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A Halloween story about a man who does every wellness protocol, then an honest grading of each one. Dr. Jordan Feigenbaum tells the story of Dale Mercer, Unit 4471, who lives through a fully optimized Sunday in the year 2049: morning light panels, cold plunges, a 31-capsule supplement tray, grey-market peptides, methylene blue, an eccentric-only lifting machine, a protein IV timed to the anabolic window, sleep and readiness scores, a glucose sensor, mouth tape, Zone 2 with lactate pricks, and a 174-degree sauna. Then Jordan grades each one on a zero-to-five pumpkin scale. He covers what the studies actually tested, where the evidence is thin or tied to the companies selling the product, and the few places with real risk, like methylene blue with antidepressants and mouth taping with a blocked nose. The takeaway is plain: lift weights in a challenging way, do conditioning that improves your fitness, sleep enough, and eat a health-promoting diet in the right amount. Most of the rest is optional. The story is inspired by Rick Sieman's 1973 motorcycle magazine column "Sunday Morning Ride … 1984." Timestamps  00:00 WELLNESS ad 00:26 Sunday Morning Protocol 2049 11:23 Where this episode came from, and the pumpkin scale 12:45 Morning sunlight and cold plunges19:44 Supplements: magnesium, lion's mane, NAD, antler velvet, creatine 25:21 Peptides and methylene blue 30:27 Eccentric overload, slow tempo, and the anabolic window 34:40 Sleep trackers, HRV readiness scores, and CGMs 41:56 Mouth tape, Zone 2, and saunas 47:44 What actually worksResources Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/Free Vital 5 Action PlanNew Barbell Medicine Hybrid 5K and 10K Run + Lift ProgramsBarbell Medicine coaching and templates: https://www.barbellmedicine.comGet early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/Creatine: Benefits, Side Effects & Safe Consumption: https://www.barbellmedicine.com/blog/what-is-creatine/Barbell Medicine Guide to Protein: https://www.barbellmedicine.com/blog/barbell-medicine-protein-recommendations/How to Measure, Use and Improve Your Heart Rate Variability: https://www.barbellmedicine.com/blog/heart-rate-variability-hrv/Burke TM, Markwald RR, Chinoy ED, et al. Combination of light and melatonin time cues for phase advancing the human circadian clock. Sleep. 2013;36(11):1617-1624. doi:10.5665/sleep.3110Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2015;11(10):1199-1236. doi:10.5664/jcsm.5100van Maanen A, Meijer AM, van der Heijden KB, Oort FJ. The effects of light therapy on sleep problems: a systematic review and meta-analysis. Sleep Med Rev. 2016;29:52-62. doi:10.1016/j.smrv.2015.08.009Thompson A, Batterham AM, Jones H, Gregson W, Scott D, Atkinson G. 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Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol. 2000;81(5):436-442. doi:10.1007/s004210050065Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B. Effects of cold-water immersion on health and wellbeing: a systematic review and meta-analysis. PLoS One. 2025;20(1):e0317615. doi:10.1371/journal.pone.0317615Buijze GA, Sierevelt IN, van der Heijden BC, Dijkgraaf MG, Frings-Dresen MH. The effect of cold showering on health and work: a randomized controlled trial. PLoS One. 2016;11(9):e0161749. doi:10.1371/journal.pone.0161749Cameron BE, Steele J, Bradley WJ, et al. Post-exercise recovery methods: a systematic review and meta-analysis. SportRxiv. Preprint posted September 19, 2026. doi:10.51224/SportRxiv.1070Roberts LA, Raastad T, Markworth JF, et al. Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. J Physiol. 2015;593(18):4285-4301. doi:10.1113/JP270570Piñero A, Burke R, Augustin F, et al. Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of postexercise cold water immersion on resistance training-induced hypertrophy. Eur J Sport Sci. 2024;24(2):177-189. doi:10.1002/ejsc.12074Liu G, Weinger JG, Lu ZL, Xue F, Sadeghpour S. Efficacy and safety of MMFS-01, a synapse density enhancer, for treating cognitive impairment in older adults: a randomized, double-blind, placebo-controlled trial. J Alzheimers Dis. 2016;49(4):971-990. doi:10.3233/JAD-150538Lopresti AL, Smith SJ. The effects of magnesium L-threonate (Magtein) on cognitive performance and sleep quality in adults: a randomised, double-blind, placebo-controlled trial. Front Nutr. 2025;12:1729164. doi:10.3389/fnut.2025.1729164Schuster J, Cycelskij I, Lopresti A, Hahn A. Magnesium bisglycinate supplementation in healthy adults reporting poor sleep: a randomized, placebo-controlled trial. Nat Sci Sleep. 2025;17:2027-2040. doi:10.2147/NSS.S524348Mah J, Pitre T. Oral magnesium supplementation for insomnia in older adults: a systematic review & meta-analysis. BMC Complement Med Ther. 2021;21(1):125. doi:10.1186/s12906-021-03297-zMori K, Inatomi S, Ouchi K, Azumi Y, Tuchida T. Improving effects of the mushroom Yamabushitake (Hericium erinaceus) on mild cognitive impairment: a double-blind placebo-controlled clinical trial. Phytother Res. 2009;23(3):367-372. doi:10.1002/ptr.2634Surendran G, Saye J, Binti Mohd Jalil S, et al. Acute effects of a standardised extract of Hericium erinaceus (Lion’s Mane mushroom) on cognition and mood in healthy younger adults: a double-blind randomised placebo-controlled study. Front Nutr. 2025;12:1405796. doi:10.3389/fnut.2025.1405796Prokopidis K, Moriarty F, Bahat G, McLean J, Church DD, Patel HP. The effect of nicotinamide mononucleotide and riboside on skeletal muscle mass and function: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2025;16(3):e13799. doi:10.1002/jcsm.13799Chen F, Zhou D, Kong AP, et al. Effects of nicotinamide mononucleotide on glucose and lipid metabolism in adults: a systematic review and meta-analysis of randomised controlled trials. Curr Diab Rep. 2024;25(1):4. doi:10.1007/s11892-024-01557-zBrakedal B, Skeie GO, Derad C, et al. Nicotinamide riboside for patients with early-stage Parkinson disease: the NOPARK randomized clinical trial. JAMA. Published online 2026. doi:10.1001/jama.2026.18828Sleivert G, Burke V, Palmer C, et al. The effects of deer antler velvet extract or powder supplementation on aerobic power, erythropoiesis, and muscular strength and endurance characteristics. Int J Sport Nutr Exerc Metab. 2003;13(3):251-265. doi:10.1123/ijsnem.13.3.251Syrotuik DG, MacFadyen KL, Harber VJ, Bell GJ. Effect of elk velvet antler supplementation on the hormonal response to acute and chronic exercise in male and female rowers. 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How much cardio should you do, and does more of it ever become harmful? Cardiorespiratory fitness keeps improving with training load and nobody has found a ceiling. Getting fitter keeps lowering mortality risk as far out as anyone has measured. The one dose dependent harm that survives scrutiny is atrial fibrillation, and it shows up around six to seven hours a week of hard endurance training sustained for years. This episode goes through the Danish jogging study behind the “fast running is as deadly as sitting on the couch” headlines and why two deaths in forty people can’t carry it, the much larger datasets that found no harm signal, and what changes when somebody measures fitness on a treadmill instead of asking people about minutes. Then atrial fibrillation, coronary calcium and heart scarring in lifelong endurance athletes, the sudden cardiac arrest numbers from 29 million race finishers, whether cardio interferes with lifting, fuel handling, weight loss and metabolic compensation, and bone density in cyclists. It closes with a rewritten version of the cardio guidelines, including volume, intensity, progression, and the fitness and health targets the real guidelines leave out. Timestamps 00:00 The jogging J-curve and the headlines02:42 The Danish study, its confidence interval, and what a MET measures08:02 Better measurement: 15 check-ins and fitness on a treadmill12:51 Atrial fibrillation: the dose, the mechanism, and stroke risk22:06 Coronary calcium and heart scarring in masters athletes25:58 The marathon death story and cardiac arrest rates29:08 How much training it takes to keep getting fitter34:12 Does cardio interfere with your lifting gains39:52 Flux, the athlete's paradox, and liver fat44:12 Cardio, weight loss, and metabolic compensation51:13 Bone density in cyclists and energy availability57:51 Writing the cardio guidelines Resources Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ Free Vital 5 Action Plan New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Get early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/ 1. Schnohr P, O'Keefe JH, Marott JL, Lange P, Jensen GB. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015. doi:10.1016/j.jacc.2014.11.023 2. Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015. doi:10.1001/jamainternmed.2015.0533 3. Lee DH, Rezende LFM, Joh HK, et al. Long-term leisure-time physical activity intensity and all-cause and cause-specific mortality: a prospective cohort of US adults. Circulation. 2022. doi:10.1161/CIRCULATIONAHA.121.058162 4. Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open. 2018. doi:10.1001/jamanetworkopen.2018.3605 5. Ekelund U, Tarp J, Steene-Johannessen J, et al. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ. 2019. doi:10.1136/bmj.l4570 6. Saulicz A, Abernethy D, Wraith D. Can too much exercise kill you? A systematic review of the risk of a cardiovascular event or death from long term strenuous exercise. Eur J Epidemiol. 2026. doi:10.1007/s10654-025-01353-3 7. Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975. 8. Davies CL, Pallikadavath S, March DS, et al. Physical activity, atrial fibrillation and the dose-response relationship: a systematic review and meta-analysis. Eur J Prev Cardiol. 2026. doi:10.1093/eurjpc/zwag535 9. Molina L, Mont L, Marrugat J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008. doi:10.1093/europace/eun071 10. Javed W, Botis I, Tomoaia R, et al. Clinical and cardiovascular magnetic resonance characteristics of veteran male endurance athletes with atrial fibrillation: VENTOUX-AF. J Am Heart Assoc. 2025. doi:10.1161/JAHA.125.042308 11. Liu B, Pagan E, Beccarino N, Chang D, Dulmovits E, Beldner S. Voltage mapping and pulmonary vein isolation in master athletes with atrial fibrillation. Pacing Clin Electrophysiol. 2022;45(11):1338-1342. doi:10.1111/pace.14602 12. Guasch E, Benito B, Qi X, et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol. 2013. doi:10.1016/j.jacc.2013.01.091 13. Flannery MD, Canovas R, Janssens K, et al. Atrial fibrillation in former world-class rowers: role of environmental and genetic factors. Eur Heart J. 2025. doi:10.1093/eurheartj/ehaf369 14. Johansen KR, Ranhoff AH, Sorensen E, et al. Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromso Study. Open Heart. 2022;9(2). doi:10.1136/openhrt-2022-002154 15. Apelland T, Letnes JM, Janssens K, et al. Arrhythmia burden, symptoms and quality of life in female and male endurance athletes with paroxysmal atrial fibrillation: a multicentre cohort study in Norway, Australia and Belgium. BMJ Open. 2025;15(8):e100496. doi:10.1136/bmjopen-2025-100496 16. Merghani A, Maestrini V, Rosmini S, et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation. 2017;136(2):126-137. doi:10.1161/CIRCULATIONAHA.116.026964 17. Aengevaeren VL, Mosterd A, Braber TL, et al. Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. Circulation. 2017;136(2):138-148. doi:10.1161/CIRCULATIONAHA.117.027834 18. Kim JH, Rim AJ, Miller JT, et al. Cardiac arrest during long-distance running races. JAMA. 2025;333(19):1699-1707. doi:10.1001/jama.2025.3026 19. Montero D, Cathomen A, Jacobs RA, et al. Haematological rather than skeletal muscle adaptations contribute to the increase in peak oxygen uptake induced by moderate endurance training. J Physiol. 2015;593(20):4677-4688. doi:10.1113/JP270250 20. Molmen KS, Almquist NW, Skattebo O. Effects of exercise training on mitochondrial and capillary growth in human skeletal muscle: a systematic review and meta-regression. Sports Med. 2025;55(1):115-144. doi:10.1007/s40279-024-02120-2 21. Church TS, Earnest CP, Skinner JS, Blair SN. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. JAMA. 2007. 22. Hickson RC. Interference of strength development by simultaneously training for strength and endurance. Eur J Appl Physiol Occup Physiol. 1980. 23. Schumann M, Feuerbacher JF, Sunkeler M, et al. Compatibility of concurrent aerobic and strength training for skeletal muscle size and function: an updated systematic review and meta-analysis. Sports Med. 2022. doi:10.1007/s40279-021-01587-7 24. Lundberg TR, Feuerbacher JF, Sunkeler M, Schumann M. The effects of concurrent aerobic and strength training on muscle fiber hypertrophy: a systematic review and meta-analysis. Sports Med. 2022;52(10):2391-2403. doi:10.1007/s40279-022-01688-x 25. Feuerbacher JF, Jacobs MW, Heumann P, Pareja-Blanco F, Hackney AC, Zacher J, Schumann M. Neuromuscular adaptations to same versus separate muscle-group concurrent aerobic and strength training in recreationally active males and females. Scand J Med Sci Sports. 2025;35(2):e70025. doi:10.1111/sms.70025 26. Montero D, Lundby C. Refuting the myth of non-response to exercise training: 'non-responders' do respond to higher dose of training. J Physiol. 2017. doi:10.1113/JP273480 27. Mezincescu AM, Rudd A, Cheyne L, et al. Comparison of intramyocellular lipid metabolism in patients with diabetes and male athletes. Nat Commun. 2024;15(1):3690. doi:10.1038/s41467-024-47843-y 28. Keating SE, Hackett DA, Parker HM, et al. Effect of aerobic exercise training dose on liver fat and visceral adiposity. J Hepatol. 2015;63(1):174-182. doi:10.1016/j.jhep.2015.02.022 29. Pearson RC, Cogan B, Garcia SA, Jenkins NT. Effect of prior exercise on postprandial lipemia: an updated meta-analysis and systematic review. Int J Sport Nutr Exerc Metab. 2022;32(6):501-518. doi:10.1123/ijsnem.2022-0043 30. Ross R, Hudson R, Stotz PJ, Lam M. Effects of exercise amount and intensity on abdominal obesity and glucose tolerance in obese adults: a randomized trial. Ann Intern Med. 2015. doi:10.7326/M14-1189 31. Westerterp KR, Meijer GA, Janssen EM, Saris WH, ten Hoor F. Long-term effect of physical activity on energy balance and body composition. 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How much resistance training do you actually need, and is there a point where more stops helping? We trace the "lift weights twice a week" recommendation back to the 1989 study it came from, which found that three days beat two, and to the citation loop that turned it into a guideline anyway. Then we go through the evidence on whether lifting is dangerous, including the heart, injury rates, and the J-shaped mortality curve, and work out where the dose-response actually saturates for strength, muscle mass, bone mineral density, and how your body handles fuel. The short answer is that almost every number in this literature marks where a benefit starts, and very little of it goes far enough to show where a benefit stops. We finish by writing the resistance training guideline the way we think it should be written, with target outcomes, a training dose, and testable targets. Timestamps  00:00 Where the "lift weights twice a week" rule came from 04:18 What actually counts as resistance training 06:56 Does lifting make your heart wall thicker 15:34 Anabolic steroids and the heart 19:16 Injury rates and cardiac arrest at the gym 22:03 How the lifting J-curve got made 28:05 ACSM audits its own recommendation 31:11 Strength: where the plateau actually sits 35:49 Why grip strength can't answer this 41:43 Muscle mass versus muscle function 44:50 Bone, and the turkey wing that settled the dose 49:50 Fuel handling, insulin sensitivity, and the clock 1:00:46 The 2018 guidelines, and how I would write themResources Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Get early access, ad-free listening, and exclusive content here: https://barbellmedicine.supercast.com/ Braith RW, Graves JE, Pollock ML, Leggett SL, Carpenter DM, Colvin AB. 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Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart. Heart. 2013;99(23):1727-1733. doi:10.1136/heartjnl-2012-303465. PMID 23474689.Smit DL, Voogel AJ, den Heijer M, de Ronde W. Anabolic androgenic steroids induce reversible left ventricular hypertrophy and cardiac dysfunction: echocardiography results of the HAARLEM study. Front Reprod Health. 2021;3:732318. doi:10.3389/frph.2021.732318. PMID 36304014.Abdullah R, Bjørnebekk A, Hauger LE, Hullstein IR, Edvardsen T, Haugaa KH, Almaas VM. Severe biventricular cardiomyopathy in both current and former long-term users of anabolic-androgenic steroids. Eur J Prev Cardiol. 2024;31(5):599-608. doi:10.1093/eurjpc/zwad362. PMID 37992194.Keogh JWL, Winwood PW. The epidemiology of injuries across the weight-training sports. Sports Med. 2017;47(3):479-501. doi:10.1007/s40279-016-0575-0. PMID 27328853.Aasa U, Svartholm I, Andersson F, Berglund L. Injuries among weightlifters and powerlifters: a systematic review. Br J Sports Med. 2017;51(4):211-219. doi:10.1136/bjsports-2016-096037. PMID 27707741.Page RL, Husain S, White LY, et al. Cardiac arrest at exercise facilities: implications for placement of automated external defibrillators. J Am Coll Cardiol. 2013;62(22):2102-2109. doi:10.1016/j.jacc.2013.06.048. PMID 23933539.Hollings M, Mavros Y, Freeston J, Fiatarone Singh M. The effect of progressive resistance training on aerobic fitness and strength in adults with coronary heart disease: a systematic review and meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 2017;24(12):1242-1259. doi:10.1177/2047487317713329.Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. Br J Sports Med. 2022;56(13):755-763. doi:10.1136/bjsports-2021-105061. PMID 35228201.O'Keefe JH, O'Keefe EL, Eckert R, Lavie CJ. Training strategies to optimize cardiovascular durability and life expectancy. Mo Med. 2023;120(2):155-162. PMID 37091937. PMCID PMC10121111.Currier BS, McLeod JC, Banfield L, et al. American College of Sports Medicine position stand: resistance training prescription for muscle function, hypertrophy, and physical performance in healthy adults: an overview of reviews. Med Sci Sports Exerc. 2026;58(4):851-872. PMID 41843416.Ralston GW, Kilgore L, Wyatt FB, Buchan D, Baker JS. Weekly training frequency effects on strength gain: a meta-analysis. Sports Med Open. 2018;4(1):36. doi:10.1186/s40798-018-0149-9. PMID 30076500.Pelland JC, Remmert JF, Robinson ZP, Hinson SR, Zourdos MC. The resistance training dose response: meta-regressions exploring the effects of weekly volume and frequency on muscle hypertrophy and strength gains. Sports Med. 2026;56(2):481-505. doi:10.1007/s40279-025-02344-w. PMID 41343037.Ortega FB, Silventoinen K, Tynelius P, Rasmussen F. Muscular strength in male adolescents and premature death: cohort study of one million participants. BMJ. 2012;345:e7279. doi:10.1136/bmj.e7279. PMID 23144234.Ruiz JR, Sui X, Lobelo F, et al. Association between muscular strength and mortality in men: prospective cohort study. BMJ. 2008;337:a439. doi:10.1136/bmj.a439. PMID 18595904.Timpka S, Petersson IF, Zhou C, Englund M. Muscle strength in adolescent men and risk of cardiovascular disease events and mortality in middle age. BMC Med. 2014;12:62. doi:10.1186/1741-7015-12-62. PMID 24731728.Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273. doi:10.1016/S0140-6736(14)62000-6. PMID 25982160.Tieland M, Verdijk LB, de Groot LCPGM, van Loon LJC. Handgrip strength does not represent an appropriate measure to evaluate changes in muscle strength during an exercise intervention program in frail older people. Int J Sport Nutr Exerc Metab. 2015;25(1):27-36. doi:10.1123/ijsnem.2013-0123. PMID 24903908.Grgic J, Garofolini A, Orazem J, Sabol F, Schoenfeld BJ, Pedisic Z. Effects of resistance training on muscle size and strength in very elderly adults: a systematic review and meta-analysis of randomized controlled trials. Sports Med. 2020;50(11):1983-1999. doi:10.1007/s40279-020-01331-7. PMID 32740889.Huebner M, Riemann B, Hatchett A. Grip strength and sports performance in competitive master weightlifters. Int J Environ Res Public Health. 2023;20(3):2033. doi:10.3390/ijerph20032033. PMID 36767396.López-Bueno R, Andersen LL, Koyanagi A, et al. Thresholds of handgrip strength for all-cause, cancer, and cardiovascular mortality: a systematic review with dose-response meta-analysis. Ageing Res Rev. 2022;82:101778. doi:10.1016/j.arr.2022.101778.MacDonald HV, Johnson BT, Huedo-Medina TB, et al. Dynamic resistance training as stand-alone antihypertensive lifestyle therapy: a meta-analysis. J Am Heart Assoc. 2016;5(10):e003231. doi:10.1161/JAHA.116.003231. PMID 27680663.Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID 32150289.Cawthon PM,

Nearly every warning you've heard about lifting weights was written down before anybody checked it. We trace where those warnings came from, starting with a Harvard student in 1854 and ending with a curve on a graph that's being used today to argue you can lift too much. Along the way: the men who built themselves with barbells and then sold the public five-pound dumbbells, because iron was expensive to mail and a booklet cost pennies. The muscle-bound myth, which nobody could define when a graduate student surveyed 45 physiologists about it. The 1961 report that took the deep squat out of every branch of the American military, measured with a device its author built himself and never validated. The claim that lifting stunts a child's growth, which no professional body ever actually made. And the argument women got, which was never about injury at all. Timestamps: 0:00 Intro2:33 2,500 years of people picking up heavy things7:24 George Windship and the Health Lift10:56 Blaikie's truck horse and the muscle-bound myth14:59 Bernarr Macfadden19:39 Charles Atlas and Dynamic Tension27:01 Carl Klein, a homemade device, and the parallel squat30:57 Thomas Delorme and three sets of ten35:20 Kids, growth plates, and where the stunting idea came from41:43 Women, "you'll get bulky," and Dudley Sargent in 191250:05 Pregnancy, from 1949 to a 2025 barbell study53:40 The pattern, and the curve on next week's graph Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com 1. Downs DS, Chasan-Taber L, Evenson KR, Leiferman J, Yeo S. Physical activity and pregnancy: past and present evidence and future recommendations. Res Q Exerc Sport. 2012;83(4):485-502. doi:10.1080/02701367.2012.10599138. PMID 23367811. 2. McMurray RG, Mottola MF, Wolfe LA, Artal R, Millar L, Pivarnik JM. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc. 1993;25(12):1305-1321. PMID 8107536. 3. Smith KM, Campbell CG. Physical activity during pregnancy: impact of applying different physical activity guidelines. J Pregnancy. 2013;2013:165617. doi:10.1155/2013/165617. PMID 23476778. 4. American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 804. Obstet Gynecol. 2020;135(4):e178-e188. doi:10.1097/AOG.0000000000003772. PMID 32217980. 5. American Academy of Pediatrics Committee on Sports Medicine and Fitness. Strength training by children and adolescents. Pediatrics. 2001;107(6):1470-1472. doi:10.1542/peds.107.6.1470. PMID 11389279. 6. Stricker PR, Faigenbaum AD, McCambridge TM; Council on Sports Medicine and Fitness. Resistance training for children and adolescents. Pediatrics. 2020;145(6):e20201011. doi:10.1542/peds.2020-1011. PMID 32457216. 7. Gardiner EN. Athletics of the Ancient World. Clarendon Press; 1930:54. See also Gardiner EN. Olympia: Its History and Remains. Clarendon Press; 1925. 8. Heffernan C. The Bybon stone and ancient strength. Physical Culture Study. 2021. Accessed September 2026. https://physicalculturestudy.com. 9. Pausanias. Description of Greece. 6.14.5. Jones WHS, trans. Loeb Classical Library. Harvard University Press. 10. Quintilian. Institutio Oratoria. 1.9.5. Butler HE, trans. Loeb Classical Library. Harvard University Press. 11. Heffernan C. Milo of Croton and the invention of progressive overload. Physical Culture Study. 2026. Accessed September 2026. https://physicalculturestudy.com. See also H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin, Milo Bar-Bell Company holdings. 12. Liddell HG, Scott R. A Greek-English Lexicon. 9th ed. Clarendon Press; entry γυμνάσιον. Thucydides. History of the Peloponnesian War. 1.6. Crawley R, trans. 13. Tomlinson RA. Gymnasium. In: Oxford Classical Dictionary. Oxford University Press; 2015. doi:10.1093/acrefore/9780199381135.013.2963. See also Stavrou D. The Greek Gymnasium [thesis]. University of Leicester; 2016:38. 14. Xenophon. Constitution of the Lacedaimonians. 1.4. Marchant EC, trans. Loeb Classical Library. Harvard University Press. 15. Plutarch. Life of Lycurgus. 14. Perrin B, trans. Loeb Classical Library. Harvard University Press. 16. Ollier F. Le Mirage Spartiate. Vols 1-2. Boccard; 1933-1943. Discussed in Rahe PA. The Grand Strategy of Classical Sparta. Yale University Press; 2016. See also Christesen P. Utopia on the Eurotas: Economic Aspects of the Spartan Mirage. In: Powell A, Hodkinson S, eds. Sparta: The Body Politic. Classical Press of Wales; 2010. 17. Pausanias. Description of Greece. 5.16. Jones WHS, trans. Loeb Classical Library. Harvard University Press. 18. Scarborough J. Galen and the gladiators. Episteme. 1971;5:98-111. 19. Tipton CM. The history of "Exercise Is Medicine" in ancient civilizations. Adv Physiol Educ. 2014;38(2):109-117. doi:10.1152/advan.00136.2013. PMCID PMC4056176. 20. Vegetius FR. De Re Militari (The Military Institutions of the Romans). Book I. Clarke J, trans. 1767. 21. Surviving halteres: a catalogue. EXARC Journal. 2017;(3). Accessed September 2026. https://exarc.net. 22. Talaga M. Physical culture in the Middle Ages: revisiting the disappearance thesis. Cogent Arts Humanit. 2025. doi:10.1080/23311983.2025.2482388. 23. Rawcliffe C. Health and the environment in the medieval hospital. History. 2022. doi:10.1111/1468-229X.13238. 24. Elyot T. The Boke Named the Governour. 1531. Croft HHS, ed. Kegan Paul; 1883:171. 25. Campillo P, Caballero D. Girolamo Mercuriale and the art of gymnastics. Hektoen International. 2020. Accessed September 2026. https://hekint.org. 26. Todd T. The myth of the muscle-bound lifter. NSCA J. 1985;7(3):37-41. Citing Van Doren C. Benjamin Franklin. Viking Press; 1938. 27. Galen. Exhortation to the Study of the Arts (Protrepticus). Chapters 9-14. Walsh J, trans. Medical Life. 1930;37:507-529. See also Xenophontos S. Galen's Exhortation to the Study of Medicine. In: Bouras-Vallianatos P, Xenophontos S, eds. Greek Medical Literature and Its Readers. Routledge; 2018:67-93. 28. Todd J. "Strength is Health": George Barker Windship and the first American weight training boom. Iron Game History. 1993;3(1):3-14. https://starkcenter.org/igh/igh-v3/igh-v3-n1/igh0301c.pdf. 29. Windship GB. Autobiographical sketches of a strength-seeker. Atlantic Monthly. 1862;9(51):102-115. 30. US Patent 46,413. Improvement in graduated dumb-bells. GB Windship, Boston. Granted 14 February 1865. 31. Savage DF. US Patent 28,505. 1860. 32. The Health-Lift Reduced to a Science: Cumulative Exercise, A Thorough Gymnastic System in Ten Minutes Once a Day. New York: Health-Lift Company; 1875. 33. Blaikie W. How to Get Strong and How to Stay So. New York: Harper & Brothers; 1879:99-100. 34. Bryant D. William Blaikie and physical fitness in late nineteenth century America. Iron Game History. 1992;2(3):3. 35. Sandow E. Sandow on Physical Training. Adam GM, ed. 1894:12, 23, 207. 36. Sandow E. Strength and How to Obtain It. London: Gale & Polden; 1897:34, Table 7. 37. Sandow E. Strength and How to Obtain It. Revised ed. London: Gale & Polden; [c1899]. Project Gutenberg ebook 65987. 38. Todd J, Todd T. Requiem for a strongman: reassessing the career of Professor Louis Attila. Iron Game History. 2002;7(2-3):42-55. 39. Pall Mall Gazette. December 1889. Clipping in Attila's scrapbook, Todd-McLean Collection, H.J. Lutcher Stark Center, University of Texas at Austin. 40. Chapman D. Sandow's first triumph. Iron Game History. 1994;3(3):3-8. 41. Robert Hoffman Business Papers finding aid. H.J. Lutcher Stark Center for Physical Culture and Sports, University of Texas at Austin. 42. Hall DT, Fair JD. The pioneers of protein. Iron Game History. 2004;8(3):26-28. 43. Shurley J, Todd J. Joe Weider, All American Athlete, and the promotion of strength training for sport: 1940-1969. Iron Game History. 2012;12(1):9-12. 44. Todd J. Bernarr Macfadden: reformer of feminine form. Iron Game History. 1991;1(4-5):3-8. 45. Yagoda B. The true story of Bernarr Macfadden. American Heritage. 1981;33(1):22-28. 46. Murtha R, Heffernan C, Hunt T. Building American supermen? Bernarr MacFadden, Benito Mussolini and American fascism in the 1930s. Sport in Society. 2020. doi:10.1080/17430437.2020.1865313. 47. New York Times. 6 October 1905:10; 10 October 1905:9. 48. Macfadden B. Macfadden's Encyclopedia of Physical Culture. New York: Physical Culture Publishing; 1912:847. Quoted in Todd T, NSCA J. 1985;7(3):37-41. 49. Danna S. Charles Atlas: muscle man. Iron Game History. 1996;4(4):3-6, 12-14. https://starkcenter.org/igh/igh-v4/igh-v4-n4/igh0404c.pdf. 50. Guide to the Charles Atlas Records, NMAH.AC.0654. Archives Center, National Museum of American History, Smithsonian Institution. 51. Charles Atlas course text, undated later edition. 52. Charles P. Roman: a gloriously healthy life. Chief Marketer. 53. Kannenberg G Jr. The ad that made an icon out of Mac. Hogan's Alley. 1999;2(3). 54. Michigan State University Libraries comic art index, Charles Atlas advertisements. https://comics.lib.msu.edu/rri/arri/atlas.htm. 55. Charles Atlas. Encyclopedia.com. 56. Todd J, Todd T. The conversion of Dr. Peter Karpovich. Iron Game History. 2005;8(4):4-12. https://starkcenter.org/igh/igh-v8/igh-v8-n4/igh0804c.pdf. 57. Murray J, Karpovich P. Weight Training in Athletics. Englewood Cliffs, NJ: Prentice-Hall; 1956. 58. Murray J. John Carrol Grimek: the nonpareil. Iron Game History. 1994;3(3):10-12. 59. Zorbas WS, Karpovich PV. The effect of weight lifting upon the speed of muscular contractions. Res Q. 1951;22(2):145-148. 60. Klein KK. The deep squat exercise as utilized in weight training for athletes and its effect on the ligaments of the knee. J Assoc Phys Ment Rehabil. 1961;15(1):6-11, 23. 61. Sports Illustrated. C

Parts of the country now get a few weeks of wildfire smoke every year, and the obvious question is whether there is a point where the air is bad enough that the workout costs you more than it gives you. We went and looked. There is a real number, it comes from about 1.5 million people, and it is not the number that gets quoted. This is a free preview of Direct Line, our monthly ask-us-anything for Barbell Medicine Plus subscribers. Two of this month's twelve questions are here in full. First: training in wildfire smoke. What PM2.5 is, why the AQI on your phone and the number in the paper are not the same quantity, where the 90-minutes-at-100-micrograms figure comes from and why it is softer than it sounds, what happened when six cities modeled telling people to stay inside, and why your breathing rate during a set of squats matters more than you would think. Second: the effective reps model. A subscriber noticed that if a set only counts when you are within five reps of failure, the triceps in a heavy bench press should not count, and if you are going to count that as a fractional set for the triceps, then a warm-up set counts for the chest. Both cannot be true. We go through the meta-regression on proximity to failure, the 67-study analysis that tested whether an indirect set should count as one, as half, or as zero, and where we actually put our sets. Join Barbell Medicine Plus today: https://barbellmedicine.supercast.com/ Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Timestamps 1:47 The question: is there a point where the air is too bad to train?2:37 What PM2.5 actually is3:05 AQI vs micrograms, and why your phone disagrees with the paper3:50 Where the "90 minutes" number comes from4:54 Austin: what breathing this air does to your lungs9:14 1.5 million adults: does dirty air cancel the benefit of exercise?10:44 Six cities modeled staying indoors. Mortality did not improve.11:22 Lifting vs cycling: breathing rate is the whole mechanism12:33 Indoor air during a wildfire, and what filtration does not fix13:24 Is wildfire smoke worse than city pollution?14:38 What we would actually tell a patient18:35 The question: hard sets, fractional sets, and the five-rep rule19:18 Reps in reserve, hard sets, and fractional sets defined20:19 The meta-regression: no threshold, just a line21:13 Do indirect sets count as half a set?23:08 Would you rather: every set at 5 RIR, or every set to failure?25:22 Why you get worse at judging RIR the further you are from failure28:42 The numbers we use: RPE 7 to 9 for hypertrophy, 4 to 6 for strength29:20 Austin: individual variation dwarfs all of this33:28 Why nobody can measure training load in the weight room Resources Tainio M, de Nazelle AJ, Götschi T, et al. Can air pollution negate the health benefits of cycling and walking? Prev Med. 2016;87:233-236. doi:10.1016/j.ypmed.2016.02.002. PMID 27156248 Ku PW, Steptoe A, Hamer M, et al. Does ambient PM2.5 reduce the protective association of leisure-time physical activity with mortality? A systematic review, meta-analysis, and individual-level pooled analysis of cohort studies involving 1.5 million adults. BMC Med. 2025;23(1):647. doi:10.1186/s12916-025-04496-y. PMID 41310726 Giallouros G, Kouis P, Papatheodorou SI, Woodcock J, Tainio M. The long-term impact of restricting cycling and walking during high air pollution days on all-cause mortality: health impact assessment study. Environ Int. 2020;140:105679. doi:10.1016/j.envint.2020.105679. PMID 32353667 Sun S, Cao W, Qiu H, et al. Benefits of physical activity not affected by air pollution: a prospective cohort study. Int J Epidemiol. 2020;49(1):142-152. doi:10.1093/ije/dyz184. PMID 31504557 Robles P, Araujo T, Brooks D, et al. Cardiorespiratory responses to short bouts of resistance training exercises in individuals with chronic obstructive pulmonary disease: a comparison of exercise intensities. J Cardiopulm Rehabil Prev. 2017;37(5):356-362. doi:10.1097/HCR.0000000000000282. PMID 28858033 Liang Y, Sengupta D, Campmier MJ, Lunderberg DM, Apte JS, Goldstein AH. Wildfire smoke impacts on indoor air quality assessed using crowdsourced data in California. Proc Natl Acad Sci U S A. 2021;118(36):e2106478118. doi:10.1073/pnas.2106478118. PMID 34465624 Aguilera R, Corringham T, Gershunov A, Benmarhnia T. Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California. Nat Commun. 2021;12(1):1493. doi:10.1038/s41467-021-21708-0. PMID 33674571 US Environmental Protection Agency. Air Quality Index (AQI) breakpoints. Air Quality System code tables. Accessed August 10, 2026. https://aqs.epa.gov/aqsweb/documents/codetables/aqi_breakpoints.html Robinson ZP, Pelland JC, Remmert JF, Refalo MC, Jukic I, Steele J, et al. Exploring the dose-response relationship between estimated resistance training proximity to failure, strength gain, and muscle hypertrophy: a series of meta-regressions. Sports Med. 2024;54(9):2209-2231. doi:10.1007/s40279-024-02069-2. PMID 38970765 Pelland JC, Remmert JF, Robinson ZP, Hinson SR, Zourdos MC. The resistance training dose response: meta-regressions exploring the effects of weekly volume and frequency on muscle hypertrophy and strength gains. Sports Med. 2026;56(2):481-505. doi:10.1007/s40279-025-02344-w Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

Most lifters have been told they need to eat in a Calorie surplus to build muscle. That rule has always come with a list of exceptions: unless you're new, unless you're carrying extra body fat, unless you're coming back from time off. Dr. Eric Helms joins Dr. Jordan Feigenbaum to work out what the rule is actually tracking, starting from a question with a real number attached: what does a pound of muscle cost to build? And then, do you need to be in a surplus to build muscle?  Timestamps: 0:00 The rule, and its exceptions2:08 Where "you need a surplus" came from7:12 Heuristics versus theories11:40 Hypertrophy, maintenance, deficit and surplus defined14:58 Body fat as a savings account18:24 How fast anyone can actually build muscle23:39 What sets the ceiling: stimulus, not genetics26:37 Microgravity, astronauts, and a 20 kg barbell31:49 What constrains growth if steroids don't break the ceiling36:44 If training sets the ceiling, what does energy do38:45 What 1 kg of muscle costs to build44:05 Why 3,500 Calories doesn't tell you what to eat44:55 REDs and the dual intervention model47:51 The 2000s bulking studies51:34 Garthe 2013: elite athletes and a 500 Calorie surplus58:30 Protein: 1.6 versus 2.5 g/kg1:03:31 What starvation research shows the body protects1:10:29 Vargas-Molina: maintenance versus deficit1:19:17 What to do if you're lean1:39:34 What would prove this wrong1:57:57 Three buckets Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Nikolaidis MG, Paschalis V, Margaritelis NV. The energetic cost of building human skeletal muscle. bioRxiv. Preprint posted online August 17, 2026. doi:10.64898/2026.08.17.745156Rozenek R, Ward P, Long S, Garhammer J. Effects of high-calorie supplements on body composition and muscular strength following resistance training. J Sports Med Phys Fitness. 2002;42(3):340-347.Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot-Borgen J. Effect of two different weight-loss rates on body composition and strength and power-related performance in elite athletes. Int J Sport Nutr Exerc Metab. 2011;21(2):97-104.Garthe I, Raastad T, Refsnes PE, Sundgot-Borgen J. Effect of nutritional intervention on body composition and performance in elite athletes. Eur J Sport Sci. 2013;13(3):295-303. doi:10.1080/17461391.2011.643923Helms ER, Zinn C, Rowlands DS, Brown SR. A systematic review of dietary protein during caloric restriction in resistance trained lean athletes: a case for higher intakes. Int J Sport Nutr Exerc Metab. 2014;24(2):127-138. doi:10.1123/ijsnem.2013-0054Slater GJ, Dieter BP, Marsh DJ, Helms ER, Shaw G, Iraki J. Is an energy surplus required to maximize skeletal muscle hypertrophy associated with resistance training. Front Nutr. 2019;6:131. doi:10.3389/fnut.2019.00131Murphy C, Koehler K. Energy deficiency impairs resistance training gains in lean mass but not strength: a meta-analysis and meta-regression. Scand J Med Sci Sports. 2022;32(1):125-137. doi:10.1111/sms.14075Helms ER, Spence A, Sousa C, et al. Effect of small and large energy surpluses on strength, muscle, and skinfold thickness in resistance-trained individuals: a parallel groups design. Sports Med Open. 2023;9(1):102. doi:10.1186/s40798-023-00651-yMountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 2023;57(17):1073-1097. doi:10.1136/bjsports-2023-106994Speakman JR, Hall KD. Models of body weight and fatness regulation. Philos Trans R Soc Lond B Biol Sci. 2023;378(1888):20220231. doi:10.1098/rstb.2022.0231Vargas-Molina S, García-Palumbo A, García-Sillero M, et al. Comparison of two nutritional protocols in body re-composition of resistance-trained participants. Eur J Appl Physiol. 2026;126(7):4019-4030. doi:10.1007/s00421-026-06209-6 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

Muscle is where most of the glucose goes, and muscle insulin resistance is the first thing that breaks on the road to type 2 diabetes. Both of those are true, and neither one means that building more muscle is the treatment for obesity. This episode works through what actually decides whether a tissue handles fuel well: not how much of it you have, but how fast it's moving fuel through. We go through the one-legged exercise studies, the 18,000-person analysis of what body composition actually predicts, the athlete's paradox, the energy cost of building a kilogram of muscle, the GLP-1 lean mass panic, and why sarcopenic obesity is named after the wrong organ. This is part two of a two-part series on storage capacity. Part one covered where body fat goes and what happens when the storage runs out.  Timestamps 0:00   The one-leg study, and the muscle-centric claim02:06   What obesity is, and the garage analogy05:06   How glucose gets into a muscle cell11:21   Insulin sensitivity improves without building muscle17:11   The best case for muscle-centric medicine21:13   What predicts falls and death: strength, not lean mass25:18   Separating muscle size from muscle function31:33   Liver fat: amount, type, and flux37:54   Should you build muscle first? The arithmetic42:37   Building muscle in a calorie deficit50:29   GLP-1s, DXA, and the lean mass panic58:23   Sarcopenic obesity, and why the name is wrong01:04:37 Why size still tells you something01:11:46 So what is obesity? Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com 1.   Richter EA, Mikines KJ, Galbo H, Kiens B. Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol (1985). 1989;66(2):876-885. doi:10.1152/jappl.1989.66.2.876. PMID: 2496078. https://doi.org/10.1152/jappl.1989.66.2.876 2.   Cawthon PM, Travison TG, Manini TM, et al. Establishing the link between lean mass and grip strength cut points with mobility disability and other health outcomes. J Gerontol A Biol Sci Med Sci. 2020;75(7):1317-1323. doi:10.1093/gerona/glz081. PMID: 30869772. https://doi.org/10.1093/gerona/glz081 3.   Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID: 32150289. https://doi.org/10.1111/jgs.16372 4.   Elgaddal N, Kramarow EA, Reuben C. Physical activity among adults aged 18 and over: United States, 2020. NCHS Data Brief No. 443. Hyattsville, MD: National Center for Health Statistics; 2022. PMID: 36043905. https://www.cdc.gov/nchs/products/databriefs/db443.htm 5.   Whitfield GP, Carlson SA, Ussery EN, Fulton JE, Galuska DA, Petersen R. Trends in meeting physical activity guidelines among urban and rural dwelling adults, United States, 2008-2017. MMWR Morb Mortal Wkly Rep. 2019;68(23):513-518. doi:10.15585/mmwr.mm6823a1. PMID: 31194722. https://doi.org/10.15585/mmwr.mm6823a1 6.   Wang T, Wang J, Hu X, Huang XJ, Chen GX. Current understanding of glucose transporter 4 expression and functional mechanisms. World J Biol Chem. 2020;11(3):76-98. doi:10.4331/wjbc.v11.i3.76. PMID: 33274014. https://doi.org/10.4331/wjbc.v11.i3.76 7.   DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S157-S163. doi:10.2337/dc09-S302. PMID: 19875544. https://doi.org/10.2337/dc09-S302 8.   Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993-1017. doi:10.1152/physrev.00038.2012. PMID: 23899560. https://doi.org/10.1152/physrev.00038.2012 9.   Petersen KF, Dufour S, Savage DB, et al. The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome. Proc Natl Acad Sci U S A. 2007;104(31):12587-12594. doi:10.1073/pnas.0705408104. PMID: 17640906. https://doi.org/10.1073/pnas.0705408104 10. Rabøl R, Petersen KF, Dufour S, Flannery C, Shulman GI. Reversal of muscle insulin resistance with exercise reduces postprandial hepatic de novo lipogenesis in insulin resistant individuals. Proc Natl Acad Sci U S A. 2011;108(33):13705-13709. doi:10.1073/pnas.1110105108. PMID: 21808028. https://doi.org/10.1073/pnas.1110105108 11. Perseghin G, Price TB, Petersen KF, et al. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. N Engl J Med. 1996;335(18):1357-1362. doi:10.1056/NEJM199610313351804. PMID: 8857019. https://doi.org/10.1056/NEJM199610313351804 12. Mikines KJ, Sonne B, Farrell PA, Tronier B, Galbo H. Effect of physical exercise on sensitivity and responsiveness to insulin in humans. Am J Physiol. 1988;254(3 Pt 1):E248-E259. doi:10.1152/ajpendo.1988.254.3.E248. PMID: 3126668. https://doi.org/10.1152/ajpendo.1988.254.3.E248 13. Mikines KJ, Sonne B, Tronier B, Galbo H. Effects of acute exercise and detraining on insulin action in trained men. J Appl Physiol (1985). 1989;66(2):704-711. doi:10.1152/jappl.1989.66.2.704. PMID: 2496077. https://doi.org/10.1152/jappl.1989.66.2.704 14. Yu R, Duncombe SL, Nemoto Y, et al. Physical activity trajectories and mortality. Br J Sports Med. 2025;59(17):1228-1241. doi:10.1136/bjsports-2024-109122. PMID: 40639966. https://doi.org/10.1136/bjsports-2024-109122 15. Saint-Maurice PF, Coughlan D, Kelly SP, et al. Association of leisure-time physical activity across the adult life course with all-cause and cause-specific mortality. JAMA Netw Open. 2019;2(3):e190355. doi:10.1001/jamanetworkopen.2019.0355. PMID: 30848809. https://doi.org/10.1001/jamanetworkopen.2019.0355 16. Wang Y, Luo D, Liu J, Song Y, Jiang B, Jiang H. Low skeletal muscle mass index and all-cause mortality. PLoS One. 2023;18(6):e0286745. doi:10.1371/journal.pone.0286745. PMID: 37288745. https://doi.org/10.1371/journal.pone.0286745 17. Umpierre D, Ribeiro PAB, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA. 2011;305(17):1790-1799. doi:10.1001/jama.2011.576. PMID: 21540423. https://doi.org/10.1001/jama.2011.576 18. Goodpaster BH, Carlson CL, Visser M, et al. Attenuation of skeletal muscle and strength in the elderly: the Health ABC Study. J Appl Physiol (1985). 2001;90(6):2157-2165. doi:10.1152/jappl.2001.90.6.2157. PMID: 11356778. https://doi.org/10.1152/jappl.2001.90.6.2157 19. Paquin J, Lagacé JC, Brochu M, Dionne IJ. Exercising for insulin sensitivity, is there a mechanistic relationship with quantitative changes in skeletal muscle mass? Front Physiol. 2021;12:656909. doi:10.3389/fphys.2021.656909. PMID: 34054574. https://doi.org/10.3389/fphys.2021.656909 20. Eriksson J, Taimela S, Eriksson K, Parviainen S, Peltonen J, Kujala U. Resistance training in the treatment of non-insulin-dependent diabetes mellitus. Int J Sports Med. 1997;18(4):242-246. doi:10.1055/s-2007-972627. PMID: 9231838. https://doi.org/10.1055/s-2007-972627 21. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A, Tildesley HD, Frohlich JJ. Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care. 2003;26(11):2977-2982. doi:10.2337/diacare.26.11.2977. PMID: 14578226. https://doi.org/10.2337/diacare.26.11.2977 22. Bucci M, Huovinen V, Guzzardi MA, et al. Resistance training improves skeletal muscle insulin sensitivity in elderly offspring of overweight and obese mothers. Diabetologia. 2016;59(1):77-86. doi:10.1007/s00125-015-3780-8. PMID: 26486356. https://doi.org/10.1007/s00125-015-3780-8 23. Mavros Y, Kay S, Anderberg KA, et al. Changes in insulin resistance and HbA1c are related to exercise-mediated changes in body composition in older adults with type 2 diabetes: interim outcomes from the GREAT2DO trial. Diabetes Care. 2013;36(8):2372-2379. doi:10.2337/dc12-2196. PMID: 23474589. https://doi.org/10.2337/dc12-2196 24. Janssen I, Heymsfield SB, Wang ZM, Ross R. Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr. J Appl Physiol (1985). 2000;89(1):81-88. doi:10.1152/jappl.2000.89.1.81. PMID: 10904038. https://doi.org/10.1152/jappl.2000.89.1.81 25. Orwoll ES, Peters KE, Hellerstein M, Cummings SR, Evans WJ, Cawthon PM. The importance of muscle versus fat mass in sarcopenic obesity: a re-evaluation using D3-creatine muscle mass versus DXA lean mass measurements. J Gerontol A Biol Sci Med Sci. 2020;75(7):1362-1368. doi:10.1093/gerona/glaa064. PMID: 32232396. https://doi.org/10.1093/gerona/glaa064 26. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JFP, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes. 2004;53(2):294-305. doi:10.2337/diabetes.53.2.294. PMID: 14747278. https://doi.org/10.2337/diabetes.53.2.294 27. Manca A, Dragone D, Dvir Z, Deriu F. Cross-education of muscular strength following unilateral resistance training: a meta-analysis. Eur J Appl Physiol. 2017;117(11):2335-2354. doi:10.1007/s00421-017-3720-z. PMID: 28936703. https://doi.org/10.1007/s00421-017-3720-z 28. Bilet L, Phielix E, van de Weijer T, et al. One-leg inactivity induces a reduction in mitochondrial oxidative capacity, intramyocellular lipid accumulation and reduced insulin signalling upon lipid infusion. Diabetologia. 2020;63(6):1211-1222. doi:10.1007/s00125-020-05128-1. PMID: 32185462. https://doi.org/10.1007/s00125-020-05128-1 29. Lee J, Kim D, Kim C. Resistance training for glycemic control, muscular strength, and lean body mass in old type 2 diabetic patients: a meta-analysis. Diabetes Ther. 2017;8(3):459-473. doi:10.1007/s13300-017-0258-3. PMID: 28382531. https://doi.org/10.1007/s13300-017-0258-3 30. Goodpaster

Most men who start testosterone never needed it, and some who genuinely do never get treated. In the final episode of the Signal series, Dr. Jordan Feigenbaum and Dr. Austin Baraki work through who actually needs testosterone replacement, who got sold it, and what the evidence says about the risks that scared the field for a decade. We cover the blinded trial where men couldn't tell real testosterone from placebo, what the heart and prostate data actually show now that we have the trials, what testosterone does to fertility, and the framework we use to decide. We also close the story of Mark, the patient whose lab result started the series. This is educational content, not medical advice. Talk to your physician about your personal situation. Here we cover the real diagnosis of testosterone deficiency, primary versus secondary low testosterone, how the system both over- and under-prescribes, the SHBG trap that makes a normal level look low, the gray-zone crossover study, what replacement should actually target, why most men quit within a year, testosterone as a male contraceptive, the TRAVERSE cardiovascular results, the saturation model and prostate safety, the blood side effect worth monitoring, and when not to start at all. Timestamps: 00:00 The study almost nobody mentions 01:31 Who this episode is for 03:35 What a real testosterone diagnosis requires 07:18 Primary vs secondary low testosterone 10:12 How testosterone gets over-prescribed 11:35 The SHBG trap: when a low number misleads 18:10 Would GLP-1 plus testosterone work better? 22:19 Why genuine deficiency gets under-treated 24:15 The cardiovascular scare and where it came from 34:11 The gray-zone study, in full 41:02 What TRT should actually target, and the "900" myth 47:38 Running TRT as a trial, and why 70% quit 52:36 Testosterone as a contraceptive: the fertility cost 57:19 Does TRT cause heart problems? The TRAVERSE trial 01:01:40 Testosterone and the prostate 01:09:13 The blood side effect worth watching 01:12:02 When not to start testosterone 01:14:26 Who actually benefits from TRT 01:18:28 The Signal framework, and what happened to Mark 01:21:14 Five things to take away 01:23:33 Our conflict of interest, and the bookResources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ Part 1: Is the testosterone crisis real?Part 2: Is you testosterone actually low?Part 3: What's actually driving your testosterone down? New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Testosterone Action Plan: https://www.barbellmedicine.com/testosterone-action-plan/  Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769. doi:10.1111/j.1742-1241.2006.00992.xBaillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001-2011. JAMA Intern Med. 2013;173(15):1465-1466. doi:10.1001/jamainternmed.2013.6895Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi:10.1210/jc.2018-00229Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423-432. doi:10.1016/j.juro.2018.03.115Corona G, Goulis DG, Huhtaniemi I, et al. European Academy of Andrology (EAA) and European Society of Endocrinology (ESE) recommendations on the diagnosis and management of male hypogonadism. Andrology. 2020;8(5):970-987. doi:10.1111/andr.12770Morgentaler A, Zitzmann M, Traish AM, et al. Commentary: who is a candidate for testosterone therapy? A synthesis of international expert opinions. J Sex Med. 2014;11(7):1636-1645. doi:10.1111/jsm.12546Mok SF, Fennell C, Savkovic S, et al. Testosterone for androgen deficiency-like symptoms in men without pathologic hypogonadism: a randomized, placebo-controlled cross-over with masked choice extension clinical trial. J Gerontol A Biol Sci Med Sci. 2020;75(9):1723-1731. doi:10.1093/gerona/glz195Clift AK, Johnson H, Huang DR, Morgentaler A. Real-world outcomes and safety of testosterone therapy: a longitudinal, retrospective cohort study of over 9,000 men. World J Mens Health. 2026;44(2):438-450. doi:10.5534/wjmh.250245Malik RD, Wang CE, Lapin B, Lakeman JC, Helfand BT. Characteristics of men undergoing testosterone replacement therapy and adherence to follow-up recommendations in a metropolitan multicenter health care system. Urology. 2015;85(6):1382-1388. doi:10.1016/j.urology.2015.01.027Donatucci C, Cui Z, Fang Y, Muram D. Long-term treatment patterns of testosterone replacement medications. J Sex Med. 2014;11(8):2092-2099. doi:10.1111/jsm.12608Saad F, Aversa A, Isidori AM, Zafalon L, Zitzmann M, Gooren L. Onset of effects of testosterone treatment and time span until maximum effects are achieved. Eur J Endocrinol. 2011;165(5):675-685. doi:10.1530/EJE-11-0221Ly LP, Liu PY, Handelsman DJ. Rates of suppression and recovery of human sperm output in testosterone-based hormonal contraceptive regimens. Hum Reprod. 2005;20(6):1733-1740. doi:10.1093/humrep/deh834Liu PY, Swerdloff RS, Christenson PD, Handelsman DJ, Wang C; Hormonal Male Contraception Summit Group. Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. Lancet. 2006;367(9520):1412-1420. doi:10.1016/S0140-6736(06)68614-5Ko EY, Siddiqi K, Brannigan RE, Sabanegh ES Jr. Empirical medical therapy for idiopathic male infertility: a survey of the American Urological Association. J Urol. 2012;187(3):973-978. doi:10.1016/j.juro.2011.10.137Kohn TP, Louis MR, Pickett SM, et al. Age and duration of testosterone therapy predict time to return of sperm count after human chorionic gonadotropin therapy. Fertil Steril. 2017;107(2):351-357.e1. doi:10.1016/j.fertnstert.2016.10.004Wenker EP, Dupree JM, Langille GM, et al. The use of HCG-based combination therapy for recovery of spermatogenesis after testosterone use. J Sex Med. 2015;12(6):1334-1337. doi:10.1111/jsm.12890Basaria S, Coviello AD, Travison TG, et al. Adverse events associated with testosterone administration. N Engl J Med. 2010;363(2):109-122. doi:10.1056/NEJMoa1000485Vigen R, O’Donnell CI, Barón AE, et al. Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels. JAMA. 2013;310(17):1829-1836. doi:10.1001/jama.2013.280386Basaria S, Harman SM, Travison TG, et al. Effects of testosterone administration for 3 years on subclinical atherosclerosis progression in older men with low or low-normal testosterone levels: a randomized clinical trial. JAMA. 2015;314(6):570-581. doi:10.1001/jama.2015.8881Budoff MJ, Ellenberg SS, Lewis CE, et al. Testosterone treatment and coronary artery plaque volume in older men with low testosterone. JAMA. 2017;317(7):708-716. doi:10.1001/jama.2016.21043Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med. 2023;389(2):107-117. doi:10.1056/NEJMoa2215025Huggins C, Hodges CV. Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. Cancer Res. 1941;1(4):293-297.Morgentaler A, Traish AM. Shifting the paradigm of testosterone and prostate cancer: the saturation model and the limits of androgen-dependent growth. Eur Urol. 2009;55(2):310-320. doi:10.1016/j.eururo.2008.09.024Khera M, Crawford D, Morales A, Salonia A, Morgentaler A. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol. 2014;65(1):115-123. doi:10.1016/j.eururo.2013.08.015Bhasin S, Lincoff AM, Nissen SE, et al. Prostate safety events during testosterone replacement therapy in men with hypogonadism: a randomized clinical trial. JAMA Netw Open. 2023;6(12):e2348692. doi:10.1001/jamanetworkopen.2023.48692Snyder PJ, Bhasin S, Cunningham GR, et al. Effects of testosterone treatment in older men. N Engl J Med. 2016;374(7):611-624. doi:10.1056/NEJMoa1506119 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

In 2004 a surgeon removed about ten kilograms of fat from fifteen women and measured everything that mattered. Nothing improved. Four years later, it still hadn't. That result should have ended an argument about body fat. Instead the argument got more specific, and the version you've heard most recently is that visceral fat, the fat around your organs, is the dangerous kind. I've said a version of that myself on this show, and in this episode I expand upon it. This one starts from the beginning: what your fat is actually for, what insulin is, and what insulin resistance means, in plain terms and assuming nothing. Then four experiments that all point the same direction. Fat removed surgically, and the disease doesn't follow. People born with no fat tissue at all, who get the entire disease anyway. A hormone that reversed a 48% fatty liver without adding a gram of fat. And a diabetes drug that made people heavier and healthier at the same time. The second half is practical. What a fatty liver actually does over twenty years, what BMI can and can't do, why the Lancet Commission changed the definition of obesity in 2025, and the exact order of tests I'd use, including the TyG index, FIB-4, and where each one stops working. Part one of two. Next episode is about muscle. Timestamps: 00:00 The Liposuction Experiment 02:06 The Visceral Fat Correction 05:47 What Fat Is For 08:14 The Carb Insulin Model 10:51 Filling The Garage 14:35 Taking The Fat Out 17:57 Born Without Fat Tissue 22:52 Heavier And Healthier 25:05 Neptune And Vulcan 29:57 The Patient Nobody Checked 33:59 What Every Ruler Missed 36:00 What To Actually Order 40:29 What Obesity Actually Is Resources: Vital 5 (TyG , waist to height, etc. discussion): https://www.barbellmedicine.com/vital-5-action-plan/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Plus podcast subscription: https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ Barbell Medicine Premium: https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal (now shipping): https://www.barbellmedicine.com/shop/learning/signal/ Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350(25):2549-2557. doi:10.1056/NEJMoa033179Mohammed BS, Cohen S, Reeds D, Young VL, Klein S. Long-term effects of large-volume liposuction on metabolic risk factors for coronary heart disease. Obesity (Silver Spring). 2008;16(12):2648-2651. doi:10.1038/oby.2008.418Sommer I, Teufer B, Szelag M, et al. The performance of anthropometric tools to determine obesity: a systematic review and meta-analysis. Sci Rep. 2020;10(1):12699. doi:10.1038/s41598-020-69498-7Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115(5):1343-1351. doi:10.1172/JCI23621Spalding KL, Arner E, Westermark PO, et al. Dynamics of fat cell turnover in humans. Nature. 2008;453(7196):783-787. doi:10.1038/nature06902Fabbrini E, Tamboli RA, Magkos F, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448-455. doi:10.1053/j.gastro.2010.04.056Garg A. Acquired and inherited lipodystrophies. N Engl J Med. 2004;350(12):1220-1234. doi:10.1056/NEJMra025261Al Yaarubi S, Alsagheir A, Al Shidhani A, et al. Analysis of disease characteristics of a large patient cohort with congenital generalized lipodystrophy from the Middle East and North Africa. Orphanet J Rare Dis. 2024;19(1):118. doi:10.1186/s13023-024-03084-2Petersen KF, Oral EA, Dufour S, et al. Leptin reverses insulin resistance and hepatic steatosis in patients with severe lipodystrophy. J Clin Invest. 2002;109(10):1345-1350. doi:10.1172/JCI200215001Miyazaki Y, Mahankali A, Matsuda M, et al. Effect of pioglitazone on abdominal fat distribution and insulin sensitivity in type 2 diabetic patients. J Clin Endocrinol Metab. 2002;87(6):2784-2791. doi:10.1210/jcem.87.6.8567Cusi K, Orsak B, Bril F, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med. 2016;165(5):305-315. doi:10.7326/M15-1774Taylor R, Barnes AC, Hollingsworth KG, et al. Aetiology of type 2 diabetes in people with a 'normal' body mass index: testing the personal fat threshold hypothesis. Clin Sci (Lond). 2023;137(16):1333-1346. doi:10.1042/CS20230586Martin S, Cule M, Basty N, et al. Genetic evidence for different adiposity phenotypes and their opposing influences on ectopic fat and risk of cardiometabolic disease. Diabetes. 2021;70(8):1843-1856. doi:10.2337/db21-0129Martin S, Sorokin EP, Thomas EL, et al. Estimating the effect of liver and pancreas volume and fat content on risk of diabetes: a Mendelian randomization study. Diabetes Care. 2022;45(2):460-468. doi:10.2337/dc21-1262Sanyal AJ, Kaplan LM, Frias JP, et al. Triple hormone receptor agonist retatrutide for metabolic dysfunction-associated steatotic liver disease: a randomized phase 2a trial. Nat Med. 2024;30(7):2037-2048. doi:10.1038/s41591-024-03018-2Portillo-Sanchez P, Bril F, Maximos M, et al. High prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus and normal plasma aminotransferase levels. J Clin Endocrinol Metab. 2015;100(6):2231-2238. doi:10.1210/jc.2015-1966Hagström H, Nasr P, Ekstedt M, et al. Fibrosis stage but not NASH predicts mortality and time to development of severe liver disease in biopsy-proven NAFLD. J Hepatol. 2017;67(6):1265-1273. doi:10.1016/j.jhep.2017.07.027Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol. 2025;13(3):221-262. doi:10.1016/S2213-8587(24)00316-4Guerrero-Romero F, Simental-Mendía LE, González-Ortiz M, et al. The product of triglycerides and glucose, a simple measure of insulin sensitivity: comparison with the euglycemic-hyperinsulinemic clamp. J Clin Endocrinol Metab. 2010;95(7):3347-3351. doi:10.1210/jc.2010-0288Sánchez-García A, Rodríguez-Gutiérrez R, Mancillas-Adame L, et al. Diagnostic accuracy of the triglyceride and glucose index for insulin resistance: a systematic review. Int J Endocrinol. 2020;2020:4678526. doi:10.1155/2020/4678526McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven G. Use of metabolic markers to identify overweight individuals who are insulin resistant. Ann Intern Med. 2003;139(10):802-809. doi:10.7326/0003-4819-139-10-200311180-00007McPherson S, Hardy T, Dufour JF, et al. Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis. Am J Gastroenterol. 2017;112(5):740-751. doi:10.1038/ajg.2016.453Mózes FE, Lee JA, Selvaraj EA, et al. Diagnostic accuracy of non-invasive tests for advanced fibrosis in patients with NAFLD: an individual patient data meta-analysis. Gut. 2022;71(5):1006-1019. doi:10.1136/gutjnl-2021-324243Bansal MB, Patton H, Morgan TR, Carr RM, Dranoff JA, Allen AM. Semaglutide therapy for metabolic dysfunction-associated steatohepatitis: November 2025 updates to AASLD practice guidance. Hepatology. 2025;83(5):1326-1340. doi:10.1097/HEP.0000000000001608Tomiyama AJ, Hunger JM, Nguyen-Cuu J, Wells C. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012. Int J Obes (Lond). 2016;40(5):883-886. doi:10.1038/ijo.2016.17Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering: prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Arch Intern Med. 2008;168(15):1617-1624. doi:10.1001/archinte.168.15.1617Mongraw-Chaffin M, Foster MC, Anderson CAM, et al. Metabolically healthy obesity, transition to metabolic syndrome, and cardiovascular risk. J Am Coll Cardiol. 2018;71(17):1857-1865. doi:10.1016/j.jacc.2018.02.055Gujral UP, Vittinghoff E, Mongraw-Chaffin M, et al. Cardiometabolic abnormalities among normal-weight persons from five racial/ethnic groups in the United States: a cross-sectional analysis of two cohort studies. Ann Intern Med. 2017;166(9):628-636. doi:10.7326/M16-1895Ruderman NB, Schneider SH, Berchtold P. The "metabolically-obese," normal-weight individual. Am J Clin Nutr. 1981;34(8):1617-1621. doi:10.1093/ajcn/34.8.1617Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001;50(12):1499-1504. doi:10.1053/meta.2001.27213National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. NIH Publication 98-4083. Bethesda, MD: National Institutes of Health; September 1998.American Medical Association House of Delegates. Resolution 420 (A-13): Recognition of Obesity as a Disease. Adopted June 18, 2013.American Medical Association Council on Science and Public Health. Report 3-A-13: Is Obesity a Disease? 2013.Rey-López JP, de Rezende LF, Pastor-Valero M, Tess BH. The prevalence of metabolically healthy obesity: a systematic review and critical evaluation of the definitions used. Obes Rev. 2014;15(10):781-790. doi:10.1111/obr.12198Hinnouho GM, Czernichow S, Dugravot A, Batty GD, Kivimaki M, Singh-Manoux A. Metabolically healthy obesity and risk of mortality: does the definition of metabolic health matter? Diabetes Care. 2013;36(8):2294-2300. doi:10.2337/dc12-1654Herman WH, Ye W, Griffin SJ, et al. Early detection and treatment of type 2 diabetes reduce cardiovascular morbidity and mortality: a simulation of the results of the Anglo-Danish-Dutch study of intensive treatment in people with screen-detected diabetes in primary car

A popular paper claimed the longevity benefit of lifting disappears once you train more than an hour a week. It's a real paper, but the claim is a misread. This is the free cut of this month's Direct Line, where Drs. Feigenbaum and Baraki also take on whether GLP-1s affect your mood, the "same calories, more weight loss" protein argument, and what you can actually do in the gym when you have chronic fatigue syndrome. For education and infotainment, not medical advice. To become a member and have us answer YOUR questions, join today: https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ Timestamps: 0:00 Intro 0:38 The paper: does lifting stop helping after an hour? 3:19 The newer 147,000-person, 30-year study 13:21 GLP-1s, mood, and motivation 14:50 The FDA reverses the suicide warning 19:29 What happened when they gave people a GLP-1 in a bar 24:54 Is a calorie just a calorie? 28:17 The "same calories, more weight loss" protein study 30:48 Does keto break the laws of physics? 34:56 Lifting with chronic fatigue syndrome 36:14 The identical-twin experiment 37:36 Can lifting in bed do anything? 45:33 Get the full Direct Line New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs Barbell Medicine coaching and templates: https://www.barbellmedicine.com Barbell Medicine Premium: https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal (pre-order) https://www.barbellmedicine.com/shop/learning/signal/ 1. Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. *Br J Sports Med*. 2022;56(13):755-763. doi:10.1136/bjsports-2021-105061 2. Dankel SJ, Loenneke JP, Loprinzi PD. Dose-dependent association between muscle-strengthening activities and all-cause mortality: prospective cohort study among a national sample of adults in the USA. *Arch Cardiovasc Dis*. 2016;109(11):626-633. doi:10.1016/j.acvd.2016.04.005 3. Zhang Y, Lee DH, Rezende LFM, Ma Y, Giovannucci E. Long-term resistance training with all-cause and cause-specific mortality: assessing dose-response and joint associations with aerobic physical activity. *Br J Sports Med*. Published online June 2, 2026. doi:10.1136/bjsports-2025-110503 4. US Food and Drug Administration. FDA requests removal of suicidal behavior and ideation warning from glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications. Drug Safety Communication. January 13, 2026. Accessed August 12, 2026. https://www.fda.gov/drugs/drug-safety-communications/fda-requests-removal-suicidal-behavior-and-ideation-warning-glucagon-peptide-1-receptor-agonist-glp 5. Hendershot CS, Bremmer MP, Paladino MB, et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. *JAMA Psychiatry*. 2025;82(4):395-405. doi:10.1001/jamapsychiatry.2024.4789 6. Klausen MK, Justesen SK, Pedersen JN, et al. Once-weekly semaglutide versus placebo in patients with alcohol use disorder and comorbid obesity: a randomised, double-blind, placebo-controlled trial. *Lancet*. 2026;407(10540):1687-1698. doi:10.1016/S0140-6736(26)00305-3 7. Haghighat N, Ashtary-Larky D, Bagheri R, et al. The effect of 12 weeks of euenergetic high-protein diet in regulating appetite and body composition of women with normal-weight obesity: a randomised controlled trial. *Br J Nutr*. 2020;124(10):1044-1051. doi:10.1017/S0007114520002019 8. Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Board on the Health of Select Populations, Institute of Medicine. *Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness*. National Academies Press; 2015. Accessed August 12, 2026. https://www.ncbi.nlm.nih.gov/books/NBK274235/ 9. Giloteaux L, Hanson MR, Keller BA. A pair of identical twins discordant for myalgic encephalomyelitis/chronic fatigue syndrome differ in physiological parameters and gut microbiome composition. *Am J Case Rep*. 2016;17:720-729. doi:10.12659/AJCR.900314 10. Rangan A, Brealey SD, Keding A, et al. Management of adults with primary frozen shoulder in secondary care (UK FROST): a multicentre, pragmatic, three-arm, superiority randomised clinical trial. *Lancet*. 2020;396(10256):977-989. doi:10.1016/S0140-6736(20)31965-6 11. Millar NL, Meakins A, Struyf F, et al. Frozen shoulder. *Nat Rev Dis Primers*. 2022;8(1):59. doi:10.1038/s41572-022-00386-2 12. US Department of Agriculture, US Department of Health and Human Services. *Dietary Guidelines for Americans, 2025-2030*. January 2026. Accessed August 12, 2026. https://www.dietaryguidelines.gov/ Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

An FDA advisory committee just voted to open a legal compounding supply line for six of seven peptides, including BPC-157 and TB-500, over the objection of the FDA's own scientists, who recommended against all seven. Dr. Jordan Feigenbaum walks through what the Pharmacy Compounding Advisory Committee actually voted on, why a vote about ulcerative colitis ends up governing tendon and joint use, what the single human BPC-157 trial does and doesn't show, and why "a pharmacy makes it safe" and "there's no money to study it" don't hold up. Evidence-based, no hype, no nocebo. Timestamps:  | 00:00:00 | The FDA voted 8-6. What it actually means  | 00:01:25 | What I am, and am not, claiming  | 00:03:21 | How they got here: Category 2 and the paperwork  | 00:07:17 | Who was in the room: the panel that flipped  | 00:10:57 | What they voted on: compounding and the bulks list  | 00:15:37 | "No money in it, you can't patent it"  | 00:18:24 | The trials already run: Plevna and MK-677  | 00:22:55 | "I took it and it worked": placebo and fake surgery  | 00:27:02 | The one human trial: Ruenzi 2005  | 00:32:28 | Is it natural? Is it even a drug?  | 00:36:58 | Harm reduction, or follow the money?  | 00:42:45 | Three times a missing trial went wrong  | 00:50:58 | Safety: known, unknown, and unknowable  | 00:55:22 | The other six peptides  | 00:58:22 | What I'd actually tell you  | 01:02:08 | What actually works, and what would change my mind Resources: Barbell Medicine coaching and templates: https://www.barbellmedicine.comPlus podcast subscription: https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/Barbell Medicine Premium: https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/Signal (book pre-order): https://www.barbellmedicine.com/shop/learning/signal/ 1. US Food and Drug Administration. FDA Briefing Document: Pharmacy Compounding Advisory Committee Meeting. July 23-24, 2026. Silver Spring, MD: FDA; 2026. 2. US Food and Drug Administration. FDA review of BPC-157-related bulk drug substances. PCAC Briefing Document. July 23-24, 2026. Media 193343. Accessed July 24, 2026. https://www.fda.gov/media/193343/download 3. US Food and Drug Administration. FDA review of TB-500-related bulk drug substances. PCAC Briefing Document. July 23-24, 2026. Media 193349. 4. US Food and Drug Administration. FDA review of KPV-, MOTS-c-, Semax-, Epitalon-, and Emideltide-related bulk drug substances. PCAC Briefing Documents. July 23-24, 2026. 5. US Food and Drug Administration. Questions for the Pharmacy Compounding Advisory Committee. July 23-24, 2026. 6. US Food and Drug Administration. Pharmacy Compounding Advisory Committee meeting roster. July 23-24, 2026. Media 193772. 7. US Food and Drug Administration. Pharmacy Compounding Advisory Committee meeting roster. 2022. Media 159040. 8. openFDA. FAERS adverse event reports for BPC-157. Accessed July 24, 2026. https://open.fda.gov 9. Pharmacy compounding; 503A bulk drug substances. 21 CFR §216.23 (2026). 10. Federal Food, Drug, and Cosmetic Act §503A, 21 USC §353a (pharmacy compounding). 11. Abigail Alliance for Better Access to Developmental Drugs v von Eschenbach, 495 F3d 695 (DC Cir 2007). 12. United States v Rutherford, 442 US 544 (1979). 13. Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017, Pub L No. 115-176, 132 Stat 1372 (2018). 14. US Food and Drug Administration. Regulatory considerations for human drug products containing peptides. Guidance for Industry (draft). 2020. 15. Ruenzi M, Stolte M, Veljaca M, et al. Efficacy and safety of PL 14736 (BPC 157) in patients with active ulcerative colitis [abstract]. Gastroenterology. 2005. Meeting abstract; full study not published. 16. Staresinic M, Petrovic I, Novinscak T, et al. Effective therapy of transected quadriceps muscle in rat: gastric pentadecapeptide BPC 157. J Orthop Res. 2006;24(5):1109-1117. doi:10.1002/jor.20089 17. Gwyer D, Wragg NM, Wilson SL. Gastric pentadecapeptide body protection compound BPC 157 and its role in accelerating musculoskeletal soft tissue healing. Cell Tissue Res. 2019;377(2):153-159. doi:10.1007/s00441-019-03016-8 18. Sikiric P, Skrtic A, Gojkovic S, et al. Stable gastric pentadecapeptide BPC 157 and hemorrhage/thrombosis. Pharmaceuticals (Basel). 2026;19(3):463. doi:10.3390/ph19030463 19. Stavchansky VV, Filippenkov IB, Dergunova LV, Limborska SA. The role of glyprolines in the regulation of gene expression: focus on Semax. Genes (Basel). 2022;13(12):2380. doi:10.3390/genes13122380 20. Mendias CL, Awan TM. The safety and efficacy of approved and unapproved peptides. Sports Med. 2026. doi:10.1007/s40279-026-02437-0 21. Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88. doi:10.1056/NEJMoa013259 22. Cobb LA, Thomas GI, Dillard DH, Merendino KA, Bruce RA. An evaluation of internal-mammary-artery ligation by a double-blind technic. N Engl J Med. 1959;260(22):1115-1118. 23. Dimond EG, Kittle CF, Crockett JE. Comparison of internal mammary artery ligation and sham operation for angina pectoris. Am J Cardiol. 1960;5:483-486. 24. Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. doi:10.1177/03635465980260030301 25. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009;19(6):790-802. doi:10.1111/j.1600-0838.2009.00949.x 26. Langberg H, Skovgaard D, Karamouzis M, Bulow J, Kjaer M. Metabolism and inflammatory mediators in the peritendinous space measured by microdialysis during intermittent isometric exercise in humans. J Physiol. 1999;515(Pt 3):919-927. doi:10.1111/j.1469-7793.1999.919ab.x 27. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309(5):461-469. doi:10.1001/jama.2013.129 28. Kearney RS, Ji C, Warwick J, et al. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021;326(2):137-144. doi:10.1001/jama.2021.6986 29. Pavlova AV, Shim JSC, Moss R, et al. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. Br J Sports Med. 2023;57(20):1327-1334. doi:10.1136/bjsports-2022-105754 30. Weintraub M, Sundaresan PR, Madan M, et al. Long-term weight control study I (weeks 0 to 34): fenfluramine plus phentermine versus placebo. Clin Pharmacol Ther. 1992;51(5):586-594. doi:10.1038/clpt.1992.69 31. Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med. 1997;337(9):581-588. doi:10.1056/NEJM199708283370901 32. Centers for Disease Control and Prevention. Cardiac valvulopathy associated with exposure to fenfluramine or dexfenfluramine: interim public health recommendations, 1997. MMWR Morb Mortal Wkly Rep. 1997;46(45):1061-1066. 33. Bombardier C, Laine L, Reicin A, et al; VIGOR Study Group. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med. 2000;343(21):1520-1528. doi:10.1056/NEJM200011233432103 34. Graham DJ, Campen D, Hui R, et al. Risk of acute myocardial infarction and sudden cardiac death in patients treated with cyclo-oxygenase 2 selective and non-selective non-steroidal anti-inflammatory drugs: nested case-control study. Lancet. 2005;365(9458):475-481. doi:10.1016/S0140-6736(05)17864-7 35. Smith RM, Schaefer MK, Kainer MA, et al; Multistate Fungal Infection Outbreak Response Team. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013;369(17):1598-1609. doi:10.1056/NEJMoa1213978 36. Adunsky A, Chandler J, Heyden N, et al. MK-0677 (ibutamoren mesylate) for the treatment of patients recovering from hip fracture: a multicenter, randomized, placebo-controlled phase IIb study. Arch Gerontol Geriatr. 2011;53(2):183-189. doi:10.1016/j.archger.2010.10.004 [Trial terminated early for a congestive-heart-failure safety signal.] 37. Nass R, Pezzoli SS, Oliveri MC, et al. Effects of an oral ghrelin mimetic on body composition and clinical outcomes in healthy older adults: a randomized trial. Ann Intern Med. 2008;149(9):601-611. doi:10.7326/0003-4819-149-9-200811040-00003 38. Van Wagoner RM, Eichner A, Bhasin S, Deuster PA, Eichner D. Chemical composition and labeling of substances marketed as selective androgen receptor modulators and sold via the internet. JAMA. 2017;318(20):2004-2010. doi:10.1001/jama.2017.17069 39. ECRI and Institute for Safe Medication Practices. Unapproved peptide products: safety and quality concerns [white paper]. Plymouth Meeting, PA: ECRI; April 2026. 40. Center for Science in the Public Interest. What are injectable peptides, and are they safe? Accessed July 24, 2026. https://www.cspinet.org 41. World Anti-Doping Agency. The 2026 Prohibited List. Montreal, QC: WADA; 2026. Accessed July 24, 2026. https://www.wada-ama.org 42. US Anti-Doping Agency. BPC-157: a prohibited peptide. Accessed July 24, 2026. https://www.usada.org 43. FDA committee votes in favor of compounding several peptides. Time. July 23, 2026. Accessed July 24, 2026. https://time.com 44. FDA advisory committee backs controversial peptides. Regulatory Affairs Professionals Society (RAPS). 2026. Accessed July 24, 2026. https://www.raps.org 45. FDA panel okays peptides for compounding, including BPC-157 and KPV. STAT News. July 23, 2026. Accessed July 24, 2026. https://www.statnews.com 46. FDA panel recommends easing peptide restrictions over agency scien

A previously healthy 21-year-old shows up with seven months of headaches and 30-plus pounds of weight gain he can’t explain. He’s eating the same and training more, and the scale climbs anyway. We hand the case to Dr. Austin Baraki cold and work it in real time: the exam, the labs, the MRI, and two diagnoses that turn a headache workup into the clearest proof we’ve got that body weight is set by the brain, not by character. This is the capstone of our weight series (willpower, calories, protein), and it ends on the drug that, this year, did something for these patients that nothing had done before. Timestamps 00:00:00 Cold open: the man who couldn’t stop gaining weight00:01:49 Meet the case (and the rules of the game)00:02:36 The presentation: 21, headaches, unexplained weight gain00:03:57 Austin’s one-liner and how a clinician builds a differential00:05:10 Secondary headaches: what raises the red flag00:13:12 The exam: vitals, and the eye findings that matter00:14:37 The labs, one number at a time00:16:08 Raised pressure and a visual-field clue (bitemporal hemianopia)00:20:45 The MRI00:21:54 First diagnosis: craniopharyngioma00:25:32 The name: a tumor built from tooth tissue00:25:50 Surgery, and what it costs00:27:43 The new mystery: gaining weight faster than ever00:33:41 Second diagnosis: acquired hypothalamic obesity00:39:17 How your brain sets your weight: the POMC brake and the AgRP accelerator00:42:07 What about leptin?00:45:46 Monogenic vs common obesity00:50:30 Why GLP-1 drugs still worked: the brainstem backdoor00:52:11 Responders and non-responders00:55:40 Setmelanotide: a drug for the broken circuit00:56:53 TRANSCEND, and the new FDA approval00:58:55 What it costs01:01:32 Why we care about body fat at all: the garage01:04:36 Flux: which fat is actually dangerous01:09:15 Close Resources Barbell Medicine coaching and templates: https://www.barbellmedicine.com Plus podcast subscription: https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ Barbell Medicine Premium: https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal (book pre-order): https://www.barbellmedicine.com/shop/learning/signal/ 1. Brijmohan A, et al. Acquired hypothalamic obesity following craniopharyngioma resection in a young adult [case report]. 2025. PMCID: PMC12268545; PMID: 40677794.  2. Miller JL, et al; TRANSCEND investigators. Setmelanotide in acquired hypothalamic obesity: a phase 3 randomized trial. N Engl J Med. 2026.  3. Rhythm Pharmaceuticals. FDA approves IMCIVREE (setmelanotide) for acquired hypothalamic obesity. News release. March 19, 2026. 4. US Food and Drug Administration. FDA approves first treatment for weight management for people with certain rare genetic conditions (setmelanotide). 2020. 5. Montague CT, Farooqi IS, Whitehead JP, et al. Congenital leptin deficiency is associated with severe early-onset obesity in humans. Nature. 1997;387(6636):903-908. 6. Farooqi IS, Jebb SA, Langmack G, et al. Effects of recombinant leptin therapy in a child with congenital leptin deficiency. N Engl J Med. 1999;341(12):879-884. 7. Krude H, Biebermann H, Luck W, et al. Severe early-onset obesity, adrenal insufficiency and red hair pigmentation caused by POMC mutations in humans. Nat Genet. 1998;19(2):155-157. 8. Farooqi IS, Keogh JM, Yeo GS, et al. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. N Engl J Med. 2003;348(12):1085-1095. 9. Clément K, Vaisse C, Lahlou N, et al. A mutation in the human leptin receptor gene causes obesity and pituitary dysfunction. Nature. 1998;392(6674):398-401. 10. Fabbrini E, Tamboli RA, Magkos F, et al. Surgical removal of omental fat does not improve insulin sensitivity and cardiovascular risk factors in obese adults. Gastroenterology. 2010;139(2):448-455. 11. Klein S, Fontana L, Young VL, et al. Absence of an effect of liposuction on insulin action and risk factors for coronary heart disease. N Engl J Med. 2004;350(25):2549-2557. 12. Guyenet SJ. The Hungry Brain: Outsmarting the Instincts That Make Us Overeat. Flatiron Books; 2017.  Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

Every couple of years a new headline warns that the protein you eat is quietly hurting you. This year the target is your kidneys. Before that it was cancer, then your bones, then the claim that your body can only use twenty or thirty grams of protein at a meal. In this episode, Dr. Jordan Feigenbaum goes through the actual studies behind each scare: the kidney trials, the 2014 IGF-1 and cancer paper that started the panic, the acid-ash bone hypothesis, and the per-meal "cap." Each fear starts from a real mechanism, and each one was run straight to a frightening conclusion the clinical outcomes never supported. The take home is simple. For a healthy adult, protein is not the lever people think it is, and where a real signal exists (processed and red meat, or a kidney that is already diseased) it tracks the whole dietary pattern more than the protein number. The two things that actually decide your health here are whether you eat mostly real food and whether you train. Timestamps 00:00 The protein scare cycle 01:23 The four fears 01:59 Kidneys: healthy kidneys under higher protein 06:22 Kidney disease: does cutting protein help? 09:38 Red meat and the dietary pattern, not protein 12:00 Muscle, aging, and lifting on a restricted diet 13:54 Cancer: IGF-1 and the 2014 study everyone cites 16:22 The age reversal, and what travels with protein 18:48 Bigger data, processed meat, and the IGF-1 tell 22:15 Bones and the acid-ash myth 25:13 The 30-gram cap 27:17 What protein actually does, and how much you need 32:20 The two questions that matter Resources: Barbell Medicine coaching and templates: https://www.barbellmedicine.com Plus podcast subscription: https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ Barbell Medicine Premium: https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal (book pre-order): https://www.barbellmedicine.com/shop/learning/signal/ Our Protein Content: https://www.barbellmedicine.com/blog/protein-and-weight-loss/ https://www.barbellmedicine.com/blog/protein-on-ozempic/ https://www.barbellmedicine.com/blog/barbell-medicine-protein-recommendations/ Studies Levine et al. Cell Metabolism 2014. doi:10.1016/j.cmet.2014.02.006Naghshi et al. BMJ 2020. doi:10.1136/bmj.m2412 Devries et al. J Nutr 2018. doi:10.1093/jn/nxy197 Antonio et al. J Nutr Metab 2016. doi:10.1155/2016/9104792 Knight et al. Ann Intern Med 2003. doi:10.7326/0003-4819-138-6-200303180-00009 Klahr et al. (MDRD). NEJM 1994. doi:10.1056/NEJM199403313301301 Hahn, Hodson & Fouque. Cochrane 2020. doi:10.1002/14651858.CD001892.pub5 Obeid, Hiremath & Topf. Kidney360 2022. doi:10.34067/KID.0001002022 Lew et al. J Am Soc Nephrol 2017. doi:10.1681/ASN.2016030248Castaneda et al. Ann Intern Med 2001. doi:10.7326/0003-4819-135-11-200112040-00008 Bauer et al. (PROT-AGE). JAMDA 2013. doi:10.1016/j.jamda.2013.05.021Fenton et al. Nutrition Journal 2011. doi:10.1186/1475-2891-10-41Shams-White et al. Am J Clin Nutr 2017. doi:10.3945/ajcn.116.145110Witard et al. Am J Clin Nutr 2013. doi:10.3945/ajcn.112.055517 Macnaughton et al. Physiol Rep 2016. doi:10.14814/phy2.12893Trommelen et al. Cell Reports Medicine 2023. doi:10.1016/j.xcrm.2023.101324 Wycherley et al. Am J Clin Nutr 2012. doi:10.3945/ajcn.112.044321 Moore et al. JAMA Intern Med 2016. doi:10.1001/jamainternmed.2016.1548 Larsson et al. Cancer Med 2020. doi:10.1002/cam4.3345 Brenner, Meyer & Hostetter. NEJM 1982. doi:10.1056/NEJM198209093071104 Chan et al. PLoS One 2011. doi:10.1371/journal.pone.0020456Berryman et al. Am J Clin Nutr 2018. doi:10.1093/ajcn/nqy088 Morton et al. Br J Sports Med 2018. doi:10.1136/bjsports-2017-097608 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

Is weight loss really just Calories in, Calories out? The equation is true, but "just count your Calories" is bad advice for most people, and almost every objection to it is pointing at something real. In part two of our energy balance series, Jordan Feigenbaum takes the biggest "it's not Calories, it's ___" claims (metabolism, thyroid, cortisol, PCOS, insulin, the type of food) and tests each against the best evidence. The verdict: none of them breaks the equation. Every one is a hand on a lever that moves Calories in or Calories out, not a hole in the math. In this episode: why your metabolism does not crash at 40, how small real metabolic adaptation actually is after weight loss, why hypothyroid weight is mostly water, what the cortisol and PCOS (now PMOS) data show, how absorption and cooking move Calories only at the edges, why even dietitians miscount their own intake, and why the carbohydrate-insulin model fails three tests, including the GLP-1 drugs that raise insulin and still produce the biggest weight loss we have ever approved. Part two of three: willpower, Calories in Calories out, then GLP-1 drugs. Next week: are GLP-1s cheating? Timestamps 0:00 Is it really just calories in, calories out?0:18 The willpower episode and the through-line2:10 Thermodynamics: what sets both sides2:41 Your metabolism is three things4:05 Claim 1: my metabolism crashed4:24 No cliff at 40: the doubly labeled water study5:33 Real metabolic adaptation after weight loss6:56 Why your food diary lies7:49 Claim 2: it's my hormones8:07 Thyroid: mostly water9:36 Cortisol: explains about 1 percent11:12 PCOS is now PMOS13:06 Menopause14:18 Claim 3: a calorie isn't a calorie16:48 Absorption: nuts, cooking, eggs19:44 Why calorie counting fails21:12 Claim 4: it's not Calories, it's insulin22:02 Testing the carbohydrate-insulin model25:52 The GLP-1 drugs that should end it28:34 The whole list, claim by claim29:53 What to actually do30:42 Next week: are GLP-1s cheating? Resources: Barbell Medicine coaching and templates: https://www.barbellmedicine.com https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/ Pontzer et al., Science 2021. https://doi.org/10.1126/science.abe5017 Muller et al., Am J Clin Nutr 2015. https://doi.org/10.3945/ajcn.115.109173 Lichtman et al., N Engl J Med 1992. https://doi.org/10.1056/NEJM199212313272701 Karmisholt et al., J Clin Endocrinol Metab 2011. https://doi.org/10.1210/jc.2010-1521 Lee et al., Endocr Pract 2014. https://doi.org/10.4158/EP14072.OR van der Valk et al., Obes Rev 2022. https://doi.org/10.1111/obr.13376 Nikokavoura et al., Diabetes Metab Syndr Obes 2015. https://doi.org/10.2147/DMSO.S85134 Greendale et al., JCI Insight 2019. https://doi.org/10.1172/jci.insight.124865 Lejeune et al., Am J Clin Nutr 2006. https://doi.org/10.1093/ajcn/83.1.89 Bray et al., JAMA 2012. https://doi.org/10.1001/jama.2011.1918 Novotny et al., Am J Clin Nutr 2012. https://doi.org/10.3945/ajcn.112.035782 Baer et al., J Nutr 2016. https://doi.org/10.3945/jn.115.217372 Baer et al., Br J Nutr 2012. https://doi.org/10.1017/S0007114511002649 Evenepoel et al., J Nutr 1998. https://doi.org/10.1093/jn/128.10.1716 Hall et al., Cell Metabolism 2019. https://doi.org/10.1016/j.cmet.2019.05.008 Champagne et al., J Am Diet Assoc 2002. https://doi.org/10.1016/S0002-8223(02)90316-0 Hall et al., Cell Metabolism 2015. https://doi.org/10.1016/j.cmet.2015.07.021 Wilding et al., N Engl J Med 2021. https://doi.org/10.1056/NEJMoa2032183 Jastreboff et al., N Engl J Med 2022. https://doi.org/10.1056/NEJMoa2206038 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com * Check out Quince and use my code BBM for a great deal: https://www.quince.com * Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc Advertising Inquiries: https://redcircle.com/brands

Obesity roughly tripled in about 60 years, and the genes didn't change in that time. So if body weight isn't a willpower problem, what is it? Dr. Jordan Feigenbaum and Dr. Austin Baraki walk through what actually sets your weight: the adoption and twin studies behind the genetics, the "defended range" your biology fights to hold, the food environment that does most of the eating for you, and where GLP-1 medications actually work. Along the way — why diets regain after you white-knuckle them, what The Biggest Loser six-year data show about resting metabolism, and four willpower myths worth retiring.  Hosted by Dr. Jordan Feigenbaum and Dr. Austin Baraki, co-founders of Barbell Medicine. Timestamps 00:00 Cold open: Danny Cahill and The Biggest Loser01:03 What we mean by "willpower"05:48 Obesity tripled in ~60 years: the one number06:31 Adoption and twin studies: genes vs. household09:37 Set point vs. the defended range10:37 Gene–environment mismatch14:03 In the clinic: a lifelong weight history19:18 Losing weight vs. keeping it off20:26 Appetite doesn't reset (Sumithran)25:52 Metabolic adaptation and the Biggest Loser data34:07 Part 2: eating on autopilot35:10 Portion size runs the meal39:12 What changed in the food supply40:42 Same genes, new environment: Pima and immigrants43:20 Why ultra-processed food is easy to overeat50:28 Processing vs. calories: the Hall ward study52:36 When the brain changes eating: gourmand syndrome1:00:01 Why the willpower story stuck1:01:08 Taft, Churchill, and the intelligence myth1:02:43 Does intelligence predict weight? (sibling study)1:11:16 Are GLP-1s cheating? What they actually do1:15:10 Beyond the scale: muscle, health, nutrition1:24:21 Myth-busting: lightning round1:39:04 Three takeaways: what to actually do1:41:00 Danny Cahill, revisited Resources   Barbell Medicine coaching and templates: https://www.barbellmedicine.com https://www.barbellmedicine.com/shop/subscriptions/plus-podcast-subscription/ https://www.barbellmedicine.com/shop/subscriptions/barbell-medicine-premium/ Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/ Coaching, programs & templates: https://www.barbellmedicine.com/ Prevalence of Overweight, Obesity, and Severe Obesity Among Adults Age 20 and Older: United States, 1960-1962 Through August 2021-August 2023. NCHS Health E-Stats. 2024. https://www.cdc.gov/nchs/data/hestat/hestat111.htm Obesity and Severe Obesity Prevalence in Adults: United States, August 2021-August 2023. NCHS Data Brief No. 508. Hyattsville, MD: National Center for Health Statistics; 2024. https://www.cdc.gov/nchs/products/databriefs/db508.htm Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science. 1998;280(5368):1371-1374. https://doi.org/10.1126/science.280.5368.1371 Morton RW, Murphy KT, McKellar SR, et al. A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults. Br J Sports Med. 2018;52(6):376-384. https://doi.org/10.1136/bjsports-2017-097608 Stunkard AJ, Sorensen TIA, Hanis C, et al. An adoption study of human obesity. N Engl J Med. 1986;314(4):193-198. https://doi.org/10.1056/NEJM198601233140401 Stunkard AJ, Harris JR, Pedersen NL, McClearn GE. The body-mass index of twins who have been reared apart. N Engl J Med. 1990;322(21):1483-1487. https://doi.org/10.1056/NEJM199005243222102 Speakman JR, Levitsky DA, Allison DB, et al. Set points, settling points and some alternative models: theoretical options to understand how genes and environments combine to regulate body adiposity. Dis Model Mech. 2011;4(6):733-745. https://doi.org/10.1242/dmm.008698 Kalm LM, Semba RD. They starved so that others be better fed: remembering Ancel Keys and the Minnesota Experiment. J Nutr. 2005;135(6):1347-1352. https://doi.org/10.1093/jn/135.6.1347 Sumithran P, Prendergast LA, Delbridge E, et al. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med. 2011;365(17):1597-1604. https://doi.org/10.1056/NEJMoa1105816 Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after 'The Biggest Loser' competition. Obesity (Silver Spring). 2016;24(8):1612-1619. https://doi.org/10.1002/oby.21538 Hall KD. Energy compensation and metabolic adaptation: 'The Biggest Loser' study reinterpreted. Obesity (Silver Spring). 2022;30(1):11-13. https://doi.org/10.1002/oby.23308 Cohen DA, Farley TA. Eating as an automatic behavior. Prev Chronic Dis. 2008;5(1):A23. https://www.cdc.gov/pcd/issues/2008/jan/07_0046.htm Rolls BJ, Morris EL, Roe LS. Portion size of food affects energy intake in normal-weight and overweight men and women. Am J Clin Nutr. 2002;76(6):1207-1213. https://doi.org/10.1093/ajcn/76.6.1207 Diliberti N, Bordi PL, Conklin MT, Roe LS, Rolls BJ. Increased portion size leads to increased energy intake in a restaurant meal. Obes Res. 2004;12(3):562-568. https://doi.org/10.1038/oby.2004.64 Hollands GJ, Shemilt I, Marteau TM, et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database Syst Rev. 2015;(9):CD011045. https://doi.org/10.1002/14651858.CD011045.pub2 Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. 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Food Availability (Per Capita) Data System, Loss-Adjusted Food Availability. https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/ Steele EM, Baraldi LG, Louzada ML, Moubarac JC, Mozaffarian D, Monteiro CA. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6(3):e009892. https://doi.org/10.1136/bmjopen-2015-009892 Wang L, Martinez Steele E, Du M, et al. Trends in consumption of ultraprocessed foods among US youths aged 2-19 years, 1999-2018. JAMA. 2021;326(6):519-530. https://doi.org/10.1001/jama.2021.10238 Schulz LO, Bennett PH, Ravussin E, et al. Effects of traditional and western environments on prevalence of type 2 diabetes in Pima Indians in Mexico and the US. Diabetes Care. 2006;29(8):1866-1871. https://doi.org/10.2337/dc06-0138 Goel MS, McCarthy EP, Phillips RS, Wee CC. Obesity among US immigrant subgroups by duration of residence. JAMA. 2004;292(23):2860-2867. https://doi.org/10.1001/jama.292.23.2860 Papavramidou NS, Papavramidis ST, Christopoulou-Aletra H. Galen on obesity: etiology, effects, and treatment. World J Surg. 2004;28(6):631-635. https://doi.org/10.1007/s00268-004-7458-5 Haslam DW, Haslam F. Fat, Gluttony and Sloth: Obesity in Literature, Art and Medicine. Liverpool: Liverpool University Press; 2009. https://www.liverpooluniversitypress.co.uk/9781846311734/fat-gluttony-and-sloth/ Townend L. The moralizing of obesity: a new name for an old sin? Crit Soc Policy. 2009;29(2):171-190. https://doi.org/10.1177/0261018308101625 Levine DI. Corpulence and correspondence: President William H. Taft and the medical management of obesity. Ann Intern Med. 2013;159(8):565-570. https://doi.org/10.7326/0003-4819-159-8-201310150-00012 Wright L, Davies NM, Bann D. The association between cognitive ability and body mass index: a sibling-comparison analysis in four longitudinal studies. PLoS Med. 2023;20(4):e1004207. https://doi.org/10.1371/journal.pmed.1004207 Mechanisms of GLP-1 receptor agonist-induced weight loss: a review of central and peripheral pathways. Am J Med. 2025 (review of hypothalamic arcuate nucleus and brainstem area postrema action). https://www.sciencedirect.com/science/article/pii/S0002934325000592 Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384(11):989-1002. https://doi.org/10.1056/NEJMoa2032183 Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity (SURMOUNT-1). N Engl J Med. 2022;387(3):205-216. https://doi.org/10.1056/NEJMoa2206038 Grannell A, Fallon F, Al-Najim W, le Roux C. Obesity and responsibility: is it time to rethink agency? Obes Rev. 2021;22(8):e13270. https://doi.org/10.1111/obr.13270 Al Khatib HK, Harding SV, Darzi J, Pot GK. The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis. Eur J Clin Nutr. 2017;71(5):614-624. https://doi.org/10.1038/ejcn.2016.201 Helms ER, Aragon AA, Fitschen PJ. Evidence-based recommendations for natural bodybuilding contest preparation: nutrition and supplementation. J Int Soc Sports Nutr. 2014;11:20. https://doi.org/10.1186/1550-2783-11-20 Garthe I, Raastad T, Refsnes PE, Koivisto A, Sundgot-Borgen J. Effect of two different weight-loss rates on body composition and strength and power-related performance in elite athletes. Int J Sport Nutr Exerc Metab. 2011;21(2):97-104. https://doi.org/10.1123/ijsnem.21.2.97 Our Sponsors: * Check out Cometeer and use my code BBM for a great deal: https://www.cometeer.com * Chec