But first, a brief comment on this topic.
This is an 11,000 word “article”. Yea….it’s lengthy, but we only have scratched the surface.
To be crystal clear incase you don’t listen to the hour long podcast or read every nuanced bit below, kids should be exposed to the lifts, but they can’t really train until they’ve matured hormonally.
What this means is that it’s very safe for kids to get under a bar, add a little weight and squat, press, deadlift, power clean, and bench press with perfect form, but they cannot train progressively until they have undergone the necessary hormonal changes that support regular progressive overload (see Tanner Stage 4 and puberty).
The risks from barbell training kids as reported is exceedingly low, much lower than- say- soccer, football, or baseball- and this makes sense, right? How can you incrementally load those sports or the contacts that occur within those sports’ games and practices? You can’t do it, but this can be done with barbell training. It also does not stunt their growth at all. Period. No evidence exists that this occurs, yet evidence to the contrary does exist. Yay for science!
Additionally, early exposure to the lifts might confer benefits to athletic development later on in life. In short, there may be a window in time where exposure to athletic activities like barbell training take advantage of junior’s young age and allow their bodies to respond in extraordinary ways, e.g. neuromuscular and coordination development not otherwise seen in inactive youths.
So now, let’s get to the transcript and as always- thanks for reading 🙂
Dr. Feigenbaum: Welcome back to the Barbell Medicine Podcast. I’m here with Dr. Baraki, what’s going on man?
Dr. Baraki: Not much, I think we’re getting ready to talk about little ones today, little [00:00:30] people.
Dr. Feigenbaum: I don’t know if that’s politically correct anymore do we need to restart the …
Dr. Baraki: Little children?
Dr. Feigenbaum: Little children. Well again I don’t want to be sizist; I don’t want to be accused of that. I also heard that you had a really good training session today?
Dr. Baraki: Yeah. It was the combination of a long block of training where I haven’t been doing much squatting trying to push my deadlift up which failed miserably, so back to the drawing board and still chasing that big 700.
Dr. Feigenbaum: What you are saying is that my deadlift is ahead of yours?
Dr. Baraki: For now.
Dr. Feigenbaum: I had to do it. No, so you know it’s interesting though and we won’t spend too much time talking about our own training. There has been this notion of, “Oh just do what works for you, try everything and then you know you’ll figure out what works for you and just try and find out.” I think you and I we both disagree with that because we would say you have to evaluate what you are going to do, what you are planning to do from known entities.
For instance we both know that in general increase in volume will drive strength up after strength has plateaued at a certain level, we both know that. We also both know that you have to modulate intensity and overall fatigue to fit the person’s needs and read things about exercise frequency. All these things we have general ideas about what will lead to improvement. If a program does not fulfill those criteria or play by those [00:02:00] rules, then you can say, “This is probably a bad idea,” without ever having run it. I mean that’s …
Dr. Baraki: Yeah.
Dr. Feigenbaum: You can say …
Dr. Baraki: It’s pretty uncommon that you would run something that fails all of those criteria and that you would be shocked at massive PRs at the end of it or something like that. Sometimes something that checks all the boxes might not work as much as you had hoped, but usually there is something under the hood that you have yet that you need to go back and diagnose.
Usually if you like, if you have an advanced lifter and you are like, “I’m going to try this super low volume low intensity super high frequency or super low frequency,” or whatever. Something like that that just doesn’t comport with what we know about training it’s like, it would be absolutely shocking that the person comes out at the other end of that training cycle with just absurd massive PRs or something like that.
Dr. Feigenbaum: I agree. Unless the training done prior [00:03:00] to that there is such a delayed training effect that it’s all realized when you are doing something that doesn’t comport with what we know. My example is this it’s like, “You know what I’m going to run Sheiko,” someone runs Sheiko, lives to tell the tale and then afterwards does 531.
Dr. Baraki: They use it as a peak.
Dr. Feigenbaum: [Then] They are like, “531 is the greatest program ever because I PRed all the time,” because they previously accrued all of this training stress that they couldn’t really deal with at that time. Then once they pulled away all that fatigue it was realized, but that’s dangerous because then they are like they ascribe all the success to 531. Then they are stuck doing 531 and God knows how many more books will be published. It’s just like man.
Dr. Baraki: I think you can definitely see a little bit more type variation in how people respond when you are picking them towards the end of a training cycle. In terms of the fundamental variables of volume and intensity and frequency and stuff like that, yeah I think we’re on the same page when it comes to that.
Dr. Feigenbaum: You would say then for older people now we’re going to talk about kids today, but you would say that for older people that decrease in their training frequency and leveraging intensity only to drive their progress would be suboptimal.
Dr. Baraki: Yeah. When you say decrease in their training frequency that implies that they were previous at a higher frequency and you take them down, yeah I would definitely agree with that. I often times will have older people who are minimally or minimally trained and I’ll start them out at a relatively low frequency but the goal was actually to increase it overtime not to decrease it.
Dr. Feigenbaum: I would agree. I actually think that maintaining twice weekly frequency for older populations is a good place to start, but I would prefer to have them train more often than not. I do think that the benefits of regular training or even if we want to call it physical activity tramps this let’s do it twice weekly, one heavy set of five add weight. I understand that may be a unpopular opinion, but …
Dr. Baraki: No, I think that if you start someone out in that age range at a two times a week schedule and you plan to keep them on two times a week forever and just hammer a weight intensity for example, it implies that you almost feel like …
It reminds of the title of that paper that was published that was titled; There Are No Nonresponders To Resistance Training Exercise. It almost seems like you believe that they are going to be a nonresponder because they will never be able to adapt sufficiently to the workload that you are exposing them to, to be able to handle a third session a week. Even if you start out the third [00:05:30] session pretty light and work it up overtime, you don’t seem to believe that they will adapt which is obviously not the case because every living organism adapts.
Dr. Feigenbaum: That smug look …
Dr. Baraki: What that about what you were going to say?
Dr. Feigenbaum: … is because you just made my argument for me.
Dr. Baraki: Yeah QID (QID means quater in die, or 4 times per day, usually relevant for medication dosing.)
Dr. Feigenbaum: Shit man you don’t need me anymore.
Dr. Baraki: Next time will be me on the Barbell of Medicine Podcast by myself.
Dr. Feigenbaum: Yeah, Barbell Medicine Podcast number six featuring Dr. Baraki long pause.
Dr. Baraki: Subtitle going solo.
Dr. Feigenbaum: I also have just a announcement while we still have people’s attention before they turn this shit off. Dr. Nadolsky will likely be joining us in the near future.
Dr. Baraki: Yes, we anticipate having a rather exciting announcement to talk about with him.
Dr. Feigenbaum: Exactly and then …
Dr. Baraki: More to come.
Dr. Feigenbaum: This is new to you because I just on the way in talked with Mr. Campitelli about coming here. I bring Campitelli on because, for the following reason here is why I want him on; he disagrees with a lot of our stuff. Not because he does, thinks we’re wrong he’s just disagreeable and I like that.
Dr. Baraki: He is disagreeable on the most polite possible way I’ve ever heard.
Dr. Feigenbaum: That’s the thing he goes, “That may be true, however,” and I’m like you know yeah maybe he is actually the nice version of me. Anyhow we have some guests coming up. We’ll, maybe I’ll record Rip while we’re drinking whisky in Texas, we can do the good old Texas …
Dr. Baraki: The Rip interviews Rip.
Dr. Feigenbaum: Yeah exactly. The Texas Three Way is really what we are calling it, not just for chili anymore. On that note …
Dr. Baraki: All right shall we move on to our topic today?
Dr. Feigenbaum: We’re going to talk about kids.
Dr. Baraki: Yes, so we’re going to talk about kids today and as they relate to training or as training relates to them. Since Jordan is the one between the two of us that is training in family medicine, meaning that he actually sees children as part of his routine practice. We’re going to say for the purposes of the podcast today that he’s going to be slightly more qualified than I am to talk about children, because I don’t see them as part of my practice at all. When I see them as part of training I will interject as needed with whatever opinions I’ve accrued from training younger people.
Dr. Feigenbaum: Perfect. I would also like to state this now; neither you or I have any children at this time and to some people that would almost disqualify us from even talking about kids. As we just introduced you don’t have to try something or do something to evaluate this a priori argument.
Dr. Baraki: Yeah, you’ve never had a baby yourself but you have delivered babies so that does not …
Dr. Feigenbaum: Oh my God.
Dr. Baraki: … disqualify you from doing such things.
Dr. Feigenbaum: Just a brief aside about that, after 40 plus deliveries in the month of March I think I’m good.
Dr. Baraki: Yeah, I would agree you are probably good.
Dr. Feigenbaum: I’m probably good.
Dr. Baraki: Lorraine would laugh since she’s probably delivered approaching like 300 or something by now, but it’s all good.
Dr. Feigenbaum: That’s good because you want Lorraine delivering you not me anyway.
Dr. Baraki: Yeah, that’s right.
Dr. Feigenbaum: Small hands. Okay, so yeah let’s actually start this thing.
Dr. Baraki: When we’re going to talk about kid’s training how are we going to, we’re all about being pedantic and specific so define what and who we’re talking about right now?
Dr. Feigenbaum: Sure, so kids is actually a pretty generic term and the way I would refer to a child- let’s say I was presenting a case to a coach who was very scientific. First things first is I would actually introduce their age in months on average or at least years and months. For instance it would be, “An 11 year old and six month male who is Tanner stage three or four or two,” depending on where they are at in their pubertal development.
Tanner staging that we’re introducing this concept very early it was named after a British pediatrician James Tanner. There are multiple stages to the Tanner system so stages; one, two, three, four and five and the higher the number the further someone is as far as their sexual maturity goes. We’re talking about; breast tissue, pubic hair, genitalia. There has also been a few other components associated with Tanner staging as far as maturity goes, but we use those stages to stratify our kid population.
A Tanner stage two and a Tanner stage three individual are two different folks from a hormonal standpoint and therefore there are different training interventions that would be appropriate or different considerations to make. Effectively once somebody is going through, starting Tanner stage three and certainly [00:10:30] once they progress to four they are basically full blown like puberty effectively.
On the internet you can get convinced that somebody is in, basically it’s better than taking anabolic steroids going through puberty. I mean that may be true I don’t know, I wish I remember what it was like and I wish I was training at that time.
Dr. Baraki: Yeah me too.
Dr. Feigenbaum: I certainly wasn’t, but I have not seen evidence that the testosterone concentrations within a pubertal male in the throes of puberty have exceeded that 1,400 nanogram per deciliter amount. Have you ever taken care of someday on anabolic steroids? Have you ever done their lab work up and everything else?
Dr. Baraki: I’ve taken care of two people in the outpatient clinic, but at the time that I saw them I didn’t have their lab work handy. I was curious but I didn’t have their numbers in front of me.
Dr. Feigenbaum: Hypothetically of course, this is hypothetical yeah. Nervous laugh, yeah but the folks I have who I know that are on, that have taken exogenous testosterone not a TRT testosterone placement therapy does this are well over 1,400. It’s outside, the lab can’t even measure it.
Dr. Baraki: It’s crazy.
Dr. Feigenbaum: I haven’t seen those same numbers reported in males in the throes of puberty and certainly not females.
Dr. Baraki: Have you seen what type of numbers are reported for males, what kind of typical range you might expect on a pubertal male?
Dr. Feigenbaum: Yeah, so it depends who you read and where you are at and I’m sure some endocrinology fellow is going to, “Hey, great if you’ll listen to this that’s cool.” I want to know what you read and where you read it, but I’ve seen everything from on average in the high 600, 700s all the way up to a thousand or more. Certainly upper edge of normal but I haven’t seen a bunch of evidence showing, “Yeah they are above 1,400 and that’s just standard.” They do just secrete more testosterone and more importantly it does appear like they are more sensitive to the existing testosterone.
Dr. Baraki: That was going to be my next question is when you talk about testosterone levels because this applies the same deal in adults. There is two sides of the coin; one is the actual serum concentration and the other side is the receptor expression. Maybe during that period of time they get a bunch of more transcription and translation and expression of testosterone receptors on their cell surfaces. The same serum concentration might exert a greater physiologic [00:13:00] effect.
Dr. Feigenbaum: They get a greater androgen receptor concentration in stereotypical areas. For males we’re talking about; traps, shoulders, upper extremities just go ham with androgen receptor density. Then those same existing receptors that they already had also become more sensitive so you have; more receptors, more sensitivity and testosterone levels or higher than they otherwise would.
Dr. Baraki: Sounds like a good combo.
Dr. Feigenbaum: The more interesting thing is the females who we would classify towards the more masculine and of phenotype. All right let’s just make sure everyone is on the same page here; genotype is genetic material, a genetic code that you are born with and the phenotype is what is actually expressed all right. For instance XX is genotypically female XY is male. There are XX females born female by sexual reproductive organ and genetic chromosomal criteria. Okay let’s call it there, who exhibit very traditionally masculine traits from a muscular scalable standpoint.
That is; narrower hips, more muscle mass in their shoulders, better response to training, more explosive all those other stuff. There is some evidence that those folks also generate a more, a higher density of androgen receptors to steroid receptors in the prototypically male areas. They end up with; bigger traps and bigger shoulders and more upper extremity, they are stronger in their upper extremities which effectively is the biggest gap amongst the sexes. In the throwing sports, if you look at age matched male and female cohorts throughout as they develop, the gap is huge already and then it just gets bigger and bigger and bigger.
Whereas the gap for running pre puberty males compared to females who are just getting in there or pre puberty females, they are the same. They effectively run about the same. Then once the females hit puberty they are faster than men but at no point are they better at throwing than men, ever.
Dr. Baraki: It’s part of the reason why it’s so freaky to see a female with a body weight plus press.
Dr. Feigenbaum: Be real nice.
Dr. Baraki: Yeah.
Dr. Feigenbaum: The whole thing is super interesting as far as things that influence androgen receptor density and sensitivity during the pediatric and formative stages of life. Yeah, because the next question people would say is, “Well how do I maximize that for my kid?” I’m going to tell you that if they are in Tanner stage three or past so in general ages if they are 12 years old or greater, you missed it. You’ve already missed this window where they are super responsive to epigenetic and environmental influences on their genetic potential.
Earlier on than that I haven’t found anything that’s clear cut like, “Yeah this makes somebody exhibit more androgen receptor density or a higher testosterone levels later on or whatever,” other than; not being malnourished, not being in super stressful situations, not being chronically ill, not having a chronic illness or losing a bunch of body weight, falling off their growth curve like known endocrinology problems.
Dr. Baraki: Female athlete triad kind of stuff too.
Dr. Feigenbaum: Female athlete yeah, sorry.
Dr. Baraki: Save it for later.
Dr. Feigenbaum: Yes, we’ll readdress.
Dr. Baraki: Okay.
Dr. Feigenbaum: We use Tanner staging and I don’t pretend that this is the correct medium to really flesh all of that out here and I think you know it would be hard to comprehend anyway. I implore you, if you are a parent or a coach of young athletes you definitely need to be familiar with the Tanner stages and all of the contributions to effectively stratifying somebody into a Tanner stage.
That’s going to let you know how biologically their age with respect to training. You could have two 15 year olds and if one is a Tanner stage, early Tanner stage three and one is a late Tanner stage four those are two different people effectively.
Dr. Baraki: Yeah, so you are differentiating between what we would consider maybe a biological age or a phenotypic age versus their chronological age. Kind of like we are talking with bone related stuff in kids too.
Dr. Feigenbaum: Bone age.
Dr. Baraki: I’m remembering this stuff back from when I was studying stuff about pediatric populations.
Dr. Feigenbaum: Now, when you cut down a bone there is the rings that’s what you are counting rings?
Dr. Baraki: Yeah I think so.
Dr. Feigenbaum: Yeah you got it. You got the bone age you have to develop, so if someone is like short of stature you’ve got to effectively look at their bone age and their epiphyseal plates and you refer them to endo, you send them to endo.
Dr. Baraki: Yeah sounds good someone who sees children. All right, so let’s say that you have someone of an appropriate Tanner stage, we can talk about maybe specifically right about what that actually entails. You want to get them started with training in some capacity.
Say you are a weight lifting coach in Siberia and you are ready to recruit the next Dmitry Klokov or you are in the suburbs of China and you want to pull a little child to get them started on the road to Olympic glory. What if that same child was in the United States there is going to be a whole lot of arguments as to why you shouldn’t do that, because you are going to hurt the little kid aren’t you? Isn’t that the usual argument that you are going to get against children training?
Dr. Feigenbaum: Certainly yeah, you are going to get people to say that and incorrectly I might add if you take nothing else from this podcast. You will have people say that child injury rates during weight training specifically the risks are so great that you shouldn’t even have, you shouldn’t try.
I guess I just don’t know where this came from because I really tried to find where there are a bunch of case reports. Once Arthur Jones came out with the Nautilus stuff that just scared everybody about training or physical activity, like weight bearing physical activity for kids. Did this just pop up out of nowhere because it started getting repeated and we don’t know and I can’t find it I’m not sure.
The injury rate for competitive weight lifting is insanely low. I mean it’s like .0006 per a thousand participation hours for competitive weight lifting and that’s for adults. If you look at overall incidents of weight training injuries most of them are for people dropping weights on their foot or like smashing a finger with their dumbbell. It’s not like acute bone explosion under a load.
Dr. Baraki: Kneebola as they say.
Dr. Feigenbaum: Yeah kneebola. You know you even things like things that do happen to kids like the traction apophysitis, the patellar tendon ligament issues, or disease states like that. Yeah the injury rates are exceedingly low especially when compared to; competitive soccer, competitive football. Even things like karate have higher injury rates but nobody is saying, “Don’t do that.”
Dr. Baraki: Yeah, it’s amazing that they don’t say that about something like karate but they would say like a pugilistic sport I suppose. They are actually fighting to hurt one another versus picking up something off the floor.
Dr. Feigenbaum: Right, I went and I looked and I was trying to find injury rates for percussionists that were like just you know, “Oh don’t join band because you are likely going to get injured.” I couldn’t find anything just some occupational data on adults, so anyway I tried to go down the rabbit hole here and I didn’t find anything.
Overall when you look at the totality of the data the idea that you can make a case against strength training or barbell training for kids even as low as Tanner stage two based on injury, is not supported by evidence. It’s not supported by evidence and I think most reasonable people who have had experience in this would say not supported by anecdote either. Having trained multiple kids before they, you don’t hurt, you are not hurting them unless you are doing stupid stuff I guess.
Dr. Baraki: Kids are pretty resilient too you know.
Dr. Feigenbaum: Turns out.
Dr. Baraki: Yeah.
Dr. Feigenbaum: Turns out. I don’t know how many kids have you had, have you taught how to squat? When I say kid so anybody under the age of 16, how many kids have you taught to squat?
Dr. Baraki: 20, 30 something like that.
Dr. Feigenbaum: Yeah, so probably a little higher, especially given the commercial gym days so we are probably nearing that.
Dr. Baraki: I fortunately didn’t have those.
Dr. Feigenbaum: Fortunately, but a good time to train people in their 90s and young, young kids. It’s interesting that when during the stage of like rapid bone growth occasionally you’ll get kids hat just don’t move very well at all and you are like, “That’s weird your squat looks all messed up.” You know what you do in that situation it’s the same thing you would do with a mid 20s person who doesn’t move very well. You are not loading that very heavy, you are working on their technique so you can feel comfortable loading their squat.
I mean this isn’t revolutionary stuff here and the final point I’ll make about this the idea that kids can’t squat safely for instance, I don’t see anybody recommending again sitting on a seated toilet or couches I mean contraindicated. Well I’m just saying they have to do it as part of their daily life anyway, so again the idea that this stuff is inherently dangerous doesn’t comport with existing evidence. The fact, the idea that kids shouldn’t squat or learn to pick stuff up when they are going to do that anyway I don’t get it.
Dr. Baraki: From the perspective of anyone who has coached people, who is also a competent coach- it almost seems impossible because you could teach them. I mean there is anatomically “right”, strictly speaking from a muscular scale standpoint there are just smaller versions of the adults that we’re coaching.
Hormonally they are very different as we are talking about, they are hormonally different during these stages but you can put them into the same positions. You can put them into the same positions, you can coach them and then an intelligent coach loads someone very intelligently I’ll say. You know what I mean? You are not going to put 405 …
Dr. Feigenbaum: 405.
Dr. Baraki: … on a five year old.
Dr. Feigenbaum: Speak for yourself.
Dr. Baraki: How many five year olds have you coached to squat 405 for a set of five?
Dr. Feigenbaum: [inaudible 00:24:22].
Dr. Baraki: Well yeah okay.
Dr. Feigenbaum: Right.
Dr. Baraki: Yeah, I mean you put a five pound aluminum training bar on their back or something like that what do you think is going to happen. [00:24:30] They are carrying heavier weights on their back, in their backpack when they go [inaudible 00:24:34]
All right, so let’s say you put some weight on their back. Let’s say you start out when you are coaching them you put the little five pound bar on their back, you put little two and a quarters or whatever on whatever side, two and a half pound plates on either side. At what point do you reach a weight where you will permanently stunt their growth and they will never grow an inch taller for the rest of their life?
Dr. Feigenbaum: The growth stunting thing is a very interesting point too. Again, I tried to look for the origins of this, like where did it come from right? Is it just that the axial loading on the skeleton is just going to destroy your, the growth plates and therefore stunt your growth. Also …
Dr. Baraki: I think that’s actually the fear that people don’t quite grasp well really how adaptation works, but much about growth plates either. They think that if you load someone you are going to fracture them through their growth plate or something like that.
Dr. Feigenbaum: Yeah, I mean I … I don’t pretend to be a bone durometer expert analyzing the hardness of the bone and certainly as we age the bones do become a little bit less squishy. However, what Austin is referring to as the growth plate is in general very difficult to fracture, unless you have a trauma to the limb that basically takes the bone above the growth plate and the bone below the growth plate and pushes them in different directions and then you get a crack across the thing.
There has to be some type of shear force across the growth plate to cause a fracture through the growth plate or you could just crush the distal end of the bone and it just goes into a million pieces and then you are in a bunch of trouble. Yeah, axial loading of the bone in general causes the bone to remodel itself; a little bit stronger, a little bit thicker, a little bit more resilient and this does not occur at the level of the growth plate.
The growth plate is putting out immature bony cells that effectively contribute to bone growth overall -both lenfth and thickness, #thethickness. I don’t know if that’s where it [the idea that loading immature bones can cause fractures through the growth plate] came from, but certainly we don’t have the evidence that just loading the human skeleton and people with non closed growth plates doe that.
We also don’t have evidence that’s loading them on their axial skeleton actually causes their growth plates to fuse earlier than they otherwise would. I thought maybe because I read this on T Nation and T Nation is obviously true.
Dr. Baraki: [TNation is] The number one source.
Dr. Feigenbaum: Number one source yes, source cited. Then there was this fear that since they were training and then testosterone levels went up when they trained, that somehow this would go and close the growth plates. Austin if you will recall from your Step One UMSLE Exam, the closure of the growth plate is not necessarily due to testosterone but rather estrogen signaling the bone- specifically the osteocytes- to effectively close the growth plate. It’s through a very long cycle of signaling through different things, but ultimately estrogen is responsible for that not testosterone.
Dr. Baraki: We know from data in adults that the acute post training hormonal effects like say your testosterone goes up in the immediate phase after training, really has fairly little significance in the big picture. I’m assuming that that’s the testosterone that they are referring to, unless they think that just like training overall will like cause a massive boost in your testosterone levels.
Dr. Feigenbaum: Well, I assume that all these kids were taking tribulus.
Dr. Baraki: Fenugreek and what other stuff?
Dr. Feigenbaum: Yeah, if you take fenugreek and tribulus as a Tanner stage three then basically you are just going to be 5’6. I mean I don’t know if you remember this but I don’t actually memorize this because I just, I look it up whenever I need it. We do know on average how tall our kids are going to be based on the parents. In general for females you are going to take about five inches off the father’s height and then average of that with the mom’s height. Then for boys you take five inches added to the mom’s height and then average that with the father’s height on average. There is obviously you know …
Dr. Baraki: Yeah, there is going to be spread on that, but yeah cool.
Dr. Feigenbaum: Sure. Growth stunting probably not going to happen certainly not trough a hormonal or through a trauma mechanism there and result in a decreased height velocity. If the height velocity is impaired that’s what the doctor would be looking for, then that usually warrants a work up if that’s been there for a while, but it’s not going to happen through barbell training.
Dr. Baraki: Yeah, I think that if you had a kid who presented to a pediatrician or a family doc for example and they saw them falling off of the growth curve. If they were to just say, “It’s probably because you are having them squat,” and leave it at that, that would be pretty inappropriate management.
Dr. Feigenbaum: Yeah, unless you are getting hit, unless you are getting hit with the barbell and just like breaking the growth plate just breaking the growth plate.
Dr. Baraki: Yeah, it would definitely deserve a full work up to assess all the more likely suspects for why someone might fall off the growth curve.
Dr. Feigenbaum: Yeah; poor absorption, chronic illness like infections stuff like that or genetic issues, or endocrine issues which you know …
Dr. Baraki: Lot’s of non barbell things.
Dr. Feigenbaum: Also just an interesting aside, have you ever seen Prader beads?
Dr. Baraki: Prader beads?
Dr. Feigenbaum: Yeah.
Dr. Baraki: No.
Dr. Feigenbaum: I saw an endo fellow and he had a set of beads that were shaped like a bracelet, but he had it on his keychain and they were Prader beads. Apparently, they are representative of the testicular volume for the different Tanner stages.
Dr. Baraki: I’ve heard of these things but I have never seen them.
Dr. Feigenbaum: Which is probably the coolest keychain I’ve ever seen because people are like, “Oh that’s cool, is that like a bracelet or whatever,” like, “Actually these are balls, kid’s balls.”
Dr. Baraki: Yeah, I bet by the time he is a staff he won’t need it anymore; he’ll just know what the volume is just by each patient. Good for him.
Dr. Feigenbaum: Good for him.
Dr. Baraki: All right, so enjoy that aspect of your career. All right so the next topic this isn’t even restricted to kids, this is like anyone who trains. If you say you have a kid who wants to play, who wants to be better at soccer, be better at football or something like that just like in the same way that we hear it with adults. If you get someone to train with barbells and you get them really strong, what’s going to happen to their quickness and their agility on the field? Aren’t they going to be all bound up with that thick muscle?
Dr. Feigenbaum: I like the #thethickness. Again, yes so Tom Brady says that if you train with weights your muscles are going to get short and tight and ultimately that’s bad. I don’t know where this came from, but again I do think if you look back far enough what you’ll see is that originally people thought that if you were of average height, average weight, average proportions you were the best, that was the best athletic body habitus that you could have.
This is well, this is a long time ago early 1930’s, 1940’s where they were like, “Yeah, if you are 5’8, 5’9 and 180 pounds and you don’t have any freakishly long arms or legs or whatever that is the best for every sport there is because you are the average. You are the Vitruvian man,” alright. The thought was, “Whoa don’t bulk up you’ll weigh more,” or like, “Don’t do anything to alter that habitus.” We know that to not be the case now, to quote David Epstein who authored The Sports Gene.
There was the big bang of athletic bodies and the freaks got freakier, so why do basketball players on average have longer wing spans than their height. Just because you are 6’5 or 6’6 doesn’t mean you are going to play in the NBA, you need to have a seven foot wing span. Why is it that if you live in the United States and you know a person between the ages of 25 and 45 and they are a true seven-footer, that there is a one in five chance that they are actually in the NBA right now.
Dr. Baraki: It’s just the selection pressures of each sport kind of directs you towards the most favorable anthropology for it, not surprising.
Dr. Feigenbaum: Does resistance training cause increase rest in muscle tone? No, I mean no. If you are sore, if you are fatigued for any reason then yes, your resting tone will be altered and your performance will be decreased because you have existing fatigue. If you have a very demanding sport and practice schedule I guess what you can’t do run a full fledged strength and conditioning program where your training frequency and volume and everything else is so high that your fatigue is unmanageable.
Again duh right. Does resistance training on average decrease range of motion? No, but I think that’s what you’ll see because you will find studies that show that exercising with weights, training with weights does decrease range of motion. However, if you take somebody who has previously had a lot of mobility and for whatever reason they are underweight or they came from a sport like gymnastics or figure skating or something like that and they stopped and just did resistance training.
More interestingly, doing resistance training with decreased range of motion like leg press or leg extensions will show decreased passive range of motion based on goniometry metrics. You think of it like this, if you are concerned about getting muscle bound because of your sport -guess what you still have to do while you are training?
Dr. Baraki: Practice your sport.
Dr. Feigenbaum: Practice your sport and guess what? There is nothing better than practicing your sport for maintaining your sport specific mobility requirements. One of my arguments against mobility training in general is why do extra mobility training that’s not sport specific when we know that it doesn’t work. When we know that it doesn’t increase range of motion long term, that we know that it does decrease force production, we know that it doesn’t improve recovery rate and we know that it doesn’t prevent injuries. Why are you doing it?
Dr. Baraki: For Instagram, man. Alright, on that note.
Dr. Feigenbaum: How many people can I get blocked by? How many people?
Dr. Baraki: You didn’t, there has been multiple people who’ve blocked you kind of out of nowhere recently right?
Dr. Feigenbaum: Out of nowhere.
Dr. Baraki: Out of nowhere.
Dr. Feigenbaum: Yeah, KILL CLIFF I don’t know why they blocked me I assume it’s because I told people that their products weren’t any good, but that can’t be a surprise to them. Then NOBULL I guess probably blocked me because I told people that their lifting shoes weren’t any good, which again can’t be a surprise so like they know.
Dr. Baraki: Alright, we are veering off the topic a little bit but we’ll save that for another episode banter I suppose. Let’s say that you have dispelled all these myths and someone is convinced that they are going to start training their kid and they are going to have you coach them. To paint a little picture as to what that would actually look like, what kind of results might we expect to see if you are going to be training a Tanner stage X kid?
Dr. Feigenbaum: Right. If you have somebody Tanner stage 2 or 3 then effectively what you’ve told me by telling me that their hormonal milieu, or to quote the physiology wiz Dr. Claude Bernard the internal milieu, is such that there is unlikely to be significant amount of hypertrophy, which is an increase in muscle cross sectional area and the reasons for that are multiple.
One, their testosterone levels are on average lower. Two, their androgen receptor density is on average lower and then their androgen receptor sensitivity is also lower. All of those things compromise muscle protein synthesis in response to training, which is why their muscles don’t on average grow very much if at all from training.
Now, obviously the older the person gets the further that they’ve gone towards the end of Tanner stage three and Tanner stage four where they are actually hormonally, it’s a hormonally viable situation to actually gain muscle mass.
Dr. Baraki: Yeah. I mean you start to see it even in the absence of training, so it seems like they are in a state where they are ready to do that especially even more if you were to give them a little load in terms of training.
Dr. Feigenbaum: Yes. So, do they get stronger and if we are going to define strength as an increase in the ability to produce more force against an external resistance the answer is yes. Then you say, “Well, Dr. Feigenbaum how?”
Dr. Baraki: How?
Dr. Feigenbaum: Because if they are not getting more muscle mass well how will you get stronger? Do they get a little more muscle mass, sure yeah. More interestingly, the motor learning processes that occur, so motor learning is a basically big umbrella term that and it’s the area of study that just how do we learn how to do physical activities. Things like writing your name with a pencil all the way to more advanced things like playing the piano and this is a huge area of research in both sports but then also rehab situations.
You have people who are losing, have lost function and then they regain function it’s because they get to use different area of their supplementary motor area. I believe that’s Brodmann’s area 43 as I recall. Let’s pretend if it is Brodmann’s area 43 like I should retire because I just, you should look that up.
Dr. Baraki: On it.
Dr. Feigenbaum: We have good evidence, in my opinion, that the younger the person is- so we are talking Tanner stage 2 or Tanner stage 3 -that if you introduce them to complex motor tasks they are very readily able to encode that in their motor cortex and learn these things very efficiently especially compared to their adult cohorts.
Not only are they able to learn it faster, but they are able to make corrections faster too. They are just better at learning. I know again this should not be a surprise. This is termed engrams- when they are learning very complex motor tasks earlier on and there does appear to be like a sweet spot in age.
Although I will be 100% honest, I don’t have a good enough age range in this to currently put out some numbers there. I know early for like perfect pitch or whatever for learning math which is a more cognitive thing, it’s usually between ages three and five they have to be introduced to music but….
Dr. Baraki: I started reading Peak and started reading about that, so that’s pretty cool.
Dr. Feigenbaum: Nice, same thing with skiing you effectively had to be born on the mountain. At age three you need to be on skis.
Dr. Baraki: Yeah.
Dr. Feigenbaum: Very interesting stuff. Effectively you’ve taken a very, a susceptible person who has whatever their genetic makeup is but it’s susceptible to being introduced to training and being responsive to training on some level.
Dr. Baraki: Yeah, so you could summarize that and say they are receptive [00:40:30] to it I suppose right?
Dr. Feigenbaum: Yeah, exactly. They are receptive to it and then you’ve effectively made them even more receptive to it later on, because now their motor cortex is refined a little bit. Their movement patterns are better, they are able to switch between movement to movement so effectively you’ve improved their ability to move in space. They are a better athlete okay, if we want to use a very generic term that people are familiar with.
The more interesting thing that I found is that if you introduce people early on they have this; we are going to term all of that neuroplasticity. Effectively, there is remodeling at the level of the neuromuscular junction in the supplementary motor cortex in the cerebral cortex in the levels of the brain stem. That later on they do seem to have a more robust response to training, when I say later on I mean Tanner stage four and in adulthood.
These are the people who you are like that are standout athletes or end up responding better even if they didn’t play sports in high school but they respond later on life and you are like, “Well, you didn’t play sports growing up that’s a strange thing you are better now.” It’s like, “Yeah, well maybe you were introduced to stuff early on.”
Dr. Baraki: Yeah, it’s like giving them a neurological base from which to jump off of later at a later time in their life.
Dr. Feigenbaum: Well phrased.
Dr. Baraki: Yes.
Dr. Feigenbaum: If I could take a little kid and not get arrested I would …
Dr. Baraki: Code rainbow or something like that or code purple.
Dr. Feigenbaum: Yeah, some where there is probably a baby snatching. I would have them at age five, six something like that I would have them start training. If they were emotionally mature enough to actually pay attention and do the stuff under, but I would have them squat and I would have them deadlift something and I would figure out a way to get them to press something. Then if the immaturity is there I’ll probably introduce you know cleans and snatches.
Dr. Baraki: I mean you can go back again to bring up who I mentioned earlier. There is I think Klokov has some videos of himself at like seven or eight years old just throwing up like pretty good snatches at that age and it just confirms. It’s like these old Russians that brought him up in the world it’s like they were already benefiting from these things that we’re discussing now that have been kind of validated by this research into motor neuroplasticity and motor learning and stuff like that.
They are like, “Yeah, if I can get him to do execute a perfect snatch of that age, he can train more efficiently and get stronger more efficiently using this neurological base as he progresses in life.”
Dr. Feigenbaum: Just as while I’m thinking about it because I did this, I think Brodmann’s area 43 is in the transverse gyrus of Heschl it’s an auditory thing and I think that the supplementary area may be 18. If it’s way off like you can crush my soul on podcast but just okay, I had to get it out.
Yes, I agree and more interestingly is those, you know the four other countries that were already participating in this is they would do a wide range of sporting selection. They wouldn’t specialize early, they would play a lot of different things. They would sample, sample, sample up until like Tanner stage three, early Tanner stage four when they are effectively becoming an adult hormonally. They are in the throes of puberty and then they get to, they start whittling that down and they end up choosing a sport if that’s kind of the way they want to go.
There is good evidence in my opinion that those who specialize early on do worse than those who specialize later. In fact if you stratify the elite performers with the near elite performers, before the ages of 20 the elite performers tend to have less dedicated practice to their chosen sport than the near elites. The people who almost made it did more specialization earlier on and ended up doing worse.
Dr. Baraki: Yeah, I would say that is, that comports with my own experience. Before I ever picked up a barbell I was as you know a swimmer for most 15 years; coached a lot of people, coached from the age of three year old kids all the way up to 20’s and a few master swimmers older than that.
Then that was the same pattern I saw. A lot of kids I would see four to five year olds and particularly in that situation it was a lot of the parents pushing the kid to train and train and train in the pool and yeah. The ones that specialized early they were either psychologically burned out by the age of 12 or they were starting to lag behind the kids who actually even started in the sport later a lot of them would end up doing better
I personally I actually started on the sport pretty late compared to most kids in the pool, I started around age nine or 10 I think. Like I said I was coaching kids by the time I was a coach that were in the pool from age three as on the young end. Yeah, I saw a lot of this phenomenon happening.
Dr. Feigenbaum: Yeah, so we should be clear that it’s not that if you think that little Jimmy is going to be a swimmer which you shouldn’t think that little Jimmy is going to be a swimmer if he is three or five years old like that’s just …
Dr. Baraki: It’s preposterous.
Dr. Feigenbaum: Yeah, anything that we know, think that we know about selecting athletes early on is wrong. We are just bad at it so you should know. Let’s say that little Jimmy is going to be a swimmer; he ends up being a swimmer. Well at age three or five it doesn’t mean he shouldn’t be swimming, it just means that in addition to swimming he should be [00:46:00] doing all sorts of other stuff.
Dr. Baraki: The other season sports yeah.
Dr. Feigenbaum: Exactly because all they’ll do, all you are doing is exposing the very malleable and you know to use the more medical term plastic right? Adaptable nervous system of the pediatric population to multiple different stimuli and ultimately that serves them well in sports later on.
The more things that you can expose them to, the more sampling they can do the better. I don’t think [00:46:30] that there is any, that it’s a big surprise that more affluent populations end up doing pretty well in sport compared to lower socioeconomic status folks because they get a bigger sampling. You can identify what you are good at and what you are not.
A more just one more, a more interesting thing sports like; soccer, football, basketball in this country; football, basketball, baseball have so much money that they are effectively taking athletes from other sports that don’t have much money. Just by saying, “Now well you know what, you may be a great track star, a track athlete or a great something else. We want to make sure that if you are going to play baseball you play for us so we are going to, we are just going to recruit you.”
The financial incentives and then for the player too they are like, “Well, I can go and make a million dollars doing this or I can make $50,000 doing this other thing even if I may be a world class of that.” Yeah, it’s interesting how that happens too. Anyway my advice as a non parent but scientist and also a doctor would be to have your kid play as many sports as you can afford all right without you know? While also making responsible financial decisions.
When they are old enough, when they are in that Tanner stage three and four [00:48:00] you are going to see them get pushed towards something. That it’s going to be they’re self selected because they are just better at it all right or because people are selecting them for their talent. I think any sort of parental push early on towards something is probably not indicated.
That doesn’t mean don’t make your kids play sports, that’s not what I’m saying because I will use that a Mark Manson quote code here like, “The only two populations that do whatever they want just based on emotion [00:48:30] are three year olds and dogs and they both shit on the rag.”
The kid might not want to go to practice sometime or whatever, I’m not saying don’t push them into sports it’s just that don’t push them towards specialization until they are selected for that would be the point. Let me do a thought experiment with you Dr. Baraki okay; you would agree with me that there are millions and millions of children in the United States who are playing football from a very young age let’s call it six just …
Dr. Baraki: Peewee yeah, for sure.
Dr. Feigenbaum: … peewee football. What if there was United States Strength and Conditioning Association, not unlike the United States Strength Lifting Federation. There was United States Strength and Conditioning Association who paired up with the Peewee Football Association of America and said, “Hey if you are going to be enrolled in football you are also going to be co-enrolled in our strength and conditioning program.
Because the idea is that if you are going to play football we want to introduce you to strength training earlier on,” and here is how you sell it. You sell it to the parents like, “Yeah, well you know early introduction to weight training is going to be good if they want to go to college and play football because you know?”
Dr. Baraki: They’ll be all over that.
Dr. Feigenbaum: Yeah and then also there are some descent evidence that shows decreased injury rate just a little bit although the popular, the age range is a little fuzzy so I wouldn’t put too much stock in that. The kids would love it, coaches are involved so now you get kids introduced to strength training early on all right.
The question is this; how would you as a coach progress them session to session? How many sessions would you have them train? What exercises, give me your top five exercises you have to do and how would you set up a session, how would you progress them?
Dr. Baraki: We are talking you said like six, eight year old something like that.
Dr. Feigenbaum: Yeah, so we’ll define so ages are going to be six to 10, so just to make things complicated.
Dr. Baraki: Sure.
Dr. Feigenbaum: Effectively you are trying to set up a large scale strength and conditioning program for kids who are not yet hormonally mature enough to run an adult type program. How would you do it?
Dr. Baraki: One thing that comes to mind is little children’s attention span. In terms of how much, how many exercises and sets [00:51:00] and reps and stuff like that I would be able to throw at them. In general we like for novices to do our novice LP with three exercise and stuff like that and I wonder about their attention span and interests holding up over the course of three separate exercises and stuff like that.
Some kids might be able to do it, some kids probably would be able to do it depending on where they fall in that age range and their motivation and buy in and stuff like that. I mean I think a squat should be taught for sure and I think a press should be taught for sure and I think a deadlift should be taught for sure. If that [00:51:30] would probably be the starting point just to get them started with how to move under a bar.
Probably actually when I think about it’s probably pretty difficult, I don’t think they’d make like pediatric size benches if you wanted to make a kid bench press. For the starting purposes here I think I will just do squat, press and pull do that for a little while and then as they start to kind of, as they go through that process for motor learning type stuff and learn how to move their body and the barbell maintain their balance, stuff like that.
Once they are able to handle maybe a little bit of load on those exercises, then yeah I don’t see any problem doing something like we mentioned earlier. Doing the cleans and the snatches type of thing to get them moving a little bit more athletically I suppose, with the bar and probably do that something like twice a week when they start out. Progress them over time to where they could train three times a week, probably start out with …
The attention span type deal would help determine are they going to do like two exercises in a session or are they going to do all three. I think just squat, press and pull are probably the place that I would start with a kid.
Dr. Feigenbaum: Yeah, I don’t disagree with any of that and I think that anybody discussing attention span for barbell training with pediatric populations is speaking just from experience only. I think us included so I don’t think that we have good evidence that kids have 90 minutes exactly. Like no one knows that, don’t say that no one knows that to be the case.
Dr. Baraki: With the loads that they would be using a training session would definitely not take anywhere near that long either. It’s not like they have like seven warm up sets to do something like to get to their work weight?
Dr. Feigenbaum: Yeah and I think an important point to be made you and I are both not talking about running a liner progression, because in a hormonally immature situation you can’t do that because the response is not going to be sufficient.
Dr. Baraki: Is not as robust yeah.
Dr. Feigenbaum: Exactly, so you might have a kid doing their three sets of five on a squat which is probably where I would start just to know if I can get them to do that with the pediatric women’s bar, five kilo bar or something like that or five pound aluminum bar depending on all sort of things. I would [00:53:30] have them the three set of five and I might stay at the same way for a week, two weeks, three weeks.
The form is going to be picture perfect all right and only then will I increase some load and it’s going to, I’ll apply a micro load from the start. Again we are sort of out in no man’s land here from an evidence stand point except for when you start looking at this neuroplasticity thing we were discussing earlier.
I do think that there is some descent stuff suggesting that utterly exposure to these things [00:54:00] are likely to improve stuff like relative motor learning just in general period, the robustness that somebody gets to training. It’s effectively your prime in the pump. You are like, “We are going to give you a little training, we are going to prime the pump,” so that.
Then addition to well how do you choose your explosive athletes? Like how do they become explosive, they are just born like that and then there is the little tadpoles that are just you know, no actually.
There is some descent stuff again showing that early exposure [00:54:30] to particular stimuli will improve; rate of motor, rate of force production. I think we could reason that strength training would certainly not hurt that, but argument that just again from everything else that’s happening that seems like a good mechanism and I do think anecdotally looking at other countries’ success you know.
They basically had these kids start exercising GPP stuff early on, they play a ton of sports and then they see where they are best suited. I also think that it’s important to remember that anthropometry is going to select a lot for certain sports. The kid who wants to play in the NBA but doesn’t make it past 5’8 so.
Dr. Baraki: It’s going to be a hard road.
Dr. Feigenbaum: It’s tough, yeah. It’s hard, it would be hard to suggest any situation where you put somebody who is not yet at their adult height and their adult [00:55:30] bone structure in one sport and specialize because you don’t know like you don’t know. I don’t know, so I’m telling you to have them play all sorts of sports. Have them play weird stuff have them do; track, gymnastics it doesn’t have to be just; baseball, football or basketball but it would be really cool if we could get them to train.
Dr. Baraki: Yeah and when you put it in this context of them playing all these different sports, the idea of putting them under something like a five pound bar and teaching them how to squat and press and pull [00:56:00] it really shouldn’t seem that preposterous to anybody to get a kid training. You know what I mean? You are going to have this kid in peewee football getting smashed helmet to helmet with another kid on the field potentially, taking all kinds of forces and you are going to put a little five pound bar and have them sit down and stand back up.
It really doesn’t seem particularly radical and the amount of; motor learning, kinesthetic awareness, proprioceptor skills and stuff like that they can learn from something like that if you have them squat again like you said even using the same way for two weeks straight. You are going to see in those two weeks an impressive improvement in the quality of their technique and how they are able to move and they just …
It’s they can almost self cue just by doing the movement enough times that you know, it just kind of a lot of these things they are harder to coach in a pediatric population because they haven’t learned any of the stuff in terms of motor learning before. It really is impressive how quickly a lot of it can work itself out just by doing these movements for a couple of times over the course for a couple of weeks.
Then once the movement looks really nice and clean yeah, you put a one pound [00:57:00] plate or something like that on either side. It’s like not a radical idea compared to having them play a contact sport or one of these other sports that has known higher injury rates and things like that.
Dr. Feigenbaum: I just also just for a full disclosure because sometimes I’m wrong. Brodmann’s area 43 it’s the primary gustatory cortex which is on the frontal gyrus, it’s not the transverse.
Dr. Baraki: Yeah, so your neuroanatomy is getting a little rusty, but fortunately no one cares about Brodmann’s areas anymore.
Dr. Feigenbaum: Speak for yourself.
Dr. Baraki: I definitely don’t.
Dr. Feigenbaum: What a savage that Brodmann was by the way, so Brodmann’s area is just how we know neuroanatomy. It’s this German did basically stating all these different areas of tissue that he is just biopsying and he is like, “Oh, this is different than another one,” and there is a bunch of that. There is 52 known Brodmann’s areas they are all different areas of the brain, so I feel bad for all of this, the people he is doing that to.
Dr. Baraki: All the people who have to memorize these 52 areas as well.
Dr. Feigenbaum: Yeah, just so Brodmann’s areas six is the motor cortex so I will fall in my sword after this. All right this is the last one I want to make and then we’ll end this thing. You and I both know from experience that training elderly population, older populations they respond less robustly to training especially if they have no prior background, they are completely untrained.
Dr. Baraki: Sure.
Dr. Feigenbaum: We’ll just in general train somebody over the age of 50 with no prior physical activity that has been formalized or any sporting or anything like that, they just do works for training. It doesn’t mean that they can’t train it just means we’ll fight an uphill battle. Similarly we know that people who have not yet gone through puberty or have a very slow progression going through training because they are just not ready there right. It’s effectively you are just both ends of the curve.
In the middle your optimal person is this 18 to 22 year old male. Again the joke is he lives equal distance [00:59:00] from whatever gym we happen to be at, at an eye hop. He lives in his mom’s basement, has all his meals made and whatever because that’s the optimal person to get the most robust type of effect from training. If and only if that person has previously been exposed to many different physical pursuits to which I would include strength training. Like the optimal person is not just the 18 to 22 year old, it’s the 18 to 22 year old who has previously been exposed to all this stuff.
Dr. Baraki: Yeah, I think we probably both coached 18 to 22 year old guys who’ve literally never done anything before athletically in their life and they don’t, it’s not like they do like impressively well all the time. A lot of times we have these kind of, these kinds of kids either college age kids in that demographic or maybe a little later in their 20’s.
A lot, we’ve coached a bunch of like computer programmer type of guys who all of a sudden decided that they wanted to get big and jack but they’ve like never done any sort of sport or athletic activity before in their life. They do all right but they don’t come out [01:00:00] 12 months later pulling 500 for five or something like that.
Dr. Feigenbaum: No, but the kid who has been training messing with the barbell for years and years and years and finally gets the green light to go ham and gains enough weight, yeah they pull 500 in a few months and you are like, “Oh my God.”
Dr. Baraki: Yeah, “What have I created?”
Dr. Feigenbaum: “What have I done?”
Dr. Baraki: Yeah right.
Dr. Feigenbaum: I see you glancing off to the distance Lorraine is probably waiting for you with the cat I assume.
Dr. Baraki: She is at work all night tonight.
Dr. Feigenbaum: The cat is looking at you longingly?
Dr. Baraki: Yeah, looking right at me.
Dr. Feigenbaum: Right, he is right and staring right at you. I will graciously thank Dr. Baraki for joining me on my nuanced trip through incorrectly labeled Brodmann’s areas and bid you goodnight. In the near future we’ll be with Dr. Nadolsky, Spencer Nadolsky. We’ll have Rip on, some point will be on Curbsiders and Austin is going to school us all on some cholesterol or lipids.
Dr. Baraki: Coming up soon both.
Dr. Feigenbaum: Same, basically the same.
Dr. Baraki: Not really.
Dr. Feigenbaum: Hey man, you don’t know my doctor said that I should …
Dr. Baraki: You’ve never been a lipid.
Dr. Feigenbaum: … you’ve never been a lipid. Anyway if you guys could please review us on iTunes it helps us jump the ratings so more people can get exposed to this, share with your friends. Thanks again for tuning in for Jordan Feigenbaum that’s me I’m out.
Dr. Baraki: Austin Baraki, see you guys later.