Ozempic & Alcohol, The Trap Bar Myth, and A Medical Mystery | Barbell Medicine AMA Teaser

0:00 [SPEAKER_01]: Welcome back to the Barbell Medicine podcast. [SPEAKER_01]: I'm Dr. Jordan Faganbaum. [SPEAKER_01]: Today, we're going to give you a look inside our direct line series. [SPEAKER_01]: This is a monthly subscriber only AMA, where Dr. Austin Barakini answered the most uncomfortable complex and sometimes strange questions that we get from our community.

0:15 [SPEAKER_01]: We're going to cover a lot of ground today from a medical mystery involving a fit marine and a life-threatening run to the ethics of prescribed ozempic to people who might be drinking too much alcohol. [SPEAKER_01]: And why your favorite gym debate about the trap bar versus the regular barbell deadlift is mostly a waste of breath.

0:29 [SPEAKER_01]: If you enjoy this deep dive and you want to join the queue for our next AMA, head over to the link in the description to subscribe to our plus fee. [SPEAKER_01]: All right, let's dig in. [SPEAKER_01]: This is going to be interesting, you I can feel it. [SPEAKER_01]: the question is, is it normal for my legs to get itchy when starting or run?

0:53 [SPEAKER_01]: What do you think about that? [SPEAKER_00]: If we frame this as a mystery case, I would start to have a lot of follow-up questions, but I do think that there's this phenomenon known as, quote, unquote, runners-edge that is probably what this person's getting at. [SPEAKER_00]: Again, there's some other possibilities that we can we can get to in a little bit.

1:06 [SPEAKER_00]: But [SPEAKER_00]: The thought has to do with changes in basically blood flow. [SPEAKER_00]: So the way a capillaries deliver blood throughout our bodies when we start exercising, our peripheral vasculature tends to be so dilate to deliver oxygenated blood to our tissues. [SPEAKER_00]: And there's a bunch of different changes that happen in the cardiovascular system.

1:24 [SPEAKER_00]: And so the thinking is that these changes in what we call hemodynamics, the changes in the vascular system are heart rate, our blood flow, or blood pressure, [SPEAKER_00]: Um, especially when somebody is not habitually adapted to this, uh, might lead to kind of mechanical stimulation in the local tissues like in the skin and things like that, that can be experienced as a sensation of itch.

1:46 [SPEAKER_00]: There are some other mechanisms of itch and so just broadly speaking again, if this were a mystery case, I would actually start by thinking about. [SPEAKER_00]: the different types of mechanisms of itch. [SPEAKER_00]: There's neurologically mediated itch. [SPEAKER_00]: There's itch that's mediated by histamine release.

1:59 [SPEAKER_00]: There can be itch mediated by other things. [SPEAKER_00]: For example, I see patients get itch when they have a lot of Billy Rubin and they're like, John, this, then turn it yellow when they have elevated your blood, your real levels, things like that. [SPEAKER_00]: So there's a lengthy list of substances and mechanisms by which people can itch.

2:13 [SPEAKER_00]: So I've talked about cardiovascular, neurological histamine is another one that you might think of as being kind of associated with allergies. [SPEAKER_00]: blow regulation, vascular regulation. [SPEAKER_00]: That's why, for example, when people are having an allergic reaction, you might see them develop what are called like wheels on the skin, or what we know call Urdicaria as the medical term, this kind of like raised light red to pink area.

2:35 [SPEAKER_00]: A lot of that's his tends to be histamine related as blood flow increases to an area, and then it kind of leaks out into the tissues leading to a little bit of swelling. [SPEAKER_00]: And it makes the nerve endings in the area a bit more sensitive. [SPEAKER_00]: And again, the sensitivity of nerve endings can play into the experience of something like itch.

2:51 [SPEAKER_00]: Um, again, I mentioned neurologic, there's this phenomenon called colonergic erdicaria and there's also other forms as well if you just look up exercise induced erdicaria that that people can experience or when they sweat. [SPEAKER_00]: That can also trigger some of these kind of itching responses again to also impacted by environmental conditions.

3:08 [SPEAKER_00]: I experienced this briefly during a time in my swimming career, and I suspect it was multi-factorial. [SPEAKER_00]: Some combination of like sweat and like chlorine exposure and maybe something else about the environment that I was in at the time. [SPEAKER_00]: It wasn't something that I experienced indefinitely or always or reliably, but I distinctly remember a period of time where I would get kind of red and splotchy on my skin and itchy.

3:26 [SPEAKER_00]: And that might have been something due to some exposure in that context. [SPEAKER_00]: So I've experienced it, but what about you? [SPEAKER_01]: Yeah, I have not, at least on to my conscious knowledge. [SPEAKER_01]: Sure, perhaps I just attributed to something else, but you mentioned a perfectly couple handful of mechanisms likely involved in this run or zitch, the vasodilation, right?

3:47 [SPEAKER_01]: Some histamine release that is normal with, particularly exercise, can sensitize skin nerve endings, and so people can feel an itch and that obviously varies between individuals. [SPEAKER_01]: Typically goes away in a few weeks, and then that colonurgic, [SPEAKER_01]: Pretty interesting.

4:03 [SPEAKER_01]: All of those are relatively benign, however. [SPEAKER_01]: Things can get weird when it comes to itching during exercise. [SPEAKER_01]: So, Dr. Barack, imagine this, 24-year-old fit Marine. [SPEAKER_01]: You went for a run, he got itchy, and then he got hives, and his blood pressure dropped to 60 over barely palpable.

4:25 [SPEAKER_01]: He didn't know that. [SPEAKER_01]: He didn't have a blood pressure cuff on him, but he did become lightheaded. [SPEAKER_01]: Thought he was going to pass out. [SPEAKER_01]: So he sat down to rest for several minutes, and what he attempted to stand, he became even more lightheaded. [SPEAKER_01]: So we called 911 and went to the emergency room.

4:39 [SPEAKER_01]: Now, he was subsequently diagnosed with exercise induced anophilaxis, which is a rare life-threatening syndrome where the immune system reacts to physical exertion, often combined with food triggers like wheat, shellfish, etc. [SPEAKER_01]: but not in this specific case. [SPEAKER_01]: Now the lesson here is that there's a difference between this case and normal like itchy legs or runners itch.

5:02 [SPEAKER_01]: It's the progression and the symptoms. [SPEAKER_01]: He didn't just itch he developed hives and hemodynamic instability, dizziness, low blood pressure. [SPEAKER_01]: So this case highlights the critical difference between itchy skin or runners itch and exercise induced antiflaxis. [SPEAKER_01]: pretty interesting case.

5:19 [SPEAKER_01]: Now we can't use that for upcoming mystery case now. [SPEAKER_01]: So I gave you an answer. [SPEAKER_00]: Yeah, I've actually heard of one of a mystery case that I listened to somebody else discussed. [SPEAKER_00]: I have heard of this once before. [SPEAKER_00]: It was in the context of some wheat exposure and then subsequent exercise.

5:31 [SPEAKER_00]: And yeah, this is a classic story for animal access. [SPEAKER_00]: The skin, itching, you know, potentially a rash. [SPEAKER_00]: And then you combine it with some other form other systems that get involved either respiratory people start wheezing, their gastrointestinal system, nausea, vomiting of abdominal pain, or cardiovascular complications like low low blood pressure.

5:47 [SPEAKER_00]: Some combination of those are kind of part of the diagnostic criteria for animal access this person gets an epinephrine and then you probably have to get assessed by an allergist immunologist to figure out like because I don't actually know aside from avoidance with the if there's any sort of treatment for this that can mitigate it if they use some kind of.

6:01 [SPEAKER_00]: You know, they mast cell stabilizer or something like that. [SPEAKER_00]: Because it would be nice so that you don't have to like, you know, worry about if I exert myself, am I going to animal acts and die and have to epitend myself? [SPEAKER_00]: When epitend movies, like in in crank that old that old movie or something like that, but yeah, interesting and unfortunate condition to have.

6:18 [SPEAKER_01]: Yeah, so to summarize, normal runners itch, you just get itching on the legs and thighs, no visible rash, uh, you feel fine or just annoyed because you're itchy. [SPEAKER_01]: Yeah, capillary wake up call. [SPEAKER_01]: It should resolve in a couple of weeks with consistent training, keep training.

6:32 [SPEAKER_01]: It'll typically resolve. [SPEAKER_01]: That's different than colinergic or decarious. [SPEAKER_01]: You've got the itching and the pinpoint hides or wheels, little red halo kind of thing. [SPEAKER_01]: Usually heat, sweat related. [SPEAKER_01]: So usually in folks cool down, potentially it can be mitigated with some anti-histamines, although it would want to refer to some clinical expertise for that, because just generally taking like a better drill before you go exercise.

6:56 [SPEAKER_01]: probably not not the move, and then that's all different than exercise induced anaphylaxis, which is the case report we talked about, which is itching in large highs, plus dizziness, weezing, nausea, you know, other sort of human dynamic instability type symptoms would recommend stopping immediately activate emergency medical services you need to be seen by some a professional.

7:24 [SPEAKER_01]: Alcohol use and GLP1 receptor agonists. [SPEAKER_01]: So the question is, how do you view heavy alcohol use alongside GLP1 medications? [SPEAKER_01]: Is this cognitive dissonance whereas someone could be on this medication for treating obesity, for example? [SPEAKER_01]: while still continuing to drink alcohol.

7:44 [SPEAKER_01]: To me, treating the obesity with GLP-1 receptor agonists immediately can improve things like metabolic health, liver function, cardiovascular risk profile, and a patient with treated obesity and excessive alcohol intake is objectively better than a patient with excessive alcohol intake plus untreated obesity.

8:04 [SPEAKER_01]: So I think, you know, [SPEAKER_01]: These are these things don't have to be like linked together. [SPEAKER_01]: It's like a a little false dichotomy there And also I should point out like the original question Suggested maybe like a substance use disorder thing whereas excessive alcohol intake is not necessarily substance use disorder There's specific DSM5 criteria for substance use disorder.

8:26 [SPEAKER_01]: It does get gray there, but [SPEAKER_01]: I just wanted to clarify, it doesn't automatically mean pathology, even though it might not be health promoting, it might not be an actual pathology. [SPEAKER_01]: So it don't need to medicalize that. [SPEAKER_01]: But overall, I kind of think the aggregate health risk is lower, even if the alcohol variable remains constant.

8:44 [SPEAKER_01]: Although the evidence suggests, and I suspect you'll get into it, it often improves. [SPEAKER_01]: GLP1 receptor agonist often seems to improve excessive alcohol intake and maybe even some indication for substance use disorder. [SPEAKER_01]: But to tie it all together, you know, we don't tell a speeding driver to take off their seatbelt because they don't deserve safety until they stop speeding.

9:04 [SPEAKER_01]: We use the seatbelt to keep them alive while we address the speed or the other driving habits. [SPEAKER_01]: The last part of this before I get into Dr. Barack use take. [SPEAKER_01]: Just like this perfect patient idea, you know, like the patient has to be perfect in order for us to treat them.

9:20 [SPEAKER_01]: So like we don't withhold statins from people who eat fast food. [SPEAKER_01]: We don't withhold metabolic treatment for those who drink in this particular case. [SPEAKER_01]: This reminds me of the diary of a CEO kind of review podcast. [SPEAKER_01]: We just did with Dr. Lauren Clensos sample.

9:35 [SPEAKER_01]: where they're like, we're going to take people off GOP ones if they're not exercising. [SPEAKER_01]: And it's like, well, look, we want people to exercise. [SPEAKER_01]: We know that exercise, even if you're not on these medications, very health promoting, even independent of any change to your weight.

9:48 [SPEAKER_01]: But if somebody doesn't, the idea that they're going to be less healthy without these medications, [SPEAKER_01]: and they're not exercising still, that's unlikely. [SPEAKER_01]: So Austin, you want to talk about some of these additional effects like health benefits that people get from GOP ones and also just how you think about this overall.

10:09 [SPEAKER_00]: Yeah, I kind of wish, you know, the initial take from the question had me kind of curious as to what exactly the question asked for here meant I wish they would have elaborated a little bit more on their on their thought process, but I think I can follow follow your lead here, but yeah, so jail people on agonists and the multi agonists that we have nowadays that are hitting more and more receptors.

10:29 [SPEAKER_00]: They aren't drugs that just work via that single hormone like in the stomach, for example. [SPEAKER_00]: Like, you know, early on, a lot of people and some people still hold these thoughts of, oh, it just slows down your stomach. [SPEAKER_00]: It makes you feel really sick, and that's why you lose weight.

10:42 [SPEAKER_00]: That is definitively not the case for these medications at this point. [SPEAKER_00]: There can be a bit of an early effect with some GI side effects, those tend to improve with time, and those are not reliably predictive of people's weight and health related outcomes. [SPEAKER_00]: So, [SPEAKER_00]: it is not nearly that that simple.

10:57 [SPEAKER_00]: And additionally, by working what we call centrally or in the brain, we also observe these impacts on appetite, reward pathways that it seems to be extending with early evidence into people's use of alcohol. [SPEAKER_00]: Now I have a pretty large, I would say, base of experience working with patients on these medicines.

11:13 [SPEAKER_00]: Over the years and have observed this in my own practice with them as well as with some emerging evidence that alcohol use in other substance use disorders actually tend to improve people tend to spontaneously consume less in the same way that they spent tend to spontaneously consume fewer calories and lose weight, which is, you know, the main mechanism of benefit for weight loss and a lot of the cardiovascular metabolic, you know, downstream consequences, similarly they tend to spontaneously end up seeking out and consuming less alcohol.

11:39 [SPEAKER_00]: But getting back to this original question, if the idea is, I have a patient who tends to drink alcohol, maybe above recommended limits, and they're on this medicine, and they continue to do so, this question of is it cognitive dissonance, like should we take the medicine away from them, quote unquote, or decline to prescribe it because they are drinking?

11:59 [SPEAKER_00]: This is a deeply, I would say, problematic, very paternalistic approach to clinical medicine, and [SPEAKER_00]: I think there's some degree of like baked in moralization just around the alcohol itself, but also the medicines. [SPEAKER_00]: And so I've talked about this a bunch before where a lot of these sorts of interventions that we have available in practice, I wish that we could propose them in a completely like de-contextualized, almost like a like a madly-abtype way where it's like here is the intervention that you have available just in terms of outcomes.

12:30 [SPEAKER_00]: It offers this percent benefit on [SPEAKER_00]: delivers this percent benefit on risk of mortality. [SPEAKER_00]: It provides this degree of benefit on liver fat accumulation and cirrhosis. [SPEAKER_00]: And here are the potential risks or the downsides in contrast. [SPEAKER_00]: This like minuscule risk of this, tiny risk of this, tiny risk of this.

12:48 [SPEAKER_00]: How do you feel about this intervention? [SPEAKER_00]: without knowing what it is or anything else about it and most people would look at these data and be like, oh, yeah, that seems like a no-brainer to do something like that. [SPEAKER_00]: And then you can like, you know, open door number one and reveal to them what that intervention is.

13:01 [SPEAKER_00]: And if it turns out to be a GLP one, agonist, everybody starts losing their minds because they're like, you know, it's cheating, it's this and that the other thing. [SPEAKER_00]: If the potential benefits outweigh the potential risks, [SPEAKER_00]: Then I think that that is a valid basis on which to use these tools.

13:17 [SPEAKER_00]: We view them as a moral tools that we have available to us. [SPEAKER_00]: And then even if there are some potential risks, if the patient goes through a fully, you know, full conversation and you can get them as informed as they [SPEAKER_00]: can be, and they say, look, I accept that risk in order to gain those potential benefits that I'm still willing to pursue it.

13:36 [SPEAKER_00]: And so this comes up because I do now a decent amount of like menopausal hormone therapy, for example. [SPEAKER_00]: And so this came up recently where had a woman who was dealing with pretty significant [SPEAKER_00]: Perry menopausal slash postmenopausal symptoms and she for her own personal reasons was declining to get mammographic screening for for breast cancer.

13:58 [SPEAKER_00]: And yet she would was stating a clear preference to have her menopausal symptoms treated. [SPEAKER_00]: Now I think in the past and even in the present, many people would say, you're unwilling to get screened for breast cancer, I'm never ever going to give you any kind of [SPEAKER_00]: But if the person if you walk through this with them and you understand, try to understand whether they're coming from what risks they're willing to accept, maybe they're reasoning for declining that kind of thing, it might be the case that, hey, I'm willing to prescribe it to you because we've had this whole conversation and you understand this potential risk in order to gain this potential benefit and it's not my job to,

14:32 [SPEAKER_00]: You know, withhold this from you. [SPEAKER_00]: Now, if alternatively the intervention is clearly more harmful than it is potentially beneficial, then things get a little bit more tricky. [SPEAKER_00]: But that, clearly today, based on the available evidence is not the case for GOP One Receptor Agnes, whether the person drinks too much, whether they, you know, are not eating the preferred dietary pattern that we might recommend.

14:51 [SPEAKER_00]: Even in some cases, if they're not exercising in the exact ways that we might recommend. [SPEAKER_00]: Now, there is a certain limit where, okay, this person's BMI is like, you know, 20 or something. [SPEAKER_00]: It's cracking, 188, 188, they're getting kick-kick for sale. [SPEAKER_00]: It's like, yeah, the medicine probably should have been stopped a while ago.

15:06 [SPEAKER_00]: Or they should have been advised to stop the medicine a while ago. [SPEAKER_00]: Maybe because now you're starting to reach a point where, okay, we're starting to go up on the other side of that U-shaped mortality curve. [SPEAKER_00]: As your BMI gets too low and I'm like, actually concerned that I'm harming you more than I'm helping you.

15:19 [SPEAKER_00]: And so that's why there's a conversation to be had with people, but I really shy away from this like aggressive paternalistic style of care. [SPEAKER_00]: But rather try to make as many decisions jointly as possible with people and not really moralizing any of this. [SPEAKER_00]: If the intervention has the potential to benefit, here it is, you know, and then we can work through it together.

15:37 [SPEAKER_01]: Yeah, shared decision-making is the key phrase here. [SPEAKER_01]: You know, I think there's another way to look at this question and perhaps the question askers original intent was with the cognitive dissonance from like maybe the patient standpoint [SPEAKER_01]: taking this personal responsibility to seek out treatment for, uh, presumably obesity, but not doing that for what the question ask reviews as excessive alcohol intake.

16:05 [SPEAKER_01]: And you know, is that cognitive dissonance at the level of the patient? [SPEAKER_01]: And it's like, well, [SPEAKER_01]: not really, you know, you don't have to check all of the boxes for health promotion to make a healthy, you know, choice. [SPEAKER_01]: It's like a person who starts exercise, but doesn't necessarily change their dietary pattern or vice versa.

16:21 [SPEAKER_01]: And it's like, look, there's so many ways that we can influence health and performance and fit, we know all these things. [SPEAKER_01]: You don't have to do all of them, you know, to do one of them. [SPEAKER_01]: That's kind of like this perfectionist idea. [SPEAKER_01]: So I don't know.

16:34 [SPEAKER_01]: I agree that from the physician patient, that sort of thing, you summarize that perfectly, just when it comes down to the individual level, behavior changes is challenging. [SPEAKER_01]: And like, you can pick a single target for behavior change or multiple targets, and that's really up to the individual and the sort of bandwidth they have to do that.

16:54 [SPEAKER_01]: Does that square with your understanding? [SPEAKER_00]: Yeah, agree. [SPEAKER_00]: You can have, you can be, you know, in a different stage of behavior change for all sorts of different potential outcomes and maybe with the GLP one use if somebody does, you know, drink above recommended limits that'll start to improve and maybe they get super motivated based on that early progress that they didn't even mean to get and it leads to snowballing effect or maybe they say, you know, it's helping, but I want to get more and then maybe then they start to open up the conversation with pursuing some other form of, [SPEAKER_00]: You know, a clinical care for that use of now trexone, other sorts of medical therapies, psychotherapies, things like that.

17:25 [SPEAKER_00]: But, you know, I think that getting the ball rolling in a positive direction with the meds here is would be my intent in this type of situation and not, you know, withholding it for that kind of a reason. [SPEAKER_01]: Yeah, it's like a backdoor treatment almost to like open up the the conversation or other options for managing it again.

17:42 [SPEAKER_01]: If there is excessive alcohol intake and a person doesn't want to change that, yeah, that's a bridge that you're creating there. [SPEAKER_01]: Yeah, but if you're going to go deeper on this, we did just drop a podcast, a GLP1 update with Dr. Nidolsky and Dr. Baraki. [SPEAKER_01]: It's also on our YouTube channel.

17:57 [SPEAKER_01]: If you prefer to watch rather than listen, and a bunch of references also in the show notes there, I've linked that in the description here. [SPEAKER_01]: All right, on to the next question, we're talking about training now. [SPEAKER_01]: This is basically a religious war. [SPEAKER_01]: All right, am I missing critical gains by using the trap bar to save my lower back does the handle height matter?

18:27 [SPEAKER_01]: So this is about the debate between a trap bar and a straight bar deadlift. [SPEAKER_01]: All right, now to me, people argue about this like, it is a religious war like it's a theological discussion, but physiologically it's like arguing copes per se. [SPEAKER_01]: You know, when you look at biomechanical studies comparing the two lifts, [SPEAKER_01]: There are distinct differences about where the training load goes, where the muscular tension is created.

18:53 [SPEAKER_01]: So for a straight bar deadlift, particularly conventional, that's been the comparator. [SPEAKER_01]: bars in front of the legs, there's tends to be a longer moment arm, the distance between the center of the barbell to the hip and back. [SPEAKER_01]: So you get more hamstring and more erector sort of loading.

19:08 [SPEAKER_01]: The same weight is distributed differently. [SPEAKER_01]: More on the hamstrings and the erectors. [SPEAKER_01]: For the trap bar, this tends to be a little bit closer to the ankles, the center mast does. [SPEAKER_01]: So you have a more upright torso. [SPEAKER_01]: So you get a little more quadriceps involvement and more glutes less lower back.

19:25 [SPEAKER_01]: The result is just that the training load is distributed differently. [SPEAKER_01]: You're not really missing any quote, games that are generally applied. [SPEAKER_01]: They'd just tend to get a little bit more training load on the quadriceps and glutes, versus the glutes and are the hamstrings and the erectors.

19:42 [SPEAKER_01]: It's just, [SPEAKER_01]: slightly different. [SPEAKER_01]: And to be clear, all of the studies to date on this are focused on EMGs, which is EMG data, which is just a study of electrical activity at the levels in the muscle. [SPEAKER_01]: We don't have like longitudinal outcomes. [SPEAKER_01]: Like group one did trap our deadliest group, two did straight, you know, conventional deadliest.

20:03 [SPEAKER_01]: At the end, we tested their leg press 1 rep max or their erect or high-perrophy or their hamstrings high-perrophy. [SPEAKER_01]: If we had that data, we could say with confidence like here, look, these are the differences in training outcomes that you can expect. [SPEAKER_01]: If you fit into that population that was studied, but so far it's just EMG stuff.

20:20 [SPEAKER_01]: And EMG data to date does not really correlate well with those outcomes. [SPEAKER_01]: It's a signal on some level, like if somebody did a lift and there was [SPEAKER_01]: 90% voluntary activation of a particular muscle group versus another exercise that had 0% activation of a particular muscle or muscle group.

20:39 [SPEAKER_01]: Well, sure, at that point you're like, yeah, my brain still works. [SPEAKER_01]: I have more than one synapse that functions. [SPEAKER_01]: You're going to get more gains out of the first exercise where the muscle or muscle group of interest is actually being electrically active, but other than that, when someone's like, well, this is 60% or 50% [SPEAKER_01]: Today, that's just, and we have a lot of EMG data out there, it just is not really instructive as far as what you should prescribe.

21:07 [SPEAKER_01]: Overall, I would predict similar strength gains in unrelated low-scale strength tests, whether that's a leg press, whether it's an isometric leg extension or leg curl, something like that. [SPEAKER_01]: But yeah, at the end of 12 weeks of trap our deadliest versus conventional deadliest with a straight bar, the biggest difference is I would predict are the performance in those individual exercises, but not really outside of that.

21:30 [SPEAKER_01]: And then further, I would like to explicitly reject the idea that conventional or straight bar deadless are more dangerous or risky on the lower back compared to the trap bar deadlift. [SPEAKER_01]: Instead, I think that both are safe when loaded appropriately, just between the two, the training loads distributed slightly differently.

21:47 [SPEAKER_01]: though to what degree and like that that matters depends on what outcomes are being tested and how. [SPEAKER_01]: You can't say that a regular straight bar deadlift makes you stronger than a trap our deadlift. [SPEAKER_01]: It's like, well, in what specific context or a conventional deadlift drives more hypertrophy than a trap our deadlift is like, well, what specific muscle group and then where's the proof because today that doesn't really exist, so I could not say that confidently.

22:13 [SPEAKER_01]: Austin, what do you think about this trap bar deadlift or straight bar deadlift debate? [SPEAKER_01]: Is it missing? [SPEAKER_01]: Is the trap bar deadlift missing anything compared to just a regular straight, you know, conventional deadlift? [SPEAKER_01]: Or is there ever a time that you would specifically prefer a trap bar deadlift over a conventional deadlift?

22:30 [SPEAKER_00]: Yeah, I mean, they're to your point slightly different exercises that distribute loads slightly differently and that leads to the expected slight differences in the adaptations that you get as a result. [SPEAKER_00]: I just generally struggle to care about this in general. [SPEAKER_00]: I think that if the person asking this question or if you're trying to answer this question for yourself, like do I have a non negotiable reason that I must.

22:51 [SPEAKER_00]: conventional deadlift from the floor like I'm entering a barbell strength related competition where that is the you know the task that I must complete. [SPEAKER_00]: If that is not the case as we've talked about before you have every possible exercise in the world at your you know that that you can that you can use to facilitate your your training towards whatever desired outcomes and goals are are important to you.

23:13 [SPEAKER_00]: And so, if somebody's not a competitor in a sport that requires it, then it's like, okay, is this just for health, then I extra don't care about the difference between the two, because, you know, if you told me, hey, I'm going to have somebody who starts training at pick your age and then a decade, two decades, three decades, however many years later, between track bar and conventional deadlift, and then I'm going to measure their resting blood pressure, or their hemoglobin A1C, or their blood lipids.

23:39 [SPEAKER_00]: What I expect to see a difference, obviously, no, I wouldn't. [SPEAKER_00]: might their end up being over a long enough time frame some differences in their abilities. [SPEAKER_00]: If you were to focus, uh, do a focused analysis of their like hamstring versus quadriceps hypertrophy. [SPEAKER_00]: Maybe a little bit if that's all they did, right?

23:56 [SPEAKER_00]: But at the same time, it's like you're also doing other exercises that probably makes some of that come out in the wash, right? [SPEAKER_00]: or their strength on a hamstring, focus task, diverse as a quadriceps, again, maybe slightly, but you're not only doing trap bar and conventional and leaving the gym, at least I don't think you are, right?

24:12 [SPEAKER_00]: You're probably also doing maybe some squatting, maybe you enjoy doing some, I don't know, good mornings or you do some machine work or something else that probably also serves to close that gap even further. [SPEAKER_00]: So my answer is no, I don't think you're missing any critical gains by doing one over the other.

24:27 [SPEAKER_00]: unless again, you're a competitor in a sport that requires it. [SPEAKER_00]: Handle height, similarly just makes it a different exercise. [SPEAKER_00]: A trapmark with low handles is slightly different than a trapmark with high handles. [SPEAKER_00]: leads to slightly different adaptations.

24:38 [SPEAKER_00]: It's probably some slight differences in strength performance through that range of motion in your training, some slight differences in hypertrophy. [SPEAKER_00]: Again, if that is the only exercise that you're doing and you're not kind of shoring up any gaps in other ways. [SPEAKER_00]: My last comment here is the question, the way it was phrased, to quote, save my lower back.

24:54 [SPEAKER_00]: And I just would like, I would be kind of poking at that a little bit and asking, tell me what made you say that? [SPEAKER_00]: Is it that I have a history of back issues? [SPEAKER_00]: And I'm worried that conventional deadlifting is going to flare it up, and so I don't do it, so I'm avoiding that movement that I might say, okay, well, I would rather that we feel a little bit more confident in just like moving in all sorts of different ways in an unrestricted capacity.

25:15 [SPEAKER_00]: So if you'd like to train the trap bars remain movement, that's great, but maybe we can either, you know, just sprinkle in a little bit of some conventional deadlifting, even if it's load cap that a super low load just to expose you to that so that you can maybe start to. [SPEAKER_00]: You know, address some of that fear around that, or maybe we just start out if that's too concerning to you of just a conventional Artiel or something like that to mimic it and move in that way.

25:36 [SPEAKER_00]: If on the other hand, you say, look, I've been doing this for years. [SPEAKER_00]: Every time I train conventional deadlifts, it goes great early on as I build up my strength, the weights go up, and then eventually I inevitably end up having a significant setback. [SPEAKER_00]: And when I train track bar instead, I never have a setback.

25:50 [SPEAKER_00]: It's like, okay. [SPEAKER_00]: You know, that I would be perfectly accepting of that explanation, even though there's probably some things that we might still be able to modify, you know, with your programming as it related to your commitment, but for some people, it's just like, I don't actually care that much.

26:01 [SPEAKER_00]: It's not worth it to me to go through all this, you know, you know, nitpicking on my program to make me taller and exercise that isn't that important to me that I'm not missing out on a ton of by doing other things and that I've experienced so many setbacks on over the years. [SPEAKER_00]: So this is kind of like that last question of like a given take in this conversation.

26:17 [SPEAKER_00]: So that's what I mean is I wouldn't say that a trapbar necessarily saves quote unquote your lower back or a safer for your lower back compared to conventional dead lifting assuming it's again reasonably programmed but different people tolerate different exercises differently right and there's some things that are just don't feel good to some people for you know even for between you and I I know that there's some movements that you like that I don't and vice versa and that's just that's okay you know as part of a more comprehensive training program the gaps are all short up one way or another [SPEAKER_00]: even if we go about the tiny details of exercise selection somewhat differently.

26:49 [SPEAKER_01]: Yeah, yeah, kind of you, this is like a, when you come to exercise selection, it's like a buffet, you know, like you're at old country buffet and like you're going to pick different foods that I am. [SPEAKER_01]: But at the end of the day, we're still like, all right, we want to make sure we get our protein, we want to make sure we get some, you know, carbohydrates, we want to make sure we get a decent [SPEAKER_01]: You know, the way we go about it, you know, that's your squat pattern, your hinge pattern, your press pattern, your pull pattern.

27:16 [SPEAKER_01]: We're going to get exposed to all of those things, but the specifics are mostly personal preference, especially when it comes to health. [SPEAKER_01]: And you know, when it comes to performance, yeah, it's it's a specific. [SPEAKER_01]: So I can envision selecting a trap [SPEAKER_01]: If they have this long injury history, like you mentioned, I still would probably want to expose them to something where they do maybe get a little more horizontal, just to, you know, exposure just so they have that, you know, in their back pocket, but also like if someone was really want to do power training, specific power training, plyometrics, they didn't really want to do power clean or Olympic variations that was really wasn't on the table, I'm like,

27:57 [SPEAKER_01]: Having done a lot of this with both the trap bar and the trap bar is an easier choice for this like a speed deadlift or jumping trap bar, you know, deadlift something like that. [SPEAKER_01]: But also if someone super intimidated to deadlifts period, they're like, do you even a rack pull for them is like no go.

28:13 [SPEAKER_01]: They might feel more comfortable starting that that could be again your Trojan horse to deadlift is the trap bar deadlift. [SPEAKER_01]: So ultimately, that yeah, all of those are good use cases. [SPEAKER_01]: But something that really bothers me is that people will say, look, people, folks who choose a trap art deadlift, they just do it because they're bad at regular deadlifts.

28:32 [SPEAKER_01]: And it's like, again, you don't need a moralized exercise selection. [SPEAKER_01]: This isn't, you don't need to herring people to do a particular exercise that you like or ascribe some sort of arbitrary value. [SPEAKER_01]: That's not important. [SPEAKER_01]: All right. [SPEAKER_01]: Yes, if you were a competitive power lifter, you're entering, like you said, a barbell [SPEAKER_01]: We want you to be prepared for that and at that point.

28:55 [SPEAKER_01]: Yeah, you do have to do it, but otherwise you don't you can live a full and complete life You know without doing a conventional deadlift from the floor. [SPEAKER_01]: I mean some former strong man competitors might say you know the full life You can't what what is the point of living if you cannot deadlift.

29:11 [SPEAKER_00]: I think that was Magnuson Although many of them don't in fact live full and complete lives because they die early depending on how they got there [SPEAKER_01]: Yeah, exactly. [SPEAKER_01]: So I just think like, again, do we don't know more or less exercise selection? [SPEAKER_01]: You don't have to do a conventional deadlift unless you are this very niche population that's probably makes up a large proportion of people listening to this.

29:30 [SPEAKER_01]: In fact, let's wrap our deadlift just fine. [SPEAKER_01]: That's, that's my take. [SPEAKER_01]: I think that the outcomes specific to each exercise are relatively unimportant for health-related applications, more important for performance-related applications, and that's kind of our view and exercise selection.

29:48 [SPEAKER_01]: Yeah, agree. [SPEAKER_01]: Alright, that wraps up this teaser of our Directline AMA. [SPEAKER_01]: Now, this is just a small portion of the full 90-minute episode where we also covered bouldering for health, the stabilizer muscle myth, and Dr. Baraki went over a behavior change many masterclass.

30:05 [SPEAKER_01]: Now, if you want the full episode, the complete archive of all of our past AMA's and our new action plans, join the subscriber community at the link in the description below. [SPEAKER_01]: Your support allows us to keep pumping out this content that's evidence-based and free from industry influence.

30:17 [SPEAKER_01]: Thanks for listening, and we'll see you on the next podcast.