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Even taking the trial at face value, it does not match what people buy. It was an enema, in ulcerative colitis patients, at 80 mg a day for two weeks. The companies wanted to sell capsules, injections, nasal sprays, creams, and suppositories. The FDA went looking for human studies of BPC-157 by any of those routes and found nothing. The closest match, a suppository, still does not match, because an enema reaches much further up the colon. What does this trial say about the vial in your gym bag? Nothing.

What does this trial say about the vial in your gym bag? Nothing.

Barbell Medicine September 8, 2026 07:00

Burning amino acids for energy is just your body using them for fuel, which is a long way from wasted and further still from stored as fat. A group in the Netherlands tested the real question in 2023. They gave people either 25 grams of protein or 100, then used tagged amino acids to follow it through the body for a full 12 hours. The 100-gram meal did not hit a wall. It produced a larger building response and a longer one. Almost none of it was burned off. None was wasted. Your body holds onto it and puts it to work over the hours that follow. There is no trapdoor that dumps the extra. They fed people 100g of protein in one meal. There was no limit on absorption.

They fed people 100g of protein in one meal. There was no limit on absorption.

Barbell Medicine September 5, 2026 07:00

Muscle is where most of the glucose goes, and muscle insulin resistance is the first thing that breaks on the road to type 2 diabetes. Both of those are true, and neither one means that building more muscle is the treatment for obesity. This episode works through what actually decides whether a tissue handles fuel well: not how much of it you have, but how fast it's moving fuel through. We go through the one-legged exercise studies, the 18,000-person analysis of what body composition actually predicts, the athlete's paradox, the energy cost of building a kilogram of muscle, the GLP-1 lean mass panic, and why sarcopenic obesity is named after the wrong organ. This is part two of a two-part series on storage capacity. Part one covered where body fat goes and what happens when the storage runs out.  Timestamps • 0:00   The one-leg study, and the muscle-centric claim • 02:06   What obesity is, and the garage analogy • 05:06   How glucose gets into a muscle cell • 11:21   Insulin sensitivity improves without building muscle • 17:11   The best case for muscle-centric medicine • 21:13   What predicts falls and death: strength, not lean mass • 25:18   Separating muscle size from muscle function • 31:33   Liver fat: amount, type, and flux • 37:54   Should you build muscle first? The arithmetic • 42:37   Building muscle in a calorie deficit • 50:29   GLP-1s, DXA, and the lean mass panic • 58:23   Sarcopenic obesity, and why the name is wrong • 01:04:37 Why size still tells you something • 01:11:46 So what is obesity? Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs (https://www.barbellmedicine.com/shop/training-templates/endurance/hybrid-5k-10k/) Barbell Medicine coaching and templates: https://www.barbellmedicine.com 1.   Richter EA, Mikines KJ, Galbo H, Kiens B. Effect of exercise on insulin action in human skeletal muscle. J Appl Physiol (1985). 1989;66(2):876-885. doi:10.1152/jappl.1989.66.2.876. PMID: 2496078. https://doi.org/10.1152/jappl.1989.66.2.876 2.   Cawthon PM, Travison TG, Manini TM, et al. Establishing the link between lean mass and grip strength cut points with mobility disability and other health outcomes. J Gerontol A Biol Sci Med Sci. 2020;75(7):1317-1323. doi:10.1093/gerona/glz081. PMID: 30869772. https://doi.org/10.1093/gerona/glz081 3.   Bhasin S, Travison TG, Manini TM, et al. Sarcopenia definition: the position statements of the Sarcopenia Definition and Outcomes Consortium. J Am Geriatr Soc. 2020;68(7):1410-1418. doi:10.1111/jgs.16372. PMID: 32150289. https://doi.org/10.1111/jgs.16372 4.   Elgaddal N, Kramarow EA, Reuben C. Physical activity among adults aged 18 and over: United States, 2020. NCHS Data Brief No. 443. Hyattsville, MD: National Center for Health Statistics; 2022. PMID: 36043905. https://www.cdc.gov/nchs/products/databriefs/db443.htm 5.   Whitfield GP, Carlson SA, Ussery EN, Fulton JE, Galuska DA, Petersen R. Trends in meeting physical activity guidelines among urban and rural dwelling adults, United States, 2008-2017. MMWR Morb Mortal Wkly Rep. 2019;68(23):513-518. doi:10.15585/mmwr.mm6823a1. PMID: 31194722. https://doi.org/10.15585/mmwr.mm6823a1 6.   Wang T, Wang J, Hu X, Huang XJ, Chen GX. Current understanding of glucose transporter 4 expression and functional mechanisms. World J Biol Chem. 2020;11(3):76-98. doi:10.4331/wjbc.v11.i3.76. PMID: 33274014. https://doi.org/10.4331/wjbc.v11.i3.76 7.   DeFronzo RA, Tripathy D. Skeletal muscle insulin resistance is the primary defect in type 2 diabetes. Diabetes Care. 2009;32(Suppl 2):S157-S163. doi:10.2337/dc09-S302. PMID: 19875544. https://doi.org/10.2337/dc09-S302 8.   Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993-1017. doi:10.1152/physrev.00038.2012. PMID: 23899560. https://doi.org/10.1152/physrev.00038.2012 9.   Petersen KF, Dufour S, Savage DB, et al. The role of skeletal muscle insulin resistance in the pathogenesis of the metabolic syndrome. Proc Natl Acad Sci U S A. 2007;104(31):12587-12594. doi:10.1073/pnas.0705408104. PMID: 17640906. https://doi.org/10.1073/pnas.0705408104 10. Rabøl R, Petersen KF, Dufour S, Flannery C, Shulman GI. Reversal of muscle insulin resistance with exercise reduces postprandial hepatic de novo lipogenesis in insulin resistant individuals. Proc Natl Acad Sci U S A. 2011;108(33):13705-13709. doi:10.1073/pnas.1110105108. PMID: 21808028. https://doi.org/10.1073/pnas.1110105108 11. Perseghin G, Price TB, Petersen KF, et al. Increased glucose transport-phosphorylation and muscle glycogen synthesis after exercise training in insulin-resistant subjects. N Engl J Med. 1996;335(18):1357-1362. doi:10.1056/NEJM199610313351804. PMID: 8857019. https://doi.org/10.1056/NEJM199610313351804 12. Mikines KJ, Sonne B, Farrell PA, Tron... Is Obesity A Muscle Problem?

Is Obesity A Muscle Problem?

Barbell Medicine September 4, 2026 09:00

There are two ways to read this. One is that money bought the vote. I cannot prove that. The other is simpler and worse: whoever filled the seats picked people who already believed peptides work, and they voted the way they already believed. Nobody had to be bought because nobody had to change their mind. That version cannot be fixed by anyone recusing themselves. Nobody had to be bribed. The room was built to say yes.

Nobody had to be bribed. The room was built to say yes.

Barbell Medicine September 4, 2026 07:00

Fen-phen was two appetite suppressants taken together. The combination was never approved and never even submitted. What existed was one 1992 study, 121 patients, single center, four years, and fewer than half finished. Doctors wrote for it off label, people lost weight, and by 1996 prescriptions passed 18 million. Then a Mayo cardiologist reported damaged heart valves in women with no cardiac history. The CDC confirmed 113 cases. One 121-patient study led to 18 million prescriptions. Then the valves failed.

One 121-patient study led to 18 million prescriptions. Then the valves failed.

Barbell Medicine September 1, 2026 07:00

This is the part the protein marketing machine leaves out. For most people, when eating more protein seems to help, the protein itself is usually not the reason. What actually happened is you swapped a pile of ultra-processed food that happened to be high in protein for lean, minimally processed protein, chicken, fish, eggs, dairy, beans, and you ate fewer total calories doing it. The number on the label went up, but what helped you was better food and less of it. That's the small version of a much bigger point. The two things that actually decide your health here have nothing to do with the protein number. Is your diet mostly real food? Are you doing something with your body? So quit asking how much protein. Ask what's on your plate, and ask what you're doing with it. Why 'just eat more protein' seems to work

Why 'just eat more protein' seems to work

Barbell Medicine August 31, 2026 07:00

While fen-phen boomed off label, a related drug, Redux, was up for approval. In 1995 an FDA advisory committee voted 5 to 3 against it over pulmonary hypertension and possible neurotoxicity. So the agency convened a second committee. That one voted 6 to 5 in favor. It was approved in April 1996 and off the market by September 1997. A panel said no, a second panel said yes by one vote, and it hurt people. An FDA panel voted no. So they convened a second panel.

An FDA panel voted no. So they convened a second panel.

Barbell Medicine August 29, 2026 07:00

Turn it around. If protein were really dissolving your skeleton, the people eating the most of it would have the worst bones. They have the opposite. The National Osteoporosis Foundation pooled 16 trials and 20 long-term studies, and higher protein came out neutral to good for bone, with a small protective edge at the spine and no harm anywhere else. That makes sense once you remember what bone is. Bone is mostly a protein scaffold with minerals packed onto it. Starve that scaffold to spare the minerals and you've protected nothing. If protein dissolved bone, the biggest consumers would have the worst. They have the opposite.

If protein dissolved bone, the biggest consumers would have the worst. They have the opposite.

Barbell Medicine August 28, 2026 07:00

Most men who start testosterone never needed it, and some who genuinely do never get treated. In the final episode of the Signal series, Dr. Jordan Feigenbaum and Dr. Austin Baraki work through who actually needs testosterone replacement, who got sold it, and what the evidence says about the risks that scared the field for a decade. We cover the blinded trial where men couldn't tell real testosterone from placebo, what the heart and prostate data actually show now that we have the trials, what testosterone does to fertility, and the framework we use to decide. We also close the story of Mark, the patient whose lab result started the series. This is educational content, not medical advice. Talk to your physician about your personal situation. Here we cover the real diagnosis of testosterone deficiency, primary versus secondary low testosterone, how the system both over- and under-prescribes, the SHBG trap that makes a normal level look low, the gray-zone crossover study, what replacement should actually target, why most men quit within a year, testosterone as a male contraceptive, the TRAVERSE cardiovascular results, the saturation model and prostate safety, the blood side effect worth monitoring, and when not to start at all. Timestamps: • 00:00 The study almost nobody mentions  • 01:31 Who this episode is for  • 03:35 What a real testosterone diagnosis requires  • 07:18 Primary vs secondary low testosterone  • 10:12 How testosterone gets over-prescribed  • 11:35 The SHBG trap: when a low number misleads  • 18:10 Would GLP-1 plus testosterone work better?  • 22:19 Why genuine deficiency gets under-treated •  24:15 The cardiovascular scare and where it came from  • 34:11 The gray-zone study, in full  • 41:02 What TRT should actually target, and the "900" myth  • 47:38 Running TRT as a trial, and why 70% quit  • 52:36 Testosterone as a contraceptive: the fertility cost  • 57:19 Does TRT cause heart problems? The TRAVERSE trial  • 01:01:40 Testosterone and the prostate  • 01:09:13 The blood side effect worth watching  • 01:12:02 When not to start testosterone  • 01:14:26 Who actually benefits from TRT  • 01:18:28 The Signal framework, and what happened to Mark •  01:21:14 Five things to take away •  01:23:33 Our conflict of interest, and the book • Resources: Buy the book, Signal: https://www.barbellmedicine.com/shop/learning/signal/ • Part 1: Is the testosterone crisis real? (https://redcircle.com/shows/0cc66fc4-ccb8-4c60-8cc6-7367e52c4159/ep/b25a8006-57e5-4dc3-b74c-203f6fbcebc1) • Part 2: Is you testosterone actually low? (https://redcircle.com/shows/0cc66fc4-ccb8-4c60-8cc6-7367e52c4159/ep/b25a8006-57e5-4dc3-b74c-203f6fbcebc1) • Part 3: What's actually driving your testosterone down? (https://redcircle.com/shows/0cc66fc4-ccb8-4c60-8cc6-7367e52c4159/ep/c9fdd6b7-3281-4904-b612-1b9d5383efb6) New Barbell Medicine Hybrid 5K and 10K Run + Lift Programs (https://www.barbellmedicine.com/shop/training-templates/endurance/hybrid-5k-10k/) Barbell Medicine coaching and templates: https://www.barbellmedicine.com Testosterone Action Plan: https://www.barbellmedicine.com/testosterone-action-plan/  1. Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762-769. doi:10.1111/j.1742-1241.2006.00992.x 2. Baillargeon J, Urban RJ, Ottenbacher KJ, Pierson KS, Goodwin JS. Trends in androgen prescribing in the United States, 2001-2011. JAMA Intern Med. 2013;173(15):1465-1466. doi:10.1001/jamainternmed.2013.6895 3. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi:10.1210/jc.2018-00229 4. Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423-432. doi:10.1016/j.juro.2018.03.115 5. Corona G, Goulis DG, Huhtaniemi I, et al. European Academy of Andrology (EAA) and European Society of Endocrinology (ESE) recommendations on the diagnosis and management of male hypogonadism. Andrology. 2020;8(5):970-987. doi:10.1111/andr.12770 6. Morgentaler A, Zitzmann M, Traish AM, et al. Commentary: who is a candidate for testosterone therapy? A synthesis of international expert opinions. J Sex Med. 2014;11(7):1636-1645. doi:10.1111/jsm.12546 7. Mok SF, Fennell C, Savkovic S, et al. Testosterone for androgen deficiency-like symptoms in men without pathologic hypogonadism: a randomized, placebo-controlled cross-over with masked choice extension clinical trial. J Gerontol A Biol Sci Med Sci. 2020;75(9):1723-1731. doi:10.1093/gerona/glz195 8. Clift AK, Johnson H, Huang DR, Morgentaler A. Real-world outcomes and safety of testosterone therapy: a longitudinal, retrospective cohort ... Who Needs Testosterone, and Who's Not Getting It I Signal Episode 4

Who Needs Testosterone, and Who's Not Getting It I Signal Episode 4

Barbell Medicine August 27, 2026 07:40

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