count as exercise.

24:47 [SPEAKER_03]: It doesn't mean that it's actually like high intensity or sprint intensity. [SPEAKER_03]: It just means that, hey, it's not actually exercise. [SPEAKER_03]: And so I suspect that at least my theory is that if you just fraction all activity into vigorous, the vigorous category based on meds, [SPEAKER_03]: then you're eliminating any of the portion of exercise that's not actually exercise.

25:12 [SPEAKER_03]: It just a problem with the way it's measured. [SPEAKER_03]: That's my theory anyway. [SPEAKER_00]: It's almost like a sensitivity specificity thing. [SPEAKER_00]: You're much more specific to capturing exercise and whereas at lower intensities, at least as captured by accelerometry, [SPEAKER_00]: You're saying that you're more likely to be capturing just maybe routine activities of daily living, for example, that might be captured on a accelerometer, but not exercising those.

25:34 [SPEAKER_00]: We don't necessarily think, can further the same degree of benefit. [SPEAKER_00]: Or at least you require a lot higher doses of routine activities of daily living to get there. [SPEAKER_03]: Yeah. [SPEAKER_03]: Well, like walking, for example, the self-selected gate speed for most folks how fast they walk is somewhere between like three, three point two miles an hour, or whatever, and now for a person who's relatively fit, going out and walking that pace, [SPEAKER_03]: probably doesn't even register as exercise, right?

25:59 [SPEAKER_03]: It's physical activity to be clear, but it's not exercise insofar as how people classically think about it. [SPEAKER_03]: Like, oh, is this gonna prove my carduaries for a fitness? [SPEAKER_03]: For example, like, probably not for a person who's in reasonably decent shape. [SPEAKER_03]: On the other hand, if a person have like COPD walking at that pace is a high intensity activity.

26:18 [SPEAKER_03]: Sure, for them, right? [SPEAKER_03]: And so, [SPEAKER_03]: But if you just use the Met score to classify things, oh, this is moderate intensity, vigorous intensity, whatever, you're just going to miss a lot here. [SPEAKER_03]: That's my, that's my thought. [SPEAKER_03]: It seems plausible, but you need some verification data.

26:35 [SPEAKER_03]: Sure. [SPEAKER_03]: Here. [SPEAKER_03]: I just don't like Met's. [SPEAKER_03]: Like I don't, I don't know what else to say. [SPEAKER_03]: I think it was a choice to use for public health like communication, like in the physical activity guidelines, but it's not like medical professionals or even fitness professionals know what a met is.

26:53 [SPEAKER_03]: And then even if you do, how do you explain that to people? [SPEAKER_03]: Like you look, you need 150 minutes, at least, of cardio per week. [SPEAKER_03]: And it needs to be their moderate to vigorous intensity. [SPEAKER_03]: And they're like, what would it matter to vigorous intensity?

27:03 [SPEAKER_03]: You're like, oh, you know, like 46 meds. [SPEAKER_03]: And they're like, well, it's a measure of energy expenditure. [SPEAKER_03]: And they're like, well, how do I rate that? [SPEAKER_03]: And you're like, I don't know actually. [SPEAKER_02]: So yeah. [SPEAKER_00]: Yeah, I agree. [SPEAKER_00]: Really frustrating to attempt to use those guidelines at least as written to deliver that type of prescription, but there are a lot of other ways I've lectured when teaching groups of students or trainees on this and we've talked about various ways to communicate exercise intensity, be it subjective metrics, RPE, talk test, things like that, at least as it relates to.

27:34 [SPEAKER_00]: credit respiratory or aerobic activity as it as a potentially more useful or understandable tool. [SPEAKER_00]: Kind of like when it comes to nutrition counseling and like how do we advise people on portion sizes and you can use like your you know palm method and various other things that are much more practically useful compared with prescribing either you know percentages of total energy intake or something like that that are not intuitive for people.

27:53 [SPEAKER_03]: Yeah. [SPEAKER_03]: So my main takeaway from this is that it is that exercise needs to be hard enough to count as exercise in order for it to work. [SPEAKER_03]: That's going to be individualized based on the person's fitness, right? [SPEAKER_03]: Obviously, and their capabilities. [SPEAKER_03]: And so what I would use rather than meds.

28:09 [SPEAKER_03]: Or like, you know, some sort of similar rating that people can't really either do on the fly like RPE, somebody could do, or even just heart rate recommendations, because if you don't have heart rate monitor or if you have some condition or whatever people vary. [SPEAKER_03]: disease the talk test as as you alluded to the talk test super super easy.

28:30 [SPEAKER_03]: So effectively you should be only be able to speak a few words before having to take a breath. [SPEAKER_03]: Most of the time the recommendations to recite something like the pledge of allegiance and if you can get all the way through it without having to take a breath in between. [SPEAKER_03]: You're not exercising hard enough based on based on the talk test.

28:46 [SPEAKER_03]: There's a counting talk test as well. [SPEAKER_03]: That's a similar thing you count from zero all the way up to the highs you can go before it's taken breath at rest and you compare that to when you're exercising. [SPEAKER_03]: When you get to the halfway point, before you take your first breath, that's a positive test, which basically means, oh, you're probably around this ventilatory threshold, one, which signifies, yeah, you're probably getting into, definitively, this is exercise.

29:11 [SPEAKER_03]: And to me, that's a more practically applicable way to measure, like, am I exercising or is this physical activity? [SPEAKER_03]: The last thing I'll say here, I'm not hating on walking or light intensity physical activity or just generally being active. [SPEAKER_03]: I think all that stuff is useful.

29:29 [SPEAKER_03]: It certainly is beneficial, just being more active, generally speaking, at this place's sedentary behavior, displaces other behaviors for example, for some folks, but I don't know that it actually contributes to fitness that much unless it's at the correct intensity to drive those adaptations.

29:47 [SPEAKER_03]: Fortunately, the intensity range that works is quite wide, you just have to get to that threshold, which is probably around 60% of your max heart rate on the low end. [SPEAKER_03]: And like, I don't know that Metz Act captures that well. [SPEAKER_00]: I think that's a reasonable argument, my only counter, I guess, not based on tons of evidence or data, but the low-level activity, I think, can plausibly contribute to fitness, depending of course on how you're testing fitness, but it's just that the dose in terms of volume has to be massive.

30:20 [SPEAKER_00]: Yeah. [SPEAKER_00]: Right. [SPEAKER_00]: And so, I mean, historically, if you go back through the history of endurance training, there are people in the olden days, [SPEAKER_00]: who their main training for marathon was hours and hours and hours and hours and hours of walking. [SPEAKER_03]: Yeah.

30:30 [SPEAKER_00]: Right. [SPEAKER_00]: And so it is possible to build fitness through that way through those methods. [SPEAKER_00]: But that's kind of the scale knob is volume versus intensity, which is obviously debates that's been going on forever. [SPEAKER_00]: And we can stand to benefit from both. [SPEAKER_02]: A little bit of both.

30:45 [SPEAKER_00]: Yeah. [SPEAKER_00]: There you go. [SPEAKER_03]: Well, overall, I think maybe the bigger takeaway outside of all of that is, Hey, we just need some better definitions in ways to communicate exercise intensity. [SPEAKER_03]: The American College of Sports Medicine just put out a new consensus statement on definitions for exercise intensity.

31:02 [SPEAKER_03]: They basically cited that there's inconsistency with jargon with terms like light, moderate, and vigorous or used in public health. [SPEAKER_03]: But [SPEAKER_03]: Sometimes these are interchanged with low, moderate, and high. [SPEAKER_03]: And the definitions for both are not always the same and cutoffs for both.

31:19 [SPEAKER_03]: So for example, light physical activity is said to be less than three metabolic equivalents, whereas low intensity cardio is often said to be less than 60% of max heart rate, and sometimes these things don't match up. [SPEAKER_03]: So like where does exercise start? [SPEAKER_03]: You know, how do you communicate this?

31:34 [SPEAKER_03]: So this ambiguity is not only a problem for public health, but also in research, right? [SPEAKER_03]: Because you'll see a paper says high intensity cardio works better than low intensity. [SPEAKER_03]: You're like, well, what does that mean? [SPEAKER_03]: It's not immediately understood and so then you have to go into the methods and you're like well why did you define it this way people just kind of choose their own adventure here so they came out with the new set of recommendations first off the intensity domains there's five of them according to this new consensus statement very low low moderate high and very high and so what they tried to do was apply this to both cardio and resistance training.

32:10 [SPEAKER_03]: So for cardio, they said a very low, we admit there's no current measure for this, so just go with God. [SPEAKER_03]: We don't know for low intensity cardio they say this has to be below the first metabolic threshold we'll get we'll get to this metabolic threshold thing here in a second.

32:27 [SPEAKER_03]: For moderate intensity cardio, it's between the first and second metabolic thresholds. [SPEAKER_03]: Again, we'll come back to metabolic threshold. [SPEAKER_03]: For high intensity cardio, it's between your second metabolic threshold and maximum workrate. [SPEAKER_03]: So it's basically like you can exercise in maximum intensity, but you can sustain it for a little bit.

32:46 [SPEAKER_03]: So not a sprint, because you can't sustain that. [SPEAKER_03]: And then very high intensity cardio is above your maximum workrate. [SPEAKER_03]: So it'd be like a sprint, basically. [SPEAKER_03]: And then they tie this to resistance training where very low intensity resistance training is greater than eight repetitions in reserve low intensity resistance training is between seven eight repetitions in reserve moderate intensity resistance training is between four to six reps in reserve high intensity resistance training is between two to three repetitions in reserve and then very high intensity is less than two repetitions in reserve.

33:20 [SPEAKER_03]: On the one hand, this does seem to unify everything. [SPEAKER_03]: It is neat and tidy, but I got some problems with this. [SPEAKER_03]: Let's go. [SPEAKER_03]: First, the resistance training thing is interesting because like, wow, this is almost the first time that this is ever tried to be tied together.

33:36 [SPEAKER_03]: But without a rep range or like some sort of measurement of relative intensity, I think it lacks specificity. [SPEAKER_03]: So for example, somebody could do a set of 30, [SPEAKER_03]: with RIR less than two, but that's not very high intensity. [SPEAKER_03]: It's hard, but it's not heavy enough, right?

33:55 [SPEAKER_03]: And I'd throw it back to that show and fill meta-analysis. [SPEAKER_03]: You know, it's a seminal paper basically showing that strength improvements are greater with higher intensity weights, higher intensity loads. [SPEAKER_03]: And the cut point here is like 60, 65% of a one-rate max.

34:11 [SPEAKER_03]: And so if, [SPEAKER_03]: the assumption is with the scale that nobody's doing sets greater than like 15 reps or 20 reps, then sure it holds, right, but that's not always the case. [SPEAKER_03]: And I think that wasn't anywhere in the paper. [SPEAKER_00]: Yeah, failing to differentiate proximity to failure from intensity as actually different concepts that get conflated at a ton by people because they envision even a low intensity set.

34:39 [SPEAKER_00]: So a relatively lightweight, but if you take it close to failure, man, if you look at the person's face on those last few reps, it looks super intense. [SPEAKER_00]: And so intensity can be just a confusing term. [SPEAKER_00]: when these two concepts that are actually distinct are conflated because they lead to different outcomes and different adaptations.

34:55 [SPEAKER_03]: Yeah, so I don't have a suggestion for this other than like you would probably want to say, look, this is really for sets less than 20 reps or less, like that's the cap, right, or 15 rep max load, or more, or 60% of 1 RM, but ultimately like [SPEAKER_03]: I think that's fine for a research setting, maybe not great for public health.

35:16 [SPEAKER_03]: I don't know, no one asked me, then this concept of a metabolic threshold. [SPEAKER_03]: So if you start your consensus statement, I'll say, look, of definitions and words and no one's in, these are all. [SPEAKER_03]: highly variable in the extra science world that we need to come over the consensus.

35:33 [SPEAKER_03]: And then you introduce a new term, a metabolic threshold. [SPEAKER_03]: It's not really new because the concept has been discussed for decades and decades, but just no one uses this word is phrase. [SPEAKER_03]: This term is used to describe an exercise intensity that results in an apparent change in metabolism.

35:49 [SPEAKER_03]: Well, it's called the metabolic threshold, so it changes in oxygen uptake, carbon dioxide production, ventilated ventilation, blood lactate levels, so on and so forth. [SPEAKER_03]: So it from that definition standpoint seems fine, but like what are we really talking about from metabolic threshold one metabolic threshold two?

36:07 [SPEAKER_03]: They're equating metabolic threshold 1 with the first lactate threshold, which represents the initial increase in blood lactate above resting levels. [SPEAKER_03]: Also called the aerobic threshold or ventilatory threshold 1. [SPEAKER_03]: Okay. [SPEAKER_03]: And then the second metabolic threshold is approximately the second lactate threshold.

36:25 [SPEAKER_03]: This is where lactate accumulation rapidly outpaces the body's ability to clear it. [SPEAKER_03]: Also called the anaerobic threshold, the respiratory compensation point or ventilatory threshold 2. [SPEAKER_03]: These things don't all line up perfectly, but they're close enough for this type of work.

36:40 [SPEAKER_03]: So, I don't know, and maybe I'm just being a jerk, like about an empathetic and whatever, but like, I'm just annoyed that they pick metabolic threshold, like why introduce a new term that's not commonly used. [SPEAKER_00]: Yeah, it is, I guess, maybe helpfully or appropriately drawing a ton of attention, I don't know, away from lactate.

36:59 [SPEAKER_00]: I don't know if that's something that we feel was necessary, but there's some potential benefits to making people worry about lactate, although there's certainly validity to it as a concept on its own in exercise physiology and metabolism. [SPEAKER_00]: And so making it a little bit more of a general thing.

37:14 [SPEAKER_00]: I don't know. [SPEAKER_00]: We're just kind of spitballing here. [SPEAKER_00]: But is what it is. [SPEAKER_00]: I doubt that this is going to have any meaningful impacts on anything in the near or medium term. [SPEAKER_03]: Well, that's that's the thing like like so with the if. [SPEAKER_03]: This new thing is adopted, right?

37:29 [SPEAKER_03]: This new intensity domains are adopted. [SPEAKER_03]: Like in the research space, maybe that's helpful, but then when you look back at historical data, then you have to kind of like reverse engineer what they did and hopefully all these things were reported. [SPEAKER_03]: So I don't know that this is helpful.

37:44 [SPEAKER_03]: But maybe it'll be helpful 50 years from now if this is widely adopted and like we have a better sense of things outside of maybe the concerns about resistance training that we talked about, but then now if you're trying to compare like high intensity or a very high intensity cardio to moderate or low intensity cardio based on these five intensity domains.

38:02 [SPEAKER_03]: do you have to measure their blood lactate to like make sure they're above a metabolic threshold? [SPEAKER_03]: Sure. [SPEAKER_03]: Yeah. [SPEAKER_03]: I don't know. [SPEAKER_03]: So, okay. [SPEAKER_03]: So what do you're listening to this podcast and you're like, what the heck? [SPEAKER_03]: How does this affect me?

38:17 [SPEAKER_03]: It doesn't. [SPEAKER_03]: This is probably, it does it. [SPEAKER_03]: I think, you know, with our previous discussion that we're vigorous intensity, physical activity did better than moderate intensity, physical activity as mentioned by Mets and the confusion around, maybe these metabolic thresholds and you're like, well look, how hard should my cardio be?

38:34 [SPEAKER_03]: Just like, can you tell me? [SPEAKER_03]: Well, we want the majority of it to be right around, [SPEAKER_03]: Metabolic threshold one that we would call that zone two, all right, and if you're exercising at that level of intensity, where again, you're becoming breathless when you try to say a phrase like the pledge of allegiance, for example, it's hard enough, but it's not so hard where you can only do a little bit of it or I start worrying about fatigue.

39:01 [SPEAKER_03]: Now, the main concern there is if you're actually doing a ton of conditioning throughout the week, like more than three hours or so, in a given week, if you're doing less than that, I honestly don't care. [SPEAKER_03]: The only thing I would really care if someone's doing less than three hours and like, oh, Jordan said, I could just do this high intensity as I want.

39:18 [SPEAKER_03]: I'm just doing all sprints. [SPEAKER_03]: I'm like, well, that's probably not one of a good idea either, just from a, of a teague standpoint. [SPEAKER_03]: I do think that the talk test, making sure you're kind of around that metabolic threshold one, which we can identify with the talk test, that seems reasonable if you're at or slightly above that, I feel fine.

39:36 [SPEAKER_03]: And if you want to do some sprints on top of that, that's all well and good. [SPEAKER_03]: It really starts to matter how you distribute your intensity far more when you're doing an actual large volume of condition. [SPEAKER_03]: Does that seem reasonable to you? [SPEAKER_00]: Yeah, I think the only other caveat that I would add is that your level of training advancement has a significant impact on how these things are distributed.

39:56 [SPEAKER_00]: And it's kind of baked into your advice there to where you said that the way you distribute it matters more when you're doing high volumes. [SPEAKER_00]: And most people are only ever doing high volumes when they're at later stages of advancement. [SPEAKER_00]: But that might not always be the case.

40:08 [SPEAKER_00]: I think that when you are newer to training, [SPEAKER_00]: You can often get away with dipping into higher intensity more often and actually that is the case for both aerobic and strength training as well. [SPEAKER_00]: We see people who, you know, push their, you know, rep max effort sets multiple times a week in beginner programs all the time where you're just adding weight to the bar all the time and you can get away with it for a bit of time, but that's not a [SPEAKER_00]: even a medium to longer term training strategy to be able to do that.

40:36 [SPEAKER_00]: So the more your level of training advancement progresses, you definitely need to distribute your intensity much more differently. [SPEAKER_00]: And so, you know, I tend to put fewer limits and recommendations and things like that in, in other words, giving beginners more options to explore and experiment.

40:53 [SPEAKER_00]: And then if somebody gets motivated, if they start to have specific goals, crystallize as they get more advanced and they need to be able to do more, then definitely those details become more and more significant over time. [SPEAKER_00]: But a lot of people could do with the trying of it harder a lot of the time.

41:09 [SPEAKER_03]: Yeah. [SPEAKER_03]: Dr. Derek Miles has said something that I do think happens to be true that generally speaking when people are trying to do this, you know, modern intensity study state stuff zone to whatever it's usually not easy enough and then when they're doing sprints or the high intensity stuff, it's usually not high intensity enough.

41:26 [SPEAKER_03]: Yes. [SPEAKER_03]: Yeah. [SPEAKER_03]: I think that it sounds truthy anyway. [SPEAKER_03]: Sure. [SPEAKER_02]: Yeah. [SPEAKER_02]: Yeah. [SPEAKER_03]: Sounds truthy. [SPEAKER_03]: Anyway, uh, this is an open access paper. [SPEAKER_03]: So all these resources are linked in the show notes below.

41:36 [SPEAKER_03]: You guys can read it. [SPEAKER_03]: And if you disagree with me vehemently and you want to argue about it on the internet, I'll do it. [SPEAKER_03]: I'll do it. [SPEAKER_01]: I will. [SPEAKER_03]: All right. [SPEAKER_03]: Now we're going to move on to some medical and wellness updates. [SPEAKER_03]: Hey, did you hear about this?

41:48 [SPEAKER_03]: New Nobel prize was awarded. [SPEAKER_03]: to Shimon Sagaguchi, Mary Brunknow, and Fred Ramstell for their work on the immune systems who took security guards, regulatory T-cells. [SPEAKER_03]: I know you're a big regulatory T-cell guy, but it wasn't just the discovery of that but this genetics switch, which is Fox P3 that controls at least some of their regulatory T-cell activity.

42:11 [SPEAKER_03]: regulatory T-cells are immune system cell, and this Fox P3 genetics, a switch, is heavily involved in a lot of autoimmune diseases. [SPEAKER_03]: So in 1995, Chamone, Saga Gucci, discovered this previously unknown class of immune cells that usually protect the body from autoimmune diseases.

42:32 [SPEAKER_03]: These are named regulatory T-cells. [SPEAKER_03]: In 2001, Mary Brunknow and Fred Ramsell identified a gene that they called Fox P3, and they demonstrated that mutations in this gene are the cause of serious autoimmune disease known as IPX syndrome. [SPEAKER_00]: you ever heard of this?

42:48 [SPEAKER_00]: I've not heard of IPX syndrome. [SPEAKER_00]: I mean, when you go down the road of autoimmunity and autoinflammatory diseases and things like that, this is a insanely complex space, a lot of genetic and molecular signaling and cytokine mediated things that, um, [SPEAKER_00]: You know, is complex even for subspecialists in that field?

43:07 [SPEAKER_03]: Yeah, look, if your rheumatologist is actually a pex syndrome, my apologies. [SPEAKER_03]: I'm unsure. [SPEAKER_03]: So, it stands for, is an acronym, it stands for immune dysregulation, polyendocrinopathy, enteropathy, and ex-linked syndrome. [SPEAKER_03]: So, IPEX, IPEX. [SPEAKER_03]: seems reasonable.

43:22 [SPEAKER_03]: So this is caused by mutations in that Fox P3 gene, which is located on the x chromosome, and it makes the gene non-functional. [SPEAKER_03]: So under normal conditions, the functional gene helps regulatory T cells not attack our own body. [SPEAKER_03]: But if it's not functioning, the system runs a muck.

43:37 [SPEAKER_03]: So it's at least early onset type 1 diabetes, thyroid disease, malabsorption, failure to thrive. [SPEAKER_03]: Yeah, usually caught pretty early and some severe long-term problems here. [SPEAKER_03]: In 2003, [SPEAKER_03]: Sagaguchi connected the findings of, you know, hey, previously discovered regulatory T cells and this FoxB3 gene, you connected these findings showing that the FoxB3 gene governs the development and function of regulatory T cells.

44:02 [SPEAKER_03]: All right, so they want this Nobel Prize. [SPEAKER_03]: What's the relevance? [SPEAKER_03]: You'll listen to Barbara Medicine podcast, what the heck is just like a Nobel Prize, like, you know, thing? [SPEAKER_03]: Well, these Fox P3 expressing T cells are also involved in recruiting satellite cells for muscle tissue generation.

44:17 [SPEAKER_03]: So their function is obviously impaired when people have this non-functioning genetic mutation. [SPEAKER_03]: and it's involved in inflammatory myopathy's like poly and dermatomyocitis, which they have less satellite cell recruitment. [SPEAKER_03]: So that failure, there's a failure to put the breaks on the immune systems repair process.

44:39 [SPEAKER_03]: You get uncontrolled inflammation at the level of the muscle. [SPEAKER_03]: You get fiber, necrosis of the muscle fibers. [SPEAKER_03]: You get muscular atrophy and fibrodic replacement of muscle [SPEAKER_03]: can appear now I went down the rabbit hole here and I know neither of us are rheumatologists and whatever and so there is a link between the amount of disease control and the amount of fiber in the process and weakness that's seen here which is kind of what you would expect but I thought that was that was interesting.

45:07 [SPEAKER_03]: There's some muscle biopsy studies where they actually look at the amount of satellite cell and myon nuclei per muscle fiber and they can kind of correlate [SPEAKER_03]: congrats on the Nobel Prize. [SPEAKER_03]: Now we need to do the final step. [SPEAKER_03]: Figure out how to fix this thing.

45:26 [SPEAKER_00]: So yeah, it's an interesting topic and to your point, the immediate applicability to the audience is going to be limited here, but here's kind of another angle on this. [SPEAKER_00]: There was another paper in the New England Journal that came out within the past week or two. [SPEAKER_00]: It's not actually formally part of our outline or our topics for discussion today, but what they basically looked at was [SPEAKER_00]: large cohorts of patients who had been diagnosed with certain medical conditions, essentially clinically, meaning the patient had looked like a prototypical syndrome that looked like maybe celiac disease, or maybe looked like some other kind of known diagnosis, and they did further genetic analysis on these folks, and often in a significant proportion of these patients

46:14 [SPEAKER_00]: that they actually had distinct different genetic syndromes that led to that similar kind of overall clinical phenotype or it looked like a condition, but it was actually a misdiagnosis of an underlying genetics syndrome that hadn't been recognized. [SPEAKER_00]: Which I can totally, as a clinician, I can totally see how this happens.

46:32 [SPEAKER_00]: If a patient looks like they have a particular diagnosis and I'm confident enough to rubber stamp that is their final diagnosis. [SPEAKER_00]: I'm unlikely to go a ton further and do a bunch of advanced genetic testing, [SPEAKER_00]: you know, standards of practice today and the technology that we have readily available to look for these types of underlying things.

46:49 [SPEAKER_00]: But recognizing that these things are possible has led to a lot of changes in how diseases are recognized and diagnosed and how they're associated. [SPEAKER_00]: Even since we were in medical school and training a lot of this stuff has evolved. [SPEAKER_00]: And additionally leads to more disease specific and more targeted therapies towards the specific genetics that a person, you know, is manifesting.

47:13 [SPEAKER_00]: targeted chemotherapy type drugs for certain types of cancers based on the specific genes that they're expressing. [SPEAKER_00]: But following this for me is useful even though I'm not a rheumatologist who's going to be routinely doing this type of advanced genetic testing, but I do see and diagnose polymysitis and dramaticysitis and thinking about, is this just run to the mill that condition or could it be part of one of these broader syndromes, for example?

47:38 [SPEAKER_00]: I'll give you one last example, something else that came up for me recently with a patient and this also reflects this evolution over time as I had a guy in his 70s and he had a history of atrial fibrillation, super common condition when I went through school and training, this was like, yep, atrial fibrillation, it happens.

47:56 [SPEAKER_00]: We'll put you on a blood dinner, we'll control your heart rate and that kind of is what it is. [SPEAKER_00]: And then he also had some chronic back pain and he ended up undergoing some imaging and it showed some evidence of spinal stenosis and in my mind that was an immediate trigger of, oh well [SPEAKER_00]: we now have now increasingly recognized over the past decade or so that there's this other condition called amoloidosis that can lead to both atrial fibrillation and spinal stenosis.

48:21 [SPEAKER_00]: It can also lead to things like carpal tunnel syndrome. [SPEAKER_00]: It can lead to tendon ruptures. [SPEAKER_00]: It can lead to neuropathy. [SPEAKER_00]: It can lead to a lot of a lot of other manifestations. [SPEAKER_00]: And if you catch and diagnose that treatment early enough, we now actually have targeted treatments for this particular type of amolidosis that can delay the progression.

48:37 [SPEAKER_00]: and prevent you from developing advanced heart failure and needing pacemakers and all sorts of things in the long run. [SPEAKER_00]: So, whereas this guide, a decade ago, would have been like, yes, you have a fib, take these meds, you have spinal stenosis, go see the spine surgeon. [SPEAKER_00]: Now, I am guiding this evaluation for systemic amolidosis, which hopefully rules it out completely, but if I catch it, will definitely alter the trajectory of this patient's life.

48:57 [SPEAKER_00]: And so, that's why, for me, keeping up with this stuff as it evolves, is actually super useful because it does actually, [SPEAKER_00]: and impacting practice at some point, even if the immediate clinical relevance like the same year that they won the Nobel Prize, like I'm not gonna be doing this gene testing, but if we find some implications or some treatment or some novel genetic syndromes that I can look for when a patient checks certain boxes, yeah, that changes how I do things and that changes patient's lives.

49:21 [SPEAKER_03]: It's very root cause of you. [SPEAKER_03]: There you go, yeah. [SPEAKER_03]: All right, move it on to SamagluTide. [SPEAKER_03]: Once again, talking about some aglutide GLP1 agnists. [SPEAKER_03]: So everybody knows that obesity is a major public health concern, although I believe the last three years were the first three consecutive years on record that we have that obesity rates have actually declined, which winning.

49:44 [SPEAKER_03]: Winning. [SPEAKER_03]: So GLP1 receptor agnists like some aglutide, so ozantic would govy. [SPEAKER_03]: These have emerged as effective pharmacological treatments for weight management demonstrating significant weight loss [SPEAKER_03]: 15%. [SPEAKER_03]: However, there has been limited data on these medications, particularly at the highest doses on their impact on body composition, specifically muscle mass, muscle function, and the risk of developing sarcopenia.

50:09 [SPEAKER_03]: In fact, it's been a lot of kind of not only public discourse among laypeople like, oh, you're going to lose all your muscle mass, but even some professional discourse where very intelligent people whom I respect are like the risk of sarcopenia from these drugs [SPEAKER_03]: So this was an interesting study.

50:25 [SPEAKER_03]: It's called the semoline study, great name. [SPEAKER_03]: This was a perspective, longitude, null trial, conducted in France to investigate the effects of once, weekly, some aglytide, on body composition, lean mass, and muscle function over a year, in adults with obesity and at least one related medical condition.

50:43 [SPEAKER_03]: So there's a hundred six patients here, 68% were women. [SPEAKER_03]: The mean BMI was 46.3. [SPEAKER_03]: So [SPEAKER_03]: pretty significant. [SPEAKER_03]: They all received some aglytide with a progressive dose escalation up to the max dose key measurements were taken at 7 months and 12 months, including in baseline.

51:01 [SPEAKER_03]: So they got dex skin to look at like lean mass loss versus fat mass loss. [SPEAKER_03]: to assess body composition. [SPEAKER_03]: They also did hand grip strength from muscle function and some other tests. [SPEAKER_03]: Notably, 49%. [SPEAKER_03]: So nearly half of the patient population exhibited sarcopenia at baseline, which they assessed with the appendicular, appendicular, skeletal muscle mass test and hand grip strength.

51:24 [SPEAKER_03]: So those are the two measures, which is a reasonable definition for sarcopenia, although the European working group would be like, mmm, we could do better. [SPEAKER_03]: Need more functional assessment? [SPEAKER_03]: Yeah. [SPEAKER_03]: Indeed. [SPEAKER_03]: First, as expected, significant weight loss was observed, averaging about 10% at seven months, and 12.7% at month 12, which pretty good, that's kind of what we expect from some aglytide generally speaking, 60% of the subjects achieved at least 10% of weight loss, and 26% of the patients achieved 15% weight loss or more.

51:59 [SPEAKER_03]: Lean mass decreased significantly in absolute terms during the first seven months of treatment, the average amount of lean mass loss was three kilograms, which then stabilized and further and didn't decrease after that. [SPEAKER_03]: To be clear, this is not just straight up skeletal muscle tissue.

52:14 [SPEAKER_03]: This is everything that's not fat mass, so this can be water, glycogen, certainly muscle tissue, but also other thing, anything that's not fat. [SPEAKER_03]: Based on the values provided in the article, they didn't actually report this, but I did some calculations here. [SPEAKER_03]: The calculated proportion of fat mass loss to lean mass loss at one year.

52:35 [SPEAKER_03]: It was approximately 80% was fat mass and 20% was lean mass. [SPEAKER_03]: Hand grip strength also improved at seven months and continue to improve at the 12 month mark, despite not exercising. [SPEAKER_03]: So, first question to you, like, is there some sort of preservation effect of GLP1 receptor agnes on lean muscle mass, because the predicted sort of a proportion of fat to lean mass loss with, like, diet only interventions is 75-25.

53:08 [SPEAKER_03]: Now, this isn't that different, but it's, it's not zero either. [SPEAKER_03]: Yeah. [SPEAKER_03]: So, like, [SPEAKER_03]: Should we all be taking GLP one agonist to start preserving muscle mass or what? [SPEAKER_00]: Yeah, I have historically found the kind of hysteria around muscle loss with these agents to be really irritating and also short-sighted in a lot of different ways.

53:30 [SPEAKER_00]: So many of the health complications that are among the leading killers worldwide, namely cardiovascular disease, cancer, things like that are more often related to the consequences of excess body fat and things like that than they are directly attributable to having insufficient muscle mass and muscle function.

53:51 [SPEAKER_00]: But even if we were to focus the lens a bit more on Sarkopenia as a problem in itself, which, hey, both of us also, we have, you know, we are quite concerned with that as well for a variety of reasons, recognizing that the assessment and measurement of it is complex. [SPEAKER_00]: It is both muscle mass and more importantly, muscle function actually has been shown to be the more important variable here.

54:17 [SPEAKER_00]: And additionally, we know that measuring muscle mass is complex, depending on the tool, the instrument that you use to measure it. [SPEAKER_00]: But also, when people have excess body fat at a positive, there are, there's also fat deposition within and around muscle fibers and all sorts of things like that, right?

54:35 [SPEAKER_00]: And so that can lead to certain measurement artifacts. [SPEAKER_00]: And so you can have a [SPEAKER_00]: the overall maybe cross-sectional area of a muscle might be declining, but the muscle quality is improving. [SPEAKER_00]: And muscle quality, which is the stronger variable related to muscle function, is what I care more about than what is the absolute just mass, or if I take a CT cross-sectional image and I just outline it and I measure the area.

55:07 [SPEAKER_00]: So muscle quality and muscle function are the things that I'm more concerned with. [SPEAKER_00]: And so to the extent that I see that improving, I'm content. [SPEAKER_00]: Now, we also know that it doesn't have to be one of the other with the use of medicines or the use of exercise. [SPEAKER_00]: We see the best results, including people gaining and building muscle mass muscle strength muscle function while losing substantial amounts of weight on these medicines.

55:29 [SPEAKER_00]: If we can just get them to lift a little bit of weights here and there, which doesn't even have to be a full on, you know, six day a week, [SPEAKER_00]: You know, two, three times a week with sets that are a couple sets that are just hard enough, you know, a beginner will respond to that.

55:42 [SPEAKER_00]: And so that's kind of my perspective on this is my interest in the overall muscle mass question. [SPEAKER_00]: It has declined over time. [SPEAKER_00]: I would say and my interest and focus on muscle quality and muscle function has continued to increase and that is more so my emphasis when I when I look at these types of results or when I'm working with patients.

56:02 [SPEAKER_00]: What can what can we do? [SPEAKER_03]: Yeah, I think there's just a misunderstanding of the disproportionate risk at both ends of, you know, body composition. [SPEAKER_03]: So what I mean by that is at the higher end where you're thinking that somebody has a lot of excess body fat, that opposed to you.

56:20 [SPEAKER_03]: Effectively, that becomes a much higher risk than the potential benefit of a lot of muscle mass. [SPEAKER_03]: Individuals with obesity tend to carry more lean body mass than lean counterparts, just generally speaking, but they're not really absolved of the risk from excess body fat just because they're carrying extra muscle.

56:39 [SPEAKER_03]: So, there's a kind of a misunderstanding on that side, and then with respect to GLP1 agitives, anti-BC medications at large, there's also a misunderstanding of the risk of developing sarcopenia because the thought is like, we lose any muscle mass that sarcopenia will know that that's not what sarcopenia is because it specifically requires a decrease in muscle function.

57:00 [SPEAKER_03]: that is large enough to cause functional decline and a lot of other problems. [SPEAKER_03]: And so at the lower end, which is way on the other side of the poll, the other side of this continuum, we're really talking about there's been such significant muscle loss that the person is now they can't function.

57:19 [SPEAKER_03]: which is not what we see, not happening. [SPEAKER_03]: It's not what we see, like if there's a concern, there was a concern with people with sarcopenic obesity. [SPEAKER_03]: So they had already poor muscle function and they had obesity and it's like, we'll should these people be on GOP one.

57:32 [SPEAKER_03]: Agnes and like, that's still a clinical question that's out there, right? [SPEAKER_03]: Because you're worried you're like, well, they already have poor muscle. [SPEAKER_03]: function. [SPEAKER_03]: And so the thought is if they lost additional muscle mass that would reduce function further, but to my mind, that's mostly like a muscle training muscle quality, while kind of kind of thing, rather than like absolute amounts of muscle mass, like they got muscle mass already, it just doesn't function very well.

57:53 [SPEAKER_03]: And so that's like an activity thing. [SPEAKER_03]: So anyway, [SPEAKER_03]: In this particular study, they actually did assess muscle function. [SPEAKER_03]: Now it was hand grip strength and we talked about hand grip strength for a while, but despite not exercising, the least they were not told to exercise.

58:07 [SPEAKER_03]: But most of these folks have tried to lose weight a number of times before, and some of them had been in previous trials. [SPEAKER_03]: The average BMI is 46.3, the idea that these folks were not had not been encouraged to exercise for their entire life seems unlikely, so unclear how many actually were exercising they did not assess that.

58:24 [SPEAKER_03]: But there was an average increase of 4.1 kilograms at 12 months in hand grip strength performance. [SPEAKER_03]: Now, this does exceed the minimal detectable change, which is 2.9 kilos, so it does appear to be real and not just like a statistical aberration. [SPEAKER_03]: But it does not exceed the minimal clinically important difference for hand grip strength, which is estimated to be between five to six and a half kilos.

58:49 [SPEAKER_03]: So I don't have a good explanation for this. [SPEAKER_03]: I guess is what I'm saying. [SPEAKER_03]: I don't know that, and I, in fact, I don't think that excess body fat necessarily itself has a deleterious effect on muscle function. [SPEAKER_03]: Where that, where by losing body fat, now like unlocks your muscles ability to actually produce more force.

59:09 [SPEAKER_03]: If I had to rationalize this, I'd say we'll look if they hadn't done a hand grip strength test before. [SPEAKER_03]: Right, familiarization with the test could have led to some of this, and that's why it didn't exceed the minimal clinically important differences basically like, oh, you figured out how to do a hand grip strength test better.

59:24 [SPEAKER_03]: And so that that that's part of the increase, but it is reassuring that at least these people didn't their hand grip strength didn't go down. [SPEAKER_03]: 100% yes. [SPEAKER_03]: Oh, cool. [SPEAKER_03]: And so with the definition they use for sarcopenia, which is reduced grip strength coupled with [SPEAKER_03]: the sarcopenia rate, which started at 49%, was 33%, at 12 months.

59:48 [SPEAKER_03]: And so yeah, we can have in awe about how they define sarcopenia and the validity of a hand grip strength to monitor muscle function over this time period. [SPEAKER_03]: But like... [SPEAKER_03]: I think it's time for some people to eat a little bit of crow. [SPEAKER_03]: I hope so. [SPEAKER_03]: I don't know that they will, but I don't think they will.

1:00:04 [SPEAKER_03]: Yeah, we'll see, we'll see, all right. [SPEAKER_03]: We've got two more topics here. [SPEAKER_03]: We'll wrap this up first off. [SPEAKER_03]: And I know these are your favorite topics. [SPEAKER_03]: We're talking politics, baby. [SPEAKER_03]: So look, effective and October of 2025 this year, the cyberspace administration of China will require influencers who create content about sensitive topics, specifically medicine, law, education, or finance, to certify that they have formal training and expertise in those fields.

1:00:30 [SPEAKER_03]: They basically have two months to submit degrees, certifications, or verify credentials to demonstrate their expertise. [SPEAKER_03]: And all content on these topics must clearly cite the sources used and specify whether it includes Germanizations or AI-generated elements. [SPEAKER_03]: And it's actually the government, apparently, of China, is putting a major on social networks like TikTok, some of the other ones that are used in that country to verify the influencers' credentials and remind their users of their own legal and scientific responsibilities regarding information dissemination.

1:01:05 [SPEAKER_03]: So, they also are banning the advertising of medical services or products, including medications, supplements, or health foods, and they're ordering the removal of counts of accounts using educational formats to promote products or impersonating professional identities. [SPEAKER_03]: And so they're basically saying, look, if you're a social network, you've got to train your algorithm to block the stuff.

1:01:26 [SPEAKER_03]: And it also, if it includes sexualized content, disguised as educational. [SPEAKER_03]: Thoughts like do you think this actually protects the public from misinformation or is it setting a concerning precedent for government control over online discourse like freedom of speech like what do you think obviously it's different countries they don't have the same Yeah, I mean I am I don't love it.

1:01:49 [SPEAKER_00]: I think that there's some good, but mostly bad here to be honest, you know, China's level of control over everything in their society is I think [SPEAKER_00]: pretty counter to a lot of the ways that we think and live in the states and the things that we value, not just in the states, but I guess in the West more broadly speaking, although there's some variations say between the US or Australia, you know, EU, things like that.

1:02:12 [SPEAKER_00]: But with that said, you know, banning advertising of medications, for example, like where I think on on the in the [SPEAKER_00]: preferring to see pharmaceutical advertising direct to consumer which that would go away. [SPEAKER_00]: But other things about this, requiring that these platforms verify communicators, degrees or certifications to be able to post things on the platform.

1:02:39 [SPEAKER_00]: I think that that is. [SPEAKER_00]: a quite onerous b also potentially problematic for a lot of ways in terms of what credentials count which ones don't go to sides from what institutions is that itself going to have some, you know, unintended second order effects of like p [SPEAKER_00]: You know, obviously there's probably some level of control over that too, but like who can open an institution that then becomes accredited or can what credentials are allowed to accept any sort of international, you know, credential like it's just it gets such like a complex web and I don't think that that is something that I would be in favor of requiring I think I tend to lean more on the side of.

1:03:19 [SPEAKER_00]: people being able to speak, you and I interact regularly with people on the internet who are fools and make all sorts of, you know, inaccurate, not educated, even in some many cases potentially harmful comments and things like that. [SPEAKER_00]: I still don't know that I am likely to fall down on the side of well.

1:03:37 [SPEAKER_00]: just because I had the fortune and the resources and everything to go through this schooling only I can speak about this thing in any meaningful way because, man, I train junior doctors, I train medical students. [SPEAKER_00]: many of them, would I like for them to go out and start opining about things on the internet?

1:03:57 [SPEAKER_00]: It's like, no, they're also likely to say wrong things, particularly if they've veer outside their scope of expertise. [SPEAKER_00]: And so I think physicians and experts there. [SPEAKER_00]: they are more likely to be correct on a topic than a non-expert that I'm, you know, I'm in agreement with that idea.

1:04:15 [SPEAKER_00]: But are they necessarily correct? [SPEAKER_00]: Is it possible? [SPEAKER_00]: Are they fallible? [SPEAKER_00]: Also very true. [SPEAKER_00]: But their fallibility does not mean that we throw the relevance of expertise out the window and make it. [SPEAKER_00]: So that everyone's opinion is equal because I don't actually think it is in most areas, but it's almost like this.

1:04:32 [SPEAKER_00]: I hesitate to use like some sort of bell curve, you know, metaphor or something like that here, but some sort of like probability distribution of who is more likely to be correct. [SPEAKER_00]: The person with more formalized education and training expertise, but I wouldn't use those as legal arbiters or limits on who can speak about something.

1:04:50 [SPEAKER_00]: At least that's that's my take. [SPEAKER_03]: Yeah, yeah, I mean, I agree with obviously, you know, big, big shocker. [SPEAKER_03]: I agree with what you said. [SPEAKER_03]: I don't like the idea of the government telling me what to do. [SPEAKER_03]: I mean, if this came to fruition in like the United States, for example, on the other hand, I do recognize that there is a huge misinformation problem, and I do think it needs to be addressed in some sort of like equitable, yet effective.

1:05:17 [SPEAKER_03]: and ideally, evidence-based manner, I just don't know how to do it. [SPEAKER_03]: I don't think it's this way, but I can understand why this was like done in that particular society. [SPEAKER_03]: And there's likely cultural differences as far as, like, different to actual experts. [SPEAKER_03]: And so maybe that works in a culture, like China, but I don't think it would work in the United States.

1:05:36 [SPEAKER_03]: In fact, I think it actually has, like, the opposite effect where it's like, [SPEAKER_03]: another social platform would pop up like black market, you know, sort of thing like no, this is where you get the real truth, ironically, I think that is a social platform. [SPEAKER_03]: So, you know, so I don't know, like, [SPEAKER_03]: We argue with less people, maybe, I think.

1:05:57 [SPEAKER_03]: Maybe not maybe, I don't know. [SPEAKER_03]: Maybe, like, yeah, does he really get to talk? [SPEAKER_03]: Cause like, he says dumb stuff all the time. [SPEAKER_03]: Does Rhonda Patrick get to talk? [SPEAKER_03]: She says dumb stuff all the time. [SPEAKER_03]: Like, we go down the list, like, we were just this morning, you know, this misinterpretation of a mouse study that, you know, these people with large platforms are just promoting is like, they have credentials, but are just not smart.

1:06:21 [SPEAKER_00]: Yeah, I think I almost sent you most recently. [SPEAKER_00]: I think Uberman's last episode had something to do with his expert commentary on the lymphatic system and how to improve your lymphatic systems health and I'm like, bro, well, you're like a neuroophthalmology PhD. [SPEAKER_00]: Yeah, look.

1:06:36 [SPEAKER_00]: You know stuff about the optic track and in rodent models, like, respect defer to all your expertise on that. [SPEAKER_00]: I'm not thinking about that. [SPEAKER_03]: Pretty much anything else outside of that, like I would probably just, uh, stay quiet. [SPEAKER_03]: All right, last topic, we're talking about protein powder and lead, obviously there's been recent headlines with the consumer reports article that's gone viral, uh, that found that a lot of protein powders have significant amounts of lead in each survey.

1:07:04 [SPEAKER_03]: Now, it should be noted, lead is this naturally occurring element that's present in our environments in the soil, it's in the water, it's in the air. [SPEAKER_03]: So virtually all food products from vegetables, [SPEAKER_03]: you know, stuff of the earth. [SPEAKER_03]: They contain trace amounts of lead.

1:07:20 [SPEAKER_03]: It's an unavoidable part of our food supply, not necessarily an indication of contamination or unsafe practices. [SPEAKER_03]: And so I just want to clarify that there's got to be some incidental lead in pretty much all-foot, right, and depending on the soil that the stuff's grown in, right, like vegetables that we consume, or should be consuming on a daily basis, we'll actually have a significant amount of lead per survey.

1:07:41 [SPEAKER_03]: But there's also the risk of contamination. [SPEAKER_03]: And so I think differentiating between those two things, that's a fair [SPEAKER_03]: That is a fair sort of thing to do. [SPEAKER_03]: Incidentally, you really can't get away from, but contamination and high levels of lead. [SPEAKER_03]: That is a problem.

1:07:55 [SPEAKER_03]: So there are multiple sort of cut-offs here. [SPEAKER_03]: And that's where I think the real problem with this article came out came from. [SPEAKER_03]: So the FDA right now recommends that if you're an infant or child, 2.2 micrograms per day of lead, that's max. [SPEAKER_03]: If you're a woman who's pregnant, [SPEAKER_03]: 8.8 micrograms per day, and if you're an adult, otherwise 12 micrograms per day.

1:08:17 [SPEAKER_03]: That's daily sort of threshold. [SPEAKER_03]: Those are based on clinical outcomes. [SPEAKER_03]: It's far below the threshold still of where lead toxicity actually occurs, but you can get this high and you're probably going to be fine. [SPEAKER_03]: It doesn't mean you go to 12.1. [SPEAKER_03]: It's like, oh no, I have a metal toxicity, collate me, kill me, kill me, kill me, and you know, not that.

1:08:34 [SPEAKER_03]: The EU has a different sort of threshold, and this is mainly for legal enforcement of, you know, stuff on the market. [SPEAKER_03]: They say you have to have less than 3,000 parts per billion of lead in something that you're putting on the market. [SPEAKER_03]: So that's their enforceable exposure.

1:08:51 [SPEAKER_03]: But the article didn't use either of those. [SPEAKER_03]: Those two targets have been around for a while. [SPEAKER_03]: They used what was in Proposition 65. [SPEAKER_03]: This was in some legislation this past in California in 1986. [SPEAKER_03]: I believe that said, look, if you're, you've got a food, you've got to supplement whatever.

1:09:06 [SPEAKER_03]: It's on the market. [SPEAKER_03]: It's got more than 0.5 micrograms per serving. [SPEAKER_03]: You've got to warn people about it. [SPEAKER_03]: Now this is 1,000 times lower than levels shown to cause no reproductive harm. [SPEAKER_03]: So this is not a clinically derived like health risk limit like the FDA or the U, but this is more like right to know labeling.

1:09:25 [SPEAKER_00]: It reminds me of when I think I first bought some iron plates from my first garage gym, and they came with stickers on it, the standard California stickers that said this, [SPEAKER_00]: may contain substances known to cause cancer by the state of California. [SPEAKER_00]: It's like that type of legislation leading to that public messaging.

1:09:45 [SPEAKER_00]: And so, yeah, just way, way more conservative, I guess, kind of cut-offs here. [SPEAKER_00]: The way lower than they would need to be to ascertain actual risk of harm in humans. [SPEAKER_03]: Yeah, to me, like the FDA limits and the use exposure limit, like those two things are they're still very low to be clear, but I also think they're reasonable because if you raise them high or now you're getting closer to the threshold where we're clinical badness can can occur, prop 65 to me, I'm like, if this label is everywhere.

1:10:20 [SPEAKER_03]: Then how useful is it, right? [SPEAKER_03]: People just, yeah, they just de-sensitized to like, well, okay, yeah, everything could potentially cause case or I guess, whatever. [SPEAKER_03]: So as far as how does this apply to supplements, well, look, some supplements are contaminated. [SPEAKER_03]: And the, I think the article does a reasonable job at highlighting some of the unregulated supplements from very popular manufacturers that do actually have a decent amount of lead in every serving or other heavy metals.

1:10:46 [SPEAKER_03]: And so I think it's reasonable to avoid those. [SPEAKER_03]: Like, look, if you were supplement, right, is not third party tested already. [SPEAKER_03]: I have concerns about contamination, and with respect to lead specifically plant-based proteins, because that's where you're getting the protein from, that accumulates more lead.

1:11:05 [SPEAKER_03]: So more incidental lead already, and then if it's not third party tested, right, for this stuff batch tested by the way, not just like once a year, I suspect that risk gets even higher, and so you have somebody who's maybe taking [SPEAKER_03]: a very popular, but I'm not going to name them, plant-based protein that's got almost seven micrograms of lead per serving.

1:11:23 [SPEAKER_03]: They take two scoops a day. [SPEAKER_03]: Well, now you're at 14. [SPEAKER_03]: Yeah. [SPEAKER_03]: I don't like that. [SPEAKER_03]: Yep. [SPEAKER_03]: And just by comparison, WRXR protein has 0.823 micrograms of lead per serving. [SPEAKER_03]: It's less than spinach. [SPEAKER_03]: All right.

1:11:36 [SPEAKER_03]: I'm not saying our way protein is a better vegetable source than spinach, but as far as way proteins go, we definitely have one of the lowest. [SPEAKER_03]: lead cut. [SPEAKER_03]: It's just the incidental stuff you can't get away from it and we're at 31 parts per billion. [SPEAKER_03]: So we're way under both of these targets.

1:11:51 [SPEAKER_03]: So look, with their party tested, every batch is third party tested. [SPEAKER_03]: If you need a protein supplement, you're good with way, I would recommend our way protein. [SPEAKER_03]: There are other way proteins and other non way protein supplements that also fit this, but just make sure that they're manufactured in a GMP accredited facility, the third party tested batch tested, not again, not just once a year.

1:12:11 [SPEAKER_03]: And you can ask these [SPEAKER_03]: They're laboratory analysis. [SPEAKER_03]: We were recently asked for ours, and we provided it It's people generally manufacturers are happy to do so especially if they have good results But if they're not testing their stuff, don't buy their stuff Like it's not worth saving a few bucks people are like, oh look I can go to some big box, you know commercial store and I can get a You know a hundred pounds They send me a vat of protein and it's this expensive.

1:12:38 [SPEAKER_03]: It's so cheap look. [SPEAKER_03]: I'm saving all this money. [SPEAKER_03]: I'm like [SPEAKER_03]: Yeah, but it's probably not worth it. [SPEAKER_03]: Again, it's not that big of savings for this potential risk from not only just led, but cadmium arsenic, etc. [SPEAKER_03]: Like it's just not worth it to me.

1:12:51 [SPEAKER_03]: I don't know. [SPEAKER_03]: Does that make sense to you? [SPEAKER_00]: Yeah, I agree. [SPEAKER_00]: I think that we're fortunate to live in a time when toxicity from these things is not terribly common. [SPEAKER_00]: But if you are buying these supplements with potentially more concentrated sources of them, and if you are using them a lot as a part of your diet, [SPEAKER_00]: Yeah, you're going to be at a higher risk compared to somebody who's using a either a different product or not using them.

1:13:11 [SPEAKER_00]: So do with that. [SPEAKER_00]: What you will there go to we play system of a down talks is to you to take us out. [SPEAKER_03]: Oh, great choice. [SPEAKER_03]: Yeah. [SPEAKER_03]: All right. [SPEAKER_03]: Well, that is a wrap here on the fifth episode of the rundown here on the Barbell Medicine podcast where we bring modern medicine to strength conditioning and strength conditioning to modern medicine.

1:13:26 [SPEAKER_03]: Again, I'm your host, Dr. Jordan Faganbaum. [SPEAKER_03]: special shout out to Dr. Austin Baroque for joining me on the podcast. [SPEAKER_03]: Before you guys go anywhere, please leave us a five-star rating and a review. [SPEAKER_03]: It really helps drive traffic to our podcast so we can keep bringing you all the latest nuance and health and fitness from everyone here at Barville Medicine.

1:13:40 [SPEAKER_03]: We'll catch you next week and every week right here on the Barville Medicine podcast.