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Q/A with Dr. Baraki and Dr. Feigenbaum

 

 

Dr. Feigenbaum:                Hey, welcome back to the Barbell Medicine Podcast. I’m Dr. Feigenbaum, I’m joined here with Dr. Baraki. This is another Q&A episode, and we like doing these things-

Dr. Baraki:                              Or episodes.

Dr. Feigenbaum:                Episodes, potentially. [00:00:30] We have a lot of questions to get through, so we’re going to have a slightly different format this time. What I will do, is I will play moderator, the first tank-top wearing moderator that the internet has ever seen, and I will read the question.

I’m going to give Dr. Baraki one minute to respond, I have a timer on my screen, hopefully this shows up on YouTube, and then I’ll give myself one minute to respond. It doesn’t mean we’re going to take opposing sides, however, that would make things interesting [00:01:00] if … First-

Dr. Baraki:                              [crosstalk 00:01:03].

Dr. Feigenbaum:                First, Austin, how is it going, man?

Dr. Baraki:                              It’s going all right. Life has gotten much better since I finished in the CCU. I’m back to the land of the living, people who are awake like during the day and asleep at night, unlike you, I’m here.

Dr. Feigenbaum:                Yeah, I have 10 days left in the intensive care unit. It’s funny, it’s actually not funny at all, but somebody asked me, this female, [00:01:30] asked me where I worked, what I did, and I told her I was in the MICU, which stands for Medical Intensive Care Unit, which just refers to adults in the ICU, right?

Dr. Baraki:                              Mm-hmm (affirmative).

Dr. Feigenbaum:                She’s like, “Oh, you mean the NICU,” thinking that I, it was like an auto correct. I’m like, “No, that’s Neonatal Intensive Care Unit.” I was like, “Not to be confused with the PICU or the SICU,” so the Pediatric Intensive Care Unit or the Surgical Intensive Care Unit, this is just medicine.

Dr. Baraki:                              For me, I confuse NICU all the time because [00:02:00] I’ve even heard some people in our place refer to the Neuro IC, like for adults with strokes, as NICU, but I’m used to thinking about it in the context of neonatal as well. There’s way too many acronyms for different types of ICU’s out there.

Dr. Feigenbaum:                There’s just, I think there-

Dr. Baraki:                              Best to just, best to stay out of them.

Dr. Feigenbaum:                Best to stay out. Yeah, I think it, yeah, if you can avoid them. Yeah, there’s too many ICU’s, that’s true.

Dr. Baraki:                              Yes.

Dr. Feigenbaum:                Training is going okay?

Dr. Baraki:                              Training is, yeah, it’s getting much better. It seems like my tendons are cooperating for the moment, [00:02:30] and I’m slowly trying to build some momentum, signed up for a meet at the end of September that I’m look forward to attacking. I think you probably saw Lorraine trained for about four weeks, training twice a week and squat at 315, so I’ll just go end it right now.

Dr. Feigenbaum:                Yeah, I think basically this is what happens when you have a person who’s got a storied athletic background, good genetic underpinnings, who gets exposed to good training methods, they show us all what rapid, rapid progress [00:03:00] looks like. Lorraine weighs what? She’s like 95 pounds now?

Dr. Baraki:                              She’s rebounded a little bit since intern year, so she’s back around a 63 kilo training weight.

Dr. Feigenbaum:                She’s in the sub-junior weight classes.

Dr. Baraki:                              Yeah, yeah. I mean it was interesting just to see because in med school we were training much, she was training much more regularly, and trained for consistently for about 18 months or so. At the time I think her all time best squat was three out of three, and [00:03:30] it wasn’t a particularly slow three out of three, she had more in the tank, but she just never actually hit more than that. Literally probably no more than like eight training sessions coming off of like nights just like when she didn’t, wasn’t able to train at all, and then she just tossed out 315, it’s just like, “What the hell?”

Dr. Feigenbaum:                Yeah, she takes like months of deloads, and then … There you go, it just means she’s due, right?

Dr. Baraki:                              Yeah.

Dr. Feigenbaum:                This is like, this reminds me of actually The Cardinals were in the world series, or it was that, or like a division series, [00:04:00] it was like game seven, Jim Edmonds was the guy. He was like our outfielder, but he would go on these crazy slumps where he’d be like O and 20 something, and everyone’s like, “Oh, frigging Edmonds again.”

It was just like you want to pinch hit for him, but then you’re like, “You know, he’s a pretty good batter sometimes,” but he was like at for like O and 17 or something like that. The announcers were saying, “The one thing that you can say about Edmonds right now is that he’s due. He’s due,” and [00:04:30] sure enough, you know.

Dr. Baraki:                              Statistically.

Dr. Feigenbaum:                Yeah, he hits a dinger and we move on. She was due for some PR’s, and I think that just, it’s good for compression. All right, last two intro questions, kind of unrelated to our podcast. What’s been the craziest thing that you’ve diagnosed in the past two weeks?

Dr. Baraki:                              Oh, jeez. I’m currently on an inpatient HIV service, so that’s where I see all the weird crazy stuff [00:05:00] that people get when they don’t have an immune system basically. I can think of a few different examples I suppose, so one gentleman who was traveling from overseas came in simultaneously with malaria as well as yersinia, E. Coli and giardia, all in his gut, so four simultaneous different infections, so that was one example.

Dr. Feigenbaum:                Sounds bad.

Dr. Baraki:                              I’ve seen diffuse cerebral [00:05:30] toxoplasmosis. I’ve seen, let’s see, multiple cases of pneumocystis, of course that’s like getting to be routine at this point. Cryptococcal meningitis in multiple ca-, just kind of stuff like that that you don’t see in any other sort of patient, but it becomes routine on this sort of service. That’s the kind of things that we’re seeing.

Dr. Feigenbaum:                Somewhere [Gullian 00:05:49] is taking his shirt off right now. For the uninitiated, Gullian is a lecture series that most medical students will listen to right before they take step [00:06:00] one, which is many years ago for you and I. His voice rings in your ears when you’re taking the test, and so you hear cryptococcas, and you say, “[inaudible 00:06:12].” Yeah, I think the craziest thing I diagnosed was chagas.

Dr. Baraki:                              Yeah.

Dr. Feigenbaum:                Well, apparently the place that I was working is the, a center for excellence.

Dr. Baraki:                              That actually happens.

Dr. Feigenbaum:                Trypanosoma, whatever it is, [inaudible 00:06:28], glad it [00:06:30] doesn’t have to do with us. Then, what are you reading right now?

Dr. Baraki:                              Oh, jeez. I’m currently deep in the literature of basically gene expression in the context of resistance training, endurance training, and how they influence gene expression. I have so many like simultaneous projects going on that I actually have not been able to keep up with leisure reading.

Dr. Feigenbaum:                Leisure reading.

Dr. Baraki:                              Because I have the Started Strength, the coaches conference coming up soon, and I’m preparing the presentation, [00:07:00] or part of the panel presentation, on the topic for that. Free time is being taken up by reading on gene expression and tissue level adaptation and its training methods, so big topics.

Dr. Feigenbaum:                Sure. Sure. I assume most of these modifiable with stretching and …

Dr. Baraki:                              Yes, MobilityWOD induced mTOR expression and things.

Dr. Feigenbaum:                That’s right, the PIK3 is maximally repressed with-

Dr. Baraki:                              Yes.

Dr. Feigenbaum:                Okay, so again, just as a reminder, [00:07:30] heres the format. I play moderator, I’m going to give both of us a minute on the clock to respond to all of your fantastic questions. I apologize in advance for the snark, but that’s just our personalities baseline.

Dr. Baraki:                              There’s also personalities plus the fact that many of these questions were probably discussed in some form previously. We’ll do our best to be nice and not do things that make people think we’re super smug and assume people’s genders [00:08:00] and things like that.

Dr. Feigenbaum:                Yeah, yeah. Also don’t be a misogynist and …

Dr. Baraki:                              Other various accusations.

Dr. Feigenbaum:                Sure. All right. Three, two, one. We’ve got a minute to win it, here we go. All right. First question is from Tom [Calliraih 00:08:14]. “What is the tastiest piece of beef?”

Dr. Baraki:                              There’s a lot to choose from here. I typically tend to go for rib-eyes. We actually, when I took that picture today, we actually [00:08:30] ended up buying some sirloins [inaudible 00:08:31]. I think a good value steak for people who need something like that is if you can find a Denver cut, that’s another actually good tasty cut of meat.

Dr. Feigenbaum:                Yeah, the John Denver piece.

Dr. Baraki:                              Yeah, I really enjoy a good rib-eye.

Dr. Feigenbaum:                I am more of a, well, and this is no surprise that I have a fancier cut of beef that I prefer, is the wagyu.

Dr. Baraki:                              Excuse me.

Dr. Feigenbaum:                Well, and the thing was I was having, the first time I had it I was having dinner with my teacher, right, and so [00:09:00] all I see is market price next to the thing. I’m like, “Oh, yeah, it’s probably not so bad,” and I’m like, they’re like, “Oh, what are you getting? I’m getting the wagyu.” Then the waiter comes over and I was like, “Oh, I’d like the wagyu,” he goes, “Oh, great. It’s $33 an ounce, three ounce minimum.” I’m like, “[inaudible 00:09:18].”

I already committed myself to the wagyu, so it’s like, “What’s the smallest piece of meat that I can get without looking terrible?” I was like, “Yo, let me get eight ounces of the wagyu. I’m on macros, bro. I’m [00:09:30] on macros. I’m trying to … ” Word to the wise, don’t do that. All right, next question, is not a question, so we’re going to, I like that people ask, it’s just statements. Like, “Plant based diet, how it effects strength training.”

Dr. Baraki:                              Yeah, right.

Dr. Feigenbaum:                Or, “Stretching [inaudible 00:09:47], et cetera.” It turns out, not a question. All right, let’s see. “Why do you guys think strength conditioning coaches for big professional sports teams, especially football and soccer, are so uninterested [00:10:00] or against getting their athletes to do some heavy barbell training?”

Dr. Baraki:                              That’s a good question. It’s something that has been discussed at length kind of in the, at least by Rip and Alan, the Starting Strength community. I think it depends on the sport for sure, but there’s a whole lot, I mean coming from a different competitor sport myself, one of the biggest reasons is really going to be tradition. I saw lots of our training methods, our programing, stuff like that, when I swam, the strength and conditioning we did was a lot of it just seemed like the traditioned thing [00:10:30] that they’ve done for the longest time.

It was hard for them to wrap their minds around leaving that tradition that has produced some of the greatest athletes in the sports that they’ve seen perform previously, to try something seemingly new and experimental, that seems less specific to their sports, since a lot of them are of the mindset that the training that they do, even outside of the contacts of their sport, needs to be sport specific. I think those are probably some, the two of the biggest factors contributing here, is kind of tradition and the desire to maintain as much [00:11:00] sport specificity as possible, which is another, a whole another topic that we’ve kind of discussed at length elsewhere, at least that’s what I saw personally.

Dr. Feigenbaum:                Allow to me play devil’s advocate.

Dr. Baraki:                              I assumed that would be the case.

Dr. Feigenbaum:                Well, so you considered the people at the top end of sport, particularly like football for instance. You’ve already selected for the baddest of the bad, right. You can make the argument that some of these folks are maybe strong enough, relative to their cohort of other players. What I mean [00:11:30] by that, if you agree that nobody’s going to continue to get stronger in the professional ranks, at the particular position, then you don’t necessarily need to select for increased strength, and you’ve already selected for super explosive folks.

I think what you have in the strength conditioning folks mind is the just the risk benefit, and in their brains, squatting, benching, deadlifting, pressing or whatever, particularly for high end strength games, may, in their brains, be, have too much risk [00:12:00] compared to benefit. Although, again if you really analyze this that’s not necessarily the case. My overall sense is that you are correct, convention, and then, “What is everybody else doing?” All right.

Dr. Baraki:                              I think Rip’s mentioned something along those before, where he said, “Well, as long as everybody agrees not to do this, then it’s fine. Then keep doing all of that.”

Dr. Feigenbaum:                Yeah, in football we need more James Harrisons. Yeah. The average length of like the football career, I thought it was less than three years on average, and you could actually make the argument that lack [00:12:30] of strength potentially is contributing to, or lack of continued strength development, or maintenance even, is contributing to this injury epidemic that’s taking people out of the league.

Dr. Baraki:                              Yeah. Maybe, yeah.

Dr. Feigenbaum:                It could be. I haven’t seen the statistic. Oh, here’s the joke, the ortho joke. Nevermind. All right. No, what do you call two orthopedics and an EKG?

Dr. Baraki:                              Oh, that’s a double blind study, man. Everybody knows that joke.

Dr. Feigenbaum:                All right.

Dr. Baraki:                              It’s [00:13:00] the kind of jokes that internal medicine people like to tell.

Dr. Feigenbaum:                Yeah, exactly, and the orthos like. Yeah, I just, I’m off work though, [inaudible 00:13:08]. Okay. This is from Mr. [Flórez 00:13:12], “Three top things that an intermediate should consider to do to continue making progress after linear pro-,” so just as on the side, this person lumped in linear progression, heavy, light, medium, et cetera.

Dr. Baraki:                              Yeah, so those are not things that can be lumped in if you work, I think we need to be more kind of, we need to delineate [00:13:30] what period of time we’re talking about more specifically. Let’s assume that you’re saying that the things that you can do to continue making progress after you finish your linear progression. I mean in my mind the biggest things, and they’re kind of like things that are probably easier said than done, but in general regardless of where you are in your training period, where you are in your training advancement, training consistency, staying healthy, things like that, are going to be the most important to longterm progress. Right, avoiding injury [00:14:00] and staying in the gym.

When you’re in the gym, especially after you finish the linear progression, you need to get out of your mind that you need to be grinding the shit out of your last heavy work reps routinely as you were at the end of your LP. You need to be not be afraid to add more training volume, potentially at a lower intensity. You need to be not, you need to not be afraid to add additional frequency when warranted on a particular lift, when they’re not moving. There’s nothing magic about doing sets of five reps, you can [00:14:30] potentially vary the number of reps you’re doing. We’ve talked about all these things before at length, we’ve said that exercise variation is not the tool of the novice to make progress, but this is the land where it can start to be, come into play. Don’t be afraid to manipulate other training variables once you get to, past the your novice learning progression phase.

Dr. Feigenbaum:                Yeah, I think the staying healthy, being consistent, always showing up no matter what, is probably the biggest thing. Then the second thing I would say, [00:15:00] or like the next sort of level, would probably be an agreement with your thing. Don’t grind everything out, it’s not going to productive for longterm training.

Then I would finally say that, your sort of, you need to have some guided practice, or deliberate practice, where someone is guiding along the way, because they’re just going to shut, they’re going to cut down that learning curve. I think if you have the means and you have the access to a good coach, you should [00:15:30] definitely use that. If you’re not, effectively you’re limiting your progression rate.

Dr. Baraki:                              Especially if you’re older and you don’t have that kind of time to toss around.

Dr. Feigenbaum:                Exactly. It’s not, yeah, it’s not just about trying hard, sometimes you need consultation. Okay, let’s see. Barbells of Bacon asks, “When you guys say the Texas Method sucks, does that apply to template?” The templates in the 12 Ways to Skin a Texas Method article that I wrote.

Dr. Baraki:                              Well, [00:16:00] this is your article. I’m going to let you answer this one.

Dr. Feigenbaum:                Yeah. No. Well, because I wrote it in order to give people options for the Texas Method style program in that actually comport with what we know to work for strength progression. I would further say, people have been saying for years now, or a long time now, that Texas Method is a young man’s program and et cetera, et cetera, and I would actually make the argument that even for young men it’s not optimal, for [00:16:30] any particular outcome. Yeah. Okay. Let’s see. This is where … Dr. Baraki, how do you work around a tight schedule and still get training in?

Dr. Baraki:                              I make it work. It’s hard to really give a very satisfying answer to that. I mean when my work hours get longer, I kind of am more deliberate with the kind of things that I spend my time on. I waste less time in the day, even though I probably don’t [00:17:00] waste that much time as it is, but I end up getting myself home as soon as I can, into the gym as soon as I can after that. I’ll shorten my rest periods, that might mean that the intensity, the weight on the bar might have to go down, that might mean that I might not hit the weights that I was hoping to hit otherwise. The idea is that I need to get the training, some form of the training stressed in as close as I can to the intended training stress. I think you need to be flexible, if you need to split up a workout and get some of the work that you had planned in on a different day, that’s [00:17:30] fine.

People ask us these questions like, “What do I do? Do I just ignore the rest of the work? Do I put it off to another day? Do I do,” it’s like, if you can fit it in it’s better than not doing it, right. Training is better than not training. I mean there’s literally a period during my CCU month where I got home and I did eight sets of five on the squat, superseded with eight sets of five on the bench, because I had tree racks in my garage gym. I could go between the two racks, and I got 16 working sets done in about 45 [00:18:00] minutes. I was basically, as they say in crossfit land, like redlining the whole time. My heart rate was up, I wasn’t feeling awesome, but I got all that work in, more work than more people will do in a regular Texas Method volume they workout, but I did it in 45 minutes, because I had to get the training in.

Dr. Feigenbaum:                [inaudible 00:18:17].

Dr. Baraki:                              Yeah, I was probably good for 800 on that day.

Dr. Feigenbaum:                Probably. Yeah, I think standard stuff, you and I both probably end up planning when we train, if we have a crazy call schedule coming [00:18:30] up. Particularly for me when I have to travel to gyms, having a gym in your place effectively gives you no excuse to miss training, ever. Then LA’s traffic is terrible, so that’s really why I have to end up planning a little bit more. Otherwise, yeah, you just do. That’s the simplest way to say it, is you just do.

There is no excuse for missing training, and I don’t mean that to say if someone close to you passes away or there’s like this terrible medical thing or emergency or whatever, [00:19:00] but there’s always going to be reasons to skip the gym, and your goal is to only accept the ones that are very, very severe. If you feel tired, if you feel a little sore, if you feel a little sick, and I don’t, look, I’m not saying that you have to be like a, and be a Kamikaze in the gym, because that’s just what we love to do. I’m just saying there’s going to be no sort of sympathy that [00:19:30] I give for like, “Oh, you’re busy.” Again, no judgment, it’s just you ask us, “How do you fit, find time to train?” You just do it.

Dr. Baraki:                              Yeah, and part of the context for this question is kind of like when people ask us, “Well, what should I weigh to be the whatever,” and we say, “Well, how strong do you want to be?”

Dr. Feigenbaum:                Exactly.

Dr. Baraki:                              It’s kind of the same situation, like, “How good or how strong do you want to be?” If you want to be the strongest possible [inaudible 00:19:55], you have to find every reason to train, and you can’t be finding reasons to skip training. You need to get [00:20:00] to the end of your training cycle and be able to look back and say, “I did what I planned to do, and I didn’t miss 30% of my training session,” or something ridiculous like that.

Dr. Feigenbaum:                How many training sessions do you think you missed in the last three years.

Dr. Baraki:                              One. I don’t know. Not very many at all.

Dr. Feigenbaum:                Yeah, I don’t think I missed any.

Dr. Baraki:                              I think I probably just rescheduled it to, I just fit the work in elsewhere. I don’t really think I have missed any.

Dr. Feigenbaum:                Exactly, the same. Interesting. Thank you for this interesting consult. [00:20:30] Thanks for joining me. We’ll be back in the near future, and thanks for your questions, everybody. Thanks for listening.

Dr. Baraki:                              Yeah, so I’m going to add two things here. Number one, if you had your question answered, you are hereby required to go on iTunes and leave a review.

Dr. Feigenbaum:                Ooh, that’d be great.

Dr. Baraki:                              I’ll say that.

Dr. Feigenbaum:                Yeah, no, that-

Dr. Baraki:                              Anyone else is highly encouraged to, you don’t necessarily have to. Those who had their questions answered, I’m going to say you’re required to. Of course, I have no way of enforcing this, but it’d be very helpful, so please do that. Then-

Dr. Feigenbaum:                Yeah, I think-

Dr. Baraki:                              The other thing, yeah, go [00:21:00] ahead.

Dr. Feigenbaum:                I think if our reviews don’t go up by like at least 20, then we just-

Dr. Baraki:                              We’re going to know something’s up.

Dr. Feigenbaum:                Yeah, we have to like boycott doing Instagram Lives for a while or something.

Dr. Baraki:                              Oh, yeah. Yeah. Then the other thing is that, we recently announced that we’re going to be doing a seminar down here in San Antonio, in September. You all should look into that and register, come on down.

We’re going to be doing lots of lectures in depth material on various medical topics that we commonly [00:21:30] get asked about, debunking BS, as we tend to do, and you’re also going to get live in person coaching from us on the basic barbell lifts as well. It should be a good weekend, so sign up and come down to San Antonio and visit.

Dr. Feigenbaum:                Yes, there is a link in my bio, it’s on the Event Brite page. We’ll be pimping that thing until it sells out.

Dr. Baraki:                              Yeah, make it happen, people.

Dr. Feigenbaum:                All right. Cool.

Dr. Baraki:                              All right, kids.

Dr. Feigenbaum:                See you.

Dr. Baraki:                              See you later, man. Bye.

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