Barbell Medicine Podcast

Barbell Medicine

Podcast by Barbell Medicine

  1. Is the Testosterone Crisis Real? The Numbers Behind the Headlines | Signal Ep 1

    2 DAYS AGO

    Is the Testosterone Crisis Real? The Numbers Behind the Headlines | Signal Ep 1

    Every week there's a new headline saying men are losing testosterone. A quarter of men now start testosterone replacement therapy without ever getting their blood tested. The supplement aisle is full of boosters that either do nothing or contain undisclosed steroids. And the lab test that gets everybody to the pharmacy? Half of low results normalize on their own. In Episode 1 of the Signal launch series, Dr. Jordan Feigenbaum and Dr. Austin Baraki (both MDs and strength coaches) walk through the three-layer problem with how testosterone gets diagnosed and treated in 2026, then take apart the "testosterone is crashing" headline with the most current data available, including a 2025 meta-analysis of more than one million men. Timestamps 0:00 Mark's story: treating the number, not the patient1:18 Welcome to the Barbell Medicine Podcast1:41 Problem 1: A quarter of men start TRT with no lab work3:36 Problem 2: Why testosterone boosters do not work (and what is in them)13:40 Problem 3: Why one low testosterone lab is not a diagnosis19:19 Setup: Is the testosterone crisis headline real?20:04 The MMAS data and the 1%-per-year number20:52 The 2025 meta-analysis of over 1 million men22:02 Why the headline is inflated: three causes22:27 Cause 1: The testing method changed (immunoassay to mass spec)25:58 Cause 2: BMI cannot see visceral fat29:37 The Nyante study: when you fix both problems, the decline vanishes33:58 What this actually means for you37:05 The broken testosterone system, summarized38:24 Five takeaways from this episode39:14 Next week: How testosterone actually works39:39 About Signal and creditsWhat you'll learn in this episode:  Why 25% of new TRT prescriptions are written without any pre-treatment lab work (JAMA, 2015)What actually happens when researchers test 50+ "testosterone booster" supplements (spoiler: 12% are contaminated with undisclosed steroids)Why a single low testosterone reading is not a diagnosis, and the Massachusetts Male Aging Study data that proves itThe real size of the population-level testosterone decline (much smaller than 1% per year)Why BMI cannot see the visceral fat that is driving most of the genuine declineThe Nyante study that shows the decline essentially vanishes when you use an accurate test and measure waist circumferenceFive practical takeaways you can apply before your next lab draw This is Episode 1 of a four-part series built around our upcoming book, Signal. Over the next four weeks we cover what testosterone actually is, how to tell when it is genuinely low, what is really driving population-level changes, and what the evidence says you can do about it. Next Steps Check out our new book, Signal (coming soon)For evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.comTo support us and get ad free listening, plus special product discounts, and exclusive content, go to supercast.barbellmedicine.comResources Baillargeon, J., et al. (2015). Trends in Androgen Prescribing in the United States, 2001–2011. JAMA Intern Med, 175(8), 1413–1415. — 25% no preceding lab; post-prescription monitoring gap. Rao, P.K., et al. (2017). Trends in Testosterone Replacement Therapy Use from 2003 to 2013 among Reproductive-Age Men in the United States. J Urol, 197(4), 1121–1126. — Prescription volume growth. Selinger, S., & Thallapureddy, A. (2024). Cross-sectional analysis of national testosterone prescribing through prescription drug monitoring programs, 2018–2022. PLoS One, 19(8), e0309160. — Recent prescribing data, 3-4 million estimate. Vesper, H.W., et al. (2015). Serum Total Testosterone Concentrations in the US Household Population from the NHANES 2011–2012 Study Population. Clin Chem, 61(12), 1495–1504. — Population testosterone levels, NHANES data. Clemesha, C.G., et al. (2020). "Testosterone Boosting" Supplements Composition and Claims Are Not Supported by the Academic Literature. World J Men's Health, 38(1), 115–122. — 62% no published data, 10% decreased T. Tucker, J., et al. (2018). Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US FDA Warnings. JAMA Network Open, 1(6), e183337. — 12% adulterated with undisclosed steroids. Trost, L.W., & Mulhall, J.P. (2016). Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials. J Sex Med, 13(7), 1029–1046. — Half of low results normalize on repeat. Travison, T.G., et al. (2008). The Natural History of Symptomatic Androgen Deficiency in Men: Onset, Progression, and Spontaneous Remission. JCEM. MMAS data — 50%+ spontaneous normalization. Travison, T.G., et al. (2007). A Population-Level Decline in Serum Testosterone Levels in American Men. JCEM, 92(1), 196–202. — Original MMAS secular decline, 15–20% lower across cohorts. Santi, D., et al. (2025). Meta-analysis of secular trend in total testosterone levels, 1971–2024. 1,256 studies, N > 1,000,000. — 0.56%/year adjusted; LH parallel decline; mass spec subgroup no significant decline.  Methods note on the ~0.56% per year figure cited in this episode: the Santi paper does not report a single percentage rate. The headline adjusted meta-regression coefficient (−0.6 nmol/L/year) is inflated by the random-effects weighting scheme and is not a biological rate. The 0.5–0.6% per year approximation comes from the pre-2000 stratified subgroup (Fig. 5, coefficient −0.1 nmol/L/year) divided by the dataset mean of 18.5 nmol/L. The post-2000 stratum runs larger (~1.1%), and the age-stratified coefficients in Table 5 cluster in the 0.4–0.9% range. The mass spectrometry subgroup (Table 3, Group 4) showed no significant trend (p = 0.845). The episode uses the conservative end of this range as the most defensible estimate of the real population-level rate after accounting for assay drift. Nyante, S.J., Graubard, B.I., Li, Y., McQuillan, G.M., Platz, E.A., Rohrmann, S., Bradwin, G., & McGlynn, K.A. (2012). Trends in sex hormone concentrations in US males: 1988–1991 to 1999–2004. Int J Androl, 35(3), 456–466. doi: 10.1111/j.1365-2605.2011.01230.x. — Archived NHANES samples, same platform, waist circumference added; no significant decline in total or free testosterone. Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    41 min
  2. Medical Mystery: The Man Who Got Weaker When He Started Training

    7 APR

    Medical Mystery: The Man Who Got Weaker When He Started Training

    A 43-year-old man starts exercising and ends up in the ER with a CK over 100x the upper limit of normal. His doctor says it’s from training. We don’t think so. In this episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through the full case — history, labs, diagnosis, and what actually went wrong — then break down the mechanisms behind the answer, the nocebo research, and what the brand-new 2026 guidelines mean for the 40 million Americans on a drug class you’ve definitely heard of. We also cover the STOMP trial (do statins actually impair strength gains?), the SAMSON trial (how much of statin intolerance is nocebo?), the difference between myalgia, myositis, and rhabdomyolysis, Austin’s clinical approach to a patient whose strength is declining on a statin, and the treatment escalation pathway for statin-intolerant patients including bempedoic acid, PCSK9 inhibitors, and inclisiran. Plus, where GLP-1 receptor agonists like tirzepatide fit into the cardiovascular risk picture. Timestamps 0:00 — A 43-year-old man is getting weaker, not stronger2:09 — Taking the history: Medications, lifestyle, and red flags12:53 — The labs come back: CK at 18,97916:05 — Metabolic syndrome and the modern treatment approach23:15 — Rhabdomyolysis: What it is and why it’s dangerous29:50 — Final diagnosis and what went wrong with the medications37:15 — 2026 ACC lipid guidelines: What changed40:32 — Three mechanisms: How statins affect muscle47:02 — The nocebo effect and the SAMSON trial54:17 — Do statins impair training? The STOMP trial1:00:30 — Who’s at highest risk for statin muscle problems1:07:36 — What happened to the patient and options if this is you1:14:12 — Five takeawaysFive Takeaway  Statin myopathy is real but relatively uncommon. The excess symptom rate above placebo is roughly 1–5% in controlled trials. But in exercising patients, especially on combination therapy, the risk can be higher.There are three proposed mechanisms: reduced energy production from CoQ10 depletion, compromised muscle cell membranes from isoprenoid loss, and accelerated protein breakdown from calcium leak via the ryanodine receptor. Exercise amplifies all three, but the vast majority of people compensate.If you’re on a statin and your strength is going down, talk to your doctor before stopping the medication or changing your training. A CK test can help separate a drug problem from a programming problemThe 2026 ACC guidelines list vigorous exercise as a risk factor for statin-associated muscle symptoms for the first time. They also provide statin-intolerant patients a clear escalation pathway: bempedoic acid, ezetimibe, PCSK9 inhibitors, and more.Lower is better for LDL. There’s a 33% relative reduction in cardiovascular events at 55 vs. 70 mg/dL. Lower for longer. Healthy lifestyle changes plus effective lipid-lowering therapy are among the best things you can do for cardiovascular risk. Next Steps For evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.comTo support us and get ad free listening, plus special product discounts, and exclusive content, go to supercast.barbellmedicine.com  Resources Training Plateau Action Plan (free): https://www.barbellmedicine.com/training-plateau-action-plan/ Fish oil episode: https://open.spotify.com/episode/4kRtXZBMZWKkZPDdIKpu1S Lp(a): https://www.barbellmedicine.com/blog/lipoprotein-a-testing-and-treatment/ Guidelines Blumenthal RS, Morris PB, et al. 2026 ACC/AHA Guideline on the Management of Dyslipidemia. Circulation. 2026. DOI: 10.1161/CIR.0000000000001423 Case László A, et al. Exercise and Statin-Fibrate Combination Therapy-Caused Myopathy. BMC Research Notes. 2013;6:52. https://pubmed.ncbi.nlm.nih.gov/23388500/   LDL Targets Lee YJ, et al. (Ez-PAVE) Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease. NEJM. 2026. PMID: 41910315 Mechanisms of Statin Myopathy Meador BM, Huey KA. Statin-Associated Myopathy and Its Exacerbation with Exercise. Muscle Nerve. 2010;42(4):469–479. https://pubmed.ncbi.nlm.nih.gov/20878737/ Safitri N, et al. Statin-Induced Rhabdomyolysis: Mechanisms, Risk Factors, Management. Drug Healthc Patient Saf. 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8593596/ Molinarolo S, et al. Cryo-electron microscopy reveals sequential binding and activation of Ryanodine Receptors by statin triplets. Nat Commun. 2025;16(1):11508. doi:10.1038/s41467-025-66522-0 Thompson PD, et al. Lovastatin Increases Exercise-Induced Skeletal Muscle Injury. Metabolism. 1997;46(10):1206–1210 Nocebo Effect and Statin Intolerance Wood FA, et al. N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects (SAMSON). NEJM. 2020;383(22):2182–2184. https://pmc.ncbi.nlm.nih.gov/articles/PMC8453640/ Khan S, et al. Does Googling Lead to Statin Intolerance? Int J Cardiol. 2018;262:25–27. https://pubmed.ncbi.nlm.nih.gov/29706390/ Gupta A, et al. Adverse Events Associated with Unblinded, but Not with Blinded, Statin Therapy in the ASCOT-LLA. Lancet. 2017;389(10088):2473–2481. https://pubmed.ncbi.nlm.nih.gov/28476288/ Moon JC, et al. Examining the Nocebo Effect of Statins through the FDA AERS. Circ Cardiovasc Qual Outcomes. 2021;14(1):e007480. https://pubmed.ncbi.nlm.nih.gov/33161769 Statins and Exercise Outcomes Parker BA, et al. Effect of Statins on Skeletal Muscle Function (STOMP). Circulation. 2013;127(1):96–103. https://pubmed.ncbi.nlm.nih.gov/23183941/ Parker BA, Thompson PD. Effect of Statins on Skeletal Muscle: Exercise, Myopathy, and Muscle Outcomes. Exerc Sport Sci Rev. 2012;40(4):188–194. https://pmc.ncbi.nlm.nih.gov/articles/PMC3463373/ Mikus CR, et al. Simvastatin Impairs Exercise Training Adaptations. JACC. 2013;62(8):709–714. https://pubmed.ncbi.nlm.nih.gov/23583255/ Slade JM, et al. The Impact of Statin Therapy and Aerobic Exercise Training. Am Heart J Plus. 2021;10:100028. https://pmc.ncbi.nlm.nih.gov/articles/PMC8477381/ Gui Y, et al. Efficacy and Safety of Statins and Exercise Combination Therapy. Eur J Prev Cardiol. 2017;24(9):907–916. DOI: 10.1177/2047487317691874  Genetic Susceptibility SEARCH Collaborative Group. SLCO1B1 Variants and Statin-Induced Myopathy — A Genomewide Study. NEJM. 2008;359(8):789–799 Autoimmune Myopathy Barkhordarian M, et al. Statin-Induced Autoimmune Myopathy. Am J Case Rep. 2024;25:e944261. https://pubmed.ncbi.nlm.nih.gov/39219126/ Statin-Fibrate Interactions Jones PH, Davidson MH. Reporting Rate of Rhabdomyolysis with Fenofibrate + Statin vs Gemfibrozil + Any Statin. Am J Cardiol. 2005;95(1):120–122 Bruckert E, et al. Mild to Moderate Muscular Symptoms with High-Dosage Statin Therapy (PRIMO Study). Cardiovasc Drugs Ther. 2005;19(6):403–414 Sinzinger H, O’Grady J. Professional Athletes Suffering from Familial Hypercholesterolaemia Rarely Tolerate Statin Treatment. Br J Clin Pharmacol. 2004;57(4):525–528 Tirzepatide and GLP-1 Agonists Al-kuraishy HM, et al. The mechanistic role of tirzepatide in atherosclerosis. Int J Biol Macromol. 2025;329(1). https://doi.org/10.1016/j.ijbiomac.2025.147734 Effects of Tirzepatide on Lipid Profile: A Systematic Review and Meta-Analysis. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11704219/ Hamidi H, et al. Effect of tirzepatide on coronary atherosclerosis progression (T-Plaque trial design). Am Heart J. 2024;278:24–32. doi:10.1016/j.ahj.2024.08.015 Fish Oil and Omega-3 Fatty Acids Bhatt DL, et al. Cardiovascular Risk Reduction with Icosapent Ethyl (REDUCE-IT). NEJM. 2019;380:11–22. https://pubmed.ncbi.nlm.nih.gov/30415628/ Abdelhamid AS, et al. Omega-3 Fatty Acids for Prevention of Cardiovascular Disease. Cochrane Database Syst Rev. 2020. https://pubmed.ncbi.nlm.nih.gov/32114706/ Manson JE, et al. Marine n-3 Fatty Acids and Prevention of CVD and Cancer (VITAL). NEJM. 2019;380:23–32. https://pubmed.ncbi.nlm.nih.gov/30415637/   Myopathy Classification Selva-O’Callaghan A, et al. Statin-Induced Myalgia and Myositis: Pathogenesis and Clinical Recommendations. Expert Rev Clin Immunol. 2018;14(3):215–224. https://pmc.ncbi.nlm.nih.gov/articles/PMC6019601/ Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    1hr 16min
  3. Overtraining Syndrome: Causes, Diagnosis, and What's Actually Going On

    31 MAR

    Overtraining Syndrome: Causes, Diagnosis, and What's Actually Going On

    In 2022, researchers conducted the most rigorous systematic review ever performed on overtraining syndrome — looking specifically for controlled studies that documented a human transitioning from a healthy training state to an overtrained state. Zero studies met those criteria.   The word "overtrained" appears in coaching certifications, wearable device dashboards, and clinical sports medicine guidelines — and in each context it means something different. That definitional chaos has consequences: it delays real diagnoses, produces nocebo effects with measurable physiological outcomes, and leads athletes to reduce training they didn't need to reduce. In this episode, Drs. Jordan Feigenbaum and Austin Baraki work through the full evidence base on overtraining syndrome — the taxonomy, the attempted studies, the six competing mechanistic theories, the biomarker failures, and what's actually happening when a lifter can't make progress.   Timestamps: 0:00 Cold open — the zero-studies finding1:21 Why "overtrained" does four different jobs simultaneously16:10 The FOR / NFOR / OTS taxonomy19:43 The supercompensation model — borrowed from endurance, never validated for resistance training32:28 Austin's clinical differential for fatigue and declining performance36:17 RT evidence — what happens when researchers try to induce OTS through lifting43:19 Austin — what actually drives the complaints he sees in practice47:30 Six theories for what causes overtraining syndrome1:01:09 The biomarker problem — why the T:C ratio and cortisol don't work1:05:09 What your wearable is actually measuring (and what it isn't)1:09:28 Austin — testosterone levels in trained athletes and when to act1:13:40 Heart rate variability — limitations for strength training1:15:36 Session RPE — the monitoring tool that actually works1:17:31 How common is overtraining syndrome, really?1:23:04 Three failure modes — what's actually happening when lifters say they feel overtrained1:32:14 Austin — what a proper medical workup looks like1:34:22 Outro What we cover: The definition problem — why a single word is doing four incompatible jobs simultaneously, and why that matters clinically and practically.The taxonomy — functional overreaching, nonfunctional overreaching, and overtraining syndrome as points on a continuous variable that can only be identified after the fact, not at presentation.The supercompensation model — where it came from, why it fails to describe how resistance training adaptation actually works, and how applying it too literally produces both overloading and underloading errors at the same time.Austin's clinical differential — what a physician actually works through when a patient presents with fatigue and declining performance, and where overtraining syndrome actually sits on that list.What resistance training research shows — including 140 maximal singles, 90 working sets per week, and daily 1-rep max attempts. No study has cleanly induced overtraining syndrome through resistance training. The hormonal data went in the opposite direction from what the endurance overtraining model predicts.Six mechanistic theories — glycogen depletion, serotonin/BCAA, autonomic imbalance, central governor, HPA axis dysregulation, and Armstrong's complex systems framework. Each one is partially supported and each falls short.The biomarker problem — resting cortisol is normal in 75%+ of OTS cases, the testosterone to cortisol ratio has never been validated against clinical outcomes as an individual diagnostic, and HRV recovery in strength training lags physical recovery by up to 30 hours.Austin on wearables — including a clinical pattern he's seeing with GLP-1 receptor agonists: wearable scores indicating deterioration when the clinical picture is actually fine.Session RPE as the real tool — why session RPE trending upward at stable training load is a more reliable signal of load-recovery mismatch than any biomarker currently used.Prevalence and confounders — the 60% figure, why it almost certainly captures all three FOR/NFOR/OTS categories plus REDS, depression, and illness, and why the residual true training-load-induced OTS in an otherwise healthy athlete may be vanishingly rare.Three failure modes — the three things Jordan actually sees in practice when lifters present saying they feel overtrained, and how to distinguish between them using session RPE.The medical workup — Austin's practical walkthrough of what to assess when programming and lifestyle changes don't move the needle, including iron deficiency (ferritin testing caveats, lab reference range problems), sleep apnea, post-viral syndromes, and hormone panels done correctly. Next Steps: For evidence-based resistance training programs: barbellmedicine.com/training-programs For individualized training consultation: barbellmedicine.com/coaching Explore our full library of articles on health and performance: barbellmedicine.com/resources To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com For ad free listening and exclusive discounts, become a Barbell Medicine Plus subscriber at https://barbellmedicine.supercast.com/  Resources  Taxonomy / Definitions Meeusen et al. (2013) European College of Sport Science / ACSM consensus statement on FOR, NFOR, and OTS taxonomy. Defines OTS as a diagnosis of exclusion. https://pubmed.ncbi.nlm.nih.gov/23247672/ Meeusen et al. (2006) "Often only after a period of complete rest" — the retrospective nature of distinguishing NFOR from OTS. https://pubmed.ncbi.nlm.nih.gov/23016079/ Nocebo Effects in Sport 2024 Systematic Review Nocebo effects in sport were approximately twice the magnitude of placebo effects on performance across 20 studies. https://pubmed.ncbi.nlm.nih.gov/38999724/ Stress-Recovery-Adaptation Model Original general adaptation syndrome / stress physiology work in Nature. Foundational source the SRA model was derived from — not a sports science paper. https://www.nature.com/articles/138032a0 Multi-system adaptation timescales; critique of single-wave supercompensation model. https://pubmed.ncbi.nlm.nih.gov/3057313/ Multi-system adaptation timescales; further critique of the SRA "window of opportunity" model. https://pubmed.ncbi.nlm.nih.gov/15044685/ Lack of empirical support for the supercompensation "window of opportunity" in real training scenarios. https://pubmed.ncbi.nlm.nih.gov/29189930/ Resistance Training and OTS Grandou et al. (2020) Systematic review: 22 studies on resistance training overtraining. 10 showed zero performance decline under deliberate overload. No reliable biomarker established for RT overtraining; sustained performance drop is the only consistent signal. https://pubmed.ncbi.nlm.nih.gov/31313309/ Coleman et al. (2024) 9-week supervised high-volume RT protocol (~90 sets/week). No OTS criteria met. Ceiling for resistance training-induced OTS is considerably higher than commonly implied. https://pmc.ncbi.nlm.nih.gov/articles/PMC10809978/ Zourdos et al. (2016) Case series: 3 competitive strength athletes performed daily 1RM squat for 30 consecutive days. All three improved. https://pubmed.ncbi.nlm.nih.gov/26816276/ Daily 1RM Bench Press Study 7 athletes attempted a true 1RM bench press every day for 38 days. All improved despite day-to-day fluctuation. https://www.thefreelibrary.com/Efficacy+of+Daily+One-Repetition+Maximum+Bench+Press+Training+in...-a0828317501 3 weeks of daily loading; volume arm hypertrophied. Daily frequency did not produce overtraining; volume drives hypertrophy, not frequency alone. https://pubmed.ncbi.nlm.nih.gov/27875635/ Fry et al. (1994) — Overreaching Protocol Original resistance overreaching induction: 10×1 at 100% 1RM daily for 14 days. 1RM dropped ~12 kg. Hormonal response was opposite to endurance OTS profile (cortisol decreased, testosterone slightly increased). https://pubmed.ncbi.nlm.nih.gov/7808252/ Fry et al. (1994) — Endurance Biomarkers Endurance OTS biomarkers (T:C ratio) do not apply to high-intensity resistance training overreaching. https://pubmed.ncbi.nlm.nih.gov/9843563/ Fry et al. (2006) Same overreaching protocol with muscle biopsies. Beta-2 adrenergic receptor density in vastus lateralis decreased 37%. Orthopedic ceiling hypothesis: structural limits intervene before neuroendocrine axis fully desensitizes. https://pubmed.ncbi.nlm.nih.gov/16888042/ Raastad et al. (2001) Daily submaximal leg training for 2 weeks; 1RM increased 6%. Intensity (not frequency) is the necessary ingredient for overreaching in resistance training. https://pubmed.ncbi.nlm.nih.gov/11394254/ Margonis et al. (2007) 12-week progressive RT peaking at ~14 tonnes/week. Significant 1RM decrements not restored after 6-week taper — the only resistance training study to approach true OTS criteria. https://pubmed.ncbi.nlm.nih.gov/17697935/ HPA Axis / Biomarkers Cadegiani & Kater (2017) — EROS Study Resting cortisol is normal in ≥75% of OTS studies. Reduced pituitary ACTH output (not adrenal failure) is the upstream dysregulation in OTS. "Adrenal fatigue" is mechanistically backwards. https://pmc.ncbi.nlm.nih.gov/articles/PMC5722782/ EROS Study — Extended Findings Further EROS study data on HPA axis dysregulation patterns in OTS. https://pmc.ncbi.nlm.nih.gov/articles/PMC6590962/ Testosterone: acute 30% drops occur routinely after a marathon and normalize within days. Never validated as an individual OTS diagnostic. https://pubmed.ncbi.nlm.nih.gov/3744643/ Saw et al. (2016) 56-study systematic review of athlete monitoring tools. Subjective measures (mood, perceived fatigue, sleep quality) tracked training load changes with greater sensitivity than objective markers including hormones, resting HR, and HRV. https://pmc.ncbi.nlm.nih.gov/articles/PMC4789708/ Meeusen et al. (2004/2010) — Two-Bout Exercise Protocol Two maximal incremental tests 4 hours apart with serial blood draws. OTS athletes show blu

    1hr 36min
  4. Episode #391: VO2 Max vs. Cardiorespiratory Fitness, GLP-1 Costs, and the 10,000-Step Myth | Direct Line March 2026 (Free)

    24 MAR

    Episode #391: VO2 Max vs. Cardiorespiratory Fitness, GLP-1 Costs, and the 10,000-Step Myth | Direct Line March 2026 (Free)

    In this free preview of the March 2026 Direct Line AMA. Drs. Feigenbaum and Baraki cover: VO2 max versus cardiorespiratory fitness for longevity (are Peter Attia’s targets evidence-based? — with Goodhart’s Law and the JAMA evidence), what GLP-1 medications actually cost now via manufacturer programs ($149–449/month), and whether 7,000–10,000 daily steps actually meet the bar for cardiovascular training. Full episode for Barbell Medicine Plus subscribers at https://barbellmedicine.supercast.com/ Timestamps:0:00 — Introduction 3:26 — VO2 Max vs. Cardiorespiratory Fitness for Longevity 14:11 — GLP-1 Costs: What you should actually be paying now 21:43 — Is Walking Enough for Cardiovascular Health? Next Steps: For evidence-based resistance training programs: barbellmedicine.com/training-programs For individualized training consultation: barbellmedicine.com/coaching Explore our full library of articles on health and performance: barbellmedicine.com/resources To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com Resources: JAMA Network Open — Cardiorespiratory Fitness & Long-term Mortality (Mandsager et al.) — Exercise capacity (METs) and longevity — the foundational CRF/mortality study cited in the episode https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428JAMA — Blair et al. — Physical fitness and all-cause mortality: a prospective study of healthy men and women https://jamanetwork.com/journals/jama/fullarticle/379243Barbell Medicine Vital Five — Multi-modal CRF benchmarks and longevity targets https://www.barbellmedicine.com/vital-5-action-plan/Lilly Direct — Zepbound (tirzepatide) — Manufacturer direct program ($299–449/month) https://www.lillydirect.com/zepboundNovoCare — Wegovy (semaglutide) — Manufacturer savings program ($149–349/month) https://www.novocare.com/patient/medicines/wegovy.htmlOrforglipron — Eli Lilly oral GLP-1 — What to know about orforglipron (small-molecule oral GLP-1 agonist, pending FDA approval) https://www.lilly.com/news/stories/what-to-know-about-orforglipron Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    31 min
  5. Episode #390: Why Your Waist Matters More Than Your Weight — The Science of Visceral Fat

    17 MAR

    Episode #390: Why Your Waist Matters More Than Your Weight — The Science of Visceral Fat

    You can have a completely normal BMI and be on your way to cardiovascular disease, type 2 diabetes, and metabolic syndrome without triggering a single alert on a standard health screening. The fat that predicts metabolic risk most accurately isn't the fat your scale or your doctor is tracking. Dr. Jordan Feigenbaum breaks down the science of visceral fat — what it is, how it causes disease, how to measure it correctly at home for free, and what the evidence actually shows about exercise, GLP-1 medications, and testosterone. Timestamps: 00:00:00 Cold Open: The Visceral Fat Finding00:00:49 The Scale Problem — What Body Weight Actually Measures00:03:50 What Is Visceral Fat — and Why It's Not Just "Belly Fat"00:05:04 Three Competing Theories: How Visceral Fat Actually Causes Disease00:08:35 Adipokines: PAI-1, Angiotensinogen, and What Happens When Adiponectin Drops00:09:52 How to Measure: Three Sites That Don't Give the Same Number00:14:30 Clinical Thresholds, Ethnic Adjustments, and the Waist-to-Height Ratio00:15:45 The Weight-to-Waist Ratio: Tracking the Quality of Your Fat Loss00:19:20 Sleep, Cortisol, and Why the Hormonal Environment Has to Support the Work00:21:24 Why Exercise Reduces Visceral Fat 6× More Than Diet Alone00:22:02 Mechanism 1 — Beta-3 Adrenergic Receptors and Preferential Visceral Fat Mobilization00:24:10 Mechanism 2 — Myokines: The Fat-Burning Signal Only Contracting Muscle Can Send00:26:21 GLP-1 Agonists and Body Composition: What the Clinical Trials Actually Show00:28:05 DXA's Blind Spot: Myosteatosis, Glycogen, and Why Lean Mass Numbers Are Inflated00:30:10 SEMALEAN, the BELIEVE Trial, and the 1-in-10 Reality of Long-Term Lifestyle Programs00:33:15 Testosterone, Visceral Fat, and the Aromatase Feed-Forward Loop00:36:05 Three Testosterone Ranges: Deficient, Eugonadal, and Supraphysiological00:38:05 The Bhasin 4-Group Study — and Why AAS Are a Class, Not a Synonym for TRT00:39:33 Tesamorelin: The GHRH Analogue That Selectively Targets Visceral Fat00:40:53 Practical Framework: What to Measure, When, and What to Do00:43:20 Key Takeaways Next Steps For evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.comBarbell Medicine Vital 5 Action Plan: https://www.barbellmedicine.com/vital-5-action-plan/ Resources: https://pubmed.ncbi.nlm.nih.gov/11502820/https://pubmed.ncbi.nlm.nih.gov/33567185/https://pubmed.ncbi.nlm.nih.gov/35658024/https://pubmed.ncbi.nlm.nih.gov/40318682/https://pubmed.ncbi.nlm.nih.gov/41068996/https://pubmed.ncbi.nlm.nih.gov/41772149/https://pubmed.ncbi.nlm.nih.gov/23944298/https://pubmed.ncbi.nlm.nih.gov/20948519/https://pubmed.ncbi.nlm.nih.gov/27213481/https://pubmed.ncbi.nlm.nih.gov/23303913/ Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    45 min
  6. Episode #389: Your Liver Enzymes Are Elevated — But It Might Not Be Your Liver

    9 MAR

    Episode #389: Your Liver Enzymes Are Elevated — But It Might Not Be Your Liver

    A fit, healthy 39-year-old was nearly sent for a liver biopsy. The cause? Was it that he went to the gym before every blood draw or because his supplement was throwing his labs off?. Dr. Jordan Feigenbaum and Dr. Austin Baraki break down the blind spot that sends thousands of healthy athletes down an expensive, potentially unnecessary diagnostic rabbit hole every year. Timestamps: 00:01:09  Introducing the Case00:03:44  How to Read a Liver Panel: ALT, AST, GGT, Alk Phos, Albumin Explained00:10:50  What Is GGT and Why Does It Matter Clinically?00:16:38  Why Exercise, Protein, and Creatine Aren't on the Differential (Yet)00:17:35  The Workup: Hepatitis Panels, Abdominal Ultrasound, and More00:19:42  Second Set of Labs — The Mystery Deepens00:25:25  Updated Differential: What's Still on the List?00:27:08  The Labs Normalize — A Critical Clue Appears00:31:40  The Reveal: Exercise Was the Cause All Along00:32:18  The Mechanism: How Exercise Elevates 'Liver' Enzymes00:32:54  Point 1 — ALT & AST Are Not Exclusively Liver Enzymes00:33:49  Point 2 — It's Unavoidable: 100% of Lifters Are Affected00:36:02  Point 3 — It Takes 10–12 Days to Normalize00:37:00  Point 4 — It's Mostly Harmless00:38:27  56% of Physicians Miss This Diagnosis00:38:48  Why Clinicians Overlook Exercise History00:44:01  Point 5 — GGT as the Differentiator (And Its Limits)00:46:42  Why Alkaline Phosphatase Also Rises Post-Workout00:48:51  The Cost of Missing Lifestyle Context: Over- and Under-Diagnosis00:53:29  What to Say to Your Doctor: 3 Patient Scripts00:59:31  5 Key Takeaways01:00:25  Final Advice from Dr. Baraki  Next Steps For evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com Barbell Medicine Vital 5 Action Plan: https://www.barbellmedicine.com/vital-5-action-plan/ Resources: Case: https://pubmed.ncbi.nlm.nih.gov/37025214/https://pubmed.ncbi.nlm.nih.gov/29059178/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7438350/https://pubmed.ncbi.nlm.nih.gov/18557801/https://pubmed.ncbi.nlm.nih.gov/19209234/https://pubmed.ncbi.nlm.nih.gov/11476029/https://pmc.ncbi.nlm.nih.gov/articles/PMC11165564/https://pmc.ncbi.nlm.nih.gov/articles/PMC12460594/ https://pmc.ncbi.nlm.nih.gov/articles/PMC2291230/https://pmc.ncbi.nlm.nih.gov/articles/PMC11319523/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3936967/https://pmc.ncbi.nlm.nih.gov/articles/PMC12188904/https://pmc.ncbi.nlm.nih.gov/articles/PMC7969109/https://pmc.ncbi.nlm.nih.gov/articles/PMC11498664/https://pmc.ncbi.nlm.nih.gov/articles/PMC3104191/ Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    1hr 2min
  7. Episode #388: Muscle Imbalances, Red Meat Risk, and the Science of Body Fat Set Points

    26 FEB

    Episode #388: Muscle Imbalances, Red Meat Risk, and the Science of Body Fat Set Points

    In this special preview of the Barbell Medicine Plus Direct Line, Dr. Jordan Feigenbaum and Dr. Austin Baraki move past the fitness basics to tackle high-level technical nuances. We dive into the persistent myth of "muscle imbalances" and why your asymmetry might actually be a functional feature of your training. We also address the "meat" of the cardiovascular debate: is red meat and saturated fat consumption still risky if you are highly active and have a high-fiber diet? Finally, we explore the Dual Intervention Point Model to explain why the body defends its energy stores and how our environment has shifted the biological "set point" for body fat. Timestamps00:00 – Barbell Medicine Plus: Special Annual Membership Promotion01:03 – Muscle Imbalances: A Reliable Predictor of Pain?03:59 – Acuted vs. Gradually Acquired Asymmetries08:55 – How Coaches Should Manage "Alignment" Beliefs11:54 – Is Red Meat Necessary to Limit if You Are Otherwise Healthy?15:36 – The Role of Substitution: Plant vs. Animal Protein19:50 – Analyzing the Lean Mass Hyper-Responder (LMHR) Phenotype26:20 – The Dual Intervention Point Model of Body Fatness30:26 – Lipostat, Gravistat, and the Regulation of Energy Stores Next StepsFor evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com Barbell Medicine Vital 5 Action Plan: https://www.barbellmedicine.com/vital-5-action-plan/  Key TakeawaysAsymmetry as a Feature: Human bodies are not naturally symmetrical. In many athletes—such as tennis players, pitchers, or rowers—asymmetry is a functional adaptation to the sport's demands.The Pathological vs. The Normal: Acutely acquired asymmetries (post-surgery or trauma) require specific clinical attention. Long-standing or gradually acquired asymmetries are rarely the primary driver of pain.Saturated Fat & The Healthy User Bias: While fit individuals have a lower overall risk profile, elevated LDL and ApoB particles represent a "time-volume" exposure risk that should not be ignored based solely on lifestyle.The Lean Mass Hyper-Responder (LMHR): We analyze the bold claims surrounding the LMHR phenotype and discuss why mechanistic hypothesizing currently lacks the "hard human outcome receipts" to prove long-term safety.Body Fat Regulation: The Dual Intervention Point Model suggests the body defends a lower boundary (starvation) and an upper boundary (predation). In the modern environment, the "predation pressure" has vanished, leading to a genetic drift upward in body fat set points. Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    34 min
  8. Episode #387: The Valsalva Maneuver- Blood Pressure & Safety in Lifting

    20 FEB

    Episode #387: The Valsalva Maneuver- Blood Pressure & Safety in Lifting

    Most doctors, trainers, and "safety-first" influencers warn that holding your breath while lifting is a dangerous habit that could lead to a stroke or heart failure. By looking back at the 300-year history of the Valsalva maneuver—from a 1704 ear treatment to the "boogeyman" blood pressure studies of the 1980s—we dismantle the myth of the "fragile tube." Discover the science of the "pressurized suit" and why your body is actually designed to handle extreme internal pressure during heavy exertion. Key Takeaways The 'Ear Trick' Origins: Originally described in 1704 by Antonio Maria Valsalva as a way to clear middle-ear infections, the maneuver wasn't linked to cardiovascular risk until the 1850s "Weber experiments."The MacDougall 480/350 Study: Why the finding of massive blood pressure spikes during leg presses may have created a "villain arc" for the Valsalva maneuver in modern medicine.Transmural Pressure Protection: A blood vessel fails when internal pressure significantly exceeds external support; during a Valsalva, the internal spike is matched by an external "cradle" of intra-thoracic and cerebrospinal fluid pressure.Reflexive vs. Intentional Bracing: The Valsalva maneuver is a hard-wired reflex that triggers involuntarily at approximately 80% of a maximal voluntary contraction to stabilize the trunk.Vascular Safety and Stroke Risk: Evidence suggests that for healthy populations, the risk of a vascular "pop" is negligible because the pressure gradient across the vessel wall (transmural pressure) remains stable.Pregnancy and Fetal Safety: Clinical data on pregnant athletes shows that heavy, braced lifting up to 90% of a 10-rep max does not cause fetal distress or compromised uterine blood flow.The 'Hissing' Safety Valve: For those prone to lightheadedness or pelvic floor symptoms, using a slow, active exhalation (a hiss) during the concentric phase can help manage pressure transitions. Timestamps [00:00] History: From the 1704 Ear Treatise to the Weber Fainting Experiments[05:26] The 1985 MacDougall Study: Origin of the "480/350" Blood Pressure Boogeyman[06:22] The Anatomy of a Breath-Hold: The 4 Phases of the Valsalva Maneuver[12:59] Reflexive Bracing: Why You Can’t Stop Yourself from Holding Your Breath[28:24] The Pressurized Suit: Transmural Pressure and Vascular Safety[31:00] The Brain and the Box: CSF Protection and Intracranial Pressure[35:27] Heart Health: Does Lifting Cause Pathological Heart Thickening?[41:17] Special Populations: Strokes, Aneurysms, and the 'Pop' Theory[46:15] The Pelvic Floor: Stress Incontinence and the Weightlifter's Paradox[49:34] Pregnancy: Monitoring Fetal Heart Rates During Heavy Braced Lifting[56:42] Contraindications: When is the Valsalva Maneuver Actually Dangerous? Next Steps For evidence-based resistance training programs: barbellmedicine.com/training-programsFor individualized training consultation: barbellmedicine.com/coachingExplore our full library of articles on health and performance: barbellmedicine.com/resourcesTo join Barbell Medicine Plus and get ad-free listening, product discounts, exclusive content, and more: https://barbellmedicine.supercast.com/To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com Barbell Medicine Vital 5 Action Plan: https://www.barbellmedicine.com/vital-5-action-plan/  References Middle Cerebral Artery and ValsalvaValsalva During Resistance TrainingValsalva and Force Production and WeightIAP During CoughingLifting Belt’s Effects Leg PressTraining and Heart AdaptationsPowerlifter’s HeartsValsalva Maneuver and Cerebrovascular DynamicsRT, VM, and Cerebrovascular PressuresWomen’s Pelvic FloorsPregnancy and RT and AgainFetal Heart RateInjury RiskHerniaSUI Podcast Our Sponsors: * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor: http://factormeals.com/bbm50off * Check out Quince: https://quince.com/bbm Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

    1hr 12min
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4.9
out of 5
103 Ratings

About

Podcast by Barbell Medicine

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  • Creator
    Barbell Medicine
  • Years Active
    2017 - 2026
  • Episodes
    427
  • Rating
    Clean
  • Copyright
    © All rights reserved
  • Show Website
    Barbell Medicine Podcast

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