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Barbell Medicine Podcast
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Podcast by Barbell Medicine
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Lifting and longevity: is 1 hour a week really the limit? Plus GLP1s and mood, training with ME/CFS, and Protein vs. Calories
5d ago00:46:09Tap to summarizeA 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 Intro0:38 The paper: does lifting stop helping after an hour?3:19 The newer 147,000-person, 30-year study13:21 GLP-1s, mood, and motivation14:50 The FDA reverses the suicide warning19:29 What happened when they gave people a GLP-1 in a bar24:54 Is a calorie just a calorie?28:17 The "same calories, more weight loss" protein study30:48 Does keto break the laws of physics?34:56 Lifting with chronic fatigue syndrome36:14 The identical-twin experiment37:36 Can lifting in bed do anything?45:33 Get the full Direct LineBarbell Medicine coaching and templates: https://www.barbellmedicine.comBarbell 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-2021-1050612. 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.2016.04.0053. 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-2025-1105034. 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-glp5. 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.2024.47896. 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)00305-37. 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/S00071145200020198. 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.90031410. 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)31965-611. Millar NL, Meakins A, Struyf F, et al. Frozen shoulder. *Nat Rev Dis Primers*. 2022;8(1):59. doi:10.1038/s41572-022-00386-212. 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 CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com* Check out FIGS: 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 quince.com/BBM for a great deal: https://www.quince.comAdvertising Inquiries: https://redcircle.com/brands
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The FDA Voted for 6 Peptides. Its Own Scientists Said No
1w ago01:06:20Tap to summarizeAn 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 mindResources: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/download3. 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.gov9. 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.2008917. 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/s00441-019-03016-818. 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/ph1903046319. 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/genes1312238020. Mendias CL, Awan TM. The safety and efficacy of approved and unapproved peptides. Sports Med. 2026. doi:10.1007/s40279-026-02437-021. 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/NEJMoa01325922. 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:10.1177/0363546598026003030125. 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.x26. 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.x27. 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.2013.12928. 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.2021.698629. 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-2022-10575430. 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.1992.6931. 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/NEJM19970828337090132. 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/NEJM20001123343210334. 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)17864-735. 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/NEJMoa121397836. 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:10.7326/0003-4819-149-9-200811040-0000338. 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.2017.1706939. 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.org41. World Anti-Doping Agency. The 2026 Prohibited List. Montreal, QC: WADA; 2026. Accessed July 24, 2026. https://www.wada-ama.org42. US Anti-Doping Agency. BPC-157: a prohibited peptide. Accessed July 24, 2026. https://www.usada.org43. FDA committee ...
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The Man Who Couldn’t Stop Gaining Weight | A Medical Mystery
2w ago01:10:08Tap to summarizeA 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.Timestamps00:00:00 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 CloseResourcesBarbell 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. 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 CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com* Check out FIGS: 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 quince.com/BBM for a great deal: https://www.quince.comAdvertising Inquiries: https://redcircle.com/brands
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The Protein Scaries: What the Research Says About Your Kidneys, Cancer, Bones, and Body Fat
3w ago00:32:41Tap to summarizeEvery 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.Timestamps00:00 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 matterResources: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/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/StudiesLevine 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-2017-097608Our Sponsors:* Check out CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com* Check out FIGS: 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 quince.com/BBM for a great deal: https://www.quince.comAdvertising Inquiries: https://redcircle.com/brands
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Is It Really Just Calories In, Calories Out? Metabolism, Insulin, Hormones and Why Counting Fails
Jul 1700:31:14Tap to summarizeIs 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?Timestamps0:00 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.comhttps://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.abe5017Muller et al., Am J Clin Nutr 2015. https://doi.org/10.3945/ajcn.115.109173Lichtman et al., N Engl J Med 1992. https://doi.org/10.1056/NEJM199212313272701Karmisholt et al., J Clin Endocrinol Metab 2011. https://doi.org/10.1210/jc.2010-1521Lee et al., Endocr Pract 2014. https://doi.org/10.4158/EP14072.ORvan der Valk et al., Obes Rev 2022. https://doi.org/10.1111/obr.13376Nikokavoura et al., Diabetes Metab Syndr Obes 2015. https://doi.org/10.2147/DMSO.S85134Greendale et al., JCI Insight 2019. https://doi.org/10.1172/jci.insight.124865Lejeune et al., Am J Clin Nutr 2006. https://doi.org/10.1093/ajcn/83.1.89Bray et al., JAMA 2012. https://doi.org/10.1001/jama.2011.1918Novotny et al., Am J Clin Nutr 2012. https://doi.org/10.3945/ajcn.112.035782Baer et al., J Nutr 2016. https://doi.org/10.3945/jn.115.217372Baer et al., Br J Nutr 2012. https://doi.org/10.1017/S0007114511002649Evenepoel et al., J Nutr 1998. https://doi.org/10.1093/jn/128.10.1716Hall et al., Cell Metabolism 2019. https://doi.org/10.1016/j.cmet.2019.05.008Champagne et al., J Am Diet Assoc 2002. https://doi.org/10.1016/S0002-8223(02)90316-0Hall et al., Cell Metabolism 2015. https://doi.org/10.1016/j.cmet.2015.07.021Wilding et al., N Engl J Med 2021. https://doi.org/10.1056/NEJMoa2032183Jastreboff et al., N Engl J Med 2022. https://doi.org/10.1056/NEJMoa2206038Our Sponsors:* Check out CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com* Check out FIGS: 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 quince.com/BBM for a great deal: https://www.quince.comAdvertising Inquiries: https://redcircle.com/brands
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Is Obesity a Willpower Problem? The Biology of Weight, Diets, and GLP-1s
Jul 1001:42:34Tap to summarizeObesity 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.Timestamps00:00 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.comhttps://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.htmObesity 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.htmHill JO, Peters JC. Environmental contributions to the obesity epidemic. Science. 1998;280(5368):1371-1374. https://doi.org/10.1126/science.280.5368.1371Morton 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-2017-097608Stunkard 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/NEJM198601233140401Stunkard 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/NEJM199005243222102Speakman 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.008698Kalm 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/135.6.1347Sumithran 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/NEJMoa1105816Fothergill 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.21538Hall 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.23308Cohen 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.htmRolls 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/76.6.1207Diliberti 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.2004.64Hollands 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.pub2Hall 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. Cell Metab. 2019;30(1):67-77.e3. https://doi.org/10.1016/j.cmet.2019.05.008Pontzer H, Raichlen DA, Wood BM, et al. Hunter-gatherer energetics and human obesity. PLoS One. 2012;7(7):e40503. https://doi.org/10.1371/journal.pone.0040503Careau V, Halsey LG, Pontzer H, et al. Energy compensation and adiposity in humans. Curr Biol. 2021;31(20):4659-4666.e2. https://doi.org/10.1016/j.cub.2021.08.016Miller WC, Koceja DM, Hamilton EJ. A meta-analysis of the past 25 years of weight loss research using diet, exercise or diet plus exercise intervention. Int J Obes Relat Metab Disord. 1997;21(10):941-947. https://doi.org/10.1038/sj.ijo.0800499Gaesser GA, Angadi SS. Obesity treatment: weight loss versus increasing fitness and physical activity for reducing health risks. iScience. 2021;24(10):102995. https://doi.org/10.1016/j.isci.2021.102995US Department of Agriculture, Economic Research Service. 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-2015-009892Wang 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.2021.10238Schulz 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/dc06-0138Goel 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.292.23.286...
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Direct Line (Free): GLP-1 Muscle Loss and Creatine, Bulking vs Cutting, One-Hour Training, & Detraining
Jul 300:49:33Tap to summarizeOnce a month we answer Barbell Medicine Plus subscribers’ questions on the Direct Line. This is a free look at June’s episode. We start with GLP-1 drugs and muscle: why DEXA overstates the loss, what resistance training actually does, and whether creatine is worth taking. Then whether bulking and cutting does anything the scale can’t already tell you, how to get real benefit from one training hour a week, and what happens to your muscle, strength, tendons, and bone when you take time off, including why muscle memory brings it back faster than you built it.What we cover:• GLP-1s and muscle: the DEXA problem, resistance training, and creatine• Bulking vs cutting vs just maintaining, and a health-first way to choose• Training on one hour a week: the least that still moves the needle• How fast you lose muscle when you stop, and why it comes back fastThe full two-hour episode and every back episode are on Barbell Medicine Plus, which can bundled with Premium. Resources and full references below.Timestamps0:00 Intro + GLP-1 and the DEXA muscle-loss myth3:00 Do GLP-1s spare or waste muscle?8:03 Does creatine help on a GLP-1?10:45 Does bulking and cutting do anything?13:18 Health first: when to lose fat before gaining22:30 Training on one hour a week36:22 How fast you lose muscle when you stop43:19 Muscle memory: why it comes back48:25 The full episode on PlusResourcesBarbell Medicine coaching and templates: https://www.barbellmedicine.comhttps://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/https://www.barbellmedicine.com/blog/glp-1-muscle-loss/https://www.barbellmedicine.com/blog/creatine-on-ozempic-does-it-prevent-muscle-loss/https://www.barbellmedicine.com/blog/novice-intermediate-advanced-strength-training/Lundgren JR, et al. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined (S-LITE). N Engl J Med 2021;384:1719-1730. nejm.org · NEJMoa2028198T-REX trial: tirzepatide with or without resistance training (Univ. of Western Australia). Preliminary. ANZCTR ACTRN12623001236684Creatine + GLP-1 pilot (Univ. of Saskatchewan). Ongoing, results expected 2027. ClinicalTrials.gov NCT07625202Momma H, et al. Muscle-strengthening activities and lower risk/mortality in major non-communicable diseases. Br J Sports Med 2022. PubMed 35228201Wall BT, et al. 2014. Immobilization and disuse muscle atrophy (quadriceps −3.5% at 5 days, −8% at 14 days). PubMed 24168489Gaffney CJ, et al. 2021. Grip strength loss with short-term arm immobilization. PMC8107283Farthing JP, et al. 2009. Cross-education and preservation of the immobilized limb. PubMed 19150859Marusic U, et al. 2021. Bed rest: strength loss outpaces size loss. PMC8325614Yoshihara, et al. 2023. Sepsis-associated muscle wasting (−26% in a week). PMC10003568Warren GL, et al. 2017. Strength loss and recovery after muscle injury (meta-analysis). PMC5214801Hortobágyi T, et al. 1993. Short-term detraining in strength athletes. PubMed 8371654Gavanda S, et al. 2020. Training cessation in previously untrained adolescents. PMC7241623Lovell DI, et al. 2010. Detraining strength loss in older adults. PubMed 20140683Mujika I, Padilla S. 2001. Physiology of detraining (review). PubMed 11474330Smith K, et al. 2003. Two years of training, then detraining, in older adults. PubMed 12955872Staron RS, et al. 1991. Detraining and muscle cross-sectional area in women. PubMed 1827108Ivey FM, et al. 2000. Detraining across age and sex. PubMed 10795719Taaffe DR, et al. 2009. Training and detraining in older adults. PMC2756799Grgic J, et al. 2022. Muscle size loss with detraining (meta-analysis). PubMed 36360927Bosquet L, et al. 2013. Detraining effects on strength and power. PubMed 23347054Bruusgaard JC, et al. 2010. Myonuclei acquired by overload persist after detraining (muscle memory). PMC2930527Weakley J, et al. 2017. Day-to-day variation in strength performance. PubMed 28277425McGuigan MR, et al. 2004. Strength performance variability. PubMed 15320651Andreoli A, et al. 2009. DEXA precision and assumptions. PMC9263164Our Sponsors:* Check out CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com* Check out FIGS: 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 quince.com/BBM for a great deal: https://www.quince.comAdvertising Inquiries: https://redcircle.com/brands
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Menopause Part 4: Training, Protein, Cortisol, Hormone Therapy, & Bone Density
Jun 2601:43:37Tap to summarizeIs there really a “menopause-specific” way to train, eat, and supplement — or is most of it marketing? In the finale of our 4-part menopause series, Drs. Jordan Feigenbaum and Austin Baraki go straight to the evidence on building muscle and bone before, during, and after the transition.We cover whether menopause blunts your response to lifting (the Isenmann 2023 head-to-head trial and the 2026 meta-analysis of ~4,000 women say it doesn’t), the one-index-card prescription that actually works. Then we work through the loudest claims in the space — cortisol “wrecking” your fat loss, anabolic resistance, the protein and creatine hype, hormone therapy as a cure-all, and “you need a different paradigm” — steelmanning each before we push back. We close with the strongest case in the whole space: heavy lifting for bone density (the LIFTMOR trial), the pelvic-floor evidence, your three biggest fears answered, and how to tell a good coach or clinician from a bad one.Claims discussed are associated with Stacey Sims, Mary Claire Haver, Mindy Pelz, and the broader functional-medicine space. We push back on the claims, not the people.Timestamps:0:00 The 90-year-olds who tripled their strength 1:10 Why this matters: heart disease and falls, not vanity 2:28 Can women still build muscle after menopause? (Isenmann 2023) 7:31 Does menopause blunt your gains? The 2026 meta-analysis 8:49 Is it menopause, or just individual variation? 14:42 The estrogen "shield" and the mechanical override 18:31 Does hormone therapy replace training? (the 2021 estradiol trial) 22:44 What actually works: the whole prescription 24:18 Program details: frequency, volume & insulin sensitivity 30:22 Nutrition: protein and the 2026 review 35:06 Creatine, vitamin D & calcium 43:29 Anabolic resistance: mostly overstated 47:22 Clinical case: the supplement-stack patient 52:23 A short history of wrong advice for women 53:38 Claim 1: "Lift heavy or lose your bones" (Stacey Sims) 1:01:09 Claim 2: the cortisol myth 1:15:18 Clinical case: the cortisol-anxious patient 1:18:20 Claim 3: "It's all hormonal, HRT fixes it" (Mary Claire Haver) 1:20:45 Testosterone in women: what it does and doesn't do 1:21:51 Claim 4: "Menopause needs its own paradigm" & the SWAN data 1:24:48 Bone density done right: the LIFTMORE trial 1:33:07 Does heavy lifting wreck your pelvic floor? 1:38:59 Your three biggest fears, answered 1:40:44 Green flags & red flags Resources:Menopause Series Part 1 : https://www.youtube.com/watch?v=yzk0IkTy0WMMenopause Series Part 2 — https://www.youtube.com/watch?v=YKAlamIOiwU Menopause Series Part 3 — https://www.youtube.com/watch?v=jzoNMQaBAcI Hypercortisolism episode - https://open.spotify.com/episode/7tDdUi8dDFWjMYx0fRJdOz Barbell Medicine coaching and templates: https://www.barbellmedicine.comSignal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/Isenmann (2023) https://doi.org/10.1186/s12905-023-02671-yIsenmann (2026) https://doi.org/10.1016/j.jsams.2026.01.004Fiatarone (1990) https://doi.org/10.1001/jama.1990.03440220053029Fiatarone (1994) https://doi.org/10.1056/NEJM199406233302501Dam (2021) https://doi.org/10.3389/fphys.2020.596130Markofski (2015) https://doi.org/10.1016/j.exger.2015.02.015Orsatti (2022) https://doi.org/10.1016/j.exger.2022.111904Walter (2026) https://doi.org/10.1186/s40798-025-00954-2dos Santos (2021) https://doi.org/10.3390/nu13113757Myung (2021) https://doi.org/10.3390/nu13020368Dote-Montero (2021) https://doi.org/10.1111/sms.13999Ravussin (2015) https://doi.org/10.1093/gerona/glv057Cadegiani (2016) https://doi.org/10.1186/s12902-016-0128-4Greising (2009) https://doi.org/10.1093/gerona/glp082Islam (2019) https://doi.org/10.1016/S2213-8587(19)30189-5Testosterone in women review (2026) https://doi.org/10.1080/09513590.2025.2592402NAMS nonhormone position statement (2023) https://doi.org/10.1097/GME.0000000000002200Vasomotor exercise meta-analysis (2022) https://doi.org/10.1080/13697137.2022.2097865Greendale (2019) https://doi.org/10.1172/jci.insight.124865Watson, LIFTMOR (2018) https://doi.org/10.1002/jbmr.3284Skaug (2024) https://doi.org/10.1249/MSS.0000000000003278Skaug (2021) https://doi.org/10.1007/s00192-021-04739-5Dumoulin (2018) https://doi.org/10.1002/14651858.CD005654.pub4Our Sponsors:* Check out CovePure and use my code CovePure.com/bbm for a great deal: https://covepure.com* Check out FIGS: 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 quince.com/BBM for a great deal: https://www.quince.comAdvertising Inquiries: https://redcircle.com/brands
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Menopause Part 3: Body Composition, Bone, Brain, & the Fitness Changes (The Data vs the Influencers)
Jun 1201:43:32Tap to summarizeMost women in 2026 are told menopause affects everything, the weight, the belly fat, the bones, the heart, the brain, and that the fix is hormones, supplements, and a proprietary protocol. The data tell a different story. Menopause does some of it, but not all of it.In this episode, Dr. Jordan Feigenbaum and Dr. Austin Baraki, with OB-GYN Dr. Loraine Baraki at the clinical handoffs, put real numbers on what menopause actually changes, e.g. body composition, the cardiometabolic shift around the final menstrual period, bone, cognition and sleep — and on the single biggest modifiable lever against what actually kills postmenopausal women.This is Episode 3 of Barbell Medicine's four-part menopause series.Timestamps:01:23 Intro 02:45 Body composition & the SWAN study 04:16 How much weight gain is really menopause? 06:55 The answer: about 1.5 kg 08:14 Subcutaneous vs visceral fat 11:08 Why waist beats weight (and body-fat %) 17:21 Does menopause crash your metabolism? 19:02 Clinic: MHT for body composition 23:51 Dr. Loraine Baraki — MHT, weight & testosterone 27:29 The cardiometabolic shift: cholesterol at the FMP 30:18 Insulin resistance & metabolic syndrome 33:12 Blood pressure & 10-year heart risk 34:54 Clinic: the "estrogen crisis" lipid panic 39:13 Bone: the advice vs the data 40:34 Why DXA misses most fractures 41:24 LIFTMOR: lifting heavy with low bone density 44:47 The LIFTMOR results 46:53 Lifting vs Pilates, and falls 52:17 Clinic: "Should I be deadlifting?" 56:14 Cognition & brain fog 57:50 Why brain fog is mostly a sleep problem 59:17 Clinic: brain fog, night sweats, broken sleep 1:03:06 Depression & dementia in midlife 1:05:43 Does hormone therapy protect the brain? 1:08:53 Clinic: "Am I getting early dementia?" 1:13:19 Dr. Loraine Baraki — the timing hypothesis & the brain1:16:15 What actually kills postmenopausal women 1:17:31 Fitness: the biggest mortality lever 1:20:21 Strength, power & grip 1:25:15 Clinic: where to start when you're overwhelmed 1:30:41 The detraining problem 1:32:38 Trained vs untrained: what's recoverable 1:34:53 The actual plan 1:39:48 TakeawaysResources:Subscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/Barbell Medicine coaching and templates: https://www.barbellmedicine.com/Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/Body composition & metabolism Greendale et al., SWAN body composition, JCI Insight 2019: https://doi.org/10.1172/jci.insight.124865 Lovejoy et al., visceral fat across the transition, Int J Obes 2008: https://doi.org/10.1038/ijo.2008.25 Pontzer et al., daily energy expenditure across life, Science 2021: https://doi.org/10.1126/science.abe5017 Karppinen et al., metabolism in midlife women, Eur J Prev Cardiol 2023: https://doi.org/10.1093/eurjpc/zwad177CardiometabolicMatthews et al., lipid changes & the menopause transition, JACC 2009: https://doi.org/10.1016/j.jacc.2009.10.009Janssen et al., menopause & metabolic syndrome (SWAN), Arch Intern Med 2008: https://doi.org/10.1001/archinte.168.14.1568 El Khoudary et al., AHA Scientific Statement on midlife women, Circulation 2020: https://doi.org/10.1161/CIR.0000000000000912BoneGreendale et al., SWAN bone loss across the FMP, JBMR 2012: https://doi.org/10.1002/jbmr.534 Siris et al., undiagnosed low BMD & fractures (NORA), JAMA 2001: https://doi.org/10.1001/jama.286.22.2815 Watson et al., LIFTMOR, JBMR 2018: https://doi.org/10.1002/jbmr.3284Kemmler et al., EFOPS 16-year, Menopause 2017: https://doi.org/10.1097/GME.0000000000000720Kistler-Fischbacher et al., MEDEX-OP, JBMR 2021: https://doi.org/10.1002/jbmr.4334 Sherrington et al., exercise for preventing falls, Cochrane 2019: https://doi.org/10.1002/14651858.CD012424.pub2ACSM Position Stand: Osteoporosis and Exercise, Med Sci Sports Exerc 1995;27(4):i–vii (no DOI)Cognition & moodGreendale et al., SWAN cognition, Neurology 2009: https://doi.org/10.1212/WNL.0b013e3181a71193Kravitz et al., sleep in midlife women, Obstet Gynecol Clin North Am 2018: https://doi.org/10.1016/j.ogc.2018.07.008Cohen et al., Harvard Study of Moods and Cycles, Arch Gen Psychiatry 2006: https://doi.org/10.1001/archpsyc.63.4.385Bromberger & Kravitz, mood and menopause (SWAN), Obstet Gynecol Clin North Am 2011: https://doi.org/10.1016/j.ogc.2011.05.011Livingston et al., Lancet Commission on dementia 2024: https://doi.org/10.1016/S0140-6736(24)01296-0Shumaker et al., WHIMS (estrogen+progestin & dementia), JAMA 2003: https://doi.org/10.1001/jama.289.20.2651 Espeland et al., WHIMS (estrogen-alone & cognition), JAMA 2004: https://doi.org/10.1001/jama.291.24.2959Gleason et al., KEEPS-Cog, PLoS Med 2015: https://doi.org/10.1371/journal.pmed.1001833 Henderson et al., ELITE (timing hypothesis & cognition), Neurology 2016: https://doi.org/10.1212/WNL.0000000000002980USPSTF, hormone therapy for primary prevention, JAMA 2022: https://doi.org/10.1001/jama.2022.18625Fitness & mortality Mandsager et al., cardiorespiratory fitness & mortality, JAMA Netw Open 2018: https://doi.org/10.1001/jamanetworkopen.2018.3605Kodama et al., fitness & mortality meta-analysis, JAMA 2009: https://doi.org/10.1001/jama.2009.681Sui et al., fitness & adiposity in older adults, JAMA 2007: https://doi.org/10.1001/jama.298.21.2507Momma et al., muscle-strengthening activity & mortality, Br J Sports Med 2022: https://doi.org/10.1136/bjsports-2021-105061Araújo et al., muscle power vs strength & mortality (CLINIMEX), Mayo Clin Proc 2025: https://doi.org/10.1016/j.mayocp.2025.02.015Leong et al., grip strength & mortality (PURE), Lancet 2015: https://doi.org/10.1016/S0140-6736(14)62000-6Detraining & trained-vs-untrainedTroiano et al., accelerometer-measured activity, Med Sci Sports Exerc 2008: https://doi.org/10.1249/mss.0b013e31815a51b3Fleg et al., aerobic-capacity decline (BLSA), Circulation 2005: https://doi.org/10.1161/CIRCULATIONAHA.105.545459Ratley et al. aerobic-capacity changes during menopause, 2025https://pmc.ncbi.nlm.nih.gov/articles/PMC12358808/ Janssen et al., skeletal muscle mass across adulthood, J Appl Physiol 2000: https://doi.org/10.1152/jappl.2000.89.1.81...
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Menopause, Part 2: The 2,000-Year-Old Lie About Women and Exercise
Jun 500:31:51Tap to summarizeThe story goes that hard exercise is risky for women, and that the idea is ancient. Both halves fall apart on contact. In this solo episode, Dr. Jordan Feigenbaum follows the claim that physical effort harms the female body across twenty centuries, and shows that almost every version of it arrived as a verdict first, with the science bolted on afterward.It runs from antiquity to the present: what Galen actually wrote, why Sparta trained its women on purpose, the Victorian “vital force” panic and Edward Clarke’s claim that studying would sterilize girls, the doctor who prescribed bed rest to women and the wilderness to men, and the 1928 Olympic 800m that was erased for 32 years over a collapse that never happened. Then the correction: the research that finally tested heavy training in older women and women with low bone mass, and what it found. The episode closes on 2026, where the guidelines say lift and the menopause market often says don’t.What we cover• Why the “ancient Greeks” origin story for the no-hard-exercise rule doesn’t hold up.• How a Victorian energy-budget idea became a medical case against women lifting and studying.• The real story of the 1928 Olympic women’s 800m and the 32-year ban.• The strong women who were relabeled as freaks or exceptions instead of counted.• What Fiatarone’s nonagenarians and LIFTMOR actually showed about lifting heavy later in life.• The cortisol panic, the fasting scare, and cycle syncing, examined against the data.• Why the cautious messaging now comes from the market, not the medical guidelines.Timestamps00:00 The 1928 Olympic “massacre” that never happened03:37 Antiquity: what the Greeks actually said06:50 The Victorians and “vital force”10:02 Mary Putnam Jacobi tests the claim, and is ignored11:53 1928 in full: who killed the women’s 800m13:53 The double standard, and Alice Milliat15:39 The strong women history relabeled20:26 The correction: what the evidence shows22:27 LIFTMOR: lifting heavy with low bone mass24:35 2026: guidelines, the market, and cortisol28:34 Cycle syncing, and naming the pattern30:40 What to take awaySubscribe to BBM Plus for the full unabridged Direct Line: https://barbellmedicine.supercast.com/Barbell Medicine coaching and templates: https://www.barbellmedicine.com/Signal book pre-order: https://www.barbellmedicine.com/shop/learning/signal/ReferencesCahn S. Coming on Strong: Gender and Sexuality in Twentieth-Century Women's Sport. Harvard University Press; 1994.Clarke EH. Sex in Education; or, A Fair Chance for the Girls. Boston: James R. Osgood and Company; 1873.Colenso-Semple LM, McKendry J, Lim C, et al. Menstrual cycle phase does not influence muscle protein synthesis or whole-body myofibrillar proteolysis in response to resistance exercise. J Physiol. 2025. PMID: 39630025.Daly W, Hackney AC. Is exercise cortisol response of endurance athletes similar to levels of Cushing's syndrome? J Sports Med Phys Fitness. 2019. PMID: 31371847.Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. PMID: 30907953.Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA. 1990;263(22):3029-3034. PMID: 2342214.Fiatarone MA, O'Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330(25):1769-1775.Galen. On the Preservation of Health (De Sanitate Tuenda). 2nd century CE. Various translations.Jacobi MP. The Question of Rest for Women During Menstruation. New York: G.P. Putnam's Sons; 1877. (Awarded the Harvard Boylston Prize.)Latella C, Teo WP, Spathis J, et al. Using powerlifting athletes to determine strength adaptations across ages in males and females: a longitudinal growth modelling approach. Sports Med. 2024;54(3):753-774.Maudsley H. Sex in mind and in education. Fortnightly Review. 1874;15:466-483.Plutarch. Life of Lycurgus. Approx. 75 CE. Various translations.Schultz J. Qualifying Times: Points of Change in U.S. Women's Sport. Urbana: University of Illinois Press; 2014.Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593-596. PMID: 6487063.Soranus of Ephesus. Gynecology. Approx. 2nd century CE. Translated by Temkin O. Baltimore: Johns Hopkins University Press; 1991.Switzer K. Marathon Woman: Running the Race to Revolutionize Women's Sports. Cambridge, MA: Da Capo Press; 2007.Todd J. Various publications. Iron Game History. Stark Center for Physical Culture and Sports, University of Texas at Austin.Tunis JR. Women and the Olympic Games. Harper's Magazine. July 1929. (And contemporaneous press coverage.)Watson SL, Weeks BK, Weis LJ, Harding AT, Horan SA, Beck BR. High-intensity resistance and impact training improves bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis: the LIFTMOR randomized controlled trial. J Bone Miner Res. 2018;33(2):211-220. PMID: 30861219.Xenophon. Constitution of the Lacedaemonians. Approx. 4th century BCE. 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